Doctor Q&A

Feeding Kids Healthy series – Eating a Balanced Diet

Traditionally, parents worry about whether children are eating enough but based on the rise in childhood obesity (2011 – 11% and updated in 2017 – increased to 13% in Singapore), parents also have to be mindful of overeating AND eating the wrong types of foods.

For this 2-part series focused on feeding kids healthy, Abbott facilitated the interviews with nutrition experts. Last week, we covered what and how much a child should eat. This week, we will focus on how we can get the child to eat a healthy and balanced diet. We have Anna Jacob, Director of Nutrition from Abbott.

Health and balanced diet for children with Anna jacobs director of nutrition abbott

MarcieMom: Thank you Anna for helping us figure out how we can actually get our kids to eat the healthy meal we’ve prepared. We assume that parents have the knowledge to serve a healthy meal of half plate fruits and vegetables (the more colour, the better), a quarter of protein and a quarter of whole grains. Let’s overcome the potential obstacles in each food group!

Getting Fruits Rights for Children

For fruits, the common ones in Singapore are apples, oranges, pears, grapes, strawberries and mangoes. Within these fruits, we have red, orange, green, purple and yellow! Would you reckon it is more attractive to kids to be served a variety of colours within a meal or rotating each fruit? What is the serving size in each case? Must they be organic?

Anna Jacob: Fruits are rich in many vitamins, some minerals and dietary fibre. Brightly colored fruits also have many natural plant compounds that are now known to be beneficial to health. For example, beta-carotene in yellow-orange fruits supports healthy skin and anthocyanins in red fruit may benefit heart health.

Beta-carotene in yellow-orange fruits supports healthy skin and anthocyanins in red fruit may benefit heart health.

There are basically five colored types of fruit:

  • Green:  Green apples, pears, kiwi, honeydew
  • White: Bananas, lychees, longans, mangosteens
  • Yellow and Orange: Oranges, papaya, cantaloupe, mango
  • Red: Cherries, watermelon, red apples
  • Blue and Purple: Blueberries, purple grapes

Parents can add color to their children’s meals with a variety of fruits, making recipes more attractive and nutritious.  However, we do not have to serve up all the colored fruits on one plate all the time. Incorporating them through different meals and snacks will help your child appreciate and eat them too.

Dietary guidelines from around the world recommend that fruit should be part of a child’s diet – starting with just half a serving after 6 months and progressing to 2 servings by 7 years. 

Examples of a serving of fruit, as defined by Singapore’s Health Promotion Board, is 1 medium banana, 1 medium apple, pear or orange, 1 wedge of watermelon, papaya or melon or 10 grapes or longans.

Fruits in Singapore are safe and rinsing the fruit in clean running water before cutting and eating it is sufficient. Therefore, it is not necessary for parents to buy only organic fruit for their children. But for those who want it and can afford it, organic fruit – free of synthetic fertilizers and pesticides – may provide peace of mind.

Getting Vegetables Right for Children

MarcieMom: For vegetables, the leafy green ones, cruciferous (broccoli, cauliflower and Brussel sprouts) are packed with nutrients. What is the best method of preparation that retains the nutrients yet appealing to kids? Do you recommend hiding vegetables?

Anna Jacob: Indeed, green leafy vegetables are rich in many nutrients including iron, vitamin C, folate, calcium and fibre.  However, many vitamins are sensitive to light and exposure to air. In addition, the water soluble vitamins and many minerals are soluble in water.

Vegetables retain their nutrients best when they are eaten fresh and not processed. To preserve the nutrients in fresh vegetables, prepare them just before eating; do not soak or cook them in water for too long, prepare just before eating, cut into larger pieces and do not overcook vegetables.

Cooking destroys some nutrients, especially the fragile, water soluble ones.  However, many children eat more vegetables when they are served up cooked. Of the many cooking methods commonly used to prepare vegetables, microwaving and steaming conserve nutrients best.  On the other hand, some nutrients in vegetables are better absorbed when prepared with some fat.  For example, tomatoes cooked in oil make lycopene (the natural red pigment) more available to the body. Cooking also makes many otherwise inedible vegetables suitable for a child’s diet – think potatoes, yam, beets and more.

Your Cooking Method Matters

So, use several cooking methods to prepare vegetables to increase your child’s exposure to a variety.  Aim to provide ½ serving of vegetables a day to a child over 6 months and, gradually progress this to 2 servings by the time he / she enters school.  A serving is defined as ¾ of a 250-ml mug of cooked or non-leafy vegetable, 150 g of raw leafy vegetables and 100 g of non-leafy vegetable.

Ideally, children should accept all food including vegetables. However, some reject vegetables due to color, taste, texture. Some scientists also suggest that a few kids are ‘super-tasters’ and may be more sensitive to the bitter notes of leafy green and cruciferous (broccoli, cauliflower and Brussel sprouts) vegetables – causing rejection of these nutrient-dense foods.

