PPSEAWA International

Children, The Family and Health: What it Takes to Give Children Long Life

The Singapore Workshop: Nutrition and Healthy Lifestyles for Children

Introduction by Paddy Walker of the Cook Islands

Dr. Hashim obtained her B.S. in Food and Nutrition in the U.S., then persued her PhD in Nutrition while working as a lecturer at the National University in Malaysia. While working in academia she was involved in different aspects of nutrition, specializing in children’s and adolescent’s issues. Dr. Hashim joined Nestle Malaysia in 1997 as a Corporate Nutrition Advisor.

By Zawiah Hashim, Nestlé Products Sdn. Bhd. Malaysia

The goal of good nutrition in the early years is for normal physical growth development and to promote good health. Individuals must take responsibility for their health. However, for children, it is a great challenge for parents to make sure the nutritional needs of their children are being provided. Eating the right kind and amount of food and following good dietary habits throughout one’s life mean a healthier body and mind, greater vitality and energy, greater resistance to diseases, and increase longevity.

The World Declaration on Nutrition and Plan of Action adopted by the International Conference on Nutrition (ICN) in Rome, December 1992, calls for a concerted multisectorial effort and commitment of all nations, non-governmental organizations and international community to eliminate hunger and reduce all forms of malnutrition. The ICN was not an end in itself. Many countries have formulated their plans of action for nutrition. What happens now is to see whether the world community has achieved success in combating all forms of malnutrition.

Today’s lifestyle is significantly different to that of twenty years ago. In general, people are more aware of the importance of nutrition to their health. More mothers go out to work and so have less time to spend on food preparation. The family lifestyle has changed which make eating together difficult to schedule. The economic status of most people has improved and meals are often taken away from home.

Given the above scenario, the objective of this paper is to impart correct nutrition information relevant to the target age group that is children, with the hope of helping to build a healthy nation in future. It is equally essential to create awareness on the importance of food and exercise in promoting and maintaining good health.

What is Nutrition?

Nutrition is the study of nutrients in foods and how the body handles them, including eating, digestion, absorption, storage and excretion. A broader definition includes the study of the environment and human behavior as it relates to these processes.

1. Who are the children?

Children can be classified into the various stages of life according to the age groups listed below:

The target age selected for this discussion will be children below ten years old. Since children in this age group are most vulnerable to malnutrition, it is important to give due consideration to their nutritional needs and eating habits. This will be one of the measures to protect the children, the future nation.

2. Why children need good nutrition

Good nutrition and dietary habits during infancy and childhood are important for growth and development. Good nutrition is not just to prevent nutrient deficiency but also to promote a healthy and active life.

What is meant by growth and development?

Growth is the increase in size, that is weight and height with age. Growth is continuous from birth to maturity but it is not a uniform process. Growth is considered as the single best indicator of children’s nutritional status. During the first year of life the growth rate is very rapid, followed by slower growth rate during early and middle childhood. Another period of rapid growth occurs during adolescence, followed by a tapering off until the growth period ends.

Development refers to the increasing ability of the body parts to function such as muscle tone, motor skills (being able to use fork and knife), speech, emotional and social development.

Factors affecting the rate of growth and development include heredity and environment. An extremely important environmental factor is nutrition. Well-nourished children reach the potential set by their heredity, both in physical and mental health.

What constitutes good nutrition?

Healthy meals or balanced diet which are safe to consume provide nutrients necessary to improve the nutritional status of children. Parents might wonder how they can provide their child with balanced diets. Balanced diet/meals refers to eating a variety of foods in the correct proportions needed to provide all the necessary nutrients for growth and development. There are simple tools like the Food Pyramid or the Food Groups that have been set up in various countries to assist the population in selecting a balanced diet from the vast variety of foods available.

What are the important nutrients?

Essential nutrients to support growth and development in children are:

How important is water and dietary fiber?

Even though water is not classified as nutrient, it is essential in life to facilitate body processes. Water must be taken every day to ensure a balance between intake and water lost. We can survive without food for several weeks but will thrive only a few days without water. Another important constituent of diet is fiber which is important for gut function. Major sources of dietary fiber are wholegrain cereals, fruits and vegetables.

3. Starting right

There are many controversies and differences of opinion about appropriate nutrition for children. Research on this issue is ongoing, just like good nutrition is an ongoing process. As children’s diet can have a lasting impact on their general health, it is important to start right.

Breastfeeding

Breast milk is the most complete food you can offer your newborn infant, and it can be the only food for the first four to six months of their life. It has just thc right level and quality of nutrients to suit your child’s first food needs. Breastfeeding can provide mother and baby a whole list of benefits as stated in nutrition textbooks, brochures or campaigns. An example of a brochure published by Ministry of National Health and Welfare, Canada is titled:

10 great reasons to breastfeed.

