Nutrition and Breastfeeding Articles

I have spoken to many parents feeling a little concerned that Christmas & school holidays may throw their nutrition routine out the window. Whilst that is ok for a short time, it is absolutely possible to celebrate and have some balance too, hooray! . Try these tips for your family:

• Don’t restrict yourself or the kids. Feed yourself and children as usual leading up to social events. So for Christmas lunch, eat a normal breakfast and morning tea if late lunch. It is best not to attend events so hungry that it is difficult to think straight, as this often leads to eating beyond fullness and makes it difficult to listen to those body cues.
• Encourage and guide your children to learn their hunger and fullness cues, practice eating slowly and waiting 20-30 minutes after eating to decide if still hungry.
• At other times, stick to meal structure, try to choose foods from the five core food groups; fruit, vegetables, meat and meat alternatives, dairy and dairy alternatives and grains/cereals, as these foods provide best energy for growing and learning.
• Engage in active play as a family. Take a ball or Frisbee to a picnic.
• If you are taking a plate, why not try a balanced option, such as wholegrain crackers, chopped fruit, vegetables, cheese, dips such as hummus & tzatziki.

 
Healthy snacks at home:
Choose fresh, natural, unprocessed foods, where possible:
-        Cheese (tasty or cottage) on seeded crackers
-        Fresh fruit cut-up
-        Carrot, cucumber or tomato cut-up and served with hummus.
-        Yoghurt
-        Popcorn (for children over 3 years of age).
-        Healthy bliss balls
-        Boiled eggs
-        Nuts and seeds
-        Canned beans e.g. chickpeas
 
How do treat foods fit in?
There is no such thing as a ‘bad’ food, as balance is the key. Treat foods do fit into healthy eating, sometimes. Parties and special occasions are those time to include these foods, the rest of the time, offer healthy snacks and meals.
 
Is nutrition actually important over school holidays?
School holidays add up to 14 weeks of the year – that is over 3 months, or 25% of your child’s total diet! Keep a similar routine to school, with meals at similar times. Encourage eating at designated times rather than snacking throughout the day to promote hunger at meal times. Promote physical activity, encourage your kids to play outside and reduce time spent on screens. Hunger levels may be different to the school year, if activity levels are different too.

​By Emma McShane (Dietitian) & Nicole Bando (APD, IBCLC), December 2022

​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
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Eczema is a disorder of the immune system caused by an abnormal skin barrier, dryness and inflammation.
30% of people with atopic dermatitis (eczema) also have an allergy.  A food allergy may trigger eczema, but it is not the cause of the eczema. Some foods such as dairy may exacerbate eczema.
 
Eczema can be normally well managed by maintaining, protecting and treating the skin by:
-         Applying moisturiser (at least twice/day)
-        Use non-soap based wash or oil in the bath or shower
-        Avoiding soap and washes that produce bubbles or foam (as these may cause the skin to dry out)
-        Using anti-inflammatory creams and ointments, such as topical steroids
-        Treating bacterial skin infections with antibiotics
-        Use immune modulating treatments if prescribed by your doctor or dermatologist.
 
Food exclusion diets are only recommended to be tried in children with eczema when the above treatments don’t work. Food exclusion diets should be guided by a clinical immunologist or allergy specialist and dietitian. Only short term food exclusion is needed to determine if the food allergy is causing the eczema.
 
Dairy is often a common trigger for eczema, even if they are not allergic to dairy but to something else. Research has shown that more often than not food exclusion diets can be short-term. This is because eczema is an immune response, and in children, their immune system is not fully developed. It is predicted that as a child’s immune system develops, they are likely less sensitive to dairy causing eczema and can slowly introduce these foods back into their diet. It is important that this is done under close guidance of a paediatric dietitian.

