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New guidelines to foster healthy eating habits in children

The first two years of a child’s life is the golden window of opportunity for parents and caregivers to inculcate healthy lifelong eating habits. During that time, what and how parents feed their children is crucial.

To prevent picky eating in later childhood, parents should introduce food such as vegetables into their infants’ diets when they are six months old and still breastfeeding.

Fruit juices and sugar-sweetened beverages should be avoided until their children turn two.

These tips come from Singapore’s first set of Guidelines for Eating and Feeding in Infants and Young Children, which was jointly developed by KK Women’s and Children’s Hospital (KKH) and the College of Paediatrics and Child Health, Singapore to help parents and caregivers foster healthy eating habits in children.

The recommendations come after a KKH study of over 1,000 caregivers in Singapore found that children’s eating behaviours and caregivers’ feeding practices were suboptimal.

The study found that children were offered a limited variety of foods, resulting in a lack of balance in nutrition.

One in five infants in the first year of life was offered foods from only three food groups or less. In addition, 10 per cent of infants here were given sugar-sweetened beverages.

Providing sugary foods at an early age can predispose children to obesity as it can cause them to develop a liking to sweet foods that can stay throughout childhood and adulthood, said Associate Professor Chua Mei Chien, the head and senior consultant of KKH’s department of Neonatology, who chaired the workgroup that developed the guidelines.

According to the study, 10 per cent of children aged between one and two years old were unable to eat independently using their hands or utensils. Self-feeding, however, should be encouraged from six months of age.

About 100 children of caregivers surveyed were distracted with digital devices during mealtimes.

Children exposed to screens while eating tend to overeat and consume more unhealthy foods as they ignore their own satiety cues when distracted. Risk of developing behavioural problems such as attention-deficit disorders is also increased, said Dr Chua.

It was also found that about half of the children who were between six months and a year old, and almost a quarter of children aged between one and two years, were still provided milk between 12am and 6am, either every night or most nights.

The guidelines advise parents to feed their infants during the day after they turn six months old as consuming calories at night elevates the child’s risk of obesity.

“No one is born a fussy eater nor with a sweet tooth. What to feed, when to feed, and when to stop feeding are deliberate choices that parents and caregivers must make for young children who will not know better otherwise,” said Dr Chua.

The guidelines were launched on Feb 23 at the Asia Pacific Maternal and Child Health Conference and the KKH-led Integrated Platform For Research In Advancing Maternal And Child Health Outcomes (Ipramho) international meeting 2024 at the hospital.

Senior Minister of State for Health Janil Puthucheary who unveiled the guidelines at the launch said they were designed to be reader-friendly, and would be made available to healthcare professionals, parents and caregivers of children aged up to 2 years.

Dr Janil emphasised the importance of influencing children’s eating behaviour early to mitigate children’s risk of obesity. Simple actions such as moderating and picking portion sizes for children can influence the portion sizes children pick for themselves in future, he said.

“Habits forged in one’s early years can last us for a lifetime. In fact, healthy eating habits that are forged during early childhood might have longer-term effects,” said Dr Janil.

Key recommendations for infants of different age groups

From the time of birth

  • Babies should be breastfed exclusively when possible in the first six months of their lives. Introducing complementary foods to infants younger than four months old can increase the risk of them developing food allergies due to their underdeveloped immune systems.
  • Parents and caregivers should avoid giving fruit juices or sugar-sweetened beverages to infants up to two years old.
  • They should also be attentive and respond to the infants’ hunger and fullness cues so they do not either underfeed or overfeed them.
  • Infants and toddlers should not be fed as a means to soothing them or getting them to sleep.
  • Parents and caregivers should interact with infants when feeding them. Screens and toys should be avoided during meal times, even as they enter their toddler years.

Between six and 12 months old

  • Parents and caregivers should progressively introduce food with a range of textures progressively into the infant’s diet to supplement breast milk. Green vegetables and other iron-rich food that are age-appropriate are recommended to prevent iron deficiency.
  • Infants in that age group should be provided with a wide variety of vegetables, fruits, carbohydrates, and proteins without added sugar and salt. It is important to introduce children to different foods before nine months of age to reduce their likelihood of becoming fussy eaters. 
  • Infants should be encouraged to feed themselves and determine the pace and amount of food consumed.
  • During that period, there should be a transition from round-the-clock feeding to eating during the day.

Between 12 and 24 months old

  • Children should eat with family members during mealtimes to promote social interaction.
  • Toddlers should be encouraged to drink liquids from a cup instead of a milk bottle.
  • Their daily routine should consist of three meals and two snacks
  • Between 18 and 24 months, parents should develop their child’s confidence to eat and drink independently, using a fork, spoon and cup.
NUTRITION AND DIETHealth and well-beingparentingbabiesKK Women's and Children's HospitalCHILDREN AND YOUTH