Children Health

Like fizzy drinks, fruit juice and squash can be high in sugar, which can cause tooth decay. Because sugary drinks can be high in energy (calories), having these drinks too often can also lead to weight gain and obesity. The best drinks to give children are plain water and milk. If your children do have sugary drinks, limit these to mealtimes rather than giving them as snacks in between meals.

Drinks with free sugars

The kind of sugar we eat too much of is known as “free sugar”. Free sugars are any sugars added to food or drinks, or found naturally in honey, syrups and unsweetened fruit juices. Drinks with free sugars include:

• squashes
• fruit juices and smoothies
• juice drinks
• fizzy drinks
• flavoured milks
• milkshakes

These drinks can cause tooth decay, and most contain very few nutrients. They can also be filling, which could reduce your child’s appetite for foods that contain the nutrients they need. Diluting squash well with water will make it less sugary.

Unsweetened 100% fruit juice or smoothies

When fruit is juiced or blended, the sugar contained in the fruit is released, which can damage your child’s teeth and may cause tooth decay. However, fruit juices contain valuable vitamins and minerals. Government advice is to limit the amount of fruit juice and smoothie we have to a combined total of 150ml a day (1 portion). 150ml of unsweetened, fresh 100% fruit juice or smoothie can count as 1 of your 5 daily portions of fruit and veg.

Healthier drinks for children

If your children like drinking milk, this is a good choice, especially if they don’t like plain water. Milk isn’t bad for teeth. It also contains calcium, as well as other vitamins and minerals. After your baby’s first birthday, whole (full fat) cows’ milk can be given as a drink alongside a balanced and varied diet. Children can have semi-skimmed milk from the age of 2, as long as they’re good eaters and growing well. Skimmed and 1% milk aren’t suitable for children under 5. Milk alternatives, such as soya drinks, can be fed to children from the age of 1 as part of a healthy, balanced diet. If you give your baby milk alternatives, make sure they are unsweetened and fortified with calcium. Children under 5 years shouldn’t have rice drinks as they may contain unsafe levels of arsenic. You can try making your own milkshakes and smoothies by blending soft fruit, such as banana, strawberries or mango, with milk or yoghurt. But remember, children should have no more than 150ml in total of fruit juice or smoothie.

Some airlines permit babies who are 2 days old to fly, whereas others will only allow babies who are at least 2 weeks old on board. There are no specific regulations regarding this matter, so check with your airline before booking. In some cases, if your baby is less than 2 weeks old, you may be asked to provide a letter from your GP stating they are fit to fly. If you have given birth by caesarean section, you may not be allowed to fly until after your 6-week postnatal check-up and if your GP gives you the all clear.

Travel safety

If you have booked your child a seat, you will also have to pre-book an in-flight cot for them. These are usually only available on long-haul flights. Alternatively, you can arrange with the airline to bring a baby car-seat with you. Very young children should not be allowed to sit in a normal adult aeroplane seat without a travel cot or equivalent. You should avoid taking a baby to parts of the world where they might be exposed to diseases they are too young to be vaccinated against. For example, babies younger than 6 months cannot receive a vaccination against yellow fever because of the risk of developing encephalitis, while babies younger than 2 months cannot take anti-malaria tablets. GOV.UK provides travel and health advice for different countries around the world.

Child passports

Remember that because of a change in the law, children can no longer travel on a parent’s passport. You will need to apply for a passport for your baby if they are travelling to a foreign country with you.

Bottled water is not recommended to make up infant formula feeds for your baby. This is because it’s not usually sterile (free from bacteria) and may contain too much salt (sodium) or sulphate.

Check the levels of sodium and sulphate

You may need to use bottled water to make up a feed if:

• your drinking water has been contaminated because of flooding
• you’re travelling abroad and drinking the local water is not recommended

If you have to use bottled water to make up a feed, check the label to make sure the water contains:

• less than 200 milligrams (mg) a litre of sodium (also written as Na)
• no more than 250mg a litre of sulphate (also written as SO4)

Boil water to make up formula feeds

As bottled water is not usually sterile, it will still need to be boiled, like tap water, before you prepare the feed. Always use boiled water at a temperature of at least 70C to make up a feed. Remember to let it cool before you give it to your baby.

