Ask the expert - we talk to Abby Ixer, RD, about teen diet and stress

Teen nutrition  - sleep, stress, exams & supplements

Welcome to the first in a two part blog series, focusing on teen diet. We spoke to Abby Ixer, Registered Dietitian, about whether food can positively impact stress, sleep and energy issues in young people, whether teens should take supplements, and common teen nutrient deficiencies.

We hope you enjoy Abby’s article.

Foodwise, the teenage years can be some of the most challenging for children and their parents.

For parents and teens, it’s a time of great change – teens strive for independence to choose their own diet yet often make unhealthy food choices when given freedom of choice, and like many adults, can be influenced by marketing and the choices of their peers.

 It can be challenging for a parent to promote independence whilst still ensuring that nutritional needs are met. Many parents struggle to encourage their children to maintain a healthy diet when they reach adolescence – for example there may be healthy options on the school lunch menu but that doesn’t mean that they will be chosen by their kids!

 Many issues arise during adolescent years including body image, exam stress, sleep disturbances and difficulty with concentration as the teenage body undergoes numerous hormonal, physical and emotional changes.

Stress and other issues

The British Nutrition Foundation states that eating a healthy, balanced diet and staying active are not only good for overall health, but could also help to cope in times of stress. With exams and peer pressure at the forefront, the teenage years can be a stressful time which sees many children reaching for unhealthy foods for comfort and convenience. Many teenagers are unaware of the impact of an unhealthy diet on their overall wellbeing – not just their weight but also their sleep quality, ability to concentrate, their skin and their mental health.

So, what is a healthy balanced diet for teens?

General healthy eating tips for teenagers:

-          Have regular meals – avoid skipping breakfast. Around a third of young people regularly avoid having breakfast on school days. It is a myth that skipping breakfast can aid weight loss, as many teenagers believe. Starting the day with a balanced meal reduces the desire to snack on unhealthy foods later on and maintains energy levels throughout the morning.

-          Include a variety of food groups for balance including fruits and vegetables, starchy foods, protein and dairy or alternatives. Encourage teens to get involved with food shopping and cooking. If they have some input into their meals they may be more inclined to try a variety of foods.

-          Eat plenty of fruits and vegetables. On average, only 7-10% of children aged 11-18 years consume the recommended five portions of fruits and vegetables daily, meaning that the majority of young people are missing out on vital nutrients.

-          Choose healthier snacks – sugary snacks may result in a sugar high and subsequent fatigue later on. Consumption of free sugars should not exceed 5% of a teenager’s total energy intake daily. Free sugars include all sugars added by manufacturers as well as those naturally present in honey, syrups and unsweetened fruit juices. The most recent result from the National Diet and Nutrition Survey (published in April 2018) show that young people’s intake of sugar is way above the recommended levels and only 5% of 11-18 year olds meet this recommendation.

-          Drink plenty of fluid to stay hydrated – aim for 6-8 glasses a day (or 1.5-2 litres). Water is the healthiest choice, making up 60-70% if the human body. It is best to avoid too many fizzy drinks and fruit juices due to the high sugar content. Fruit juices should be limited to no more than 150mls daily. Also be wary of smoothies as these can also be high in sugar. Data shows that the main source of sugar in a teenager’s diet comes from non-alcoholic drinks. This is especially important for active teens who participate in a lot of sport. Healthy drinks include water, milk, sugar free squash or herbal tea.

The three vitamins and minerals that your teenage child may need more of:

 The main current healthy eating advice for teenagers is based on the Eatwell Guide (see link in references below). However, there are specific micronutrients that are particularly important for teenagers. These include:


Iron is essential for building red blood cells to transport oxygen around the body to use for energy. Teenage requirements for iron are higher than any other age group, as their bodies are still growing and preparing them for adulthood. Teenage girls need more than boys (14.8mg for girls compared to 11.3mg for boys). Survey data shows that around 48% of 11-18 year old girls in the UK consume below the recommended amount of iron. Iron deficiency (known as anaemia) can lead to fatigue, lethargy and weakness. Iron rich foods include red meat, green leafy vegetables, dried fruit, nuts, beans, wholegrains and fortified breakfast cereals. Vitamin C helps us to absorb iron, so including fruits or vegetables with each meal will increase the absorption.

vitamin d

Vitamin D is needed to aid the absorption of calcium – essential for the maintenance of healthy bones and teeth. Vitamin D is produced mostly in the skin in response to sunlight, but can also be found in small amounts in oily fish, red meat, eggs and fortified breakfast cereals.



