Nicole Bando | Dietitian & Lactation Consultant

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one more serve of veg

By Nicole Bando, APD, IBCLC

  • Make a breakfast omelette – throw in a handful of veg such as spinach, capsicum, mushrooms. Add lean ham, cottage cheese or feta.
  • Snack on a small can of corn or 4 bean mix
  • Snack on a cob of corn
  • Grate loads of leftover veg to make vegetable fritters, recipe
  • Snack on vegetables sticks & dip
  • Try roasted chickpeas/ fava beans or edamame as a snack
  • Munch on celery & cream cheese
  • Roast a big tray of vegetables and use in lunches
  • Grate some carrot into your sandwich
  • Load some raw chopped mushrooms into a wrap with tuna and avocado
  • Mix washed baby spinach leaves through pasta or rice
  • Make a loaded veg soup and eat throughout the week
  • Stock up on frozen veg and add a couple of handfuls to your meals
  • Add some sliced tomato and basil to your morning toast with cottage cheese or avocado instead of vegemite
  • Add a tomato and handful of greens to your morning eggs
How to talk to children about nutrition & weight

As a Melbourne based Paediatric Dietitian, I discuss this very emotional topic with parents frequently. I like to to use positive language and practical strategies to encourage my families towards healthy change. Here are my tips for addressing the hard topic of nutrition and children’s bodies:

– Take action: it may be time to change family eating & lifestyle habits. Offer balanced meals and snacks based on the core food groups. Avoid having too many treat foods in the home. Be active together. Change as a family creates a positive environment for learning and avoids focus on an individual, which can create pressure, anxiety and fuel risk of disordered eating and negative body image.

– Talk about body image concerns: what we can do and the sort of people we are is more important than looks or weight. This is a great podcast: https://www.abc.net.au/…/teaching-your-kids…/12625036

– Avoid making negative comments about your body or your child’s body. As an adult, avoid crash diets as this role models unhealthy eating behaviours. Say positive things about your own body.

– Avoid blaming or shaming the child for their food choices or preferences. Remember that young children will eat what is on offer in their immediate environment and parents can change this.

– Talk about feelings of hunger and fullness. Children are excellent at reading their own cues. Remember it can take 20 minutes after eating for the hormones (chemical messengers) to send a message to the brain that the stomach is full. Encourage everyone in the family to recognise these signals, this can help to avoid 2nd portions when they may not be needed.

– Depending on the child’s age – use phrases such as: ‘eating fresh and colourful foods help us to grow strong & concentrate at school’ or talk about what they love. If your child loves soccer, then ‘eating ‘grow’ foods like meat, chicken and eggs makes our muscles strong to kick the ball’ and ‘go-go foods like bananas and Weet-bix give us the energy to play soccer or swing on the monkey bars.’

– Primary school aged children: don’t talk about weight, take action that involves changing the family habits

– Make changes gradually, growth occurs over time and small changes make a big difference

– Work with a paediatrician and paediatric dietitian for expert guidance.

A note about older children who may be feeling conscious about their bodies. Talk openly, answer their questions and understand why and how they are feeling this way. Social media has an incredible impact on our children’s body image & perception of self. Seek advice if you are concerned. Focus on health and growth, rather than ‘weight’. If children are overweight, it is recommended they maintain their weight, whilst their height catches up.

– Avoid demonising foods. Treat foods have their place and should be enjoyed in small portions, occasionally

Children’s vitamins: are they necessary?

By Nicole Bando, May 13, 2021

Myriad colourful, fizzy, chewable children’s vitamins line pharmacy shelves, causing parents worry that their child may be lacking in vital nutrients. As a Paediatric Dietitian & Lactation Consultant, I am often asked ‘should I give my child a multivitamin?’ In most cases, a healthy child who is eating across the food groups does not require additional supplementation. Many foods are fortified with vitamins & minerals, so your child may be consuming more of these nutrients than first considered. There is no evidence that additional vitamin and mineral supplementation benefits health. In fact, taking an excess of certain vitamins, such as fat-soluble A, D & E can have negative health effects. Fat-soluble vitamins accumulate in the body, unlike water soluble vitamins, such as Vitamins B & C, where excess is generally filtered out through the urine (N.B. there is still potential for toxicity in large quantities). For example, excessive Vitamin A in children can cause skin irritation, vomiting & an enlarged liver.

