Common nutritional questions

Questions answered by Suzannah Olivier

Giving nutritional guidance and advice to our children is key to a healthy life

I notice that food labelling now seems to omit the E additives. Are they now referred to by their chemical name?? If so can you tell me what they are?? Some children react negatively to these additives, and I am concerned that they are no longer easily recognisable on the labels of foods in my supermarket. Has the law changed regarding labelling? My Grandchild appears to be particularly hyper active after eating certain processed foods. I await your comments thank you in advance for your assistance

You are not the only person who is confused about food labelling! The Food Standards Agency, the Consumers Association, and the pressure group FLAG (Food Labelling Agenda) are all aware of the problems and are aiming to reach agreement on different food labelling issues - albeit slowly as they all seem to have different viewpoints on the subject. E-numbers are not often put on the labels with their 'E' name these days as they don't really tell the public anything. Instead the full chemical or ingredient name is listed and then you need a chart to find out what they mean. The best references are the books 'E for Additives' by Maurice Hanssen, or 'What The Label Doesn't Tell You' by Sue Dibb. Not all E-numbers are bad as some are natural antioxidants such as vitamin C, natural colourings such as beetroot and thickeners such as pectin - E-numbers quoted for these just tend to scare people. On the other hand there are many suspect additives, as you quite rightly say, in particular food colourings and preservatives which can be a problem for behavioural problems in children and asthma. It is not possible to give all the names as there around 900 E-numbers, but you can look them up in one of the reference books mentioned above (ask your library for these). Alternatively, my book Allergy Solutions gives a list of all the E-numbers which are not likely to be harmful and can even be beneficial.



In the last two months, my 17 month old son became a picky eater. He's weight percentile has dropped drastically to 0-5%He was born in the 75th percentile and it's dropping consistently with every check up. I've been critized or adviced by relatives and friends that our diet is too low in fat. Ryan, our son does eat with us sometimes. Our main diet is white meat, organic vegetables, organic grains, and fresh fruits. We don't drink fruit juice nor dairy products. Occasionally, I would make fresh soy milk. I'm starting to give him Organic lactose free 2% fat milk. (The organic lactose free doesn't come in whole) What are the foods that you would recommend for my child to maxize his nutrient intake. Here is an example of his daily menue: Upon wakening: breastfeeding. (I couldn't wean him.) Breakfast: 4 oz. baby oatmeal mixed with milk and 1 oz. fresh blueberries, and 3 oz. milk. Or savory steam egg custard made with 1 egg, 2 oz. clear chicken broth, 1/4 oz. spinach, 1/2 oz. carrots,1 oz. avocado, and a dash of sea salt. (He usually don't finish even half of it.) Lunch: 1 1/2 oz. chicken, 2 oz, vegetables, 2 oz. pasta, 1tb canola or olive oil, and 2-3 oz. milk. (if he didn't eat much breakfast, he would finish his lunch.) Snack: 2 oz. of fruits, 1/2 slice of bread and 3-4 oz. milk. Dinner: same as lunch. I'm sorry to make you read all this. Please help.

The approximate daily requirement for a child of Ryan's age is between 1200-1400 calories and ideally this should come from a nutrient dense diet as children are growing fast at this age. From the menu you describe your son is actually getting between 750-900 calories, assuming he eats all his food. As you can see this is too low for his age and would explain his drop in weight percentile.

Children of this age need lots of calories but only have little tummies, and their appetites often do not match their calorie requirements. This means that they need a calorie dense diet and consequently a low-calorie adult diet is not appropriate. The foods you are giving him are of a good quality and are nutrient dense, but more calories need to be added to his day's intake. His faddiness may just be a phase that he is going through which is common to small children (though it usually starts a little later). However it is obvious from your description of foods that you are very health conscious (organic foods and making your own soya milk) and he may be picking up some nervousness in relation to food from you. I would, first of all, examine whether you enjoy your mealtimes and if eating is a pleasure for all the family.

