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Ask the Dietitian is not a substitute for a consultation with a professional who can inform you of all the facts of your particular situation. We answer questions in general terms only, to give you information that may used as a starting point.
TOPIC - Infants & Children
Question
Adults are advised to avoid fats or fatty foods. Children, being active, requires fats to burn off. Is this a fact or fallacy? Or should children also avoid fats to prevent future health problems?
Answer
That is an excellent question. Children under 2 years of age should have full fat foods such as homogenized/full cream milk, regular cheese & yoghurt, eggs, and the use of oils in foods does not have to be restricted. Young children require the fat for brain and organ development. For children under 6 years of age, if he/she is underweight or at normal weight, they can continue using full-fat dairy products. If they are overweight, you should switch to part skim milk and reduce the use of fatty foods while maintaining a well-balanced diet.

We use carbohydrate (starches) for energy, rather than fat. So it is better to give children starchy foods such as bread, buns, rice, noodles, crackers, etc. to supply fuel for energy. As children get older, it is a good idea to introduce healthy eating habits and gradually reduce the high fat foods in their diet. Emphasize wholegrain foods that are not highly sweetened or salted, lots of fruits and vegetables, and ensure they take at least 2 cups of milk a day. Limit fast food, candy, cakes, cookies, ice cream, etc.
Question
My 3 year old daughter weighs a mere 10 kg and I am getting worry about her weight issue. She is very active and picky eater. Any advice or help ?
Answer
Children are naturally picky eaters, particularly as they gain independence, they like to exert their preferences and this includes food. You did not mention what foods your daughter will eat, but if they are even a little healthy, give them to her as much as she wants. At the same time, offer her other foods in very small portions and give her the opportunity to try them. Do not force or coerce her to eat them, but offer her a variety of food from the four food groups. It is important not to have a power struggle over food as she may refuse food just to get attention.

To help a picky eater gain weight, you have to make every bite count.
  • Add extra fat & oil to her food ie. butter her toast and bread, put cream cheese on crackers, add butter to boiled potatoes and vegetables, serve her fried eggs, etc.
  • Serve foods that are higher in fat such as fried chicken, chicken rice, french fries, along with the fruits, vegetables, and starches
  • If she will not eat meat (which is common for toddlers), give her peanut butter; full fat dairy products like yoghurt, cheese, and cottage cheese; eggs and tofu.
  • Serve fruit smoothies for a snack made in a blender with full-fat vanilla yogurt or ice cream and any of her favorite fruits.
  • Avoid giving her items that may fill her up but are not calorie dense such as clear broths, congee, juice, soft drinks, etc.
  • Serve snacks between meals, but make sure that there is at least 2 hours between eating so that she has time to get hungry.
I have given you some suggestions as a start, but I would suggest that you make an appointment with a dietitian at the KK Hospital and seek further help if her weight continues to be low.
Question
My daughter is 8 months of age and I have breastfed her so far. I am now considering introducing formula/whole cow milk - which of these is a better way to go? Also I want to factor in that she will be going to India and will be exposed to buffalo milk there - will that be a problem?
Answer
Most experts recommend introducing formula if you are weaning a baby under a year old, minimally you should wait till 9 months before introducing whole cow's milk. The reason for this is that the nutrient profile in formula (such as casein to whey ratio, amount of protein, etc.) is closer to that in breast milk. Cow's milk contains a higher amount of protein and places a higher renal solute load on an infant's immature kidneys. Similarly, buffalo milk may be the same although I do not have a full nutrient profile on it.
Question
I have a 2-1/2 year old daughter & she has a constipation problem, although not very severe. I started her on diluted prune juice (3oz add 4oz water) everyday since she was about 10 mths and 1 slice papaya recently. She does not have any problems when she takes all this. Will this have any side effects on her health?
Answer
There is no problems in drinking prune juice and eating papaya every day. If it helps with your daughter's constipation, you can continue giving it to her. However, while papaya is rich in vitamin A and C, it does not have much fibre (less than 1 gram per slice). I would suggest giving your daughter different types of fruits, vegetables and whole grains daily to help with her constipation, as well as provide her diet with a variety of nutrient-rich foods. Fruits high in fibre include dried dates, raisins & prunes, guava, jackfruit, mangosteen, and any fruit eaten with its peel such as pears, plums, and apples. Vegetables such as broccoli, green beans, corn, peas and cabbage are high in fibre. Lastly, whole grains such as brown rice, wholemeal bread, bran cereal are rich sources of fibre.
Question
I have a child who is 6 years and just refuses to take anything that are healthy. How could I ensure he take them? What are his nutritional needs as he is hyperactive??
Answer
It depends on what your child is eating right now and what you define as "healthy" food. The other question is where is he getting "unhealthy" food from? If he is only offered healthy food when he is hungry, what does he do? Will he eat the healthy foods or refuse to eat?

As I mentioned in the previous answer, offer him a variety of healthy alternatives at each meal time. Let him eat what he wants and take the food away when he does not want anymore. Do not offer him anything else, especially unhealthy food if he ask for it. If you persist with this approach, he should come around and start accepting the healthier choices offered. Also do not give him too much juice (no more than 1/2 cup twice per day) or other high-sugar drinks as he could easily fill up on those.