  1. Tailor made
  2. Nutrients plus
  3. Convenient & safe
  4. Automatic
  5. Continue special relationship
  6. Available for months
  7. Easy on budget
  8. Help you lose weight
  9. An enriching experience
  10. Works for working mothers

Mothers who are interested to know more about breastfeeding, can contact the various Breastfeeding Advisory Associations or relevant organizations in their individual countries.

Weaning

Weaning is the gradual transition of infants from a milk diet to one that contains other foods, or in simple term introducing solid foods. Nutritionally, solid foods are not necessary before 4 - 6 months old, Parents are generally concerned on the right timing to introduce solids. Babies normally let their parents know when they are ready for solids. if you notice your baby is not gaining weight and seems unsatisfied after being breast or bottle fed, it may be time to introduce solids on a regular basis, along with milk or formula. Hence it is important for parents to monitor babies’ weight regularly.

Some General Tips About introducing Solids

The 6-11 month period is an especially vulnerable time because infants are just learning to eat and must be fed solid foods. Care must be taken to ensure that these foods complement rather than replace breastmilk. Breastmilk continues to be an important source of energy, protein and micronutrients. Increase feeding frequency as the child gets older and gradually increase food consistency and variety to improve nutritional quality of diet. Good hygiene and proper food handling is critical during this period.

Rates of malnutrition usually peak at this time with consequences that persist throughout life. Children who do not get enough to eat and are malnourished tend to be smaller and more likely to become ill than well fed children. Their learning ability may be affected as well.

Feeding Toddler and Preschoolers

Your child will reach 1 year old without you realising it. During this period children’s appetite begins to diminish consistent with the slowing of growth. At the same time your child seems to lose interest in food as he or she begin to explore the surrounding. Children’s bodies also change at this age and they tend to trim down as they increase their exploring activity. You will notice your child does not seem to grow as fast as before. A parent should not become alarmed if changes in eating behavior occur, such as fluctuation in appetite, lack of interest in foods and eating only a few foods day after day.

Good nutrition is important at this stage not only for physical growth but also for learning. Your child is ready to join in family meals. However they need to eat small amounts frequently throughout the day to maintain the energy they need for playing and learning. The Food Groups or the Food Pyramid can be used as a guide to choose foods for your child. Each of the foods in the Food Groups or Food Pyramid has a specific role in health and development; hence it is important to choose wisely.

Choosing the foods is one hurdle but getting your child to eat the selected food is a big problem. Foods have to be eaten in order to provide the required nutrients, therefore honoring the children’s preferences is another way of ensuring compliance to foods. Mealtime should be a happy time so that your child has a pleasant experience in order to develop positive eating attitudes and behaviors. It is a great challenge to parents to provide nutrition in a most effective and interesting way.

Nutritional needs of the primary school children

Meeting the nutritional requirements of the 5 - 10 year old child takes larger amounts of the same foods needed by preschool-aged child. Children in this age group are in the period where growth is slow but steady. In contrast, intellectual and social growth is rapid. Primary school children have a long and mentally demanding day followed by some very active periods. Learning about food, growth and health is an important part of this age group.

A primary school child needs a diet that provides sustained energy, something to keep them going through the long day. A good diet which provides day-long energy will help prevent fatigue and help maintain concentration during school hours as well as keeping your child healthy and active. This means the content of breakfast, lunch and snacks are very important in getting them through the day.

Breakfast is an important meal for the whole family and more so for a child. Children who skip breakfast are less well fed since it is difficult to make up missed nutrients at other meals. Missing breakfast also can affect the child’s concentration at school. Peers and teachers may influence eating behavior during this stage of life. Children who show a marked dislike of certain foods at home sometimes accept and enjoy those foods when they see other children are happily eating them.

Children need an energy top-up at lunch time or after school. It is not difficult to construct a balanced nutritious meal to keep your child going through the rest of the day. Select a carbohydrate source, which can be rice or bread or pasta. Choose a protein food either chicken, fish or egg plus a vegetable and you can make up a complete and balanced meal for your child. Fruits can be offered as dessert and milk is very important to help build strong bones and teeth. It is good to encourage your child to drink 2-3 glasses of milk plus another 2-3 glasses of other fluids per day.

In the present environment, the evening meal may be the only time a family eats together and it is important good eating habits should be practised. As parents you should keep your own attitude to food positive and eat healthy foods yourself. After all your health is as important as your child’s.

Good nutrition is based on variety, moderation, balance and regularity. Healthy life involves more than just eating. Children should be encouraged to get involved in physical activities regularly in order to have a good weight maintenance. Adequate sleep and rest are also important towards sustaining a healthy life.

4. Common Nutritional Problems

Malnutrition

Your child may have a special problem or condition or circumstances that require you to pay special attention to his or her diet. The most common problem among children is malnutrition, comprising both under- and over-nutrition. Insufficient food intake will lead to inadequate nutrients which result in growth retardation or stunted growth and other diseases associated with micronutrient deficiencies. This problem is most common in under-developed countries and developing countries. Undernutrition is most often associated with poverty and improper food distribution system.

