If there are two things I’ve learnt since becoming a mum, the first is that we can only try our best to get things right. The second is that it’s often impossible to do everything we set ourselves in one day. On a good day, I manage half. On top of this, food has become tricky – we’re offered so many types; sophisticated food marketing can make it difficult to work out whether or not something is healthy or not; and we’re offered advice and mixed messages from family, friends, Government and the media.

As both a mum and a nutritionist, I passionately believe that the food we feed our children has an enormous impact on their day-to-day health, how their bodies develop, their ability to learn and to concentrate. It’s this passion that I want to pass on to parents, to inspire you to nourish your child’s potential. I hope my advice and recipes will boost your knowledge, confidence and energy, so that you can feed your child nutritious food and turn eating well into a central and deliciously fun-filled part of your lives.

KEY CONCERNS

Organic food
Additives
Probiotics
Prebiotics
Sugar
Salt
The vegetarian child
The vegan child
Keeping a food diary

CURING EVERYDAY PROBLEMS WITH FOOD

Colds & coughs
Concentration
Constipation
Diarrhoea
Food poisoning
Nausea 

 

CHILDHOOD HEALTH CHALLENGES

ADHD
Asthma
Coeliac disease
Diabetes
Eczema
Food allergies & intolerances
Glandular fever

Panic attacks

Being a Nourish parent

 

Key concerns

Organic food

I try to buy organic food where possible, though not exclusively. Studies haven’t categorically been able to show that organics food is better for us. But our kids’ immune systems, guts, growing bodies, are surely better off not being bombarded with the heavy toxins, pesticides, waxes and hormones so often found in non-organic produce. That said, I also think it’s important to buy locally grown food, which means it will be seasonal.

For more about organic food, see Nutrition Basics: Fruits and Vegetables - Should I buy organic?

 

Additives

When we talk about additives, most people rightly think of E numbers, but although I would generally avoid these as much as you can, not all E numbers are bad! Some of them are even natural ingredients such as vitamin C and vitamin E. Additives can enhance the flavour, texture and appearance of food. Others help stop food from becoming rancid, going off and being prone to bacterial growth.

Some E numbers have been criticised for what many people feel is their negative effect on kids – some make kids go wild, or sedate them, others can give them headaches. And research still can’t tell us the long-term effects of eating a diet high in additives.

Most additives are found in processed foods, which makes avoiding them easier.

These are the ones to look out for and to steer clear of:
• Tartrazine (E102)
• Sunset Yellow (E110)
• Carmoisine (E122)
• Ponceau 4R (E124)
• Sodium benzoate (E211)
• Other benzoates (E210-219)
• Sulphides (E220-228)
• Nitrates and nitrites (E249-252)
• Monsodium glutamate and other glutamates (E621-623)
• Antioxidants (E310-312, E320-321).

 

Probiotics

Everyone has probiotics – also known as ‘friendly bacteria’ – in their gut. Their main purpose seems to be to help maintain a healthy digestive system. They break down tough fibre, enzymes and other proteins found in food. They produce important nutrients such as vitamin K and they ferment organic acids, which are absorbed for energy. They also fend off disease and infection, help treat diarrhoea and reduce susceptibility to dermatitis.

The balance of good bacteria in the gut can be upset by stress, poor diet and antibiotics (also, for adults, age, ill health and alcohol). I recommend taking antibiotics for getting over short-term problems like a tummy but or if your child is taking antibiotics for an infection.

For longer-term benefits, regular daily intake is required. A small pot of bio yoghurt with probiotic bacteria is an inexpensive option (it’s also rich in calcium and magnesium). Or, if your child has had a tummy upset or antibiotics, you could give a daily capsule of probiotic bacteria (containing at lease a billion bacteria per dose; they need to be kept in the fridge to keep the bacteria live) for a couple of weeks. I’ve seen some kids’ guts recover very quickly from being very runny or painfully constipated after taking probiotics.
Probiotic supplements Experts are divided on how effective they are. To maximise the chances of the supplements working, take them with food (or open the capsue and sprinkle on your child’s food), keep them in the fridge and make sure the ones you buy have been kept refrigerated in the shop.

Probiotic drinks These are not regulated because they are classed as foods, and some studies have found they do not claim the amount of probiotics they claim. A supplement needs to contain 1 billion bacteria per capsule to be effective.

The names to look out for:
• Lactobacillus acidophilus
• Lactobacillus casei
• Lactobacillus delbreckii
• Bifidobacterium adolescentis
• Bifidobacterium longum
• Bifidobacterium infantis

 

Prebiotics

These are carbohydrates that feed the friendly bacteria and not digested by the body’s own enzymes. The two main ones are insulin and oligofructose. Current thinking is that we should give our bodies roughly 5g of prebiotic sugars a day. Good sources include asparagus, bananas, barley, chicory, garlic, Jerusalem artichokes, leeks, milk, onions, tomato, wheat and yoghurt. It can be difficult to get enough prebiotic inside our kids from a normal diet, so I suggest you top up with a prebiotic supplement.

 

Sugar

So many parents are unaware of how much sugar their children are eating and the damage it could be doing. As well as the risk of long-term health problems such as diabetes and obesity, many parents (myself included) find their kids turn into wild ‘little monsters’ after consuming quickly absorbed sweet foods – fizzy drinks, for example. If you can start children off on a healthy and naturally low-sugar diet, though, they won’t miss the extreme sweetness of so many refined foods.

Of course we know that sugar is found in sweets, cakes and biscuits. But it also turns up in cough mixtures, ready-made meals, soups, sandwich spreads, juices and yoghurt drinks.

