A snotty nose

My gorgeous niece has recently started at a child minders as her mother has gone back to work. Instantly my sister has discovered....a snotty nose....

I have 4 children. The oldest are 2 and 4. They both continually have a snotty nose. We live in Spain and they even have  a snotty nose throughout the summer. My 2 year olds first Catalan word was ‘mocos’ (snot) ‘mocos nose’ he says half in English, half in Catalan. So, is there something wrong with my children? Should I be worried about the constant stream of gack that they are forever sniffing back up their noses? 

There are several contributing factors to my children’s snotty noses. The first being that they aren’t that great at blowing their noses (they are getting better but they are quicker at sniffing than I am with the hankie.) Hence, the snot hangs around (going backwards and forwards like a slimy yo-yo) rather than being neatly cleaned away and deposited of.

The reason that most children have a snotty nose in the first place is that they are fighting off infections. The nose makes clear mucus that helps to wash away the germs and protects the lungs from invading bugs. When the immune system starts making cells such as white blood cells to fight the infection, the snot will turn white or yellow. Snot is green either because it has bacteria in it, or because certain enzymes which help fight off bugs contain a green pigment.

So why do children have so many snotty noses? Children have immature immune systems. When the come across a bug, they often won’t have met it before and have to learn how to fight it off. Generally, the more bugs they learn about, the better their immune system is. A mature immune system (i.e. an adult one) has learnt about lots of bugs. It has met them before and knows how to fight them off. So when an adult comes across a bug they may not even know that their immune system is busy defending them from attack. Children come across lots of new bugs and it seems as if they constantly have a runny nose or are unwell in some way. Actually, it’s probably lots of different bugs and different infections but they run into each other, seeming like one long snotty nose.

So, no, I’m not worried about my children’s runny nose (other than it is a bit embarrassing when Spanish people tell them to blow their nose in English). That’s not to say there aren’t other reasons why some children have snotty noses, it’s just I know my children have the ‘common garden variety of snotty nose’ and one day they’ll grow out of it (whether that is before or after they become adept at blowing remains to be seen.)

See also:

Babies and Colds (a quick guide)

Breathing problems in babies

Why kids always have colds and snotty noses

Progressing with weaning

So, you've started weaning, you've got through the more food coming out than going in phase, you're used to the fact that your walls are now speckled with orange and you're keen to try new things...


Increase variety and type of food
The rate at which your baby will progress with weaning will depend on your baby and how old they were when you started. You can introduce them to more tastes as you feel they are ready. It’s quite easy to give them what you are cooking for your family and just adapt it for them. For example, last night, we had pasta and I gave my 8 month old baby pasta and peas whizzed up with some cream cheese. You can pretty much whizz up anything, just add some boiled water to thin it if it’s not the texture you want. If I make stew, I’ll take some out before I add the stock, which may seem a bit backwards, but you can adapt your cooking. In fact, your taste buds adapt to the amount of salt they are used to so if you reduce the amount of salt that you cook with, you will find that you don’t need as much salt.


Gradually you can increase the types of food that you give your baby. Introduce protein in the form of meat, fish, pulses and eggs. From about 9 months, babies should be having 3 meals a day with snacks. Introduce lumpy food as well. Lumpy foods should be introduced by about 10 months, but it’s fine to do it earlier if you think your baby will cope with it. You can gradually increase the lumpiness of the food. So, for example, begin by not whizzing the purée so smooth. Then you could add little bits (e.g. small bits of pasta) to smooth food or use a fork to mash things rather than a blender. It is really important to introduce lumpy foods so that you don’t miss the window. If you leave it too late, your child could develop an aversion to lumpy food and will end up on a diet of smooth soup and yoghurt.


If your child doesn’t seem to like a particular food, that’s fine, don’t make a fuss about it. Just keep presenting it to them but don’t avoid it altogether. Before the age of 2, children have an amazing capacity to try new things (after that ‘don’t like it, don’t like it’ will echo around the house). It has been shown that forcing a child to eat a particular food will decrease the liking for that food and that restricting access to particular foods increases rather than decreases preferences. By contrast, repeated exposure to initially disliked foods may break down resistance.

Similarly, it is important not to make a fuss about eating at meals times. Many children go through a phase when they don’t want to eat anything. In our developed world, they are not likely to starve. Have a think about what they eat during the day. Are they having lots of milk that will mean they are not hungry? Or are they filling up on biscuits and other snack food? If you make a fuss about mealtimes, they will manipulate the situation so that meals become a battle (which they will win). I don’t mean that they consciously set out to do so, they just see that a certain behaviour results in a certain behaviour from you.

