Start Them Young!

Get your children into the habit of healthy eating.

As adults, we usually suffer from a sporadic cold or fever, perhaps three to four times a year. Children, on the other hand, especially toddlers and preschoolers who attend day care centres, are usually not so lucky.

The common cold or fever may strike a young child on average three to 12 times a year. And this does not include other ailments your child may suffer from, such as diarrhoea and so on.

Being sick often causes your child to lose his appetite, eat less than he normally does, or sometimes not eat at all. However, it is important for him to continue to eat his meals, as good nutrition is crucial for proper and faster recovery.

Why are good meals essential?

Infections not only reduce appetites, they may also adversely affect nutrient absorption by the digestive system. Some children may suffer from acute malnutrition and lose weight, especially if they do not eat enough. This is due to the fact that when insufficient nutrients are taken in, the body uses its own stores of fat and muscles for energy.

Acute malnutrition causes infections to become worse, as your child’s immune system may become less efficient, and is unable to fight infections effectively. Sick children also need plenty of fluids, especially clean, plain water, as they tend to lose more water than normal. Furthermore, they should continue to eat proper meals which are nutritious and healthy, especially during the recovery period after a sickness.

What should you feed your child?

There are certain foods and drinks you may need to withhold from your sick child, depending on his illness. However, feeding your child with regular nutritious meals is very important. Here are some suggestions on the types of food you could feed him:

Children with fever often have little or no appetite. Try offering smaller meals, which are also higher in calories, as they would not be eating much. You can also offer bland meals such as oatmeal, chicken porridge or soup, and mashed potatoes. Offer plenty of fluids as well, especially plain water, or even juices, to combat dehydration that may occur with high body temperatures.

Warm soupy foods, as well as soft and easy to eat foods often appeal to children with colds. This may include chicken soup or porridge, scrambled eggs, mashed potatoes, pancakes, and oatmeal. Warm foods can also act as a vaporiser, loosening nasal mucous congestion.

Diarrhoea can usually be treated at home, and mostly involves preventing dehydration from occurring. Try not to provide any medication, unless prescribed by your child’s paediatrician. Offer your child plenty of fluids, which may include water, broth and oral rehydration salt solutions. Foods that are easy to digest, such as oatmeal or porridge, cooked vegetables in soups or broths, should be given as well.

Give him plenty to eat and drink!

It can be difficult to coax your young one to eat a decent meal when he is feeling under the weather. Try offering him smaller meals more frequently, that is, every 1-2 hours, instead of 2-3 big meals a day. Encourage him to eat as much as he can, but do not force-feed him – this may cause him to choke or throw up.

Food with a sweet taste can entice your child’s appetite, especially if he has been feeling nauseous or has been vomiting. You can offer mashed bananas or even ice-cream, or “tau foo fah” to help increase his appetite. Don’t forget to give him plenty of fluids, including plain water, fresh fruit juices, coconut water or even soups.

When your child starts to recover, his appetite will improve. Increase the variety of foods you feed him, as different types of food provide different nutrients. Also increase the frequency of feeding as his energy and nutrient requirements during recovery will be more than usual. Eating nutritious and healthful meals will help your child regain his energy and appetite for a faster recovery!

At 8 years old, Adam weighs a whopping 67kg, which is too much weight for him to carry on his slight frame of 125cm. The cause: Excessive sugar consumption along with other unhealthy eating habits as well as the lack of physical activity, which caused the increase in his weight, leaving him unproportionate with his height and age. His parents may have also caused this increase in weight as they unknowingly contributed to it by using chocolate and cookies as rewards, or not reading the food labels properly.

Hidden sugar

"But I don't really give my children sugary snacks often!"

Even if your child doesn't eat chocolates or sweets much, you would be shocked to know that many of the food products you buy in supermarkets contain refined sugar. Did you know that one tablespoon of ketchup contains one teaspoon of sugar? Other processed foods like cereals, cooking sauces, peanut butter, fruit jams, steamed buns or pau like kaya or red bean pau, frozen products like pizza, and canned fruits all contain sugar. This does not even include the usual treats like sweets, cookies, cakes, local kuih like kuih talam, chocolates and carbonated drinks which your child may take in quite regularly as well!

The different forms of sugar

Sugar comes in many different forms and in a variety of names. Sucrose is the most widely used sugar and comes from sugar cane, sugar beets and sugar maples. Some of the more common members of the sucrose family include white sugar (table sugar), turbinado sugar (raw sugar), brown sugar, maple sugar, maple syrup and molasses.

Lactose and galactose are forms of sugar found in milk. However, they are not consumed as sugar but as part of milk products, and therefore not considered food additives.This differs from sweetened condensed milk with added sugar and reduced milk protein content.

Too sweet for comfort

Refined sugars can cause a lot of damage to the body if taken in excess amounts. Some of them are listed below:

• Tooth decay. Bacteria in our mouths use the sugars to produce a substance known as glucan. Glucan helps the bacteria stick to our teeth and acids that corrode the protective teeth enamel are produced.
• Obesity. Large amounts of sugars are often found contained in small quantities of refined food. These foods consist of empty calories and you usually tend to eat more than is needed before you start to feel full. Furthermore, many children also like to drink carbonated soft drinks, which a 350ml can of soft drink has at least 7 teaspoons of sugar. This overconsumption of sugar leads to an increase in weight as the calories are converted into fat and stored.
• Diabetes. Refined sugars break down easily into glucose, which is then absorbed into our bloodstream; insulin is produced to control these levels of sugar in the blood. When there is an excess of sugar in the blood, insulin is produced in even greater amounts to control the blood-sugar levels. Too much insulin further causes the removal of too much sugar and the body releases another hormone to bring up the sugar levels again. Over time, this fluctuation can cause damage to the insulin-producing mechanism leading to diabetes mellitus.

Remember to always read the food labels carefully before making any purchases. Reduce the usage of unnecessary sugars whenever possible and always choose healthier alternatives like fresh fruit. Avoid sugary snacks and sweets, though the occasional piece of cake would not do much harm to your child. In the long run, he will definitely thank you for letting him grow up healthy and happy!

Fortified foods have been around for a very long time, often used as a way to control deficiencies in micronutrients such as vitamin A, D, several B vitamins, calcium, iodine as well as iron. Fortifying food, which means to “strengthen” food, is simply the addition of micronutrients to processed foods such as bread, cereal, milk and cheese or other dairy products.

Essential nutrients

Micronutrients can be found in everyday foods; these micronutrients are essential for growth and development, especially in children. However because they occur in very small quantities in some foods, it is possible for deficiencies to take place. In ensuring that the requirements of these micronutrients are met, it is therefore important that children take in a variety of foods.

What foods are commonly fortified?

Many packaged foods are fortified with some vitamins or minerals. Among the more common foods that are fortified include:

• Bread, rice, cereals – Iron, B vitamins (thiamine, riboflavin, niacin).
• Milk, margarine – Vitamins A and D.
• Orange juice, soymilk – Calcium.
• Infant formula, fortified milk – Iron.

Fortified foods – the way to go?

Children need to eat various types of foods to get all the nutrients required. This may be harder for picky eaters, as they choose the food they like and refuse all others. When this occurs, they are at risk of deficiencies. Kids with very small appetites may also lose out important nutrients. In these cases, you can help by giving your child fortified or nutrient-rich foods to meet the requirements. Fortified foods provide an alternative. For example, a lactose-intolerant child may get his additional calcium needs from fortified orange juice, to still ensure strong bones and teeth.

Semakin bayi membesar, adalah juga penting untuk anda merangkumkan pelbagai jenis makanan yang berlainan ke dalam diet si manja, termasuk daging merah, ayam dan ikan, serta pelbagai jenis buah-buahan dan sayur-sayuran, produk susu, bijirin, nasi, pasta dan kentang. Apabila si manja mencapai umur satu tahun, anda boleh mulai memberikannya hidangan keluarga. Ini juga membantu memberi banyak pilihan dan mengelakkan anak menjadi cerewet makan apabila besar!

Too much can be toxic

Fortified foods provide benefits to a child in ways of reducing the risks of falling sick as well as improving their overall mental and physical health. Rare are cases of nutrient overload as the body can expel excess minerals easily. However, toxicity from vitamin A and D, usually due to supplements without prescription, causes fatigue, irritability, vomiting, and drowsiness.

Always try to stick with a large variety of foods that can offer your child all the micronutrients needed for proper growth and development before turning to fortified foods. As much as possible use of natural food sources and avoid supplements unless advised by your child’s paediatrician.