References:

1. Eczema and food allergy. Fast facts. ASCIA. 2020. Available at: https://www.allergy.org.au/patients/fast-facts/eczema-and-food-allergy

 

1. National eczema association. Everything you need to know about eczema and food allergies. 2018. Available at: https://nationaleczema.org/blog/eczema-food-allergies/

 

1. Nikolovski A, Rallis S (2020) The Impact of Dairy Elimination on Pediatric Atopic Dermatitis. J Nutri Med Diet Care 6:044. doi.org/10.23937/2572-3278.1510044

 
 

Dairy is a common allergy in babies. In Australia and New Zealand, more than 2% of infants are allergic to cow’s milk protein. Mild or moderate signs of a dairy allergy include:
-        Swelling of lips, face, eyes
-        Hives or welts on the skin
-        Stomach pain
-        Vomiting
-        Diarrhoea
 
Severe rapid onset allergic reaction (anaphylaxis): This reaction is life threatening, and immediate medical attention should be sought by calling 000.
-        Noisy breathing
-        Wheezing
-        Swelling or tightness in throat
-        Young children may be pale and floppy
 
Delayed reactions to cow’s milk and other dairy foods can occur, and reactions usually occur hours or days after consuming dairy.
Symptoms may include:
-        Eczema
-        Delayed vomiting
-        Diarrhoea
-        Blood in the stool
 
Lactose intolerance is caused by the lack of the enzyme, lactase, which helps to digest the milk sugar, lactose. It commonly occurs after the age of 5 years.
Symptoms of a lactose intolerance include:
-        Vomiting
-        Diarrhoea
-        Stomach pain
-        Gas (wind or bloating)
These symptoms are uncomfortable but are not life threatening. Lactose-free dairy is the best alternative. Very rare lactase insufficiency in babies can present as very poor growth, severe diarrhoea and is a medical emergency.
 
Secondary lactose intolerance: may occur due to conditions such as gastroenteritis, which damages the gut lining and will resolve once the virus passes. Lactose intolerance can also present with a new diagnosis of coeliac disease; once treated, it will resolve.
 
Functional lactose overload: may occur in breastfed babies who are receiving large amounts of lactose-rich milk, often in a case of over-supply. This can be managed with the right breastfeeding support, there no need to stop breastfeeding or switch to a lactose-free formula.
 
If you notice any of the above symptoms in your child, it is important to speak to your doctor, dietitian or lactation consultant, so the appropriate action may be taken.
 
For up-to-date, evidenced based information on allergies, check out the Australasian Society of Clinical Immunology and Allergy (ASCIA) website: https://www.allergy.org.au/ 

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

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Eggs: how many is too many?
Eggs are a great source of nutrition, including protein, iron, choline, Vitamin D, B12, and selenium. Eggs contain heart healthy monounsaturated fats and also some saturated fat (which can increase cholesterol in excess). Include up to seven eggs a week, this won’t increase risk of heart disease. Those at increased risk of heart disease can eat up to six eggs per week.
 
How often should I eat fish?
Research supports including 2-3 portions of fish per week.  Try to choose sustainably sourced fish and limit high mercury options, such as shark, swordfish, barramundi, orange roughy and ling. Low mercury fish include salmon, mackerel, tuna, sardines and shellfish.
Fish are a great source of omega-3 fatty acids (unsaturated fats – known as good fats!) which contributes to brain health and development and reduces risk of heart disease.
Protein, selenium, zinc, iodine, and vitamins A and D are other important nutrients in fish.
 
Vegetables: what’s 5 a day?
We may have all heard that adults need five serves of vegetables a day. To help figure this out, a serve of vegetables is ½ cup of cooked vegetables, canned or cooked legumes, or 1 cup of green leafy vegetables or chopped salad. To achieve this, aim to include half a plate of vegetables at lunch and dinner.
 
Did you know that toddlers need 2-3 serves per day, increasing to 5 serves by aged 9? A great way to increase vegetable intake, is to offer them 2-3 times per day, for important nutrients, including potassium, fibre, Vitamins C & A. Eat from the rainbow by choosing lots of different coloured vegetables. If 5 a day feels a bit tricky, start small and try to add some chopped carrot or cucumber to your morning snack. Frozen, canned and fresh are all great options.

