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Parents are the back bone of a child’s life. They feed them, clothe them and decide what is best for them. But how do parents know what is best? Are children receiving the best possible food and nutrition?
There is a combination of factors why parents may have issues with what they feed their children. Time is a major issue. So is the feeling of guilt at having left them in the care of others. When it comes to trying new foods and flavours, parents are often not willing to have the arguments or to take the time to encourage children. It is far easier for them to provide foods which are quick and easy that they know their children like. Often snacks will be given that are unnecessary but reduce the feeling of guilt that the parent feels when picking up their child from your care. Overeating is a major issue as is snacking for comfort. Unwittingly, a lot of parents are encouraging a behaviour that will stay with the child for life. Also snacking on foods that are high in sugar is giving children unnecessary calories and contributing to weight gain. Tooth decay is also on the rise and this is attributed to children eating too many sugary, sweet snacks.
Parents need to be informed about the best foods to give their children. Advice should be available to inform them of the implications of their food choices. A survey commissioned by the Infant and Toddler Forum gave a fascinating insight into the eating habits of young children today. The survey looked at what 1000 parents with children aged between 6 months and 3 years gave them to eat and drink.
15% are fed adult convenience foods or ready meals for most meals
29% are eating takeaway meals at least once a week
29% have chocolate or sweets almost every day
23% have crisps almost every day
16% have fizzy drinks almost every day
By 2050 the Foresight Report (commissioned by the Department of Health) estimates that Britain will have a population that is mainly obese. This is an alarming statement, but the trend is already here. Although obesity is not caused by food choices alone, being educated about the implications of giving children unhealthy foods is vital. As nursery managers you play an important role in many children’s early years. Some of the responsibility must fall onto your shoulders to help to support and educate parents. Working with parents you can ensure the best healthy start for the children who are in your care.
The difficulty from a nursery point of view is how to go about taking this responsibility. You can give guidance as what parents should be feeding their children. You can decide what food and drink you serve the children in your care, giving them an opportunity to try new foods.
Remember that children will eat new things if others around them are eating them too. If the other children and hopefully the staff are sitting down and eating together then the food will be seen as safe and will be tried. Often bad habits are picked up at home where mum and dad will be eating biscuits for breakfast and wondering why their child will not eat a bowl of cereal.
Parents can seem intimidating but often this is because they are rushed before work or tired at the end of the day. If this is the case then offer them a particular time to come in and have a chat or offer them a workshop. If time is an issue, you could add information to your website and encourage them to read it.
Parents are always trying to do the best for their children but often do not know how. It may be that parents think they are being careful giving their children all the right foods, but once they start to learn about sugar and fat contents for instance they are horrified at what they are feeding them.
At Greenlane Children’s Centre we ran a healthy eating course for 5 weeks where each session was 1.5 hours long. We looked at foods from different meal times and made parents aware of the ingredients particularly the sugar, salt and fat. The workshops were very interactive and the parents were encouraged to read the foods labels and to weigh out the ingredients such as the sugar, fat and salt. The most alarming findings made by the parents were the amounts of sugar in foods such cereals, snacks and fruit juices - even ones that were perceived to be healthy.
An interesting point that came out of the course was how many parents were giving their children sugary cereals for breakfast. They were aware that they were not the healthiest option but were shocked as to just how much sugar there was in a serving. We talked about alternatives and ways to encourage children to eat more fruit and fibre at breakfast.
At every session there was a selection of fresh fruit for the children and adults to try. This always got eaten and dispelled some myths that “my child does not eat fruit”. This shows that fruit and healthy foods need to be offered so that they can be tried and when in the company of others.
Over the course we found that parents were keen to learn to cook and we took this on board and made a few simple dishes in the limited time period that we had. The reason that the parents on the course were buying ready meals was really down to their confidence in the kitchen being low and being stuck for ideas as what to cook. In order to boost confidence we made a soup, that showed them how easy and quick that could be and how much better than a bought one. We provided participants with a recipe book of what had been cooked during the course.
The course evaluation showed where changes had been made. One parent who admitted giving her child fizzy canned drinks stopped completely and changed to a watered down squash drinks. One lady who had been giving her children potato hoops as a snack stopped and gave fresh fruit instead.
As a nutritionist I work with Joanna Moss at Greenlanes Children's centre to support healthy eating and provide guidance for changing diets and lifestyles. Having run some very successful groups, we decided that we should address the South Asian population to try and make them more aware of health related issues.
