Infants and Young Children

Key Message: Once infected with foodborne pathogens, high-risk individuals such as infants and young children are more likely to develop severe symptoms and even life-threatening. Therefore, it is necessary to avoid eating high-risk foods. In addition, this article also mentions other foods that may affect the health of infants and young children.

The natural defences of infants and young children against foodborne pathogens are weaker. Because their immune systems are immature, and the gut microbiota may not be as protective as adults. The gastric juice acidity of a newborn baby is lower than that of an adult. Bacteria and other pathogens are more likely to survive in their bodies. Also, infants and young children consume more food in proportion to their weight than adults, therefore proportionately consuming more toxins or contaminants if present in food. Once infected with food-borne pathogens, infants and young children are more likely to develop severe symptoms which could be life-threatening. Infants and young children should avoid consuming high-risk foods.

Raw or undercooked foods

Raw or undercooked foods are high-risk foods, as there is no or inadequate heat treatment to eliminate the microorganisms present that can pose risks to human health. Infants and young children should avoid eating them. Click here to read about raw or undercooked foods.

Honey

Honey may contain Clostridium botulinum that can produce toxins in a baby's intestines, leading to infant botulism, which causes breathing difficulties, muscle paralysis and even death. Honey may also cause tooth decay.
Honey is not recommended for babies under 1 year old.

Nitrate and Nitrite in Food and Infant Feeding

Nitrate occurs naturally in the environment and plants. Nitrate itself is relatively non-toxic, but it can be converted to nitrite in the infant's body that can cause infant methaemoglobinaemia, otherwise known as "Blue Baby Syndrome". It is a condition where a baby's skin turns blue while there is not enough oxygen in the blood. Infants and people with glucose-6-phosphate dehydrogenase (G6PD) deficiency are more susceptible to the above condition. To prevent "Blue Baby Syndrome":

Babies are recommended to start weaning when they reach 6 months of age. Nitrate-rich vegetables, such as Chinese spinach, Shanghai cabbage and Petiole Chinese cabbage, should not be given to babies until they are 6 months or older.
Babies suffering from gastroenteritis should avoid eating nitrate-rich vegetables.
Babies should not eat processed meats because table salt and/or nitrite compounds are commonly added to these products.
A variety of vegetables (including leafy vegetables, brassica vegetables, root vegetables, fruiting vegetables and legume vegetables) should be introduced to babies so as to avoid overconsumption of certain vegetables naturally high in nitrate.
Weaning food should be prepared hygienically and stored safely. When preparing and handling weaning food with leafy vegetables, apply Five Keys to Food Safety:

Choose	Use fresh and undamaged leafy vegetables.
Clean	Wash leafy vegetables under running water. Use clean utensils to prevent bacterial contamination.
Cook	Cook leafy vegetables in boiling water for 1 to 3 minutes to soften the vegetables for pureeing and kills bacteria.
Separate	Feed immediately and throw away any leftovers as saliva contaminates the food with bacteria.
Safe temperature	If not used immediately, cool the vegetable puree as quickly as possible and store it within one hour after cooking: (1) in a refrigerator and use within one day; or (2) in a freezer and use within one week. Reheat refrigerated/frozen puree until piping hot before use. Do not reheat more than once.

Fish

Avoid giving young children shark, swordfish or marlin as well as their products, such as fish ball. The amount of mercury in these fish can affect the development of young chilren's nervous system.

Click here for Q&As concerning methylmercury in fish.

Infant formula, breast milk and baby food

Infant formula, breast milk and baby food are rich in nutrient and can easily spoil if not handled properly.

Powdered infant formula should be prepared with boiled water no less than 70ºC to kills harmful bacteria which may be present. Cool the prepared formula quickly to feeding temperature by holding the bottle under cold running water. All equipment used for feeding babies and preparing infant formula should be thoroughly cleaned and sanitised. Consume the prepared formula within two hours.
Expressed breast milk should be stored in the fridge if not consumed immediately to inhibit growth of harmful bacteria.
Follow the manufacturer’s instructions on how to prepare and serve prepackaged baby food.

Please refer to the websites of Family Health Service of the Department of Health for details:

Choking Risk

Young children have weak chewing or swallowing abilities and are prone to choking after eating certain foods:

Foods that are small and do not dissolve easily (e.g. konjac jellies in mini cups)
Small hard foods (e.g. nuts, raw carrot pieces and sunflower seeds)
Small round / oval foods (e.g. grapes, peas)
Foods with skins / leaves (e.g. sausages, lettuce, nectarines)
Compressible foods (e.g. hot dogs, marshmallows, chewing gum)
Thick pastes (e.g. chocolate spreads, peanut butter)
Fibrous / stringy foods (e.g. celery, raw pineapple)

To reduce the risk of food-related choking, when preparing meals for young children, caregivers are advised to:

Modify the texture of foods by fine chopping, mashing, cooking, peeling off the skin or removing the strong fibres.
As an example, caregivers should not let young children eat konjac jellies by sucking, but instead they should cut the jellies into small pieces for consumption.
Avoid giving foods with a texture difficult to be modified (e.g. small hard foods) to young children.

Foods worthy of Attention

Lychee	Lychees naturally contain two chemicals, hypoglycine A and methylene cyclopropylglycine, which inhibit the body's production of glucose, and the content of unripe lychees is higher. Compared with adults, children have less glycogen reserves, and skipping meals is more likely to lead to hypoglycemia. If children eat a lot of lychees on an empty stomach, the chemicals in lychees may cause blood sugar to plummet, resulting in convulsions, coma, and even death. Remember not to eat lychees on an empty stomach, and control the amount of lychees each time you eat. Children should not eat more than 5 lychees at a time.
Ginkgo	Ginkgo is toxic because it contains toxins such as 4'-methoxypyridoxine and cyanogenic glycosides. 4'-methoxypyridoxine is a food poisoning chemical. Although cooking cannot destroy 4'-methoxypyridoxine, it can remove the toxicity of heat-labile toxins such as cyanogenic glycosides, thereby reducing the toxicity of ginkgo. Only consume a few ginkgo per day, and children should pay extra attention.
Caffeinated drinks	Caffeine is a central nervous system stimulant that exists naturally in plants such as coffee beans, tea leaves, cocoa beans, and kola nut. Many foods and drinks are fortified with caffeine for its bitter taste and refreshing effect. Tolerance to caffeine in different individuals is different. Excessive intake of caffeine can cause anxiety, rapid heartbeat, tremors, sleep disturbance, upset stomach, etc. In children, excessive intake may temporarily affect behaviour. Children should avoid beverages high in caffeine such as coffee and milk tea, and should maintain a balanced and varied diet.