By Emma McShane, Dietitian, edited by Nicole Bando (APD & IBCLC), October 2022
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Water is essential for our body’s vital functions; to maintain healthy cells, eliminate by-products and excess electrolytes (salts), regulate body temperature, aid digestion and more. In a child over 12 months, it is the first choice of fluid. Many drinks (other than milk and water) contain sugar (or artificial sweeteners), colourings and limited nutrients. These drinks can impact healthy growth and reinforce a preference for sweet foods. Why not try to flavour water with mint leaves, frozen fruit pieces, orange or lemon rind?
 
Are sugar free drinks ok?
Sugar free drinks contain large amounts of artificial sweeteners, colours and flavouring to substitute the sugar. They are not a great choice for children as can promote preference for sweet foods. Carbonated drinks are acidic and can erode tooth enamel.
 
Is fizzy water ok?
Fizzy water is recommended in small amounts, as the bubbles can cause tummy upset. Research has also shown that excessive sparkling water can erode tooth enamel.
 
What about juice?
Consume in small amounts, for a child this may mean ½-1 glass occasionally. The sugar content of juices is high, as it can take 4 pieces of fruit to make 1 cup of juice! Juicing removes vital components of fruits and vegetables, such as fibre which is important for our bowels and stomach health. When making juice, use 1 piece of fruit and add vegetables such as carrot, celery, cucumber, spinach etc.
 
Are probiotic drinks ok?
Kefir is a great example of a healthy probiotic drink for children and adults. It’s a great source of Vitamins A, D, protein and calcium. Alternative, high sugar probiotic drinks on the market are not recommended for children.
 
Smoothie recipe:
 
Smoothies can be a good way and versatile way to use up fruit and vegetables in your fridge, and cook with your child. Try using this structure to make a smoothie for 1:

1. Liquid base -  e.g. 1 cup milk/alternatives (e.g. soy milk with added calcium)
2. Add 1 piece of fruit, try frozen for a creamy consistency.
3. Vegetables – add in 1-2 vegetables such as spinach
4. Flavour – add a teaspoon of nut butter, cinnamon or 1 tb of cacao.
5. Extras: 1 tb chia seeds, 2 tb of yoghurt or 2 tb of oats will boost the nutrition of the smoothie.
6. Add a handful of ice.
7. Blend and enjoy!!

By Emma McShane, Dietitian, edited by Nicole Bando (APD & IBCLC)

​Fruit contains vital nutrients including fibre, slow release carbohydrates, and myriad vitamins, minerals, plant nutrients & antioxidants (prevent damage to cells). The amount of fruit an individual needs depends on their age and stage. The type of sugar found in fruit is generally slow release energy and different to the free sugar added to processed foods, making it an excellent component of the daily diet. Leave the skin on for added fibre, to assist regular bowels and happy gut bacteria. Choose a variety of fresh, frozen or canned in juice. Watch out for products such as fruit straps, stringers & puffs as they tend to be high in fruit puree, concentrates & added ingredients, making them high sugar, low nutrient options.
 
What is a serve of fruit?
-          1 medium apple, banana, etc.
-          1 cup of canned fruit in juice
-          2 small stone fruit or kiwi
-          30g dried fruit = 4 dried apricots halves, 1 ½ tb of sultanas (include dried fruit occasionally, around once per week).
 
So how much does a child or adult need per day?
-          1-2 years: ½ serve = e.g. ½ medium apple, ½ cup canned fruit or 1 small apricot
-          2-3 years: 1 serve = e.g. 1 medium apple, 1 cup of canned fruit or 2 small apricots
-          4-8 years: 1 ½ serves = e.g. 1 apple & ½ cup strawberries,
-          9-18+ years: 2 = e.g. 2 medium apple/banana, etc. or 4 small apricots/kiwi/plums.
 
Aim to mix up the variety of fruit across the day and week. For example, a 4 year old may have 1 medium apple, and 1 small apricot to reach 1 ½ serves.
 