Heart disease is the largest killer in the UK, averaging around 65, 000 deaths a year. As a population we are all prone to eating the wrong types of foods and not exercising enough. Some ethnic groups are far more prone to developing health related complications and as our population has become more diverse it includes people from many different ethnicities whose health may be at risk.
The South Asian population are up to six times more likely to develop type 2 diabetes and are one and a half times more likely to suffer from heart disease than white people (Diabetes UK and British heart foundation). The reason for this increased risk is unclear but research has pointed to a mixture of genetics (family history), lack of exercise and eating habits. Being overweight also plays a big part in the probability of developing a heart or diabetic condition which can further lead to stroke or renal failure.
The aim of the course was to introduce the concept that less oil and salt could be used when cooking as well as promoting the idea that more fruit and vegetables should be eaten. Sugar was also a priority to be reduced, as many South Asians have a sweet tooth. Indian restaurants may not be well known for their desserts, however at home their is a tradition of preparing delicious desserts that are unfortunately full of fats and sugars.
Using lots of oil and salt in cooking is a big factor in South Asian culture. Initially the group was against the idea of using less. Tradition is powerful and change is not easy as South Asian women not only have to please their husbands but often their mothers-in-law too. The greatest worry was that the taste of the food would be altered. To get over this barrier it was suggested that they gradually reduced the amounts used so their family's taste buds would get used to the changes gradually.
During the course food was cooked using healthier methods. The group was keen to try this and there were few complaints. The biggest success was making a carrot halva where the milk used was skimmed rather than full fat and the sugar was cut by three quarters.
To support the course, material from the British Heart Foundation was used. We ordered handout books in a variety of languages, mainly Urdu, which proved very useful. Members of the group whose English was not very good found these useful and also took them home for their mother-in-law to read.
The evaluation of the course which lasted for five weeks, took place on the last week with healthy dishes being cooked and shared. All the ladies felt they had changed their cooking methods to use less oil and salt.
Constipation in children
Constipation in children is more common than you might think – it is a condition that causes unhappiness and discomfort for the child and family. Hopefully understanding some of the signs and being aware of some advice to help alleviate the problems and will provide confidence and reassurance. It is important to know that you can tell your parents that they are not alone. If you have any reason that you think any children in your care child may be constipated, do not be afraid to seek help.
Constipation is caused by a variety of factors, some of these may be nutritional:
- Too little dietary fibre and fluid
- Too much milk in the diet
- Overfeeding in infancy
Other factors that may cause constipation are: the child ignoring the urge to go to the toilet or lack of exercise.
Potty training is a big milestone in a child’s life and it is important to get it right, as when mistimed or mismanaged it may cause constipation. Ensuring that children are eating a healthy and balanced diet with plenty of fluids (preferably water) will help. Talk to parents about being aware of signs that children are ready; it is not something to be rushed. Explain the importance of a regular routine: a few minutes on the potty after a meal, then have fun washing hands. Make the point with parents that although difficult sometimes, they must try not to make a fuss about accidents; try and always be positive.
Some signs of a child being constipated are
- No bowel movement for three or more days
- Lots of hard stools being passed
- Using avoidance techniques, such as dancing around or hiding
- A generally unhappy child with little energy
Soiling is when a child is constipated, and their bowels are very full, but they cannot go to the toilet. They may have little ‘dribbles’ these will be noticed in the child’s pants, night clothes or bedding. These are accidents and the child is not being naughty – it is sign that help must be sought.
It is important that children are drinking sufficient fluids - Toddlers should ideally have around 6 – 8 drinks every day, each drink being around 3 – 4 fl.oz. Water is the best drink – try to encourage toddlers to drink more of it at meal times and in between. Diluted fruit juice may be given at meal times, however this contains unnecessary sugar, and one glass only counts as one of our 5 a day. Milk should be limited to max 120mls a day as any more limits the ability to consume foods containing dietary fibre.
When talking to parents explain the importance of encouraging their child to eat the same as them, which is hopefully, healthily! Interaction at meal times is really important so try to push the point that meals should be eaten together around a table and without the telly! At nursery these rules must be followed too and it is important that childcare workers sit down at meal times and eat with the children and provide a family atmosphere.
In order to ensure adequate fibre is being eaten, present the children in your care with a variety of fruit and vegetables as well as cereals. Each meal and snack should be of a nutritious quality rather than quantity (fruit and vegetables rather than crisps and sweets). Remember that the more fibre is eaten, the more fluid (water) needs to be consumed.