Remember that the types of foods your baby gets used to will be the types of food that they will like when they're older. So, it's really important that you get them used to eating healthy foods now. Encourage fruit, vegetable, fish, meat and starchy foods. Avoid biscuits, chocolate and sugary treats.

Water

When you start weaning, it’s a good idea to start introducing water. To being with, use cooled boiled water and give it in a sippy cup (one with a spout on the end). Your baby will find it fun to be given a cup and will probably hold it upside down and try to suck a handle but that’s fine. It’s just getting them used to it. They will continue to get their fluids from milk. By the age of one, children should be using cups rather than bottles. Bottles are really bad for your teeth, especially if they have anything other than water in them (milk is also quite sugary and fruit juice, even sugar free juice is acidic.)

Finger food

Babies love putting everything in their mouths. They explore the world by seeing what it tastes like and what texture it is. ‘Hmmm, tastes like yellow duplo’, ‘I prefer blue’! So what a perfect opportunity to help them explore by giving them something edible to explore. Anything they can hold in their hand and are not going to choke on is suitable. Start with a crust of toast, or some fruit. Soft pear is perfect as some fruits can be quite hard. Banana is good if they can grip it but it becomes really slippery (and turn black in the washing machine). Make sure you peel things as they can choke on the skin. You can give them boiled vegetables such as carrot or a lump of potato, hard boiled egg.

Things like rusks and baby biscuits often have sugar added. I often get adult rice cakes that have no salt added, just break them in half.

Family meal times

It’s a really good idea to feed your baby with the rest of the family as often as possible. Not only does this teach them etiquette and how to behave at the dinner table, it encourages them to eat as they see other people eating around them. It is also a lovely sociable experience to spend some ‘family time’ together. I realise that it is difficult for many people whose partners get home late. In that case, sit and eat something with your children at their dinner time and use the weekends to have proper family meals together. Now, I know that I said it would be a lovely family experience, perhaps I should say, that the aim is to have a lovely family experience. It really is much easier to let your toddler sit in front of the television and shovel food down into their mouths as if they were a zombie. But what does that teach them? They need to practice manners and using a knife, fork and spoon and they need to practice without the distraction of the television. There will be days when dinner will be a bit of a disaster, but it is worth persevering. Consult a behaviour book such as Supper Nanny for advice. Anyhow, getting back to the point…If you start your baby having family meals early, it will just be part of the course for them, what they have always known.

This is a good NHS leaflet on healthy eating and children's portion sizes.

Weaning part 4, what to give them.

There are many jars of baby food available which are good for convenience. However, they do become expensive and many of them add things like sugar and salt which are not recommended for babies. Personally, I don’t think it’s particularly difficult to make your own baby food. In fact, even if you’re a hopeless cook, you can probably still manage to cook a few carrots and whizz them together. Jamie Oliver would be proud! Equip yourself with a little food blender (about £10-£15) and all will be plain sailing. You don’t need one of those specific baby ones, they’re much more expensive. Just a normal hand-held one will do (it needs to have a little chamber attachment).

The first things to try are simple food such as fruit or vegetable purée. Try apple, pear or banana. With the apple and pear, you need to stew it first. Just peel it, chop it up, add a little water and heat until soft. Then throw it in the whizzer. Sometimes, I have to confess, I don’t even peel them, it’s going to get whizzed up anyhow. Don’t be tempted to add sugar or honey. The banana doesn’t need cooking, but to begin with, I would whizz it up so that there are no lumps. Banana is a great food, but it’s quite slippery and some babies find it difficult to keep in their mouths to begin with (or in their fingers later on.) Also, be warned that it turns black in the washing machine and makes poo look like black worms.

If you want to try vegetables, think about potatoes, sweet potatoes, carrots, turnips, parsnip, swede, pumpkin or squash. You can boil or roast the vegetable then give them a whizz and hey presto! Be a bit careful whizzing potato as you can break down the starch if you whizz too much and it becomes quite thick. You can still give it to your baby though. Sweet potato and cinnamon is favourite of many babies. If you are cooking something like squash or pumpkin, it can be a little watery and runny. You can always add a little baby rice to thicken it.