Ultimately, the best advice is to make sure that your child is receiving enough nutrition from food & supplements cannot replace the value of whole foods. If your family could do with some guidance to make sure that everyone is maximising their nutrition potential, see a family dietitian.

In certain cases, vitamin supplements are necessary, such as:

  • Vitamin D deficiency (darker skin, inadequate exposure to sunlight, exclusively breastfed babies)
  • Iron deficiency, which may occur in extremely fussy eating or vegan/vegetarian diets
  • Vegan/vegetarian diets
  • Certain diseases which may reduce absorption of nutrients
  • Multiple allergies, where whole food groups can be excluded
  • Slowed growth
  • If needed, a blood test can show if there is a deficiency in certain nutrients (e.g. iron, Vitamin D).

Your dietitian or paediatrician will advise if this is the case. Products are roughly categorised into multivitamin preparations, single nutrients (e.g. iron), probiotics and then marketing categories, such as ‘immune boosting’ or ‘brain development’. Here’s a brief overview of a few popular multivitamins:

  • Centrum Kids & Swisse Children’s Multi: if needed, these are both good multivitamin options that give a general coverage of key nutrients, including small amounts iron, zinc and negligible calcium. Centrum Kids contains Vitamin A in excess of the recommended daily intake for children (RDI). Swisse Children’s Multi contains a large proportion of the RDI.
  • Blackmores Super Kids Multigummies: Mostly B vitamins, small amount of zinc & iodine. No iron, calcium or Vitamin A. Sugar-free.
  • Nature’s Way Vita Gummies: B vitamins, Vitamin A close to RDI. Small amount Vitamin D, some E. No calcium, iron, zinc. Most children get enough B vitamins, so these vitamins would generally be lost in urine. Contain sugar.

What’s the bottom line?
Unless your child fits into one of the above categories, or you have concerns that their diet may be inadequate, a multivitamin is likely not necessary. Seek professional guidance.

Acknowledgements:
Rodney Whyte, Senior Pharmacist, Monash Health

Sources:
NHMRC, Nutrient Reference Values for Australia and New Zealand
Royal Children’s Hospital, Vitamin A: https://www.rch.org.au/immigranthealth/clinical/Vitamin_A/
Dr Anthea Rhodes, RCH Paediatrician & Director, Australian Health Poll https://blogs.rch.org.au/news/2016/09/13/blog-vitamins-and-kids-do-they-really-need-them/

Do I need to burp my newborn baby?

It depends. As a Melbourne lactation consultant, this is one of the top questions I am asked by lovely new mums about their beautiful newborn babies.

A breastfed baby takes in less air than a bottle fed baby & will generally bring up a burp in any position, without assistance. If your baby seems unsettled during or after a feed, try burping bub for a few minutes to see if it helps. If baby is settled, don’t worry about it – trying to burp a settled baby can lead to an unhappy baby!

A bottle fed baby may take in more air during feeding. Help your baby control the milk flow with ‘pace feeding’. Use a narrow neck teat, hold bub quite upright, hold the bottle horizontally and give breaks during feeding (see video link below). If baby is unsettled, burp during the feed or after. There is no evidence for/against burping; one small powered Indian study showed no significant reduction in colic in newborn babies who were burped.