Physical exercise is another great way to try and get children’s bowels moving – encourage parents to take their children to the park, go to soft play or walk to the shops. When the children are in your care, you can play games to encourage activity and if you have a garden try and get them playing on bikes, play equipment and be generally active.
Being aware that a child is constipated is not a trivial matter and is not just a matter of increasing fibre in the diet. The child may well be in pain and discomfort and it is important to seek professional help so they can start on a road to free bowels. This may mean laxatives will be prescribed – but don’t worry this is normal and important for the child to begin having regular movements.
Why hydration matters to the elderly
Ensuring that the elderly are drinking enough fluids is vital for their overall wellbeing. Dehydration in the elderly is linked to mortality and can cause hospitalization. Dehydration is a worrying condition and studies have shown that up to 48% of older patients being admitted to hospital are dehydrated. In nursing homes, up to 31% of patients maybe dehydrated.
Dehydration usually affects those patients who are ill or who are more physically dependant on care. They may be unable to move away from the window where the light is streaming in or move out of a room where the temperature is too hot. In a study in a nursing home where staff were encouraged to provide regular drinks and reminders, the levels of overall wellbeing amongst the clients rose significantly, and there was a 50% decrease in falls. One of the main reasons that the elderly often refuse water is due to a worry about increased visits to the toilet. In the above study, toilet trips initially increased, but soon returned to normal levels.
As we age, changes occur in the body which alter the body’s ability to take on water and can often lead to dehydration.
The main causes of this are:
Thirst response in ageing adults declines, meaning thirst is not recognised
The body does not hold the same amount of water. From the age of 60, body fluid is reduced due to changes in muscle mass. On average body fluid is reduced from 60% to around 52% for men and 46% for women.
Kidney function may be impaired: In some elderly people their kidneys may be unable to concentrate their urine and lose more water than is necessary.
Medical conditions such as dementia, frailty, difficulty in swallowing may all affect a person’s ability to drink.
Ensuring that clients are properly hydrated is vital but more important is understanding the reasons why it happens and what the benefits of regular drinks are. Care givers need to be constantly aware of both the risks and signs of dehydration and have strategies in place to monitor these.
Care givers need to be aware of the clients who have
- Lost their mobility and therefore cannot get themselves a drink
- Suffer from poor sight and find it difficult to pour themselves a drink
- Have a lack of cognitive function, which gives rise for confusion
- Are taking medications such as diuretics and laxatives which lessen the urge to drink
- Have difficulty in swallowing
Care staff must ensure that they are well aware of their clients’ needs and limitations. They must also be aware of their diets and monitor the amount of food that is eaten. Water is not purely obtained by fluids alone, food contains a considerable amount. If the appetite is suppressed and dietary intakes are lessened then fluid intake will also be decreased.
Within a care or nursing home, it is the role of the care givers to offer drinks and foods to prevent dehydration which in turn leads to
- Fewer falls
- Less constipation
- Reduced bladder cancer in men
- Increased wound healing (in particular pressure sores)
Staff within the care environment needs to be adaptive and assess the client. They need to be supportive of their needs.
Opportunities to drink should be encouraged, for example when activities are on offer, drinks should automatically be made available. As it is more difficult to encourage an elderly person to drink, and because they may feel that they have drunk enough very quickly, they will not be drinking sufficient liquids. If this is the case, drinks that encourage thirst, for instance fizzy drinks or fruit juices can be offered.
Nursing staff need to make time for patients who may be positioned inappropriately, for example those who lie on their side and need moving so that a drink can be drunk and be prepared to sit with patients and offer them sips of water rather than just leaving a drink on the side.
The importance of water in the diet
Being hydrated is important for so many reasons and becoming dehydrated can not only decrease energy levels but also concentration which can affect learning and overall wellbeing. Children need to learn to recognise the symptoms of thirst, as this is not a given behaviour. It is important the carer who is responsible for the child makes fluids available (preferably water) and is aware of situations when fluids should be increased. To ensure that enough water is drunk, it is important that you act as a role model, so apart from cups of tea, make sure that water is the only drink that you drink when around the children.
Knowing when to give children drinks is important and there are no current guidelines as to how much water should be drunk. It is important that as carers you recognise the signs of when to give your charges more fluids. Examples are when a child has loose stools and is then losing more water or when they have a high temperature. As a rough guide 6 – 8 glasses should be drunk a day. This may seem like a lot, but remember that foods, especially fruit and vegetables contain water which adds to the daily amounts.