If your child loves fruit and is eating more than is recommended, it may mean they are missing out on other foods from the core food groups. Also, excessive fruit can lead to tummy upsets, due to the overload of fructose (this does not mean they are fructose intolerant). Try these alternative healthy snacks:

• Vegetable sticks e.g. carrot, cucumber and celery with dips

●       Corn on the cob
●       Boiled eggs
●       Cheese on crackers
●       Yoghurt
●       Nuts (if older than 5 years)
●       Snack size canned chickpeas and edamame
●       Popcorn (if older than 5 years)
 
See our article on Healthy Lunchboxes for other healthy snack ideas: https://www.nicolebando.com/articles/a-healthy-lunchbox
 
References:
Eat for Health. Recommended number of serves for children adolescents and toddlers. 2015. Available at https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/recommended-number-serves-children-adolescents-and

​By Emma McShane, Dietitian, edited by Nicole Bando, APD

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Children attend multiple parties every year. If each party provides lolly bags (alongside party food), our kids are likely to consume excessive amounts of sugar, with minimal nutrients. These foods take the place of healthier options and can impact healthy growth, mood & concentration, not to mention the copious plastic packaging that ends up in landfill. We can have a positive impact on our children and planet by choosing healthier party food options & lolly bag alternatives. Why not give these ideas a try for your next children's party?
 
-          Craft to-do sets e.g. scrapbooking materials
-          Colouring in books
-          Play-Doh kits
-          Pencils and notebooks
-          Books
-          Seedlings to grow a garden
-          Frisbee or sporting equipment such as a ball
-          Recipe cards to healthy recipes to make at home
 
Try providing these in paper bags instead of plastic bags to make your party more environmentally friendly. 

​By Emma McShane, Dietitian. Edited by Nicole Bando, Dietitian & LC

By Emma McShane, Dietitian. Edited by Nicole Bando, Dietitian & IBCLC, August 2022

At a party, a small amount of sugary food is okay, though it is important to ensure the majority of the food includes healthy options for children to ensure they are being nourished for growth & their best health. Children may have many parties over a weekend, which means their opportunity to eat high sugar, processed foods is beyond their needs for growth.
 
For quick, easy packaged food options to include in your next kids’ party, check out this link:
https://www.nicolebando.com/blog/simple-packaged-snack-swaps
 
These colourful ideas also promote growth, mood, play & concentration:
 
-          Vegetable sausage rolls made with filo pastry
-          Assorted sandwiches using multigrain bread
-          Fruit skewers
-          Fruit and yoghurt cups
-          Wholemeal pita bread pizzas loaded with vegetables such as spinach, capsicum, tomato, mushrooms etc.
-          Healthy bliss balls
-          Popcorn for children over 3 years of age
-          Cheese and crackers
-          Rice crackers & dips
-          See our allergy friendly party food list 

Lolly bags have an excessive amount of sugar and minimal nutrients, and are generally not recommended. Try swapping out lollies for something else, such as colouring books and utensils, craft ideas or recipe cards for healthy foods to make at home. Or offer 1 small treat instead of a bag.

​If you are planning a party for children who have food allergies, it can seem overwhelming to know where to start. Follow these steps for safe and yummy party food. A food allergy is when a person’s immune system reacts to the protein in a food, causing symptoms such as hives, rashes or in more severe cases swelling of the mouth and throat (anaphylaxis).  Find out which allergens you need to exclude and take it from there. The key allergens are: peanuts, dairy, wheat, egg & fish.

