• Skipping breakfast is linked with poorer cognition, psychosocial function and academic performance among schoolchildren.
• Eating regular meals will prevent overeating at the next meal.
• Parents are role models and healthy eating habits need to be cultivated from young.
It’s been said that you are what you eat. Fortunately, it is never too late to learn to eat right.

A MOTHER-TO-BE makes every effort to stay healthy for herself and her coming little bundle of joy. She eats well not just in quantity but also in quality. The joyous occasion arrives, the little one is born and mum makes every effort to breastfeed her child. Her doctor, dietitian or nutritionist have rightly told her that mother’s milk is the best for the baby, for it has the right nutrient composition for the infant’s first six months of growth. The initial milk flow of colostrum in the mother's milk, though in small quantity, is packed with high concentrations of nutrients and antibodies, though in small quantity.

The growing years
Then comes the weaning stage from six months onwards, and mum tries very hard to introduce solids. She does it very carefully, one food and one flavour at a time while continuing to breastfeed to ensure the baby continues to obtain optimal nutrition as it grows. The next four years sees a great transformation as the child undergoes physical, cognitive and mental developments.

The schooling years
The child then progresses into his/her next stage of life and it is time to enrol into the primary school. Parents, or the maid, play a very important role in deciding what the child eats. As a parent, your visits to the child’s school should also include a trip to the cafeteria so that you know what is sold and what your child is likely to purchase from there. Parents play an important role in working with the parent-teacher association and the school authorities to ensure only nutritious food are sold in the cafeteria. Nutritious food means a healthy child who will be physically active and fit and can excel in studies.

Current health issues
In Malaysia, development and industrialisation over the years have resulted in a more urbanised concept of living while conveniences of life like automation and computers have increased the risk of a sedentary lifestyle. Although some schoolchildren may be picky eaters and are underweight, the bigger problem is over-nutrition rather than under-nutrition. There is no known national survey conducted to determine the prevalence of overweight and obesity among children. However, a survey of 11,500 schoolchildren aged between 6 and 12 years from four regions in Peninsular Malaysia revealed a prevalence of six per cent obesity in both sexes with small difference between urban and rural children (Ismail et al. 2003). Convenience foods, high-calorie beverages and snacks and frequently eating out can pose health issues. The food, if not wisely selected, will result in high intake of dense calorie foods, poor quality mix of nutrients in the meal and overeating, thereby leading to obesity. There is an increasing trend of childhood obesity, which is a major concern as the extra kilogrammes often increase risk of Type 2 diabetes. These children are at risk of other associated diseases like hypertension and hyperlidaemia in later years.

Eating regular meals
Breakfast is the most important meal of the day after a fast at night and yet this meal is often missed, even by adults. Research has shown an association between breakfast consumption and overall nutritional quality of the diets of the children and adolescents. Children who skip breakfast tend to have a reduced intake of micronutrients like vitamins and minerals compared with those who regularly eat breakfast. Skipping breakfast among schoolchildren is linked with poorer cognition, psychosocial function and academic performance (Politt & Matthew, American Journal of Clinical Nutrition, 2007 ).

WHICH SCENARIO DOES YOUR CHILD FIT INTO?

SCENARIO 1
NG Chew Seng is in Year 1 and is a picky eater. He does not like the food sold at his school canteen and prefers his mother’s home-prepared food. His mother prepares food for him to bring to school. 

DIETITIAN’S ADVICE: It is not that difficult to plan ahead and prepare a quick breakfast for the child at home and pack foods for school. If you are unable to do this daily, try doing it a few times each week. This way, you can decide what the child eats. This will relieve stress of wondering what the child buys from the canteen. Pupils often use their pocket-money to buy food that they would love to eat, but these may not not be what you want them to eat. Children are very easily influenced by their peers, and buy tit-bits like sweets, crisps, nuts, ice-cream and sweet drinks. These are junk food, and they have little or no nutritional value and must be cut down in diets of children who are overweight.