When it comes to baby, there are no special rules – always look to baby for cues as to what they may need & follow your own instincts. If your baby is fussy during breastfeeding or bottle feeding, a session with a lactation consultant may help.

https://education.possumsonline.com/video/about-paced-bottle-feeding-renee-keogh

Seasonal eating

Humans have lived according to the seasons for millennia. Seasonal eating is better for the environment as buying local, seasonal vegetables reduces food miles (i.e. how far the food has travelled to get to your plate), it is also more economical for a family. Transportation and additional packaging contribute to carbon emissions. Also, seasonal food tastes sensational. Why not take along reusable produce bags on your next grocery shop and try fresh spring produce:

Fruit:
Avocado
Apple
Banana
Fig
Grapes
Kiwifruit
Lemon
Lime
Oranges
Passionfruit
Peach
Pear
Plums
Quinces

Vegetables:
Asparagus
Green Beans
Beetroot
Broccoli
Cabbage
Carrots
Cauliflower
Cucumbers
Eggplant
Lettuce
Mushrooms
Potatoes
Pumpkins
Snow peas
Spring onions
Sweetcorn
Tomatoes
Turnips
Zucchini

By Emma McShane, Dietitian, September 2022

6 steps to reduce your family’s plastic waste

Plastic waste is affecting our main and freshwater ecosystem globally. One study suggests that 19 to 23 million metric tons entered our aquatic ecosystems in 2016. Waste in our oceans poses a great threat to our aquatic wildlife, which get caught up in plastic bags or attempt to eat plastics. Small steps to reduce plastic in a household can help to reduce the amount entering our aquatic ecosystems.

More sustainable living doesn’t mean having to change your entire lifestyle, as this can be daunting and to be quite frank, a very large task! Small, attainable steps to a more sustainable lifestyle make a huge difference at a broader level.

Here are some tips to reduce plastic waste:
1.Use glass containers to store food
   – Dry spices, and grains can be stored in glass jars.
   – Glass containers can be bought and used for food leftovers.
   – There are many shops that reduce food packaging by using ‘serve yourself’ boxes e.g. bulk flour that you scoop in your own container. An example of one of these shops is ‘The Source bulk food store’ available in various locations around Australia.
   – Try to avoid single use serves, buy foods in larger quantities and decant into smaller containers.

2. Grocery Bags Supermarkets are making positive steps to reduce plastic waste by banning single-use plastic bags. You can also move away from plastic bags for fresh fruit and veg, perhaps try reusable cotton bags instead. Try keeping some in your car for those last minute grocery runs!

3. Beeswax wraps Instead of using plastic cling wrap to cover food, try using other options instead, such as beeswax wraps, which can be reused (over 6-12 months) and simply cleaned in hot, soapy water. Beeswax wraps are made from organic ingredients that use materials that would often be wasted post use. Purchase some from our friends, here: (not sponsored) @littlebumblewraps
Or, simply cover bowls and dishes with a clean plate – simple!

4. Keep cups Single-use coffee cups go straight into landfill and are a major contribution to the world’s waste. If you love a takeaway coffee, why not bring along a keep cup. As a bonus, many cafes offer a discount if you BYO cup. Keep one at home, the office and car, to cover all bases. Or, take 10 minutes and enjoy a quiet coffee at your local cafe.

5. Reusable water bottles
Reusable water bottles are a simple way to reduce the use of single use plastic water bottles, which contribute to landfill. We are so lucky in Australia to have safe drinking water, a glass & tap will do! Keep a bottle at home, work & in the car. Water is the healthiest option and may save you reaching for a soft drink or juice.

​6. Soft plastic recycling Sometimes it is hard to completely avoid plastics and that is okay, as a society we will gradually move towards this. Did you know that you can recycle soft plastics at the supermarket? These include bread bags, cat and dog food pouches, cereal box liners, frozen food bags, pasta bags, and zip lock bags. They are recycled into outdoor furniture, signage, roads and concrete.

By Emma McShane, Dietitian, September 2022

Babies & constipation

By Nicole Bando, Family & Paediatric Dietitian & Lactation Consultant

Constipation in babies occurs when a baby’s poo or stool in hard and difficult to pass. I spend a lot of time talking baby’s poo, as what goes in must come out! There is variation in how often babies poo, related to feed type; breast, formula or mixed, age & stage.