1. Have a plan: Find out the symptoms of the child’s food allergy. Who will be supervising them? What is their allergy/anaphylaxis plan? Make sure they have their epi-pen & you or a supervising adult knows how to use it. Call an ambulance if the child demonstrates signs of an allergic reaction.
2. Know your key allergens and read the ingredients list. It is Australian law that processed foods must be clearly labelled to include allergens using their common names (e.g. egg or milk) so that they can be easily recognised. Allergens are often shown in bold in the ingredients list. There is also a ‘contains’ section that has a summary list of the allergens present in that food. Check food labels every time you buy the product, as ingredients and processes can change. 
3. What about ‘may contain traces of?’ This means that there is a potential cross-contamination risk.  It may be best to avoid these foods for safety reasons.
4. Food preparation and cross contamination: When the tiniest amount of an allergen comes into contact with another food (e.g. crumbs from wheat bread are on the bread board used to prepare gluten-free bread) it can be enough to cause an allergic reaction. Set up the food preparation area in a clean environment away from other foods being prepared. Use only clean (using hot, soapy water) equipment when preparing food. Make sure that your hands are cleaned prior to preparing and serving as well and that any products used haven’t been exposed to allergens (e.g. margarine previously used for wheat containing bread). 
5. So what party foods can I serve? Choose fresh over processed foods, it is easier to avoid multiple food allergens this way. Have fun with fruit, e.g. fruit skewers or try our simple allergy-friendly popsicle recipe: Blend 500ml of plant-based milk, 1 tb of maple syrup and your choice of 300g frozen fruit. Pour mixture into moulds, add an icy-pole stick & freeze until solid. Also try gluten-free pizza bases with vegetables (either without cheese or with vegan cheese), tofu and vegetable skewers, mini beef burgers with gluten free rolls, 100% corn chips & avocado dip, popcorn (over 3 years), rice crackers & dried fruit.  Consider party bags that are food free and perhaps involve craft, such as colouring.
6. What about the cake? Check out this allergy free birthday cake recipe! https://www.allergicprincess.com/egg-free-dairy-free-nut-free-cake/ - if looking for a wheat/gluten free option, swap out the plain flour for gluten-free flour.

 
References:

1. What is allergy? - Australasian Society of Clinical Immunology and Allergy (ASCIA) [Internet]. Allergy.org.au. 2022 [cited 9 July 2022]. Available from: https://www.allergy.org.au/patients/about-allergy/what-is-allergy
2. Avoiding Cross-Contact [Internet]. FoodAllergy.org. 2022 [cited 9 July 2022]. Available from: https://www.foodallergy.org/resources/avoiding-cross-contact
3.  [Internet]. Allergy.org.au. 2022 [cited 9 July 2022]. Available from: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_general_info_2019.pdf

 
 By Emma McShane, Dietitian, edited by Nicole Bando, Dietitian & LC, August 2022
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A well-balanced diet with a variety of plant foods can help to ensure your immune system is functioning properly. If a diet is nutritious, there may be no need for dietary supplements.
 
The three nutrients important to maintain a healthy immune system is zinc, vitamin C and vitamin D. Zinc can be found in food sources such as lean meat, fish, nuts, seeds, and legumes. Vitamin C is found in oranges, strawberries, tomatoes, broccoli, and kiwi fruit and Vitamin D is gained from the sun, eggs, liver, and oily fish. Other nutrients of importance are selenium, iron, and protein. Check out my latest blog posts on Zinc and Vitamin C for more information.
 
A hearty, nutritious soup such as chicken soup with large amounts of vegetables or a red lentil soup, or a pumpkin soup may help increase your immunity and help with relieving some of the symptoms of a common cold. The anti-inflammatory properties of whole ingredients, including vegetables, may reduce symptoms associated with upper respiratory tract infections.  Please see my latest blog posts, for hearty, nutritious, and tasty soup recipes.
 
Fermented foods promote the growth of good bugs in our gut, which help with immunity and digestion. Examples of fermented foods to include in your diet are sauerkraut, kombucha (if less than 5g of sugar per 100g), and kefir.
 
To protect your immune system, it is recommended to reduce those foods that provide a limited amount of nutrients, such as ultra-processed foods high in saturated and trans-fat, high sugar foods, and excess alcohol. Social distancing, mask wearing, hand washing & staying home if you have symptoms are all first line defences against illness.
 
SM post 1: What do I eat to improve my immunity this flu season?
A well-balanced diet with a variety of plant foods can help to ensure your immune system is functioning properly. If a diet is nutritious, there may be no need for dietary supplements.
The three nutrients important to maintain a healthy immune system is zinc, vitamin C and vitamin D. Try out hearty soups full of vegetables and fermented foods this flu season to improve your immunity!
 