 

Nourish tip: look at the label – if a sweet snack has more than 10g sugar, try to find an alternative treat.

How much sugar per day?

1-3 years old, a maximum of 31g for boys and 29g for girls
4-6 years old, a maximum of 43g for boys and 39g for girls
7-10 years old, a maximum of 55g for boys and 46g for girls

If your child has a lot of sugar, try to wean them off it slowly, say over a month, as they may rebel otherwise. You could dilute juices with water or reduced processed sweet foods to every other day. For more advice on reducing sugar intake, see Sugar in Nutrition Basics.

 

Nourish tip: don’t ban sweet foods entirely as you may find your child starts to eat them in secret.

Salt

None of us needs the levels of salt we come across in everyday life. Even if you’re not adding salt to fresh foods, you can stumble across it in bread, breakfast cereals and other foods your tongue wouldn’t detect as salty. Experts now think we consume as much as 75% of our salt intake from processed foods, while only 9% is added in cooking at home and 6% at the table.

Too much salt causes high blood pressure, which increases our chance of developing heart disease and stroke. Diets high in salt have been linked to asthma, stomach cancer, brittle bones and fluid retention.

Maximum recommended daily amounts of salt in the diet for children:

• 1-3 years old, 2g salt (equivalent to 800mg sodium)
• 4-6 years old, 3g salt (equivalent to 1.2g sodium)
• 7-10 years, 5g salt (equivalent to 2g sodium).

One of the reasons it’s really important not to add salt to your child’s food early on is so that you don’t give them a craving for it – like sugar. If you’ve already been in the habit of adding salt, and maybe a few high-salt foods have been standard in your family’s diet, try over the next few weeks to reduce the amount of salt you add to food – don’t do it all at once, otherwise your child will notice and may refuse the ‘bland’ food.

For more on salt and tips on how to reduce intake, look at Salt in Nutrition Basics.

The vegetarian child

It’s perfectly possible to bring up children as vegetarians and for them to thrive nutritionally. In fact, studies have shown that children brought up on a vegetarian diet consume more fresh fruits and vegetables and are less likely to suffer from obesity and diseases such as bowel cancer and heart disease as adults.

You will need to watch that your child is getting the full spectrum of key nutrients and in plentiful quantities.

 

Vegetable protein

Children’s bodies need protein because the amino acids it contains help to build and replenish a strong digestive, muscular, hormonal and immune system. Animal protein is what we call complete, as it contains sufficient quantities of all the essential amino acids that the body needs. The same can’t be said about vegetable protein, with the exception of soya (and soya products, such as tofu) and seaweed. It’s simple to get round this by keeping up a wide variety of the plant-based proteins.

Sources of protein in a vegetarian diet:

Legumes: Chickpeas, Butter beans, Black-eyed beans, Kidney beans, Borlotti beans, Haricot beans (used for baked beans)

Pulses: Lentils, Split peas, Dried green peas Soya products: Miso (fermented soya bean paste), Tofu (soya bean curd), Tempeh (soya meat alternative), Tamari (wheat-free soy sauce)

Nuts and seeds: Almonds, Brazil nuts, Cashew nuts , Hazelnuts, Pine nuts, Peanuts , Walnuts, Sesame seeds, Sunflower seeds, Pumpkin seeds

Vitamins and minerals

Your vegetarian child should have a plentiful supply of five key minerals – calcium, magnesium, iron, zinc and selenium – as these are required to build and maintain their bones, heart and immune system, and also to help ensure their body remains healthy. Good sources include dairy produce, green leafy vegetables, nuts and seeds, dried fruit, fortified breakfast cereals, lentils and baked beans.

Energy

Children, especially vegetarian children, need good healthy sources of energy in their diet, which usually come from fats and carbohydrates. On the fat side there are two main types: those that come from animal foods, such as butter, cream, cheese, yoghurt, milk, and those that come from vegetables, seeds, nuts, olives, avocados, hemp and nut oils.

There are great advantages for vegetarian children if you include some dairy foods in their diet. As well as being energy-giving foods, they also provide a good source of calcium and some vitamin D. However, you need to watch that they don’t consume too much dairy, otherwise they might start to put on too much weight or begin having problems with the amount of saturated fat in their diet.

Although soya milk and soya products contain plenty of protein, they tend to be very low in fat, so they’re good for children’s hearts but are not great for energy boosting. Include other vegetable fats, too – for example, you could make porridge based on soya milk but then stir in a dollop of nut butter or a teaspoon of ground seeds and nuts.

Veggie fast foods

Ready-made vegetarian foods can contain hydrogenated or trans fats – check the labels. They can also be high in calories, as manufacturers sometimes pile in a lot of oil and cheese, which can be a problem for kids who have an issue with excess weight. Fast-food outlets such as burger bars can produce very fatty, high-calorie veggie burgers with not many vegetables in them, so be wary of these.

Find some tasty vegetarian recipes kids will love here.

The vegan child

It’s a lot easier to follow a vegan diet now that supermarkets, health food stores and online suppliers stock such a wide variety of non-animal milks, yoghurts, butters, cheeses and ready-made vegan meals based around ingredients such as nuts, grains, pulses and soya. The problem with ready-made vegetarian and vegan foods is that they can be high in hydrogenated fats, which have been linked to heart disease. This doesn’t mean you can’t grab a tofu burger every now and then, but try as much as you can to make up your child’s foods from fresh ingredients.