Many parents often do not realise the importance of snacking between meals. Eating regular meals have been stressed upon in our society today so much so that frequent snacking has been viewed as a bad thing. However, there are advantages and benefits of snacking and it is an essential part of a growing child's diet.

Snacking is Important...
Really?

Snacking, which has been viewed as just munching in-between meals, is in reality an essential part of a child's daily menu. This is because energy levels naturally drop several hours after a main meal and snacks are needed to maintain these energy levels throughout the day. However, not all snacks are equal! Healthy and nutritious snacks help in boosting energy levels, thus enabling children to perform to the best of their capabilities.

Add in the Essentials

Planning healthy snacks for your children need not be tedious and difficult. Refer to the food pyramid as a guide and keep in mind some of the nutrients that should be present in your child's diet to maintain and boost his energy levels. These include:

• Fibre - important to keep the digestive system healthy and to avoid constipation, especially in younger children.
• Carbohydrates - major source for energy.
• Protein - builds muscles and other tissues in the body such as the organs.
• Vitamins and minerals – help boost the immune system, support normal growth and development.

A combination of these nutrients makes up a healthy snack that will provide your child with the necessary nutrients needed to get through his day.

Creative and Attractive Snack Ideas!

Healthy snacks need not be boring and bland; they can actually comprise of a large variety of tasty foods.

It is common for children to prefer snacks such as pretzels, potato chips as well as cheese crackers or chewy fruit snacks. Although these snacks are marketed as healthy and low fat, they are actually high in sugar and sodium. Here are more tips in which you could use to promote a healthier snacking:

• No junk food in the house. Do not stock up on chips or cookies; instead buy healthy snacks such as high-fibre crackers, cereal bars and plenty of fresh fruits. Children will look for other options if they are hungry enough.
• Quick cook meals. These meals do require some cooking, but are simple, healthy and easy to prepare! Make mini sandwiches of egg/tuna/cheese, cook up some French toast or corn-incup (limit the margarine and do not add any more salt).
• Keep it simple and nutritious. Some ready-to-eat snacks are both tasty for your child and easy for you! Get some popiah basah, tau fu fah or steamed pau for a healthy snack.
• Offer a variety. Always offer a variety of healthy snacks that they can choose from, which also allows them to be in the habit of choosing healthy snacks in the future.

Never Restrict Anything Completely

Do not restrict sugary snacks completely. Instead, set limits and provide them as treats, yet not to be given out everyday. Eliminating these foods from a child's diet may make them crave for them even more. Make sure that snacks are not given too close to mealtimes as this can ruin your child's appetite. Limit snacks to at least 2 hours before a main meal and never let snacks be a replacement of the main meals!

With good knowledge of which foods contain the nutrients necessary for your child's growth, planning and preparing healthy snacks will be a breeze!

The rate of childhood obesity has been growing in an alarming manner and is now one of the most common nutritional problems worldwide. Childhood obesity has been associated with numerous health problems that extend well into adolescence and is in fact an early risk factor for much of adult morbidity and mortality.

What Causes Obesity in Children?

Genetic factors may be one of the reasons children become overweight or obese. But with more kids spending less time being physically active and more time in front of the television or computer, it’s no wonder the numbers of overweight children have been rising at alarming rates. Today’s busy parents also do not have enough time to prepare balanced and nutritious meals for their children and family, leaning towards fast foods and other unhealthy alternatives that are high in sugar, salt and empty calories.

Unhealthy Lifestyles Invite Diseases

Overweight children have a higher risk of developing chronic diseases in the future such as diabetes, hypertension and high cholesterol – all of which have been once considered exclusively adult diseases. With current eating habits and sedentary lifestyles, these will affect the child’s health, as well as his quality of life in the future. Some children may even develop psychological problems, including depression and eating disorders, and also be at risk for substance abuse.

Why Does this Happen?

The convenience of pre-packaged foods and fast food reaches out to ease the burden of working parents. However, many parents do not realise the content of these food products. Many of the products may contain high sugar, saturated fats and salt. Parents should read the ingredients stated on the label. Sugar includes palm sugar, syrup and condensed milk, while salt includes sodium chloride, soy sauce and MSG. Processed food usually contains high levels of salt (or preservatives) so that the food may last longer.

The over-consumption of food, from snacks (eg sweets, chips, chocolates) to daily meals served on the table plays a part. When these foods are consumed more than the dailyrecommended values for the child and with the lack of physical activity (about 54.2% do not play sports in school), it causes the unused calories to be stored in the body as fat. Calorie-dense (eg cakes) and fried foods are usually a favourite with kids.

The Healthy Way Out

Helping your overweight child starts with healthy eating habits at home.

• Balance, Moderation, Variety (BMV). Ensure that meals consist of a balance of all food groups in the food pyramid, in moderate portions and in variety throughout the day.

• Practice what you preach. Cultivate good eating habits and an active lifestyle within the family. You are his role model and whatever actions you take will set an example for him.

• Do not single out your child. Be sensitive to your child’s needs, as overweight children tend to be more self-conscious. Encouragement and support from the family is important.

• Get him moving. Give him simple chores such as wiping bookshelves, sweeping or washing his own school shoes. These add up to his daily physical activity, and indirectly teach him about responsibility.

• Family fun time. Make weekends a family time with activities like swimming and cycling in the park with the kids. Create other fun activities that they will enjoy and look forward to.

Nip childhood obesity in the bud. Cultivate the simple rules of practising BMV and physical activity in the family, it is never too late to start now. He may not realise the importance of a healthy lifestyle now, but by making it a family affair, you are caring for him and also the family for future well being.

Fast food was once a luxury for children, consumed only during special occasions. However, with our lifestyles getting increasingly busier and the price of fast food becoming progressively affordable for some parents, they are turning to fast food as a quick mealfix for their family. Recent statistics show that the frequency of children eating fast food at least once a week has increased from 35.4% in 2001/02 to 56.6% in 2007/08 – an increase of 21.2% in just 6 years!

It is advisable for parents to monitor and limit the consumption of fast food in their children. With few changes in the way the food selection is made, you can help your child obtain a healthier and more nutritious meal from fast food.

How to Replace with Healthier Option?

What: Soft/Carbonated drinks.
Why: They are high in sugar and empty calories.
How: Some restaurants allow you to change the drinks in your set meal with little or no extra cost. So instead of getting a carbonated drink, get water, some fresh juice, malted drink or soya bean milk as a replacement. The extra cost would hardly make a difference when you see the health benefits reaped.

What: “Dressing” your food (eg salt, sauces, spreads, cheese, mayonnaise).
Why: Salt and fat intake are increased, which may lead to hypertension and obesity.
How: Don’t allow your child to add “more taste” to their food with too much tomato or chilli sauce. Additionally, you can also request for your order to be specially prepared (ie less mayonnaise for your burgers). For salads, instead of the usual dressing, opt for something healthier like vinegar or olive oil.

What: Grilled food vs. Fried food.
Why: Fried foods are higher in fat and calories.
How: Reduce feeding your child fried foods like char kuey teow or fried chicken if eating out at hawker centres. Choose foods that are grilled or baked instead. Also, foods that are steamed and boiled are much healthier choices as they have less fat and calories.

What: Keeping the portions small.
Why: Children need less nutrients and calories compared with adults.
How: Many fast food joints have meals in large portions, usually catered for adults. When ordering for your child, get the kids meal, which is usually smaller than the adult portion, or cut everything in half to share with your child. This avoids overeating.

What are Nutrition Labels or Nutrition Information Panels (Nip)?

They are panels found at the back or the side of pre-packaged foods that provide detailed information on the nutritional content of the product.

Why are the Labels Important?

• Educate us on the nutritional contents of the food we intend to purchase.
• Guide us to make appropriate food choices, taking into consideration our energy and nutrient needs.
• Enable us to make comparisons between similar products of different brands.

What should You Look for in a Label?

1. Serving size. This is the amount usually consumed at one time. In this example, the suggested serving size is 5 pieces or 20 gram.
2. Serving per package. This indicates the number of servings available in one packet of the food product. In this example, each packet contains 5 servings of the food.
3. Nutrient listing. This list shows the energy, protein, carbohydrate and fat declared in the NIP. Vitamins, minerals and fibre may also be listed. Choose foods with higher protein as well as those rich in calcium, iron and vitamins for your child. Reduce intake of foods that are high in fats and sodium contents.
4. Amount of nutrients. This column lists the amount of energy and nutrients contained in every 100g or 100ml of the food product. If you wish to compare nutritional values of one product with another similar one, you must make the comparison based on 100g or 100ml.
5. Amounts of nutrients per serving. The figures stated in this column shows the amount of energy and nutrients your child receives if he consumes one serving of this food. If he consumes two or three servings, the amount of nutrients and energy consumed multiplies accordingly.