A breastfed baby: In the first 6 weeks, baby might poo 1-5 times per day or as infrequently as every 5 days or more. Their poo has a cottage cheese, mustard appearance and is soft, runny and easy to pass. A breastfed baby does not need additional water in the first 6 months. If baby’s poos are hard & painful to pass; this can be a sign of inadequate breast milk. Offer additional feeds. This can also be done in hot weather, or if baby has a temperature.

A formula/mixed fed baby’s stools will be firmer and a green/brown colour; baby may poo 1-2 times per day. This is because the protein in formula (cow’s milk protein) differs to human breastmilk protein. If baby’s poos are crumbly, pellet like or dry, ensure that you are making the formula up as per instructions. Additional water is generally not advised in the first few months of life, and extra feeds may be required. See your doctor if concerned.

Solids: At around 6 months, when solids are introduced, baby may take a few sips of water or expressed breast milk from a sippy cup at meal times. Introduce fibre containing foods, such as fruit, vegetables, wholegrain breads & cereals. If baby’s poos are hard to pass, stewed pear, apricots or prunes, or diluted prune juice can be offered a few times a week.

When to seek help: In the early months, constipation, poor growth, a very unsettled baby and blood or mucous in the poo are all indicators to seek medical attention. If you are concerned, check in with your doctor.

What to expect when you meet a Lactation Consultant

As a Melbourne-based Lactation Consultant, I offer home visits or clinic consultations for an initial 1.5 hour visit. I often think I have the world’s best job, meeting babies and their wonderful parents. It is a privilege to be involved in a new family’s most precious, earliest moments. I am a health professional (Family & Children’s Dietitian) with additional specialist training in breastfeeding management & counselling, baby sleep and settling.

I will aim to understand your specific goals and concerns, such as: damaged or sore nipples, latching problems, worries about oversupply or low supply, baby’s growth, mastitis, thrush, blocked ducts, how to mix feed & which formula to use, how to introduce solids & general questions, such as ‘how do I know when my baby is full?’ or ‘is my baby getting enough milk?’ or ‘is my baby’s poo normal?’. I will take a detailed history about your pregnancy and birth and the overall health of mum and baby. I will assess how your baby is growing, by plotting their weight, height and head circumference on growth charts and then explain the charts to you. I assess baby’s appearance, behaviour, sleep & output (number of dirty and wet nappies). I understand that newborn sleep & feeding patterns can be unpredictable and I will guide you with questions to enable an accurate assessment.

I will examine your breast and nipple health, followed by observation of a breast or bottle (or both) feed & an expressing session (if needed). I assess how the baby is positioned, feeding, breathing and swallowing at the breast or bottle and will explain to you what I see. During the feed, I will make suggestions to improve the latch for a comfortable and efficient breastfeed and have you and your baby fitting together like a gorgeous puzzle. I will also have a look inside your baby’s mouth, to check for tongue tie & assess your baby’s sucking pattern.

As a Dietitian, I might also ask about your eating habits, to make sure that you are looking after yourself, as rapid weight loss, or not eating properly can also affect supply, and impact overall energy levels and coping. In the early days of sleep deprivation with a newborn baby, a mum needs all the energy she can get. Here are some quick tips on easy meals and snacks for new families.

I will talk you through every part of the assessment and answer all your breast & bottle feeding, baby sleep and settling questions and provide you with options for management to best fit you and your family. We will make plans for follow up as needed. You will be provided with written recommendations, resources & local support information. With your consent, I will liaise with other members of your healthcare team, such as your GP or paediatrician. I phone my families within a few days of the initial lactation consultation to see how things are developing. I would love the privilege to meet you and your little one, please contact me on 8840 1652 to discuss your family’s needs.

Image courtesy of Colin Maynard on Unsplash