My grandson is two years old and hardly eats a thing. He will have perhaps two teaspoonfuls of Coco Pops in a day. He does drink a lot though, mainly milky tea and drinking chocolate. We have tried cutting down his drinks, but he still refuses to eat. He has been prescribed iron for anaemia. Despite this he has lots of energy, loves to play with his football and his weight is average. My daughter keeps asking the doctor if there is anything we can do, but we are told that many children are like this. What is your advice? Name and address supplied
I can see why you are concerned, although the fact that he has plenty of energy is a good sign. But it is worrying when a child doesn’t seem interested in eating. It might be worth excluding any physical reason for your grandson’s lack of interest in food. Occasionally, “hidden reflux”, where food comes back up from the stomach into the oesophagus or gullet, can be a problem and may make a child reluctant to eat because eating is followed by discomfort. It would be a good idea for your daughter to take her son to their GP to rule this out.
It is also a good sign that your grandson is growing and gaining weight, so I think a more likely explanation could be that he is getting most of the energy he needs from milky drinks and that this is suppressing his appetite. More variety in his diet will give him the iron and other nutrients he needs. A good first step would be to cut down on the milk he drinks to make him feel more hungry.
At 2, he should not need more than about 350ml of full- fat milk each day. This will give him the calcium he needs for healthy bone growth. If there is any question about the adequacy of a child’s diet, full-fat milk is always recommended. For children who eat a healthy diet, semi-skimmed milk is fine from the age of 2.
Perhaps your daughter could try cutting out a milky drink first thing in the morning to give him more of an appetite for breakfast. She could give him water or diluted fruit juice instead and offer a choice of iron-fortified breakfast cereals. Letting him choose will help him to feel in control, and he might forget his milky drink. Offering a small amount of fruit at breakfast, such as chopped apricot, raisins or banana, will also add interest and nutrients. It’s important that he has a set time for lunch and tea, preferably eating with other family members, to get into a routine. Offering him a variety of foods, and giving him plenty of opportunities to see the rest of the family enjoying them, will help him to get used to these foods.
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Young children often have small appetites, so he may prefer to have small meals with snacks; for instance, crackers and cheese, mid-morning and mid-afternoon.
Encourage his interest in iron-rich foods. Too much milk reduces the body’s ability to absorb iron and this could have happened in your grandson’s case. Red meat is the best source of iron, in a form readily absorbed by the body. White meat and fish, especially dark-fleshed and oily fish such as tuna and mackerel, also contain iron in this form. Other foods that contain iron but are less easily absorbed include vegetables, especially those with dark green leaves such as broccoli and spinach, and iron-fortified breakfast cereals. It is possible to improve the body’s ability to absorb iron from these sources by including vitamin C (in the form of green vegetables, citrus fruits or citrus fruit juice) with these meals.
If in a couple of months your daughter hasn’t seen an improvement, she should ask her GP to refer her to a community dietitian who will assess his diet and offer advice.
SUNNY SIDE UP
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I feel confused about the protection that my sons, aged 7 and 5, should have in the sun. I had always assumed that it was best to plaster them in a high- factor sunscreen, to insist that they wear flap hats and T-shirts all the time and to keep them out of the sun during the hottest part of the day. But I recently heard an American doctor arguing that children need limited unprotected exposure to the sun in order to manufacture vitamin D. Is this right? If so, how exactly does this work and how long do my children need to be in the sun in order to make sure that they make enough of this vitamin? Name and address supplied
Vitamin D is made when the sun acts on the skin, making a preliminary form of the vitamin. This is then converted in the liver and activated by the kidneys into its truly active form. It is also contained in small amounts in some foodstuffs: dairy products, oily fish and fortified cereals.
Vitamin D has several functions, including being involved in the absorption of calcium. The vast majority of children in the UK have both an adequate diet and adequate exposure to sunlight, and have normal vitamin D levels.
There is no population evidence to suggest that vitamin D deficiency is a big problem in this country. However, there are a number of people who, for cultural and ethnic reasons, are always very well covered in clothing and have reduced skin exposure to sunlight and so may be at increased risk of vitamin D deficiency.
Also, babies who are breastfed exclusively after the age of six months may sometimes be at risk and for this reason the Department of Health recommends that breastfed babies over this age should be given vitamin D drops.
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Children in this country are far more likely to be at risk of excess exposure to the sun and this carries the well- documented risks of skin cancer and premature ageing. I would advise you to continue protecting your children in exactly the way that you have been doing. This is especially important at the beach where sunlight is reflected and intensified by sand and water.
Jane Collins is the chief executive and honorary consultant paediatrician at Great Ormond Street Hospital
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OVER TO YOU
E-mail Dr Jane Collins at drjane@thetimes.co.uk or write to her at Body&Soul, The Times, 1 Pennington Street, E98 ITT. Please include your name, address and telephone number. Dr Collins cannot enter into individual correspondence.