Is a sustainable diet suitable for young children?

The discussion about healthy eating, whilst considering the environment is a topic that comes up much more frequent in my consultations. This can be a real challenge when you want to achieve iron requirements, but not eat too much meat, when you want to achieve essential fatty acid intake, but do not want to contribute towards over-fishing and when you are aware that too much fibre (which is common in a plant-based diet) can impact on the availability of many vitamins and minerals.


Already in 2017, the British Dietetic Association launched a toolkit for dietitians to help them advise a more sustainable diet and recently, the LANCET, one of the most well-known medical journals, gathered healthcare professionals working in public health to work on a diet that is both healthy (i.e. meeting all requirements) and is good for the environment. According to this publication “Global consumption of fruits, vegetables, nuts and legumes will have to double, and consumption of foods such as red meat and sugar will have to be reduced by more than 50%”. A diet rich in plant-based foods and with fewer animal source foods confers both improved health and environmental benefits.”  ) I have copied below the suggested diet, based on the research by the LANCET, but the problem with these nutritional aims is that to date, they have not been adjusted for children and in particular for babies and toddlers.

Whilst, I can certainly not replace a whole research team, which really is required to answer this question on exact amount, I will try with this blog to provide some general guidance for parents who want to raise their children taking food sustainability into account but not harming their health.

  1. Breast milk and/or formula play an essential part of the diet until your baby is 1 year of age and should not be limited due to environmental concerns.
  2. After 1 year of age full cream milk or plant-based alternative can be considered. According to the planetary diet, cow’s milk/cow’s milk products need to be limited to 250 ml per day, which would not achieve calcium requirements for young children. Whilst calcium enriched plant-based milks provide a similar calcium content, they are generally low in energy, protein (outside of soya-based milk alternatives) and iodine (essential for brain development). Of course, you have other plant-based sources of calcium like broccoli, tahini ect, but the availability for absorption of the body is often quite low due to the fibre content. So it is really difficult to establish exactly how much a baby is in fact absorbing when this nutrient is combined with a lot of fibre. I therefore usually suggest from 1 year of age to aim for 250 ml milk + 1 portion of 30 cheese/100 ml yoghurt to achieve requirements. If you use a plant-based milk, then you need to aim for 300 ml/day or 250 ml + calcium enriched yoghurt (the plant based cheeses are usually enriched with calcium). As a lot of plant-based milks are low in energy and protein (outside of soya) its important to consider how these are replace. In addition, iodine is usually low in plant-based milks and is essential for brain development. It is worth looking at alternatives, including seaweed and in some countries bread is supplemented with iodine (not in the UK).
  3. If I convert the suggested planetary diet meal plan for protein you get the following weekly plan:
    1. Red meat – 1x per week
    2. White meat (poultry) – 2x per week
    3. Fish – 2x per week, of which one portion should be an oily fish
    4. Egg – 1 per week
    5. Legumes (including nuts) – daily
  4. The above schedule of protein would achieve protein and iron (and zinc) requirements in babies/toddlers, but it is worth to consider combining your legumes with a vitamin C rich source (i.e. fruit as dessert or tomato as finger food) to increase the iron absorption. The reason I am not suggesting here cooked vegetables as vitamin C source, is that a lot of the vitamin C is lost during the cooking process.
  5. The planetary diet also suggests reducing saturated fats (i.e. animal fats) and increasing polyunsaturated fats. Its very important to mention here, that babies and toddlers (when growing normally) should not be on a low-fat diet, as they need plenty of fat to sustain energy intake and this nutrient contributes also towards brain development. I therefore suggest to use a combination of olive oil, rapeseed oil and sunflower oil (all contribute different fats) and not to avoid nut butters if not allergic. Palm oil is a saturated fat, but it is essential to assess how this has been sourced. In regards to coconut oil, this is also a saturated fat and can be used, but its also important to establish where this has been sourced and think about the fact that both these fats are not manufactured locally in European countries (i.e. needs to be imported).
  6. The rest of the diet is supposed to be composed of fruit, vegetables and grains. Whole grains I would avoid until 1 year of age and after this age be careful in the amount of wholegrain products, because this can affect the availability of vitamins and minerals by affecting the absorption. For fruit, I would keep to 3 portions of fruit per day (what the child can hold in hand/size of hand) and totally avoid fruit juice.
  7. Avoid sugar, honey and salt definitely until 1 year of age and limit this to a minimum after 1 year of age.


I will post guidance on vegan/vegetarian diets in my next blog, as I know this is also a hot topic.

