Children are at particular risk for developing allergies if parents or siblings have or have had allergic conditions (asthma, hayfever, atopic eczema (childhood eczema) and food allergies), which have been diagnosed by a doctor.
The Danish Department of Health recommends the following for children at particular risk for developing allergies:
Until the child is at least 4 months, every effort should be made to breastfeed the child only. If that is not possible, the recommendation is highly hydrolyzed formula.
After the first 4 months of life, the recommendations are the same as for all other children: Continue breastfeeding up to age 1 (or preferably longer), which may be supplemented by regular formula. Do not offer food by spoon until the child is at least 4 months old, at which time it can be offered without any special precautions as for all other children. Once the child is older than 4 months, diet and special formula have no preventive effect on developing allergies, regardless if the child is at risk for developing allergies.
If you suspect that the child is allergic to something in the food, you should contact your home health nurse or your doctor. Only if the doctor finds that the child has developed allergies and prescribes a diet should you feed the child a diet that excludes one or more foods.
Carbohydrates in food provide energy when digested and broken down in the body. This is especially true for starchy and sugary carbohydrates, such as fructose, lactose, and regular white sugar.
Starch is the most important source of energy. Starch occurs naturally in things like potatoes, vegetables, bread, grains, rice, and pasta. But also sugar types found naturally in fruit (fructose) and in milk (lactose) are good sources of energy. Foods that naturally contain starch and sugars are good carbohydrate sources, because they also provide natural dietary fiber, vitamins, minerals, and other beneficial substances. Other products contain significant amounts of added sugar. These products are less likely to provide the nutrients needed by the body.
Limit the amount of cinnamon and cinnamon-sugar for infants and small children.
Cinnamon contains a substance called coumarin that can cause liver damage if you consume too much of it.
Instead, put shredded fruit or boiled, puréed fruit on your child’s porridge. Rice porridge with cinnamon and sugar can still be part of a healthy, balanced diet. You may want to go lighter on the cinnamon and heavier on the sugar. Baked goods containing cinnamon should also be given to small children in very limited amounts.
Cow’s milk has a very high protein content and low iron content. It is known that a high protein intake in the first year of life increases the risk of later developing overweight and obesity. Therefore, cow’s milk for drinking is not recommended until after the age of 1. Before the age of 1, the child can eat the family’s food, where milk is included as an ingredient.
Elderberries, raw
Elderberries can be used for things like elderberry soup, juice, and jam, but not for smoothies or for eating raw in any form. Raw, ripe elderberries contain toxins that can cause nausea, vomiting, and diarrhea. Even a few berries can cause poisoning symptoms in children. Since the toxins in elderberries are heat sensitive, raw elderberries for children must always be boiled between 15 and 20 minutes. After that, there is no longer a danger of poisoning.
The amount of energy in food is also called energy density. Water and dietary fiber reduce energy density in foods, while fat, sugar, and starch increase energy density.
If the energy density is low, small children must eat large amounts of food in order to meet their energy requirements. Energy density in food can be so low that the child can’t eat the amounts of food needed to meet energy requirements, risking inadequate growth in the child.
Examples of foods with low energy density are thin porridges or porridge made only with water and grains or vegetables puréed only with the water used to boil them. Often, puréed fruit has low energy density as well. One exception is mashed bananas and mashed avocados.
Fat is the nutrient that provides the most energy per gram. Therefore, if you want to increase energy density, you will want to increase the fat content in the food. This is the basis for recommending that the fat content of food for infants is higher than in the food for everyone else.
For older children and adults, the issues are different. Here, high energy density will increase the risk for developing obesity. Cake and candy have high energy density, but they do not contribute vitamins and minerals.
The energy in food is provided by fat, carbohydrates, and protein.
Fats in the child’s food
First and foremost, fat is an important source of energy in the food. Furthermore, fat contributes fatty acids that are important for forming new cells in the body and for various hormones.
The following recommendations should ensure that the child’s first foods contain sufficient energy:
- Add fats and formula (may be powdered) to homemade porridge and purée.
