Nutrition and Breastfeeding Articles

Drinks may be flowing in December, are you worried about overdoing it? Try these tips:

• Space them out: Alternate alcohol with water or bubbly water, to reduce overall alcohol and keep you hydrated.
• Pouring at home? Know your serves: 100mls wine & sparkling, 30mls spirits, 285mls beer (less than a stubby), 425mls light beer, 285mls cider.
• Limit cocktails, they are very high in sugar and contain multiple standard drinks.
• Be the nominated driver: If you have lots of parties, can you go alcohol free for some?
• Try zero alcohol options: a great alternative to alcohol. Check the labels before buying as remember they may also be high in sugar and added chemicals. We found these good options:
• Dash peach infused sparkling water
•  Polka botanical non-alcoholic spirit
• Iced tea homemade e.g. with a teabag and sparkling water

I’m breastfeeding, can I drink alcohol?
The safest option whilst pregnant and breastfeeding is to avoid alcohol altogether, as it can reduce breastmilk production and impact baby’s growth and development. Alcohol is present in breastmilk in the same levels as the bloodstream and it takes approximately 2-3 hours for the mother’s body to clear the alcohol in one standard drink. This time increases with each drink consumed. So if choosing to consume alcohol, wait around 2 hours before breastfeeding. Any milk expressed before the 2-hour window will need to be discarded, as it is not safe for the baby to consume. If there are times where a mother plans on drinking more than one standard alcoholic drink, plan ahead and express some breast milk beforehand to feed baby during this time. Below are two links to resources for further information:

• NHMRC Infant Feeding Guidelines
• Feed Safe App

By Emma McShane, Dietitian & Nicole Bando, APD, IBCLC
​

​Transitioning from breastfeeding or formula to family foods is a natural progression for a baby. A breastfed baby may continue to breastfeed beyond the first 12 months of life, whilst including dairy and family foods.
 
If your child is 12 months or older, it is safe to give your child whole cow’s milk (or fortified dairy milk alternatives) as a drink. Do not give cow’s milk as a drink 12 months of age, continue to breast or bottle feed. Beyond 12 months, formula is no longer required, this includes toddler formula, which is ultra-processed and creates a preference for sweet foods & takes up tummy space for core food groups, making fussy eating more likely.
 
Beyond 12 months:
 
By 12 months, a breastfed baby may include dairy in cereal, yoghurt and cheese as a snack. Continue breastfeeding as you wish, as breastmilk continues to provide ongoing benefits for health and immunity, and is a source of calcium and other nutrients.
 
A bottle fed baby may only be including a morning and night bottle of formula by 12 months. The morning feed can be replaced with a larger breakfast; add milk into cereal such as oats or Weet-bix, or try yoghurt and fruit or cottage cheese on toast. Incorporate dairy into snacks, e.g. small bowl of natural yoghurt with fruit, cheese and crackers or ½ cup of full cream milk, either after some meals or offered as a snack. . Offer dairy 3 times a day to ensure adequate calcium for growing bones.
 
What about the night time bottle?
 
Many parents report that their toddlers drink milk before bedtime and worry that stopping it will upset the bedtime routine. Parents are often concerned that their child isn’t eating enough during the day, especially if dealing with a fussy or selective eater.

There are many good reasons to change the evening milk routine. The evening bottle of milk may fill your child up and affect their appetites, which may contribute to fussy eating. Drinking milk out of a bottle or after teeth brushing can contribute to dental caries. Dairy contains 10 essential nutrients, including protein for growth, zinc for immunity and vitamin B12; essential to nerve cell function. However, it does not contain iron, so children who drink large quantities of milk are at risk of iron deficiency, as milk may replace other foods in their diet. Also other nutrients in milk can interfere with the absorption of iron, when consumed in excessive quantities.
 
Whilst your child adapts to the change, it may be a good time to alter the evening routine. Offer a small amount of milk at the end of the evening meal in a cup if concerned that dairy needs have not been met during the day. Perhaps a feeding chair can become the story chair, or moved out of the room if no longer needed.
 
Is toddler formula necessary?
Toddler formula is not required for healthy children. Formula may make your toddler too full to accept a variety of other solid foods. It is ultra-processed and creates a preference for sweet tasting foods. As it takes up tummy space for core food groups, fussy eating is more likely. Toddlers do not grow as much in their second year of life and will have variable appetites, which means some days they may eat more than others. Continue to offer a variety of foods across the core food groups to your toddler and trust their appetite, to meet individual growth needs. If you are feeling worried about your toddler’s intake, see a paediatric dietitian for support.
 
