Infant feeding: Current concerns and recommendations

In the UK we have a series of nutritional surveys, the most popular of which is probably the NDNS or – The National Diet and Nutrition Survey. These surveys are carried out with the aim of informing the government, scientists and health professionals what people in the UK are eating – which in turn allows us to see if children and adults are meeting current dietary recommendations.

What are our infants and toddlers eating?

What are our infants and toddlers eating?

Learning what the diet of young children consists of is important in assessing the health of future generations, however, the NDNS only looks at nutrition intake of people from 18 months and over.

Therefore the Diet and Nutrition Survey of Infants and Young Children (DNSIYC) was born to try and capture information on what children between 4 and 18 months of age are consuming through dietary intake.

An analysis of these two recent surveys (released in 2012 & 2013, respectively) revealed some interesting results about the UK infants’ nutritional intakes.

Findings and my recommendations

Findings:

  • In the UK, the government recommends that all children from 6 months of age if being breastfed (or once having less than 500mls of formula milk) should be taking vitamin supplements containing vitamin A and vitamin D. This recommendation is mainly a safeguard, to ensure that children get these vitamins, which are often a challenge to get from the diet. However, research suggests that actually only 9-11% of infants in the UK are taking the recommended supplements.
  • The NDNS and DNSIYC also show that the recommended nutrient intake (RNI) for vitamin D is not being met by a vast majority of infants (average intake was 33-55% of recommended).

Recommendation – For all families in the UK, children from 6 months of age (if breastfeeding or consuming less than 500mls of formula) should be taking vitamin supplements containing vitamin A and vitamin D.

These can be bought at most pharmacies and supermarkets and the ones I normally recommend are the vitamin drops e.g. Abidec or Dalivit as these do not contain added sugar and are easy to add to food or drink (as long as it’s not heated afterwards).

The government also have their own version – Healthy Start Vitamin Drops – which you can get free if you are eligible. Visit their website for more information.

 

Finding:

  • Iron intakes in young children were also shown to be ‘sub-optimal’ meaning they were slightly less than the recommended intake. Some groups had significantly lower intakes than others such as South Asian children and children from manual occupation households.

Recommendation – It is important to offer iron rich foods in the diet along with the introduction of other solid foods. Meat, fish, eggs, beans, lentils, nuts and pulses are all good sources of iron and can be offered to baby from 6 months of age. It is a good idea to offer an iron rich food (such as the above) once a day once your baby is having three meals or gets to around 7 months of age to ensure they will be getting enough iron in their diet. Remember to always offer food variety and if you give meat, fish and eggs make sure they are cooked thoroughly, all the way through. Speak to your doctor if you or your partner are allergic to nuts before offering them to your baby.

 

Finding:

  • Interestingly only 2% of those aged 12-17 months and 9% of those aged 18-35 months had low intakes of vitamin A. However, this is difficult to assess using the methods used in the dietary surveys.

Recommendation – Make sure you offer a variety of foods when feeding your baby and offer vitamin drops as currently recommended by the government.

 

Finding:

  • A small proportion of children were found to have low intakes of zinc in their diet (4-6%).

Recommendation – Make sure you are offering a varied diet to your child. Meat and dairy foods are the main sources of zinc as well as nuts and pulses and vegetables so as long as these are offered zinc intakes should be fairly adequate.

 

Finding:

  • Energy intakes for this age group were recently revised by the Scientific Advisory Committee on Nutrition (SACN) in 2011 and results from the surveys now show that the energy intake of children between 4 and 34 months of age exceed the estimated average requirement. This means that many children are eating more energy than they need and could be a reason for high levels of childhood obesity. Bringing this energy intake down could therefore help to reduce childhood obesity rates in the UK.

Recommendation – Infants and toddlers are very good at regulating their own appetite. However, often, in my experience, parents are often overly anxious that their children aren’t eating enough and therefore over compensate by either encouraging excess food consumption or offering excess milk. The best advice is to let your child guide you as to how much they want to eat and how much they want to drink. Don’t feel that you need to meet certain milk intakes every day and instead look at how much they are eating and drinking over a week, not just a day.

Children’s appetites will vary hugely from day to day and it’s important we don’t override their natural hunger and fullness signals by encouraging over feeding. Attending child health clinics and getting your child’s weight checked is the best way to see if your child is growing well and eating enough. If concerned, speak to your GP or local nutrition/dietetics team.

 

Finding:

  • Protein intakes in both surveys were in excess of the recommended intakes for this age group and were more than double those recommended for children between 1 and 3 years of age. This is possibly of concern as recent research suggests an association between high protein intake leading to fast weight gain in the first year of life and obesity later in life.

Recommendation – Try and breastfeed wherever possible and allow your child to regulate their own appetite. More research is need into this field to make further recommendations.

 

Please contact me for further advice or clarification on any of the above points. The above is a summary of some findings suggested in the following study:

Nutrient adequacy and imbalance among young children aged 1–3 years in the UK by – S. Gibson* and A. Sidnell†

Based on two further studies:

Bates B, Lennox A, Prentice A et al. (2012) NDNS Headline Results from Years 1, 2 and 3 (Combined). Department of Health and Food Standards Agency.

And

Lennox A, Sommerville J, Ong K et al. (2013) Diet and Nutrition Survey of Infants and Young Children, 2011 [online].