SM post 2: What foods potentially affect my immunity?
To protect your immune system, it is recommended to reduce those foods that provide a limited amount of nutrients, such as ultra-processed foods high in saturated and trans-fat, high sugar foods, and excess alcohol. Try swapping some of these foods in your diet for foods from the five core food groups, especially vegetables to improve your immunity. Are you eating a rainbow of fresh food? Social distancing, mask wearing, hand washing & staying home if you have symptoms are all first line defences against illness
 
References:
Nutrition Fact Sheet. Food and your immune system. Baker Heart and Diabetes Institute. Available from: https://baker.edu.au/-/media/documents/fact-sheets/baker-institute_food-your-immune-system.pdf. Accessed on 26 June 2022. 
 
TH. Chan. The Nutrition Source. 2020. Nutrition and Immunity [online]. Harvard, School of Public Health. Available at h https://www.hsph.harvard.edu/nutritionsource/zinc/ [accessed 26 June 2022].
 
​By Emma McShane, Dietitian. Edited by Nicole Bando (APD, IBCLC. July 2022

​Echinacea is a plant that is widely used to treat the common cold. There are nine known species that are all native to North America. The most common species used in dietary supplements are Echinacea purpurea or Echinacea angustifolia. Echinacea available for purchase can vary greatly due to different types, preparation, and parts of the plant being used. 
 
Many studies have investigated effects of Echinacea, with varying outcomes and no clear understanding that Echinachea helps to prevent a cold. However, studies have shown that some preparations of Echinacea purpurea can help to shorten the duration & severity of the common cold. This may be effective in adults, but not in children.
 
It is recommended that Echinacea preparations shouldn’t be consumed for longer than 8 weeks. At this stage, no harmful side effects are known, but the evidence for long-term use is still very limited. 
 
It is important to know that products of Echinacea on the market differ greatly. If taking Echinacea, look for Echinacea purpurea as an alcoholic extract, or pressed juice. Overall, the evidence is inconclusive & more studies are needed to determine if echinacea prevents or reduces the effect of the common cold. 
 

References:
Sachin A Shah, Stephen Sander, C Michael White, Mike Rinaldi, Craig I Coleman, Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis,The Lancet Infectious Diseases, Volume 7, Issue 7, 2007, Pages 473-480, https://doi.org/10.1016/S1473-3099(07)70160-3.
 
Linde K, Barrett B, Bauer R, Melchart D, Woelkart K. Echinacea for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD000530. DOI: 10.1002/14651858.CD000530.pub2. Accessed 26 June 2022.
 
National Center for complementary and integrative health. Echinacea. NIH. 2020. Available at: https://www.nccih.nih.gov/health/echinacea. Accessed on 26 June 2022.
 
By Emma McShane, Dietitian. Edited by Nicole Bando, APD, IBCLC, July 2022

Zinc is an important mineral involved in making new cells and enzymes to help your body fight infection. It also helps use to digest nutrients such as carbohydrates, fat, and protein in food and is vital in wound healing. Does supplementation help treat or prevent a cold? Which foods should you eat?
 
Good food sources of zinc are:
-      Meat
-      Shellfish
-      Dairy foods such as cheese
-      Bread – fortified with zinc
-      Cereal products – with added zinc
-      Nuts, seeds
 
Studies show that zinc may help to prevent or reduce the length of a cold (not COVID specific), though more research is needed. If you are vegetarian or vegan, you may need a supplementation as zinc is found mostly in animal products. The fibre in plant foods, such as legumes, can reduce the absorption of zinc. Supplements are not needed unless your diet is low in the above foods, or you are diagnosed with a zinc deficiency. Too much zinc can affect the absorption of other minerals, such as iron and copper, so it’s important to seek professional advice before supplementing. Include a good range of lean meats, fish, low fat dairy, wholegrains, nuts & seeds to meet your needs.