You can take your baby swimming at any age, both before and after they have been vaccinated. It doesn’t matter if they haven’t yet completed their course of vaccinations. Babies sometimes experience side effects after a vaccination. These are generally quite mild and shouldn’t stop you taking your baby swimming. However, babies who are feverish or irritable in the days or weeks after a vaccination may not feel up to swimming for a few days, so you may prefer to wait.

Babies and young children can become ill during very hot weather. Their health can be seriously affected by:

• dehydration
• heat exhaustion and heatstroke
• sunburn

Try these tips for keeping your child happy and healthy in the heat.

Sun safety

Keep your baby cool and protect them from the sun.

• Babies less than 6 months old should be kept out of direct sunlight. Their skin contains too little melanin, which is the pigment that gives skin, hair and eyes their colour, and provides some protection from the sun.
• Older infants should also be kept out of the sun as much as possible, particularly in the summer and between 11am and 3pm, when the sun is at its strongest. If you go out when it’s hot, attach a parasol or sunshade to your baby’s pushchair to keep them out of direct sunlight.
• Apply a sunscreen with a sun protection factor (SPF) of at least 15 to your baby’s skin. Make sure the product also protects against both UVA and UVB rays. Many brands produce sunscreen specifically for babies and young children, as these products are less likely to contain additives that might irritate the skin. Apply the suncream regularly, particularly if your child is in and out of the sea or paddling pool.
• Make sure your child wears a sunhat with a wide brim or a long flap at the back to protect their head and neck from the sun.

Avoid dehydration

Like adults, babies and young children need to drink plenty of fluids to avoid becoming dehydrated.

• If you’re breastfeeding your baby, you don’t need to give them water as well as breast milk. But they may want to breastfeed more than usual.
• If you’re bottle feeding, as well as their usual milk feeds, you can give your baby a little cooled boiled water. If your baby wakes at night, they’ll probably want milk. If they have had their usual milk feeds, try cooled boiled water as well.

You can be creative when trying to keep your child hydrated. If they’re over 6 months old and get bored with water, try giving them a combination of very diluted fruit juice, ice cubes and homemade fruit juice lollies throughout the day. For older children, plenty of fruit and salad will also help keep their fluid levels up.

Keeping cool

Follow the tips below to help keep your children cool and safe during hot weather.

• Playing in a paddling pool is a good way of keeping babies and children cool. Keep the pool in the shade during very hot weather and supervise the children carefully at all times.
• Run them a cool bath before bedtime.
• Keep your child’s bedroom cool during the day by closing blinds or curtains. You can also use a fan to circulate the air in the room.
• Keep nightwear and bedclothes to a minimum. If your baby kicks or pushes off the covers during the night, consider putting them in just a nappy with a single well-secured sheet that won’t work loose and cover their face or get entangled during the night.
• A nursery thermometer will help you monitor the temperature of your baby’s room. Your baby will sleep most comfortably when their room is between 16C (61F) and 20C (68F).

During the last 3 months of pregnancy, antibodies from the mother are passed to her unborn baby through the placenta.
This type of immunity is called passive immunity because the baby has been given antibodies rather than making them itself.
Antibodies are special proteins the immune system produces to help protect the body against bacteria and viruses.
The amount and type of antibodies passed to the baby depends on the mother’s immunity.
For example, if the mother has had chickenpox, she’ll have developed immunity against the condition and some of the chickenpox antibodies will be passed to the baby.
But if the mother hasn’t had chickenpox, the baby won’t be protected.
Immunity in newborn babies is only temporary and starts to decrease after the first few weeks or months.
Breast milk also contains antibodies, which means that babies who are breastfed have passive immunity for longer.
The thick yellowish milk (colostrum) produced for the first few days following birth is particularly rich in antibodies.
Premature babies are at higher risk of developing an illness because their immune systems aren’t as strong and they haven’t had as many antibodies passed to them.
As newborn immunity is only temporary, it’s important to begin childhood immunisations when your baby is 2 months old. This applies to babies who are either premature or full-term.
The first immunisation, given when your baby is 2 months old, includes whooping cough and Hib (haemophilus influenza type b) because immunity to these conditions decreases the fastest.
Passive immunity to measles, mumps and rubella can last for up to a year, which is why the MMR vaccine is given just after your baby’s first birthday.

