LittleStomaks » Iron deficiency

Ask the Expert – Balancing Milk and Meat in a Toddler’s Diet

TwinToddlersDad — Tue, 20 Jul 2010 10:00:55 +0000

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

Growing children need both calcium and iron in their early years. This week, Registered Dietitian Cindy Williams explains why you need to balance milk and meat for your toddler so he doesn’t miss out on these critical minerals.

Cindy Williams, RD

New Zealand Registered Dietitian. Master of Public Health (University of Queensland, Australia) Grad. Diploma in Communication (Queensland University of Technology)
Over 20 years’ experience as consultant dietitian to food industry, corporate health, sports teams and media
Senior writer for New Zealand Healthy Food Guide magazine
Website: www.nutritionchic.com
Twitter: @nutritionchic

Question: How much milk and meat should I feed my child?

Answer:

Milk

Milk is an excellent source of calcium. Children need plenty of calcium to build strong bones and teeth. Up until 12 months a baby should not drink cows’ milk because the protein is too large for the baby’s immature digestive system. After 7-8 months babies can have a little cooked cow’s milk as part of a milk pudding or custard. Yogurt and cheese are also fine for this age group – and a great source of calcium. Babies who drink cows’ milk before 12 months are at greater risk of iron deficiency.

Up to the age of two children should have full fat cows’ milk. They need the extra energy from the fat for growth. After the age of two toddlers can drink reduced fat milk so long as they are eating a good variety of food.

Up until the age of five, health authorities recommend children should drink about two cups of milk a day. Some toddlers love milk and would be happy to drink it all the time. Stick to two cups a day otherwise they will fill up on milk and have no room to eat their meat and vegetables. Toddlers who regularly drink more than two cups of milk a day are at greater risk of iron deficiency.

In a day they could have milk on cereal for breakfast, a small glass of milk sometime during the day, a little cheese and perhaps a milk pudding or half a carton of yogurt. The amounts will vary according to the child’s appetite. Remember the parent decides the quality and the child decides quantity.

Meat

Meat, especially beef and lamb, is the best source of iron and zinc for a child. The type of iron found in meat is called heme iron and it is easily absorbed. Children can also get iron from non meat foods such as iron fortified cereal, legumes (split peas, dried beans, lentils) and green leafy vegetables. Only about 5% of this iron is absorbed but having vitamin C with the food will increase absorption. Give your child some vitamin C rich fruit such as orange or kiwifruit with their breakfast cereal and they will absorb about four times more iron from the food.

Research has found that children who eat fruit with their meals are less likely to be iron deficient than those who eat fruit between meals.

Babies are born with enough iron stores to last about six months. Premature babies have lower iron stores because iron is mostly stored in the last three months of pregnancy so it is especially important for these babies to start eating iron rich foods sooner rather than later.

At six or seven months a baby can eat cooked, pureed meat, chicken or fish. It provides essential iron for brain development but at this young age is still a top-up after the usual milk feed. By 7-8 months a baby should be eating two or three small meals a day with 2 tablespoons to 1/2 a cup per meal. Increase the amount gradually before increasing the number of meals. Include some cooked minced meat with mashed vegetables most days.

A one year old needs more iron than his or her dad. It is vitally important that toddlers get enough iron from their food. This is when their brain is developing the most rapidly. If they miss out on iron at this stage their brain will not develop to its full potential – and they can’t make up for it later. The American Academy of Pediatrics recommends two serves of meat (or protein equivalent) a day for children under six years. A serve is 1oz of meat, fish or poultry or 1 egg or 2 tablespoons peanut butter or 4-5 tablespoons legumes. Remember to give your child an orange or piece of fruit with the egg, peanut butter or legumes to increase iron absorption. Give your child a mixture of meat, chicken, fish and vegetarian meals each week. Variety is good for both their health and training their taste-buds to enjoy different flavours.

KEY POINTS

Don’t drink cows’ milk before 12 months.
Toddlers should drink no more than 2 cups milk a day.
Eat fruit with meals rather than between meals.

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

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Ask the Expert – Getting Enough Iron on a Vegetarian Diet

TwinToddlersDad — Tue, 04 May 2010 10:00:01 +0000

This week, Registered Dietitian Nour El-Zibdeh offers tips for getting enough iron from a vegetarian diet without relying on supplements.