Calcium is required to maintain healthy bones and teeth. The majority of bone mass is built in childhood, and by the time our children reach the end of their teenage years, their bones have already almost reached their maximum strength and density. Therefore it is crucial to ensure optimal nutrition during the teenage years in order to ensure healthy bones as adults. Teenagers need more calcium than any other age group; with males needing 1000mg daily and females needing 800mg daily (the average adult needs just 700mg). Calcium can be found in dairy products (milk, cheese, and yoghurt), tinned fish, green leafy vegetables, nuts and soya products (such as tofu).


The following table lists recommended sources of iron, vitamin D and calcium in various common foods.

The following table lists recommended sources of iron, vitamin D and calcium in various common foods.

Does my teenager need a supplement?

According to NHS guidance, if a teenager is eating a balanced diet, they generally shouldn’t need any supplements unless there is a known deficiency.  

The exception is vitamin D, as the body is unable to produce vitamin D all year round because sunlight exposure is reduced during the winter months. Generally, the body should produce enough during the summer to maintain good reserves during the colder part of the year. In today’s society, teenagers are spending more time indoors and therefore receiving less sun exposure during the summer and as a result, the incidence of deficiency is increasing. In recent years, low vitamin D status has been observed in 22% of 11-18 year olds across the year as a whole, with an increase in deficiency being observed during the winter months. As there are very few dietary sources of vitamin D, the new government guidance states that teenagers should consider taking a daily 10µg vitamin D supplement during autumn and winter.

meal ideas for optimum teen nutrition:

Whilst we all understand the concept of a balanced diet, it’s easy to get stuck in a rut of the same old breakfasts, lunches and dinners. We asked Abby for some quick meal ideas which to help fuel your teen through the day, and minimise energy slumps.


Porridge made with milk (or a dairy free alternative). Try one of these tasty variations:

o   ‘Crunch’ porridge: small handful of dried fruit and mixed seeds (try dried apricots and pumpkin or sunflower seeds).

o   ‘Apple pie’: grated apple, a small handful of flaked almonds and a pinch of cinnamon.

o   ‘Banana bread’: mashed banana, a small handful of pecan buts and a pinch of nutmeg.

o   ‘Summer berry’: cooked apple and berry compote

o   ‘Carrot cake’: grated carrot, a small handful of walnuts and a pinch of cinnamon.

Wholegrain cereal such as shredded wheat, bran flakes, Special K or Weetabix).

Wholemeal/seeded toast with one of the following:

o   Peanut butter

o   Marmite

o   2 poached or scrambled eggs

o   ½ tin of baked beans

 Also include a piece of fruit or 150ml of fruit juice for extra vitamin C and a calcium rich food (e.g. low fat yoghurt, glass of milk, etc.)


Jacket potato, baked beans, cheese, salad

Sandwich with various fillings:

o   Tuna and cucumber/sweetcorn/green pepper.

o   Chicken/turkey, lettuce and tomato.

o   Smoked salmon, low fat cream cheese and cucumber.

o   Egg and cress.

o   Hummous and red pepper.

o   Peanut butter and banans

Tinned sardines on wholemeal toast.

Lentil and vegetable soup.

Omelette – add vegetables for a vitamin and fibre boost.

Also serve with a piece of fruit and a calcium rich food as before.


Bean chilli or stew served with brown rice/couscous and vegetables.

Spaghetti Bolognese – made with lean beef mince and served with whole-wheat pasta and salad.

Serving of meat/fish/tofu with boiled new potatoes (skins on) and vegetables.

Try to ensure that main meals contain a balance of carbohydrates, protein and vegetables.


A handful of mixed nuts and dried fruit.

Low fat Greek yoghurt with fresh fruit.

Carrot/cucumber/pepper sticks with hummous.

Small wholemeal pitta bread with hummous or tahini (sesame seed dip).

Sliced apple with 1 teaspoon of peanut butter.

Oatcakes with low fat cream cheese.

30g piece of cheese and a handful of cherry tomatoes.

Plain popcorn – add a sprinkle or chilli powder or cinnamon for extra flavour.

Glass of milk (or dairy free alternative).

For a sweet treat, try homemade frozen yoghurt - mix together low fat Greek yoghurt with mashed banana and chopped mixed berries. Freeze until solid, stirring occasionally.

Join us for part two (published 19th nov 2018), when we discuss teenagers and caffeine, sleep, memory and stress.

And sign up below for a live teenage diet Q & A with Abby, and Organic Cookery School founder, Lucy, on 25th November 2018 (limited places)

Solutions for baby CMPA - tips from parents on how to get your baby seen and treated as soon as possible.

cmpa parent advice treatment diagnosis organic cookery school.png


CMPA affects between  1.9 – 4.9% of young children and is the leading cause of food allergy in infants and young children younger than 3 years (GP INFANT FEEDING NETWORK), with many growing out of their symptoms by the time they are toddlers. However the journey from diagnosis to treatment (and solving baby pain) can be long and convoluted. 