Lastly, it is important to note that this advice is not suitable for children that are on a restricted diet due to allergies or other conditions and they require individualised advice. If in doubt, speak to your dietitian.

Keeping your Baby and Toddler Hydrated in this Hot Weather

We have been having exceptionally hot weather in Europe and unlike other years where this may last just for a day or two, this seems to be going on and on.

Babies/Toddlers (as well as elderly) are at higher risk of becoming dehydrated, because of their smaller bodies they have less body fluid reserve and their surface area to volume ratio is higher. Its important therefore to recognise the symptoms of dehydration early, which include:

  • seem drowsy
  • breathe fast
  • have few or no tears when they cry
  • have a soft spot on their head that sinks inwards (sunken fontanelle)
  • have a dry mouth
  • have dark-yellow pee (less wet nappies)
  • have cold and blotchy-looking hands and feet

Firstly it is important to keep them out of the sun and clothe appropriately with light, breathable clothing. Ensure also that your baby is not wrapped up too hot when sleeping.

For breastfed babies < 6 months of age, the ideal is to increase the breastfeeding frequency, which often occurs naturally, as babies signal when they need more fluid. For formula fed babies, they will need more formula as well during hot weather and again, most babies will signal this automatically.

For babies over 6 months of age, cooled boiled water should be offered frequently in hot weather. I often get asked how much they should have, which very much depends on the weight and age of the baby. Most babies > 6 months of age weigh > 5 kg, so that means you are looking at 100 ml/kg of total liquid (that is milk and water) to maintain hydration, during very hot weather this can increase to a total 120-130 ml/kg of water. This is just a rough guide as some children want more than that and some are fine just with 100 ml/kg. It is therefore important to monitor their hydration status.

For toddlers, milk of course is not such a prominent liquid in their diet as for babies. It is therefore really important to ensure that they consume sufficient additional liquid, ideally in the form of water. Fluid requirements are calculated as follows:

  • first 10 kg = 100 ml/kg and for the following 1 kg its 50 ml/kg. So a toddler of 13 kg would require 1150 ml liquid per day.
  • Remember though that food also contains water and contributes to the total fluid intake

I do have children that refuse to drink water and although I am not a fan of fruit juice, in this hot weather its more important to keep them hydrated, so I usually suggest (in cases that refuse to drink plain water) to flavour water with a little bit of fruit juice (1:5 dilution) and/or you can also try fruit ice lollies (blending fruit with water). In addition, offer plenty of juicy fruit (i.e. water melon) and vegetables that contain water (i.e cucumber).

If ant any stage you are worried about your baby or toddlers’ hydration status, please seek professional medical help.

What oil/fat to use for my child?

I took a photo this morning of all of my oils in my cupboard and was astonished to see how many different types of oils I have and have been reflecting how confusing this has to be for parents with children.



When I qualified as a dietitian, saturated fats (i.e butter, animal fats) were bad and we started to use plant fats (i.e. sunflower oil), in fact this was recommended by all international cardiovascular associations as the oil/fat of choice. However a couple of years ago, trans fat were highlighted as a contributing factor in cardiovascular disease, diabetes and even cancers.  This is a type of unsaturated vegetable fat that has a trans configuration (instead of a more common cis configuration) that occurs through an industrial process that adds hydrogen to liquid vegetable oils to make them solid. This occurs in particular with low fat products and also with heating at very high temperature. So, now we have palm oil that is replacing hydrogenated vegetable oil in products and many have switched to coconut oil/fat as fat source.

So first of all, both palm and coconut oil are saturated fats, so they are in the same category nutritionally as animal fat (like butter and like the fat on a piece of steak). I have heard so many times from my parents in clinic that they have been told that coconut oil/fat is an essential fat, which is absolutely not the case. The fact that we should be worried about palm oil, in particular in regards to our environment, I have written about in a previously published article, so this is not one I come across in my clinic a lot. Palm oil a possible health and environmental dilemma – Rosan Meyer Oil seeds Focus March 2017

However, this still leaves parents in a situation where they ask themselves what their child needs. I always like to go back to breast milk, which is just the most wonderful food every for children. The World Health Organisation recommends breast feeding until 2 years of age and breast milk contains around 50% fat. So this is really an important nutrient for children.

Children (and adults) require a mix of saturated (animal based fats and yes also coconut fat/oil), polyunsaturated (these are your rapeseed oils, sunflower oils) and monounsaturated fats (like olive oil). Essential fatty acids, are those that the body can not make themselves and you have to ingest them. These are your omega 3 and 6 fatty acids – omega 9 is not essential as this can be synthesised through other fatty acids. The omega 3 and 6 fatty acids fall under the category of poly unsaturated fatty acids and can be subdivided further in a couple of types of omega 3 and 6 fatty acids. This is also confusing, as many people think that omega 3 for example from rapeseed oil is the same as omega 3 from oily fish, but they are in fact very different type of omega 3 fatty acids and you need both (so one does not replace the other).

