Health & Nutrition – Solid advice

Are you up to date with the latest food advice for young children? With advice changing regularly and no single central source of recommendations, it can be a challenge to keep up with what they should and should not be eating.

Some of the most significant recent changes include:

• weaning timescales
• when and how to introduce high-allergenic foods
• guidance on egg consumption
• tighter guidelines on snacks with added sugar or those which are high in calories.
  
  

WEANING

The advice has varied over the years on when children can start solids. Most recently, NHS recommendations changed from four months to six months. Current advice suggests children should start weaning from six months because:

• breast milk or first infant formula provides the energy and nutrients needed until around six months (although breastfeeding women should consider taking a daily vitamin D supplement)
• this gives babies time to develop so they can cope fully with solid foods
• babies aged six months are more able to feed themselves
• babies will be better at moving food around their mouths, chewing and swallowing, which may mean they can have mashed, lumpy and finger foods and may not need smooth, blended foods at all.
• The signs that indicate a baby is ready for weaning are when they are able to:
• stay in a sitting position, holding their head steady
• co-ordinate their eyes, hands and mouth so they can look at their food, pick it up and put it in their mouth
• swallow food rather than spit it back out.

High-allergenic foods

The advice has also changed over the years for the introduction of high-allergenic foods such as nuts, gluten and fish.

The current advice is to start introducing these foods from when babies start weaning, rather than holding off on the basis that children may be allergic.

Bahee Van de Bor, spokesperson for the British Dietetic Association and specialist paediatric Harley Street dietitian, explains, ‘There is no advantage in delaying introducing these foods. In fact, there is evidence that delaying introducing these foods may increase a baby’s chance of developing a food allergy to them.’

NHS advice recommends introducing foods that can trigger allergic reactions one at a time, in very small amounts, so it is easier to spot any reaction.

Eggs

Similarly, eggs, which were previously only to be introduced to chidren from two years of age, and not to be eaten raw or with runny yolks, can now be eaten from six months, according to the Government’s Scientific Advisory Committee on Nutrition (SACN).

Pregnant women had also been advised to avoid runny eggs entirely, but advice from the Department of Health introduced in 2017 says that as long as eggs have the British Lion Mark stamped on them, they can be eaten by babies, infants and pregnant women in any form as they are considered very low risk for salmonella.

‘This is due to the high safety standards of the British Lion Mark scheme, so they no longer need to be thoroughly cooked,’ explains Bridget Halnan, lecturer at Anglia Ruskin University and fellow of the Institute of Health Visiting.

‘Eggs are a really good source of nutrition for babies from six months of age, providing many important vitamins and minerals as well as protein. They can now be incorporated into a baby’s diet in any form, from dippy eggs, omelettes, scrambled, or in any other form or recipe.’

Sugar

To combat rising levels of child obesity, guidance has also changed on sugar intake and snacking. Governmental advice currently recommends limiting calories to no more than two packaged snacks per day of 100 calories.

While awareness of how much and what we eat is growing, Ms Van de Bor suggests more specific advice about fruit and vegetable intake would be helpful.

‘There’s been lots of action around childhood obesity, but I can’t help feeling we could do more,’ she says. ‘Taxing biscuits is one way to help manage childhood obesity, but what are we going to do to help children have better access to fruit and vegetables?

‘I have worked with some fantastic nurseries who have prioritised nutrition and been very proactive about helping children meet their two servings of fruit and three of vegetables a day, but at present, good nutrition in this form is not mandatory.’

KEEPING UP WITH ADVICE

While it can be challenging to keep up with changes to advice, Dr Halnan believes there is no need for a more centralised hub for providing nutritional recommendations.

‘This may not be worthwhile, as it should be about trust and evidence-based practice,’ she says. ‘There could be the potential for commercial considerations to creep in. The world of infant formula promotion is one such example, where spurious health claims can be made for commercial reasons only.’

Dr Halnan recommends practitioners keep updated by monitoring guidelines and resources provided by the Department of Health via Start for Life, the National Institute for Health and Care Excellence (NICE), and SACN, as well as journals provided by health visitors and other clinicians.

Plant-based diets

In terms of any further changes on the horizon, Ms Van de Bor suggests meat intake could be reconsidered in the future.

‘Plant-based diets are becoming more popular, and we need to be conscious about sustainability and catering accurately for children with multiple food allergies,’ she says.

‘Nursery and school settings are the perfect places to teach children to love eating a variety of plant-based foods like lentils and chickpeas, and it would be good to see more unprocessed plant-proteins featured in the nursery menu.

‘Nursery and childcare settings will certainly need to think about how to cater for this, not just for those children who follow a vegan lifestyle, but because we cannot continue to eat meat at our current rate.’

MORE INFORMATION

• www.nhs.uk/start4life/weaning
• https://elliotteggs.co.uk/downloads/official-new-advice-on-egg-safety.pdf
• www.allergyuk.org/information-and-advice/conditions-and-symptoms/42-childhood-food-allergy#downloads
• www.nhs.uk/change4life/food-facts/healthier-snacks-for-kids/100-calorie-snacks
• ukkidsnutrition.com
• https://infantandtoddlerforum.org