Nutrition and Breastfeeding Articles

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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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

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
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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:
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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.

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INTRODUCTION TO SOLID FOODS,
By Emma McShane, Dietitian
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The World Health Organisation states ‘infants should be exclusively breastfed for six months and after this time continue breastfeeding with appropriate introduction to solids’ (2020).
When breastfeeding is not possible, bottle feeding is recommended.
How do you know if your baby is ready for solid foods?

• Your baby has good head and neck control and can sit upright when supported
• Your baby shows an interest in food e.g. looks at or reaches out for your food
• Your baby opens their mouth when offered food on a spoon
• Your baby has an increased appetite, is feeding more often, and wants more breast milk or formula at the end of their usual feed.

 
VARIETY OF FOODS:
It is important to include a variety of foods from the five core food groups in your baby’s diet.

CEREAL FOODS
Be sure to offer a variety of grains including wheat, rice, oats and corn.
Example of cereal foods: Bread, crackers, pasta, iron-fortified cereals e.g. Weet-bix, all bran

DAIRY FOODS
Yoghurt, cheese, and cow’s milk on cereal.
Cow’s milk should not be given as a drink (instead of breastmilk or formula), for babies under 12 months of age.

MEAT AND MEAT ALTERNATIVES
Beef, lamb, poultry, well-cooked egg, fish, other seafood, legumes (e.g. lentils and chickpeas)

VEGETABLES AND FRUITS
Can be grated, cooked, pureed or mashed.

Introducing Common allergy causing foods:

• Common allergy causing foods should be included in your baby’s diet before nine months of age, as research has shown that early introduction may reduce the chance of your baby developing a food allergy.
• These common allergy causing foods are: Eggs, Cow’s Milk, Wheat, Soy, Peanut, Tree nuts, Sesame     Fish, Shellfish
• It is important to introduce one new allergy causing food at a time, early in the day, and then wait a few days to try another new food, so that you can identify any foods that may cause an allergic reaction.
• An example of how to introduce an allergy causing food, is to mix a small amount (1/4 tsp) of an allergy causing food e.g. hard-boiled egg or smooth peanut butter into your baby’s usual food e.g. vegetable puree. If there are no signs of an allergic reaction (These signs include: hives, welts, swelling of the lips, vomiting, or change in behaviour), then gradually increase the amount next time (1/2 tsp). If your baby does show signs of an allergic reaction, stop offering the food and seek immediate medical attention.
• It is important that once you have introduced these foods, to include these foods in your baby’s meals at least twice a week.

The below is a guide of solids progression, showing texture, quantity and breast/bottle feeds; it may be highly variable for each baby. You may also choose a ‘Baby Led Weaning’ approach, this involves introducing solids through appropriately textured and sized finger foods and allows your baby to explore the food themselves. There is no set way to feed your baby, so do what feels best for your family.
The above is an approximate guide for food quantities and expected number of breast and bottle feeds, this is because there are no set guidelines, as each baby will progress differently. If you feel unsure about how to introduce solids to your baby, a Children's Dietitian (Paediatric Dietitian) can provide specialised feeding advice.
  
6 MONTHS

TEXTURES
Coarsely pureed/mashed

QUANTITIES
1-2 tablespoons, twice a day (start with 1 meal and progress to 2 over weeks).

EXPECTED NUMBER OF BREASTFEEDS
Breastmilk is the main nutrition source. Continue breastfeeding on demand.

EXPECTED NUMBER OF BOTTLE FEEDS
If your baby is not breastfed, continue with bottle feeds, as this is still the baby’s main nutrition source. Slight decreases may be seen in the amounts taken.

EXAMPLE OF FOODS
Start with iron-rich foods; as your baby’s iron stores gained during pregnancy start to run low. These foods include fortified baby cereals, eggs, beans, lentils and soft cooked and pureed meat. Introducing allergy causing foods e.g. yoghurt added to pureed fruit and vegetables, Semolina porridge made with breast milk or infant formula.