When you whizz foods, you have to have a certain amount in the whizzer otherwise it doesn’t work. If it looks too thick, add a little boiled water to thin it out. You can freeze the rest in little ice trays. To begin with, a baby will only need one ice cube but as they get older they will progress to 2 or more. You can then mix and match your vegetables and fruit….carrot and parsnip, carrot and squash, potato and carrot, apple and pear…whatever you like.

When you serve the food, it should be luke warm. In reality, it tends to get cold before it’s eaten. It can always be zapped for a few seconds to reheat it, but make sure it’s not too hot otherwise you’ll upset your baby. Babies have very sensitive mouths so test the temperature on your wrist or your lip before you put it in your baby's mouth.

The start of weaning is a very exciting time for both you and your baby. Be warned, it is messy. (I must have had a premonition when I decided to paint my kitchen orange when I was 38 weeks pregnant.) Anyhow, it's a great opportunity for photos, some future xmas pressies for grandparents.

Next time....Progressing with weaning.

Previous weaning blogs:
How to start weaning
Weaning and when to start
The Rules

Weaning: The Rules!

There are certain ‘rules’ about weaning. Some of the rules have good evidence behind them, some don’t. Not everyone agrees on the ‘rules’. It is worth noting that children need a different balance of diet than we do. A healthy adult diet is high in fibre and low in fats. A baby doesn’t need as much fibre (it will stop them from absorbing so many nutrients) and they do need a higher percentage of fat than we do. They need lots of calories to help them grow. Although, having said that, in the developed world we do have an epidemic of obesity, even childhood obesity, so don’t over feed your children as the long-term consequences will be devastating.

Here are some of the areas that you may read conflicting advice on so may be confusing:

Allergy

Below the age of 5 you shouldn’t give whole or chopped nuts. This is as nuts, especially peanuts are a chocking hazard. They are pretty much the exact size of a child’s windpipe and therefore, especially bad for choking on. It’s fine to give puréed nuts, like in smooth peanut butter. Some people say you should avoid giving them if you are allergic to them but The European Society for Paediatrics, Gastroenterology, Hepatology and Nutrition (ESPGHAN) say :

‘Avoidance or delayed introduction of potentially allergenic foods, such as fish and eggs, has not been convincingly shown to reduce allergies, either in infants considered at risk for the development of allergy or in those not considered to be at risk.’

(They do recommend introducing foods one at a time in case they have an allergy so that you can tell what it is.)

This is also true of gluten. The advice used to be not give gluten (found in wheat, barley and rye so that’s bread and pasta) until at least 6 months of age. However, the advice has now changed and it can be given before 6 months. ESPGHAN say :

“It is prudent to avoid both early (before 4 months) and late (after 7 months) introduction of gluten and to introduce gluten gradually while the infant is still breast-fed because this may reduce the risk of coeliac disease, type 1 diabetes mellitus, and wheat allergy.”

This is not what the NHS says, they say you shouldn't give wheat based products to babies under 6 months. Well, who are you to believe? Personally, I gave my children wheat products under the age of 6 months. You are welcome to read both 'sides' of the argument. The ESPGHAN paper is quite long, the NHS weaning leaflet is not, it just makes a statement rather than giving any evidence. Doctors like evidence. Otherwise the NHS leaflet is a good leaflet which I recommend reading.

Generally agreed guidelines

Below one year of age you shouldn’t give children:

• Salt or sugar. This helps set the child’s threshold for sweet and salty tastes later in life; it helps avoid dental caries (decay) and it doesn’t over-load the immature kidneys with lots of salt.
• Low-fat products.
• Cows’ milk as a main drink. It’s fine to have cows’ milk in part of a meal e.g. in mashed potato or as yoghurt.
• Honey. Honey can contain the spores of botulinum (botox) which occurs naturally in the environment and is a muscle relaxant (hence why when you inject it into your forehead you don’t have any wrinkles because you can’t move your muscles.) However, if you ingest it, it can stop your respiratory muscles and you stop breathing. If the honey has been treated using high-pressure and high-temperature treatments, it should inactivate the spores but it might just be easier to avoid honey for a year.
• Shellfish, pate, blue cheese and soft cheeses with rinds like brie (rather than Phillidelphia), soft eggs should only be given from 1 year. This is because this group of foods is good at harbouring bugs that can lead to food poisoning.

From 6 months you can give:

• Well cooked eggs.
• Citrus fruit (it’s very acidic for young babies).

How to start weaning.

Welcome to "weaning part 2". Your baby is over 17 weeks old, able to sit up and putting everything in their mouth. (See previous blog, Weaning and when to start.)

