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Part 6

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The truth is…

Part 6 Online version

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About Diet

1. Should picky eating be regarded as disobedience?

Answer : There are many reasons why children develop picky eating. These include: unpleasant eating experience, imitating care-givers’ eating behaviours, lack of nutritional knowledge, dental problems, etc. To find out the reasons behind, parents should maintain communication with teachers or other family members and then work out a solution. Picky eating should not be regarded as disobedience.

If children do not refuse to eat all food items in a food group (e.g. not eating peas only but consume other vegetables), it would be acceptable for them not to eat occasionally or for a short time as soon as their growth and body functions are not affected. Parents should provide a wide variety of food and encourage children to try:

Change the cooking method.

Keep on providing the rejected food items in small amounts so that children will have more opportunities to get familiar with the food items. Praise them as a sign of encouragement if they are willing to try.

Act as role models and eat together with children.

Create a relaxing and harmonious dining environment and atmosphere.

Cook with children using the food they reject to arouse their interest.

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2. There are so many brands of milk formula targeting “picky eaters” in the market. Can these products solve the problem?

Answer : There is no single food to solve the problem of “picky eating”. Behavioural modification is the solution to the root of the problem. Over-reliance on milk formulae will curb children’s opportunities to try other foods and impede their development of good eating habits. Moreover, it may lead to excessive energy intake and increase the risk of obesity. Consult a dietitian, paediatrician or family doctor promptly if the problem of picky eating is found to affect children’s growth or bodily functions.

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3. Is food reward to children an effective way to train obedience?

Answer : Most food items commonly used as rewards, such as soft drinks, candies, chocolates and potato chips, are high in fat and sugar. These foods, used as rewards, discourage healthy eating and prevent children from forming good dietary habits affecting their health in the long run. Using food as rewards may:

encourage children to eat high-fat/-sugar foods and hinder their development of good eating habits; it may increase the risk of obesity and other chronic diseases

encourage children to eat even without feeling hungry, contrary to the healthy habit of “eat when hungry and stop when full”

encourage children to associate emotions with certain food items; for example, when they experience a positive or negative mood, they may turn to certain foods when they are happy or raise their mood

To reward a child’s good behaviour without using food, you can consider the following ways:

Saying something approving to the children, or commending them openly, e.g. “Well done!”, “You are so brave to try new food!” or “Good boy, John. You tidy up the toys yourself today!”

Giving children small gifts like stickers, stamps, stationery, etc. as rewards.

Taking them to playgrounds or parks or allowing more time for games and play.

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4. Is organic food more nutritious?

Answer : “Organic food” refers to the foods that have been produced without involving chemicals, pesticides and genetic modification. Regarding nutrition, organic foods are similar to their non-organic counterparts, but are relatively more expensive and available in fewer choices.

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5. Are cakes or biscuits healthy snack choices?

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Answer : Most cakes and biscuits are prepackaged foods which in general have a higher content of trans fat, saturated fat, salt and sugar than fresh foods do. Hence, they should not be considered as healthy snacks and are not recommended for daily consumption. Long-term consumption of snacks high in salt, fat or sugar can lead to increased risk of obesity and other chronic diseases. Wholegrain bread, pita bread, bread roll and raisin bread are some of the better grain-based snack choices.

With regard to healthier biscuit options, avoid those with fillings (e.g. sandwich biscuits or wafers) and that are well known for high fat (e.g. cookies). Read the food label on the package to compare nutritional content among similar products and choose the ones that contain less salt, fat and sugar. Refer to the following guidelines on how to make healthy choices (per 100g of food):

total fat ≤ 3g sugar ≤ 5g sodium ≤ 120mg

Plain biscuits (e.g. Marie biscuit, animal-shaped cracker and soda cracker) are relatively healthier options, but they should only be occasionally given and take 2-3 pieces each time.

For cakes, plain sponge cake is a better choice but has a high content of sugar nevertheless; frequent consumption of such is thus not recommended. If you want to bake your cake, use a reduced amount of fat and sugar, or replace some ingredients with healthier options (e.g. replacing butter with canola oil and sugar with raisins or fruit pulp).

In fact, there are many choices of healthy snacks. Examples include fresh fruit, bread roll, raisin bread, wheat bread, poached eggs, low-fat milk and calcium-fortified, low-sugar soy milk. Remember to give a small portion to avoid affecting the child’s appetite for main meals.

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6. Is “long-boiled” pork bone soup rich in calcium that promotes young children’s bone development?

Answer : Many people believe that “long-boiled” pork bone soup is rich in calcium, which promotes bone development in young children. In fact, the calcium in bones cannot be released during the cooking process. Instead, a large amount of fats (especially saturated fat) are dissolved into the soup. Consuming the soups may very likely result in excessive intake of saturated fat, and thus causing adverse health effects in the long run. Therefore, its consumption should be restricted. Instead, try clear soups made with vegetables (including gourds), beans and a small amount of fish or lean meat.