Nour El-Zibdeh, RD

Current graduate student: Health Sciences—James Madison University
BS: Human Nutrition, Foods, and Exercise—Virginia Tech
Registered Dietitian: nutrition consultant, freelance writer, and blogger
Experience in clinical dietetics, wellness, family nutrition, and nutrition communication
Website: Practical Nutrition
Twitter: @NourRD
LinkedIn profile: Nour El-Zibdeh
Contact: via blog

Question: How can I ensure enough iron if my child is on a strict vegetarian diet?

Answer:

Iron is important for health. It is part of hemoglobin, a protein found in red blood cells, and its main role is to transfer oxygen to body tissues and cells.

Too little iron causes fatigue, decreased immunity, and may impair psychomotor development in infants. Iron deficiency occurs due to three general reasons:

increased needs of iron (growth),
decreased absorption (iron in the diet comes from sources that are not easily absorbed, such as plant foods),
decreased iron intake (low total food intake).

The prevalence of iron deficiency in the United States is low. However, toddlers are at a high risk because they don’t drink or eat iron-fortified formula or cereal anymore, and their intake of iron-containing foods may still be low. Toddlers who are on vegetarian diets, drink more than 24 ounces of milk a day, or suffer from decreased availability of food are at an increased risk.

Type of iron in the diet

There are two types of iron in the diet, heme and non-heme. Heme iron comes from animal sources and is the most easily absorbed. Non-heme iron is the most prevalent in food, found in both animal and plant sources, but its absorption is less efficient and can be influenced by many factors.

When discussing plant sources of iron, two points must be distinguished. First, the amount of iron in plant foods, and second, the amount that is actually absorbed. For example, half cup of soybeans has 4.5 mg of iron, but the fiber and protein in soybeans prevent its absorption. Half cup of tomatoes, on the other hand, has 1 to 2 mg of iron but is easier to absorb. Vitamin C improves the absorption of iron, while phytates (in bran and whole grains), oxalates (in spinach, rhubarb, strawberries, nuts, chocolate, and wheat bran), polyphenols (in coffee and tea), calcium, and fiber prevent its absorption.

Tips for vegetarian toddlers

Offer a variety of plant foods, especially those high in vitamin C. These include guava, lemon, orange, papaya, tomatoes, beetroot, broccoli, cabbage, cauliflower, pumpkin, and turnips.
Choose iron-fortified cereals and grains when possible.
If you are interested in numbers, toddlers one to three years old need 7 mg or iron a day, and toddlers over four years old need 10 mg a day. Since iron in plant foods is not absorbed entirely, aim for more than the recommended amount from plant foods, not supplements. Here are some foods rich in iron.
Don’t give your toddler more than 24 ounces of milk (cow, goat, or soy) a day. Milk is low in iron and high in calcium (prevents iron absorption), and too much can be filling causing your child to be uninterested in other iron-containing foods. Too much cow’s milk can also irritate the gastrointestinal tract and cause bleeding, which will lead to iron losses.
Don’t stress about iron deficiency unless your child shows symptoms, which include fatigue and weakness, pale skin, mucous membranes, rapid heartbeat, irritability, decreased appetite, dizziness, or feeling lightheaded.
Consult with your pediatrician if you suspect deficiency, and don’t give your child iron supplements on your own. The human body doesn’t have a way to get rid of excess iron, so too much can be toxic and cause organ damage.

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Ask the Expert – Vegetarian Diet for Toddlers

TwinToddlersDad — Tue, 06 Oct 2009 10:00:01 +0000

This week, Registered Dietitian Rebecca Subbiah offers advice on how to ensure a balanced, nutritious vegetarian diet for your toddler.

Rebecca Subbiah, RD, LDN, cPT

Rebecca Subbiah RD, LDN cPT is a Freelance writer, Registered Dietitian and Personal Trainer, with over 8 years of experience in a variety of clinical areas. She has worked both in the United Kingdom and America. Her forte is weight management and motivational interviewing.

Question: My child is on a vegetarian diet. How can I ensure he is getting proper nutrition? Should I give him any supplements?