It is vital that as the carer you are offering fluids, preferably water. Children do not think to drink and therefore need to be encouraged. The need to drink and understand when you are thirsty is a learnt behaviour; a dry mouth indicates that a drink is needed and that you are getting dehydrated. Children have not learnt behaviour and as such can go for long periods without drinking.
Young children and babies need more water than adults. Their bodies are made up of 75% water (which is over 25% greater than adults). Not only do babies and young children have more water in their bodies to be maintained, they also do a very good job at getting rid of the water that they have. One such way is by having the ability to breathe faster than adults and as such lose more water through respiration.
Children have a greater surface area of skin relative to their body size with which to lose water, so on a hot day when we are all maintaining our body temperature by losing water (evaporation) through the skin in order to cool the body, children are losing considerably more. It is imperative that on hot days, children are regularly offered water to drink.
Babies especially if they are breast fed will be getting all the fluid they need. Bottle fed babies, will be getting fluid, but may need additional cooled boiled water so when a baby cries try offering them water if the pacifiers are not working.
When early weaning is started, the amount of water being ingested will increase due to the foods being offered, as this is will be fruit and vegetables which are full of water.
As the child gets older and more complex foods are eaten such as protein and carbohydrates then less water will be ingested. It is important at this stage that water is provided at meal times in cup.
Fizzy drinks and fruit juice should be offered in moderation as they contain extra calories which are not needed and contribute to weight gain, as well as being acidic and may cause dental caries. A glass of fruit juice, accounts for one of your ‘5 a day’, however no more than this should be drunk unless it is watered down as each 150ml glass contains 3 teaspoons of sugar. The vitamin C in fruit juice can help iron in food be absorbed so encourage the main meal to be drunk with a glass of fruit juice.
Be careful of giving too much fluid, especially full fat milk. Not only is full fat milk full of saturated fat, which adds to weight gain, it also reduces iron absorption. Too much milk and water, primarily milk, fills the child up so that a proper meal is not eaten and they are then not eating a diet full of the necessary nutrients. Milk however is an important drink for children providing vitamins and calcium that are vital to strong bones and teeth.
Iron is needed by the body to ensure that oxygen gets carried to all parts of the body. Iron is a component of haemoglobin which is found in red blood cells and helps to transport oxygen around the body to cells and to the muscles.
Low iron stores can affect anybody but it is important to be particularly aware of the part it plays in growth and development. It is important to ensure that children, both preschool and school aged children are not deficient as they are most of risk. Between six months and three years rapid growth is taking place and iron that might have been received from being breast fed is no longer available. After three years, growth is slower but still occurring and iron is needed to increase their quantity of red blood cells. In puberty growth is rapid, (more so in boys) and iron is needed to support the growing need of tissue growth and increased blood volume.
Women in pregnancy are often low in iron as the growing foetus will take whatever iron it needs from the expectant mother. However pregnant women are closely monitored. Teenage girls and women who menstruate are classed as high risk, and should ensure they are eating a healthy balanced diet and if concerned they should get a blood test from the doctor to check their iron status.
The other age group that may be at risk of low iron status is the over sixty fives. This may be due to medication taken, medical conditions such as ulcers or tumours or simply that appetite has decreased and a not enough nutrients are being consumed.
It is estimated that over 2 billion people in the world are iron deficient. The main reason for this is that there are two main types of iron, haem and non haem iron. Haem iron is readily absorbed by the body and is available from animal sources, although the amounts present will differ, calf’s liver for instance will have around 8 mg of iron per 100g, whereas a lamb chop will have around 2 mg per 100g. Pregnant women however should not eat liver, due to the high levels of vitamin A.
Vegetarians who chose to eat a meatless diet and for those in developing countries, who generally have no choice, but to eat a plant based diet will be eating non haem iron. Non haem iron is poorly absorbed by the diet, and although there are factors that can aid with its absorption there are also those that can inhibit it.
The best way to aid non haem iron absorption is to drink a glass of fruit juice at the same time. Vitamin C is a great enhancer of iron and aids absorption.
To ensure that iron is easily absorbed, do not drink, tea (particularly black), coffee or red wine when eating iron rich foods or taking iron tablets. These all have a process that inhibits iron absorption.
Although haem iron is the most readily absorbed form and is mainly found in red meat, this is a food not to be eaten on a daily basis, As with everything, it is in moderation. Iron can be absorbed from both chicken and fish, (ry and eat oily fish twice a week) and vegetarians can have very good iron status. The reason being is that if eating a diet high in fruit and vegetables, the amount of vitamin C in your gut will be high which allows for greater absorption of iron . A very good reason to increase the amount of fruit or vegetables that are eaten. Vitamin C is easily lost however so make sure that vegetables are only cut up at the last minute to avoid oxidation and if boiling them use the cooking water to make a sauce or a soup..
