In the first five years of his or her life, your child will develop at an incredible rate, going from a small, helpless infant to study toddler. “The first five years of life of an individual has the fastest growth after birth,” says Prof. Pujitha Wickramasinghe, Consultant Paediatrician and member of the Nutrition Society of [...]

The Sundaytimes Sri Lanka

1-5 years: Early diet will dictate later health

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In the first five years of his or her life, your child will develop at an incredible rate, going from a small, helpless infant to study toddler. “The first five years of life of an individual has the fastest growth after birth,” says Prof. Pujitha Wickramasinghe, Consultant Paediatrician and member of the Nutrition Society of Sri Lanka, adding that since at birth a child’s organs are not fully developed, they need “optimum nutrition to grow and mature to the maximum potential.”

In the first year of life, a baby’s weight triples and the height increases by half. While growth slows a little between the ages 2 through 5, the average child will still grow about 4-6 cm and gain close to two kg a year. All this growth is fuelled by what your child is eating and one of the most important things a parent can do is ensure their child consumes a variety of healthy, nutritious foods. Continuing our series on healthy diets for all ages, this week Prof. Wickramasinghe tells us about diets for children under age 5.

Young children’s diet can decide their health as well as their intellectual performance for years to come. Poor childhood nutrition is a risk factor associated with diseases like obesity, hypertension, diabetes and coronary heart disease. Additionally, many children learn the eating habits they’ll carry through into adulthood during these years. “Growth and maturation of organs of the body requires a lot of energy as well as other nutrients such as proteins, vitamins and minerals,” says Prof. Wickramasinghe. “All these have to be provided by food. Therefore diet plays a very significant role in this process.”

Dietary composition and volume vary according to the child’s age and specific requirements. However, Prof. Wickramasinghe recommends that from the time of starting complementary food a balanced diet containing all major food groups (starch, vegetables, pulses and legumes, fruits, milk based food and animal food) should be included.

Breastfeeding is unequivocally encouraged, particularly soon after birth. Mother’s milk is irreplaceable. While infant formula does mimic a few of the nutritional components of breast milk, it cannot hope to replicate the many nutrients in mother’s milk nor how it changes to meet the changing needs of the child. “Certain factors in breast milk would help towards having a healthy gastro-intestinal tract,” he says. “Some nutrients which are in breast milk are in the form in which it is best absorbed into the body – known as highly bioavailable foods.” Breast milk not only provides sufficient amounts of nutrients and water till the completion of six months of life, it also helps boost a child’s immunity, while also providing the mother with a range of health benefits. “If the mother is not available after four months of age (due to employment) or a doctor has diagnosed that the child is not growing appropriately, solid foods (complementary feeds) can be started at the completion of four months,” says Prof. Wickramasinghe, cautioning that a health professional’s advice is crucial. “No breast milk substitute (formula milk) should be given to a child without professional medical advice,” he adds.

Ideally, a child should be breastfed until he is 2 years old, with breast milk being the only food for the first six months. Once solid food is introduced, a mother can gradually reduce the frequency of breastfeeding, until by the time the child is a year old, he or she is breastfed only thrice daily. “After starting complementary feeds a child should not be breastfed on demand, but at regular intervals. It is important that a child should not be breastfed throughout the night,” advises Prof. Wickramasinghe.

As for complementary food or solid meals (4-6 months onwards), the ideal diet will bring together a blend of starchy foods as well as vegetables, fruits, pulses and legumes, milk based food and meat. Consult your child’s doctor to determine what the appropriate proportions are. While all food groups play their part, fruits and vegetables contain essential nutrients as well as fibre and phytochemicals that are critical to a child’s development. If used to eating vegetables as a child, you are much more likely to eat them as an adult – so get your children in the habit early. If not cooking a curry, try cutting and presenting vegetables in fun ways to get them interested. It may help for kids to see you eating an equally varied and healthy diet.

As children grow, their dietary needs change as well, particularly in terms of volume. “The child gets more active, uses up more energy,” says Prof. Wickramasinghe, cautioning though that quality should not be exchanged for quantity. “The diversity of the diet should be kept more or less constant according to the food groups that were given earlier,” he says. In general, the range of calories recommended for 2 to 5-year-old children is 1,000 to 1,600. However, this may vary depending on how old and how active children are (the older and more active, the more calories).

Routine is important at this stage. Plan your child’s diet and create a timetable for meals. “They should not be encouraged to eat at times they wish and what they want,” says Prof. Wickramasinghe. While it might be difficult to stick to healthy menus and fixed times with a finicky child, he says “parents should not think that they should give an alternative to the child if he does not eat the regular food. This will lead to the child dominating his/her parents regarding food choices which are usually lower in nutrients and higher in energy; less nutritious food instead of more important food.”

While a balanced diet does help boost a child’s health, children will still fall sick. It’s important that when a child is ill or recovering from an illness that food should not be restricted. Children may need to be fed a little extra to help them catch up on nutrition. Malnourished children who have not enjoyed a healthy diet often display poor growth and lethargy as well as other problems like a poor attention span that can affect their performance in school.

However, the opposite is also true. As child obesity rises, children are developing more and more disease and being deprived of a healthy childhood and adolescence. Parents should be wary of overfeeding young children – be aware of portion sizes. Usually, younger children need about half the portion of an adult. If your child is putting on weight, encourage him or her to exercise more. If you are particularly concerned, seek the advice of a doctor as weight loss diets could harm your child’s wellbeing.

Many young children will experience at least phases of being picky or finicky. Some may develop an inexplicable aversion to foods they once loved or eat only the same one or two foods over and over again. One way to work around a fussy eater is provide more variety and calorie dense food. Ensuring the child is hungry before offering him or her food will also increase the chances they will actually eat. Prof. Wickramasinghe suggests parents should allow their children to explore the food for themselves – touching it, picking it up and feeding themselves.

Food with a variety of flavours, colours and textures keeps children interested. Pair a child’s favourite foods with new foods – introducing the latter one at a time. If possible, let your child be involved in menu planning, shopping and if safe, in cooking. “This builds interest in the child towards new foods,” he says.

Fast food: Practise restraint

When it comes to unhealthy foods like deep fried snacks or sugary drinks, restraint is the key. Total bans are unnecessary. “Fast food can be given fortnightly and coincide with a main meal,” says Prof. Wickramasinghe.

The only problem is if a child is allergic to a particular food, in which case it’s only common sense to remove it from his diet. If you suspect your child is allergic to a food, give it in very small volumes and see, he suggests, adding that if a child develops any reaction, then repeat it in about a week and if he develops similar symptoms, then consider is a non-suitable food. Otherwise, it’s safe to gradually increase it and then incorporate it fully into a child’s diet.




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