Answer:

It is very possible for a toddler to follow a vegetarian diet along with the family, as long as it’s well balanced and varied to ensure nutritional adequacy.

Toddlers have unique nutritional needs based on their age and growth, needing between 1000-1400kcal a day, 3 -4 servings of grains, such as a slice of bread, ½ a cup of pasta, half of the servings coming from whole grains. A vegetarian diet should be rich in fruits and vegetables of all the colors of the rainbow in order to get the range of vitamin’s and minerals. Aim for 1-2 cups of vegetables a day and 1-2 cups of fruit per day.

In regard to dairy, aim for 2 cups of milk a day, full fat for the first few years, cheese and yogurt to meet calcium and vitamin D requirements for growing bones. Toddlers between the ages of 2-4 need 500mg of calcium and 400IU of vitamin D. If your child cannot tolerate dairy use calcium fortified cereal and soy products, some orange juice is also fortified with calcium.

A nutrient of concern in a vegetarian diet is iron as the most easily absorbed sources come from meat. Toddlers need 7mg of iron a day, especially after one year as their stores are depleted. Ensure your toddler doesn’t fill up on drinking too much milk and eats well at meal times. Provide iron fortified grains, tofu and beans. With meals serve them along with vitamin C rich foods, such as orange juice, broccoli, strawberries and tomatoes as vitamin C aids iron absorption.

It is also important to eat good sources of protein such as lentils, beans and pulses. Offer your toddler 3-4 servings of protein a day with a serving being ¼ cup of cooked dry beans, or one egg. Look up recipes from around the globe for inspiration particularly in countries that are predominantly vegetarian such as India. You will find a wealth of recipe ideas with dals using lentils, dishes like pongal that combine rice and lentils and many dishes for beans and wonderful ways to cook vegetables.

In Middle Eastern cuisine you will find hummus and falafel. Of course stir-fries are wonderful with vegetables and egg for protein, also vegetable fried rice. Pasta dishes also lend well to vegetarian options and pasta comes in such fun shapes and colors that kids adore.

Here is a simple vegetarian recipe you can try:

Savoury Pongal

Ingredients:

Mong dal 1/3 cup
Rice 1 cup
Cumin
Pepper
Cut ginger
Coriander leaves
Curry leaves

Method:
1. lightly roast the mong dal
2. add rice and dal to pressure cooker with 4 cups of water and let the whistle go 2 times
3. then simmer for 5 minutes
4. heat oil or ghee and add spices, curry leaves and salt then add to the pongal
This is a easy and tasty traditional South Indian dish actually eaten on Pongal Harvest Festival in January. It is great eaten with spinach dal.

References:

Nutrition guide for toddlers on Kids Health
Infant and toddler nutrition on MedlinePlus

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Five For Fridays – May 8, 2009

TwinToddlersDad — Fri, 08 May 2009 11:00:49 +0000

Bonjour! So glad it’s Friday again! Last week was Safe Kids Week (Apr 26 – May 3). It is a good time to remind us of the very real risks of unintentional injuries to young children. Check out a short video on kids safety in this week’s Five for Fridays in addition to the usual nutrition-related stories. And of course, feel free to share your tips for safety especially in the kitchen.

Tips for kids safety

I was shocked to learn this scary statistic – there is one unintentional injury to a child every 12 minutes that is serious enough to require a visit to the ER. In recognition of this, Safe Kids USA along with its founding sponsor J&J is running an awareness campaign called Raising Safe Kids – One Stage at a Time focused on child development and injury risks to children 14 and under. Although their website has very useful information for various age groups, my interest was mainly in the 1-4 years old Stage (Little Kids). Here is a short video for this age group -

Burns in the kitchen or at the dinner table are among the 5 major risks identified by Safe Kids USA. Make sure the stove area is a “kid-free” zone. Use the back burners and turn the handles of pots and pans away from the front of the stove. When using the oven, be vigilant and do not allow children to get close because the oven door can get really hot. Use large bowls when serving hot foods like soup and allow it to cool down by stirring with a spoon before giving to your child. Cut meats and vegetables into small bite sized chunks – this will cool them down and also reduce the risk of choking. Knives and other sharp objects can also be dangerous and should be kept out of reach. Same goes for matches and lighters. The cabinet under the sink where you are most likely to keep dishwashing detergents and other cleaners should be locked. Consider getting a fire extinguisher and keep it in a safe, easy-to-reach place in your kitchen.