Too much fat isn’t good for any child, but since the vegan diet is generally very bulky, full of vegetables, fruits and grains, it’s important you don’t shy away from using oil or nut butter in each meal. Vegan children really need the calories and energy hit that fats bring – so drizzle oils over vegetables, dip bread in oil at the table, make a sandwich with creamy hummus and roasted vegetables, or top warm toast with tahini and sliced peaches.

Vegan store cupboard essentials

• Seed pastes like tahini, which can be stirred into bean salads and is the basis of hummus. Tahini can be spread on bread or crackers as a butter substitute, stirred into a bowl of pasta or used to top jacket potatoes.

• Nut butters such as peanut, cashew, hazelnut and almond. Yummy on bread and rice cakes and good in vegetable casseroles and bakes.

• Vegetable oils that help vary the taste of recipes but also contain different fatty acids – for example, walnut oil is rich in omega-3 fatty acids and avocado oil is rich in monounsaturated fats. Check out rapeseed, avocado, nut (walnut, hazelnut, peanut, etc.) and hemp oil.

• Avocados are wonderfully creamy and rich in fat – good on jacket potatoes, in salads and sandwiches, even mashed on rice cakes spread with nut butter and sliced banana.

Watch the B vitamins

You need to ensure that your vegan child gets enough vitamin B12, as this is a nutrient that’s often low in the vegan diet. You can buy fortified cereals, soya drinks, spirulina (a form of algae which you can buy in capsule or powder form and stir into smoothies) and low-salt yeast spreads to spread thinly on slices of hot toast. However, it’s not easy to get your child to eat enough of these foods to cover their basic requirement, so consider giving them a supplement containing 1.2 mcg per day until they’re 9 and then increase this to 1.8mcg per day.

Omega-3 fatty acids

The best source of omega-3 fats is oily fish. If your child is vegetarian or vegan, their main source of omega-3 will be from ALA (alpha-linolenic acid), found in linseeds, soya bean oil, pumpkin seeds, walnut oil, rapeseed oil and soya beans. The ALA is then converted in the body to EPA and DHA. Unfortunately, due to the body’s inefficiency at converting ALA, it’s hard to provide these two vital fatty acids in the amounts the body needs. I suggest giving your child a vegetarian omega-3 supplement to cover their needs. This will take the pressure off you, and means you can enjoy using seeds, nuts, etc, as part of their general diet without thinking they’ve got to consume a certain amount in order to meet their omega-3 requirement.

Keeping a food diary

This can be one of the best ways not only to check how your child’s diet is going, but also to see the effect specific foods are having. Try to record things as your child eats and drinks them.

• Date and time
• Food and drink consumed - if you know the ingredients, write those down too. 
• Quantity - use ordinary household measures, e.g. teaspoon, slice.
• Symptoms - e.g. crabbiness, constipation, nausea, tummy-ache.

Curing everyday problems with food

Colds and coughs

Dairy products are not responsible, as many believe, for causing blocked sinuses – and to deplete a child’s body of calcium is a mistake. The answer is to help strengthen the body’s immune system.

• Nourishing soups soothe won’t hurt sore throats

• Honey and lemon is a classic and effective remedy for cold symptoms

• Hydration is very important: aim for your child to drink about 2 litres of water a day.

Concentration

There are five elements to boosting attention span and concentration: brilliant breakfasts, sustaining sugars, intelligent fats, wonderful water, and cutting out brain-cloggers.

• Brilliant breakfasts. Eating breakfast has been show to positively influence ability to sole problems and boost concentration and memory. Others studies show that kids who eat breakfast tend to be more creative and have more energy for longer. Try wholegrain cereal, toast or a fruit smoothie.

• Sustaining sugars. There’s an enormous amount of evidence to show that our kids’ academic work level improves when they receive regular nutritious meals. See Nutrition for kids: the basics [link] and aim for three meals a day, with two snacks between, to keep blood sugar levels stable.

• Intelligent fats. Research has shown that a diet rich in omega-3 fatty acids appears to boost brain power. Try to get your child to eat sardines, fresh tuna, mackerel and herrings.

• Wonderful water. The cheapest and best brain power food. Lack of water induces tiredness, grumpiness and lack of concentration – children who are active should drink 6-8 small glasses of water every day. Older kids can drink 6 large glasses a day.

• Brain cloggers. There is some evidence linking too much caffeine and certain E numbers such as tartrazine with poor concentration, so I would suggest you keep them out of your child’s diet as much as possible. Too much fatty food can sit heavily in the gut, meaning the body would rather sleep than concentrate on the tasks in hand.

If you feel your child’s lack of concentration may be down to ADHD, seek professional help. In addition, not eating or an unbalanced diet that lacks certain nutrients, such as iron and the B vitamins, may also lead to poor concentration.

Constipation

The whole issue of not being able to go to the toilet when they and you want them to can be a worry, and the last thing you want is for them to get into a cycle of not wanting to go because it’s so painful and then perhaps getting so blocked up that when they do go they have accidents.

• Boost their fluid intake. Lack of fluid can be one of the commonest reasons why children get bunged up. Try to get them to drink plenty of plain water. Chamomile tea is very soothing for a constipated gut. A little aloe vera juice added to their water can soothe a sore tummy and also loosen the stool and get things moving.

• Make sure they’re getting enough fibre. Fibre found in plant cell walls swells in the presence of water and stimulates the gut to move. Choose wholemeal bread, wholegrain cereals and oats; include more fruits and vegetables, raw or cooked; eat lentils and beans; stir seeds and nuts into porridge, and dollops of fruit compote or stewed fruit into yoghurt.