Many mums start with their Health Visitor or GP, and have to return time and time again to be (eventually) referred to a paediatrian, and dietitian. 

With such high occurences, we thought it valuable to talk to parents who've been through this, and (just about) escaped intact - many of whom have gone on to blog about their experiences and offer support to other families on this journey.

The aim of this article is to illustrate the recurring point that you know your baby best - and if they have any symptoms associated with CMPA, you have a right to expect these symptoms to be addressed as soon as possible. 

We'll be exploring this issue in further depth in our upcoming dietitian-led parent workshop (online on 7th June, book a place here), when Nishti from Nishti's Choice will offer her advice on self-diagnosis tools and resources which will help you evidence your baby's problems to health care professional and get support as soon as possible.

Resources include:

  • Nishti’s Choice - My Baby’s Assessment  (to self diagnose)

  • Nishti’s choice - My Baby’s Symptom Tracker (to show to your healthcare professional)

  • The Milk Ladder Symptom Diary (to help you through the milk ladder)

  • CMPA Food Fact Sheet (to help you check food labels)

  • Alternative Products for the Dairy Free Diet (to help you pan your meals, especially if breastfeeding)

Book your place on the parent workshop here

But now it's time to hear from the ladies who've been through this. 

Emma's story, (from Free From Farmhouse).

It took 9 months to get my son officially diagnosed, despite terrible eczema, frequent doctors visits, a trip to A&E and reactions during weaning. With my daughter I knew from day one but I still had to fight for a diagnosis and dairy free formula. Unfortunately it's such a common story. I interviewed lots of experts for my book about living with allergies, which comes out next year with Allergy UK, and they all know the issues but still have a hard time getting GPs to recognise symptoms. 

Nina's story, (from Non-Ige Baby).

It took (sic) around 28 days for my youngest - he couldn’t lay flat for vomiting, his skin was awful and at the point when he struggled to breathe even when bolt upright he was diagnosed. My eldest is still waiting and she’s nearly 3. Luckily she’s able to drink oat milk and is willing to take supplements! I don’t think she’ll ever get any help if I’m honest- it was a battle with my son when the problem was plain as day to everyone who saw him.

Becky's story (from Incredible Isla)

We (sic) sSelf diagnosed after 5 months. Immediate dietitian referral who has been amazing in helping us through multiple severe food allergies .

Laura's story (from Five Little Doves)


(It took) 12 months with my first daughter and 9 months with my second. My second daughter was in and out of hospital for 9 months before they finally took it seriously and ended up really unwell. I wish I had pushed harder.

Sarah's story (from Mummy Cat Notes)

It took six months to finally get a diagnoses with my son, none of the doctors believed me and I had to change his milk that was recommended to me by a friend to show that milk was effecting him and they finally accepted it. it’s shocking how it’s one of the most common childhood allergies but no one believes it. 

Laura's story (from Edinburgh With Kids)

It took (sic) 14 months here. After an initial hospital visit at 3 months due to a lot of vomit, we were in and out of doctors visits as she went from vomiting and weight loss to chronic constipation, finally got referred to allergies at about 9 month but another 5 to actually be seen. 

 Zoe's story (from Mummy and Liss).

It took months for me to get a diagnosis for my daughter, I knew it was more than 'just colic' and I was right. In regards to speeding up the process of a referral.. just keep on at them, it sounds bad but do not back down or you will be turned away.. hang in there & just know that you're not an annoyance,  you're doing what's best for your baby  

Lauren's story, (from Dilan and Me).

 It took several months here. My little boy was sick all the time (actual puddles of sick everywhere we went), then his weight gain flat-lined. He fell below the second centile and was diagnosed as “failure to thrive” but no one knew why. I began to suspect CMPA as a friend's baby just had that diagnosis. At 6m we started BLW and he had some chicken cooked in a cream sauce, then immediately came out in hives everywhere it had touched. Luckily he hadn’t ingested any. We both cut out dairy and soya immediately (I was Breastfeeding) and his sickness stopped, and his weight shot up. So basically it was completely diagnosed by myself with very little healthcare professional support. I was dairy and soya free for 2 years until he self weaned, and he’s very very slowly progressing up the milk ladders now at 4.5. 

