By Dr. Nikit Milind Shah
In today's fast world, we have unfortunately forgotten the importance of nutrition for a child’s physical and mental growth. There are many factors that affect the mental development of a child, nutrition being the most important. But nutrition does not simply mean eating or feeding. Rather, “It’s a science of how you eat and what you eat, with a tint of love and care from parents and grandparents.”
There are some common misconceptions regarding the food we eat and the diseases we develop. On top of this, television commercials have had a worse impact on our food habits. Following are some of the common questions parents ask doctors these days:
“Is there a tonic to increase hunger?”
“My child is not growing, can you prescribe any nutritional supplements or powders?”
“My child only drinks milk. Are there powders that can be mixed with milk to improve nutrition?”
Even before a doctor prescribes one of these, the children are already eating/drinking one.
What we need to understand here is, as compared to commercially available formulas, naturally available nutrients are in best digestible form. Besides, I sometimes feel that milk is a highly abused food item. If the child does not eat, he gets milk; if he does not sleep, he gets milk; if he is cranky, he gets milk, and so goes the routine. It looks like every situation has excuse of milk. This eventually becomes a habit, and it does no good to the child. I have seen children as old as four years feeding on a bottle or even on their mother's breast. I have seen five-year-old holding sipper bottles with artificial juice or milk in it. Unfortunately, a one-year-old child eating a biscuit as a full meal is a common scenario today, the excuse being that they spit out food or do not like spice.
During and after COVID, feeding the child while watching videos on a mobile phone or TV has also become a common practice. Culturally, it is said that eating is a process you should engage in with all five of your senses. Unfortunately, if the mobile screen is your companion while eating, you are not using any of your senses. You do not have a feeling of satiety and therefore tend to overeat.
While giving their phone to the child, parents are often under the impression that their child is at least eating something, which would take care of their nutrition. But due to this, they are losing out on the few hours they get to interact with their children. A parent once gave me an excuse that they give the mobile to the child only when he is eating. It may be noted that parents are recommended to spend 3-4 hours of quality time with their children every day. An average child of 1-2 years eats 5-6 times a day and spends approximately 30 minutes on every feed. The parents have essentially lost 3-4 useful hours per day here (I would not say the child has lost time). I had to literally calculate this time and tell them that they were wasting 1/3rd of the child's awake time.
The parents eventually understand their mistakes, but by then they have already lost time. The first 1,000 days of a child’s life are very essential for brain development. What they learn during these days stays with them for their life.
Besides, there are many important nutrients like iron, vitamin B12, vitamin B complex, vitamin D, and other minerals like calcium that help our body maintain good mental health, which should be included in a child’s diet. Here, we shall discuss a few important ones.
Iron is one of the most abundant minerals on earth, but unfortunately also the most neglected one. The mineral is present in many of the coloured foods which children do not usually like to eat. Parents often fall prey to tantrums and do not inculcate the habit of eating these food items in the child. But persistence is very essential in this situation. As a parent, you have to innovate 100 different ways to feed your child.
But what happens instead is that the parent gets tired and gives the child milk, sweets, or biscuits as replacement, most of which are absolutely nutrition-less. It may be noted that I have nothing against milk, but as an essential food, it is only sufficient for a child until six months of age. In fact, when it comes to iron-deficient children, milk is mostly the culprit. It inhibits absorption of many other nutrients. Even in our culture, it is said that milk should not be mixed with any other food item, as it reduces the nutritional value of other foods.
Iron, beyond doubt, has been proved to be essential for brain development. There are multiple programmes run by the World Health Organisation (WHO) and the Government of India to prevent anaemia in children and pregnant women. Iron deficient children often have up to 20 points less IQ than their counterparts, and exhibit a lot of behavioural, sleep disturbances. Iron deficiency in the pregnant mother can also impact human genetics and brain structure formation.
Lots of common foods contain iron — special mention to green leafy vegetables. Food cooked in iron-containing vessels is also a very important source of iron. Jaggery, rather than white sugar, is also a good option.
Vitamin B12 is a vitamin present only in animal-based products. The only B12 source for vegetarians is milk and milk products. Vegans are commonly deficient in Vitamin B12 and would depend on food fortification or supplements for their needs. In our practice, we have seen children from vegetarian families, or children less than a year old and haven't started on a non-vegetarian diet yet, improve after we supplement them with Vitamin B12.
Vitamin D is absolutely essential for muscle and brain function. In our current lifestyle, with our children spending a majority of their time inside home, they are less exposed to sunlight and tend to have Vitamin D deficiency. Mothers who are deficient in Vitamin D during pregnancy also often have children with this deficiency, which may manifest in them as developmental delays.
Calcium is as essential as Vit D. Deficiency of which cause developmental delay and seizures. Usually Indian diet contains enough amount of calcium and usually do not need supplements. Pregnancy is the time when mothers if not taking enough calcium are found to have low calcium in their newborns causing various problems.
As a neurologist, 1/3rd of the children who are brought to us with developmental and behavioral problems have underlying nutritional issues. Unfortunately, there is a significant delay of at least six months in the identification and treatment of these deficiencies. But these problems are treatable with changes in dietary practices. Most of the time, they do not need any supplements.
Here are a few factors to keep in mind that would help with a child’s nutrition and mental health:
> A wholesome diet that includes a colourful platter of food items such as the dark leafy greens, red and orange coloured foods like berries, beetroots, tomatoes, oranges, and papayas. Including lemon in the diet will also increase the absorption of micronutrients.
> Replace refined grains with a variety of complex grains and millets.
> Include curd, cheese, and fermented foods for good bacteria.
> Milk should only be used as a supplement and not a replacement for a meal.
> Substitute packaged foods with homemade, raw foods like salads and fruits. Refill the fridge with these, thereby making these easily accessible. Give preference to raw fruits over fruit juices. Substitute fresh coconut water for packaged beverages. Fruit portions amounting to twice the fist size of a child is recommended for everyday consumption. As they say, “no fruit causes disease unless it contains pesticides”.
> Keep nuts like peanuts and roasted bengal gram handy. Nuts like walnuts and almonds, which are rich in omega-3 fatty acids, help in brain development (caution in children < 2 years of age).
> Pill popping and sugary syrups for every minor ailment should be avoided. Inadvertent use of antibiotics damages the good bacteria in the gut, and should be administered with caution.
> Limit sugar intake (especially white sugar and sugars made in factories). Jaggery/ honey are better than sugar. Avoid gummy vitamins that contain an overdose of sugar.
> Do brain exercises and play mind games with kids, in addition to routine physical exercise. Learn the art of being a child with your children.
> Be aware that anything packaged contains preservatives to increase shelf life. Read the contents of the package carefully before you buy.
> Limit screen time.
> There are no ‘hunger tonics’. Please do not ask your doctors for one.
> Above all, provide a safe and secure environment to your children without being overprotective. Let them face their own adversities, overcome their fears, and learn from their own mistakes.
This article has been produced in association with Rainbow Children’s Hospital.