So to make it practical, children need fat, and they need them from all categories of different types of fats as they have different physiological roles. If your child has a non-vegetarian diet, its likely that they already have enough saturated fat from meat  and full cream milk products. In regards to the oils that you are using, I would vary between different polyunsaturated ones (sunflower/canola/rapeseed) and olive oil (or avocado oil which also is high in monounsaturated fatty acids) and most importantly not forget about oily fish. In a breast fed child, mothers intake of omega 3 fatty acids influences the content of breast milk. In formula milk fed children, omega 3 fatty acids (and other fats) are highly regulated to ensure children get enough. Otherwise, current UK guidelines is to aim for 2 portions of oily fish per week in children (portion size of their little hand palm) and to avoid shark, marlin and swordfish because of the mercury content. See FSA advice on mercury.

I will write about the pro’s and con’s of frying foods as this covers a totally different emerging area in a future blog.



Cooking for my baby and toddler – practical tips

I have decided this week to write about cooking, reheating, boiling and not boiling water  for your baby/toddler as it is still question that many parents have.

I think the most common question I get is whether to boil/steam foods and if they are older whether its okay to roast. There are no specific guidelines on the cooking methods for children and as this mainly depends on whether you are using the baby led weaning approach (see my previous blog entry under Introduction of Solids) or whether you are introducing solids in the more traditional way (i.e. puree and then lumpy). Of course with cooking, you will loose some of the heat sensitive vitamins, but its important initially to have a texture that is suitable for your child. In particular in the initial phases of weaning, vitamins and minerals will come mainly from breast milk or formula, so cooking the vegetables for example really softly (i.e. very long) to a manageable texture is not going to lead to vitamin deficiencies. As a side, energy/protein/carbohydrate and fat content does not change with heating and most minerals (i.e. calcium) are heat stable.

In regards to equipment, I find steamers really useful and of course a good hand-blender. There are many baby steamers that have integrated blenders. I have tried a couple and find most okay, but when you want to prepare bigger volumes for freezing for example, I find their container size quite small. So before you go an buy something special, think about the future and whether you envisage cooking fresh each day (then smaller container makes sense) or making larger batches. When it comes to the texture, if its too thick you can either  add your breast milk, formula or the cooking water to thin it to a texture tolerated by your baby. However, if you are planning to freeze these in batches, its better to not add your breast milk/or formula to the foods you are freezing but rather do this fresh after reheating.

Okay, so now to cooking and reheating. Firstly the cooked food should be cooled as quickly as possible and then frozen  and then place this into the fridge or freezer. Foods kept in the fridge, should be eaten within 2 days. Foods that are frozen should ideally be defrosted first (for example take out and place in fridge) and then reheat to piping hot and let it cool down to a temperature tolerated by your baby. I get a lot of questions about using the microwave. Reheating in the microwave is not ideal, as it often creates heat pockets and areas that are not properly heated. If you want to use the microwave, then stir the food whilst heating so that you make sure that all areas are properly heated through. Foods that have been reheated and not eaten should not be reheated/used again.

More information on this is on this NHS website.

In regards to water; in the UK we follow the WHO guidelines for mixing of formula, which is to mix formulas with cooled boiled water that is about 70C. You reach this temperature after boiling the kettle and letting it stand for about 30 min (see this site for more information). Fully breastfed babies do not need any water until they’ve started eating solid foods. Bottle-fed babies may need some extra water in hot weather. For babies under six months, use water from the mains tap in the kitchen, boil this water and then cool as per guidelines above regarding temperature. Water for babies over six months doesn’t need to be boiled, however if your child is immunocompromised (has an illness/diagnosis effecting their health) then you may be advised by your healthcare professional to boil until 1 year of age. Bottles and teats need to continue to be sterilised until a baby is 12 months of age.

Bottled water is not recommended for making up formula feeds as it may contain too much salt (sodium) or sulphate. It does however happen when travelling that tap water is not safe and you do not have a choice. If this is the case, its best to have a discussion with your healthcare professional to discuss which bottled water has low sodium and also how to establish what is high/low sodium as your healthcare professional may not know the names of bottled waters outside of UK/EU. This website may be useful for you.


The New Vitamin D Requirements for the UK

I am not sure how many parents know that the vitamin D requirements for infants and children have changed in the UK….finally. The change followed a review of all the scientific evidence by the Scientific Advisory Committee on Nutrition (SACN) in the UK.