Here is an excellent report on kids safety which gives a lot of handy tips.

Should junk food advertising aimed at children be banned?

Rising rates of childhood obesity in Australia have galvanized a few public health and consumer advocacy groups to kick-off the Burger Corp campaign against junk food advertising on TV during prime time. They want the Australian Communication and Media Authority (ACMA) to come out with tougher regulations this year once they complete their review. Ban the practice of giving out free toys with junk fast food; ban the use of popular cartoon or other promotional characters; regulate advertising beyond TV in print media and newspapers – in short ban! ban! ban! Although I certainly do not support excessive and misleading advertising aimed at kids, I am not a big fan of over-regulating our way out of this public health problem either. There is also a role for parents, educators and community leaders to act as role models and to inform, influence and inspire young kids to make healthy choices, not just for food but for everything else that affects their health and growth. Removing ads from TV will not solve the problem of excessive TV watching. Banning free toys and promotional characters will not reduce the allure of inexpensive, great tasting junk food rich in salt, sugar and fat. Some regulations is needed; in my opinion it should be limited to restricting false and misleading claims. We should rather focus our resources on improving affordability of healthy options and increasing awareness of the link between nutrition and long term health. What do you think?

Don’t take a multivitamin supplement on an empty stomach

Even though there is considerable debate and uncertainty about the effectiveness of multivitamin supplements, they are quite popular and many people, including me, take them daily. That is why this question about when and how to take vitamins on the Fitness and Nutrition section of the New York Times caught my eye. According to the experts, the time of the day you take the vitamins is not important. What is important is that you take them consistently and that you take them with food. The water soluble vitamins B and C can absorb well on an empty stomach, but the fat soluble vitamins A, D, E and K need some fat from food to absorb in the body. Of course it does not mean that you need to eat fatty foods in order to take your vitamins. Simply eating some food right before taking the pill should do just fine.

Second hand smoke linked to iron deficiency and low antioxidant levels in children

Exposure to second hand smoke is getting a lot of attention in the 2009 annual meeting of the Pediatric Academic Societies this week in Baltimore. In two separate studies, data from the National Health and Nutrition Examination Surveys (NHANES) for children under 18 years of age was analyzed. One study from researchers at the New York University School of Medicine reported a link between second hand smoke (estimated by blood levels of cotinine, a metabolite of nicotine), obesity and iron deficiency. The other, from researchers at the University of Rochester Medical Center concluded that second hand smoke reduces the levels of anti-oxidants in children. Anti-oxidants work to protect the cells in our body from damage by free radicals which are produced as part of normal body functions. Vitamin C is a good antioxidant; although the researchers did not clearly make a recommendation about supplements to counter the effect of second hand smoke. Bottom line – second hand smoke is bad, not just for your lungs, but also for your nutritional health.

Good nutrition strongly linked to education

A new study published in the Journal of the American Dietetic Association concludes that highly educated and affluent people are more likely to have a low energy density diet (lean meat, fruits and vegetables) compared to those on the lower income and education levels. I was not able to read the original article; still I found this summary very interesting. I am not surprised by it because we have all heard enough about affordability of nutritious food. I think that more than education, awareness and basic understanding of nutrition are more critical in making this choice. I know of many highly educated people who have very poor eating habits. And this is even when they know that salty, fatty and sugary foods are no good for their health. So there is still another factor that is critical – and that is a genuine desire to take a long term view of health and nutrition. And while it is true that low energy density, nutrient rich foods cost more, there are many ways to still have a healthy diet. As I wrote in last week’s Five for Fridays, simply by cutting down on packaged foods and preparing your meals at home, you can save a lot of money and improve your nutrition. You don’t need to be a rocket scientist or a genius – just have a desire, some knowledge of nutrition and cooking and be able to find some time to cook. Go for it!

Enjoy your weekend! And do share your opinion or recent nutrition related news you found interesting.

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