By Nicole Bando, APD & IBCLC, 17th September 2019

Water is vital for all of our body’s basic functions, such as carrying nutrients to cells, regulating body temperature and ensuring healthy bowel motions. I am often asked, how much fluid do children need?
The answer depends on their age, body weight and other factors, such as illness, environment & physical activity levels. My advice is based on a healthy population.

0-6 month old babies need 150mls of fluid per kg per day. Many parents of breastfed babies worry that they can’t quantify how much milk their baby is receiving. There are many ways to tell if a baby is well hydrated, remember that what goes in must come out.

At least 5 heavy wet nappies and multiple soft stools per day are a good indicator that baby is well hydrated. Please note that after about 6 weeks, a breastfed baby poo only once per day. it is also normal for a breastfed baby to last 7-10 days without a bowel motion, this is quite normal if baby is otherwise gaining weight and well. Bottle fed babies may only poo once every 2 or 3 days.

Baby’s skin tone, colouring and alertness is also a good indicator of hydration. Diarrhoea or vomiting increase fluid requirements and increase risk of dehydration at any age, which can be life threatening in children. If your child ever becomes listless, has a depressed fontanelle (soft area on baby’s forehead prior to the bones closing), won’t drink breast milk or formula or becomes unresponsive, seek emergency medical attention.

Both breastfed and formula fed babies are likely to need extra feeds offered in hot weather. A formula fed baby may need additional sterile water, it is best to discuss this with your GP. Breastfed babies do not require additional water, and instead may be offered extra breastfeeds.

Children 6-12 months require 120mls fluid per kilogram per day (e.g. a 9kg baby requires just over 1000mls per day). This includes water consumed from sippy cups, breastmilk, formula, as well as water found in foods.

Basic fluid requirements per day beyond 12 months (+fluid from diet) are listed below:
1-3 years: 1000mls
4-8 years:1200mls
9-13 years: Boys 1600mls, Girls 1400mls
4-18 years: Boys 1900mls, Girls 1600mls

Fluid is defined as anything liquid at room temperature (milk, jelly, yoghurt, custard), it also comes from high water content foods, such as fruit and vegetables. These are difficult to quantify, but they do count towards total fluid intake (in adults up to 20% of total intake). Beyond 12 months, cow’s milk (or alternative) and water are the best drinks for children. Specialised toddler formulae are not required in healthy children. Juices, diet and sugary soft drinks are not recommended to be part of a child’s diet. Many schools now only allow water in the classroom and children are encouraged to drink throughout the day.

If your child is straining, passing hard pellet like stools, or passing urine that is dark and offensive, this can be a sign of inadequate hydration, which can contribute to constipation and other medical concerns. See your GP if you have any concerns and seek help from a Paediatric Dietitian for specialised dietary help if you feel constipation or diet may be an issue.

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

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.

We have lots of parties on the weekend, how do we manage to eat healthily as a family?

Children have a lot of parties to attend, which may make it seem hard to establish healthy eating patterns. These tips can help you navigate busy social times:

• Make sure you feed your child as usual leading up to the party, and don’t restrict meals or food. It is important to continue to model healthy eating habits both prior to, during and after the party. Let your child’s appetite guide their eating after the party. They may not feel like much for dinner, or be a little less hungry the next day, that is OK.
• All food is good food, it is about balance. Treat foods can be eaten sometimes, we choose foods from the five core food groups most of the time. These are; fruit, vegetables, meat and meat alternatives, dairy and dairy alternatives and grains/cereals. They give us fuel and energy for learning, playing and growing.
• Honour the appetite. Discuss what if feels like to feel hungry & full (the concept of the happy tummy vs a sore and unhappy tummy when overfull). By learning these cues, your child will learn to let their appetite be the guide. This will help to prevent overconsumption of party food.
• Provide a positive food environment for your children at home, and aim to keep the talk around food and eating positive. There is no such thing as bad food.
• Make the change: when planning your children’s parties, choose healthier food options, you will be impacting the health of those around you too & reducing your carbon footprint with less processed options.
• Plan healthy lunchboxes, see our tips here;

By Emma McShane, Dietitian. Edited by Nicole Bando, APD & IBCLC