 

References:

1. Nicholas K. How to transition from formula to milk: 5 tips. Peanut app. 2022. Available at: https://www.peanut-app.io/blog/how-to-transition-from-formula-to-milk
2. Centers for disease control and prevention. Weaning. Nutrition. 2021. Available at: https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/weaning.html
3. Nicole Bando. Dairy & toddlers. Nicole Bando Paediatric & Family,  Dietitian & Lactation consultant. 2019. Available at: https://www.nicolebando.com/articles/previous/3

 
​By Emma McShane & Nicole Bando, November 2022
​

​Dairy products contain 10 essential nutrients; calcium, potassium, phosphorus, magnesium, carbohydrate, protein, vitamin A, riboflavin, vitamin B12 and zinc, important for healthy immune and blood systems, eyesight, muscle and nerve function, healthy bones, skin, energy, growth and repair of your body. If your child cannot have dairy, whether it be due to an allergy, intolerance or dislike, it is important to find alternatives that provide these nutrients.
 
Soy milk has the most similar nutritional profile to cow’s milk and is considered the best choice if your child cannot have dairy, unless they have a soy allergy. Soy milk is also high in protein. Look for soy milks with added calcium, Vitamin A, B1, B2, and B12. When opting for a milk alternative, always look for brands that contain 120mg/100mL of calcium.
 
If your child cannot have dairy and soy, other options are:
-        Oat; contains protein, fibre and is high in carbohydrates. Choose those fortified with calcium.
-        Almond milk; low in protein and carbohydrates. Again choose unsweetened brands with added calcium.
-        Coconut: High in saturated fat, and low in most nutrients e.g. protein, carbohydrates, vitamins and minerals.
-        Check out our article comparing plant vs dairy milks: https://www.nicolebando.com/articles/which-milk-a-review-of-plant-vs-dairy-milks
 
For dairy-free brands, see our article; https://www.nicolebando.com/articles/dairy-free-andor-soy-free-foods-supermarket-brands-to-look-for.
See here for information on how much dairy kids need.
 
Full cream or low fat milk?
The latest evidence suggests that full cream milk is recommended from the age of 12 months onwards, even into your adult years, unless you have high cholesterol, and then reduced fat is recommended.
 
Infants (0-12 months of age) should only be given breastmilk or infant formula. Cow’s milk as a drink is not suitable for infants under 12 months of age. Cow’s milk may be consumed as part of a meal, e.g. in cereal. 

By Emma McShane, Dietitian, November 2022 (Edited by Nicole Bando, APD, IBCLC)

By Emma McShane & Nicole Bando, March 2022
 
Some people need to remove dairy and soy products from their diet due to a food allergy or intolerance. As these foods contain vital nutrients, including protein and calcium; important for the health of our bones and muscles, dairy and soy should be replaced with nutritious substitutes. This easy to follow guide provides simple swaps to help you enjoy the foods you love and get the nutrients you need.
 
*Please note that this resource is a guide only. Always check the ingredient labels of foods, medications and supplements for allergens, as ingredients may change.  This resource displays food products labelled as dairy-free (DF*) or soy-free (SF*) or both. Products ‘may contain traces’ of either soy or dairy, please consult with your allergist or dietitian for guidance. Please note that plant based milks may not meet the growth needs of young children, seek advice from a dietitian. Daily calcium requirements vary according to age and gender.

Are you breastfeeding and avoiding soy/dairy? See this article for more about how to meet your dietary needs.
See here for more about breastfeeding & nutrition.

For further label reading advice, see: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_cows_milk_soy_2015.pdf
This does not substitute individual dietary and medical advice. 

By Emma McShane & Nicole Bando
​
New mothers need quick, convenient, and nutritious snacks and meals (see ideas & sample meal plan, below).
Choose carbohydrate foods that provide a slow, sustained release of energy, such as wholegrains e.g. wholemeal bread with seeds, oats, fruit, dairy, and starchy vegetables, such as sweet potato. These foods manage appetite and help to avoid sugar crashes. Avoid large quantities of high sugar, high-fat foods; these provide a quick release of energy, followed by a crash in blood sugar and energy levels, which can increase feelings of hunger and impact mood levels. Of course, the occasional chocolate or treat is OK.
 