• Try natural laxatives. Certain fruits seem to have a particularly strong laxative effect – the most powerful ones are figs, dates, apricots, papayas, prunes, rhubarb and soft fruits such as plums and greengages. You can make your own prune puree by simmering the dried fruit in a little orange juice until soft. Then just mash with a fork. You could also give your child a small glass of prune juice every day, either on its own or mixed with freshly squeezed orange juice.

• Reduce fast food. Fast-fried, ready-made food and not enough fresh vegetables and good home cooking is more likely to bung children up.

• Check for food intolerances. These can cause constipation.

Diarrhoea

Diarrhoea may be sign of a stomach bug or simply that your child’s digestive system is struggling to break down a food it hasn’t had before. Keep trying small amounts of the new foods and the gut should soon adapt.

When children feel sick or have diarrhoea, there's little point in forcing them to eat. What you need to remember is that getting fluid down them is essential. To keep your child’s electrolyte balance healthy, give him some rehydration fluids. You can buy these from the pharmacy or make your own.

Nourish tip: for a rehydration remedy, add a pinch of salt, a pinch of lo-salt (potassium) and 1 tsp of sugar to 250ml water. Boil until the sugar and salt dissolve, and cool.

Food poisoning

If you suspect that your child may have food poisoning, see your GP. Food-poisoning symptoms such as diarrhoea and vomiting start after a few hours, though occasionally it can take days before the bacteria have reproduced enough in your child’s body to make him feel ill. If you think your child may have food-poisoning, it's best to stick to water and simple dry foods, like rice cakes, plain dry toast, plain rice.

Nausea

A child may feel sick in the morning when they’ve had a disturbed night or feel anxious for some reason. Even if they don’t feel like eating, it’s better to get them to nibble on something small.

• Toast, cereal or porridge can settle the stomach.

• Bananas and papayas can be soothing.

• Live natural yoghurt can restore healthy gut bacteria.

Childhood health challenges

ADHD

If your child suffers from ADHD, food and the way he or she eats can help alleviate some of the symptoms, such as poor concentration, mood swings, etc. The starting point should be a good three meals a day, with a couple of good snacks such as fresh fruit, plus plenty of water. I also find that a low GI diet helps to keep blood sugar levels within the optimal steady range, as foods with a high GI value can upset concentration and moods.

There is some research to show that children suffering from problems such as ADHD and dyspraxia can benefit from taking an omega-3 supplement that provides a 500mg combination of EPA and DHA each day. EPA in particular has been shown to improve the mood, behaviour, concentration and learning abilities of children with ADHD.

Sometimes children with ADHD can have food intolerances and their behaviour improves when they avoid that food. If you feel this may be the case, keep a food diary of your child’s food and symptoms/behaviour, and ask to be referred to a paediatric dietitian for support.

On rare occasions, kids with ADHD have been shown to be reactive to a group of naturally occurring chemicals known as salicylates, which can aggravate their behaviour. These are healthy foods, so they shouldn’t be avoided unless absolutely necessary. If you notice your child craving and eating a lot of any food on the list below, try reducing their intake and seeing if it helps to improve their behaviour.

Foods rich in salicylates: Oranges, Almonds, Apples, Apricots, Tomatoes, Cherries, Cranberries, Cucumbers, Grapes, Nectarines, Tangerines, Peaches, Plums, Peppers, Prunes, Raisins.

Asthma

A European Commission study has found that 13.2% of British children have asthma, almost double the European average of 7.2%. When an asthma attack happens, the airways that carry air into and out of the lungs swell, making it hard to breathe.

While I can’t say that nutrition can cure asthma, changing the way children eat can definitely have a positive effect on their breathing. It’s worth keeping a food diary of what your child eats and their breathing, as sometimes an allergic reaction to a food molecule can cause an asthma attack. Specific additives such as tartrazine, used in canned drinks and processed foods, are commonly to blame, but even the most natural foods, such as oranges, milk or wheat, can be the culprit. If this is the case, seek advice from a paediatric dietitian to ensure your child’s diet is nutritionally balanced.

• Boost antioxidants Research shows that asthma can be caused by a lack of antioxidant-rich fruits and vegetables. The phytonutrients in apples can also help to improve lung function.

• Eat oily fish Full of beneficial omega 3 fatty acids and also vitamin E, which are beneficial to asthmatics.

• Reduce salt High salt intakes has been implicated in aggravated breathing.

• Major on magnesium Unsalted nuts, seeds and soya milk are rich in magnesium, a mineral that relaxes the muscles and reduces the activity of MAST (allergy) cells in the airways.

Coeliac disease

This inflammatory condition which affects the gut can be very successfully managed by sticking to a diet free from gluten. Gluten is the protein found in wheat and rye grains; coeliacs can also have problems dealing with very similar damaging proteins found in oats and barley.

The gluten damages the lining of the small intestine, which causes symptoms such as diarrhoea, vomiting, tummy pains and bloating. Having a damaged intestine also means sufferers will have problems absorbing essential nutrients. Lack of calcium can cause bones to become brittle, especially later in life, and the poor absorption of iron can cause anaemia.

Symptoms of coeliac disease usually appear when you first feed your child solids containing gluten, although symptoms may go unnoticed and undiagnosed for years. If you suspect your child may have coeliac disease, contact your doctor before you remove gluten from their diet, who can arrange for a simple test.

Although this sounds frightening, be reassured that children with coeliac disease live very healthy lives. They will not grow out of the condition, however, and will need to follow a gluten-free diet for life.

