Tips for keeping your child healthy through the winter months

Keeping your child healthy over the winter months can feel like a losing battle. Paediatric dietitian, Jenny Douglas from Jumpstart Nutrition shares her tips.

A balanced diet is essential to support immune function, and one that gives adequate energy, protein, and fats alongside all the vitamins and minerals, is needed to ensure your child stays healthy over the winter. Your family should have a variety of foods from all the food groups, such as meat or meat alternatives, high fibre grains, vegetables, fruit, milk or milk products and healthy fats. The cost of food has made it challenging for families to eat a balanced diet, but you can still achieve this by using cheaper yet nourishing options such as frozen vegetables and fruit, growing some simple options such as lettuce on the window ledge of your kitchen, and bulking up dishes with lentils and legumes that are packed with protein and fibre.

Breastfeeding

If you can breastfeed your baby, it’s a fantastic way to keep them well over the winter months. Antibodies from mum are passed on to bubs to help fight infection. These antibodies are especially high in colostrum, which your baby would have received in the first few days of birth, but antibodies continue to be present in breast milk for as long as you continue to breastfeed. Your breast milk also contains energy, fats, sugars, white blood cells, and anti-virals and anti-inflammatories such as lactoferrin, that help keep your child’s immune system strong. There is also some evidence to suggest your breast milk produces antibodies that target your child’s specific infection when they’re unwell – magic! It’s recommended to continue breastfeeding your child until they are around two years of age if you can.

Regular vitamin C from fruit and vegetables

Vitamin C is well known to help reduce the risk of getting sick, but also higher amounts when you are unwell can help shorten the length of an illness. Most meals and snacks for your child should include either vegetables or fruit to ensure they are given plenty of opportunity to eat these. Start with smaller portions on their plate if it’s a new vegetable or fruit and then add more if they are happy to accept it. Grating vegetables into mince dishes or into patties can be a great way to get the nutrients in. Fruit can also be served within a baked product if they will not eat it fresh.

Zinc

Zinc is an important nutrient for the immune system and for skin repair. Our body utilises this quickly when unwell and it’s useful to have it regularly to ensure recommended intakes are achieved. Seafood, meat, and nuts are all high in zinc and these should be offered often.

Fat soluble vitamins

Fat is an essential part of a young child’s diet as it is high in energy and packed with nutrients to support immunity. Fat soluble vitamins (Vitamin A, D, E and K) are absorbed alongside fat and are stored in the fatty tissues within the body. Vitamin E, contained in almond, peanut and sunflower oils, is an antioxidant. Vitamin A, contained in brightly coloured vegetables and fruit is a useful anti-inflammatory. Vitamin K, found in green leafy vegetables, plays a role in red blood cell production and blood clotting. Vitamin D is often called the ‘sunshine vitamin’ as we synthesise vitamin D from direct sunlight on our skin. There are some foods that contain vitamin D such as oily fish, eggs, and liver, or fortified milk or milk alternatives containing supplemented vitamin D, but most vitamin D requirements come from sunshine. Vitamin D is not only important for bone health, but it also helps to support a healthy immune system by reducing inflammatory processes and support immune cell function. Vitamin D supplementation (400IU per day) is recommended over the winter months for those who live in the southern regions of New Zealand, infants who are exclusively breastfed over the winter months, those with darker skin, and those who spend most of their time inside. You only need 10-15 minutes each day of direct sunlight during the summer months on your face and arms to meet your vitamin D requirements.

Probiotics

A good immune system relies on a healthy gut microbe. Studies have shown that including probiotics into your diet can improve the colonisation of healthy bacteria and minimise growth of undesirable bacteria. Probiotics can be naturally occurring in fermented products such as yoghurt, kefir, sauerkraut, and kimchi, but these will have variable amounts and types of probiotics depending on how it is produced. There are commercial probiotic capsules and powders on the market that can be given to infants and children, but it is important to choose the right strain of bacteria to help with reducing sickness. Studies have shown that Lactobacillus Rhamnous G.G. alone or in combination with Lactobacillus Acidophilus NCFM and Lactobacillus Casei DN can be effective in reducing colds and coughs and decreasing the number of days absent from daycare due to sickness. These commercial probiotics can be added to milk from three months of age, into porridge or added to smoothies. If your child needs antibiotics for a bacterial infection you can reduce the risk of antibiotic-associated diarrhoea by offering a probiotic, or probiotic food such as yoghurt or kefir.