- Do not add extra fats to off-the-shelf porridges and baby food in jars, as the energy content is already high enough.
Instead of formula, you can obviously use pumped breastmilk for the porridge. Use breastmilk or formula instead of milk types with a lower fat content between the ages of 6 and 12 months.
The fats you add may be butter, margarine, or oil. It is best, if the fat in porridge and purée isn’t always butter, since the child already receives quite a bit of this type of fat through breastmilk.
Fish contains good nutrients, such as vitamin D, iodine, selenium, and fatty acids, which are not as prolific in other foods. Fatty fish in particular contain wholesome fish oils (N-3 fatty acids) and vitamin D. Both children and adults benefit from eating various types of fish in sandwiches and fish for dinner at least twice a week. It is a good idea to switch back and forth between fatty fish like salmon, herring, and mackerel, and lean fish like pollock, flounder, plaice, and cod.
However, the child should not eat large predatory fish like tuna (steaks), pike, halibut, sword fish, perch, zander, butterfish, harvest fish, ray, and shark because of the quicksilver content. Nor should the child eat canned tuna before the age of 3.
It may be an advantage to prepare large portions of meat, fish, vegetables, and fruit and freeze them in smaller portions appropriate for the child to eat in one sitting.
Make sure that the packaging is appropriate for storing and freezing food. This may be indicated by the “Glass and fork symbol” and the “Ice crystal symbol”, or it may say “For food” and “For freezing”. Also, it is important to read any instructions for use.
Ensure also that cooling and freezing of the food is done quickly. Here, the size and form of the portions is critical (should be small and/or flat).
Cool the food quickly after preparing. This is done most quickly by dividing the food into smaller portions, which you refrigerate until they are cold enough to put into the freezer.
- You may want to use ice cube trays or small plastic cups placed in a freezer bag to freeze the food. But make sure the containers are appropriate for freezing food.
- Store the food for no more than 1 month and keep the temperature at -18°C or lower.
- Thaw meat and fish in a bowl in the refrigerator. Thawing in a plastic bag in cold water is an option if you are in a hurry. Thawing in warm water is not recommended due to rapid bacteria growth.
- Thaw fruit and veggies directly in the cooking pot before use. This is the best way to preserrve the taste, as well as vitamins and minerals.
- Make sure the food tastes good by always tasting it yourself first, but don’t use the child’s spoon.
Never refreeze food that has been thawed. Especially not food for your infant. Food must be discarded if previously frozen.
In principle, porridge could be frozen in small portions as well. But don’t add formula to the porridge until after it has thawed.
We recommend that parents boil frozen raspberries for one minute before eating or using in dishes that are not heat-treated afterwards. If you want to be completely sure to avoid infection from other frozen berries, you need to boil those as well.
The reason you should boil berries is because they can carry virus. The recommendation is strictly for frozen, not fresh, berries. Always rinse fresh berries and fruit with water before eating. That way you remove any virus and germs in whole or in part. Virus from berries can cause malaise, nausea, vomiting, stomach pains, and a low-grade fever. The disease is best known as norovirus.
In people who are predisposed, gluten can cause Celiac disease. If the disease is not diagnosed and treated, it makes the bowels unable to absorb many necessary nutrients. People with Celiac disease must eat a gluten-free diet for life. There is no documentation for a preventive effect from not introducing gluten until after the child is 6 months of age.
Gluten is found in the grain products wheat, rye, barley, and oats. The content in wheat is significantly higher than in the other three grain types.
Corn, rice, buckwheat, and millet do not contain gluten. Semolina is made from wheat grain. Spelt is also a kind of wheat, and therefore contains gluten. Industrially produced wholegrain porridge has a high content of wheat. Porridge made from flour and flakes containing gluten should be introduced for variety with porridge not containing gluten and in increasing quantities.