Children aged 7 to 10 years old need lots of energy and nutrients because they’re still growing. The amount of energy that food and drink contains is measured in both kilojoules (kJ) and kilocalories (kcal), and is commonly referred to as calories. A report from 2011 estimated that the average daily energy requirements for children aged 7 to 10 years old are:

Age (years)  Boys                                Girls

• 7                   6,900kJ /1,649kcal            6,400kJ /1,530kcal
• 8                   7,300kJ /1,745kcal            6,800kJ /1,625kcal
• 9                   7,700kJ /1,840kcal            7,200kJ /1,721kcal
• 10                 8,500kJ /2,032kcal            8,100kJ /1,936kcal

But these figures are only a guide. Children may need more or less than these estimates depending on a number of factors, including how physically active they are. While the amount of energy your child needs is important, they should also eat a healthy, balanced diet.

Healthy, balanced diet

A healthy, balanced diet for children aged 7 to 10 should include:

• at least 5 portions of a variety of fruit and vegetables every day
• meals based on starchy foods, such as potatoes, bread, pasta and rice (choose wholegrain varieties when possible)
• some milk and dairy products (choose low-fat options where you can)
• some foods that are good sources of protein, such as meat, fish, eggs, beans and lentils

Make sure that your child doesn’t eat too many sugary or fatty foods, such as sweets, cakes and biscuits. They also shouldn’t have too many sugary fizzy drinks. These foods and drinks tend to be high in calories but contain few nutrients. Get ideas for healthier school packed lunches and helping your family get 5 A Day.

Babies and children only need a very small amount of salt in their diet. However, because salt is added to a lot of the food you buy, such as bread, baked beans, and even biscuits, it is easy to have too much. The maximum recommended amount of salt for babies and children is:

• up to 12 months – less than 1g of salt a day (less than 0.4g sodium)
• 1 to 3 years – 2g of salt a day (0.8g sodium)
• 4 to 6 years – 3g of salt a day (1.2g sodium)
• 7 to 10 years – 5g of salt a day (2g sodium)
• 11 years and over – 6g of salt a day (2.4g sodium)

Babies who are breastfed get the right amount of salt through breast milk. Infant formula contains a similar amount of salt to breast milk. When you start introducing solid foods, remember not to add salt to the foods you give to your baby, because their kidneys cannot cope with it. You should also avoid giving your baby ready-made foods that are not made specifically for babies, such as breakfast cereals, because they can also be high in salt. Lots of foods produced for children can be quite high in salt, so it’s important to check the nutritional information before you buy. The salt content is usually given as figures for sodium. As a rough guide, food containing more than 0.6g of sodium per 100g is considered to be high in salt. You can work out the amount of salt in foods by multiplying the amount of sodium by 2.5. For example, 1g of sodium per 100g is the same as 2.5g salt per 100g. You can reduce the amount of salt your child has by avoiding salty snacks, such as crisps and biscuits, and swapping them for low-salt snacks instead. Try healthy options such as dried fruit, raw vegetable sticks and chopped fruit to keep things varied. Making sure your child doesn’t eat too much salt means you’re also helping to ensure that they don’t develop a taste for salty food.

Children and young people are advised not to drink alcohol before the age of 18. Alcohol use during the teenage years is related to a wide range of health and social problems. However, if children do drink alcohol underage, it shouldn’t be until they are at least 15.

Health advice

The Chief Medical Officer has provided guidance on the consumption of alcohol by children and young people (PDF, 1.5Mb). This can help parents make decisions about their children and their relationship with alcohol.

Health risks:

• Drinking alcohol can damage a child’s health, even if they’re 15 or older. It can affect the normal development of vital organs and functions, including the brain, liver, bones and hormones.
• Beginning to drink before age 14 is associated with increased health risks, including alcohol-related injuries, involvement in violence, and suicidal thoughts and attempts.
• Drinking at an early age is also associated with risky behaviour, such as violence, having more sexual partners, pregnancy, using drugs, employment problems and drink driving.

Advice for parents:

• If children do drink alcohol, they shouldn’t do so until they’re at least 15 years old.
• If 15 to 17 year olds drink alcohol, it should be rarely, and never more than once a week. They should always be supervised by a parent or carer.
• If 15 to 17 year olds drink alcohol, they should never exceed the recommended adult weekly limit (14 units of alcohol). 1 unit of alcohol is about half a pint of normal-strength beer or a single measure (25ml) of spirits. A small glass of wine equals 1.5 units of alcohol. Read more about alcohol units.
• If your child intends to drink alcohol, using positive practices such as incentives, setting limits, agreeing on specific boundaries and offering advice can help.