Naturally gluten-free foods: Rice, potatoes, lentils, beans, corn and rice-based cereals, rice, corn, buckwheat, millet, soya, gram flour, sugar, honey, jam, some chocolates (check labels), fish, chicken, eggs, lean meat, all fruits and vegetables, milk, some yoghurts (check labels).

Diabetes

Type 1, or insulin dependent diabetes, normally develops during childhood. In kids who have Type 1 diabetes, the cells in the pancreas suddenly stop making insulin and the lack of this hormone causes a build-up of glucose in the blood, which disturbs the body’s biochemical balance. Unused glucose is then excreted, as the body tries to rid itself of this potentially toxic substance by making large volumes of urine and giving your child an unquenchable thirst.

When the blood sugar is too high kids usually feel exhausted, as the body is unable to use the sugar they take in as fuel. They can also lose lots of weight, partly because the body gleans energy by breaking down fat and protein stores in the body. Kids may also go off their food. In rarer situations, uncontrolled diabetes can cause abdominal pain, vomiting and rapid breathing, and if not treated can cause confusion, loss of consciousness and coma. If you have any suspicion that your child might be diabetic, you must phone your doctor straight away as urgent medical treatment is necessary.

Type 2 diabetes usually develops in overweight adults, but there are increasing numbers of children with the condition. This is because fat levels in their body have become too high, so that pancreas cannot produce enough insulin to manage blood sugar levels. In the majority of cases of Type 2 diabetes, kids who succeed in losing excess weight can usually manage their blood sugar well without much medical intervention. Their doctor will advise on this.

If diabetes is managed well, with appropriate medication and a carefully maintained diet, your child’s life can be completely normal and healthy.

Diabetes Frequently Asked Questions

Q Can my child eat a normal diet?
A When you’re diabetic, it’s all about maintaining as normal blood sugar levels as possible. Generally speaking, a diet for a child with diabetes is virtually identical to any healthy eating diet for a child, with consistent proportions of fats, protein and carbohydrates. You need to be consistent about when your child eats because they will rely on insulin injections to work alongside the food.

Q Can my diabetic child eat chocolate and other sweets?
A Kids with diabetes can include some sweet foods in their general day-to-day diet. The GI index is a useful tool in managing diabetes [see Nutrition Basics: Sugar], as it’s an indicator of sugar in all sorts of foods, not just the obviously sweet ones. It also gives you crucial information on the other components of the food, such as fats, fibre and protein, which mitigate the effects of the sugars. Even for diabetic kids its fine on occasions to have the high GI foods like chocolate and biscuits but, as always, they’re best eaten as part of a meal – say, as a pudding after a low GI dinner.

Q Do I need to buy diabetic products?
A No. They make kids with diabetes feel unnecessarily different when they don’t need to. Plus, their sweetness comes from artificial sweeteners that can cause stomach upsets and diarrhoea if you have too much of them.

Q How can I tell if my child’s blood sugar is too low?
A The symptoms of hypoglycaemia are sweating, dizziness, confusion and tummy-ache. Give them something very sweet that will be quickly absorbed – fresh fruit juice, a biscuit, honey and milk, chocolate. If this doesn’t work, follow medical advice.

Q Do diabetic kids need to watch their fat intake?
A Yes. People with diabetes tend to have increased risk of heart disease, so you need to keep their diet generally healthy: lots of fresh fruits, vegetables and lean proteins. The best fats for kids are vegetable oils and the omega oils (oily fish, seeds, nuts, hemp oil, etc), rather than saturated animal fats.

Q What if they are poorly and lose their appetite?
A If they’re not up to eating something substantial, try them with milky drinks, fruit juices, yoghurt with banana, or soups such as leek and potato.

Eczema

Eczema is an inflammatory skin condition, causing dry, itchy skin that if it's scratched can break and bleed, leading to infection. It's thought to be an allergic condition where the body overreacts to something and produces too much immunoglobulin G, aka IgG or Immunoglobulin E, IgE antibodies. Genes play a part, but there are also environmental and lifestyle factors, as well as diet, that can have an impact.

Anti-eczema foods

• Oily fish and other foods rich in omega-3 fatty acids can help with reduce inflammation. Alternatively, give your child an omega oil supplement containing 1,000mg omega-3 fatty acids and 300mg gammalinoleic acid (GLA). You need to be patient, as it can take several weeks for the skin to calm down. Once the skin has improved, you will need to carry on giving the supplement.

• Vitamin C Make sure your child eats plenty of fresh vegetables and fruits (apart from citrus fruits, especially oranges, as they can irritate eczema), as this gives them skin-healing vitamin C.

• Vegetable fats Butter and other animal fats don't work well with the omega oils. As a bonus, vegetable oils such as linseed and hemp oil are rich in vitamin E, which is great for irritated skin.

Eczema and food allergens

When kids with eczema avoid the offending food allergen, their skin can return virtually to normal. An incentive chart is a good idea, with a treat at the end of the week if they get through each day without eating the suspect food. Try to give the rest of the family the same foods. You'll soon see if it makes a difference.

If your child's eczema is mild, you might decide that it’s not worth excluding a food and instead settle for a well-balanced diet with an omega-oil supplement. If your child has more serious eczema and you suspect a food allergy may be aggravating it, I strongly recommend seeking advice from a paediatric dietician

Nourish tip: research suggests that improving the balance of bacteria with probiotics can help your child’s gut cope with eczema-aggravating allergens.

Common food allergens: milk (usually cow’s, but could be sheep’s or goat’s), eggs, citrus fruits (especially oranges), seeds, nuts (especially peanuts), shellfish, wheat, soya, food additives.