When choosing bread for the child, it is great if it’s a bit dense and made from wholegrain flour. But that doesn’t mean you should go for bread where you can see whole grains. Children need dietary fiber from the food they eat, among other reasons because dietary fiber contributes to keeping the stomach regular. Dietary fiber is supplied from fruit and vegetables and from grain products, especially from bread made from coarse flour and from oatmeal.
Dietary fiber is found in the husk of the grain. Coarse flour is made from whole grains that have been ground and rolled, so the dietary fiber of the husk has been included. These are rye flour, graham flour, whole-wheat flour and oatmeal. Even if you don’t see whole grains in the bread, it still contains dietary fiber.
Many kinds of rye bread and wholegrain bread also contain whole grain that have not been ground or rolled. They may be whole rye or wheat grain, but they may also be sunflower seeds or flax seeds. They can taste good, but if you don’t chew the grains thoroughly, they come out the other end in one piece. For this reason, small children do not benefit from whole grains, and if they get too many it will cause very loose stools.
Flax seeds and sunflower seeds have a fairly high content of the heavy metal cadmium that gets concentrated in the body and which, in the long term, can be damaging, especially to the kidneys. Therefore, these seeds should not be consumed in excess quantities. Other oily seeds like sesame seeds, piños, pumpkin seeds, and poppyseeds have significantly lower cadmium content than sunflower seeds and flax seeds.
In order to limit the cadmium intake from oily seeds like sunflower seeds and flax seeds, the Danish Veterinary and Food Administration makes this general recommendation for everyone:
- Sunflower seeds and flax seeds should not be eaten in large quantities, but they may be used in limited amounts for things like bread.
- Sunflower oil and flax oil can be used the same as any plant oil, since there is no cadmium in the oil.
Remember the general dietary advice about eating a balanced diet. This is also true for bread and cereals. About half can be pumpernickelbread and oatmeal. And the rest can vary between other types of coarse bread and finer white bread.
Do not use ‘green garnish’ on hot food for infants and small children. Fresh herbs and leafy vegetables can only be used in hot foods if they are cooked with the rest of the dish or used in stuffing or ground meat that will be fried or baked thoroughly.
Parsley, chives, and other leafy greens may be contaminated with soil and, as such, soil bacteria – even after thorough washing. When food is kept warm or left at room temperature, bacteria can grow, resulting in nitrite. Infants and small children can eat ‘green garnish’ on cold foods, but all leftovers with green garnish must be discarded.
Honey is not recommended for children under 1 year of age due to the risk of infant botulism. Honey can contain bacteria spores, which, in the digestive system of infants taking breastmilk or formula, may multiply and develop the toxin that causes the disease.
Infant botulism is a serious poisoning that can be avoided by not giving honey until the child is a year old. The bacteria spores are not as dangerous for children over age 1 and adults.
Fluorinated substances – Some fluorinated substances are under suspicion of being hormone-disrupting. These substances can be used to make cardboard and paper water- and grease-repellent and can therefore be found in things like baking paper. You can’t always tell from looking at baking paper if it has been treated with fluorinated substances. If you want to be totally sure to avoid these substances, you can choose Swan-marked baking paper.
Bisphenol A – Bisphenol A is another hormone-disrupting substance. You find it in places like the varnish on the inside of cans and metal lids (such as lids for glass jars). However, bisphenol A is not used in all cans – for instance, all fish products produced in Denmark are typically packed in cans that do not contain bisphenol A.
When possible, you should choose packaging that has no bisphenol A content – especially for children and pregnant women. In Denmark, bisphenol A is banned in all packaging materials for children between the ages of 0 and 3 years, including baby bottles, sippy cups, and packaging for food that is intended specifically for small children, such as baby food in jars. One way to reduce your intake of bisphenol A is to buy food in cartons rather than in cans.
Children born to term are born with iron depots, which, combined with the iron content in breastmilk, can meet the child’s need for iron for the first 6 months, after which the iron depots become depleted.
From 6 months of age, it is important to offer the child iron-rich foods at most meals – even snacks.
Iron-rich foods are things like meat and fish, eggs, vegetables, legumes, porridge, and coarse bread. You may want to vary the porridge offerings by adding industrially produced porridge products enriched with iron.
