Q: I have an allergy to wheat and am concerned that my baby may at some point develop it too. Are food allergies inherited? If so, are there any early warning signs that I could look out for in my baby?
A: A true allergy to wheat is rare and more often adults experience wheat intolerance which is unpleasant and can cause symptoms such as wind, bloating, fatigue, headaches and other problems. Coeliac disease is an inability to deal with gluten, a protein found in wheat, which leads to malabsorption of nutrients from food. Failure to thrive is a serious condition where a child does not put on weight and is often linked to coeliac disease – if this is suspected medical advice must be sought immediately. In any event babies should not be given gluten-containing grains (wheat, rye, barley, oats) before six months as this increases the risk of sensitivity. Babies’ guts take a while to mature sufficiently to cope with gluten. Most first stage baby foods are gluten free, but it is worth checking labels. Allergic families do tend to have an inherited trait and allergies to foods such as peanuts are more common when family members have ‘atopic’ problems such as asthma, eczema and psoriasis. A true wheat allergy could fall into this category, but a wheat intolerance is unlikely to do so. Early warning signs of wheat intolerance are usually digestive, and include trapped gas, diarrhoea or constipation. Children need a varied diet to obtain all the nutrients they need, so if you are planning to cut back on wheat it becomes essential that substitutions are made. Starchy grains that substitute well include rice, corn, oats, buckwheat and millet.
Q: My son Alexander has just been diagnosed as being lactose intolerant and so can’t have certain types of milk. What are my options as far as replacements are concerned and are there any organic varieties I can get hold of?
A: Lactose intolerance is much more common that people generally realise and involves an inability to produce lactase. Lactase is the enzyme we produce to digest the milk sugar, lactose, found in breast milk and all other milks (cow, sheep, goat). After the age of two, which is presumably when mother nature thinks we should be fully weaned, about 70 per cent of people slowly lose the ability to digest lactose. This is particularly prevalent in those of Asian, African, Middle-Eastern, Jewish, Latin American and Southern European descent. Symptoms of lactose intolerance are bloating, cramps, trapped wind, nausea and, sometimes, diarrhoea after ingesting milk.
Skimmed milk has the highest amount of lactose, semi-skimmed has less and full-fat milk has the least, which means some lactose intolerant people can tolerate it in small amounts. Goat and sheep milk have just as much lactose as cow milk. Cheese is mainly fat and protein and so has almost no lactose, and cream and butter also have almost none. The lactose in good quality yoghurts has mostly been pre-digested by the ‘good’ bacteria. Most large supermarkets stock lactose-free milk in the speciality section, alongside soya milk, rice milk and oat milk which are also lactose-free. However, if you choose the last three for a child make sure you chose calcium-enriched versions. Depending on the degree of intolerance, you may not have to restrict all foods made with milk (such as creamy sauces) but concern yourself mainly with drinking-milk). Finally, I am not aware of any organic varieties of lactose-free milk. Another option is to buy lactase enzyme drops from a health-food shop to add to milk an hour or so before consumption to pre-digest the lactose (it turns the milk quite sweet as the milk-sugars are broken down). This will allow you to choose organic milk.
Q: My 9 month old seems to always be hungry. I am worried that I could be feeding her too much and I was wondering if there was a certain recommended limit for her daily food intake. Should I just be feeding her as much as she will eat or should I cut off her consumption at a certain point?
A: Babies of this age need around 800-900 calories per day. Appetite is regulated, to a degree, by the genetic make-up of a child which dictates growth rate – infants who are destined to be taller will eat a little more than those who are destined to be shorter. In the first six months of life babies double their birth-weight and in the first year they triple their birth-weight and your health visitor will tell you how Rachel measures up on her centile chart. Your baby should still be getting 0.5 litres/1 pint of breast or formula milk daily at this age and if she is not getting this much she might be more hungry than usual. Make sure the foods she is eating are nourishing (fruits, vegetables, rice, oats, potatoes, bread, lentils, fish, eggs, meat, etc) and if possible avoid too many packaged baby foods. Foods which supply a good level of vitamins and minerals as well as good quality fats, proteins and carbohydrates are likely to be most satisfying. If you are giving her foods which are sweetened (babies don’t need sugar) then cut back on these as she could be craving the sweet taste rather than just satisfying hunger pangs. Of course, she may just like the taste of food – many parents complain of the exact opposite and struggle to get their children to eat, so at the moment I wouldn’t worry too much as long as she is growing normally.
