If it's a choice between your child's favourite sugary cereal or nothing, then go with the cereal - but add milk or yoghurt.
Those brightly coloured breakfast cereal boxes are, in many homes, often parents' only way to lure their children to the breakfast table.
It's the concept that's vital. Your mother was right: breakfast is indeed the most important meal of the day.
In a world of conflicting information and advice for parents desperate to know the truth about whether food can indeed influence their children's behaviour, even the dieticians say they're trying to make sense of available research, which mostly doesn't come to hard and fast conclusions.
But, says dietician Sandi de Klerk, who is associated with the Sports Science Institute of South Africa, if your child skips breakfast, you will certainly see consequences that include restlessness, irritability, and reduced concentration and performance.
The benefits, on the other hand, are: more energy to learn, more punctuality, better school attendance, fewer stomach aches, better concentration, problem-solving and muscle co-ordination, less obesity - and better behaviour.
In South Africa, recent research did show that between 14% and 19% of children skip breakfast, whether because they claim they're not hungry or as a result of time constraints. Socio-economic circumstances were not studied as a possible cause.
"But it's easy to see why breakfast is so important," De Klerk says.
"Basically they haven't eaten since the evening before and for a small child, that's a very long time. In addition, they get to school early and are expected to start using their minds straight away.
"Parents complain of having no time in the mornings, and their children say they're not hungry, but there are plenty of easy, nutritious alternatives available today, leaving little excuse."
Among her suggestions are: a fruit/yoghurt smoothie, fresh fruit and yoghurt, a cheese or peanut-butter sandwich, or cereal bars.
Porridge or wholegrain cereals may not be very exciting, in spite of their nutritional value, but De Klerk suggests adding variety, such as sliced banana, chopped fruit, chopped nuts or dried fruit.
So what about sugar?
De Klerk says there are claims that sugar causes hyperactivity, depression and mental confusion - but that this is not the case with all children, nor as widespread as is assumed. One study even found that it actually calmed children.
However, many children do have too much sugar in their diet, which is not a good source of other valuable nutrients, she warns.
Her suggestion to parents is the "sugar test". Limit your child's sugar intake for two weeks. On some days give the youngster sugar-sweetened drinks, and on others artificially sweetened drinks, and monitor the behaviour carefully.
That leads the discussion to "glycaemic index" (GI), a relatively new concept ranking carbohydrate foods, based on their effects on blood sugar levels.
Foods ranked as high GI result in bigger "spikes" in blood sugar levels.
But again, De Klerk warns, simply focusing on foods with low GI ratings doesn't give the full picture.
"No one should lose sight of the fact that some naturally high GI foods, such as carrots for example, still contain valuable nutrients like beta-carotene, and shouldn't therefore be excluded based entirely on their GI rating.
"It's also important to consider that the quantity of food eaten determines the effect on blood sugar levels. So 10 carrots will certainly raise your blood sugar levels significantly higher than just one carrot alone. And if you combine a carbohydrate with a protein, or unsaturated fat, the protein or fat will lower the overall glycaemic index of the meal anyway," she says.
Try to include more low-GI foods, but be aware that if you exclude high-GI foods altogether, you could be removing many valuable foods from your diet too.
And what of food additives, specifically artificial sweeteners, such as aspartame?
De Klerk says numerous studies have shown that food additives - especially food dyes like tartrazine - significantly affect the behaviour of a small percentage of children.
The concern is obviously that children are much smaller than adults, yet the amount of additive they take in from foods and drinks that contain it will be the same.
Aspartame, in particular, is believed to alter the way in which the brain transports amino acids, and could lead to low blood sugar levels, but De Klerk says research to date has shown no detrimental effects of aspartame on behaviour or mood.
"But if you're worried about it, it's an easy thing to remove from a child's diet without causing any nutritional deficiencies, so definitely take it out," she suggests.
A recent South African survey, looking at children in rural and urban populations, found intakes lower than two-thirds of the recommended daily allowance (RDA) for micronutrients and minerals such as iron and zinc.
One study, among children aged six months to six years, found one in 20 had iron deficiencies that had resulted in anaemia, and one in 10 children were iron-depleted.
De Klerk says the symptoms of iron deficiency can include disruptive behaviour, poor school achievement and concentration problems.
Sources of iron include liver and red meat, poultry, fish and shellfish, dried fruits, beans and vegetables like spinach and broccoli.
Another suggestion from De Klerk is that parents should be aware of some factors that could inhibit the absorption of iron, such as caffeinated cooldrinks, coffee, and regular tea, due to its high tannin content.
