SummaryEating well and being physically active are essential for any child’s health and development. As children are active and grow rapidly they have a high energy requirement relative to their body size - per kilo of body weight children need more calories than adults. However, younger children may have a small appetite due to the small size of their stomachs, so the frequent consumption of energy and nutrient-rich foods in small amounts is essential to ensure that their nutrient requirements are met. Of course, children’s dietary requirements vary considerably according to age – a food which is suitable for a five year old is not necessarily appropriate for a two year old, and the energy requirements of an eight year old are higher than those of a four year old.
Ensuring that children learn good eating habits and enjoy exercise in the early years are key to ensuring that such good habits are continued throughout life. A child who eats fruit and vegetables and plays football or goes swimming is more likely to enjoy these activities as an adult compared to a child who doesn’t.
Energy requirements for children aged 1-6 years are relatively high as they are growing quickly and are active, but their stomach capacity and appetites are small. Therefore, it is important that young children eat small and regular meals which are not too high in fibre or too low in fat. Fibre-rich diets are bulky and fill small stomachs quickly. As a result children may be missing out on important nutrients and energy, as they may not be hungry or want to eat. Furthermore, high fibre diets can interfere with the absorption of certain key nutrients, e.g. iron. That said, fibre is an important nutrient, so make sure that wholegrain versions of a child’s favourite foods are provided from time-to-time, for example, wholemeal bread or wholegrain breakfast cereals. Fat is a source of energy and therefore should not be restricted in pre-school children’s diets. A number of foods containing fat are also a source of important vitamins and for this reason it is recommended that children under the age of two years are given whole milk and not given semi-skimmed milk, whilst children under the age of five years should be given whole or semi-skimmed milk and not given skimmed milk.
It is important that children consume enough calcium, zinc, iron, vitamin A and vitamin D as well as protein. Calcium and vitamin D are essential for the formation of strong and healthy bones. Sources of calcium include milk and dairy products (from which calcium is most readily absorbed by the body), calcium-fortified soya products or breakfast cereals, canned fish where the bones are eaten (tuna being an exception) and bread. Vitamin D is found in eggs and oily fish, margarine and breakfast cereals which are fortified with this nutrient. Vitamin D can also be synthesised via the action of sunlight on the skin and most vitamin D in the body is obtained in this way. As a result, some exposure to sunlight is essential. Diet is particularly important during the winter months when the sun is not of a sufficient wavelength for the body to produce vitamin D. To avoid some of the problems from too much sun, it is best to limit young children’s outdoor activities to avoid the hottest period of the day.
There are ten key principles to healthy eating which apply to children of all ages:
1. Enjoy food
Ensuring that children enjoy learning about food, shopping for food, cooking, and eating food will help establish a healthy attitude to food. Try not to make mealtimes a fight.
2. Eat a variety of different foods
Variety is the key to ensuring a healthy diet is eaten, providing all the nutrients required for growth and development. Different foods provide different nutrients, so by eating a variety of foods children should be getting the nutrients they need.
3. Eat the right amount to be a healthy weight and be physically active
The number of children who are overweight or obese in the UK is on the increase. Ensuring that a child does not eat more energy then they use is important for ensuring that they maintain a healthy body weight, but it is only one part of the equation – physical activity being the other.
4. Eat plenty of starchy foods
Starchy carbohydrates such as bread, pasta, rice, cereals and potatoes should form the basis of every meal and make up around a third of the diet. Wholegrain versions of these foods should also be included.
5. Eat plenty of fruit and vegetables
Aim for at least 5 different portions each day of fresh, frozen, dried or canned fruits and vegetables. A portion is roughly the equivalent of a child’s handful of that fruit or vegetable. A small glass of 100% fruit or vegetable juice counts as one, and only one, portion a day.
6. Eat moderate amounts of meat, fish and other sources of protein
Foods such as meat, fish, eggs, pulses and (vegetarian) alternatives to meat (e.g. tofu and Quorn) are a source of protein needed by growing children and should be eaten at each meal. Choose lean cuts of meat or reduced fat versions of burgers and sausages. Oil-rich fish (e.g. salmon, trout, mackerel and fresh but not canned tuna) are a good source of omega-3 fatty acids. Avoid giving children shark, swordfish or marlin before the age of 16 years due to the potential for (methyl) mercury exposure, which may impair development.
7. Eat moderate amounts of milk and dairy products
Milk and dairy foods are an important source of calcium, which is needed for bone development. These foods also provide protein and B vitamins, zinc and magnesium. Aim to provide 2-3 servings a day. During childhood and adolescence bone growth and development is at its peak and childhood forms an important window of opportunity for achieving a high bone mass: the higher the bone mass the lower the risk of osteoporosis in later life.
8. Don’t eat too many foods that contain a lot of fat
Foods rich in fat tend to be high in calories, so if eaten in excess can cause weight gain. Limit consumption of fat-rich foods such as pies, crisps, mayonnaise, butter and fried foods. Grill or bake rather than fry foods.
