Kids and Fish



Fish is an ideal food for children because it's jam-packed with protein - which is pivotal in the diet of a growing child. 



General



· Fish is an excellent source of protein and omega-3 fatty acids. It is a good source of energy and contains vitamins B12, B6, B3, niacin, and iron.

· Certain types of fish may contain high levels of mercury, which may be harmful. As such, the type of fish available for sale is changing. However, fish provides important nutritional benefits for a balanced diet. 

· Recommendations are changing with respect to the number of servings and the type of fish chosen for various ages including portion sizes for pregnant and breastfeeding mothers. 



Fish Benefits



· 60% of the brain is fat and 1/3rd of it is omega -3 fatty acids. One type of omega-3 fatty acid, called DHA, has important health benefits. 

· Sources of DHA include baby's formula (e.g. Enfamil A+, Good Start), fish, meat, enriched egg etc., omega-3 caplets or other forms/preparations sold (not in vegetables). Breastfed babies can receive DHA through breast milk, should the mother include DHA in her diet. 


DHA can:

- Help develop the brain and eyes of the fetus.

- Improve cognitive, behavior, language skills, coordination, and visual function in infants and children.

- Effect emotional and intellectual development.

-  Improve immune functions, and reduce the risk of heart disease and blood pressure.



· It is therefore important to have an appropriate nutritious diet to provide DHA to the fetus and the child since many may not consume enough fish. 



Fish Risks



Fish may be contaminated with environmental toxins with special concern for mercury, which is a neurotoxin. Those most at risk from exposure to high amounts include pregnant women, infants and children:


1. Fetuses - Mercury can cross the placenta and lead to motor impairments (e.g. walking delay), cognitive impairments (deficits inattention, language, memory IQ), and other central nervous system effects.

2. Children - Mercury can impair neurological development.

3. Too Much Salt - Do not offer canned fish for adults to your baby as it contains too much salt.

4. Raw Fish - Raw fish may contain parasites or bacteria that can lead to illness and /or fetal complications. Pregnant women should not consume any raw fish including those found in sashimi and some sushi dishes (which often contain fresh or frozen tuna high in mercury).

5. Nitrites Content & Bacteria - Some fish (e.g. smoked Salmon, trout, and white fish) may have high nitrites contents and may be contaminated with bacteria such as Listeria.



When to Start



· Fish is usually introduced after the age of one year due to allergy and mercury risks.

· Some experts believe it is safe to begin adding fish into the diet as early as 6 to 10 months of age, if the infant is at low risk for developing food allergies. Others suggest waiting until a later age, especially if there is history of food allergy.


Comment:
The updated 2008 AAP guidelines now state that "no current convincing evidence exists to recommend specific avoidance of certain foods beyond four or six months of age for the prevention of allergy."



Which & How Much 



One Canadian food serving of fish is 75 grams or 2.5 ounces (about ½ cup).



1. Low Mercury Fish (Choose Often)

- For infant-child, 2 servings a week ; women and teenagers, 4 servings a week. 

- E.g. Mackerel, salmon, sole, tilapia, sardines, trout, and tuna - canned light, anchovies, cod, flounder, haddock, herring, oyster, shrimp, Pollock, Oyster. 


2. Medium Mercury Fish (Choose Sometimes)

- For infant -child, 1-2 servings a month; women and teenagers, 2-4 servings a week.

- E.g. Grouper, Halibut, Mackerel, tuna - canned or Albacore, Crab Crawfish, whitefish, Lobster, Snapper, stripped Bass, Lobsters.


3. High Mercury Fish (Choose Rarely) 

- For children, women, and teenagers -less than 1 serving a month.

- E.g. Barracuda, Sea Bass, Pickerel, Shark, Swordfish, Tilefish, Tuna (fresh or frozen). 



Comments: 

1. The following are fish that have high levels of omega -3: Anchovies, Arctic char, Herring, Salmon, sardines, trout rainbow, Mackerel -king or Spanish, striped bass, trout -lake.

2. Canned tuna has lower levels of mercury than fresh and frozen tuna. When purchasing canned tuna, choose "light" tuna more often than "white" or "albacore" tuna since it has less mercury.

3. Salmon: When possible, choose wild salmon more often than farmed salmon; it is lower in PCBs (a type of pollutant) while canned salmon is usually wild.


Preparation/Administration



· When you introduce fish to your child, select one of the "white flesh" types such as flounder, haddock, cod, and sole. These seem to contain the lowest allergy risk and are easily digestible. 

· It is very important to remove the bones prior to serving fish to your child. Bones may cause choking (canned fish is safer than fresh fish).

· When preparing fish, choose low- fat cooking methods such as broiling and steaming to avoid unnecessary fat and calories.

· Fish should be cooked thoroughly until it is white, flaky, and separates easily from the bones. Puree the cooked fish immediately and keep at room temperature for no more than a few minutes (freeze immediately after).

· You may poach, bake, or steam the fish and then puree it as you would any other meat and you may serve tuna in its own water or in a light broth. 


Fish Allergy



· Amongst other foods (milk, eggs, soy, nuts, etc.), fish also has a relatively high tendency to cause allergic reactions (a reason why some recommend introducing fish after the age of one year or even later).

· Shellfish, crabs, shrimps, lobsters and "bony" fish are high-risk allergenic foods; therefore, delay their introduction until your child is three years of age or older.

· If your child suffers from fish or shellfish allergy, it is better to avoid all fish and its products (including caviar, Caesar salad, Worcestershire sauce, imitation seafood (e.g., sushi), oysters, scallops, clams, etc.). However, some children are able to tolerate certain types of fish while being allergic to other types.

· Be careful with fried foods in restaurants, as the deep fryer may be used to fry fish, prawns, and other shellfish, contaminating your child's chicken or French fries.

· Altogether, it is better to avoid all seafood restaurants and seafood in general, if your child has an allergy.


About the Author: Dr. Maurice Levy, an eminent pediatrician, has 30 years of day-to-day medical experience in hospitals and in his active pediatric primary care and consultation clinic. Former Chief of Pediatrics and currently Head of Pediatric Research at North York General Hospital, Dr. Levy has trained and worked in various hospitals across the globe. Along with his medical degree and specialty in General Pediatrics, Dr. Levy has received various specialized diplomas and received numerous awards and publications. For more information, visit: www.babyandtoddlerhealth.com.

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