So, now you have decided that it’s time to start on solids, what should you do? To begin with, the aim is to teach your baby how to swallow food rather than to actually feed them. They should carry on having the same amount as milk as before as the amount of calories that they will get from the ‘solid’ food will be minimal. 

Choose a time when you baby hasn’t just had a milk feed but isn’t overly tired. It doesn’t really matter what time of day it is. Start with something simple like baby rice or fruit or vegetable purée. The consistency of the food should be relatively runny but not too runny. Put baby in highchair. I would advise giving them something to play with, like another spoon (my first son just used to snatch the spoon and we’d end up using about 4 spoons each feed.) Bibs are definitely advisable, you can get ones that cover the arms as well, we call them radiation suits. Put a small amount on the end of the spoon and get it into the baby’s mouth. Sounds easy doesn’t it? Your baby will probably turn their head in every way other than where you want it, it’s okay to steady their head so that they don’t get purée in their eye. Try to place the food on the roof of their mouth as it will stand a better chance of staying in their mouth.

It’s amazing, you put some food in and 3 seconds later, twice as much comes out. Until now, they’ve only sucked on either a breast or a bottle so when you put the food in their mouth, they try and suck it, the result being that it is pushed forward and out of their mouth. Don’t worry, they will get there in the end.

In the next blogs, we'll look at 'What to give them' and 'The Rules'.

Weaning and when to start

In honour of the fact that my niece is rapidly approaching weaning age, I thought I'd do a few articles on weaning. Over the next few weeks, I'll cover the topics:

When to start weaning

How to start weaning

What to give them

The Rules

Today, let's look at when to start weaning.

The Department of Health and the World Health Organisation say that breast milk or formula will meet all your baby’s nutritional requirements until they are 6 months old. They both agree that solid foods should not be given before 17 weeks old (4 months).

The Department of Health advises that your baby should be able to sit up, want to chew and is putting things in their mouth and reaches and grabs accurately. 

The European Society for Paediatrics, Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommend weaning between 17 weeks and 26 weeks.

So, although there is a slight discrepancy in advise, general consensus is between 17 weeks and 26 weeks.

It's important to remember that all children are different. With my first child, I thought I would hold off weaning him until he was 6 months. But from an early age, he showed all the signs of wanting to be weaned. He would watch us as we ate and seemed very interested in food. His evening feeds were getting earlier and earlier as he was clearly hungry. I ended up weaning him at 17 weeks and he took to it like a duck to water.

With number 2, I thought I'd do the same thing. I started at 17 weeks and it was as if I was trying to poison him. I delayed a few weeks and everything turned out fine.

Don’t leave weaning too long after 6 months as there is a window of opportunity. Babies who are weaned too late can develop problems swallowing lumps and also, they will need more calories and iron than milk alone can provide. 

Beware sugary drinks!

A study by the University of Glasgow has reported that people hugely underestimate the amount of sugar in drinks that are perceived to be 'healthy' such as juices and smoothies. This included not only fizzy drinks but also regular drinks such as apple juice and orange juice. They suggest that the average person in the UK consumes around 450 calories a day in (non alcoholic) drinks. That's amazing, that's roughly 2 chocolate bars worth of calories. 

I remember buying a bottle of 'water' in a garage once to discover that it was 'flavoured mineral water'. It was  made with mineral water and looked like mineral water but contained flavourings including sugar…so, er colourless squash then? Rather than 'water'.

On a serious note, we do have an epidemic of obesity in the UK, mainly affecting adults, but increasingly being seen in children. (Sadly with complications of obesity now being seen in children, like type 2 diabetes). Generally, the eating habits that you develop in childhood will continue into adulthood. So, if your child drinks water and eats healthily, they are likely to continue to do so as an adult. Equally, if they drink lots of sugary drinks and unhealthy snacks as a child, they will as an adult. I'm not saying that children should never have sugary drinks and treats, but that mostly they should eat healthily and have treats as treats.

Another thing to consider is their teeth. Brushing twice a day is great, but their diet also contributes to dental health. There is an increasing epidemic of dental decay in children (especially in Scotland, where the research was done.) Sugary drinks are among the worst culprits, along with sweets, particularly those that you suck. Once you have your second set of teeth, that's it, there are no more.

So, as Dr Seuss says "Don't gobble junk like Billy Billings. They say his teeth have fifty fillings!"

And don't be a sop, drink water instead of juice or squash or pop….

University of Glasgow