Patience is the key when you want to inculcate healthy habits – offer the same vegetable over and over again, without forcing, so that the vegetable becomes familiar. Model eating the same food item at family meal times and, vary the presentation, cooking method and flavoring.  If and when all these suggestions for introducing vegetable fail or take time to achieve, parents may have to be creative and incorporate vegetables in foods. So, ‘hiding’ vegetables is a last resort and not the best option.  But, it is still a valid option and, so, do not feel guilty if you are doing it. Just keep working on all the suggestions listed above, and, soon over time, you will succeed – at least to some degree.

Getting Grains Right for Children

MarcieMom: For grains, whole grains like whole wheat, brown rice, quinoa are better than white rice. As there is less natural sugar in these than white rice, how should they be prepared to be appealing?

Anna Jacob: Natural grain foods – whole grain and polished – do not contain natural or added sugars. All carbohydrates in grain foods, after digestion are absorbed into the blood stream as simple sugars. This is unavoidable as it is the way the body handles carbohydrates. Sugars and starches are not all bad – they do help provide energy to keep children active. In the right proportion, they ensure that children get the energy they need to grow and be active. One advantage of whole grains is that it has more fibre, vitamins, minerals and natural plant components than refined grains. So, definitely, whole grains are more nutritious and therefore, the healthier choice. Here are some tips on how to cook them:

  • Brown rice can be steamed or boiled. However, you need to adjust cooking time and added water volume to achieve a soft and edible grain suitable for your child’s eating ability.
  • Whole wheat grains can be boiled to prepare porridge or milled to make whole meal flour. The flour is versatile and you can make a variety of breads and biscuits with it.
  • Quinoa, usually prepared by the absorption method, requires two-times the volume of water as quinoa and cooks in 10 – 15 minutes.

As these are staple foods and, we eat a good portion of them at each meal, so, it is best to prepare them simply with less fat, salt or sugar. They can be eaten with vegetables and lean proteins as side dishes.  In addition, for variety, you can toss whole grains with fresh or cooked vegetables, nuts, lean meat and some natural seasonings to prepare delicious one-dish meals or snacks.

5 Tips to Get your kid to experiment

MarcieMom: Apart from the food preparation, can you share your top 5 tips for getting children to experiment different foods and eat the foods served to them? What are the top 3 pitfalls to avoid when getting a child to eat his/her meal?

Anna’s Top 5 Tips for Getting Kids to Experiment Foods
  1. Involve your child in food preparation. From gardening to shopping and cooking, involving your child will help him/her learn about food, become familiar with it and, even develop a sense of pride and ownership. Time spent together over these activities will offer you many opportunities to teach your child about the nutrient-goodness of food as well.
  2. Eat with your child. Children learn about nutrition best by modeling healthy eating behaviors. As you eat a wide variety of food, your child will learn to do so too. You can use these special moments to teach table manners and to bond.
  3. Offer healthy foods. As a parent, you need to ensure age-appropriate and healthy foods are available at regular meal and snack times. However, you need to allow your child to select the portion he wants to eat. Encourage independent eating too. Over time, your child will develop a healthy attitude towards food and eating.
  4. Be creative but do not become a short-order cook. Offer your child a variety of food items, cooked in various styles. You can do this by becoming a creative cook or introducing your child to various food choices out of home. But, once the menu is set, and the food is on the table, do not entertain preparation of special dishes for your child.
  5. Allow your child to occasionally eat with peers. Kids also learn fast by watching their friends. Eating a meal or two with peers helps your child pick up skills he never had.
Anna’s Top 3 Pitfalls of Feeding Kids
  1. Do not abdicate responsibility for your child’s nutrition. Many working parents do not have the luxury to be at home with their child at every meal time. But, set the menu. Know what is served and what is eaten. Talk to your child’s caregivers and, tell them what you would like your child to eat so that they can work with you to ensure good nutrition.
  2. Do not force feed. While you decide when, where and what your child eats, please give your little one the right to select how much he wants to eat. Force feeding is counterproductive as it stresses the caregiver and, scares the child or causes defiance.
  3. Do not distract your child while eating. It is another common practice to let children watch television or play computer games during meals while the caregiver feeds the child. This feeding style does not develop a child’s self-feeding ability – to know and appreciate what is served and learn to be conscious of how much he is eating.

While you should encourage healthy and appropriate eating, this takes time and much effort, you should track growth with your child’s physician at regular visits; and, in the interim you may provide a complete and balanced supplement to fill nutrient gaps, if any – to achieve optimal growth during the critical periods of life.

MarcieMom: Thank you so much to Anna Jacob for sharing these tips. Even for families who are already eating healthy, it is a good reminder to keep up the effort, try new foods and enjoy a healthy life!

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