As a matter of urgency you need to add more calories into his diet. He should be getting full fat milk, and this can come from pasteurised goats or ewes milk if you are avoiding cows milk for any particular reason. If lactose is actually a problem (rather than an anticipated problem) you could give him full-fat milk laced about an hour before-hand with liquid lactose digestive enzymes (available from Biocare and available from good quality health food shops - if you can't find it in the shops Biocare are based in Birmingham). This will predigest the lactose in the milk. Other high calorie foods to add to his diet are all going to be high fat foods: use butter, or soya margarine if your prefer, on his bread, give him higher fat meats such as minced lamb (and he will also benefit from the additional iron and zinc), oily fish such as tuna, mackerel and sardines, full fat yoghurts (soya yoghurts if you wish), more avocado, and if he is not allergic to seeds or nuts then some ground sunflower seeds added to his porridge.

If your son does not put on weight you will need to seek your doctor's advice.



My 15 month old son suffered from gastric reflux from birth, the condition worsened when put on cows milk at one year old, i then switched to soya and the entire problem has ceased. My question is :- is it ok long term for him to stay on Soya milk and how much should he be consuming daily and should he have any supplements.

You do not mention if you have put your son on soya milk designed for children, which is fortified with certain nutrients such as calcium, or if it is 'normal' soay milk. There is no problem if you son enjoys soya milk, as long as it is calcium enriched and as long as he does not develop an allergy to it (a significant number of cow's milk allergic people also turn out to develop an allergy to soya). Quantity wise it is generally advised that children drink a pint of milk to get their calcium intake right, but this also 'fills up' little stomachs. If you son is a good eater then this is fine, but if he is scant in his eating habits, then you may want to cut back on the milk partially, give him some water instead and make sure he has a varied diet. Finally it may be a good idea to give your son some child-formulated infant vitamin drops.



I am a father of two lovely girls the elder one is 2.5 years and the younger on is 1.5. We don’t have problems on feeding the younger one, but with the elder one, we have a lot of problems.  She will often refuse food and can often go for days only accepting milk .

It is fairly common for 1.5 year olds to be good about eating as they have not yet discovered the 'negotiating value' of refusing foods that 2.5 year olds are only too aware of. While I am sure you are right that you have a very egalitarian attitude to your two daughters, it could still be the case that your older daughter is unsettled by having a younger sibbling (which is in many ways a natural reaction) and this could be a possible explanation for her bahaviour (or it may not be!). You do not mention how long your older daughter has been behaving like this, but it is certainly not good, from a nutritional point of view, for her to just fill up on milk and several nutritional deficiencies can arise in this way (iron deficiency being most common). I would suggest, as a minimum making sure that she gets some child-formulated vitamin drops and an iron tonic (follow the dosage instructions for her age). You also do not mention if she is underweight or has other health problems such as allergies as a result of her eating habits, but I suggest that you have her checked by a health visitor or your GP to be sure. One of the problems of giving her too much milk is that it will blunt her appetite for real food and this may be contributing to the problem. If you eat as a family and do your best not to react too much to her habits she may find that her behaviour has no value and that she will start eating in the same way as the rest of the family.



My 4 and a half year old son hardly eats anything, which I know is quite common, but all he eats is milk twice a day, weetabix with a small fromage frais in the morning, sausage or actually chicken frankfurters in a wrapper three times a week for lunch, cheese sandwich and a banana for dinner every day, sometimes the odd chicken pizza, kentucky fried or pasta to fill in the rest of the week for lunch. No veges at all, was told to encourage him to eat chocolate at least it is better than nothing. Now he started to develope this fainting and headache and light headed feeling, my health visitor is not all that helpful, don't want to go to gp for that reason, what to do?