Q: My toddler refuses to eat while either my partner or I am watching him. If we turn our backs, he’ll happily feed himself. I’ve no idea why he started doing this but is there any way we can get him to stop?
A: Many (possibly most) children go through different stages of food refusal of one sort or another. Sometimes this is to do with likes and dislikes, but usually it is to do with exerting their ‘authority’ over their parents’ – essentially, a form of power-play. Small children have very few ways in which they can bring their parents to heel so food-refusal becomes a very potent tool. In the parents’ mind food is linked to nurturing and caring and it is very important that the child should eat as well as possible at all meals. Children can be finely attuned to the fact that food-refusal sets off alarm bells in the parent and the coaxing, pleading, bribes and threats that often ensue underscore this nicely.
Your toddler obviously likes the food served because it gets eaten if you turn you backs, so taste is not an issue. You do not mention that your child has a poor appetite, is listless or is failing to put on weight and height, so obviously sufficient calories and nutrients are being consumed. What remains is simply an issue of who is going to get the most emotional mileage out of the situation. I absolutely guarantee that if you a) stop worrying about it b) let your toddler eat when you turn your back if he is eating on his own without coaxing or comment, but if the meal is uneaten after 20 minutes clear the table, and c) when eating as a family calmly clear the table after the end of the meal, again without comment, that eventually two things will happen: 1) hunger will eventually take over at mealtimes, whether your back is turned or not, and 2) there will be no emotional mileage to capitalise on and the tactic will simply be dropped. This may take a few days to achieve, but it will work as long as you don’t pass any comments.
Q: My 12 month old son, Simon, hates onions. I’m sick of having to make two separate dinners every night. I love onions and use them in virtually everything I cook. Is there anything I can do?
A: Onions are extremely tasty and also very healthy: they boast a powerful antioxidant called quercitin. I assume you have tried all the usual subterfuge methods (mincing finely and hiding in dishes/sauces). Everyone has likes and dislikes and sometimes this has to be respected. A quarter of all adults and children are ‘supertasters’ who find strong tastes more distasteful than the rest of us do – this means they eat less foods like broccoli and grapefruit. This can have adverse effects on their health in the long run, not just because they avoid these foods but also because they often disguise them with creamy/buttery sauces, sugar or salt. However, if this is actually a food-fad problem, research confirms that it takes around ten exposures to a new food before a child will accept it, so perseverance usually pays off – and this means being firm. As it happens I experienced the identical problem - my son refused onions for a long time after seeing a friend refusing them, though he loved garlic, and ate lots of other vegetables. I used to use whole or halved onions in dishes to give flavour, insisting on including them as there was a limit to how much I was going to pander to his tastes, but so they were easy to leave to one side. Finally, I gave him some onion bhajis in an Indian restaurant (at an older age than Simon is, and telling him they were vegetable bhajis – the truth, sort of) and after I told him what they were, he was OK with onions from then on.
Q: I’m a vegetarian and would like to wean my child as a vegetarian also but I’m getting pressure from my parents and friends not to. They think he won’t get all the nutrients he needs. Is there any way I can make sure he gets everything he needs but without meat?