Stress and Eating
Stress affects us all in different ways –
but why is it important that we understand what it does to our bodies?
When we are suffering from acute stress, our bodies may react with physiological changes. Some of these may be:
- Slow gastric emptying
- Raised blood pressure
- Increased heart rate
- Decreased blood flow to non-essential organs, i.e. to the digestive system
To overcome symptoms of stress it is common to increase behaviours such as smoking, alcohol consumption and eating.
What is it that encourages us to eat more? Research has shown that we crave foods higher in fat and sugar when stressed, and therefore as a consequence we gain weight, that will in turn makes us more stressed.
The chronic stress response network
The way the body deals with stress has been shown to be in part due to the emotional side of the brain and the levels of the circulating hormone cortisol. In terms of encouraging us to eat more, it is thought the hormones such as cortisol, neurorpeptide Y and leptin are responsible.
How does Cortisol work?
Cortisol is a stress hormone and in times of stress of it is released. In terms of performing a speech in public this works well for the body as it gets us to operate at our peak. However what is detrimental for the body is prolonged stress when the cortisol levels stay high.
What foods are we attracted to?
Current research is showing that it is high energy foods, high in fat and sugar, that are eaten when stressed. Examples of high energy foods are: cakes, biscuits, chocolate, and sweets.
Ways to help with stress levels and to eat healthier
All to often breakfast is either a missed or rushed meal. It may be a cliché but breakfast is the most important meal of the day: it sets us up for the day, resets our metabolism and gets us going. It is important to spend time in the morning for yourself and have a quiet time to start the day.
Make sure enough water is drunk throughout the day – keep hydrated
Try not to mindlessly munch – if you feel that you might be tempted, buy healthy snacks – fruit, nuts and raisins.
Get away from you desk at lunch time
Go for a walk and get some fresh air, even if it is only for 10 minutes.
Be prepared for the evening meal
- Cooking can be a relaxing hobby, but you have to be prepared and have the right ingredients.
- Have a cooking session at the beginning of the week and cook for the week
- Buy a slow cooker – so dinner is ready for you when you get home.
- Knowing what you are going to eat in the evening, will stop you buying fast or processed food and eating those unwanted calories
The body has a very complex endocrine system, with hormones interlinking and working together in a way that is far more complicated than the London Underground system!
There is hope that there may be a slimming pill on the market and to date there have been some attempts. However these have been withdrawn after time due to health risks that have become associated with them. New hormones and interactions are constantly being discovered making it a complicated process.
One hormone may be discovered to affect certain levels of appetite regulation and a breakthrough is announced – only for it to be discovered that there are other hormones and other stimulus that are interacting and working together to a different degree. There are many inter connecting pathways and internal switches that can be changed by differing levels of hormone present.
The hypothalamus, found in the brain, is the centre for appetite regulation. It has been noted that there are three phases of eating:
Satiation (when we know we are full)
Different hormones are responsible for these different phases, for example it is understood that a hormone called CKK is released from the small intestine and affects satiation, as does Peptide YY , thus telling us we are full and to stop eating. Grehlin on the other hand stimulates hunger and encourages us to eat! In fact Grehlin has been called the `hormone of hunger! ’ It is Grehlin that sends signals to the brain telling us we are hungry whilst we are fasting, thus encouraging us to eat more!
Leptin is a hormone that is being carefully researched at the moment to fully understand the possible links between itself and obesity. Those people who are within a healthy weight range will respond to signals by leptin regarding their energy status, and can react accordingly. However for those people who are outside the healthy weight range, the body has seen to been leptin resistance, it has been seen that in over weight people their levels of leptin are far higher than slimmer people. This means that the body has plenty of leptin in the body, but it is not recognised and rather than suppressing the appetite, the appetite is increased.
The hormones themselves may be found in carrying sites including the adipose tissue and in the small intestine. Often there may be varying sites of the one hormone or they are made at one site and work at another.
There are a many other hormones that are responsible for appetite regulation. Some examples are: Insulin, NPY, CKK, Adipopectin, GLP-1, PYY, Orexins, Norepinephrine and Cortisol to name but a few.
Research is constantly being carried out to discover more. Grehlin is a relatively new and exciting hormone, there is new research taking place which is making it a very much talked about hormone. There have been links with stress and why we may eat more and a recent study looked at foods that we feel are `naughty` foods and our grehlin levels.