You are right that it is fairly common for 4 year olds to be quite faddy about what they eat, however this often has roots in what the parents will let the child get away with eating - we all know the effects of 'pester power' and the emotional blackmail that often goes on with what a child will eat and not eat. My first advice is that you should indeed go to your GP, because if your child is experiencing fainting fits, headaches and light headedness, this is something you doctor should be aware of and ought to establish that there are not other more serious causes other than diet. Secondly your GP or health visitor needs to advise you if your son is within the normal ranges of height and weight for his age. If he is, then he is probably eating enough calories for his needs - the foods he does eat are fairly high in calories so he may be doing better than you believe. Finally, you probably need to be a little firmer about what he can eat and not allow yourself give in - this does not need to set the scene for arguments or show-downs, but you can persuade him kindly and gently that this is simply the healthy way to eat and why - remember that you are in charge. Chocolate bars are no solution and are likley to exacerbate the situation. On the other hand you could try strawberries, banana or melon cubes coated in melted chocolate and see if that is a good place to start. Make food fun and appealing for him and let him join in with the preparation. Your doctor should check your child for anaemia (iron deficiency) as you describe symtpoms such as fainting and light-headedness. Iron rich foods include red meat, dark poultry meat (ie chicken or turkey leg), cheese, nuts and seeds. A gentle iron tonic, such as Floradix (available from chemists - follow the directions on the label) might also help, or your doctor might prescribe iron for him to take.


My 5 year old son will only eat certain foods, ie sausages, chips, nuggets and pasta. He used to eat everything I put in front of him until he went into hospital, my husband and I have everything we can think of to get him to eat what we eat, ie get him to help us make dinner, let him chose what he wants by looking through a recipe book etc. We were just wondering if you had any ideas? and is there any thing to worry about?

There are two possibilities - one is that the hospital visit somehow affected your child's eating (ie the food available in hospital influenced his choices, or that he was somehow 'traumatised' by the experience in such a way that he feels the need to exert his influence via food/eating) and the second possibility is that this change in behaviour is merely a coincidence that happened at the same time as the hospital stay. Either way, you know that your child is capable of eating a varied diet (evidenced by his previous eating habits), and that he is bringing pressure to bear via his current food choices. I suggest that you offer him his choices, say, three times a week on the understanding that he eats exactly what the family eats the rest of the time. That way you are not denying him his choices some of the time (and therefore not creating a craving for 'forbidden foods') and you are also saying that we eat as a family in a particular way and that you expect him (firmly but kindly) to co-operate. He may miss a couple of meals this way, but in the end he is likely to eat just because he is hungry.



I was wondering why toddlers shouldn't eat grapes?

Grapes are, of course, a perfectly nutritious food and for a small child they are very attractive because they are sweet and easy to handle. This means that they are a popular choice for encouraging small children to eat fresh fruit as part of a healthy diet. The advice to be cautious about grapes stems from the fact that it is all too easy for small children to choke on them. Grapes are just the right size to be breathed into the windpipe by accident, which then blocks the passage of air and can choke and suffocate a child. Ideally grapes should be halved or quartered and have their pips removed (or offer seedless grapes). Never leave your child unattended when eating grapes, or any other food, so that you are on hand to deal with any emergency



My son has an intollerance to soya which causes him to suffer with the runs permanently, I keep finding soya hidden under guises such as lecithin, or even vegetable oil... Is there any guide to help me find my way around hidden soya in products?

Soya is used extensively in the food processing industry and while it has many health benefits for many people it is also a fairly common food allergen and many people are either allergic or sensitive to it. The obvious soya containing fods are soya milk, soya yoghurt, soy sauce, soya flour and TVP (textured vegetable protein), which find their way into a vast number of prosessed foods. These include most commercially made breads, pastries and cakes. Many processed meats, salad dressings, sauces, sweets and margarines contain soya oil. As you point out lecithin, the most common emulsifyier in foods, is also frequently sourced from soya. There is no list that I am aware of which means that you need to keep you eye on lable listings and prepare many foods from fresh. You can contact companies that produce foods in which you are interested to make sure that they are soya free, or buy foods which specify that they are soya free. If you speak to the manager at your local supermarket they should be able to provide you with a list of their own-brand foods, and sometimes common-brand foods, that are free of specific allergens.



