nutritional guidance for early years: food choices for children aged 1-5 years in early education and childcare settings

nutritional guidance for early years: food choices for children aged 1-5 years in early education and childcare settings

3 additional information

3.1 Physical activity

Physical development and movement is a key aspect of a child's development and learning (Scottish Office, 1999). All children, including children with disabilities, should have the opportunity to be physically active and the pre-5 setting plays a key role in contributing to the minimum recommendation for at least one hour a day. Young children, given the chance, will be physically active as part of spontaneous play - this play allows them to have fun as well as to develop/enhance physical and social health.

Children should be encouraged to be physically active and carers should plan opportunities for structured activity and unstructured active play. Having access and opportunity to a range of physical activities encourages young children to develop positive attitudes to the benefits of physical activity.

Staff and carers should ensure that activities are developmentally appropriate to the age and stage of a child and ensure that links are made with the Curriculum Framework for Children 3 to 5.

3.2 Drinks

It is important for infants and young children to have plenty of fluids to drink to help their body to function properly, keep cool and prevent constipation.

• Children should be encouraged to drink water if they are thirsty. Water quenches thirst, replenishes body fluid, does not spoil the appetite and is safe for their teeth. Milk and water can be taken between meals and cool drinking water should be made available to all children, at any time throughout the day.
• After 1 year of age whole cows milk should be the main drink until the child is at least
  2 years old. After age 2, semi-skimmed can be introduced gradually as a main drink, provided the child is eating well, with enough energy and nutrients from a varied diet. Fully skimmed milk is low in energy and low in some nutrients and for this reason is not suitable as a drink for children under the age of 5.
• Remember that cows and goats milk are unsuitable as the main milk drink for children under one year. However, cows milk can be given as part of milk-based dishes, e.g. yoghurt, custard, rice pudding and white sauce.
• Fresh fruit juice is a good source of Vitamin C and is best given with breakfast or a main meal to help with the absorption of iron. Fresh fruit juices are quite acidic so can be harmful to teeth and should be diluted with water (1 part juice to a minimum of 5 parts water). Juice should be served in a cup rather than a bottle and preferably taken with other food, to minimise the risk of tooth decay.
• Children should be discouraged from frequent consumption of sugared or fizzy drinks. Unsuitable drinks include: fizzy (carbonated) drinks, still sugary drinks, squashes, sugared and fizzy waters. These contribute to dental problems, are a poor source of nutrition, tend to displace other more nutritious foods and can result in poor energy balance. If children have these drinks they should be diluted one part to ten of water.
• Tea and coffee are not recommended for children under 5 as the tannin present can interfere with the absorption of iron.

3.3 Snacks

Children need a varied diet to ensure they get all the nutrients they require for growth and development. Nursery aged children often have small appetites and need regular meals with snacks in between. Snacks should be as nutritious as possible and low in free sugars to prevent tooth decay. Chocolate bars, sweets, cereal bars and sweet biscuits should be saved for after mealtimes and as treats rather than offered between meals.

Here are some suggestions for nutritious snacks:

• Fruit - mouth size chunks, cubes or slices of apple, pear, satsuma, orange, banana, kiwi, melon, strawberries, grapes, peaches and plums.
• Raw vegetables - carrot, pepper, celery, cucumber, cherry tomato, red cabbage, turnip, radish, courgette, broccoli.
• Toast, breads, rolls, baps, french bread with a small amount of butter or spread. Mini sandwiches with marmite, cheese, tuna or thin slices of meat. Pitta bread pockets - cut into small slices; plain or with fat spread high in monounsaturated or polyunsaturated fat, e.g. sunflower or olive spread.
• Bread sticks - on their own or with a dip or soft cheeses, home-made pizza triangles.
• Oatcakes, rice cakes, crackers, crispbreads, melba toast; plain or with butter or spread high in monounsaturated or polyunsaturated fat, e.g. sunflower or olive spread.
• Natural yoghurt with fruit or fromage frais - on its own or as a dip.
• Muffins, plain, potato or cheese scones, crumpets, pancake, plain buns, plain popcorn, low sugar breakfast cereal.

Note: Crisps or corn snacks, e.g. Quavers, Golden Lights, Wheat Crunchies, Tortilla Chips or Twiglets - these can be offered as part of a snack or meal option as an alternative texture and taste, e.g. beside a filled sandwich or salad dish. However, they are high in salt and fat and young children should only be given a small portion (e.g. 15-20g) about twice in the week.