But parents shouldn't panic and rush out and supplement with iron before they have their children's iron levels properly checked.
Supplements can result in an iron overload, with potentially serious consequences.
As far as zinc deficiencies are concerned, they have been shown to affect brain development and behaviour in animals. And recent research looking at supplementing in children with attention deficit disorder showed potentially promising results in those that had previously low zinc levels.
Further research is needed, De Klerk says.
Good sources of zinc are seafood, liver, red meat, dairy products, wholegrains and egg yolks.
Now that salt has been iodised in South Africa, iodine deficiency has become less of a concern. But iodine deficiency has been shown to result in impaired school performance, decreased IQ and enlarged thyroids.
What about Attention Deficit Disorder (ADHD)?
De Klerk refers here to essential fatty acids, called omega 3 and 6, which are the subject of ongoing research, but which she says have been hailed for improving the memory pathways, improving control of sensory input and musculo-skeletal control.
One pilot study in 2002 suggested reduced symptoms, specifically learning difficulties, in children with ADHD, following supplementation with unsaturated fatty acids.
However, De Klerk says, most studies have shown no significant improvement and again, more research is necessary.
Sources of these essential fatty acids include fatty fish such as tuna, yellowtail and mackerel, and flaxseeds, linseeds, legumes, wholegrains, dark green leafy vegetables and vegetable oils.
"I'd first try to get those into the diet, before I'd recommend supplementation in this regard for children," De Klerk says.
So are there cases in which parents should give their children supplements?
De Klerk says there is no proof that children need supplements to improve their behaviour if they're eating a good diet.
Current suggestions for fruit and vegetables are five to nine portions daily.
If you are going to supplement, don't give a high- dosage supplement of a single vitamin or mineral.
"Rather opt for a general multivitamin that provides 100% of the recommended daily allowance," she suggests.
- Dieticians De Klerk, and Jenny-Ann Smuts and Lauren Tanchel, from Shelly Meltzer & Associates, have been involved in giving nutrition-behaviour related talks to selected schools, a project that was initiated by Woolworths.
How to tailor a menu to manage the effect of food on your child's behaviour
- Encourage your child to eat breakfast, even if it is on the run.
- Control your child's blood sugar levels by providing regular meals and snacks, and choose carbohydrates with a low glycaemic index (GI). Remember that protein and fat lower the GI, so it is useful to combine a carbohydrate with protein or unsaturated fat.
- Reduce your child's sugar intake. Although sugar has not been consistently shown to have adverse effects on behaviour, the possibility that it may affect a small group of children cannot be ruled out. Choose nutritious snacks that are low in sugar such as homemade popcorn, a peanut butter or tuna sandwich, fruit, trail mix, biltong, bran or fruit muffin, and yoghurt.
- Try removing food additives from the diet, starting with artificial colourings and moving on to artificial flavourings, preservatives and sweeteners. Some names to look out for on food labels include tartrazine (E102), erythrosine (E127), benzoic acid (E210), sulphur dioxide, EDTA, BHA, BHT and calcium propionate.
- Next, consider omitting foods with a high salicylate content. Some foods high in salicylate include coffee, peaches, oranges, apples, berries, tea, tomatoes, cucumber and peppers.
- If your child's behaviour does not improve with the above dietary changes, try the "few foods" diet, which involves exclusion of foods shown to be a problem for some children. Foods to exclude are caffeine, wheat, eggs, milk and other dairy products, chocolate, soybeans/tofu and corn products. You should keep your child on the diet for two weeks, under the supervision of a health professional.
- Once the offending foods have been identified, the diet needs to be checked for its nutritional adequacy. Ensure the diet is varied by choosing a variety of foods. But if your child is following a very restrictive diet then you need to consult a registered dietitian.
- Before resorting to supplements, focus on improving your child's diet. Essential fatty acids, especially omega-3 fatty acids (found in fatty fish and linseeds), may have a beneficial effect on children with behavioural problems, but more studies are needed. In the meantime, include foods rich in essential fatty acids such as fish, nuts, seeds, legumes, wholegrains, dark green leafy vegetables, and vegetable oils. Seek professional advice before taking herbal supplements, as they may interact with certain drugs, and some may have side-effects. There is no such evidence for the use of high-dose multivitamin and mineral supplements. If you want to give your child a supplement, choose a multivitamin and mineral that provides 100% of recommended daily allowance.
- Children's behaviour can be very erratic, so it is often not easy to link behaviour to diet. Try being as objective as possible, and use a food and symptom diary to help you along. - Information from Shelly Meltzer and Associates, dietitians associated with the Sports Science Institute of South Africa.