7. Young children sweat a lot when exercising. Should I give them sports drinks to replenish fluids?

Answer : Most sports drinks available in the market contain mainly water and sugar, and some even contain caffeine. If young children have sports drink instead of water on a daily basis, they may have a sweet tooth, which hinders the formation of good eating habits. Caffeine may even affect the quality of sleep of children. Therefore, water is the best and most convenient choice. Children should drink fluids regularly (e.g. during a meal, during the day or in the midst of activities) to replenish fluid loss.

8. Young children do not like to eat vegetables. What should I do? Should I replace vegetables with fruit?

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Answer : Fruit and vegetables are two separate categories, each having their own properties and their special nutritional values. Both categories are important for a balanced diet. If young children dislike one or two types of vegetables, you can replace them with others of a different colour, shape, taste, etc. It is advisable to start with vegetables of a sharper colour, a sweeter taste and a crisper texture (such as tomatoes or sweet peppers) to appeal to their appetite. Also, young children can be encouraged to join their parents in cooking and even in choosing the food materials. This way, they will become more interested in the vegetables and will thus be more willing to embrace the vast variety of species and tastes of them.

The Department of Health recommends an intake of at least one serving of fruit per day for young children. That having been said, fruit contains fructose, overconsumption of which may increase the intake of energy and sugar and spoil the appetite for proper meals.

9. Young children either eat too slowly or swallow too slowly. What should I do?

Answer : If young children eat too slowly, there must be a reason behind. Maybe they don’t like the food they are eating, or the food is too hard, too dry, or too big to eat, or there is too much food, or the children are already full. To improve the situation, you should find out the true reason first.

You can cook something that your kids like, and put in more fruit and vegetables to make the dish more appetising. The point is: cook something delightful, appetising and healthy for young children. If the food is too hard, too dry or too big in pieces, young children may not be able to bite or swallow properly, and so they refuse to eat. In this case, try cutting the food into smaller pieces,

or cooking longer until it is more tender. At a proper meal, give young children the right portion. And, to avoid spoiling their appetite, stop giving them snacks or drinks at least 1.5 hours before the meal. Also, you should maintain a serene and pleasant ambience suitable for eating, so that young children can eat without being disturbed. It is thus advisable to put the toys away and switch off the TV and other electronic screen products such as computers, computer games, e-books and magazines, tablets computer, etc.

10. Is chicken powder healthier than salt? Should salt be replaced with chicken powder when I cook for young children?

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Answer : When chicken powder is compared to the same amount of salt, chicken powder does contain less sodium. In practice, however, we usually use a greater amount of chicken powder than we use salt during cooking and so we end up adding a significant amount of sodium to dishes. High sodium intake in the long run will increase the risk of high blood pressure and cardiovascular diseases. As recommended by the Chinese Dietary Reference Intakes (2013), the daily proposed sodium intake for children aged 4 to 6 should be less than 1200 mg (i.e. about ½ teaspoon of salt or 1 tablespoon of soy sauce). For children aged 2 to 3, we should try to avoid adding sodium-containing seasonings to their foods.

Apart from using chicken powder or salt, there are many other better and healthier ways to boost flavour in dishes, such as adding fresh herbs or vegetables (e.g. spring onion, ginger, garlic, tomato, lemon, orange and mushroom); see page 16 for “Seasonings” and page 21 for “Less Salt”. For the sake of young children’s health, it is important to retain their sensitivity towards salt by always giving them light-flavour foods and not salty foods.

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Aboutphysical activity

1. It is recommended that adults should accumulate at least 30 minutes of physical activity each day and young children 180 minutes. Is it too much for the latter?

Answer : The recommendation for adults covers only physical activity of a moderate to vigorous level of intensity, it excludes light intensity activities (e.g. slow walking). The 180-minute physical activity recommendation for young children, however, includes light intensity activities (e.g. playing with toys, dressing up, packing school bags, etc.) on top of more vigorous ones (e.g. brisk walking, rope skipping, playing hide-and-seek, etc.). Also, young children tend to be physically active in an intermittent pattern, with short bouts of rest in between; thus, the recommended 180 minutes should be accumulated throughout the day. Some evidence shows that the physical activity level of children may decline progressively as they grow; it may even decline further as they start primary school because of the changes in school environment. Therefore, it is necessary to encourage an active lifestyle in our preschool children before they proceed to primary education.

2. As for the recommended 180 minutes of physical activity, should it be performed at a moderate or vigorous level?

Answer : Not necessarily so. A summary of the guidelines from various countries and regions suggests that the said 180 minutes can cover physical activity of any intensity. For preschool children, it is more important to accumulate an adequate amount of physical activity rather than focus on the intensity. However, it is worth noting that activities of a higher intensity are more conducive to cardiopulmonary fitness and bone growth. Therefore, as they grow up, it is necessary to encourage them not only to maintain an active lifestyle, but also to participate more in physical activity of a higher intensity for extra health benefits.