It is helpful to serve fruit with iron-rich foods. Citrus fruits, apples, pears, and most other fruits contain vitamin C, which helps the body absorb the iron from the rest of the foods the child eats.
If the child is not breastfed, they should drink formula from a bottle and a cup. Formula is enriched with iron, making it a great supplement to the child’s diet during transition.
Children eating vegetarian food while being breastfed throughout the transition should take an iron supplement in drop form, about 8 mg a day, until the age of 1.
Children born prematurely needs supplemental iron. Furthermore, you need to offer them iron-rich foods from the age of 6 months like all other children. You might want to consult your home health nurse if you are not sure whether your child should get supplemental iron.
Cow’s milk has low iron content that is poorly absorbed in the body, and it should not be given until after the age of 1.
Good kitchen hygiene is all about handling foods in hygienic ways to prevent getting sick from eating the food. Good kitchen hygiene is particularly important when preparing food for infants, who can easily come down with stomach trouble because they have less resistance to bacteria than older children and adults do.
Tips for good kitchen hygiene:
- Refrigerate purchased food as soon as you bring it home
- Wash your hands before preparing food – and when switching between different foods and work processes
- Avoid spreading bacterier between raw foods, e.g. don’t use the same utensils for meat and vegetables, nor for raw and off-the-shelf food.
- Thaw frozen foods in a bowl in the refrigerator and make sure they are not dripping unto other foods.
- Refrigerate leftovers immediately.
It is important to handle leftovers correctly, so you avoid spoiled food. If some of the food is intended for eating the following day, set aside the portion you want to save and put only the portion on the table that you will be eating.
Quick cooling
- Hot food should either be eaten or refrigerated. Food to be saved for later must be cooled down to 10°C within no more than 3 hours.
- Warm leftovers should be refrigerated as soon as they stop giving off steam. Stir the dish to cool it faster. Larger portions of newly prepared food are best cooled by placing the dish/bowl in a basin of constantly ice-cold water. You can also divide the food between smaller bowls to make it cool faster.
- Cold leftovers, e.g. for sandwiches, should be refrigerated immediately.
- Don’t keep food warm for someone eating later. Refrigerate the food and warm it back up just before eating.
Reheat to boiling
- Reheat the food until boiling. It is not enough to get the food lukewarm. Stir the food to distribute the heat until it is all boiling.
- Excess hot food containing fresh herbs and leafy vegetables, such as spinach quiche, parsley sauce, and creamed cabbage, can be reheated as long as the hygeine guidelines listed above are observed.
Discard
- Always discard excess cold food with green garnish.
- Only plate the amount of food the child can eat and throw away whatever the child doesn’t eat, as it may be contaminated with germs from the child’s mouth.
Microwaveovens heat food unevenly. Follow the directions and stir food before serving.
Some vegetables have a high content of nitrate – this applies to veggies like spinach, beets, fennel, and celery.
It is a known fact that infants are particularly sensitive to nitrate in the first months of life. Therefore, the recommendation is to hold off on giving the above-mentioned vegetables to the child until they is older than 6 months. Once the child is between 6 and 12 months of age, nitrate-rich vegetables should only be equal to about 1/10 of each portion. If they constitute a larger share of the meal, they should only be served for the child occasionally, about every two weeks.
Nitrate is easily converted to nitrite. Nitrite in large amounts cause vomiting and a blue tint to the skin, because nitrite reacts with the hemoglobin in the blood, which then can no longer bind and transport oxygen around the body.
You will want to give your child organ meats from calves and pigs from time to time, even if you may not care for it yourself.
Liver: Wipe the blood of a slice of liver and cut or pull off any membranes. Boil the slice of liver, either whole, cut into strips, or cut into bite-sized pieces. Boil it only briefly, about 5 min. for strips. Cut the meat to see if it is cooked through. Cooking the meat for too long makes it tough and dry. Depending on the child’s age and ability to chew, the boiled liver can be blended (with a little of the cooking water) or cut into small pieces. Excess liver can be frozen.
