There’s something about a chubby baby that makes the heart melt: Little “bracelets” on the wrists and ankles; and cheeks everyone wants to pinch. Sadly, bigger isn’t necessarily better, says Professor Atul Singhal, Honorary Consultant Paediatrician at theWhittingtonHospitalandGreatOrmondStreetHospital; Deputy Director, MRC Childhood Nutrition Research Centre; and Professor of Paediatric Nutrition at theInstituteofChild Health,London.
“In 20 years of studying nutrition and its impact on the long-term health of children, your baby’s size and the nutrition he or she receives will determine his or her size and health in later years,” Prof Singhal says, citing the 2008 EarlyBird Diabetes study published in the journal Pediatrics, led by Professor Terry Wilkin, of the Peninsula Medical School, Plymouth, UK, after following over 200 children from birth. “This study determined that by the age of five, your child’s propensity for obesity is established.”
With obesity levels in children now a massive health concern globally the medical profession notes with interest that, while breast feeding still ensures the correct rate of weight gain as set out by the World Health Organization, many mothers are not in a position to breastfeed for as long as they may like to, owing to work pressures and other issues.
“In cases where breastfeeding is impossible, mothers must look to milk supplements to ensure their children are getting quality nutrition and not just quantity,” Prof Singhal says. “Not only is nutrition vital for growth rate, it also affects cardiovascular health and the mental development of the child,” he adds, highlighting the fact that both under- and over-nutrition constitute “malnutrition”.
According to Dr Mohamed Iqbal S. Miqdady, Division Head and Senior Consultant atSheikhKhalifaMedicalCity, UAE and Adjunct Staff, Department of Paediatric Gastroenterology, Paediatric Institute, Cleveland Clinic,USA, deficiencies in vitamins A and D; and in zinc, iodine and iron are seen in many toddlers as they learn to eat foods with different tastes and textures.
Dr Miqdady says a zinc deficiency – vital for physical and mental growth, as well as for building immunity – is seen in as many as 45% of South African children. “Iron deficiency is also prevalent in around one third of children globally. Combine this with deficiencies in iodine, vitamin A and vitamin D and you have children whose immune systems don’t easily fight off illness; along with memory problems and often lowered mental capacity.”
Problems with picky eaters
Both Dr Miqdady and Prof Singhal agree that picky eating in toddlers presents another problem for parents trying to ensure good nutrition. “It’s a stage most children go through when they are given new foods,” says Prof Singhal. “They may have issues with new textures and tastes. However, in order to ensure the best possible nutrition, parents have to persevere with ensuring their children get a broad range of foods from different food groups.”
Dr Miqdady concurs: “These children are at higher risk of multiple vitamin and micronutrient deficiencies than non-picky eaters, with around 11% of them growing below expectations.” Then there are the children whose picky eating includes foods that encourage rapid weight gain. “Again, we come back to the propensity for obesity,” Prof Singhal says, “and its attendant problems like possible diabetes and heart disease.”
While not every slight or larger child is malnourished, both doctors suggest that parents of picky eaters visit a paediatrician if they feel their child may not be getting the vitamins and micronutrients he or she needs for optimal growth and a healthier future.
“It’s always best to intervene earlier rather than later,” says Prof Singhal. “Some deficiencies may only be noticed by parents when it’s too late. A medical diagnosis will enable both the paediatrician and the parents to make the necessary dietary changes and give the child his or her best shot at a healthy future. Where supplements are required, they must be used as a safety net rather than a replacement for foods. This way, your child is assured of being properly nourished while experimenting with new foods.”