Food allergies & intolerances

Children are far more likely to have a food allergy than adults, for numerous reasons, including the fact that their immune systems take time to develop, so they can over-react to foods if they're given too early. One of the main reasons why we wait until 6 months to wean babies is that by introducing small amounts of different foods at that stage we can help them develop an appropriate immune response and hopefully stop them becoming allergic.

Many children with food allergies grow out of them (except for peanut allergies, which seem to be lifelong), which means that only 1–2% of adults have a food allergy, as opposed to 5% of children under the age of four.

Reactions, which are often immediate, range from swollen lips and an itchy mouth to vomiting, diarrhoea, hives, eczema, coughing, runny nose, wheezing and headache – although children seldom have all of these. The most common food allergens in children are cow’s milk, peanuts and other nuts, eggs, soya milk and soya products, wheat, chocolate, sesame seeds, fish and shellfish, although virtually any food or even food additive can potentially cause an allergic reaction. Sometimes children can tolerate a food when it’s cooked, but not in its raw state.

If you suspect that your child has a food allergy, ask your doctor to refer you to a paediatric specialist. Professional help is important, because not only can a child's allergic reaction be very severe (see anaphylaxis, below), but you also need to ensure that his diet is nutritionally balanced after you cut out the offending food or foods.

Anaphylaxis

Anaphylaxis is a severe and life-threatening allergic reaction. It can hit within seconds, or hours later, and while it usually happens when children eat the offending food, it can also result from just touching it. In anaphylaxis the body produces massive amounts of histamines and other chemicals, which cause the blood vessels to swell and the blood pressure to drop. The lips can swell, and so can the throat, which can cause problems with breathing and talking. The heart can start racing, hives and rashes can appear, and the child can start wheezing. The lowering of blood pressure can make children feel weak and even collapse.

Anaphylaxis is an extremely serious and frightening situation for everyone, and what you need to do is immediately give the child a pre–loaded junior adrenaline (epinephrine) injection – kits are available on prescription. The injection works really quickly and they return to normal, if slightly exhausted and a little shaken.

Mild reactions to foods such as nuts, seeds, shellfish and fish should not be ignored, because future reactions may be severe.

Nut allergy

Peanut allergy is the most common nut allergy, frequently resulting in a very severe anaphylactic reaction. If there is a history of atopy in your family (asthma, eczema, hay fever, food allergies), don’t introduce nuts of any sort, or sesame seeds – or their products – into your child’s diet before the age of 3. (Whole nuts should not be given to children under the age of 5 because of the risk of choking.)

If you don’t have a family history of allergy you can introduce small amounts of nuts, nut oils, etc., after the age of 6 months, as it seems that a small amount of exposure to nuts (smooth nut butters, nut oil, etc) helps the immune system develop an appropriate reaction.

The peanut actually belongs to the bean family. Nuts that grow on trees, such as pecans, walnuts and hazelnuts, seeds, particularly sesame seeds, and kernels such as pine nuts can also cause reactions. Coconut is not a nut, so it doesn't have to be avoided by those who are nut-allergic.

• Common foods that can include nuts or sesame seeds include: cakes, desserts, chocolates, sweets, fruit yoghurts, biscuits, salads, salad dressings, dips, curries, pre-made Asian sauces, chillies, stuffings and breakfast cereals.

• Other foods include pesto (pine nuts or walnuts), satay sauces (peanuts), marzipan (almonds), nougat (almonds), halva (sesame), hummus (sesame) and tahini (sesame).

• Peanuts and peanut oil (also called groundnut oil) find their way into many processed foods, such as biscuits, cakes, breakfast cereals, savoury foods, Asian foods, breads and confectionery. A reaction to refined peanut oil (found mainly in processed foods) is unlikely, but unrefined peanut oil (mainly bottled oil and found in ethnic foods) carries a higher risk.

Foods that are labelled as containing nuts like cashews or hazelnuts may also contain peanuts, which are not labelled. Many products are now labelled 'may contain nuts' because of the dangers of cross-contamination with other foods.

Q Is a food intolerance the same as an allergy?
A Some doctors dismiss the concept of food intolerance and consider that anything other than a true clinical allergy is purely coincidence or the result of fussy eating habits. However, children with food intolerances can be really quite poorly – with digestive problems, rashes, headaches, unexplained fatigue – and as soon as the food in question is removed from their diet they get much better.

Immunologically, food intolerance is very different from food allergy – it's not so severe, but it can still cause a lot of distress. An intolerance is usually the result of the body not being able to deal with a food as well as we’d like it to. With lactose intolerance, for instance, children do not have enough of a special enzyme called lactase to break down the lactose, a sugar present in milk. When they drink milk or eat milk products they can become bloated, have diarrhoea, feel sick and sometimes actually vomit as the body tries to get rid of the lactose. Some children are able to tolerate a little cow's milk cheese and yoghurt, but some just can’t take any lactose-containing foods at all. Temporary lactose intolerance can happen if your child has a stomach bug or a bad cold.

Milk intolerance

A child might have a problem with cow's milk protein, or an issue with lactose, the sugar in milk (see above). If it’s cow’s milk protein they have an intolerance of, they should still be able to tolerate other sorts of dairy milk, such as goat's and sheep’s (although not always). But if it’s milk sugar that’s their enemy, you need to go for cereal-based milks such as soya, oat, almond and rice milk.

To find out if your child has a milk intolerance, keep a food diary and note any symptoms after eating dairy products. If you think there is a problem, cut out dairy foods completely for a couple of weeks. This means avoiding all dairy milk, yoghurt, cream, butter, cheese, cream. In the case of packaged foods, the label may mention lactose, milk, skimmed milk powder, cow's milk protein, or casein or whey (both derivatives of milk. If something is labelled lactose-free it should be fine.

