Shocking or extreme health issues usually make it on to television documentaries and into the newspapers to sell copies but in the last few months the press has reported on worries by doctors and controversial claims by children’s charities that toddlers are eating too much fruit and vegetables, something that will likely be of concern to all of us.
Does this not conflict with the messages we keep hearing that we should try to eat healthily, cutting out the fat and sugar and eating five portions of fruit and vegetables a day?
GIVING CHILDREN EXCESSIVE AMOUNTS OF FRUIT AND VEGETABLES STEMS FROM AN EASY MISUNDERSTANDING THAT WE SHOULD BE FEEDING 1 TO 4 YEAR-OLDS A HEALTHY DIET DESIGNED FOR ADULTS NOT CHILDREN
This is all very confusing and we no longer all have health visitors or close-knit families to pass on advice to us about diets. How do we find out what toddlers and young children can be fed, why do they need certain foods and not others and how on earth do we, as parents, positively encourage a healthy diet in our children?
Dr Alex Richardson*, founder of the charity Food and Behaviour Research, speaking at the National Children’s Nutrition Conference in June, recognised that parents don’t usually have “easy access to reliable information about just how important good nutrition is to their child’s development - and especially to their child’s brain and behaviour.”
What we do know is that children under 5 years old have very specific dietary needs. The current issue of potentially giving children excessive amounts of fruit and vegetables stems from an easy misunderstanding that we should be feeding 1 to 4 year olds a healthy diet based actually on advice designed for adults not children.
Such an adult diet does not take into account the range of nutrients, sugar, fat, protein and carbohydrates that children will need in the early years to grow properly and develop body and brain.
Children need food and nutrients to form muscles, strong bones and teeth, body tissues and strengthen their immune system. This early years growth needs huge resources of energy.
Sam Montel of the Food Standards Agency (FSA) believes that it is great to let children try fruit and vegetables but it is important to remember that they need a nutritious, balanced diet. “They are very active, they are growing. They need a lot of fat in their diet and less fibre.”
The British Nutrition Foundation also advises that toddlers continue to need energy-dense diets: “Care needs to be taken over the amount of fibre eaten. If the diet is too bulky due to too many high fibre foods, there is a danger the child will be unable to eat enough food to satisfy its energy needs.”
Children under 5 years old have very specific dietary needs
Iron - Needed to make red blood cells which carry oxygen around the body. The immune system also needs iron. Found in: Meat, liver, fortified cereals, bread, dried fruit, eggs, beans, pulses and green leafy vegetables like cabbage, spring greens, broccoli and green beans
Calcium - Important for strong bones and teeth, blood clotting, nerves and muscles. Found in: Milk, yoghurt, cheese, fromage frais, dark green vegetables, sesame seeds, sardines, fortified orange juice and pulses
Zinc - Essential for cell division, growth and tissue repair, normal reproductive development, immune system and healing of wounds. Found in: Milk, cheese, meat, eggs and fish, wholegrain cereals and pulses
Vitamin A - Formation and maintenance of skin, hair, and membranes, needed for bone and teeth growth, normal vision and immune system. Found in: Yellow and orange fruit and vegetables (carrots, peppers, tomatoes, mango, apricots), dark green leafy vegetables, liver and dairy products
Vitamin C - Essential for structure of bones, cartilage and muscle. Helps the immune system and the absorption of iron as well as acting as an antioxidant. Found in: Citrus fruits, berries, and vegetables (provided that they aren’t cooked until very soft), tomatoes, potatoes and fruit juice
Vitamin D - Aids in bone and tooth formation and helps the heart and nervous system. Important for absorbing calcium and phosphorus from foods. Found in: Oily fish (salmon, tuna, mackerel, sardines), fortified margarine, eggs, meat and dairy products. Most is obtained through the action of sunlight on the skin
Different foods contain the different but necessary vitamins and minerals. No single food contains everything we need so the key is an overall balance of foods to provide enough energy and nutrients. It is just a matter of getting this balance right, says the FSA: “Too little protein can interfere with growth and other body functions, too much fat leads to obesity and heart disease.”
This is something that the British Heart Foundation is keenly aware of but the charity also notes that: “Babies and toddlers up to the age of 2 years depend on high fat foods like whole milk and margarine for the fat-soluble vitamins A, D and E they contain. Between the ages of 2 and 5 years they can make a gradual transition to lower fat products and start to adopt more adult-type eating habits.” It is interesting to know that breast milk has over 50% energy from fat. After the age of 2, toddlers’ diets move gradually to lower 35% energy from fat recommended by the age of 5.
So, what nutrients do children need?
There are four main suitable food groups and a small fifth group of fatty and sugary foods which can be dipped into every so often. These are:
- Fruit and vegetables
- Bread, rice, potatoes, past and other starchy foods
- Milk and Dairy products
- Meat, fish, eggs, beans and other non-dairy sources of protein
- Foods high in fat and/or sugar
The balance of these food groups is shown in the Eatwell Plate below. If children’s intake, as far as possible for each meal, is based on these groups all the important nutrients will be provided. Children should still strive to eat 5 portions of fruit and vegetables a day, a portion being the size of a child’s hand.
In these developmental years the nutrients children need and get from these five food groups are:
- Calcium
- Starchy carbohydrates
- Protein
- Fat
- Iron
- Zinc
- Vitamins A, C and D
Vitamins A, C and D are essential but can often be missing in diets. Iron requirements, for example, are high at this age but a child’s dietary intake is usually low.
At the National Children’s Nutrition Conference, Dr Paul Clayton* highlighted a key problem with children under the age of 5 being the iron and vitamin A deficiencies. Research has shown that up to 80% of toddlers have iron deficiencies and up to 50% have lower than recommended levels of vitamin A. The foods that provide these nutrients are highlighted in our summary box on the previous page.
It is a natural stage of development that, in their second year, children become fussy eaters. This is an evolutionary response to stop them eating things that might not be food or that might be poison
This is all very well but toddlers are notoriously difficult with food so how do they get the nutrients they need? It is a natural stage of development that, in their second year, children become fussy eaters. This is an evolutionary response to stop them eating things that might not be food or that might be poison.
It is a normal phase and children need to take a while to learn that these foods are ok, that they are familiar to them. As their mouths develop, they also have issues with texture so advice focuses on offering foods that are familiar to children. It is good for them to see other people eating them and slowly they will start to accept them and begin to eat them. It can take up to 15 times of being given a certain food for a child to accept it. Dr Gillian Harris of Birmingham Children’s Hospital featured in the ITV programme “My Child Won’t Eat” says: “Try to keep calm at meal times and not get stressed or increase anxiety about food. Let them eat what they want and slowly introduce new foods.”
It can take up to 15 times of being given a certain food for a child to accept it
Getting children to understand how food helps their bodies, by involving them in the cooking process and eating together whenever possible, especially at the table, right from very early days is thought to get children’s ‘buy in’ in relation to food. It helps children understand where food is from, how it effects their health and starts them taking responsibility for their own bodies and minds whilst learning practical and social skills that will stay with them for life.
Professor Kevin Morgan of Cardiff University sums it up. He has researched school food systems throughout Europe and the US, finding the best school food system to be in Rome where children were given a starter of pasta and tomato sauce, followed by meat and vegetables with cut up fruit for pudding. One of the teachers who sat on the table with the children and ate the same food as them explained: “Food is a pedagogic moment: the children eat what I eat. Without knowledge, how do they know what food to choose.”