Palak Vyas

<ul><li>Generally there is a notion that a gluten free diet is healthy but it is not true for everyone. Gluten free diet is for those who have either 1) celiac disease (immune reaction against eating wheat) or 2) non celiac gluten sensitivity. Gluten present in wheat, barley, rye and other products can be troublesome for celiac patients and it can make gluten sensitive people sick.</li><li>So if the kid has any of the above conditions you can go gluten free otherwise it isn’t wise to keep your child’s diet gluten free.</li><li>Gluten free diet generally includes food like vegetables, high quality protein, healthy fats (nuts, seeds, avocado), fruits and grains that do not have gluten.</li></ul> Reasons why you should not have gluten free diet for your child:<ul><li>Whole Grains that contain gluten have lots of crucial nutrients including B vitamins, antioxidants, iron, selenium, magnesium etc. Excluding whole grains will lead to nutrition deficiency in children.</li><li>Whole grains have fibre too which is good for digestion.</li><li>Gluten free diet can be too low in calories for growing children. It is hard to get healthy calories from other sources.</li><li>Gluten free diet can be high in arsenic. Those who do not eat wheat prefer rice as a staple food. Now rice and rice products are rich in arsenic which is not good for the baby’s body.</li></ul>

It is very important to maintain a balanced diet for the proper growth and development of the baby. Going gluten free or not is an individual's choice. It is better to look into the pros and cons before taking the decision.

Gluten free diet for children or not

There is a difference between an overweight child and a child who overeats. Overweight leads to health problems but over eating does not always leads to heath issues if your child is active. If your child is overeating:Accept that children come in all shapes and sizes and their appetites also vary. You should trust your child to be able to feed himself/herself. If your child is extremely active physically, his or her appetite may be larger. This is completely normal. Remember that your kid is constantly growing and (s)he needs food to support their development. But if your feel that your child is an over-eater and is not very active physically, then in this case, overeating may lead to your child being an overweight child. In case of an overweight child:As a parent stop blaming your child for unhealthy eating habits. Shouting and forcing them never works. Instead of stopping it altogether, you can reduce it gradually and simultaneously increase healthy food intake. Parents can also make healthy food interesting by either using colourful utensils, or different shaped plates, dressing food in an interesting way, creating a back story associated with the food. On a standard Body Mass Index (BMI) chart, kids ages 2 to 19 fall into one of four categories:<ul><li>Underweight</li><li>Normal weight</li><li>Overweight</li><li>Obese</li></ul>Depending on your child's BMI and health, the doctor may refer you to a registered dietitian or a weight management program. Here are 5 key ways you can help your child maintain a healthy weight:<ul><li>Be a good role model – A child is going to follow what he/she sees so have healthy eating habit and the child will follow.</li><li>Encourage physical activity. Make time for a little walk or play a small game wherein the child has some physical movements.</li><li>Keep to child-sized portions.</li><li>Eat healthy meals, drinks and snacks.</li><li>Less screen time and more sleep.</li></ul> Overweight children soon cross the mark of obesity hence it is important to keep a check on their eating habits. Obesity leads to several health problems in later life such as:<ul><li>Type 2 diabetes</li><li>High blood pressure</li><li>High cholesterol</li><li>Bone and joint problems</li><li>Shortness of breath that makes exercise, sports, or any physical activity more difficult</li><li>Restless sleep or breathing problems at night</li><li>Liver and gallbladder disease</li></ul> Obese kids might also deal with emotional issues like low self-esteem, and may be teased, bullied, or rejected by peers. Kids who are insecure with their weight can be at risk for:<ul><li>Unhealthy dieting and eating disorders</li><li>Depression</li><li>Substance abuse</li></ul> Reasons behind obesity:<ul><li>Diet habits: high consumption of fat-filled, processed or packaged foods.</li><li>Lack of exercise: older kids and teens should do moderate to vigorous excerise for atleast one hour.</li><li>Genetics: Genes help determine body type and how the body stores and burns fat.</li><li>Some medication</li><li>Endocrine problem</li><li>A combination of the above</li></ul> Preventing Obesity:<ul><li>Make healthy eating and exercise a family affair.</li><li>Take them along when you go grocery shopping.</li><li>Teach them how to make good food choices.</li><li>Cut down on TV, phone, computer, and video game time and discourage eating in front of a screen (TV or otherwise).</li></ul> Encourage healthy eating habits. There’s no great secret to healthy eating. To help your children and family develop healthy eating habits:<ul><li>Provide plenty of vegetables, fruits, and whole-grain products.</li><li>Include low-fat or non-fat milk or dairy products.</li><li>Choose lean meats, poultry, fish, lentils, and beans for protein.</li><li>Serve reasonably-sized portions.</li><li>Encourage your family to drink lots of water.</li><li>Limit sugar-sweetened beverages.</li><li>Limit consumption of sugar and saturated fat.</li><li>Remember that small changes every day can lead to a recipe for success!</li></ul>

