Prof Dr. Max J. Coppes is momenteel hoogleraar kindergeneeskunde aan de Universiteit van Nevada, Reno School of Medicine and medisch directeur van het Renown Kinderziekenhuis in Reno (staat Nevada). Max J Coppes werd in Leiden tot arts opgeleid en vervolgens in Utrecht tot kinderarts. In 1988 vertrok hij voor een jaar naar Toronto om zijn opleiding tot kinderoncoloog te voltooien, maar is sindsdien in Noord Amerika gebleven. Hij werkte naast Toronto respectievelijk in Cleveland, Calgary, Washington DC, Vancouver, en nu dus Reno. Hij is bovendien met Nederland verbonden als lid van de raad van commissarissen van het recentelijk geopend Prinses Maxima Centrum voor kinderkanker in Utrecht. Een kinderoncoloog die bijna een vluchtchirurg werd, is hij net zo comfortabel in een benedictijnenklooster als in een internationale meeting met over 10,000 gedelegeerden.
Food for thought for infant and toddlers (0-2 years)
Special nutritional considerations exist for each life stage, including for the period that covers newborn to 2 years of age. The goals for age group specific dietary recommendations include the promotion of health and wellbeing, a reduction of diet-related chronic diseases risk, and achieving the right energy balance. An important additional factor of nutritional choices in the first 2 years of life is its impact on developing taste preferences and food choices.
In general, human milk or infant formula are the primary source of nutrition during the first 6 months of life, at which time complementary foods and beverages are introduced. In the second year of life the toddler completely transitions to ‘family foods’. Breastmilk has demonstrable health benefits for children, including reduced risks of type 1 diabetes, asthma, and obesity. When breastfeeding, it is recommended that lactating mothers consume foods rich in “long chain polyunsaturated fatty acids”, such as fatty fish (think salmon, tuna, sardines), nuts and seeds, and plant oils, because this will improve the infants fatty acid status. Over the past decades, we have come to appreciate the importance of lipids (fats) on child (and adult) he
alth: they are indispensable for the assembly of cell membranes for example, play an important role in brain development, and are capable to affect cognitive functioning. The American Academy of Pediatrics (AAP) recommends not introducing complementary foods before the age of 4 months. In the past, the introduction was recommended at 6 months of age but more recent studies suggest neither benefits nor disadvantages to starting earlier. Therefore, in general, it is safe to start at 4 months of age, but waiting 2 months longer is fine too. It is also recommended introducing peanuts and eggs in the second 6 months of age and not delaying it beyond 12 months of age; their introduction at this age may in fact reduce the risk of food allergy. Then, at age 6-12 months, infants benefit from foods rich in iron (meat, fish, chicken, tofu, beans, eggs) and zinc (meat, nuts, wholegrain cereal, legumes). Iron supplementation however, in particular if the child has been or still is being breastfed, has no benefits if the child is otherwise healthy. Starting at 2 months of age, vitamin D supplementation (400 IU/day) is recommended for all breastfed infants. Babies receiving infant formulas usually, but not always, get enough vitamin D in the formula. By 1 year of age, foods should be the major source of nutrition with milk (breast, formula, cow, or cow milk alternatives) being supplemental.
When dealing with a young toddler (12-24 months), it is recommended to provide flexibility; many foods will be new and the toddler will want to test them. In addition, at this age the child starts realizing the power of refusal. So be willing to give and take, expose your child to a wide variety of healthy foods, accommodate for cultural preferences, shaping a healthy dietary pattern.
Sugar sweetened drinks should best be avoided before 2 years of age. They replace energy that should be provided by more nutritious sources, increase the risk of obesity, and affect oral health, causing tooth decay.
Finally, when in doubt, ask your pediatrician: he or she will be delighted to help you out.