I advise mums to research as much as they can for themselves, and to read the MAP guidelines which health care professionals should be following. Unfortunately you have to be quite pushy and really advocate for your child to get the support you/they need, but I find showing a GP the guidelines in black and white tends to get them to act and actually refer you to wherever you need. For breastfeeding mums in particular a dietician referral is recommended because it’s important someone is monitoring their diet too for all the correct vitamins and nutrients x

Lauren has created a really helpful Dairy and Soya Free Treats list (perfect if you are breastfeeding).

Samantha's story (from Serenely Sam)

 It took around 4 months for my daughter to be diagnosed. I know thats a lot faster than some but it was only thanks to my amazing health visitor. My GP was very dismissive and wouldn't listen to any of my concerns about my daughter's symptoms. She was being sick all day, explosive nappies all day, she was writhing in pain during every feed, had blood coming from her bum on a few occasions, and also had reflux. The GP refused to look passed the reflux, even when she knew that CMPA ran in my family! My Health visitor's hands were tied really as I had to go through my GP but when the GP wouldnt help, and my daughter was so ill, she referred us to a dietician herself as an emergency case. My daughter was prescribed Similac formula which immediately helped her. 

Nathalie's story (from The Intolerant Gourmand)

My son had a severe allergic reaction and was rushed to A&E at 8 weeks old. But it took until he was 16 months old, and 3 further severe allergic reactions where we almost lost him, before he was finally diagnosed with multiple severe allergies, including CMPA! 
I now work with a number of clients creating allergy safe recipes, lecturing with leading Paed Consultants at various conferences across Europe to help them better understand the impact of diagnosis and the time taken for diagnosis, and coach parents and children to help them to live positively with allergies.

Don't forget to join us on 7th June 2018, for our live parent/dietitian workshop. Tickets cost £10 and are limited in number.

Thank you to all the bloggers who shared their experiences in this post. Please check out their websites and let them know we sent you :)

Ask the expert - we talk to an oral health expert about the best ways to look after your family’s teeth and avoid child tooth decay and extractions.


The dental health of children, including issues such as tooth extractions and decay are currently making headlines for all the wrong reasons. Numbers of child tooth extractions are up, causing what must be for many children, a great deal of unnecessary stress and discomfort, as well as putting additional pressure on the NHS.

Hospitals extracted multiple teeth from children and teenagers in England a total of 42,911 times – 170 a day – in 2016-17, according to statistics obtained by the Local Government Association

As a parent, and someone who spent a lot of time in the dentist’s chair from the age of ten (due to two broken front teeth rather than cavities), this worries me deeply not only because I know just how distressing and painful dental work is, but also because for most, it is avoidable.

I’d like to think I’m a well informed parent, but these statistics make me wonder just what’s missing in our parenting education, for this problem to be growing so dramatically.

Yes, we need to give our children less sugary foods.

Yes, supermarkets need to stop promoting sugary food.

But as well as dietary choices, how much do parents really know about the best ways to care for their children’s teeth?

As a parent educator, I also know it’s something that other parents lack confidence in too, especially those who have babies starting solids or preschoolers.

Is there enough support and information to support parents right from when a baby starts solids, through to when a child is left to brush their teeth independently?

With this in mind, I decided it was time put some of our parent questions to an expert, and I am very grateful to Samantha Glover, Dental Public Health Program Manager at Public Health England, for taking part in the following Q and A. All questions were submitted by The Organic Cookery School’s Parent Focus Group.

This first question came from Isabel, who like many parents often gives homemade smoothies as a way to boost her children’s intake of fruit and veg (particularly spinach, which as we all know becomes infinitely more acceptable to a child blitzed up with fruit)

Q: Are smoothies really bad? Are they better if drunk through a straw?

A: It is so much better to eat whole fruits; when you blitz the smoothie you release the sugars which can damage your teeth.

These can also be quite acid, leading to enamel erosion. If you are going to have a smoothie or any drink that is not water or milk, drink it with a meal and over a short period of time. The worst thing you can do is sip these drinks throughout the day as it means the damage is continual rather than being in one hit.

If straws reduce the amount of time a sugary drink is in contact with teeth, then yes, but this is reduced if being sipped over a long period.

Find out more on this topic here

Amy wanted to know whether it’s better to offer smoothies at a particular time of day.

Q: Is it better to give a smoothie in the morning (because you can brush teeth after)

A: Give it with a meal and stick to water or milk in between meals. Do not brush your teeth for 45mins after you have eaten or drank anything. Once you eat or drink the sugars and acids in the food form an acid which attacks the enamel. Over the next 45 mins your saliva with help neutralise this acid environment and bring the PH back to a neutral level. At this point it is safe to brush again. If you want to help you teeth drink some water after eating or drinking.