For overweight children, you cannot just take away interesting food altogether. It needs to happen gradually over the time.

Overweight Child

No human can stay hungry for long. Hunger is an integral part of survival. Every child has his/her own set of likes and dislikes when it comes to food. So the problem should not be that a child does not eat, rather the problem is that the child does not always eat what his/her parent wants them to eat. Every child likes something or the other. Identify that and feed them that. Introduce new foods along with their favourite foods.A few things which you can keep in mind:<ul><li>Avoid introducing junk foods with high taste levels at a young age: For example, if you introduce chocolate too soon, your child will be habituated to an intense sugary taste. Also, chocolates, biscuits, wafers have more calories. So if children eat 4-5 chocolates or biscuits, their calorie count is fulfilled and they will not require any more food for the whole day. These foods are highly rich in calories but do not provide other quality nutrition. Eating excess junk food will result in nutrient deficiency when they grow old.</li><li>Stop giving any junk food altogether: If you totally stop giving chocolates or biscuits, the child will gradually divert towards healthy nutritious food because no one can survive without food. You will have to work hard to develop a new habit of eating healthy and this can be time consuming and can demand a lot of patience.&nbsp;</li><li>Work as a team: When you know some things are not right for your child’s health, sit with the entire family and convince everyone to not give junk food every time a child demands. By being stricter, gradually your child will develop healthy eating habits.</li><li>Be a role model: If you want your child to follow your instructions, you too will have to say goodbye to your junk food habits. A child learns the most from his parents. Eat healthy and so will your children.</li><li>A frequent intake of sugar and sugary foods and drinks between meals causes tooth decay. Snacks and drinks taken between meals should be sugar-free.</li><li>Do not add more salt in the food either while cooking or at the table, as babies’ kidneys are not fully developed.</li><li>Every day, children need three meals plus snacks. Provide nutritious meals and snacks.</li><li>Young children are very active and have high energy (calorie) and nutrient needs in proportion to their small body size.</li></ul>

Children learn from your behaviour. Changing your eating habits will help them develop healthy eating habits as well.

Developing healthy food habits

Samiksha Choithani

Newborns and infants cannot inform when they are hungry. Some of these signs are subtle hints that will tell you when the child is hungry:<ul><li>The baby is putting fingers in mouth</li><li>Sucking lips or tongue</li><li>Making little crying sounds</li><li>Getting restless</li><li>Avoids other family members and only wants to be with mother</li></ul> Some babies are too sleepy and do not show any signs of hunger, but wake them up and feed the baby at least 8 to 12 times in 24 hours. Babies often get hungrier than usual (every hour) during the growth spurt. Growth spurt is the time when the baby is physically growing; it lasts for 2-3 days. Growth spurts occur periodically, within 7-10 days of birth, 2-3 weeks, 3 months, 4 months, 6 months and 9 months.

Irritability is probably the most common signs among babies that indicates a child is hungry.