In the past it was thought that sufficient vitamin D was synthesised through the skin exposure of sunlight, but now with public health recommendation to wear protective sunscreen it is recognised that it is no longer  possible. In addition, most children receive very little vitamin D from their diet as the diet on average only contributes only about 10% of requirements and this is based on an optimal diet that contains foods rich in vitamin D or  supplemented with this vitamin.

I am sure you are keen to know what these guidelines are. So here are they are:

  1. All babies under 1 year should receive 8.5 ug-10 ug per day of vitamin D – in particular children that are breastfed from birth should receive these vitamin drops
  2. If your baby is on an infant formula and consumes more than 500 ml per day, it is assumed that you are achieving this amount, as these formulas are highly enriched
  3. All children between 1-4 years should have a daily supplement of 10 ug vitamin D per day

The above recommendations are based on achieving musculoskeletal health and not for any other therapeutic intervention as there continues to be significant debate around levels for prevention of certain diseases. Its important to know that as with any supplementation, too much is also not good, so please do not double the amount suggested and think it will only do good. Vitamin D is not only a fat soluble vitamin, which you can lead to toxicity, but it has a potent effect on the immune system, which may not always be a good thing it taken in excessive amounts.

You will notice, that it is currently difficult to find supplements that contain exactly 10 ug, as most of them contain 7.8-8.5 ug of vitamin D. This is because many supplements are still based on the Department of Health recommendations and the NHS Healthy Start vitamin drops also contain this dose. We are expecting this to change.

So the message from this blog entry is, do get a vitamin D supplement if your child falls within the above category and if in doubt talk to your healthcare professional to assist you.

The issue about salt in children

The question about salt comes up very frequently from parents I talk to, in particular if babies are above 1 year of age. Before 1 year, everybody has accepted that a “no salt policy” is a good one for baby food, but somehow there is this thinking that something magical happens at the age of one and suddenly salt intake can be totally liberalised. Of course kidneys mature with age and the amount of salt tolerated increases, but the idea behind the guidelines for reducing salt intake is also to raise a new generation of adults that are not as salt dependent as many of us are and therefore become healthier adults.

It is well known in adults that excessive salt intake affects blood pressure, but new research has shown that high salt intake in children may predispose children to high blood pressure, osteoporosis, respiratory illness (i.e. asthma), stomach cancer and obesity. So how much can your child have? The following are recommended intakes for the UK, but other EU countries have similar guidelines.

0-6 month: < 1 g per day

6-12 months: 1 g/day

1-3 years: 2 g/day

4-6 years: 3 g/day

7-10 year: 5 g/day

11 years and above: 6 g/day (adult requirements)

 Simple tips for reducing salt in your toddler’s diet:

  • Do not add salt to food – you can use herbs, spices and garlic/onion to make the food really yummy
  • Be careful of adult type crisp/salty crackers
  • Be careful of sauces/stock – you can find baby stock that does not have salt added and even better make your own
  • Smoked salmon, ham, cheese, bacon and many sausages contain a lot of salt, so best to keep the intake limited of these foods
  • You can also find a lot of salt in bread, snack and even breakfast cereals – food companies in the UK have really improved, but its important to be aware of hidden sources

How to read labels?

Firstly you need to know how to convert salt to sodium and visa versa, as many of the labels use sodium rather than salt.


Salt = sodium x 2.5 – so if something contains 2.4g of sodium, it means it contains 6 g of salt. Be careful as often sodium is put in mg, so 2400 mg of sodium = 6 g of salt. Let me give you some further examples: if a product per 100 g contains 300 mg of sodium, this is 0.3g sodium x 2.5 = 0.75g of salt or if the product contains 0.2 g of sodium = 0.5g of salt. Hope this makes sense.

Many products now use a traffic light system to indicate salt content and are provided per 100g portion of the specific food.


  • High is more than 1.5g salt (0.6g sodium) per 100g. These foods may be colour-coded red.
  • Medium is between 0.3 (0.1 sodium) and 1.5 g (0.6 g sodium) salt per 100g. These foods may be colour-coded in amber
  • Low is 0.3g salt (0.1g sodium) or less per 100g. These foods may be colour-coded green.


Useful Sites/leaflets

NHS Live Well Salt Guideline

You will see that the UK has published  2017 salt reduction targets for foods like ham, bread and other general products, which should help all of us in the future. You can read them here.

