Establishing good eating habits in young children

Dr Lucy Chambers with advice on how to encourage healthy eating in children

Children need to learn how to eat (well)

Young children need plenty of time and opportunities to learn important life skills, such as walking and talking, and eating is no different. During early childhood, they become accustomed to eating the types and amounts of foods that their family eats, and the family rules and traditions around eating. These early food experiences play a significant role in determining children’s eating habits, including the foods they accept and reject and how much they eat, throughout childhood and beyond, which, in turn, influence the quality of their diet.^1,2 Providing parents and carers with advice on what types and amounts of foods are appropriate for young children and how to feed these foods can help children along the journey to establishing lifelong healthy eating habits.

What foods should young children be eating?

Feeding young children a wide variety of foods that are part of a healthy, balanced diet right from the start will not only ensure that they get all the nutrients (with the possible exception of vitamin D, which should be given as a supplement) and energy needed for good health and appropriate growth, but also help them to learn to like these foods. 

Although the UK healthy eating model, the Eatwell Guide, does not apply to children under two years of age as they have different requirements to older children and adults, the basic principles are relevant to children from two years of age who should gradually move to eating family foods in the proportions of the Eatwell Guide by aged five years.  The focus should be on providing a variety of foods from the following groups: fruit and vegetables, starchy foods, protein foods, and dairy and alternatives, while minimising intake of foods high in fat, salt and sugars, such as cakes, crisps and sugar-sweetened drinks. The best drink options for young children are plain water and milk.³

Young children typically require three meals a day plus some healthy snacks. Energy and nutrient requirements will differ between children depending on their age, sex, body size, rate of growth and physical activity levels and it is normal for young children’s appetite to fluctuate day-to-day. Therefore, a range of example portions sizes are provided in the table below (older children will require bigger portions).⁴

How should parents and carers feed these foods?

The overarching approach used to feed young children, and the food environment they are exposed to, play important roles in the development of their eating habits. There is some evidence that taking a ‘responsive’ approach might protect against overeating and encourage healthy eating.^5,6 The emphasis here is on recognising and responding appropriately to the child’s signals of hunger and fullness, regarding mealtimes as periods of learning about foods and eating, and feeding with warmth and patience.

There are also specific feeding techniques that parents and carers can use to encourage the development of healthy eating behaviours.

• Exposure – Repeatedly offering a new food, so that it becomes familiar, is known to increase children’s willingness to try it and, once they’ve tried it, eventually learn to like it. It can take 10-20 offerings before some children begin to like a food and so it’s important to be persistent. If children are initially unwilling to taste the food, exposure in other ways (e.g. through messy play or cooking) can help to encourage them to taste it.²

• Treat food as food – Using food as a reward, to soothe or placate a child should be avoided. This is because these practices are associated with increased intake of, and preference for, less healthy foods (such as biscuits and sweets, which are invariably given in these circumstances) and the tendency to overeat in young children.⁸
• Use non-food rewards when necessary – Some children need extra encouragement to eat new or previously rejected foods and non-food rewards, such as a sticker or praise, can be helpful.²
• Create a relaxed eating experience – It can be worrying if children are not eating much or eating a non-varied diet but it’s important that children are not pressurised or coerced into eating as this can cause them to develop negative associations with a food and mean that they may be even less likely to eat it in the future.⁸
• Serve appropriate portions – Serving children too large portions can teach them to disregard feelings of hunger and fullness, lead to overeating and contribute to excess weight gain.⁹

In addition to the techniques parents and carers use when feeding their child, eating well themselves and creating a healthy home environment can help promote the development of good eating habits in their child.

• Be a role model – Children are influenced by important people in their lives and so parents and carers should try to lead by example and eat the foods that they want their child to eat (and eat less of the foods they want their child to avoid), and endeavour to always show a positive attitude to healthy eating. ^{2, 7}
• Create a healthy home – Keeping less healthy foods out of sight and out of mind in the home, stocking up on a variety of healthy choices, limiting exposure to food advertising and minimising distractions (e.g. TV) while eating are all conducive to establishing good eating habits in children.^{2, 7}

Dr Lucy Chambers is a senior nutrition scientist at the British Nutrition Foundation

References

¹Birch L., Doub A. Learning to eat: birth to age 2 years. American Journal of Clinical Nutrition 2014; 99(3): 723S–728S

²Anzman-Frasca S, Ventura A,  Ehrenberg S,  Myers K. Promoting healthy food preferences from the start: a narrative review of food preference learning from the prenatal period through early childhood. Obesity Reviews 2018; 19(4): 576-604

³NHS Choices. What to feed young children: www.nhs.uk/conditions/pregnancy-and-baby/understanding-food-groups/ (Accessed 2 August 2018)

⁴More J, Emmett P. Evidence-based, practical food portion sizes for preschool children and how they fit into a well balanced, nutritionally adequate diet. Journal of Human Nutrition and Dietetics 2015; 28(2):135-54

⁵Hurley K, Cross B, Hughes S. A Systematic Review of Responsive Feeding and Child Obesity in High-Income Countries. Journal of Nutrition 2011; 141(3): 495–501.

⁶ Daniels L, Mallan K, Battistutta D, Nicholson J, Meedeniya J, Bayer J, Magarey A. Child eating behavior outcomes of an early feeding intervention to reduce risk indicators for child obesity: the NOURISH RCT. Obesity 2014; 22(5):E104-11

⁷Yee A, Lwin M, Ho S. The influence of parental practices on child promotive and preventive food consumption behaviors: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity 2017; 14(1): 47

⁸Mitchell G, Farrow C, Haycraft E, Meyer C. Parental influences on children’s eating behaviour and characteristics of successful parent-focussed interventions. Appetite 2013; 60: 85-94

⁹Hetherington M, Blundell-Birtill P. The portion size effect and overconsumption – towards downsizing solutions for children and adolescents. Nutrition Bulletin 2018; 43(1): 61-68

¹⁰Llewellyn C, Fildes A. Behavioural Susceptibility Theory: Professor Jane Wardle and the Role of Appetite in Genetic Risk of Obesity. Current Obesity Reports 2017; 6(1): 38-45

Useful resources

British Nutrition Foundation guide to toddler portion sizes: www.nutrition.org.uk/healthyliving/toddlers/734-5532-a-day.html

Child feeding guide (Loughborough University): www.lboro.ac.uk/enterprise/child-feeding-guide/