Prebiotics

You may have already heard of probiotics and may already be regularly giving these to your child, but a healthy gut microbe also relies on being fed the food that helps support the growth of healthy bacteria and this is where prebiotics come in. Prebiotics are a group of foods that help feed the gut microbe and maintain healthy colonisation. Some examples of prebiotic foods that are useful to offer your baby and child are onion, garlic, leek, banana, and leafy greens. Once established on a variety of foods your older infant and child can be offered high fibre options such as high fibre grains, legumes, and pulses to help improve gut function and support a healthy gut microbiome.

Look out for dehydration

Dehydration is when the body has become too dry from losing water and electrolytes, and can be made worse with fever, vomiting and diarrhoea. Some signs that your child is dehydrated are:

+  Fewer wet nappies, nappies not as wet as usual, or older children not going to the toilet as much

+  Dark yellow or brownish urine

+  Dizziness or light-headedness

+  Dry lips, tongue, or throat

+  In severe cases they may have cold hands/feet, no tears when crying, mottled blueish skin, unable to wake or very drowsy

Seek medical attention if your child is showing signs of dehydration. If showing signs of severe dehydration or if they are under six months of age, go immediately go to your local emergency department.

Preventing dehydration

To help prevent dehydration you may need to think of some novel ways to increase fluid intake. Some tricks to help:

+  Offer an infant breast milk or formula frequently over the day. Do not stick to scheduled feeding when they are sick, aim to offer milk feeds every hour if they are unwell

+  Offer a small amount of water frequently over the day

+  Diluted juice can be given to a child over 12 months of age

+  Avoid giving undiluted juice, fizzy, or sports drinks in infants and young children as this can make diarrhoea worse due to the high sugar content

+  Add fresh fruit into their water bottle to give some flavour

+  Offer with a straw, different cup/drink bottle

+  Make some fruit or smoothie ice-blocks

+  Aim for high liquid foods such as yoghurt, mandarin, cucumber, and soup

+  Some toddlers may take more from a bottle than a cup when unwell and you can change back to a normal cup when they are better

+  Small amounts of water can be given via a syringe into the side of the mouth

+  Oral rehydration solution, such as Pedialyte or Gastrolyte, can be useful especially when they have fever, diarrhoea, and vomiting

Hygiene

It’s good to get your child into a routine of washing hands before eating or helping prepare any food from an early age. This will help reduce the risk of infections as they get older when they’re visiting daycare, kindergarten, playgrounds, or school more often. And as with all public health messaging, if you are unwell, stay at home.

Even if you manage to achieve a healthy balanced diet and meet all their nutritional requirements, it is likely your child will have some sickness over the winter months. So, how do you support them nutritionally when they are sick?

+  Focus on fluids and don’t worry too much about how much they eat

+  Aim for around four cups of fluid per day with the focus on breast milk/formula for infants. In older children aim for water or milk, but they may need diluted juices to ensure they are having something

+  Offer plain foods such as toast, crackers, eggs, soup

+  Focus on foods high in vitamin C. These might also help with fluid intake such as orange, pineapple, and kiwifruit

Getting back to eating again

It’s completely normal for a child to reduce their food intake when they are unwell, or to only want their favourite foods such as fruit and toast. It may take up to a week for their appetite to return to normal. Once they're well, return to a normal diet of family foods quickly so that they have nourishing foods to help with recovery, and this also helps prevent selective eating behaviours after being unwell. For children who have vomited a certain food, they may have an aversion to the food for some time. Give the food a rest for a while and then retrial it a few weeks later to see if it is accepted.

It is quite common for a baby or child to lose a small amount of weight when they are sick, but this should return with regular meals and snacks. Very occasionally a child may have lost a lot of weight and in these cases, it can be useful to add extra fats into their foods once they are well such as olive oil, butter, cream, avocado and hummus to increase their energy intake. If your child has lost a lot of weight, they should have a check-up with their GP and then contact a dietitian to help with ideas for nourishing foods to regain weight.

Having an unwell child can feel stressful, so reach out to friends and family for extra support. Most childhood illness resolve in a few days, and sometimes just enjoying those extra cuddles and letting household chores slide can be all that is needed to help you through.

Jennifer Douglas is a registered dietitian with over 18 years of experience working with families as an expert on baby & child nutrition. Jenny runs clinics in Dunedin or sees families online to help managing food allergies/intolerances, reflux, gut problems, growth issues, fussy eating, and mealtime battles with simple and practical advice so that your family can eat well For more information head to jumpstartnutrition.co.nz or Facebook: Facebook.com/JenniferDouglasDietitian and @jumpstart_kids_nutrition_nz on Instagram.