Heart: Rinse the heart thoroughly in cold water. Cut it in half and remove blood and sinews. Cut the heart into thin strips and boil it for about 20-30 min. until tender. Excess heart can be frozen.
Children who are born too early (premature children), have smaller stores of vitamins and minerals in the body compare to children born full-term. Therefore, there are special recommendations for supplements in premature children. How long you provide an iron supplement depends both on the week the child was born and on birth weight. Consult your doctor or your home health nurse about how long your child needs an iron supplement and about how much they needs.
It may be difficult to describe precisely when a child should start to get foods in addition to breastmilk.
It depends in part on the child’s development and appetite and how prematurely the child was born. Talk to your doctor or your home health nurse, once you feel your child needs to start eating foods other than breastmilk or formula.
Protein is important for the child’s growth. Insufficient protein in the diet will stunt growth. It is important that the child get enough protein to meet this need during the first year, when growth is particularly rapid. Protein is necessary for building and maintaining all the cells of the body and for producing hormones and enzymes. Breastmilk and formula have a protein content that matches the child’s needs for the first 4-6 months.
Too much protein in the child’s first year of life can increase the risk of becoming overweight later in life. The protein content in whole milk is about three times that of breastmilk and formula, which is why only breastmilk and formula are recommended during the child’s first year of life. This is also why dairy products with high protein content should be avoided for children under age 2. These are skyr and fromage frais, junket and ylette, quark (incl. fruit quark), and cottage cheese.
From 9 months of age, the child can have sour milk products based on whole milk, such as A38 or yogurt as part of a balanced diet. Start by giving ½ dl and increase to 1 dl at the age of 1. Meat, fish, and cheese have a high protein content as well, but there are no recommendatins for limiting them, as the child will naturally eat these things in small quantities. Furthermore, meat and fish contribute to covering the recommended allowance for iron and other nutrients. Protein is also supplied from cereals and legumes, such as dried beans and lentils.
You can give quinoa porridge for variety with other porridges. But because of the high protein content in quinoa, it shouldn’t be the very first porridge introduced to the child. As first choice, we recommend common porridge products based on corn, millet, and buckwheat, which are low in protein.
Quinoa seeds can be used as other grains. Unlike things like rye, wheat, and barley, quinoa does not contain gluten. Like millet and oats, quinoa seeds are relatively rich in protein. The whole grain has long been used in porridge, gruel, and soups. The seeds can also be ground into flour for use in baking bread.
Different sorts of quinoa contain various levels of bitter-tasting saponins, which can be harmful to your health, although more study is needed.
It is uncertain whether saponins break down during cooking or baking. You can reduce the content of saponins by husking, scrubbing, and washing the seeds. Since husked seeds have a lower content of saponins than seeds with husks, you should use husked seeds.
Children should only eat raisins in small portions, and not every day. Small children under the age of 3 should eat no more than 50 g raisins a week, while older children can eat more raisins.
Raisins can have a high content of the antifungal substance Ochratoxin A, which comes from mold and is a carcinogenic. It doesn’t matter if children eat a lot of raisins one day and again the next day. It is the total consumption over a length of time that needs to be limited.
Other dried fruits do not pose the same problem.
Rhubarb is great for things like porridge, compote, soup, and marmalade. If you use rhubarb more than very occasionally, you will want to add ‘Nonoxal’ (calcium chloride) while cooking. It prevents the rhubarb juice from reacting with calcium in the body, which can otherwise cause an unpleasant dental reaction. Foods containing large amounts of oxalic acid can hinder the absorptin of calcium from the bowels.
- Vary between different types of porridge and make sure the child does not get rice-based porridge every day.
- Avoid giving the child rice milk and rice cakes.
Rice contains arsenic, which can cause cancer. Essentially, arsenic is no more dangerous for children than for adults. But since children eat more compared to their slight bodyweight, their arsenic intake can be relatively higher compared to that of adults.