SCENARIO 2
AZRUL Rahman is in Year 5 and is slightly overweight. His hobbies are watching television, playing computer games and eating. He enjoys fried snacks and fizzy drinks but dislikes vegetables. He usually has a light breakfast at home but eats in the canteen cafeteria during recess. He also eats his lunch at the canteen four times a week as he is involved in sports.

DIETITIAN’S ADVICE: It is good that Azrul takes his breakfast at home, so he has calories and nutrients ready to be used to jumpstart his day. Seeing that he eats at the school canteen quite often, it is important for Azrul to know about the types of food he eats and differentiate between what are healthy foods and what are less healthy. Being overweight, he needs to cut down on high calorie foods. Sugary foods and fried foods are often laden with sugars and fats which have high concentration in calories. He needs to cut down on fried snacks and fizzy drinks. Being active in sports, he will need to drink sufficient amount water to prevent thirst and dehydration.  Plain drinking water (zero calories) will be a better option than sweetened fizzy drinks (a can of 325ml drink contains up to 140 calories). He needs to cut down on potato crisps, chips, fried peanuts, fried kueh, ice-cream, etc. Replace them with biscuits, buns and sandwiches, which can be easily packed from home. Like most children, Azrul does not like vegetables, but vegetables are a rich  sources of vitamins, fiber, antioxidants and phytochemicals which have antioxidants properties.  The fiber in vegetables also help in bowel movement and prevent constipation in children. Carrots, cauliflower,  broccoli, baby corn seem to be more popular among children than the green leafy fibrous types. Make sure the child eats at least two servings of fruits per day. A serving of fruit is like an orange or an apple. When your child gets home from school, a fruit-vegetable juice can make a refreshing drink.

SCENARIO 3
JANE Wong, who is in Year 1, stays up late at night. By the time she finishes her homework and finishes playing computer games, it is already late.  She has a habit of sleeping late, and eats supper every night. She usually gets up in the morning, just in time to dress up and go to school. She does not eat breakfast at home and by recess time, she eats at the school canteen.

DIETITIAN’S ADVICE: When the child goes to school on an empty stomach, she will be hungry during classes and find it difficult to concentrate. This will likely affect her academic performance. It is best to avoid eating a heavy or substantial meal just before going to bed. A glass of milk and some biscuits will suffice. If she has a heavy meal before going to bed, the food may not be fully digested during the night, and the child will still feel full in the morning. Get the child into the habit of sleeping early as well so that she can get up early and have sufficient time for breakfast. If your child regularly has no breakfast, she runs the risk of developing gastric problems over time. When the child get too hungry, she will also tend to overeat at the next meal.

SCENARIO 4
MAHENDRAN Krishnasamy, who is in Year 2, finds it hard to eat anything between 6am and 7am. He can  only manage a mug of hot chocolate. When he was in Year 1, he had a bad experience of throwing out each time he had breakfast. However, during weekends, he enjoys having breakfast with his family at between 9am and 9.30am after a morning stroll with his parents.

DIETITIAN’S ADVICE: Some children get anxious easily in the mornings when the clock is ticking. They worry about having to eat their breakfast quickly because dad/mum has to leave early or they have to rush out and wait for the schoolbus. If the child is unable to eat a solid meal, a milky drink can be a nutritious replacement as it has all the macronutrients (protein, carbohydrate and fat) and micronutrients ( vitamins and minerals). Know the limit of your child. Do not force feed your child as it may do more damage than good. Instead, encourage and motivate to have breakfast. Include a few biscuits along with the milk. Try include one to two tablespoons of instant cereal. Changes need to be gradual for the mind and body to be accustomed to.

* Tan Yoke Hwa is the president of the Malaysian Dietitian’s Association and chief dietitian at Hospital Kuala Lumpur. Article is courtesy of Malaysian Dietitians' Association (www.dietitians.org.my)