Sugar Free Baby-Toddler Biscuits

One of the most common questions I get from parents is about treats for their baby. The truth is that treats are driven more by us as adults than a need by the child – but by starting them, there is an expectation to continue. For me a treat is a birthday party and special occasions, but not a daily occasion. This brings me to the question about biscuits. In the UK I find a lot of nurseries and schools still provide quite sugary biscuits (and even cakes) as snacks. It is really beyond me, why this can not be changed to just fruit/fresh vegetables. In any case, I therefore set myself a challenge to work on a biscuit recipe that parents could use from 8 months of age. The reason I put 8 months is just to ensure that the baby has got the oral motor skills to manage it, so if your child is one of the more advanced baby lead “weaners”, then this could be consumed earlier, on the other hand, if your child’s oral motor skills are not quite there, then you may need to wait. Also note, this biscuit is NOT supposed to be sweet like the biscuits we eat, it just has the tinge of sweetness from the fruit added.


  1. 1 cup of flour (you can easily use 1/2 cup of flour + 1/2 cup of nut flour if you are introducing nuts early as per new guidelines – speak to your healthcare professional)
  2. 50 g of butter (I use unsalted butter)
  3. 1/4 of a grated apple – this is where it becomes exiting, I just grated apple using a very fine grate (with the skin), but you could use pear, mashed banana and many other fruit. Depending on the moisture content of the fruit you may need to grate more or sometimes less
  4. 2 Tables spoons of skimmed milk powder
  5. Tip of a knife of vanilla powder – you can replace this with cinnamon or other spices that your toddler may like



  1. Heat oven to 180C
  2. Rub cold butter into flour mixture
  3. Grate in fruit – start with a small amount and feel with your fingers the density of the dough, it needs to end up like a pastry density
  4. Add the vanilla or other spices
  5. Leave in fridge for 30 min
  6. Roll in small finger sized biscuits (so that your to Toddler can hold them)
  7. Bake for 15 min – they keep for a good 2 weeks in a tinIMG_2643

Should a toddler be on a low fat high fibre diet?

This question does come up every now and again in my practice and I do often see young children on low fat yogurts, skimmed milk, very lean meat, only whole grain products and looking very skinny and often iron deficient. Firstly, I want to say that the suggestions I am making today, are for children that grow normally and where overweight and obesity is not a problem.

Fat is the most energy dense source of nutrition in our toddlers’s diets and does not only play an essential role in the development of the cell membranes of the organs (i.e. retina) and the central nervous system, but with a small stomach capacity plays an important role in achieving energy requirements. Do you remember expressing breast milk and being surprised at the thick fat layer when the breast milk separates out?  Well, almost half of the energy from breast milk comes from fat.  The World Health Organization recommends that breast feeding ideally should continue until 2 years of age, meaning also that they have requirements for higher fat until this age.

Of course there is fat, fat and fat. So breast milk is high in essential fatty acids and therefore an ideal source of fat. We also do not want young children to have a diet high in saturated fat (i.e. animal fat), but rather a mixture of different fats – olive oil, rapeseed oil, coconut oil, avocado oil and yes they can have real butter (remember that butter can be high in salt, so check this) as well. Its best though to provide a variety of fat as each type of fat has a different role.

When it comes to protein that often contributes to fat intake – ideally one should aim for 2 portions of oily fish per week, the rest white meat, white fish and pulses and limit red meat to twice per week. When it comes to milk products, in a child that grows normally the recommendation is to have full fat milk and products until 2 year of age and then you can consider changing this to semi-skimmed milk and lower fat milk products. Remember, that fat does not only contribute energy but some of the fat sources contain fat soluble vitamins like vitamin D, E and A and omega-3-fatty acids.

Now what about fibre content of foods. Should you give whole grain rice/pasta and bread from the time you start weaning? The exact amount of fibre young infants require is unclear, but we do know that excessive fibre leads to rapid gut transit time, meaning that the food moves faster through the gut and can reduce the time for absorption. In addition, too much fibre can bind essential vitamins and minerals and reduce the availability for absorption. It is therefore better to have a balanced approach as your toddler should already have 5 portions of fruit/vegetables per day which provides plenty of fibre. I usually suggest providing whole grain (not granary) bread from when they are able to finger feed and they can have Weetabix or other whole grain breakfast cereal from 7-8 months of age (make sure low in salt and sugar), but to wait for whole grain rice/pasta and other similar products until they are one year of age.

It has become a big fashion to add ground up flaxseed and other seeds to toddler meals, but remember flaxseed for example is very very high in fibre, so your child does not get the time to absorb the omega-3-fatty acids, so rather use the oil than the seeds themselves if you want to increase the omega-3-fatty acid intake.