Talking to your child

Talk to your child about the dangers of alcohol before they start drinking. You can use the points below as guidance.

• Make it clear that you disapprove. Research suggests that children are less likely to drink alcohol when their parents show that they don’t agree with it.
• Don’t shout at your child, because it will make them defensive and could make the situation worse. Stay calm and firm.
• Make it clear that you’re there for them if they need you, and answer any questions they have.
• Talk to your child about how alcohol affects judgement. Drinking too much could lead them to doing something they later regret, such as having unprotected sex, getting into fights or drink driving.
• Warn your child about the dangers of drink spiking and how to avoid it.
• If your child wants to drink alcohol, advise them to eat something first, not drink too much and have a soft drink between alcoholic drinks.
• Make sure your child tells you where they’re going and has a plan for getting home safely. If they’re planning to drink, make sure they’re with friends who can look after them.

What the law says

The police can stop, fine or arrest a person under 18 who is drinking alcohol in public. If you’re under 18, it’s against the law:

• for someone to sell you alcohol
• to buy or try to buy alcohol
• for an adult to buy or try to buy alcohol for you
• to drink alcohol in licensed premises, such as a pub or restaurant

However, if you’re 16 or 17 and accompanied by an adult, you can drink (but not buy) beer, wine or cider with a meal. If you’re 16 or under, you may be able to go to a pub or premises that’s primarily used to sell alcohol if you’re accompanied by an adult. However, this isn’t always the case and it can depend on the premises and the licensable activities taking place there. It’s illegal to give alcohol to children under 5.

If you think your baby is having a reaction to cows’ milk, see your GP to discuss your concerns. They will be able to assess if your baby’s symptoms may be caused by a cows’ milk allergy or something else. Make sure you get medical advice before taking cows’ milk out of your child’s diet as it contains important nutrients.

Cows’ milk allergy in babies

Cows’ milk allergy (CMA), also called cows’ milk protein allergy, is one of the most common childhood food allergies. It is estimated to affect between 2% and 7.5% of babies under one, though most children grow out of it by the age of five. CMA typically develops when cows’ milk is first introduced into your baby’s diet either in formula or when your baby starts eating solids. More rarely, it can affect babies who are exclusively breastfed because of cows’ milk from the mother’s diet passing to the baby through breast milk. There are two main types of CMA:

• immediate CMA – where symptoms typically begin within minutes of having cows’ milk
• delayed CMA – where symptoms typically begin several hours, or even days, after having cows’ milk

Symptoms of cows’ milk allergy

Cows’ milk allergy can cause a wide range of symptoms, including:

• skin reactions – such as a red itchy rash or swelling of the lips, face and around the eyes
• digestive problems – such as stomach ache, vomiting, colic, diarrhoea or constipation
• hayfever-like symptoms – such as a runny or blocked nose
• eczema that doesn’t improve with treatment

Occasionally CMA can cause severe allergic symptoms that come on suddenly, such as swelling in the mouth or throat, wheezing, cough, shortness of breath, and difficult, noisy breathing. A severe allergic reaction, or anaphylaxis, is a medical emergency – call 999 or go immediately to your local hospital A&E department.

Treatment for CMA

If your baby is diagnosed with CMA, you’ll be offered advice by your GP or an allergy specialist on how to manage their allergy. You may also be referred to a dietitian. Treatment involves removing all cows’ milk from your child’s diet for a period of time. If your baby is formula-fed, your GP can prescribe special infant formula. Don’t give your child any other type of milk without first getting medical advice. If your baby is exclusively breastfed, the mother will be advised to avoid all cows’ milk products. Your child should be assessed every 6 to 12 months to see if they have grown out of their allergy. Read more about cows’ milk allergy.

Could it be lactose intolerance?

Lactose intolerance is another type of reaction to milk, when the body can’t digest lactose, a natural sugar found in milk. However, this is not an allergy. Lactose intolerance can be temporary – for example, it can come on for a few days or weeks after a tummy bug. Symptoms of lactose intolerance include:

• diarrhoea
• vomiting
• stomach rumbling and pains
• wind

Treatment for lactose intolerance

Treatment depends on the extent of your child’s intolerance. Some children with lactose intolerance may be able to have small amounts of dairy products without having symptoms. Your child may be referred to a dietitian for specialist advice.