Yesterday I had a worried parent approach me with her five-year-old kid. Her grouse was that her kid had frequent cough and cold because of which, he would miss his classes a lot. I simply asked the mother one question, 'Does your child eat his vegetables and fruits?' The kid would only eat rice and ghee, skipping everything else.
This is not a one-off case, most of the toddlers and pre-schoolers I consult hate to eat veggies and would only fill up on carbs. But in reality, their growing body is still hungry for nutrients.
Indian children falling short on vitamins and minerals
Unfortunately, Indian pre-schoolers are found to be deficient in many micronutrients, most prominently iron, zinc, folate and vitamin A. This is particularly concerning because toddlers and pre-schoolers require 2.5 times more iron, 4 times more calcium and 2 times more energy when compared to an adult.
The varied functions of micronutrients could explain their high needs. Iron is required for physical and mental development. Even a mild deficiency can impair brain development. Iodine is also a nutrient with capabilities to prevent learning disabilities and delayed development in children. Zinc and vitamin A are required for better immune function and for good vision.
Are micronutrients from food really available?
Colourful fruits, green leafy vegetables, eggs, lean meat, fish, dairy products, and fortified foods provide these micronutrients in the diet. But the real problem is, nutrients from these foods are not easily absorbed and available. Below are the reasons:
Simple and everyday cooking procedures can reduce micronutrient content from foods. For example, cooking dals in boiling water causes loss of nutrients such as iron and zinc; pasteurization can reduce vitamin C content from milk. Whole grains, green leafy vegetables, dals have a certain components that can bind to vitamins and minerals, reducing absorption. For example, phytates from whole grains bind to calcium, iron, magnesium, and zinc. Oxalates from spinach make calcium unavailable. Finally, toddlers and pre-schoolers can be really choosy in what they eat. Research has found that choosy eaters had a low intake of iron; zinc; vitamins A, B6, E, and C; thiamine; niacin; and riboflavin compared to toddlers who ate most of the foods. In addition, picky eaters tend to be slow on growth and weight gain compared to kids eating most foods.
Preschoolers not so keen about their fruits and vegetables
As much as 56.3 percent children had less than the recommended intake of vegetables. 51 percent preferred fruit juice over eating fruits.
Tips to ensure your child gets enough micronutrient
Despite all these issues, there are some ways by which micronutrient needs of your child can be met.
Tips for better absorption
Look for nutrient combinations that help with better absorption. Combining iron-rich foods with vitamin C is better for iron absorption. So always ensure you add vitamin C-rich foods like amla, lemon, guava when serving iron-rich meats and veggies to your child. Similarly, zinc helps in the absorption of Vitamin A. Nuts and fruits can be an ideal snack combination that helps nutrient absorption too. Calcium alone is of no use unless vitamin D is present, helping its absorption. Milk is an ideal food as it has calcium and it is usually fortified with vitamin D. A class of foods called 'Prebiotics' has shown to improve absorption of iron and calcium. Prebiotics are indigestible foods found in apple, onion, garlic, banana, barley, wheat in some amounts. They can also be added to supplements.
Tips for choosy eaters
Keep offering new foods to your child. Remember it takes 10 or more times for your child to develop the taste for the new food. Offer fruits as snack and do away the system of bribing. Your child will assume the food that is held as bribe to be more important than main meals. Be a role model for your child by eating healthy foods.
Finally, discuss with a pediatrician to understand if your child might benefit from supplementation and which one is suitable for your child. It is important to choose a supplement that is low in sugar and fat.
The author is founder chairman and consultant neonatologist at Cloud Nine Hospital.