References:
Penny M, E: Zinc Supplementation in Public Health. Ann Nutr Metab 2013;62(suppl 1):31-42. doi: 10.1159/000348263
 
Wolfgang Maret, Harold H. Sandstead, Zinc requirements and the risks and benefits of zinc supplementation, Journal of Trace Elements in Medicine and Biology, Volume 20, Issue 1, 2006, Pages 3-18 ,https://doi.org/10.1016/j.jtemb.2006.01.006.
 
Office of Dietary Supplements. Zinc Factsheet for Health Professionals [online]. National Institutes of Health. 2021. Available at: https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/ [accessed 26 June 2022].
 
TH. Chan. The Nutrition Source. 2020. Zinc [online]. Harvard, School of Public Health. Available at h https://www.hsph.harvard.edu/nutritionsource/zinc/ [accessed 26 June 2022].
By Emma McShane, Dietitian, (Edited by Nicole Bando (APD, IBCLC),) July 2022

A balanced, nutritious lunchbox is important to support the growth and development of children. Food is fuel, that children need to learn, concentrate, thrive, play, and grow. A balanced lunchbox can help promote performance (academic, physical, emotional), as well as body image, mood and environmental sustainability. It also helps your child to learn to manage their hunger & fullness cues, a wonderful habit to take through life.
 
When providing food to children, it is up to the parent to provide:

1. The right types of food
2. Regular meals and snacks.

 
However, it is up to the child to decide:

1. What to eat
2. How much to eat

It can take up to 1-15 times for a child to accept new food, which may seem like a lot, however the lunchbox provides the perfect opportunity to introduce new foods. Role modelling and positive food environments play a key role in children trying and accepting new foods, so the school environment can have a positive effect on your child’s eating. To save time, pack lunches the night before, you can even use dinner leftovers packed into a thermos.
 
Choose an option from boxes 1-4 to create a balanced lunch box.

See below for 3 days of lunchboxes:
Also see our great resources on simple snack swaps and soy/dairy-free alternatives.

By Emma McShane, Dietitian & Nicole Bando, Dietitian, May 2022

Emma McShane, Dietitian

References:    

1. National Healthy School Canteens: Guidelines for Healthy Foods and Drinks supplied in School Canteens. Breakfast Cereals. Australian Government: Department of Health, 2013. (Available from: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/nhsc-guidelines~food-drink-table~breakfast-cereals, accessed September 3, 2021).
2. National Healthy School Canteens: Guidelines for Healthy Foods and Drinks supplied in School Canteens. Savoury Snack Foods. Australian Government: Department of Health, 2013. (Available from:https://www1.health.gov.au/internet/publications/publishing.nsf/Content/nhsc-guidelines~food-drink-table~savoury-snack-foods, accessed September 3, 2021).
3. Queensland Health. Sodium. The State of Queensland (Department of Health), 2021. (Available from:  https://www.healthier.qld.gov.au/guide/sodium/, accessed September 3, 2021).
4. Coles. Food products. Coles Supermarket, 2021. (Available from: https://www.coles.com.au/, accessed August 22 - September 3, 2021).
5. Woolworths. Food products. Woolworths Supermarket, 2021. (Available from: https://www.woolworths.com.au/, accessed August 22- September 3, 2021).
6. Tong, T., Rangan, A., & Gemming, L.  Evaluating the Nutritional Content of Children's Breakfast Cereals in Australia. 2018. Children (Basel, Switzerland), 5(7), 84. https://doi.org/10.3390/children5070084

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  

Is it normal for a toddler to be a fussy eater?
By Melbourne Dietitian, Nicole Bando
As a children's dietitian, this is a commonly asked question. Many parents feel concerned about the variety and quantity of food their toddler eats. A fussy eater is defined as a child who refuses to try a new food at least 50% of the time. Fussy eating behaviours in the second year of life are normal and part of how your child expresses their new found independence whilst exploring the world around them. It is normal for children to be uncertain of new tastes and textures; an evolutionary mechanism designed to keep us safe from danger! We have a natural preference for sweeter foods as they are higher in calories, another survival mechanism which no longer serves us.
Establishing healthy habits early in life is important for a child’s optimal growth and development, and reduces the risk of obesity and chronic disease later in life. When a child develops fussy eating behaviours, meal times can become stressful for the whole family. There are many strategies to prevent and manage selective eating habits, making meal times enjoyable once again.