If he is hyperactive & will not sit down long for meals, offer him snacks often. Snacks such as peanut butter sandwich, cheese & crackers and fruit can be important addition to his diet and help meet his caloric needs. If you would like to get a full assessment of whether he is getting enough, see a dietitian.
Question
I have a 2-1/2 old girl who does not eat, she'll go for weeks without, all she asks for is juice. What can I do to increase her appetite? The site of food also makes her revolt, she has sometimes thrown up after taking a few bites forcefully.
Answer
Feeding toddlers can be a challenge. You may want to start by not giving her too much juice. Small tummies gets filled up on juice & the sugar content keeps them going for a while. Offer her water as an alternative if she is thirsty and she may kick up a fuss, but she may be more willing to try some food if she is not filled up with juice.

Continue to offer her a variety of food and have her sit with the rest of the family as you all have your meal, but do not force her to eat. Take away the food at the end of the meal if she does not want anymore, even if she has not eaten or have only taken a few bites. The more you battle with her, the less likely she is to eat. Toddlers have small appetites and do not need as much food as before due to slowing of their growth at this age.

Do not be too concerned about her seemingly not eating for weeks if she is maintaining weight. They only gain 5-6 pounds per year at this stage. If you like more information, read the article on Healthy Eating for Children on the website. Ellyn Satter has a good book on "How to Get Your Kid to Eat....But Not Too Much" (1987) which you may want to check out. Good luck!
Question
My 13-month old does not like whole milk. I am worried she will not get enough calcium. What is the calcium requirements of one year olds and what other ways can I provide it to her?
Answer
A one-year child requires about 400-500 mg of calcium (US RDA is 800 mg for 1-3 year olds). There is 290 mg of calcium in 1 cup of whole milk, 220 mg in 1/2 cup of yoghurt and 200 mg in 30 grams (1 oz) of cheese. You can substitute yoghurt & cheese for the whole milk if she does not like it. You could also try giving her different types of milk such as reconstitued full-fat milk powder, infant formula and follow-up formulas. Sometimes children prefer the taste of one type of milk over another. You can also add the milk powder/formula to food to boost her calcium intake. Some examples of this would be adding it to oatmeal, soups, casseroles and baked goods such as muffins, cookies, etc. You can also give her other calcium-rich foods, see the list in the Focus on Calcium article found in the Healthy Eating section.
Question
My 1-year old son often have constipation problem. His porridge always have 1 meat, broccoli, potato & tomato (sometime carrot). Will these meal cause him to have constipation? I give him a lot of fluid but doesn't help.
Answer
If you are using white rice for your porridge, you may want to switch to brown rice porridge. It is also known as red rice - it is rice where the husk is not taken off, thus the fibre content is much higher. You may want to mix it half and half (white & brown) initially. Increasing the fibre content of your son's diet will help with the constipation, however you have to do this gradually. Adding too many high-fibre foods too quickly may cause gas and bloating. Other high-fibre foods you can introduce are wholemeal bread, wheat crackers and rolled oats. Also if you are still chopping up the vegetables very fine, you may want to make them chunkier as chopping finely breaks down the fibre.
Question
I'm curious as to what is the recommended serving size for children in the different food groups.
Answer
The serving sizes given in the Healthy Diet Pyramid are for adults. For children, the serving sizes are generally half to three-quarters of the adult serving sizes depending on the age of the child and how active they are ie. 1 to 1-1/2 slices of bread or 1/2 to 3/4 bowl of rice for one serving. Read the section on Healthy Eating for Children for more information.

The Health Promotion Board has some leaflets on appropriate serving sizes for children. You can e-mail the Health Information Centre at: hpb_hic@hpb.gov.sg to request for copies of these handouts.
Question
What are kids overall energy needs? Kids aged from 4 to 6 and is active - what kind of meal (balanced) is suitable for them? What is their nutrition value?
Answer
Please refer to the article on Healthy Eating for Children for information on what to feed a 4-6 year old. Use the Recommended Dietary Allowance for Children to determine the energy needs. For balanced meal plans, you should follow the guidelines of the Healthy Diet Pyramid for the number of servings, but use child-size portions.
Question
My 7.5 mths old baby has a reflux condition which leads to urinary tract condition. Is it OK to give him cranberry juice which is believed to be good for urinary problem?
Answer
Cranberry juice is found to reduce urinary tract infection in adults, however little research has been done on children. It probably will not hurt to give him small amounts of cranberry juice. You can give him about 4 oz. diluted cranberry juice per day, add equal volume of water to regular strength juice and feed that to him.
Question
What are the nutritional needs of a child aged from five to six?
Answer
Read the section on Healthy Eating for Children. There is a link to a table of Recommended Dietary Allowances for Children - these are the Singapore's Ministry of Health guidelines. If you are not from Singapore, you may want to obtain local figures from your Ministry of Health.
Question
Is it ok to serve fish as the main course for my 13 month old baby's daily diet?
Answer
Lightly seasoned steamed fish with no bones certainly make a good choice from the Meat & Alternatives group for your child. You will want to avoid highly spiced or salted fish till your child is older. If you are introducing fish for the first time, you will want to give him/her a small amount to try and watch for any signs of allergies. This is particularly true for shellfish (such as prawns, crab, clams, mussels, etc.) which tends to be more allergenic than finfish (such as pomfret, sea bass, kurau, etc.). To balance out the meal for your child, you should serve choices from the other food groups as well but in child-size portions.

For more information, read the sections on Healthy Eating for Infants and Children if you have not done so.


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