Include a couple of pieces of fruit, and vegetables at least twice per day, dairy/dairy alternatives three times each day, lean meats (or alternatives), and healthy fats e.g. omega 3 & 6 fatty acids (from fish, nuts, etc.) three times each day.
For more information about the nutritional needs of breastfeeding mums, see these articles: Breastfeeding & Nutrition: www.nicolebando.com/blog/nutrition-during-breastfeedi and Weight loss after baby and special diets/situations: www.nicolebando.com/blog/weight-loss-after-baby-and-special-dietssituations
 
EASY IDEAS:
Meals:

• Omelettes loaded with frozen vegetables and cheese.
• Stir-fries with frozen vegetables and rice noodles.
• Pita bread with vegetables and low fat cheese as a cheats pizza
• BBQ chicken in wraps with salad mix.
• Meals that can be eaten hot or hold such as frittata, zucchini slice
• Serve grain foods like rice, pasta, quinoa or couscous with main-meals such as stir-fries, curries and casseroles.
• Buy meat and vegetables already diced

 
Snacks:
●      Boiled eggs
●      Individual serves of yoghurt
●      Cut-up vegetable sticks and fruit
●      Nuts & seeds
●      Canned fish, canned beans and lentils

• Leftovers – on their own or in a toasted sandwich
• Cheese and crackers

Download my easy list, below:
​

By Emma McShane & Nicole Bando
​
WEIGHT LOSS AFTER PREGNANCY
There is a lot of pressure from society on women to ‘bounce back' to their pre-pregnancy weight, however, this is not realistic nor recommended. Some of the weight gained during pregnancy is used to fuel breastfeeding, which is why breastfeeding can help a woman gradually return to her pre-pregnancy weight. Weight loss is recommended at the rate of around 2kg loss per month, as this does not affect breast milk production. It takes 9 months to grow a baby, so it is expected to take 9-12 months to return to pre-pregnancy weight. It helps to be patient, realistic and kind to the incredible body capable of growing a child. Restricting eating can affect not only a mother’s health but can reduce milk supply and impact a woman’s bone health. 
 
Aim to be intuitive with eating (e.g. listen to hunger cues), choose whole foods from the core food groups and avoid too many high sugar and high fat treat foods to help weight loss to occur gradually. See these posts on a woman's special needs whilst breastfeeding: www.nicolebando.com/blog/nutrition-during-breastfeedi and www.nicolebando.com/blog/meal-snack-ideas-for-new-parents
 
Gentle exercise has been shown in multiple studies to effectively help with post pregnancy weight loss. Exercise can help to boost overall health and wellbeing too. It is important to let the body recover after birth, and when ready, commence gentle exercise to strengthen your bones and muscles, improve sleep and stress levels, help to lose weight, and improve mental wellbeing.
 
SPECIAL DIETS/SITUATIONS:
 
VEGAN & VEGETARIAN DIETS:
Mothers who are vegan or vegetarian are at high risk of nutrient deficiencies, in particular; protein, iron, calcium, Vitamin B12, and omega-3 fatty acids. These nutrients can mostly be obtained from plant-based products, except for Vitamin B12, which is mainly found in animal products. In some cases, a blood test to check levels, and a B12 supplement may be required.
 
INTOLERANCES/ALLERGIES:
Some babies may have intolerances or allergies to proteins present in their mother’s breast milk. The most common allergies are cow’s milk, soy, eggs, peanuts, and tree nuts. Avoidance of the particular protein in the mother’s diet may be needed. However, each mother and baby duo is different, so seek medical advice from a doctor and dietitian before excluding food group(s). If a mother needs to exclude a particular protein, the nutrients from that food will need to be replaced with alternative foods (e.g. alternatives to cow’s milk for adequate calcium).
 
 
CLOSE PREGNANCIES & MULTIPLE BABIES:
Mothers who have close pregnancies are at higher risk of nutrient deficiencies, as the nutrient reserves in the body may not have been fully replenished before the next pregnancy. Iron is at most risk of deficiency, as the body may not have had time to fully replenish the stores lost during pregnancy. Supplementation of this nutrient, as well as calcium, magnesium, zinc, and essential fatty acids may be needed but it is important to seek support and guidance from a dietitian who can accurately assess your dietary intake and blood levels of these nutrients. Women who have had multiples (e.g. twins) have greater demands for nutrition and need an additional 2000kJ in energy, per baby, as well as increased vitamin and mineral needs.
 