A: Around 5% of people are vegetarian in the UK. There are some definite health benefits: vegetarian children are less likely to have weight problems, they get more fibre in the diet and tend to eat more vegetables. The main nutrients from meat to consider are iron, zinc and selenium. Protein levels in vegetarian diets are rarely a problem. Good sources of iron are fortified cereals and bread. Iron and zinc are found in all protein foods such as pulses (lentils, beans), nuts and seeds (these must be ground for young children to avoid choking and avoided if there are allergies in the family), cheese and eggs. To double absorption of iron from plant foods give a source of vitamin C with meals: citrus, strawberries, kiwi, blackcurrants, peppers, cauliflower, broccoli and Brussels. Selenium is found in nuts and seeds (particularly Brazil nuts). Omega-3 fatty acids, which are important for brain development, are found in oily fish. If you are avoiding fish make sure your child gets related omega-3 fatty acids from walnuts, flax, pumpkin seed oil, canola oil, or three omega-3 enriched eggs a week are equivalent to one portion of fish. I only have two reservations about vegetarianism 1) if it tips over into veganism (when dairy and eggs are avoided) where I do think extreme care needs to be taken with a child’s diet, and 2) if a ‘junk food’ vegetarian diet is followed – after all crisps and chocolates can be vegetarian: the real message is to pay attention to healthy eating whether a child is a vegetarian or an omnivore.
Q: I'm weaning my little boy James at the moment and heard somewhere that you shouldn't give honey to children under one, is this true? And are there any other seemingly innocent foods that I shouldn't give him?
A: You are absolutely right. Honey can be a source of the food poisoning bacterium Clostridium botulinum which can cause infant botulism, which is rare but life-threatening. Acidity in the infant gut is not sufficiently developed to kill the bacteria. Soft-boiled eggs can harbour salmonella, unless they are lion-mark which guarantees salmonella-free flocks. Healthy gut-flora help to protect infants against pathogenic bacteria from food poisoning. Breast-feeding improves the gut-bacteria composition of babies’ guts by providing ‘growth factors’ called oligosaccharides which promote healthy gut-bacteria; some infant formulas, such as Omneocomfort, are adding oligosaccharides in to replicate these beneficial effects, with some success. Of course good hygiene, careful food storage and thorough cooking remain the best defences. Potential sources of food toxins which should be avoided are green skin on potatoes and undercooked kidney beans or chick-peas. Apart from food toxins babies should not be exposed to gluten (from bread, flour, pasta, breadsticks, etc) before the age of six-months as it is too harsh for their undeveloped digestive systems. It is generally advised that peanuts and even sesame seeds - potential allergens - should be restricted until three years, unless you feel that allergy is not a likelihood in your family. Families with a tendency towards atopic allergies, such as asthma, eczema or inflammatory bowel disease, should be cautious about trigger-foods such as wheat, dairy, soya and eggs, but specialist nutritional advice needs to be sought before excluding main food groups from an infants’ diet. This is all covered in my book What Should I Feed My Baby? (Weidenfeld & Nicolson £8.99).
Rose, sorry to plug my book here (take if out if you prefer) but it seems appropriate to provide further info.
Q: My nephew has been diagnosed with ADHD. I have heard from a friend that some foods can aggravate the symptoms. What foods are they and why do they have to be avoided? Also are there any foods that may help the condition?
A: Diagnoses of ADD (attention deficit disorder) and ADHD (attention deficit hyperactivity disorder) have been on the increase, and nobody is quite sure why – it could relate to better diagnoses, social issues and also have genetic and nutritional features. They are more common in boys. From a nutritional standpoint ADHD is believed to be part of a spectrum of disorders that encompasses dyslexia, dyspraxia and even Asperger’s syndrome and autism. This is because it is thought that structural changes and signalling in the brain are linked to dietary intakes. A large part of the brain is made up of certain fatty acids which are deficient in the diet. Additionally the brain is sensitive to sugar levels in the blood. It also might be hyper-sensitive to certain additives that are common in processed foods. Altering a child’s diet is unlikely to hurt and could do a lot of good, though don’t stop or reduce any prescribed medication without consulting your doctor.
The nutritional changes which could help are
Q: I am confused about food labelling and would like to know more about what to look out for.