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3. What are the effects of screen-time activities on young children? Why should we limit their screen time?

Answer : Too much screen-time activity not only reduces children’s participation in physical activity, but also has negative impacts on their eating habits and behaviours. As found in the Report of Advisory Group on Health Effects of Use of Internet and Electronic Screen Products published by the Department of Health in 2014, around half of the parents participating in the survey believed that their children spend too much time on the Internet, which affects their daily lives. Most screen-time activities are sedentary. When screen time becomes excessive, less time will be spent on physical activity. Moreover, there are many advertisements on the screen, some of which promote unhealthy foods that are high in oil, salt, sugar and calories. These foods make it more likely for people to develop unhealthy eating habits and will lead to health problems such as obesity in the long term. In addition, spending too much time in front of the screen affects children’s learning of social communication skills, as well as sleep and sleep quality. Hence, parents should limit children’s screen time and replace screen-time activities with physical activities. They should also keep children away from TV at mealtimes so as not to affect their appetite or prevent them from developing the habit of eating by themselves.

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4. How should we arrange physical activity for overweight or obese preschool children?

Answer : Overweight or obese preschool children may have a weaker exercise endurance and poorer agility due to the lack of physical activity. Parents could help them with a stepwise approach – arrange multiple but short bouts of physical activity (about 15-20 minutes each) throughout the day. When they perform better, increase the amount of physical activity gradually. Using this approach, children will be able to achieve a smaller goal each time, which will, in turn, enable them to build confidence and perseverance.

Physical activities that are weight-bearing in nature such as frame-climbing, running and rope skipping, etc. may be too strenuous for obese children. It is advisable to choose cycling or swimming as substitutes. Parents may also consider increasing the amount of physical activity gradually to further enhance their children’s health condition once their physical fitness and body weight have improved.

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5. I am very busy at work. How can I make my child do more physical activity?

Answer : A simple way is to integrate physical activity into daily life. For example, walk to school with children (instead of using the stroller) or play with them in the park. Parents also need to restrict their time for sedentary activities such as watching TV or playing computer games, and replace these by doing physical activity together. The above measures will not only encourage children to do more physical activity but also foster better relationship between parents and children.

6. When children sweat heavily, does it mean that they are exercising too vigorously and that they should stop at once?

Answer : Sweating is a normal bodily response during physical activity. As the duration and intensity of physical activity escalate, sweating also increases to regulate body temperature. Parents need not stop the activity simply because children sweat a lot; instead, ask them to drink plenty of water to replenish fluid loss, especially in hot weather. Parents could arrange for children to undertake indoor physical activity with good ventilation. When there’s the need for outdoor games, they should be scheduled for anytime but noon. Parents should also make sure that children drink plenty of water for rehydration to avoid heatstroke.

7. Should children focus on learning rather than spending time on physical activity in the school?

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Answer : It is stated in the Kindergarten Education Curriculum Guide (2017), issued by the Education Bureau, that “physical fitness and health” is one of the six key learning areas. This highlights the essential role of physical activity in the growth of preschool children. Indeed, physical activity has a positive impact on their learning performance, such as improved attention span, patience, obedience and learning ability in children. Please refer to the previous chapters for information on the importance of physical activity to the healthy growth of young children. Encourage children to do more physical activity so that they can enjoy the fun and learn to do exercise regularly.

8. Is playing toys conducive to motor development of children?

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Answer : Certainly. Games like jigsaw puzzles and building blocks can train fingers and wrists for better fine motor skills whereas tossing, throwing and catching of small soft balls can promote eye-hand coordination and fulfil the needs of children’s physical development. All these will help young children with their development. On the other hand, sustained aerobic exercises (e.g. running, jumping, cycling and swimming) can promote gross motor skills and cardio-respiratory fitness effectively. Hence, parents should provide children with adequate activities addressing both gross and fine motor skills training to balance their development needs.

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9. Can children with asthma exercise?

Answer : With all precautions done, it is safe for asthmatic children to do a suitable amount of physical activity, which can in fact improve heart and lung functions, increase physical fitness and boost immunity. In the long run, it has a positive effect on asthma control. Parents should follow doctors’ advice and bring along prescribed medicine (e.g. bronchodilators) and pay attention to children when they are engaged in physical activity. Ask them to stop and take medication if there is any sign of asthmatic attack, and consult a doctor if necessary. Also, parents should inform the school of the child’s health condition so that necessary arrangements can be made. Children with asthma should not have physical activity in cold, dry or highly polluted environment which may lead to asthmatic attacks. For further enquiries, please consult your doctor.