Find out more on this topic here:

Lianne has a toddler and school-aged child and wanted to know how important it is to use toothpaste targeted at different age groups.

Q: Do I really need different toothpastes for all the different ages? Does it matter if my two year old and 8 year old have the same one?

A: The difference in ages for toothpaste is the fluoride content. Children from 4 years old who are developing their adult teeth benefit from the higher dose of fluoride (1450ppm). This is the same for all children older than this. With children 4 and above use a pea sized blob. Children under this age use just a smear. Rub the toothpaste in to the toothbrush so the child doesn’t just suck the paste off the brush and swallow it.

Find out more on this topic here:

Lianne also asked about mouthwashes targeted at children.

Q: Do my children need to use children’s mouthwash?

A: Children should not need to use a mouthwash unless recommended by their dental professional. After brushing the teeth for two minutes with a fluoride toothpaste spit out the bubbles but do not rinse. You want that fluoride to soak in to the enamel to help keep it strong. If you rinse with water or mouthwash you will wash all of this away. The child’s saliva will slowly  wash this away once it has done its job.

Monika wondered about whether toothbrushes need cleaning.

Q: Should I clean my child’s toothbrush (eg sterilise it)?


A: No, toothbrushes should be replaced regularly. Every three months is recommended but if yor child has been sick or been unwell replace the toothbrush before. Use a toothbrush cover once the brush is dry or keep them in a cupboard. Do not use each other’s brushes. It is always best to replace than try and sterilise or disinfect a brush. Just rinse the bristles well after use and leave to try.

Find out more on this topic here:

Inga wondered about the effects of dried fruit on teeth, especially as a playtime snack or at lunch.

Q: Can I give my children dried fruit snacks during the day?

A: Dried fruits such as raisins are very concentrated sugar and stick so they stay on the tooth surface for a long time. Try to limit snacks to two a day (100cals) and drink plenty of water after a snack to help clean the mouth.

Find out more on this topic here:

Ines posed a great question about foods that might help neutralise sugar acid during the day.

Q: Does cheese (or any other food) neutralise sugar acid?

A: Yes to a degree. Low acid and sugar snacks include rice cakes, cheese and milk. These can be a good addition to the diet and water and milk are a good option after something acidic or with sugar.  

Find out more on this topic here:

Chloe, one of our ‘Cooking for Baby’ mums asked about babies and teething.

Q: Is it ok to let my baby chew her toothbrush when teething?

A: Teething rings are better for long term chewing but introducing your baby to a toothbrush whilst they are teething is a good idea, they can get used to the feeling of the bristles so this feels more familiar when you start to brush the teeth. Children should be supervised to brush up to the age of 7.

Sam wondered whether her son’s current dental routine was linked to recurrent bad breath.

Q: My child has bad breath, but we clean teeth regularly, are we doing something wrong?

A: Bad breath can be a sign of a throat or stomach problem. Take the child to check that the teeth and gums are clean and healthy. If this is the case then check with your GP.  Often when a child has a throat infection or stomach problem it can cause a bad taste and smell in the mouth.

We also asked about rinsing with water.

Q: Should my child rinse with water or leave some toothpaste in their mouth after brushing?

A: Spit don’t rinse (see above)

And whether Samantha had any specific advice on sippy cups/giving up bottles.

A: Children should be encouraged to drink from a free flowing cup from 6 months. This will help with keeping the teeth healthy as the liquid is not pooling in the mouth and is in contact with the teeth for a shorter period of time. It will also help with speech development as different muscles are used to drink from a cup.

Find out more on this topic here:

Best books to encourage your children to brush their teeth (and eliminate worry at the dentist)


As parents we all want our children to understand the importance of brushing their teeth properly, but the natural consequence of not doing so (tooth decay, drilling, filling, gum disease and even tooth extractions) are pretty scary. Most of the dentists I’ve visited have been brilliant with my daughters but it can still be a little scary, particularly if you have an anxious child.

The following book list has been put together by myself and Samantha Glover,  Dental Public Health Program Manager at Public Health England, who recently answered parent questions about the best ways to look after your children’s teeth.

When choosing stories on a dentist/tooth brushing theme, Samantha tries ‘to steer away from books that link the dentist with toothache i.e ‘little princess had a terrible tooth ache so she went to the dentist to get it fixed’. We want young people to get used to going to the dentist (from one year old) as a routine thing not related to pain or anxiety.’

The following books are all available from Amazon, and should be accessible from your library too.

You can read the full article, Ask the expert - we talk to an oral health expert about the best ways to look after your family’s teeth and avoid child tooth decay and extractions, by clicking this link.

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