Q Should I give my child supplements?
A When you drop a food group from your child’s diet you should try to add a different source of the nutrients this food usually provides. With milk this means calcium, so you need to look to non-dairy sources such as fortified soya milks, green leafy vegetables, pulses, seeds such as sesame, small-boned fish like sardines. A calcium supplement isn't necessary at first, while the intolerance is being investigated, but after a couple of weeks, talk to your GP or dietician about it.

Q What do I substitute?
A For children over six months old, you could try goat's or sheep’s cheese products (although since the milk proteins are very similar they could cause a reaction). Olive oil spreads can sometimes be dairy-free (check the labels, but you also need to check that they don’t contain hydrogenated fats or trans fatty acids, as these are bad for the heart).

If your child’s symptoms don’t get any better, you need to look at going dairy-free altogether, which is more difficult and potentially damaging for kids.

• Avoid all cow's, goat's and sheep's milk products, and foods containing dairy ingredients: the words to watch for are the obvious milk, cream, dairy, cheese, yoghurt but also ghee, butter, butter fat, buttermilk, butter oil, casein, whey, sodium caseinate and calcium caseinate.

• You may want to try soya, rice, almond or oat milk, either to glean some calcium or as an alternative to add to drinks, cereals, etc. However, intolerance and allergy to soya are becoming increasingly common, and you need to keep a detailed food diary when you make nutritional changes, to track how your child’s body is responding.

If after a few weeks off dairy you find that your child starts to feel much better, you could explore whether it's possible for them to take in a little lactose, say some sheep’s cheese or yoghurt, every couple of days without triggering any symptoms.

 

Wheat allergies and intolerances

Wheat and wheat-based foods such as pasta, pizza, bread, etc. are perfectly healthy for the majority of children to eat. However, an increasing number of parents want to take their children off wheat, because they believe they have an intolerance. The first thing to point out is that if you notice your child having any of the following symptoms after eating wheat, you need to take him to the GP before you start changing their diet, as he might well have a condition called coeliac disease.

• Weight loss or failure to gain weight

• Stomach pains and rectal bleeding

• Very pale, floating stools that have an unpleasant smell

• Pale skin and tiredness

If you get the all-clear medically, and you still want to look at the whole issue of wheat intolerance, keep a food diary. If it's apparent that your child's body just doesn’t feel right after eating wheat, it may be worth investigating whether they have an intolerance. Take obvious wheat foods out of your child’s diet for a couple of weeks – with children who have an intolerance to wheat that isn’t diagnosed as coeliac disease, you will generally notice that their symptoms disappear or lessen significantly. At this stage you don't need to check labels for gluten and ingredients like wheat starch, but if you want to know the fine details of completely wheat-free and gluten-free products, contact the Coeliac Society.

Q Is there any other cereal or starch my child can eat?
A Choose from the delicious spelt or rye breads, oat biscuits, rice, and corn pasta (even chickpea, spelt and buckwheat pasta), and starches such as potato, rice, barley couscous (made with barley, not the traditional wheat) and quinoa that can be added to soups. Although spelt wheat sounds close to wheat, in fact it is a distant cousin, and it seems that some children with a wheat intolerance can get on better with spelt.

You can buy wheat-free breakfast cereals – Rice Crispies, cornflakes – and wheat-free mueslis and porridge. It's important to include these non-wheat starches so that children have enough energy and fibre in their diet and don't lose too much weight.

Q When will I notice an improvement?
A Some children's symptoms are gone in a day or two, but with others it’s more gradual, over a month or so. If the change is gradual, this may mean that they will be able to digest a little wheat a couple of times a week. Just cutting down can make them feel better. If you replace wheat with other cereals and starches, like rye, spelt and rice, you shouldn’t normally need supplements.

Egg allergy

Egg allergy is one of the most common food allergies. Egg allergy is most common under 12 months and then becomes progressively less of a problem. Few children are allergic to egg after the age of 6, though in some cases an allergy can persist into adult life. Children with other allergies (such as cow's milk) or with a family history of allergy seem to be particularly vulnerable – so if this is the case, talk things through with your health visitor or GP.

More than half the babies who develop egg allergy begin to have symptoms within minutes of being given an egg for the first time.

A red rash usually appears around the mouth within seconds of eating an egg, followed a few minutes later by swelling around and inside the mouth and on the face. A few babies vomit. After a while, parts of their skin can swell, or they can develop eczema and/or wheezing, sneezing, or watery eyes. If you suspect that your baby has an allergy to eggs, seek professional advice.

What to avoid

Heat can alter egg proteins, so sometimes small quantities of egg in a cooked food may cause no reaction in a child with a mild egg allergy (in which case they’re more likely to grow out of it). Severely allergic kids will, however, need to take particular care, especially over foods that may have a ‘hidden’ egg content. While the use of eggs in custard, mayonnaise, soufflés and cakes is well known, their use in bread, in the glazes added to buns or pies, pastas and in sweets may not be so obvious.

A paediatric dietitian will be able to help you through the long list of products you need to avoid. The words to look for on labels are, of course, egg, and albumen. The emulsifier known as lecithin can be derived from egg, although in practice this is uncommon. If you are in doubt about any product, contact the retailer or manufacturer. Although some pasta does contain egg, nowadays you can find plenty that doesn’t and it tastes just as good.

The MMR injection is normally cultured on egg. Anaphylactic reactions to the MMR have been reported, but they are very rare. If you have a child with a severe egg or any other food allergy you should let your GP know before any immunisations.