Remember to make choices based on the overall nutrient content, and not just on one or two nutrients declared on the NIP. It is also important to know how much your child actually needs to help you make the best and healthiest choices for your child. Get into the habit of reading nutrition labels whenever you go grocery shopping; the more practice you get, the better you become in using them as a tool to plan a well-balanced, healthy diet for your whole family!

Practising Food Safety For Health

Foods are supposed to be wholesome, ie clean, safe to eat and nutritious. Parents should take note of food safety issues to protect their children from foodborne illnesses.

Did you know that children as young as two years old can start helping around in the kitchen? Having your child help you around the kitchen is a win-win situation. On one hand, you’ll get an extra pair of hands and quality time with your child. On the other hand, your child gets to learn and have fun at the same time. He’ll be able to pick up skills like counting and measuring, expand his vocabulary and also use this opportunity to express his creativity and imagination. Additionally, for children who are often difficult when it comes to meal times, participating in the food preparation process can do wonders to his appetite and eating habits!

Let’s Get Started

Naturally, your child will get excited when he gets the chance to prepare meals. This is his chance to do “grown-up” work! He probably wants to be involved in every process but do ensure that the tasks that you’ll be giving him are ageappropriate. Below are activities that your child can do, depending on his age:

2 Year Olds

3 Year Olds

4 Year Olds

5-6 Year Olds

7-10 Year Olds

• The brain largely consists of four specific kinds of essential fats (known as arachidonic acid (AA), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and dihomo-gamma-linolenic acid (DGLA)) that are vital for intelligence and behavior. These fats remain important throughout life, so it is never too late to boost the level of these fats.

• Iron also has several important roles in brain development, with neurotransmitter production being amongst them.

Developing Concentration

Your child’s concentration needs to be sustained to maximise his abilities to learn. However, children are often restless and appear to have short attention spans. Accompanied with fluctuating blood sugar levels, this may make it difficult for them to sit still physically. Thus, you can make him focus longer by planning his food intake.

• Serve a nutritious, low glycaemic (sugar) breakfast to kick-start his morning. This helps maintain an even blood sugar level.

• Prevent excess consumption of simple carbohydrates (e.g. sweets) as this will elevate his sugar levels.

End Sleep Deprivation

School-aged children need between 9-12 hours of sleep. The brain builds and consolidates neural connections during sleep and it is this process that enhances learning. Without enough sleep, your child may find it difficult to concentrate in class, and may feel moody and irritable, which can diminish his readiness to learn. Additionally, too little sleep can also compromise his growth, and negatively affect his immune system.

• Ensure he consumes foods that are high in tryptophan, a sleep-promoting substance found commonly in protein-based foods.

• Foods that are high in sugar will disrupt his sleep.

Blues, Blues Go Away

Your child’s mood plays a role in his ability to learn. When he is bored, angry or even sad, it could limit his opportunities to learn effectively. What he consumes can indeed affect his mood.

• B-vitamins and folic acid are involved in a biochemical process that is vital in balancing neurotransmitters that keeps him motivated and happy.

• Additionally, omega-3 fats consumption can enhance serotonin (a neurotransmitter that regulates mood) transmission to the brain.

• Zinc and magnesium can help relax the mind and muscles.

Defending the Immune System

It is vital to keep your child’s immune system healthy, as sick children do not normally make good learners. A healthy child is free to explore and learn thus enabling him to gain more experience. Therefore, proper nutrition is essential to boost his immune system.

• Start early by breastfeeding your child. Besides containing antibodies from the mother, breast milk also contains high levels of antioxidants in the form of vitamin E and beta-carotene.

• Continue to boost his immunity in later life by giving him a diet rich in antioxidant vitamins especially from fruits and vegetables that are dark green, red, yellow and orange in colour.

Nutrient intake from its natural sources are the best. Therefore additional supplements isn’t necessary with a wide range of food to provide the learning booster!

Spoilage. Your food may deteriorate and develop unpleasant odours, tastes and textures caused by microorganisms such as bacteria, yeast, or mold as a result of poor refrigeration practices. You can do a great deal to prevent the growth of these microorganisms with good refrigeration.

Food-borne illnesses. Some microorganisms in food may be harmful to us, and especially to our children as their immune systems are still maturing. You have to be vigilant as these microorganisms can sometimes cause serious problems.

Is Your Fridge a Defender of Food?

Know your basics to keep your family from being affected by food-borne microorganisms. Here are some useful tips for healthy habits in the use of refrigerators.

• Keep foods chilled at proper temperatures. Bacteria and fungi grow well in temperatures ranging from 4-60°C. Proper refrigeration will prevent growth of such microorganisms. Therefore, ensure the refrigerator temperature is always at 4-5°C. The freezer temperature should be set at -18°C.
• Never overfill your fridge. This will prevent good cold air circulation and promote pockets of warm air.
• Beware of cross-contamination. This happens when bacteria spreads between food, surfaces or equipment. It will most likely occur when raw food touches or drips onto cooked food. Use plastic bags, covered containers, aluminium foil or place foods on a plate covered with clingwrap to prevent raw juices from dripping or food contact.
• Store them right. This prevents microorganisms from multiplying and preserves food texture. Ensure that the various types of food are placed in the correct storage areas. Fish, poultry, meat and frozen food should be stored frozen in use-size portions if you’re not cooking it the next day. This avoids repeated thawing and refreezing which encourages build-up of microorganisms. The top shelf is for storing butter, cheese, preserves, salad dressings, sauces and eggs. The middle shelves should be for cooked and leftover foods and salads. The bottom shelf is for raw meat and poultry which are left to thaw before cooking. The vegetable drawer, the warmest part of the fridge (10-12°C) is only used for unprepared fruit and vegetables. Liquids like fresh fruit juices should be consumed within six hours even when they are stored in the refrigerator.
• Clean and defrost your fridge regularly. Keep the refrigerator sanitised by routinely cleaning the inside and outside surfaces with warm, soapy water. Make sure you clean right into the corners of your fridge. For odour control, use baking soda and warm water. If your refrigerator fails or the power goes off, keep refrigerator and freezer doors closed. Avoid opening it unduly. This way, your refrigerator will keep food cold for about four hours.

Good Nutrition Is Every Child’s Right
The formative years of 1-6 are the most important time in any child’s life. It is thus imperative that parents start providing good nutrition to children right from birth to promote optimum health, growth and development (see box-up on the side).

Dr Tee E Siong, the President of the Nutrition Society of Malaysia, in emphasising this point, adds on to say that parents should realise that there is only a small window of opportunity open to them during this period to start feeding their children right.

“Don’t wait. Make time today to ensure the nutritional needs of your children are met,” says Dr Tee, adding that there was a pressing need for a varied, balanced diet and that parents should know what types of foods to provide in the appropriate amounts.

Dr Tee says the importance of child nutrition was underlined in this year’s Nutrition Month Malaysia (NMM) initiative, which carried the theme “Healthy Children, Healthier Nation.” The annual nutrition education programme, held every April since 2002, is organised by the Nutrition Society of Malaysia, the Malaysian Dietitians’ Association and the Malaysian Association for the Study of Obesity.

“We realise that child nutrition is extremely important, and this is why Nutrition Month Malaysia will focus on children in three different age groups from this year until 2010.”

The Facts & Figures
The Third National Health and Morbidity Survey (NHMS III) by the Ministry of Health was conducted nationwide in 2006 on 22,032 children aged between 0 and 18 years. The findings, released in 2008, revealed that:

• 13.2% of children were underweight!
• 15.8% of children were stunted!
• 5.4% of children were overweight!

“Let’s Talk Kids!”
Dr Tee E Siong discusses the NHMS III with Positive Parenting.

Q: What is malnutrition?
A: Children’s bodies require a range of essential nutrients such as carbohydrates, proteins and vitamins and minerals such as iron, zinc and calcium. Malnutrition occurs when the body gets too much or too little of these nutrients, which then leads to health problems.

Q: The NHMS III states that a total of 5.4% of children were overweight. Is this a major problem?
A: Yes. This figure is sufficient cause for concern. Other studies have also indicated a higher prevalence of obesity, mainly in urbanised areas. Although it is only 5.4%, parents should not take this figure lightly, but instead take measures to ensure their children do not add to it.

