Two-year-old Zekaniah Bon is still a few years away from starting school, but the food he pops in his mouth today could have a big impact on his education.
The charismatic toddler is healthy, happy and full of energy.
But more than 60 per cent of babies in remote Far North Queensland, where Zekaniah was born, have a blood disease that new research has linked to developmental disadvantage in young children.
The James Cook University (JCU) study found 46 per cent of babies who suffered early childhood anaemia under-performed in national standards for measuring development, compared to 23 per cent of those who had not.
Anaemia is a condition where the number and size of red blood cells falls below an established cut-off value, which impacts the body's ability to transport oxygen through the blood.
JCU senior lecturer Dympna Leonard said the findings could help explain poor education outcomes among Indigenous children.
"It means they're disadvantaged when it comes to starting their formal education," Ms Leonard said.
The study used results from the Australian Early Development Census (AEDC), a national measure of child development.
"It is a good predictor of how children will do later at NAPLAN during their school years, so this does interrelate to numeracy and literacy," Ms Leonard said.
Dietitians dropping off the map
National Dietitians Association director Tara Diversi said the results were concerning, and could be linked to a staggering decline in the number of dietitians working in remote areas as a result of funding cuts.
"In 2009, we had 143 dietitians working in population and preventative health and that's been reduced by about 90 per cent," she said.
"We need to have a look at our workforce — we need to have more dietitians and nutritionists that are working in areas that have high rates of anaemia, particularly those rural and remote Australia."
Having grown up on Thursday Island in the Torres Strait, Zekaniah's mother Siegrid David agrees.
"Every mother wants the best for her children and I think nutrition is really important," Ms David said.
"We never really grew up with healthy food and never got taught to eat healthy — I think there should be more programs to help young mothers, to show them what is best for children."
The study has also sparked calls for an new focus on nutrition in Australia's Closing the Gap initiative, which failed to meet its 2018 education target.
"I think that what's happened is nutrition has dropped off the agenda — it's certainly not especially included in the Closing the Gap agenda," Ms Leonard said.
"I would like to see nutrition in early life for mums and bubs included in all those agendas and I'd also like to see an added layer, which is anaemia prevention.
"When you've got widespread anaemia, you really need specific programs for anaemia prevention."
Poverty, remoteness underpins disadvantage
Ms Leonard said Indigenous communities needed to be consulted over the implementation of solutions to address iron deficiency in babies.
"The World Health Organisation recommends that food is fortified with a special multi-micronutrient preparation that is added to the baby's food," she said.
"Where they've done those interventions it's been very effective at preventing the early childhood anaemia.
"What we're talking about is children are not developing to their full potential, so it's really important that we do everything we can to enable children to develop to their full potential so they're not disadvantaged when they start school."
She said there were also problems accessing fresh, healthy food in remote areas.
"When people are living in remote communities, living on very low incomes, it is very hard to provide enough nutritious food for a large family, so you're looking fundamentally at issues of poverty and high food cost underlying this issue," Ms Leonard said.
Iron requirements soar in pregnancy
Ms Leonard said nutritional adequacy in mothers was also important for preventing anaemia in babies.
"The baby gets his or her iron from mum during pregnancy and that carries the baby through to four to six months and that's why we talk about needing solid food around that age," she said.
"By that time, the iron that mum has provided has run out. If mum is low on iron, the bub is more likely to run out of iron earlier."
Ms Diversi said women required more iron during pregnancy.
"They need to talk to their health professionals during pregnancy about what they're eating," she said.
"We know that we can't get enough iron from food during pregnancy and we need to look at supplementing."