The other type of malnutrition which is common in developed nations and is fast catching up in developing countries is overnutrition which results in obesity. Obesity is not a disease but a condition which contributes to a higher risk of other health and medical problems such as cardiovascular disease. It is important to practise prevention when it comes to obesity. A child who is obese needs careful management. Weight reduction is not recommended because it may easily impair growth in children. Instead aim to limit additional excessive weight gain or maintain a constant weight while the child grows taller.

Adverse reaction to Foods

This refers to unusual responses to food which include intolerances and allergies. Adverse reactions to foods can threaten children’s nutritional health to varying extents, depending on the severity and duration of the reactions and the foods involved. Temporary reactions may lead to permanent avoidance of foods, while permanent reactions can, if not detected and treated, cause chronic illness.

Food intolerance is the adverse reactions to foods that do not involve the immune system. Among the causes may be enzyme deficiencies, such as lactose intolerance, reactions to chemicals in foods or psychological aversions.

Food allergies refers to the adverse reaction to foods that involve an immune response. A true food allergy occurs when a whole food protein or other large molecule enters the system and cause an immunologic response. Allergic reactions to food may be immediate or delayed varying from minutes to 24 hours. Foods that most often cause allergic reaction are eggs, peanuts, milk, soybeans, wheat and fish.

Dental Caries

Dental caries or tooth decay is a common problem in children who do not practise good oral hygiene. Dental caries occur when bacteria in the mouth reacts with sugars in food to produce an acid, which eats into the tooth and makes a hole. Brushing teeth regularly, and thoroughly helps prevent accumulation of bacteria. The best approach to prevent tooth decay is to encourage children to brush and floss their teeth after eating since it is unrealistic to expect them to totally stop the intake of foods they like.

5. Benefits of Good Nutrition

Good nutrition will lead to good nutritional status among the children which is associated with benefits such as:

What constitutes healthy lifestyle?

A child’s healthy lifestyle is dependent on more than food and nutrients. Emotional nuturing, learning experiences and socialization all play a part in the growth of a child’s personality, abilities and uniqueness. Hence a good nutritional status, plus adequate physical activity in a suitable environment with proper social and psychological guidance, can result in a healthy, active and intelligent child.

References

FAO/WHQ/UNLJ. 1985. Energy and protein requirement. WHO Technical Report Series 724. Geneva.

Food and Nutrition Board. 1990. National Academy Press, Washington D.C.

Krause M\T, Mahan LK. 1984. Food, Nutrition and Diet Therapy. 7th edition. W.B Saunders Company. Philadelphia.

National Coordinating Committee on Food and Nutrition. 1995. National Plan of Action for Nutrition of Malaysia. PNMB.

Peckenpaugh NJ, Poleman. CM. 1995. Nutri1lion: Essentials & Diet Therapy. 7th Edition. W.B Saunders Company. Philadelphia.

Whitney EN, Rolfes SR. 1993. Understanding Nutrition. West Publishing Company. New York.

Questions and Answers

J.dC, Philippines

Q - What is the psychological effects ofdiet on a child? Is this a good idea?

A - Find out why child is overweight and correct the issue. Is it food or exercise and activity? Some fat and protein is needed for growth. Watch the balance and encourage good habits. Computer, TV, video games need to be limited and active sports encouraged

Indonesia

Q - Breastfeeding. Goal for Indonesia, 50% in 2000 - what are the statistice for Malaysia?

A - 4months of exculsive breastfeeding/ up to two years encouraged.

Q. Weaning diet - how should food be processed?

A - Homecooked food is recommended for children vs prepared. Homecooked is best IF the water is clean, unless you prepare for one feeding only, there can be a loss of food value and minerals. Variety and balance is most important. Convenience for the parent is also important.

Q- Do people really eat out that much?

A - Ann Tan of Singapore - The national pasttime in Singapore is eating. Things are busy right now because it is the holiday. Restaurants have reduced the prices 10 - 30% due to the economic crisis. Healthy food is currently big in restaurants. The Ministry of Health rates the stalls - gives them guidelines for less salt, less MSG, better sources of fat, etc

Paddy Walker - Cook Islands

Q - People are going without dairy products. How would that effect you?

A - If there are other sources of calcium adequate to promote and maintain bone growth and loss it is okay.

G. de Castro - Philippines

Q - How do we keep children from eating “junk food”?

A - There is no such thing as bad or “junk food”. For example, chips are made up of protein and carbohydrates and provide energy for activity. A steady diet of this is not good, but some is fine. High salt levels can be a problem. There needs to be some fun in eating.

M. Taylor - New Zealand

Q - The vegetarian trend among young people, is it god or bad?

A - It can be a problem if the young person has inadequate education in nutrition and does not know how to add proper protein to the diet. Animal protein is more complete than plant protein. Adding milk and eggs into the diet will help the balance, especially during the growing years


Last Modified: November 29, 2002