Signs that indicate babies are hungry

A balanced diet for a young child means having variety of foods.&nbsp;From the age of two, a child should be moving towards a diet that is similar to the rest of the family.Follow below mentioned measures to increase weight of your underweight child in a healthy manner:<ul><li>Your child should have at least five portions of a variety of fruit and vegetables every day.</li><li>The meals should be based on potatoes, bread, rice, pasta or other starchy carbohydrates.</li><li>Some dairy or dairy alternatives (such as soy drinks and yogurts). Choose lower-fat and lower-sugar options.</li><li>Some beans and pulses, in case you prefer non-vegetarian food, fish, eggs, meat and other protein. Aim for two portions of fish every week – one of which should be oily, such as salmon or mackerel.</li><li>Plenty of fluids such as water, milk, fresh juice making up to – 6-8 cups/glasses a day. Energy-dense foods such as whole milk, yogurt, cheese and oily fish can also be given.</li><li>By the time your child is five, they should be eating a healthy low-fat diet. There are a few steps you can take to increase your child's calorie intake until they reach a healthy weight, while still providing a healthy diet.</li><li>Bulk up mashed potato by putting milk or cheese in it</li><li>Put grated cheese on beans on toast</li><li>Make milk puddings</li></ul> Try not to give more of:<ul><li>Sugary drinks and foods – It's not recommended to give your child high sugar drinks and foods. The longer and more often sugar touches your child's teeth, the more damage it causes. If your child does have sugary foods or drinks, it's best to give them at mealtimes to minimise damage to their teeth.</li><li>Saturated fats – These are unhealthy fats, such as those contained in burgers, sausages, pies, biscuits, cake and cheese. Try not to give these too often.</li><li>Whole grains – Wholegrain foods, such as wholemeal pasta, bread and brown rice, can be high in fibre and may fill up your child before they've taken in the calories and nutrients they need. After the age of two, you can gradually introduce more wholegrain foods.</li></ul> Note: It’s normal to worry that your child is not getting the food that he or she needs to grow. But kids are more than capable of knowing whether they are hungry or not. Unless your doctor tells you that your child isn’t getting the nutrients that he or she needs, you should not worry about the lack of food intake. As long as your child's weight is fine, (s)he is sleeping well and has normal bowel movements, there is no need to worry that whether your child is eating enough or not.

Underweight children require foods and diet that can provide them with enough nutrition and sufficient calories.

Underweight child

As per the doctors’ recommendations, a child shouldn’t be given anything till 6 months. Child should only be breastfed till 6 months. This is applicable for masses. But this can be customised depending upon a child’s health and under parental supervision; a child can be introduced or can be given liquidised food and water from 5 or 6 months. Liquid foods should be those which are culturally acceptable. These include – fruit juices, vegetable soups, daal or moong water, non-veg soup, etc. Children should be encouraged to drink adequate amounts of fluids. While introducing new foods, parents should keep 2 things in mind: <ol><li>Never introduce 2 foods at the same time. If you are giving daal water today, do not give fruit juice on the same day. It helps in identifying any consequences/allergic reactions or adverse effect due to new foods. Let the child get habituated to a new thing for at least a week and then introduce a new food item.</li><li>The quantity also matters. On the first day start with 2 spoons of say daal water, on second day 4 spoons, likewise keep increasing quantity gradually for a week and if the child is able to digest it all well. In the second week you can introduce fruit juice along with daal water. Keep the quantity in check and ultimately know how much is enough for your child.</li></ol> Please note:<ul><li>Children’s appetites may vary, not only from day to day, but also from one meal to the next.</li><li>Children have smaller stomachs than adults so it is important to consider portion size when plating food.</li></ul>

Introducing food at the right age will make your child habituated with eating all kinds of food.