I have been told that my 18-month-old isn't eating enough, but he weighs 10 kilos so should I stop worrying? The not eating enough comment came from a dietician who analysed a two-day food diary, which I think may not have been very accurate. My baby doesn't take any milk apart from a little breast milk still (don't know how much) - should I be concerned about this too? Many thanks!

Your child is only slightly below the average weight for his age (within a range of 9-14 kgs), and as long as he has a reasonable appetite and is eating a varied diet you should not worry. His weight may be simply related to the fact that he has a slight build. Children need around 1100 calories daily at 18 months and you can work out if he is getting this by using a calorie chart. If you need to get more calories into his diet you could add full fat milk into savoury or creamy dishes, yoghurt or cheese, or if he does not like this add high calorie foods such as avocado, egg yolks and olive oil. Milk is not absolutely essential and can actually blunt the appetite so that a less varied diet is eaten, so do not worry about this as long as your child is eating a variety of other calcium rich foods such as green leafy vegetables, dried fruit, eggs, sardines and maybe calcium enriched soya products. If you continue to be concerned about his weight check with your doctor, but the chances are that he will have his own growth spurt in his own time.



I am a nanny and I work with a family, who has a 2 year old boy. The mother is still giving her child food from a jar for 7 months as when the child does get proper chunkier food he refuses to eat it. The child is still on a bottle and won't take from a cup or a beaker. The child is small for his age. No matter how much the Health Visitor and myself talk the Mother about this see doesn't seem to take any notice. The child can drink out of a beaker because he was doing it just before i went on holiday but when i got back he was back to using bottles. Can you give me some advice.

As a nanny you are in a difficult position regarding the question of weaning the little boy you are looking after. There are many good and authoritative books on the subject of weaning and you may be able to persuade the mother of the little boy to look at some of these - you can order some from the library. You will find that all books will suggest that by the age of two a child should ideally be weaned onto a wide variety of nutritious foods. Ultimately the responsibility for judging if the child is underweight or undersize, and communicating any concerns to the parents lies with the health visitor. If you are worried about the child and are unable to make your concerns known to the mother, then the correct thing to do would be to discuss the problem with the appropriate health professionals.



My daughter Sara is a poor eater. I give her three meals a day. Cereal for breakfast, usually rice and some veg + meat for lunch and something similar for dinner. She also has about 16oz of formula milk during the day. She does not always finish what is given to her. I have tried giving her things like scrambled eggs and toast, fish fingers etc. but find that not much goes into her mouth. Most of the food ends up on the floor. She seems healthy and active. She weighs about 21 pounds and is 13 months old. Is there anything I can do to increase her weight? Any advice would be most welcome.

It sounds as if you aim to give your daughter a varied diet and that is always a good start towards developing a wide range of tastes in your child. At 21 pounds your daughter is well within the normal weight range for a girl of her age. Of course there is much variability in what is normal from one child to another because some children are quite simply smaller or larger than others. If you have any concerns about whether she is putting on weight sufficiently you must check with your health visitor.

 At about the age of one to one-half the number of calories needed by a child takes a slight dip because the fast rate at which they grow in the first year begins to slow down to a steadier pace (other wise we would all end up as big as houses!). This timing is perfect because this is also the age when children start to feed themselves, and as you observe most of the food ends up on the floor. They also take more interest in what is going on around them and so are easily distracted away from eating. Your childs behaviour sounds completely normal to me, and you say she seems healthy and active. You may want to make a point of eating several meals a week with her - instead of her eating separately from the family - to encourage her to understand that sitting down to eat is a united and sociable process. Keep up the good work with her varied diet 

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