9. Foods and drinks containing sugar should mainly be consumed at mealtimes
Sugar helps improve the flavour of food and can help ensure that children eat a nutrient-rich and balanced diet by widening the range of foods that they will eat. However, frequent consumption of sugar (and other fermentable carbohydrates) influences risk of tooth decay. Encouraging good dental hygiene and brushing teeth twice daily with fluoridated toothpaste is the best way to ensure healthy teeth.
10. Limit the amount of salt in children’s diets
Whilst some salt (or more specifically sodium) in the diet is needed, most children eat too much. Sodium occurs naturally in many foods so there is no need to add salt to children’s diets. Keep an eye on food labels to help limit the amount of salt that a child eats.
Zinc is required for growth, tissue repair and immune function. Found in foods such as meat, fish, bread and breakfast cereals, it is also required for normal skin structure and reproductive development. Iron, on the other hand, is needed for the formation of red blood cells, normal metabolism and immune function. It is found in meat (from where it is readily absorbed) and plant foods such as cereals, pulses and certain vegetables (from which it is less readily absorbed). However, vitamin C can increase absorption of iron from plant sources. Vitamin A is needed for normal growth and development, immune function and normal vision. It is acquired from foods such as whole milk, cheese, liver, butter and margarine as well as carrots, dark green leafy vegetables and orange coloured fruit.
Inadequate nutrient intakes that may lead to deficiency states are a concern amongst children, especially young children and teenage girls. The most common include vitamin A, riboflavin, iron and magnesium. Intakes of calcium are also often less than adequate. For this reason it is important to encourage consumption of a varied and balanced diet in sufficient quantities. Furthermore, children may be given a daily supplement of vitamins A, C and D up until the age of 5 years to ensure that they consume adequate intakes of these nutrients.
Breakfast is essential for all children, as it provides them with a source of energy for the day ahead. Breakfast cereals are a good choice for children as they include carbohydrate and milk and many are fortified with important vitamins and minerals. There has been some concern with regard to the presence of sugar in breakfast cereals, but sugar helps improve palatability. Without sugar, many breakfast cereals providing important nutrients would be inedible. Other good breakfast foods include toast, fruit and fruit juice, and bagels.
Snacks can be a useful means of fulfilling energy and nutrient requirements, as long as consumption is appropriate to a child’s needs and frequency is reasonable. For example, yoghurt and fromage frais are a good source of calcium, a number of B vitamins, protein and energy. They are a popular food choice amongst children and thus form an important source of nutrition. Other snack foods such as chocolate, cakes and crisps can form part of a healthy balanced diet and can be enjoyed by children, as long as their energy content is taken into consideration and they are not eaten over and above a child’s energy requirements.
Foods and drinks containing sugar, e.g. fruit, chocolate, cakes, fruit juice and squashes should mainly be saved for mealtimes, as the frequency of carbohydrate (including sugar) consumption can influence tooth decay. Consuming sugar containing foods and drinks at mealtimes reduces their potential for tooth decay, partly due to the production of acid-neutralising saliva associated with chewing, and partly because of the potential for consumption of protective food components (e.g. cheese) at mealtimes. It is important to instil good dental hygiene at an early age to reduce the risk of dental decay and disease. Brushing teeth twice daily with fluoride-containing toothpaste should be encouraged from the time when the first teeth erupt.
Nutrient and energy requirements increase once again during adolescence to coincide with puberty and the growth spurt. However, a number of teenage girls deliberately restrict their food and energy intake to control their bodyweight. This increases risk of nutrient deficiencies. Of particular concern amongst teenage girls is iron deficiency, as iron requirements increase following the onset of menstruation and many teenage girls fail to consume anywhere near enough of this nutrient. There is also concern regarding calcium intakes in adolescents: bone mass accrual during this time is high, and calcium requirements are higher than at any other stage of life. Many adolescents fail to reach an adequate intake of calcium which could lead to problems for bone health in later life.
There are concerns about the increasing number of children who are overweight or obese. Both diet and physical activity are involved in energy balance and determination of bodyweight. Ensuring that children participate in physical activity can help control bodyweight, improve wellbeing and increase bone mass. It is recommended that all children, from toddlers to teenagers, participate in at least 60 minutes of physical activity, of moderate intensity, each day. Furthermore, it is recommended that they should include activities that improve bone strength and increase muscle strength and flexibility at least twice a week, e.g. weight bearing exercise such as dancing, football, walking and tennis.
- Department of Health (2004) At least five a week. Evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. Department of Health. London.
- Gibson SA (2000) Breakfast cereal consumption in young children: associations with non-milk extrinsic sugars and caries experience: further analysis of data from the UK National Diet and Nutrition Survey of children aged 1.5-4.5 years. Public Health Nutrition 3. 227- 32.
- Gibson SA (2000) Associations between energy density and macronutrient composition in the diets of pre-school children: sugars vs. starch. International Journal of Obesity 24. 633-8.
- Zaura E, van Loveren C, ten Cate JM (2005) Efficacy of fluoride toothpaste in preventing demineralization of smooth dentin surfaces and narrow grooves in situ under frequent exposures to sucrose or bananas. Caries Research 39. 116-22.