BARIATRIC (WEIGHT LOSS) SURGERY:
There have been multiple studies that have investigated the impact of bariatric surgery on breastfeeding. People who have had bariatric surgery may be at greater risk of nutrient deficiencies, as the surgery can change how nutrients are absorbed, so it is important to check levels of vitamins and minerals before, or at the start of pregnancy, to see if supplementation is needed.  A study investigating the composition of breastmilk, comparing nourished mothers who had undergone weight-loss surgery and those that had not, found there was no significant difference in nutrient composition between the two. This, however, takes into account that it is important to still consume a balanced diet. As some bariatric surgeries may result in ongoing complications e.g. reflux or reduced food consumption or absorption, which all may affect nutrient intake, it is important to seek support from a dietitian.
 
PREMATURE OR LOW BIRTH WEIGHT BABIES:
Breastfeeding is important in babies who are premature or of low body weight as breastfeeding can reduce the risk of the baby developing medical complications. The production of milk components starts in pregnant women before 22 weeks of pregnancy, so even with very premature babies, most mothers can produce colostrum. Breastfeeding may be difficult if a baby is in the neonatal intensive care unit, requiring some mothers to express breastmilk. There are multiple barriers for both mother and baby to overcome when breastfeeding a premature, or low birth weight baby, such as a delayed or traumatic start to breastfeeding, and maternal stress. Recent studies however have shown that there is a higher rate of breastmilk feeding amongst very low birth weight infants, often due to mothers recognising the fragile health of their baby and the benefits of breastfeeding.
 
Good nutrition at this time is vital to cope with the energy demands of expressing and or breastfeeding, to maintain supply and provide energy to cope during a stressful time, and to replete nutrient stores used during pregnancy. Follow the general nutrition advice set out above. If you have experienced a bumpy start to breastfeeding, seek guidance from a lactation consultant.
 
NAUSEA & VOMITING IN PREGNANCY:
Some women experience severe nausea/vomiting during pregnancy that can affect the quality and quantity of food consumed. It is important during this time to eat high-energy and protein foods such as eggs, dairy, and meats/meat alternatives. Try having cold foods, as hot foods and their smells can exacerbate nausea. If nausea/vomiting continues, seek advice from a doctor and dietitian to see if supplementation of specific nutrients is needed. A woman who has experienced severe nausea and vomiting in pregnancy may be at greater risk of vitamin and mineral deficiencies and will need extra help to replenish her stores. 

By Emma McShane & Nicole Bando 

Nutrition whilst breastfeeding is vital to optimise the health of both mother and baby. New motherhood is a very busy time, and many women put their own health last.  A woman’s remarkable body will produce the live, biodynamic, complete food that is breastmilk that evolves with her baby’s growing needs. Milk production is robust and will only be affected in very extreme circumstances. The average woman produces 750mls of breastmilk per day, from 1-6 months. Fat stores accumulated during pregnancy are used to fuel milk production when baby arrives, though this does not cover all of the energy needed to produce breastmilk. Some elements of breastmilk are impacted by a woman’s diet and those that follow a vegetarian or vegan diet, are at greater risk of vitamin and mineral deficiencies.
 
DID YOU KNOW?

• Adequate nutrition can help with coping with a new baby and the adjustment to motherhood, mood, and energy levels. Restrictive eating during breastfeeding can impact mood, milk supply, overall coping, and bone health.

• Certain nutrients in breastmilk, such as lactose and protein are fairly constant, however the fat content of breastmilk changes according to how empty the breast is. The types of fatty acids and quantities of iodine and Vitamin B12 are also affected by the mother’s diet.

• A mother’s varied diet exposes baby to different flavours and tastes, which will help baby to accept a wider range of solid foods, including fruit and vegetables.

• Regular nutritious meals and snacks are important to nourish both mother, and baby. There is no need to aim for dietary perfection.

 
ENERGY:
An extra 2000kJ per day is needed for a breastfeeding mother, though this can change depending on individual needs. This is equivalent to a serving of spaghetti Bolognese with cheese (1 cup pasta and ½ cup sauce), or a bowl of porridge with apple, yoghurt, and nuts (½ cup uncooked oats, made with 1 cup of milk, 1 apple and a handful of nuts) or a combination of snacks throughout the day, such as yoghurt (¾ cup), popcorn (small packet/1 cup), crumpets, and peanut butter (1 crumpet with 1 tb of nut butter). Studies show that not eating enough can directly impact milk supply and composition, so a wholesome diet is vital to fuel both mother and baby.
 