All children must have supplemental vitamin D up until the age of 2, and some for longer. Furthermore, children who were born prematurely and children weighing less than 2500 g at birth need supplemental iron. Besides these, supplements and homeopathics are inappropriate and unnecessary for children under the age of 2.
Vegetarian is an umbrella term for people who eat plant foods (fruits and veggies, grains, legumes, nuts and seeds, etc.) exclusively, with or without supplementing with dairy products and/or eggs. Vegetarians eat no types of meat, fowl, fish, shellfish, or biproducts from the butchering of animals.
Vegans are people who live plant-based and avoid – to the extend possible – meat, fowl, fish, shellfish, and biproducts from butchering. In addition, they endeavor to avoid animal products like milk, eggs, cheese, leather, fur, wool, honey, products tested on animals, etc.
A vegan diet is not appropriate for infants and small children. The risk of the child not eating a diet with sufficient energy and nutrients is too great, and if that happens it can have dire consequences for the child’s growth and cognitive development. This is particularly true for vitamin B12, as vegetarian foods do not contain this vitamin. Vitamin B12 insufficiency can damage the nervous system, and therefore the brain. The damage is irreversible.
The food often has low energy content while taking up a lot of room on the plate. Small children can have difficulty eating sufficiently large amounts of food to get enough energy from their vegan diet.
Vegetarian diet – If you choose for your child to eat a vegetarian diet, it is important that the child’s food is varied and that it contains both eggs and dairy products. The child should still follow the recommendations for milk that applies to other children. Additionally, the child should eat eggs in reasonable quantities.
In a vegetarian diet, meat and fish should be replaced with lentils, cooked dried beans and other legumes, eggs, and vegetable oil.
In other words, the vegetarian diet should include: • dairy products and eggs • vegetables and fruit • lentils, cooked dried beans and other legumes • potatoes, bread, and cereal products • plant oils • nuts and fatty seeds and grains – finely ground and in limited quantities.
Vegetarian diets must follow the same recommendations for adding fats as diets that include meat and fish. If your child does not eat fish, however, a great deal of the fats must be oils containing omega-3 fatty acids, such as canola oil, but remember it is important to vary the fats you use.
It is recommended that children eating a vegetarian diet who continue to be breastfed during the transition period be given supplemental iron in the form of drops, about 8 mg each day for the entire transition. If the child is not breastfed, they should have formula, in which case the child does not need supplemental iron.
Infants and small children eating a vegetarian diet need the same supplemental vitamin D as other children.
It is recommended that you give children vitamin D supplements in the first 2 years of life. The supplement should be 10 mg per day, given in form of vitamin D drops. You can give the drops on a spoon with a little breastmilk or formula. Don’t mix it into the bottle. If the child gets at least 800 ml per day of formula enriched with at least 1.3 mg vitamin D per 100 ml, however, they does not need the vitamin D supplement. Talk to your home health nurse about it.
For dark-skinned children – and children who usually have their arms and legs covered – the recommendation is to continue with vitamin D throughout their childhood.
Because of the choking risk, you should not give vitamin D in tablet form until the child is 18 months old.
Vitamin D is necessary for bone development, and a lack of vitamin D can cause rickets and soft bones. Vitamin D is supplied through breastmilk (only small amounts), formula, and the foods we eat.
Vitamin D is found mostly in fatty dish, cod roe, meat, organ meats, egg yolks, and high-fat dairy products.
Infant foods cannot cover the vitamin D requirement, making it necessary to give the child a vitamin D supplement.
Vitamin D is also formed in the skin through the ultraviolet rays from the sun in the summer season. Infants should not spend time directly in the sun, wherefore they don’t get sufficient sunlight to form enough vitamin D. Dark skin forms vitamin D more slowly, making it necessary for dark-skinned children to continue taking vitamin D supplements throughout their childhood.
There are different kinds of vitamin D products, and they should be stored and dosed in different ways. Read the label to see how the vitamins should be store and how much the child needs – or ask your home health nurse for advice.