2) When should I worry about my toddler's eating?
Growth slows during a child’s second year, and so their intake reduces. Many parents worry that their child isn’t eating enough, however may have unrealistic expectations of how much their child needs each day. Toddlers have a small stomach capacity and need to graze frequently throughout the day. Remember that a healthy child will never go hungry, and if energetic and thriving, they are likely eating enough. Seek help from your GP, Maternal Health Nurse or Paediatric Dietitian, if your child is:

• exhibiting extreme fussy eating behaviours and mealtimes are very difficult
• lethargic and lacks energy for daily activities
• appears unwell

• gagging or vomiting often, or has problems with chewing or swallowing
• eating a very limited variety of foods and missing out on entire food groups
• unable to drink from a cup from around 16 months
• rejecting whole food groups or groups of foods of a similar texture
• not growing or developing as expected

 
3) How can I encourage my toddler to eat what I offer them?
Are you or any other adults in the house fussy eaters? Research shows that eating meals (as often as possible) demonstrates positive role modelling. If children see their parents eating a variety of foods, they are more likely to learn and copy that behaviour. These times give opportunity to chat, as well as share a meal. Try to cook 1 family meal, so that everyone is eating the same food (may need slight modification for texture), together as often as possible. It doesn’t matter if your child doesn’t want to eat or try everything on the plate. Repeated and exposure of a variety of new foods will help your child to develop healthy habits. 
The below strategies can help manage fussy eating behaviours:
     Parents use a consistent approach with all strategies
     Keep calm, avoid a fuss as this gives issue more attention which can lead to a power struggle
     Avoid using punishment or bribes e.g. dessert as reward for eating vegetables
     Minimise distractions: eat at table, away from television, devices or toys.
     The Division of Responsibility: it is the parent’s job to offer a variety of healthy foods at the right times and the child’s role to decide what, and how much to eat.
     Offer foods in different ways e.g. broccoli with melted cheese, or stir-fried to promote enjoyment and acceptance
     Keep meal times to a reasonable time limit and develop a routine around meals.
     A new food may need to be offered up to 15 times before it is accepted. Many parents give up after a few times.
     Harness your toddler’s independence and encourage self-feeding, with a mixture of finger foods and mixed textured foods, requiring a spoon or fork
     Children love helping and can assist with shopping for the family’s food and simple meal preparation.
     Your child’s appetite can vary considerably day-to-day depending on activity and growth. If your child rejects the food offered, avoid offering an alternative, instead reoffer the food at a later stage, perhaps they are just not hungry.
     Sometimes children can be filling up on milk and this takes away their appetite for other foods. They may not be fussy, just full.
     Toddler formula is not necessary in a child’s diet. It displaces food gives preference to sweet tasting drinks. After 12 months, cow’s milk or a suitable dairy alternative can be provided as a drink. Breastfeeding may continue for as long as mother and child are enjoying it.
     Keep high sugar and high fat treat foods to a minimum. These can take place of foods from the other food groups, which means your child does not have the appetite for nutritious foods.
4) Should I force my toddler to eat?
Forcing a child to eat will create a negative association with food, which can have long-lasting effects, such as poor relationship with food, food aversions and worsening fussy eating behaviours, a high level of stress at mealtimes and reinforcing an idea that healthy foods are bad. It also overrides your child’s own hunger and fullness cues, and this can contribute to weight gain and obesity in later life. Forceful behaviour includes coercion, ‘have one more mouthful’ and negotiation, ‘eat this and you can have dessert’. If your child does not want to eat at a particular time, it can be for a whole range of reasons, so if you feel concerned, see your health professional to discuss. Children are excellent at regulating their own appetites and by using the above strategies, you can help your child to create a healthy relationship with food.  

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.