Glandular fever

Glandular fever, which is caused by the Epstein-Barr virus, is a horribly debilitating illness common to teenagers. Affecting people in numerous ways, from aching joints and depression to exhaustion, it can also slide into ME and chronic fatigue syndrome. It is important, therefore, to support the immune system with a healthy nourishing diet rich in antioxidants; these come mainly from fruits and vegetables, so give your youngster plenty of soups, juices and salads. Zinc and selenium also benefit the immune system, so encourage them to eat foods such as unsalted nuts, red meat, chicken, shellfish, pulses and whole grains.

It’s best if they avoid the pattern of grabbing chocolate or similar snacks to give them energy, and then slipping back into sleep or inactivity. Not only does the rollercoaster of quick fix followed by quick crash undermine the body’s ability to get stronger, but they will run the risk of becoming depleted in essential vitamins, minerals, proteins and carbohydrates.

If they are also suffering from a very sore strep throat (which often coincides with the Epstein-Barr virus), feed them dishes that will slip down with relative ease, such as fruit sorbets, soups, soufflés and risottos.

Panic attacks

Panic attacks are bad news no matter how old you are, but can be absolutely terrifying for children and teenagers. The adrenaline rush causes a racing heart, sweating, anxiety – often followed by feeling completely shattered. The first thing is to ban caffeine – coffee, tea, chocolate. Introduce relaxing herbal teas instead, such as camomile, lemon verbena and lemon balm.

Look at how generally well balanced your child’s diet is. If they eat regular, nutritious meals they are far less likely to suffer anxiety than if they eat a fast-food, high-GI (glycaemic index) diet (including biscuits, cakes, white bread, fizzy drinks and sweets). Not all high-GI foods are obviously bad for you – they include bananas, watermelons, figs, dried dates, raisins, squashes, pumpkins, swedes, cooked carrots and mashed potato.

Try to encourage medium-GI foods, such as grapes, oranges, fresh dates, mangoes, kiwis, raw carrots, sweetcorn, peas, pasta (white or wholemeal), porridge, rye bread and rice (brown or white). Low-GI foods include apples, pears, peaches, grapefruit, plums, cherries, dried apricots, avocado, green leafy vegetables, soya and pulses.

Being a Nourish parent

A crucial part of being a good parent or carer is looking after yourself. It’s easy to be attentive to your child’s life and wellbeing, and then find that there’s little time left for you. But what we put into our own body, as much as our child’s, has an enormous impact on family life. I’ve put together ideas to maximise how you feel physically and emotionally, to help you get back into shape if your body has lost its way (this is for dads, too), and to give you the energy to keep up with your into-everything youngster.

My Nourish tips for parents

• Prepare double quantities and freeze or refrigerate half for later.

• Get on top of your Internet or weekly shop, so you always have the ingredients for a quick meal to hand.

• Carry fresh fruit, unsalted nuts and dried fruits with you to keep up your energy and help you to avoid biscuits, crisps and chocolate.

• Break the nightly glass (or more) of wine routine by having a relaxing bath or shower after you’ve put your child to bed instead. It can help to break the habit.

• Swap herbal and fruit teas for caffeinated tea and coffee. Chamomile tea is de-stressing; mint tea can soothe an overtired, acidic gut.

• Can’t get to sleep? Starchy foods such as bread, potatoes and pasta encourage the brain to produce serotonin, a natural sleep-inducer. And try a cup of warm milk or a soothing herbal tea before bed.

Breakfast

Breakfast is an opportunity to get nourishment inside the whole family, including you. How you start the day will be affected by how old your child is. You might munch toast while breastfeeding, or sit down with your toddler and eat cereal together. Try to make time to sit down with your child – it will give the message that eating, and eating together, is important. If your child sees you just grabbing bites while doing other things, it can be confusing.

5 easy, nourishing breakfasts

1. Porridge with honey or fresh or dried fruits
2. Wholemeal toast with peanut butter and banana
3. Homemade or bought sugar-free muesli with fresh fruit and natural yoghurt
4. Scrambled eggs on wholegrain toast
5. Oatcakes with a little butter and pure-fruit spread, and a glass of milk.

Lunch

You need refuelling just as much as your child does. A good lunch can give you the energy and emotional strength to tackle the rest of the day. Eat with your child, or use naptime as a chance to make a nutritious meal for yourself. Take a look at our recipes for delicious child-friendly lunches.

5 quick lunches for when you’re child-free

1. Tinned cream of tomato soup with wholegrain toast. You could add half a tin of chopped tomatoes to the soup to make it go further.
2. Hummus and cucumber sandwich on wholegrain bread.
3. Tinned sardines or mackerel mashed with lemon and black pepper, on wholegrain toast.
4. Prosciutto with salad, avocado and tinned beans, seasoned with lemon juice and black pepper.
5. Cheese, oatcakes and fresh fruit or celery sticks.

Dinner

Longer working hours mean many parents eat separately from their children. Even if you’re going to be eating later, aim to sit down with your child and have a healthy snack (fruit, a salad, a piece of cheese and an apple) while they eat. If you expect to go until 9pm without a late-afternoon snack, you may find you don’t have the energy to cook anything at all.

5 dinners for when your baby is in bed

1. Pasta with grated Parmesan, fresh rocket, tomatoes and olive oil.
2. A bowl of steamed veggies, with a dollop of hummus on top.
3. Fresh fish baked in foil, with salad or vegetables, and rice, potatoes or couscous.
4. Salad with roasted butternut squash.
5. Mushroom omelette.