FLUID:
Breastmilk production requires fluid, so a breastfeeding woman requires more fluid than usual. The amount depends on various factors such as weather conditions, activity levels, and the food eaten. Be guided by your body, and ensure you’re drinking water consistently throughout the day.
 
CAFFEINE:
Caffeine transfers directly into breastmilk, so avoid large quantities of caffeinated drinks when breastfeeding. 1% of caffeine enters breastmilk and peaks an hour after consumption. A newborn baby can take up to 160 hours to process caffeine, however by 6 months that drops to 2-3 hours, so an older baby is able to better tolerate caffeine. A morning latte or a few cups of tea across the day might not cause any issue, but observe baby; a mother may consider changing to a decaffeinated tea or coffee if she notices that her baby is very wakeful after her morning coffee. A moderate amount of caffeine a day, such as two cups of coffee (latte or espresso), three cups of instant coffee or four cups of tea is usually fine. Remember that sources of caffeine include: cola, chocolate, tea, guarana, and energy drinks.
 
Caffeine can also affect the let-down (the milk ejection reflex) and worsen nipple vasospasm (occurs when blood vessels tighten and spasm, causing nipple pain).
 
ALCOHOL
The safest option while pregnant and breastfeeding is to avoid alcohol altogether, as it can reduce breastmilk production and impact baby’s growth and development. Alcohol is present in breastmilk in the same levels as the bloodstream and it takes approximately 2-3 hours for the mother’s body to clear the alcohol in one standard drink. This time increases with each drink consumed. So if choosing to consume alcohol, wait around 2 hours before breastfeeding. Any milk expressed before the 2-hour window will need to be discarded, as it is not safe for the baby to consume. If there are times where a mother plans on drinking more than one standard alcoholic drink, plan ahead and express some breast milk beforehand to feed baby during this time. Below are two links to resources for further information:

• NHMRC Infant Feeding Guidelines
• Feed Safe App

MIXED FEEDING:
Any amount of breastfeeding increases a woman’s dietary requirements, however given the wide variation in breast milk production when mixed feeding, it can be difficult to estimate. A woman should use her appetite as a guide and may require additional foods from the core groups. A dietitian can help to guide this.

DO CERTAIN FOODS INCREASE BREASTMILK PRODUCTION?
Oats: Many women wonder if oats or lactation cookies help with milk supply, however, there is no clear evidence to support this.
Fenugreek: There is poor quality and limited evidence to suggest that fenugreek increases milk supply.
Breastfeeding with good attachment, flexibly and frequently is the best way to protect milk supply.

IMPORTANT NUTRIENTS:

By Emma McShane, Dietitian, August 2021

What is Mastitis?
Mastitis is inflammation of the breast tissue, affecting 10-25% of breastfeeding women. The majority of cases occur during the first 6 weeks of breastfeeding, however mastitis can occur at any time during the breastfeeding journey. Mastitis can be caused by engorgement or inadequate milk removal from the breast, resulting in a blocked duct. This causes the milk blocked behind the duct to be forced into the nearby breast tissue, causing inflammation. This inflammation is known as mastitis and can lead to infection. Fast and supportive treatment is needed, as mastitis can lead to early weaning from the breast, or complications such as a breast abscess if left untreated.
 
Mastitis may occur due to latching problems, sucking issues, sleepy babies, oversupply, or hurried feeds, including limiting a baby’s time at the breast. These factors can affect how much milk is drained from the breast.
 
How do I prevent Mastitis?

• Ensure your baby is well-positioned and attached to the breast.
• Make sure your bra is loose and there is no pressure on your breasts e.g. clothing or fingers while feeding.
• Feed on demand, offering flexible and frequent access to the breast, as missed feeds or long intervals between breastfeeding can increase your risk of developing mastitis.
• Relax whilst breastfeeding to help encourage your milk flow.
• Gently massage the breast by stroking towards the nipple whilst your baby feeds.
• If your breasts become uncomfortably full, wake up your baby to feed them. If they do not want to feed, express a small amount for comfort.
• Hand express to empty the breast.
• Practice good hygiene, and if using a breast pump, clean this often, as this will help to prevent contamination.
• Check your breasts frequently for lumps, pain, or redness.
• Alternate from which breast you begin each feed, as this will help to ensure one breast is drained well at every second feed.
• Let your baby finish when they’re ready to ensure they have taken the most milk out of the breast. Avoid timing your baby at the breast.
• If you choose to wean your baby, make sure you do this slowly as rapid weaning can cause mastitis.
• Stress, fatigue, vigorous exercise, or overall poor health and nutrition can increase your risk of mastitis, so self-care and adequate nutrition is essential.

