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How to get children to eat healthily

Sarah Schenker
BSc SRD PhD
Nutrition Scientist British Nutrition Foundation
London

Relative to their size, the energy requirements of children are higher than those of adults. During both infancy and adolescence, energy requirements increase rapidly because children are growing quickly and becoming more active. Therefore they should eat foods that are high in energy to help them achieve this energy intake. Because young children do not have large enough stomachs to cope with big meals, they often eat small frequent meals and snacks.

What do children eat?
Key findings from a recent national survey of children's diets and nutrient intakes included low levels of fruit and vegetable consumption and a high intake of sugar, salt and saturated fatty acids. The average energy intake was lower than estimated average requirements, which has been a common finding in other studies. However, this level is unlikely to be inadequate as children were found to be taller and heavier than in previous surveys. In fact statistics from the National Audit Office survey, published in 2001, show that even though children have a relatively high energy requirement, the number who are overweight is increasing.
 
What are the implications of current dietary habits?
While children do not suffer the health problems of previous generations, there is concern that many aspects of their diet may be storing up problems for later in life. Heart disease, stroke, osteoporosis and certain cancers are all partially nutrition-linked and potentially preventable. Poor vitamin D and calcium status in childhood is likely to result in lower bone mineral density and could potentially lead to the development of osteoporosis. Low intakes of zinc, vitamin A and certain B vitamins have been implicated in the aetiology of some cancers. High intakes of saturates may increase the risk of heart disease in later life, and a high intake of salt is linked to raised blood pressure. In addition, an association exists between the frequency of consumption of nonmilk extrinsic sugars and the risk of dental caries.
There is evidence to suggest that children's weight tends to track into adult life. Children who are overweight in their early teens are more likely to be overweight as adults, and adult obesity is usually more severe if obesity started in childhood. There is also evidence to show that overweight adolescents, regardless of whether they remain obese as adults, are more likely to develop chronic diseases.

What is healthy eating for children?
Healthy eating guidelines are represented by the "Balance of Good Health" (see Figure 1) and apply to both adults and children over the age of two years. The most important thing to remember when thinking about making changes to a child's diet is that food should be enjoyable. Many people think that they cannot offer children healthy foods because they would be rejected. Foods should not be classified as either good or bad - in fact any food, no matter how bad its reputation, can be included in a healthy diet as long as the overall balance of nutrients in the diet is right. All foods provide energy and nutrients, and it is achieving the correct intake of those nutrients that is important for health.
The Balance of Good Health is divided into five food groups: fruit and vegetables; starchy foods; meat, fish and alternatives; milk and dairy foods; and foods containing fat and sugar (see Figure 1).

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Eat plenty of foods rich in starch and fibre
Most of a child's dietary energy should be provided by starchy foods such as bread, rice, breakfast cereals, pasta and potatoes. While wholegrain varieties, which are higher in fibre, are the better choices for adults, children can find them too bulky. If a child is offered a meal with a high fibre content, they may find it too filling and not finish the meal, which reduces their nutrient intake.

Eat plenty of fruit and vegetables
It is important to include lots of different types of fruits and vegetables in a child's diet to provide vitamins, minerals, fibre and antioxidant phytochemicals. The recommendation of consuming at least five portions of fruit and vegetables every day also applies to children, but portion sizes are likely to be smaller for younger children, so, for example, a satsuma counts as one portion, whereas adults should really eat two or more.

Don't eat too many foods that contain a lot of fat
Children should avoid eating too many fried foods. They should be offered lean meat and lower-fat dairy foods; semiskimmed milk is suitable for most children over the age of two, but skimmed milk is too low in energy and vitamins for children under five. Cakes, biscuits and chocolate should be eaten only in moderation. This will help to ensure that fat intake is within healthy eating guidelines.

Don't have sugary foods too often
Frequent consumption of sugary foods can increase risk of tooth decay. Sugar-containing foods and drinks can be part of a healthy balanced diet. However, it is advisable for children to consume these foods as part of a meal rather than constantly throughout the day.

Why should we encourage children to eat healthily?
Early experiences with food have a strong impact on the future eating habits and health of young children. The best time to teach good dietary habits is during the early years. Nutrition research shows that children develop their adult food preferences from around the age of four to five years. Introducing new foods during these years helps expand the number and variety of foods they eat during their school-age, teen and adult years. Developing a preference for a variety of foods at an early age can positively influence children's long-term health and nutritional status.
Provide a variety of nutritious foods from the five food groups for children to choose from every day. Each food group provides a different set of nutrients that are essential for good health. For example, key nutrients in the milk and dairy foods group are calcium, protein and riboflavin, whereas key nutrients in the fruit and vegetable group are b-carotene and vitamin C. When children miss out on one food group, they miss out on an entire set of nutrients. Some foods within each food group are better sources of a nutrient than others. In the fruit and vegetables group, for example, oranges are a good source of vitamin C, but less so for b-carotene. Carrots on the other hand are a good source of b-carotene, but not of vitamin C. Make sure children eat a variety of foods within each group every day.
Children don't have to give up foods like hamburgers, chips and ice cream to eat healthily - such foods can be eaten in moderation. Balancing food choices from the "Balance of Good Health" plate model, and checking the nutrition information on food labels, can help keep the diet healthy.

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Resources
British Nutrition Foundation
A briefing paper entitled Nutrition and School Children will be available from the British Nutrition Foundation in summer 2002
W:www.nutrition.org.uk
Food Standards Agency
W:www.food-standards.gov.uk
E:foodstandards@ eclogistics.co.uk
The Nutrition Society
W:www.nutsoc.org.uk

Forthcoming event
30 May 2002
Nutrition: Communicating the Message
British Nutrition Foundation
London
Contact:Stephanie Hyman
British Nutrition Foundation
52-54 High Holborn, London WC1V 6RQ
T:020 7404 6504
F:020 7404 6747
E:postbox@nutrition.org.uk