Q: In general, there’s an abundance of food here, yet as much as 13.2% children were found to be underweight. Why this figure?
A: The NHMS III revealed that the underweight problem not only occurred in rural areas, but also in urban centres. This shows that the underweight problem is not due to a lack of food, but poor feeding practices in both urban and rural communities. Many parents do not provide a balanced, varied diet and do not ensure regular meals. As a result, their children do not get enough nutrients to grow normally and healthily.

Q: What are positive steps parents can take today to make sure their children eat right?
A: Well, the first thing to do is to be well-informed about child nutritional needs and how to feed them right. For this, make greater efforts to find reliable, accurate information from health experts and websites. Next, conscientiously put into practice what you have learned. Plan your food purchases and meals, and take charge of what your child eats everyday.

Malnutrition Can Kill
Nutrition has a direct relationship to health, and when malnutrition occurs, children can die. According to a study of under-five deaths in Malaysia by the Ministry of Health in 2006, malnutrition was the third most common co-morbid condition.

Dr Hussain Imam Muhammad Ismail, the Head of the Paediatric Department of Hospital Kuala Lumpur, says that the study showed that 195 children under-five, or 19.8%, succumbed to malnutrition in that one year.

“Clinically, malnutrition is characterised by an inadequate or excess intake of protein, energy, and micronutrients such as vitamins, as well as the frequent infections and disorders that result,” he says, adding that malnutrition occurs both in under-nourished as well as overweight and obese children. In both its forms, malnutrition increases the risk of disease and early death.

Dr Hussain says that for example, protein-energy malnutrition in underweight children plays a major role in half of all under-five deaths each year in developing countries. “Vitamin A deficiency, as another example, is the leading cause of preventable blindness in children and increases the risk of death and disease from severe infections.”

On the other end of the malnutrition scale is overweight and obesity. These occur when children consume too much calories (over-nutrition) and don’t get sufficient physical activity. Dr Hussain says that overweight and obese children are more likely to stay obese into adulthood and develop non communicable diseases (NCDs) like cardiovascular diseases, diabetes and hypertension at a much younger age.

“It’s no wonder that childhood obesity is associated with a higher risk of premature death and disability in adulthood,” he says, adding that for most obesity-based NCDs, the risks depend partly on the age of onset and on the duration of obesity.

Don’t Wait, Start Today!
It’s not difficult to provide children the right foods in the proper amounts, says nutritionist Associate Professor Dr Norimah Karim.

“All you need to remember is Variety, Balance and Moderation,” she says. “If you’re busy with work or other responsibilities, you can make these three fundamental aspects of good child nutrition a part of your daily life by adopting a few simple steps (see box-up).”

Remember Variety, Balance And Moderation!

1. Provide a Variety of food
   “Little bodies have multiple needs and require various essential nutrients. The types and amounts of nutrients differ from food to food, so be sure to add variety to their diet.”
2. Ensure Balanced meals
   “Your children’s diet should comprise a balanced mix of complex carbohydrate foods (eg rice, noodles and cereals), fruits and veggies (for vitamins and minerals), protein-rich foods (eg poultry, meat, fish and eggs) and milk and dairy products (calcium and other vitamins and minerals).”
3. Feed in Moderation
   “Too little or too much food results in health issues, so teach your children to eat moderately from young. It’s also important they eat regular meals, don’t skip meals and don’t overeat.”

Eating Together Creates Happy Families
For healthy eating to be effective, you have to make its principles a part of your family’s lifestyle, says Dr Anjli Doshi-Gandhi, the Deputy Director General of the Family Development, National Population and Family Development Board of Malaysia.

She says that one such way to do so is to eat together. This not only brings everyone in the family closer, but offers many other positive benefits, including allowing you to focus on your children and spend quality time with them.

“By eating together, you can also make good food choices for your young ones and instil the right attitudes and habits of eating,” she says, adding that parents should also make every effort to inculcate good eating habits in children from an early age.

Eating together makes you more sensitive to your children’s problems, says Puan Norsheila Abdullah, the President of the Association of Registered Childcare Providers Malaysia.

“Family mealtimes make you more aware of your children’s moods,” she says. “If your young ones are depressed or sad about something, you are in a position to do something about it.”

Puan Norsheila also adds that since children are influenced and look up to their parents, it’s always wise for you to make the right food choices and practise healthy eating habits.

“For instance, if you eat in front of the television or keep irregular meal hours, it’s a good bet that your children will emulate your behaviour,” she says. “Your children will think that if mummy or daddy is doing it, I can do it, too!”

Nutrition Knowledge is Essential
All parents want to provide the best for their children, but when it comes to good nutrition, not many know where or when to start, says Datuk Dr Zulkifli Ismail, the Immediate Past President of the Malaysian Paediatric Association & Chairman of the Positive Parenting Management Committee.

“Providing good nutrition and inculcating healthy eating habits do not come naturally to many parents,” he says. “That is why there is a need for them to make an effort to learn about nutrition for the benefit of their children.”

Datuk Dr Zulkifli also says that many parents do not have the time to pay attention to their children’s foods or eating habits, adding that it would become harder for parents to change unhealthy eating patterns once their children move past the formative years.

Datuk Dr Zulkifli says the Positive Parenting programme, as well as the Nutrition Month Malaysia initiative, function as a starting point, adding that these programmes provide expert knowledge, information and advice that will enable parents to give their children optimum nutrition.

Parents should also explore other avenues, including the Ministry of Health and local or international authoritative websites run by professional health organisations. “You must take the trouble to find out all you can,” he emphasises. “Only then will you have the necessary knowledge and skills to optimise your children’s health and wellbeing.”

Choose Properly. Whenever possible, fresh is best. Look at the appearance of the fruits and vegetables you are buying. If it is yellowing or bruised, pick another one. You can purchase processed foods as well, which can come in handy if you have a busy schedule. Just remember to choose healthier options when picking processed food. For example, if you are buying canned tuna, look for tuna which is packed in water or brine (salt water) instead of oil. Your child does not need to consume additional oil from the product. Learn to read the labels so that you know exactly what the ingredients are.

Go Straight Home. There is no point in spending another hour or so in the shopping area while your groceries are being kept in the car. Leaving your groceries in the car will only result in food that is not as fresh anymore. If you plan to catch a movie or go for dinner, leave the grocery shopping till the end.

Educate Your Child. Never say ‘no’ to your child and ban fast foods from your child’s life. Banning fast food will only make your child crave it even more, causing him to sneak food behind your back. Instead, teach your child that he needs to enjoy a wide variety of food and practice healthy eating.

Set A Limit. If you really must have fast food, make sure you set a limit on the food portions served. Your child tends to overeat when he is offered large quantities of food. So buy according to the portions that are suitable for your child’s age. Also, limit the frequency of eating fast food to once or twice a month.

Order Smart. When visiting a fast food restaurant, adopt some ordering and eating strategies. Check the nutritional content of each item before ordering. Opt for healthier options such as foods with less fat, salt or sugar, and with fresh ingredients. Consider a balanced and varied diet when ordering each meal.

De-emphasise Fast Food. Don’t make going out for fast food a big deal, especially if your child is a picky eater. Otherwise, your child will equate eating fast food with fun. Don’t use fast food as a reward either. There are other things, such as a trip to the local park or playing badminton, which you can offer as reward, instead of a trip to a fast food restaurant.

Eat In More Often. Try to make time to prepare home-cooked meals for your child. There are so many delicious and healthy meals that you can prepare without too much effort. Get your child involved in preparing the meals to make it more fun for him to eat at home.

Set An Example. Children often look up to parents as examples. So if you are eating a king-size meal, your words will not count much when you try to refrain your child from eating too much fast food. In addition to that, try eating with your child at home more often.

Start Them Off Early
You should inculcate your kids at the earliest stage possible with a lifetime habit of eating breakfast and educate them on its importance in maintaining good health. The best way is to set a good example and eat your breakfast!

Here are some simple steps to incorporate into your daily routine to make sure you and your children eat breakfast daily:

• Wake up a few minutes earlier to prepare breakfast.
• Prepare breakfast the night before if you think you (or your kids) will be rushing the next morning.
• Pack a meal for your little ones so they can eat on their way to school or at school.