 
Symptoms:
Please note that some mothers do not get the early signs of a blocked duct, and feel that mastitis comes on ‘out of the blue’. 

Treatment:
It is important that if you feel a blocked duct coming on, to start treatment immediately. The most important part of treatment is to allow for effective milk removal, regularly. 

• It is important to drain the breast often, but gently.
  
• Feed frequently, starting on the affected breast.  This is not the time to wean your baby as symptoms can worsen. Allow your baby to drain the breast and also make sure that you are offering the unaffected breast. The milk is safe for your baby to drink.
• Change feeding positions as this may help to clear the blockage. You can try positioning your baby at the breast with their chin or nose pointing to the blockage, as this will help drain the affected area.
• Gently massage your affected breast, as this will help to improve drainage and symptoms.
• Ensure good positioning and latch. A lactation consultant can help you to achieve this.
• Use cold packs on the affected breast, as this can help to reduce swelling and relieve pain. 
• Use warm heat packs sparingly just before bed (only for a few minutes), to help trigger your let-down to help clear the blockage.
• It is very important to get as much rest as possible.
• Simple analgesia can be taken as needed such as paracetamol or ibuprofen.
• When treated promptly, a blocked duct should clear in 24-48 hours. 
• If the blockage is not clearing within 24 hours, seek advice from your doctor, as antibiotics may be needed if an infection occurs. Please note that antibiotics only treat an infection, not the cause of the blockage. 
• Milk supply can sometimes be affected when mastitis is occurring, so look out for signs that your baby is getting enough milk including urine and stool output, and that your baby is putting on weight.  A change in supply can be addressed with frequent and effective feeding.
• A Lactation Consultant can check your baby's positioning at the breast to prevent mastitis & blocked ducts.
  
• Breast ultrasound can be an adjunct to treatment to help clear the blocked duct.  

 
Nutrition:
 It is very important to keep up your fluids, which means consuming >2 litres per day

• Breastfeeding is a demanding process on the body that requires more energy and protein than usual. Other important nutrients include iron, iodine, and calcium. A dietitian can help you to meet your requirements.
• Try to eat regular meals & snacks across the day, even if feeling unwell.
• Simple meal and snack ideas include: Scrambled eggs with toast and chopped vegetables, baked beans on toast, roasted chickpeas, vegetable sticks and hummus or cheese and crackers.
• Below is the Australian Guide to Healthy Eating recommended serves for each food group during breastfeeding.

 
Are probiotics helpful?

• Scientific trials have found inconclusive results on the benefits of probiotics to prevent or treat mastitis. There is an emerging field of research to suggest that probiotic use may help to prevent mastitis, however further research needs to be conducted in this area to reach a conclusion.

When a mother is breastfeeding a baby with an allergy or intolerance to dairy and/or soy proteins, these foods may need to be eliminated from the mother’s diet for 2-4 weeks, before possible reintroduction (under guidance of a health professional). These conditions include Cow’s Milk Allergy, Food Protein Induced Allergic Proctocolitis (FPIAP) and Food Protein-Induced Enteropathy (FPIES).
 

• Both dairy and soy are common food sources of calcium, and many other important nutrients including Vitamin A, Vitamin B12, protein, zinc & magnesium.
• Calcium is vital to ensure strong bones and teeth and reduce the risk of osteoporosis, therefore it is important to find other sources of this mineral within your diet.
• A mother who cuts dairy and/or soy out of her diet may be at risk of developing weak bones and osteoporosis if she doesn’t replace these foods with alternatives
• Calcium in the breastmilk is constant and comes from the mother’s skeleton. A women’s dietary intake of calcium, or supplements does not affect the amount in breastmilk.
• The calcium taken from the mother’s bones is restored within a few months of stopping breastfeeding. Studies show that women who breastfeeds are not at higher risk of osteoporosis than a woman who does not breastfeed. 