6-8 MONTHS

TEXTURES
Lumpy, finely chopped, progressing to finger foods

QUANTITIES
Progressing 1-4 tablespoons of food 1-3 times/day by 8 months (slow progression) – up to ½ cup of food

EXPECTED NUMBER OF BREASTFEEDS
On demand

EXPECTED NUMBER OF BOTTLE FEEDS
3-5 times per day at 6-8 months

EXAMPLE OF FOODS
Peanut butter added to mashed foods or porridge, hummus mixed into mashed vegetables, finely shredded, soft meat added to puree vegetables.

8-10 MONTHS

TEXTURES
Grated, diced, chopped finger foods, progressing to regular menu
You’ll find your baby starts to play with their spoon. 

QUANTITIES
Up to 1 cup of food at each meal
At 9 months: 3 meals
At around 10 months: Introduce mid-meals, roughly ½ to ¾ cup of food (e.g. ½ cup full fat yoghurt with cut up banana).

EXPECTED NUMBER OF BREASTFEEDS
On demand; By 9 months: 4-5 breastfeeds

EXPECTED NUMBER OF BOTTLE FEEDS
3-4 formula feeds at 9-12 months

EXAMPLE OF FOODS
Well-cooked spiral pasta as finger food, hard-boiled egg with mashed avocado, soft grated cheese as finger food, pikelets.

10-12 MONTHS

TEXTURES
Chopped finger foods, Begins spoon feeding

QUANTITIES
Small balanced meals 3x/day e.g. 1 scrambled egg, chopped soft fruit, 1 Weetbix with cow’s milk, plus mid-meal snacks 1-2x/day.

EXPECTED NUMBER OF BREASTFEEDS
On demand; 3-4 breastfeeds per day

EXPECTED NUMBER OF BOTTLE FEEDS
600mL Bottle feed/day

EXAMPLE OF FOODS
Omelettes, cottage cheese and fruit mixed together, bread offered as toast fingers or sandwiches, homemade fish fingers, pesto sauce with pasta.

1-5 YEARS

Family foods (avoid small, hard pieces of food).  Can offer cow’s milk as a drink after 12 months.
Example foods: Scrambled eggs, Crumbed fish, vegetables dipped in hummus, pastas, cereals with cow’s milk
 
References:

1. Australian Breastfeeding Association. Breastfeeding and family foods.  ABA, 2020. (Available from: https://www.breastfeeding.asn.au/, accessed May 31st, 2021).
2. Australasian Society of Clinical Immunology and Allergy. Introducing foods and allergy prevention fast facts. ASCIA, 2019. (Available from https://www.allergy.org.au/images/pcc/ff/ASCIA_Introducing_Foods_Fast_Facts_2019.pdf, accessed  May 31st, 2021).
3. NIP Allergies in the Bub. Introducing solid foods. Prevent Allergies, 2018. (Available from https://preventallergies.org.au/introducing-solid-foods/, accessed 31st May 2021).
4. NIP Allergies in the Bub. Around 6 months (not before 4 months). Prevent Allergies, 2018). (Available from https://preventallergies.org.au/wp-content/uploads/2020/10/Food-Ideas-for-Babies-around-6-Months.pdf, accessed May 31st 2021).
5. NIP Allergies in the Bub. Around 7 to 9 months. Prevent Allergies, 2018. (Available from: https://preventallergies.org.au/wp-content/uploads/2020/06/RECIPE-IDEAS-FOR-BABIES-7-9-MONTHS.pdf, accessed May 31, 2021).
6. NIP Allergies in the Bub. Around 10 to 12 months. Prevent Allergies, 2018. (Available from: https://preventallergies.org.au/wp-content/uploads/2020/06/RECIPE-IDEAS-FOR-BABIES-10-12-MONTHS.pdf, accessed May 31, 2021).
7. Castle J., Jacobson M.  (2013). Fearless Feeding. Jossey Bass. pp 40-54. Accessed May 31, 2021.
8. Surwald, D. (2017). Baby-led weaning & introduction of solids. Peninsula Health. Accessed June 10th 2021. Available from: https://www.peninsulahealth.org.au/2017/08/25/baby-led-weaning-introduction-of-solids/

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).