General Breakfast Principles
You’re making an effort to get your kids to breakfast everyday, but what do you feed them? Some principles that can guide you in preparing wholesome, healthy breakfasts include:

• A balanced, varied meal ensures your kids get all the essential nutrients e.g. carbohydrates, protein, fat, vitamins and minerals.
• Choose one item from at least three of these four groups: fruits and veggies; grains (e.g. whole grain bread, bran muffins); dairy (milk, cheese, yoghurt) and protein (eggs, tuna, lean slices of meat, peanut butter).
• Make milk and eggs (good sources of protein) a must.
• Always serve breakfast with a nutritious beverage high in protein, vitamins and minerals. Milk should always be the first choice, followed by fresh fruit juice.

• As an essential component for the functioning of healthy membranes
• Insulates and acts as a shock absorber for bones and organs
• Provides hormone-like substances to regulate many bodily functions
• Omega-3 fatty acids assist in growth, development and brain function
• Helps the body absorb fat-soluble vitamins A, D, E and K
• Provides structural components of myelin, the fatty insulating sheath surrounding each nerve fibre, enabling it to carry messages faster

Types of Fatty Acids
Chemically known as fatty acids, FAs are known simply as fat. Fatty acids can be categorised into 3 basic groups: monounsaturated fats (MUFAs), polyunsaturated fats (PUFAs) and saturated fats (SFAs)

MUFAs and PUFAs (including essential fats like Omega-3 and Omega-6) are known as good fats and are neutral and beneficial to heart health. SFAs and trans fats (also referred to as trans-fatty acids) are harmful fats. Too much saturated fats increase the amount of cholesterol in the blood.

Colour up your child’s diet!
The attractive colours of fruits and vegetables are more than meets the eyes. They are not only
pleasing to the eyes but consist many health benefits hidden behind these colours. There have
been many research and studies done to unravel the hidden benefits. Read on to find out more.

Tips to Increase Your Child’s Intake of Fruits and Vegetables

• Don’t throw away edible skin (contains phytochemicals) of fruits like apples, pears and prunes. Just make sure it’s properly washed.
  
  
• Give 2 servings of fruits and 3 servings of vegetables a day to your little one. To know how much one serving is suitable for your child, ask him to grab a handful of vegetables or fruit. The amount he is able to handle is the amount you give him per serving.
  
  
• Ensure that your child gets a cruciferous vegetable (broccoli, cabbage, cauliflower) a few times a week.
  
  
• Switch candies for dried fruits like apricots and plums as snacks.
  
  
• Sneak in some chopped vegetables and cut fruits in different colours to dishes like fried rice, porridge or even pizza!
  
  
• It is best to consume fruits and vegetables to get sufficient amounts of antioxidants and other health benefits compared to pills and supplements.

• Plays with his food eg throwing his food around in hopes of making his meals smaller.
  
  
• Takes a long time to finish his meals.
  
  
• Only likes certain types of food, food preparation, presentation and maybe even specific food brand.
  
  
• Is a poor eater but does not present any associated clinical
  condition.

Research has shown that nearly half of children in paediatric clinics were shown to be picky eaters and the majority of parents claim that their children have some difficulties during meal times. Therefore, it is no surprise that you are concerned for your child since picky eating could lead to a series of health problems.

Possible Effects Of Picky Eating
• Weight loss and poor mineral and vitamin status
• Difficulty in concentrating at school
• Falling sick frequently due to low immunity against infections
• Poor growth and development
• Increased risk of developing eating disorders in future

Sometimes a child may refuse to eat because he is not accustomed to new foods. At times, they might reject the foods served to them due to food neophobia (unacceptance of new and unfamiliar food).The good news is your role in his acceptance of food is more influential than you think.

If your child is showing signs of poor appetite, nutrition counseling and a nutrition supplement for children ages 1 to 10 years old may help him with catching up in growth and also keep him strong and healthy. This approach may help you and your paediatrician to try to find the real problem underneath poor eating behavior. Do consult a paediatrician for advice on this.

Carbohydrates
When carbohydrates are broken down into glucose in the body, it fuels the body with energy. Fibre found in grains and cereals, the main sources of carbohydrates, is also important to maintain good health. Other sources of carbohydrates include fruits, vegetables and tubers such as potatoes, sweet potatoes and tapioca.

Protein
Protein is vital for your child’s growth as it functions as the body’s building blocks. In addition, protein helps the repair and renewal of tissues in the body. In fact, adequate protein consumption is necessary for optimum growth levels. Ultimately, growth influences brain development and therefore, your child’s ability to learn in school. With this, adequate quantities of protein from fish, meat products, milk and beans should be given for healthy growth.

Fats
While fats should not be taken in excessive amounts, dietary fats are important as a source of energy, fat soluble vitamins (vitamins A, D, E and K) as well as essential fatty acids in the production of cell membranes and hormones. Healthy fats comprising monounsaturated fat, polyunsaturated fat and omega-3 fatty acids should be consumed in greater quantities as compared to unhealthy fats. Sources of monounsaturated fats include olives, peanut and canola oil, while sunflower and cottonseed oil are sources of polyunsaturated fat. Cold-water fish such as salmon, herring and mackerel are great sources of omega-3 fatty acids.

Food Guide Pyramid
The Food Guide Pyramid for Children shows the proportions of the various food types that should be fed to a growing child. This provides parents with information on the food types and amounts necessary to meet a child’s daily dietary requirements. Each food group is represented by a different color. Narrower bands indicate lower quantities, while wider bands mean that more from that food group should be given. Most importantly, give your child plenty of water each day.

• Limit the oil Avoid using too much oil when cooking or deep-frying food. Instead bake, grill, boil, steam or stir-fry.
• Got milk? As milk is important for growth and building bones and teeth, encourage milk consumption by serving a variety of milk products. Alternate plain milk with chocolate or strawberry flavoured milk. Introduce a selection of cheeses, yogurt, milk biscuits and other dairy products.
• Make it colourful A simple rule of thumb when it comes to deciding what to serve your child: make it as colourful as possible. For instance, serve a variety of vegetables and fruits of different colors! How about green spinach, bright orange carrots, yellow cauliflower, fish, white rice and a red apple for dessert?
• Find fun in variety Plan your menu on a weekly basis. Select food from the different food groups and in the right serving sizes. Vary the food types of each food group for all meals. For instance, carbohydrate foods can be bread for breakfast, noodles for lunch and rice for dinner. Keeping a record will help you ensure that you have variety throughout the week!

Out of sight, out of mind
Rid your kitchen of unhealthy foods – the less your child sees his beloved sweets, the less he will want them.

Provide healthful choices
Stock up on healthful options such as oatmeal crackers, fruit puddings, sponge cake, egg tarts, fruits etc. Designate a ‘snacks’ area in the fridge or on the countertop where your child can reach to get his food (with your permission, of course).

1½ to 2 hours before a main meal as this will fill him up too much to eat lunch or dinner. Snacks must not replace main meals.

Boost nutrition
“After snacking on sweets for so long, he will revolt if I give him a fruit pudding,” fretted Brandon’s mum. Wait! Do not ban the snacks your child loves. Instead, reduce portion size and serve with something nutritious like red bean soup or soybean milk.

Make mealtimes pleasant
Miserable nibbling at mealtimes? Mums tend to turn into drill sergeants the moment it is lunch or dinner time, “Sit down! Eat! Finish your food or you get the rotan! ” Not exactly fun, is it? Mums (and dads), let go a little. Create a pleasant mealtime atmosphere. Do not get mad or force your child to eat. Never let mealtimes drag on for over an hour. Give small servings and let your child ask for more. Remember, you also have plenty of healthful snacks if your child gets hungry later on.

BOOSTING BRAIN & EYE FUNCTION
The two most important dietary essential fatty acids in brain development and function are omega-3 and omega-6 fatty acids. Omega-3 and omega-6 are actually major components of your child’s brain cell membranes. They also make up an important part of the enzymes within cell membranes, which allow the membranes to transport nutrients in and out of the cells. Because these two essential fatty acids make up such a major part of your child’s brain, a deficiency of these fats in his diet could lead to compromised brain development.

Did you know that the retina of the eye contains a high concentration of the fatty acid DHA (docosahexaenoic acid)? Therefore, the more appropriate the type and amount of fats in your child’s diet, the better the development of his eyes. And since many children are visual learners, better vision means better learning!

• Consistently offer new foods at mealtimes but make sure there is at least one thing on the table you know your child will eat. Then, offer one or two backup foods (ie. peanut butter or cereal) that do not require cooking and that your child can prepare himself.
• Establish structured snack and mealtimes and make sure your child is not filling up between meals on things like milk or juice.
• Get your child involved in food preparation.
• Keep non-nutritious snack foods out of the house.
• Give your child a nutritional supplement as a beverage or include it into foods (eg. cakes or cookies) to promote health and boost the immune system.