​Below is a table of dairy-free (DF) and/or soy-free (SF) food sources of calcium. Check food labels every time you buy a food, medication or supplement, as ingredients may change. Use this guide for label reading: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_cows_milk_soy_2015.pdf

​

This sample meal plan provides 1319mg of calcium across the day, and meets nutritional requirements from the five core food groups, in line with the Australian Guide to Healthy Eating (AGTHE), for a breastfeeding woman. It is a guide only. 

​Sometimes a calcium supplement is needed to ensure that you are getting the amount of calcium you need every day. Your dietitian or GP will help you decide if a supplement is necessary. 

References:
1.UCSF Health (2021). Calcium content of foods. University of California. Accessed June 10th 2021. Available from: https://www.ucsfhealth.org/education/calcium-content-of-foods
2.Nutrient Reference Values (2014). Calcium. NHMRC. Accessed June 10th 2021. Available from: https://www.nrv.gov.au/nutrients/calcium
3.Fishbein L. (2004). Multiple source of dietary calcium – some aspects of its essentiality. Regulatory Toxicology and Pharmacology. 39(2);67-80. Accessed June 10th 2021. Available from: https://doi.org/10.1016/j.yrtph.2003.11.002.
4.Gueguen L., Pointillart A. (2013). The Bioavailability of Dietary Calclium. Journal of the American College of Nutrition. 19;sup2, 119-136. Accessed June 11th 2021. Available from: 10.1080/07315724.2000.10718083
5.Australasian Society of Clinical Immunology and Allergy. Cow’s Milk (Dairy) Allergy. ASCIA, 2019. (Available from https://www.allergy.org.au/images/pcc/ff/ASCIA_Introducing_Foods_Fast_Facts_2019.pdf, accessed  May 31st, 2021).
​6. Australian Guide to Healthy Eating Serve Sizes [Internet]. Eat for Health. Australia; 2015. Accessed June 23rd 2021. Available from: https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/serve-sizes  

Calcium is an essential nutrient for building healthy bones and teeth. The majority of our body’s store (99%) is found in the skeleton. The major source of calcium in our diet is dairy; though it is present in other foods too. Many parents report that their toddlers drink milk before bedtime and worry that stopping it will upset the bedtime routine. Parents are often concerned that their child isn’t eating enough during the day, especially if dealing with a fussy or selective eater.

There are many good reasons to change the evening milk routine. The evening bottle of milk may fill your child up and affect their appetites, which may contribute to fussy eating. Drinking milk out of a bottle or after teeth brushing can contribute to dental caries. Dairy contains 10 essential nutrients, including protein for growth, zinc for immunity and vitamin B12; essential to nerve cell function. However, it does not contain iron, so children who drink large quantities of milk are at risk of iron deficiency, as milk may replace other foods in their diet. Also other nutrients in milk can interfere with the absorption of iron, when consumed in excessive quantities.

So how much calcium does your child need? 1-3 year olds require 500mg per day, this increases to 700mg at 4-8 years. 1 serve of dairy provides 250mg of calcium, so a toddler needs two serves per day. See the list below to check your child’s diet for adequate calcium.

1 serve of dairy = 250mg calcium:
250ml milk
2 slices cheese – 40g
½ cup evaporated milk
½ cup ricotta cheese
¾ cup yoghurt
1 cup calcium fortified grain or nut milk
Other sources include:
100g almonds
60g sardines
½ cup canned salmon with bones
100g firm tofu – may differ between brands

Whilst your child adapts to the change, it may be a good time to alter the evening routine. Offer a small amount of milk at the end of the evening meal in a cup if concerned that dairy needs have not been met during the day. Perhaps a feeding chair can become the story chair, or moved out of the room if no longer needed. Offer full fat dairy at other times of day, for example – milk in cereal, yoghurt with fruit or cheese and biscuits as a snack, to easily meet the daily requirements.  Breastmilk continues to be a source of calcium and other nutrients for breastfed toddlers.

