New BC Pediatric Nutrition Guidelines

Relevancy to practice
In the era of “Doctor Google” and celebrity nutrition experts, the need for evidence-informed nutrition information to support health care practitioners in communicating nutrition information to their patients is imperative. Physicians are instrumental in reducing the toll of the obesity and diabetes epidemics, and the importance of starting with infants and children cannot be overstated. The new Pediatric Nutrition Guidelines (Six Months to Six Years): For Health Professionals[1] provide a framework for physicians to use to reverse the conditions that predispose their patients to these and other chronic diseases.

Highlights
The Provincial Health Services Authority and the BC Ministry of Health and regional health authorities have partnered to adapt the Pediatric Nutrition Guidelines from Ontario for use in BC. The purpose of the BC Guidelines is to assist health professionals identify nutrition issues related to child growth and development and to ensure consistency in nutrition messaging among health professionals throughout the province.  

The Guidelines are intended to be a quick reference tool. Information includes:  
• Developmental milestones that relate to feeding. 
• Food, fluid, and feeding relationship guidelines to support the nutritional needs of infants and children. 
• Markers of increased nutrition risk.
• Additional information on topics such as allergies, growth monitoring, and informed decision making. 

First foods
One of the most common conversations about infant feeding is when and what to feed infants as first foods. Signs of developmental readiness for solid foods can be found in the Guidelines (page 4) and may appear a few weeks before or just after 6 months of age. From a population health perspective, the iron content of food remains the main consideration when selecting first foods. Maintaining sufficient iron status is essential to infant growth and cognitive, neurological, motor, and behavioral development.[2] 

Parent/caregiver influences on eating habits 
A battle of the wills is a common problem at mealtime. Control over who eats what and when can leave families feeling frustrated and lead to unhealthy relationships with food for everyone. Healthy children have the ability to self-regulate the amount of food they consume. Children will compensate for eating less on some days or at a particular meal by eating more at other meals. Parents/caregivers interfere with this regulatory ability when they try to force children to eat certain types or amounts of food. 

Parents/caregivers, older infants, and young children have a shared responsibility when it comes to eating and meal times—a concept described as the “division of responsibility”[3] by leading child-feeding expert Ellyn Satter. Before a child is 1 year old, where and when feedings take place should be led by infants and their hunger cues; after age 1, parents/caregivers take over the responsibility for where and when the child is fed. The parent/caregiver must continue to trust the child’s ability to decide how much to eat and whether to eat, just as in infancy. 

To support responsive feeding, the Guidelines encourage parents/caregivers to avoid distractions such as toys, books, or screens during mealtime, and to not pressure babies and children to eat through prodding, scolding, punishment, pleading, bribing, praising, or coercing.  

Nutritional red flags
What do you do when one of your patients tells you their child does not consume iron-rich foods daily or is not eating a variety of foods by 1 year of age? You may use the Guidelines to determine the appropriate recommendations and associated nutrition risk indicators. You may also refer your patients to the Dietitian and Physical Activity Services at HealthLink BC4 (dial 811), another go-to resource for free nutrition support from registered dietitians across BC. 

Pediatric nutrition is a hot-button issue. New guidance on juice and sugar-sweetened beverages may be forthcoming from the federal government in the coming months, as well as information related to marketing of food and beverages to kids. Stay tuned.
—Vanessa Perrodou, RD
Provincial Manager Healthy Eating Resource Coordination, BCCDC
—Paul Martiquet, MD 
Medical Health Officer, VCH

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This article is the opinion of the Nutrition Committee, a subcommittee of Doctors of BC’s Council on Health Promotion, and is not necessarily the opinion of Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.

References

1. Government of BC. Pediatric nutrition guidelines (six months to six years): For health professionals. November 2016. Accessed 11 October 2017. www.health.gov.bc.ca/library/publications/year/2016/pediatric-nutrition-....

2. Government of Canada. Nutrition for healthy term infants: Recommendations from birth to six months. A joint statement of Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada 2015. Accessed 1 August 2017. www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/in...

3. Ellyn Satter Institute. Accessed 1 August 2017. www.ellynsatterinstitute.org.

4. Government of BC. Dietitian services at HealthLink BC. Accessed 11 October 2017. www.healthlinkbc.ca/dietitian-services.