Keep up, mom!

“The right nutrition will provide the foundation for your child’s physical and mental development,”
says Assoc Prof Dr Poh Bee Koon, Honorary Secretary of Nutrition Society of Malaysia.

His entire set of baby teeth will have developed by the age of 21/2 years. He is also learning to gain control over his physical movements. From holding on to chairs and toddling unsteadily, he is gradually learning to walk, run and climb. He is also picking up fine motor skills, like learning how to hold a pencil, use scissors, write and draw.

Along with his increasing activeness, he is also displaying an insatiable sense of curiosity and adventure. He will be constantly asking questions, wanting to do this and that, and avidly observing everything that goes on around him.

Whew! How does a parent keep up with this bundle of energy? More importantly, how do you ensure that he is well and healthy to enjoy these formative years?

The right nutrition will provide the foundation for these physical and mental changes. He needs energy so that his body can grow and he can do all the things a kid should be doing. He needs protein, which provide building blocks for his muscles and organs. He needs all the different vitamins and minerals, which are responsible for hundreds of functions in the body. Different foods provide all these nutrients, so your child needs to eat a wide variety of foods every day to ensure that he gets all the essential nutrients. Good eating habits are best cultivated at an early age, so teach your child to enjoy healthy eating, so that he will continue to practise it for life.

Here are some other Pyramid pointer to keep in mind.

1. The lower the level, the more of foods it contains should be eaten each day. In other words, your child should:
   • Eat Most from Level 1
   – Foods in this level are sources of carbohydrates that provide energy for your child.
   – The different types of foodshere include rice, noodles,bread, other cereals and cereal products, tubers
   • Eat More from Level 2
   – Foods grouped here are good for vitamins and minerals that help maintain good health by ensuring proper bodily functions.
   – The foods include fruits and vegetables
   • Eat Moderate Amounts from Level 3
   – Fish, lean meat, poultry, eggs, beans and bean products are important for supplying protein to your child.
   – Milk and dairy products should not be neglected as they are the best source of calcium for strong bones and teeth.
   • Eat Least from Level 4
   – Fats, oil, salt and sweets have a place in your child's diet. However, they are to be taken in minimal quantities because excess can lead to a host of health problems, ranging from dental caries (in the case of sweets) to obesity that can give rise to heart diseaseand stroke in later life.
   
   
2. Water is not shown in the Food Guide Pyramid but you still need to ensure that your child drinks sufficiently throughout the day. It helps prevent dehydration (especially in our hot and humid climate) while maintaining the balance of chemicals in his or her body.

Draw Up Your Own Yummy Kiddie Menu

Running out of ideas for what to serve up? Don’t worry. It’s really not that hard to please your child if you equip yourself with a list of yummy ideas. Here are some well-loved kiddie delights for you to pick and choose for your own yummy kiddie menu.

Beat Boring Breakfast Blues

• Porridge with meat, chicken or vegetable
• Sandwich or bun with tuna, sardine, egg or cheese as fillings
• Toast with half-boiled egg or baked beans
• French toast
• Toast spread with margarine, peanut butter or jam
• Thosai or iddli with a little dhall curry
• Putu mayam with a little bit of brown sugar and grated coconut
• Breakfast cereals with milk
• Fried rice, meehoon, mee or kway teow with lean chicken and vegetables, cooked using less oil
• Pau with meat, chicken, vegetable or red bean filling
• Sweet corn custard
• Curry puff, served occasionally
• Egg custard tart
• Stuffed tofu with tomato sauce
• Banana pancake
• Sponge cake
• Fruit pudding
• Fruit and milk-based jelly
• Bubur chacha with milk
• Appam kukus or appam balik
• Popiah basah
• Pengat pisang or pengat made with sweet potatoes (use milk instead of coconut milk)
• Cream crackers or oatmeal crackers
• Barley and fuchok, red bean or green bean soup

Note: always serve breakfast with a nutritious beverage containing protein, vitamins and minerals. Examples are milk, fruit juice or soybean milk.

Marvellous Main Meals

• Dishes that go with rice and vegetables:
  – Chicken cooked in light soy sauce or tomato sauce
  – Chicken kurma
  – Chicken, meat or fish soup with carrots and potatoes
  – Chicken, fish or egg curry (non-spicy)
  – Sweet sour fish
  – Steamed tofu with minced meat
  – Fishballs stir-fried with vegetables
  – Egg fuyong
  – Ikan masak lemak without chilli, using small amounts of coconut milk
  – Ikan masak pindang

Quick ’N Easy All-In- One Meals

• Fried noodles, pasta or rice with vegetables and chicken
• Rice porridge with minced meat and carrots
• Porridge with ikan bilis and spinach
• Noodles in soup
• Steamed chicken rice

Tutti Fruity Fruits and fruit-based desserts help to end the meal on a sweet and nutritious note as they are rich in vitamins and minerals.You’ll find papaya, banana, starfruit, watermelon and ciku highly versatile as they can be served up freshly cut, or added to jelly and pudding.

If you’re a new parent, you may panic every time your child sneezes or has a temperature. Don’t worry! By the time your second or third child comes along, you’ll be seasoned enough to know that kids fall sick every now and then. After all, it gives them an excuse to stay home from school!

However, if your child is always pale and weak, or gets a sore throat and runny nose every fortnight, this is a sign that her immune system is weak. The body’s immune system is made up of an “army” of cells, such as phagocytes, lymphocytes and antibodies. Just like soldiers need food to keep fighting, these cells also need nutrients to defeat bacteria and viruses.

Proper nutrition provides the “fuel” and “raw materials” to help maintain the immune system. It also protects cells and organs from damage caused by components in your child’s environment, such as pollution. Your child may be eating plenty of food, but if she is not getting the right balance of nutrients, her immune system will be weak.

There are no special foods or nutrients for the immune system. All nutrients – vitamins and minerals, protein, carbohydrates and fat – are important to maintain the immune system. So, your child needs nothing more than a wellbalanced diet to stay healthy. Give her a variety of foods every day, so that she gets a good balance of all the different nutrients. Make sure she eats all the colourful fruits and vegetables, as these are the best sources of vitamins and minerals.

A strong immune system means that all the body’s soldiers are in top fighting form. The next time bacteria, viruses or other germs try to attack your child, they’ll be soundly defeated!

EAT WELL, STAY WELL!

So you want to keep your child healthy with a good diet. Did you know that it begins with what you eat even during pregnancy? Here are some tips to keep your child healthy, from womb to childhood.

During pregnancy

• Eat more foods rich in vitamin C, such as guava, papaya, citrus fruits, starfruit and mango.
  
• Eat more foods rich in vitamin A, such as liver, milk, eggs, yellow- and red-coloured fruits, and vegetables.
  
• Eat more foods rich in vitamins B, such as liver, lean meat, fish, poultry, milk, green leafy vegetables, dark-yellow fruits and vegetables, and legumes.
  
• Eat more foods rich in iron, such as liver, lean meat, poultry, soya bean products, fortified cereals and bread, and green leafy vegetables.
  
• Eat clean, well-cooked foods. Avoid taking raw fish, undercooked meat, half-boiled eggs, unpasteurised milk and dairy products, and soft matured cheeses (eg Brie).

When breastfeeding

• Breastfeed baby for as long as possible, because breastmilk contains antibodies and other immune system components that protect your baby against infections.
  
• Breastfeed baby immediately after birth because early breastmilk (called colostrum) is very high in antibodies.
  
• Eat a well-balanced diet when you are breastfeeding, with emphasis on foods that are rich in nutrients, such as wholegrain foods, meat, legumes, fruits, vegetables, milk and soyabean foods.
  
• Do not smoke when you are breastfeeding baby; it may cause nausea, vomiting or diarrhoea in baby.
  
• You can continue breastfeeding even if you have a cold or the flu. The antibodies produced in your body will pass through your milk and protect your baby.

When your child is growing up

• Give your child a well-balanced diet, with emphasis on nutrient-rich foods (as mentioned earlier).
  
• Don’t put your child on a low-fat diet, unless recommended by a paediatrician or a dietitian.
  
• Teach your child to choose wholesome nutritious snacks, instead of having “junk food” every day.
  
• Teach your child not to share eating utensils at school, and to wash her hands before eating.
  
  

Nutrients (like carbohydrates, fat and protein) enable the tissues in these organs to form properly, regenerate, repair themselves, and have the energy to carry out their individual functions.