A word on toddler formulae - these are not required for healthy children. Beyond 12 months, children should be eating the same foods as the rest of the family. Formula may take up valuable stomach space and prevent a child from accepting a variety of solid foods. Offer foods from all groups, including adequate dairy; and though toddlers may not eat consistently from day to day, this will help to ensure that your child's growth needs are met. If you feel uncertain, see a paediatric dietitian for thorough assessment of your child's diet.
Fussy eating is a normal stage of toddlerhood that usually passes. A healthy child will never go hungry. As parents, offer a variety of fruit, vegetables, meat or alternatives and whole grains over the day to help your child get used to different tastes and textures. Their intake will vary day to day. If your child is a very fussy eater, is not growing well or you feel concerned about lack of variety, see your NEST GP and our Women’s and Infant Health Dietitian and Lactation Consultant, Nicole Bando.

References
1. Osteoporosis Australia www.osteoporosis.org.au (accessed 18/10/17)
2. National Health and Medical Research Council. Eat for Health Australian Dietary Guidelines Summary. Canberra: Commonwealth of Australia, 2013. (Available from: https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55a_australian_dietary_guidelines_summary_book.pdf, accessed 18th October 2017).

Thanks to Victoria Hobbs, Deakin University for data collection.

It’s time to examine a snack that has been trending for some time; the bliss ball. Are they actually a healthy snack and what sort of marketing tricks to the companies use to lure us in? I look at kilojoules/calories per serve, as well as fibre, sugar and protein per 100g. What are the top 3 ingredients – do they contain sugar, do they contribute nutrients? A good guideline for a snack is generally 300-600kJ, depending on your nutrition goals.
Let's compare products:

1. Special K protein bliss bites: 420kJ/serve, moderate fibre, low sugar and a good source of protein (from milk). The fats and protein may improve satiety.
​
2. Carmen’s Bliss Balls : ~312kJ/serve (similar calories to an apple), 6-10g fibre/100g, high sugar 39-47g/100g across the range. A source of refined sugar, the primary ingredient is dates. Contain nuts, so a valuable source of protein. However, will 1 bliss ball fill you up? Consider how many you need in order to feel full and note if they take you through until the next meal.

3. Creative Gourmet Super Balls (fridge section): 525kJ/serve (equivalent to 1.5 apples), moderate fibre 6g/100g (2.1g per serve, an apple delivers up to 3-5g), high sugar 24.5g (mainly from dates as the first ingredient), good source of protein (whey), though also high in saturated fat from coconut cream.

4. I Quit Sugar’ Superfood protein ball mix:
This product is so directly misleading. Initially appears to be a good contender for a healthy snack: it is high in fibre, low in total sugars (<3g/100g) and 486kJ per serve. Its main claim to fame is being fructose free.
However, THIS DOES NOT INCLUDE the ingredients that must be added to the mixture to actually make the protein balls. Once the rice malt syrup, coconut oil and coconut are added, these protein balls lose the ‘no sugar’ kudos and increase to 640kJ/serve, refined sugars increase to ~25g/100g and they are a source of saturated fat from all of that coconut. This is marketing genius at its best. Not much better than a muesli bar and so very misleading.
Note: I have checked to see if I can locate this product and it is temporarily unavailable. Check other mixes such as these to see if the nutrition information panel reflects ALL ingredients, or dry portion only.

5. Bounce Peanut bliss balls:
A high energy snack with 880kJ/serve, they are low fibre, high sugar, despite being a good protein source – (derived from ~30% nuts). The second listed ingredient is brown rice syrup. This is OK as an occasional snack if you are very active, but may not fill you up for long and could contribute to weight gain over time.

6. Bounce Cacao raspberry balls:
High energy at 710kJ per ball, high sugar and moderate fibre. A better choice than the peanut ones, but not by much.
My verdict? Choose the top 2 products, stick to the serving size. Enjoy occasionally and observe if they fill you up enough to last until the next meal. They are similar in nutritional profile to muesli bars. Alternatives such as fruit, low fat dairy, nuts, seeds and grains provide more benefit nutritionally.

Why not make your own bliss balls at home to enjoy occasionally? This way you can reduce the serving size and choose the ingredients that will be healthiest. I like this recipe from shift nutrition:
https://shiftnutrition.com.au/recipe/chocolate-peanut-butter-bliss-balls/ (~300kJ/serve)

DISCLAIMER: I RECEIVE NO FINANCIAL BENEFIT FROM REVIEWING THESE PRODUCTS, THIS IS AN INDEPENDENT PRODUCT REVIEW BASED ON MY PROFESSIONAL OPINION. I HAVE REVIEWED A SMALL RANGE OF AVAILABLE SUPERMARKET PRODUCTS, THIS IS NOT AN EXHAUSTIVE COMPARISON.