A: You are not the only person who is confused about food labelling! The Food Standards Agency, the Consumers Association, and the pressure group FLAG (Food Labelling Agenda) are all aware of the problems and are aiming to reach agreement on different food labelling issues - albeit slowly as they all seem to have different viewpoints on the subject. E-numbers are not often put on the labels with their 'E' name these days as they don't really tell the public anything. Instead the full chemical or ingredient name is listed and then you need a chart to find out what they mean. The best references are the books 'E for Additives' by Maurice Hanssen, or 'What The Label Doesn't Tell You' by Sue Dibb. Not all E-numbers are bad as some are natural antioxidants such as vitamin C, natural colourings such as beetroot and thickeners such as pectin - E-numbers quoted for these just tend to scare people. On the other hand there are many suspect additives, as you quite rightly say, in particular food colourings and preservatives which can be a problem for behavioural problems in children and asthma. It is not possible to give all the names as there around 900 E-numbers, but you can look them up in one of the reference books mentioned above (ask your library for these). Alternatively, my book Allergy Solutions gives a list of all the E-numbers which are not likely to be harmful and can even be beneficial.
Q: I am bottle-feeding my son and am committed to giving him organic but can’t find any organic formulas which are enriched with LCPs which I have read are important for infants.
A: At this time there is no organic infant formula available which is enriched with the LCPs AA and DHA. In addition to Cow&Gate and Hipp the other available organic formula is from Babynat (0118 951 0518, info@organico.co.uk). I suspect that it will not be long before a manufacturer such as Cow&Gate who offer both LCP enriched milk and organic milk will combine the two options, however that will not help your question as you will no doubt have weaned your baby by then. One reason why this might be slow in happening is that some of the LCPs come from fish sources and it may be difficult to adequately source organic fish ingredients (I believe they use parts of fish eyeballs). So the question is, which one is the best choice? This is hard to answer and depends on priorities - I am a strong advocate of organic feeding for infants and children and of course think it is essential that children receive adequate LCPs which are very important for nervous system development. I suppose on balance I would say that the LCP issue wins out over the organic issue, though I would prefer - as I think you would - not to have to make the choice.
Q: My son seems to have an aversion to anything that's lumpy. He's 18 months old now and I think he ought to be eating less babyish foods. Any ideas how I may be able to gradually introduce proper solids?
A: By 18 months children should ideally be eating foods with a variety of textures and foods they are able to chew. This helps with jaw and tooth development. However, some children can be resistant to change and often they eat ‘baby food’ if they can get away with it. This can be an emotional regression where they stay in a comfort zone, but usually it has just become a habit. One answer may be to involve your child more with food and give him foods to hold as he feeds himself, such as chunks of banana, carrot sticks or let him eat strips of sliced chicken with his hands. He can also start to help with stirring mixes such as chopped salads, with his (clean) hands if necessary – some will probably end up in his mouth. The chances are that when he joins playschool or nursery that he will make the transition without fuss as he sees other children tucking in and enjoying their food and the situation will resolve itself without further worry.
Q: My two year old loves his breakfast of porridge but won't eat anything else. I want to include more fibre into his diet, so any ideas how I can get him interested in muesli or can you suggest any other alternatives?
A: Porridge is an excellent breakfast providing complex carbohydrates and soluble fibre which is healthy for the digestive tract and cardiovascular system. It is far better than the high-sugar cereals that children often eat. There is no official recommendation for fibre levels for children but those who eat more fibre have healthier bowels and blood sugar control. Muesli and very high fibre bran cereals are actually not necessarily good for children other than once or twice a week. This is because the fibre they contain partly binds with minerals such as iron, zinc and calcium, reducing absorption. Good sources of fibre which your son might accept are wholemeal bread (soldiers to go with his egg), oatcakes or rye crackers with a topping, beans and pulses (such as hummus dip, baked beans or green peas) fruit (try making fresh banana and strawberry milkshakes for instance) and vegetables (use them as cruditées with the hummus). Other ideas include: nut butters which are high in fibre, Twigglets which are a high fibre, low fat snack (though a bit high in salt), Garibaldi biscuits or fig roles.