Food at the right age

Prachi Shah

Children tend to get fussy while eating food because either they are not hungry or because they are irritated with something else. Follow these to keep your cool and to prevent this from becoming a habit: <ul><li>Remove the food without making or passing a judgement. Do not scold your child. Offer the same food at the next meal or snack time.&nbsp;</li><li>Keep your attitude friendly and relaxed. This will help your child to understand that eating is a pleasurable way to satisfy hunger rather than a battleground.</li><li>Small helpings of food may be better accepted by your child. Second helpings can then be offered if appropriate.</li><li>Do not try to bribe children to eat food they do not want with the reward of a pudding or sweet snack.&nbsp;This will only make matters worse.</li><li>It may be useful to adopt the approach that a food refused is ‘not liked today’. If a food is refused, try it again a few days later. Changing the way a food is given, may make it more acceptable.</li><li>Consider possible reasons for the food refusal, such as drinking continually throughout the day, or frequent large snacks between meals, as both of these can reduce the appetite for main meals.</li><li>Never force a child to eat. Your child will gradually learn to eat.</li><li>Make sure the child eats with the entire family.</li></ul>

You can gradually make your fussy eater child accustomed with all kinds of food.

Fussy eaters and giving food to them

If your child does not like milk or takes time to have a glass of milk every morning, do not get impatient. Threatening the child is not a solution.Calcium is important for bones and milk intake is important for a child’s health, so you can try these techniques or give alternate sources of Milk: <ul><li>Keep offering milk at each meal.</li><li>Make a smoothie with Banana or make almond milkshake.</li><li>You can pair milk with cornflakes or healthy cereals.</li><li>Give a handful of almonds and oranges as a substitute.</li><li>Sprinkle some sesame seeds in salads or add them when you knead a roti dough.</li><li>Give plenty of curd or yogurt/cheese/ghee - these are good substitutes of milk.</li><li>Don’t start with a full glass and insist on finishing it; try small quantities and gradually increase the intake.</li><li>You can even pair it with you child’s favourite biscuits or cookies.</li><li>Give them options of colourful glasses to choose from so as to make the milk consumption appealing.</li></ul> REMEMBER the goal is to fulfil the calcium need in a child's body. So if your child dislikes animal milk, you can try almond or coconut milk or given him/her alternative sources of calcium.

If your child does not like milk or takes time to have a glass of milk every morning, do not get impatient.

What to do if child does not drink milk?

Chewing may start around 6-9 months. By 10 months, your baby should be given textured food and opportunity to chew. Babies can do light chewing till 1.5 years as they still lack molar teeth. There can be several reasons behind a child not chewing its food properly:<ul><li>Late introduction of food</li><li>Delayed development of motor skills (jaw, tongue, swallowing)</li><li>Disinterest in food because of test, texture, or flavour</li><li>Boredom of same food</li><li>Allergy</li><li>Consumption of milk three times</li><li>Big portions</li><li>Distraction</li></ul> Please refrain from the following behaviour:<ul><li>Generally, parents put on child's favourite cartoon or TV programme and feed their child. For parents, the only concern is to make the child eat sufficient amount of food so as soon as this is done, they think that their part of duty to feed the child is over.</li><li>This is where children get into the bad habit of eating while watching T.V. When a child eats in front of the screen, (s)he does not know what (s)he is eating. The child will also not chew the food properly.</li><li>If a child observes that his/her parent is taking a sandwich in their hand while going to office and eats moving around the house or watches television while eating, the child will learn the same. The child models their parents’ behaviour and thus (s)he doesn’t chew properly. Either they eat too slow or just gulp without chewing.</li></ul> For improvement, take the following steps:<ul><li>When a child eats food on their own, proper chewing habit develops easily. This way the child becomes independent and learns to do his/her own thing. So encourage them to eat their food on their own.</li><li>Make it a point to have a family meal time where everyone eats together.</li><li>Vary the type of food, food's texture to keep the food interesting for your child.</li><li>Instead of a screen, tell them stories or talk to them while feeding them.</li><li>Make sure there is sufficient gap between meals. When the child is not hungry, (s)he does not chew the food properly. Take this as a sign that your child is not hungry.</li><li>You can constantly keep telling them about the importance of chewing process and help them develop this habit by following it yourself.</li><li>Eat with them, but in a different plate. When a child watches you eating calmly and properly, (s)he learns the same.</li></ul>

Kids tend to skip chewing and try to swallow the food directly. Do not get angry, try to be patient and address the problem.

food problems health concerns

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