3.4 Vegetarian and vegan diets

• Vegetarian diets

Vegetarians don't eat fish or meat, but most will eat animal products, such as eggs, milk and dairy products. Using the menu guidance provide food from the main food groups. Choose alternatives to meat such as eggs, soya products such as tofu and humous, lentils, beans including baked beans, chopped nut and nut pastes, seed pastes such as in humous, meat substitutes such as soya mince or Quorn, chick peas, e.g. falafel.

Vegetarian meals and snacks are suitable for all children.

• Vegan diets do not include any food from animal sources, therefore in addition to meat and fish they exclude dairy produce, eggs and honey. In this situation meeting the nutritional needs of the child is more complex and should be discussed with the parents and guardian.

Meeting iron requirements on a vegetarian diet

As meat is one of the main sources of iron it is important that vegetarian and vegan children eat other iron rich foods such as wholemeal bread, breakfast cereals, pulses, beans, peas, dried fruits, fortified cereals and dark green vegetables, broccoli, tinned sweetcorn, baked sweet potato. Tea and coffee reduce the uptake of iron in the body and for this reason are not suitable for young children. Fresh fruit and fresh fruit juice are rich in Vitamin C. Vitamin C enhances the uptake of iron in the body when taken along with iron rich foods.

3.5 Food choices and religious faiths and beliefs

Families and children may choose to exclude, include or prepare foods in a particular way according to their religious faith and belief. There may be individual differences in food choices between families of a similar faith and these should be checked for each child with his or her parent or guardian from the outset.

3.6 Children with special needs or therapeutic diets

Children with special needs may have a particular problems associated with eating. It is important that anyone involved in caring for children with eating difficulties is trained to give the most appropriate assistance. These problems should not be a barrier to enjoyment and learning about healthy eating.

For a special or therapeutic diet, a parent/guardian or Registered Dietician will supply the staff or carer with details of the child's dietary needs. Early years staff, carers and caterers should be appropriately advised of the specific nature of the dietary requirements, including suitable food choices for meals and snacks and any foods, which should be excluded.

Food allergies are not uncommon in pre-school age children. There are foods which are more commonly associated with allergy in children: these are milk, wheat, peanuts, fish, soya, eggs, shellfish and citrus fruits. A wide range of symptoms can occur if a child is exposed to an allergen in food, ranging from a mild reaction to a very rapid and severe response.

Allergy to some foods for some children, e.g. peanuts, peanut products, other nuts and shellfish can be particularly serious. Children who are known to suffer from a severe food allergy need to know the exact ingredients in their food to avoid an acute, potentially fatal reaction. When a child has a severe allergy to a particular food the staff or carer may decide to minimise the risk of exposure in the child's environment, as far as is possible, e.g. avoid having the food/ingredient in the nursery at snack or meal times, incorporating information into the local policy with regard to food brought into nursery. In this situation it is important that advice is taken from a Registered Dietician.

3.7 Oral and dental health for toddlers and pre-school children

Staff and carers can work with young children and parents to help develop good oral and dental health habits.

The three most important points in promoting healthy dental habits are:

• choosing foods low in added sugar - if choosing sugary foods or drinks have them as part of a meal.
• Tooth brushing - teach children to use a toothbrush as early as possible.
• having check-ups with a dentist - parents should register their child with a dentist providing NHS care, where treatment is free up to the age of 18 years.

Tooth brushing

Parents and carers should begin tooth brushing as soon as teeth appear. Twice daily tooth brushing with a soft 'baby' toothbrush and fluoride toothpaste is important to prevent tooth decay. A smear of toothpaste should be used for babies and a small pea-sized amount for toddlers and older children. Help children with tooth brushing until they are around
6-8 years old.

Registering with a dentist

If parents have not registered their child with a dentist before leaving them in your care, ask them to do so. If they cannot register with a NHS dentist, then the Community Dental Service may be able to help. Children should visit a dentist for regular check-ups as early as possible and certainly before the age of 2 years.

3.8 Vitamin supplementation

Some children may receive vitamin drops, containing Vitamins A, D and C. This is the responsibility of parents and guardians and can be discussed with them. However, it may be helpful for early years staff and carers to be aware of current advice on children who may benefit from vitamin drops.

For children aged 1-5 the current advice for vitamin supplementation is to take Vitamins A, D and C. ^10,11 Children at risk of vitamin deficiency include: those who are persistent poor eaters and those who consume a very limited number of foods; children on restricted diets of choice, e.g. vegan or exclude food items for management of allergy or intolerance.

Children at risk of Vitamin D deficiency specifically are those living in northern latitudes (Scotland) and those from traditional Asian or Islamic communities (this is particularly important in Scotland in the winter months ¹² (see Annex 2)).

There is no recommendation to give young children aged 1-5 years other more complex multi vitamin and/or mineral preparations unless they are on a special or therapeutic diet and then should be advised by a Registered Dietician.