Every little process in the digestive system is regulated by the nervous system, hormones and enzymes, which need certain nutrients (especially vitamins and minerals) to be present. Sometimes, bacteria, viruses and parasites may get into your child’s digestive system as a result of unhygienic practices or contaminated food. Again, your child needs all the right nutrients of a balanced and varied diet so that his immune system will be strong enough to battle gastrointestinal infections caused by these nasty germs.

Occasionally, the digestive system seems to “go on strike”, causing your child to be constipated. This usually happens because your child does not have enough fibre or water in his diet. Fibre (found in fruits, vegetables, whole-grain cereal and cereal products, legumes and beans) provides bulk that
softens the stools and makes your child pass motion more regularly.

A well-balanced diet, with a variety of foods, will help to keep your child’s gastrointestinal system healthy. Then he will be able to digest food properly, absorb the nutrients for other uses in the body and stay strong against infections.

CLEAN INSIDES

According to the Food and Agriculture Organization (FAO) and World Health Organization (WHO), food and waterborne diarrhoeal diseases, commonly caused by germs (like salmonella, campylobacter, V cholerae and E coli) kill an estimated 2.1 million people annually in developing countries.

When preparing and providing food for your child, it is very important to practise good hygiene and safety. Here are some tips you and your family can follow:

• Always wash your hands before and after handling food.
  
  
• Wash utensils and boards used in the preparation of foods. Use separate cutting boards and utensils for raw and cooked foods.
  
  
• Wash raw fruits and vegetables thoroughly before eating and cooking.
  
  
• Thaw frozen food in the refrigerator and cook it immediately after thawing.
  
  
• Do not leave raw or cooked food at room temperature for more than two hours.
  
  
• Cook foods thoroughly to kill any bacteria that may be present.
  
  
• Reheat cooked foods thoroughly to kill any bacteria which may have developed during storage.
  
  
• If you are not sure about the safety of a food, throw it away.
  

• Everyone, especially children, should wash hands before eating!
  
  
• When choosing food stalls, restaurants or other eating places, make sure the staff, cutlery, equipment and environment look clean and tidy.
  
  
• If food, especially raw food, in a restaurant smells, looks or tastes odd, it should be returned.
  

• Store raw foods at the bottom of the refrigerator, and cooked foods at the top.
  
  
• Wrap or properly cover food before storing.
  
  
• Do not put hot food in the refrigerator, as this will cause the temperature inside to rise.
  
  
• Store cans, packets and bottles in a cool, dry place, protected from insects, rodents and other pests.
  

• When buying fresh foods, make sure it looks, feels and smells fresh.
  
  
• Don’t buy foods where the packaging is damaged (dented or bloated cans, tampered safety seals, torn packaging) or which have passed their expiry (“best before”) date.
  
  
• If you buy foods that need to be chilled, go home as soon as possible and store it in the refrigerator or freezer.
  
  

His bones are growing longer and stronger, making him taller and his body proportions more mature. His muscles are growing and contributing to more of his body weight. By the time he is 5 years old, 35% of his body weight will come from his muscles.

His teeth will begin emerging at 6 months, which may cause some days of teething terror for your baby. Rest assured that the teething discomfort only occurs in the initial stage and will not accompany every tooth that emerges subsequently. Your child should have his entire set of baby teeth by the age of 21/2 years. Between ages 6 and 14, permanent teeth will begin replacing his baby teeth.

OTHER CHANGES

Gross motor skills involve movements of your child’s limbs to enable him to crawl, sit, walk and run. Fine motor skills relate to his ability to manipulate little things with his fingers, like picking up a pencil to draw, and other small, but purposeful, movements.

Your child’s speech begins with his cooing and babbling. He later develops language skills, which not only involves intelligible sounds, but also gestures, to communicate.

The last area is social adaptation, which is how your child learns to get along with other people. He moves from the thought that he is the centre of attention, to making friends and interacting with them. He learns about conversation, interaction, friendship, as well as likes and dislikes, and develops from a state of dependence to one of independence, and eventually interdependence.

THE RIGHT FOUNDATION

Stimulation in the first two years in the form of close family interaction, educational toys, communication and frequent conversation will help your child along. But they cannot substitute the need to provide him with the right nutrition to grow and develop to his full potential.

Your milk also contains antibodies that protect him from infections and illnesses. You should breastfeed your baby exclusively from birth up to 6 months, even through the period when you introduce complementary foods to his diet.

Breastfeeding can still continue beyond 6 months, until your child is about 2. You do not have to stop breastfeeding even when you return to work. You can express your milk by hand, or with a breast pump, and refrigerate the milk in clean milk feeding bottles. Breast milk can be stored in the refrigerator for 24 hours. Unrefrigerated breast milk in our tropical climate should be used within 6 to 8 hours of expressing. While you are at work, the milk can be given to your child by a caregiver.

INTRODUCING COMPLEMENTARY FOODS

As your child grows older, he will not be able to rely on breast milk alone for all his nutrients. He may be ready for complementary foods (semi-solid and solid foods that are introduced to his diet) between 4 and 6 months.

You will need to provide him with a nutritious diet that meets all his nutrient requirements. Variety is the key. The food choices you make for your child now will play a role in shaping his food preferences for life, which will be evident later on. Giving him a variety of complementary foods will make it easier for him to accept a wider range of foods in toddlerhood and beyond. Where possible, avoid mashing different foods together; let him try each type of food one at a time, so that he learns to distinguish and like the taste that each provides.

PRE-SCHOOL EATING

Pre-school is a fun and active time for your child. At this age, he will need a lot of energy to grow, play and learn. You can give him a boost by providing him with a nutritious diet. At times, this will not be easy as pre-schoolers have quirky eating habits and unpredictable appetites.

Nevertheless, with the help of BRIGHT START Nutrition’s 13 nutrition guidelines, you can overcome these hurdles and keep providing your child with a healthy diet.

By providing right nutrition, you are endowing your child with the vitality of childhood. From this foundation, he will be able to take the next steps with confidence. When he does, be sure to go along for the ride, it’s bound to be an enjoyable one!

TODDLER & PRE-SCHOOL NUTRITION GUIDELINE

With healthy eating in mind, the Malaysian Paediatric Association supported the initiative of the Nutrition Society of Malaysia to develop the BRIGHT START Nutrition Guidelines. The 13 prime messages below will help you ensure the appropriate diet quality for your child.

1. Provide a variety of wholesome and nutritious foods
   
   Your child needs a variety of foods, to get all the nutrients that he needs. The best way to ensure this is to follow the recommendations of the Food Guide Pyramid.
   
   
2. Make rice, other cereals and cereal-based foods the main source of energy
   
   Your child needs carbohydrate foods, such as cereals, grains, rice and tubers, to provide him with energy. Rice is a good choice, as it is the staple food of our country, and provides a lot of energy, while being low in fat.
   
   
3. Encourage more fruit and vegetable intake for vitamins and minerals
   
   Fruits and vegetables contain vitamins and minerals, that help promote growth and development, build a healthy immune system and ensure overall well-being. They also contain dietary fibre, which helps prevent constipation. Children need both fruits and vegetables; one cannot substitute the other.
   
   
4. Give fish, lean meat, poultry, eggs, beans, bean products and pulses for protein
   
   Protein is what your child’s body uses as building blocks so that he can grow. He needs a combination of animal and plant protein to meet the requirements. If your child cannot take animal protein (for religious or cultural reasons), give him a variety of beans, bean products and pulses.
   
   
5. Give milk, milk products and other calcium-rich foods daily
   
   The healthy growth of your child’s bones and teeth depends very much on a mineral called calcium. The best source of calcium in your child’s diet is milk and dairy products. Other sources are fish with edible bones (e.g. sardines and anchovies/ikan bilis), and leafy green vegetables.
   
   
6. Give lean meat, poultry, fish, vegetables and other foods that are rich in iron daily to prevent deficiency
   
   Iron deficiency is the most common nutritional deficiency among children worldwide. Your child needs iron from his foods, such as lean meat, poultry, liver and fish. Iron can also be obtained from cereals, fruits, vegetables and beans. Do not resort to giving him iron supplements, unless recommended by a doctor.
   
   
7. Fat is important; however excessive amounts should be avoided
   
   Your child also needs appropriate amounts of fat in his diet to provide energy, fatty acids, and fat-soluble vitamins. Essential fatty acids are important for development of your child’s brain, nervous system and eyes. However, excessive intake of fatty foods can cause unhealthy weight gain in your child. This may lead him to grow into an overweight adult, and be exposed to the risk of diseases, like coronary heart disease, stroke, diabetes and some cancers. On the other hand, low-fat diets are not suitable for young children either.
   
