Most mothers have been there at some point ... sitting endlessly at the table desperately trying to coax something green into one of their offspring. But how bad is it for your child if they do not eat fruit and veg and should supplements be given to picky eaters? In 2005 the BBC ran a programme about a 15 year old boy who had lived on strawberry jam sandwiches for breakfast, lunch and dinner for most of his life. Craig was in relatively good health and didn't suffer from any more illnesses than other children of the same age but his doctor and parents worried that he might have serious underlying problems related to his eating problem so they sent him for tests. The tests showed that there was no serious damage to any of the main organs and he was generally in good health but the blood test did reveal an iron deficiency that could lead to anaemia.
Serious problem or just a fussy eater?
Craig's case although extreme was not as unusual as you might think and it is estimated that approximately 20 % of children under 7 are fussy eaters and are not getting enough of some important nutrients. To supplement or not to supplement, that is the question? It is a controversial issue and criticising food supplements is a staple diet for the science pages of the popular press. You can be sure that headlines such as 'vitamin junkies are flushing their money down the toilet', 'food supplements do not work' and 'supplement scams' will appear in the paper just as easily as your coffee will appear on the breakfast table. But then those headlines are often contradicted a day later by some new evidence that a certain group of the population lack a particular nutrient and that supplements will help. Vitamin D is an excellent case in point. The chief medical officer for England, Dame Sally Davies recently announced that one in four children under the age of four is vitamin D deficient and advised supplementing those at high risk, this included all pregnant and breastfeeding women, children under five years old, people aged over 65, and people at risk of not getting enough exposure to sunlight (so a large portion of UK residents then).
Visit a qualified doctor, dietician or nutritional therapist.
Parents should certainly not be feeding their children high levels of supplements without first taking the advice of a qualified doctor, dietician or nutritional therapist. You can have too much of a good thing and some nutrients can be toxic at quite low levels. Nor should you give up on encouraging your child to try new foods. Some children will just be fussy eaters but others may turn out to be food neophobic or have a recognised Feeding Disorder of Infancy or Childhood (FDIC) in which case they should see a specialist counsellor.
Getting the timing right for the introduction of new foods
It seems that there is a good and a bad time to deal with your child's relationship with vegetables. A joint study between university groups from Britain, Denmark and France investigated the characteristics that predict acceptance of new foods in infants aged between 6 and 36 months. The children were divided into three groups and given a new vegetable (artichoke puree) between five and ten times, always at a time when they were hungry. Group one were given the basic artichoke puree, group two were given the artichoke puree with added sweetener and group three were given the puree with added energy. Results could be classified into four types. Forty per cent of the children gradually increased the amount of puree they ate over the study time and were classified as 'learners'. Twenty one per cent of the children ate more than 75% of the puree that they were offered and were called 'plate-clearers' and only sixteen per cent ate less than 10g of the puree, even after five trials and they were classified as non eaters. The remaining 23% couldn't be classified as there was no consistency to their eating patterns. Older children were more likely to be non-eaters and younger children were much more likely to be learners, confirming what many mothers have always thought, that introducing new foods at a young age is the best way to begin the process of healthy eating patterns in children.
He we report on three new pieces of evidence that back the case for supplementation.
Public health policy in the UK is still not preventing vitamin D deficiency
A new study carried out by UCL's Institute of Child Health, investigated the numbers of hypocalcaemic (low blood clacium) seizures that are due to vitamin D deficiency in children in the UK and Ireland. The study group analysed data on children aged between 0 and 15 years of age who were resident in the UK and Ireland and who had suffered a hypocalcaemic seizure between 2011 and 2013. Results showed that there were 3.49 cases of seizures per million children and that males and infants were more likely to suffer the problem than females and older children. Children from Asian or Black ethnic groups were more at risk than Caucasians. The group concludes that the present policy to deal with vitamin D deficiency in the UK is not achieving the desired results.
Nutritional supplementation improves health in Chinese children who are fussy eaters.
A joint study between a US university group, a Chinese and a Hong Kong group has investigated whether nutritional supplements and nutritional counselling can improve the growth of children who are fussy eaters. The children who were included in the study were aged between 30 and 60 months and had a weight for height that fell on or below the 25th growth percentile. The children either received nutrition counselling or nutrition counselling with milk supplements over a period of 4 months. Results showed that the counselling plus nutritional supplements group had better weight for age scores than the counselling alone group. They also had higher intakes of energy, protein, carbohydrate, docosahexaenoic acid, arachidonic acid, calcium, phosphorous, iron, zinc, and vitamins A, C, D, E, and B6. The group concludes that children who are fussy eaters benefit from nutritional supplements in combination with nutritional counselling.
Iron supplements in young children could improve school work and mental health
A study carried out in Chile has investigated the long term behavioural effects of iron supplements in young children. Healthy children who had no iron deficiency at 6 months of age were separated into two groups. Group one were given normal formula milk , supplemented with iron, group two were given formula milk with no supplementation, up to the age of 1 year. At age 10, the children's socio-emotional behaviour was assessed. Results showed that the iron supplemented children were more cooperative, confident, and coordinated. they were also more persistent in trying again after failing at something and worked harder after praise compared with the no-added-iron group. The children who had received the supplements smiled earlier than the non supplement group and laughed and smiled more, even during the social stress task. The group concludes that iron supplementation in infancy leads to better adaptive behaviour later and this could improve children's mental health, personal relationships and school work.
3. Sheng et al. Randomized controlled trials to compare growth parameters and nutrient adequacy in children with picky eating behaviours who received nutritional counselling with or without an oral nutritional supplement. Nutr Metab Insights. Oct 2014.