   
8. Limit sweets, sweetened foods and sugary drinks; minimise salt intake
   
   Children have a tendency to go for sweets and other sugary foods. These foods tend to be high in calories but usually contain very little nutrients. Too much of these foods could make your child overweight. Your child also does not require much salt in his diet. Too much of it may increase the risk of high blood pressure later on.
   
   
9. If snacking is required, give nutritious foods in small portions and at the right times
   
   Your child may need snacks between mealtimes to keep him going. Be sure that these snacks are nutritious, not the size of regular meals, or too close to mealtimes.
   
   
10. Prepare foods that are hygienic and safe to eat
    
    Your child is vulnerable to infections and illnesses that can be caused by contaminated food. Practise hygienic food preparation and storage to prevent your child from being afflicted with these infections.
    
    
11. Encourage physical activity for fitness and optimum development
    
    Instead of watching TV or playing computer games all day long, your child should play and run around with his friends. This promotes his growth and development, increases his fitness, and lessens the risk of him gaining unhealthy weight.
    
    
12. Measure growth regularly to monitor health and nutritional status
    
    Monitor your child’s growth regularly to see if he is growing at a healthy and normal rate when compared against internationally accepted growth charts. Ask your doctor for them or contact BRIGHT START Nutrition at Tel: (03) 5621 1408 for a set.
    
    
13. Make mealtimes an enjoyable family experience
    
    At home, mealtimes are perfect for encouraging healthy eating habits. Children often love to imitate adults, so set a good example for your child by making healthy food choices for yourself. Mealtimes should be enjoyable and cheerful, so that your child will look forward to good times, eating with you and the rest of the family.

But growth isn’t just about weight and height. Bones, teeth, muscles and blood are also important to consider.

Growing bones, for example, affect not just your child’s height but also his body proportions. From age 1, his limbs will visibly start to lengthen. His legs will also straighten as his abdominal and back muscles tighten to give him more support. All these will give him an increasingly more mature appearance.

As for growing teeth, they start making an appearance at 6 months of age. By 3 years old, your child should have his entire set of baby teeth (ten on the upper jaw and ten on the lower). Enabling him to eat solid foods, these teeth also serve to stimulate his jaw to grow and act as guides for the permanent set of teeth which will eventually replace them.

Muscles, which are lean tissues, must develop to keep up with your child’s increasing mobility. Meanwhile, your child’s body fat tends to decrease, reaching a minimum when he is approximately 6 years old. This explains why many children this age appear ‘skinny’ but they aren’t necessarily weak or unwell!

Blood plays an important role by transporting nutrients and oxygen to his cells so that he can grow, play and learn well. Conditions that impair the quality of your child’s blood (such as anemias) can be prevented by eating a well-balanced diet.

ENERGY & NUTRIENTS FOR GROWTH

Right nutrition is the foundation for healthy growth. But with their decreasing growth rates, toddlers and pre-school children tend to have a relatively small capacity for eating. Some also develop irregular eating patterns and eccentric food choices (for example, they may easily get bored with their usual foods or want the same food for weeks on end).

You need not get worried over such eating quirks as they are normal. However, you need to ensure that your child receives the right nutrition he needs.

He must have sufficient energy. It is the fuel that enables him to play and learn, his cells to grow, and his internal organs to perform basic bodily functions (including digesting and breaking down food!). Energy is so vital that your child must consume sufficient energy-giving foods (like cereals, grains, tubers and milk) so that his body will not convert protein into energy – a situation which could lead to ‘protein-energy malnutrition’.

The protein your child receives is better off being used for building tissues. Protein is found in milk, dairy products, meat, poultry, fish and legumes (like peas, long beans and soybeans).

Vitamins and minerals perform hundreds of functions. This is why you should give your child fruits and vegetables, along with other foods that contain these micronutrients. B-vitamins (which help the body better produce and utilise energy) can be obtained from meat. Calcium is found in milk, leafy green vegetables and canned fish with bones (eg sardines). Of all these sources, milk provides the highest quality calcium that the body can absorb. Furthermore, milk also contains vitamins A and D which work with calcium to build strong bones and teeth.

Iron is needed for producing red blood cells and transporting oxygen through the blood. Lack of this trace mineral can lead to fatigue, irritability, headaches, lack of energy and even iron-deficiency anemia (which manifests itself from paleness on the face and underneath the lower eyelids). Ensure that your child is getting enough iron by offering meat, poultry, milk, iron-fortified breakfast cereals, dried beans, nuts and dried fruits. Avoid giving iron supplements unless prescribed by a doctor; iron overdose can cause serious problems.

Another trace mineral that is essential for growth is zinc. Deficiency can result in growth failure, poor
appetite, decreased taste sensitivity and poor wound healing. Meats and seafoods are good sources for zinc.

The best way to ensure the right nutrition for your child is by offering a well-balanced diet comprising a variety of wholesome foods. This may also include foods – like milk, breakfast cereals and snacks – that have been specially enriched or fortified for optimal growth. In these foods, nutrients have either been replaced (due to loss during processing) or introduced (when they did not exist originally) to meet accepted standards, like the US Recommended Dietary Allowances (US RDA).

KEEPING AN EYE ON GROWTH

Take your child to the doctor at regular intervals for a complete assessment of his growth and development. Using measurements taken during each visit, the doctor will be able to chart your child’s growth patterns and alert you if any problems are detected. Signs of trouble include lack of weight gain or loss of weight over a period of months. They could be warning signs of under-nutrition, an undiagnosed chronic disease, or significant emotional or family problems.

On the other hand, excessive weight gain also poses a significant health problem. Some parents over nourish their children while failing to encourage regular and sufficient physical activity. As a result, their children become overweight and, in some cases, obese. This may increase the children’s likelihood of becoming overweight adults with a higher tendency to develop chronic illnesses (like diabetes, high blood pressure and heart disease)in their later years.

If severe illness has temporarily slowed down or halted your child’s growth, the doctor can provide advice on how to help your child’s ‘catch-up growth’ when he recovers.

Feeding a growing child isn’t easy. Find out what are the best foods for your child.

By Dr Nik Shanita Safii, Dietitian

Feeding him too much or too little from each food group can be harmful, because each type of food has different roles in your child’s nutrition.

Carbohydrates
Your body breaks down the carbohydrates you eat into glucose, which is your body’s “fuel”. Too few carbohydrates in your child’s daily diet may result in her being sluggish or lacking energy to go about her daily activities. Too much will cause the body to store the extra energy as fat in her body, and will eventually lead to obesity.

Protein
The body uses energy from protein as the basic materials for growth. The right amount of protein is essential for a young child’s growth, not just to ensure that she grows as tall as she can, but that she has sufficient muscle mass for all the busy, fun activities of childhood. Excess protein in the diet will also be converted to fat and be stored in the body, so feed your child just as much as she needs.

Fats
Like carbohydrates, fats provide energy for everyday activities. They also help regulate body temperature and have a part in hormone and cell production. This is the role that fat stored in the body plays. Fats are also important for brain development, eg docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and arachidonic acid (ARA) which are derived from the essential fatty acids, namely lienoleic and linolenic acids.

Vitamins A, D, E and K are categorised as fatsoluble vitamins, therefore the only way to ensure your body absorbs these nutrients is by taking foods that contain a certain amount of fat. Studies show that a daily diet which contains less than 15% of total energy from fat might have a tendency of not getting enough fat-soluble vitamins.

Vitamins & Minerals
Vitamins are organic chemicals that the body needs tiny amounts of in order to function properly, but cannot manufacture on its own. Each vitamin has a different role. Part of the reason for eating a balanced diet is that vitamins are present in varying amounts in different foods, therefore eating a more varied diet over time ensures that enough vitamins are consumed.

• Vitamin A is found in liver, dairy products, dark-coloured fruits and leafy vegetables
  Vitamin B is found in grains, cereals, liver and other organ meats, egg yolk and dairy products
• Vitamin C is found in most raw fruits and vegetables
• Vitamin D can be found in most types of fish and in egg yolk, but is also derived from other chemicals already present in the body when a person is exposed to sunlight. Five to ten minutes of sun exposure per day (with sunblock lotion) is therefore important to ensure sufficient Vitamin D.
• Vitamin E is found in vegetable oils and nuts
• Vitamin K is found in dark green, leafy vegetables

Dietary minerals are elements that the body needs in order to remain in good health. A balanced diet of different types of vegetables, meats, grains and dairy products is usually enough to ensure that a child gets all the minerals he needs.