Nutrition in the early years - an overview of current food and drink

guidelines for early years settings in England and recommendations

Nutrition for Health and Wellbeing Seminar Programme

Supporting good nutrition in the early years

Food Matters Live, 22 November 2017

Dr Patricia Mucavele, former Head of Nutrition

Children’s Food Trust

Today’s presentation

• Current nutritional status of infants and young

children

• Importance of investing in nutrition in early childhood

• Helping children eat better in childcare

• Rationale for and development of the Voluntary Food

and Drink Guidelines for Early Years Settings in

England

• Development of the Government example menus for

early years settings in England

• Overview of practical resources to help early years

settings promote and support healthy eating

2

Children’s Food Trust

• Our mission was to get every child eating

well, wherever they are eating

• Spreading the skills, knowledge and

confidence to cook from scratch

• Helping everyone who provides food for

children to do a great job

• Encouraging industry to help children and

their families make better food choices

We all have a duty of care

3

• Infants and young children consumed a varied diet

• Dietary recommendations generally met by the majority

• Estimated average energy requirements exceeded by

three quarters and mean protein intakes well above

Reference Nutrient Intake (RNI)*

• Mean intakes of most key vitamins and minerals above

RNI*

• Proportion of children over 6 months with intakes of

vitamins/ minerals below LRNI** low, except for iron

* RNI values are set at levels of intake considered likely to meet the requirements of 97.5% of the population.

** LRNI is amount of nutrients sufficient for only a small number of people; those below LRNI likely to have

insufficient intakes.

4

Diet and Nutrition Survey of Infants

and Young Children (2011)

DH, FSA, NatCen (2011)

Measured food consumption, energy and nutrient intakes and nutritional status of infants and

young children aged between 4-18 months

• Mean daily energy intake -114% of estimated average

requirement for age group

• % energy from carbohydrate (50.7) and fat (33.9) in line

with dietary guidelines

• % energy from non-milk extrinsic sugar (11.9) above 2015

SACN recommendation (as free sugars)

• Intakes of salt (3.3g) higher than SACN recommendation

for children aged 1-3 years (2g)

• Intakes of many micronutrients appear adequate, but

more than 5% children had intakes of vitamin A and iron

below the LRNI* (therefore unlikely to be adequate).

*LRNI is amount of nutrients sufficient for only a small number of people; those below LRNI likely to have

insufficient intakes.

5

National Diet and Nutrition Survey

(years 1-4; 2008-9 to 2011-12)

PHE, FSA (2016)

Measured food consumption, energy and nutrient intakes and nutritional status of

children aged 18 months to three years.

6

Current health status of young children

• Almost a quarter of reception children were

overweight including obese (NCMP, 2017).

• The number of obese children in reception year

has risen for the second consecutive year – to

9.6% in the 2016 to 2017 school year, up from

9.3% in 2015 to 2016.

• Poor dental health in many young children

• 12% of 3-year olds had experienced tooth

decay in 2013 (PHE, 2014)

• 28% of 5-year olds in England had tooth decay

in 2012 (PHE, 2013)

RCPCH (2017)

National Statistics (2017)

Stubborn gap between the richest and poorest - in the most

deprived areas 12.7% of children in reception year are

obese, compared to 5.8% in the least deprived (PHE, 2017).

Adolescents learn

better & achieve

higher grades

in school

Girls & women

are well-

nourished and

have healthy

newborn babies

Families &

communities

emerge out of

poverty

Communities &

nations are

productive &

stable

The world is a

safer, more

resilient &

stronger place

Young adults are

better able

to obtain

work & earn more

Why invest in nutrition?

Because when..

Children receive

proper nutrition

and develop

strong bodies &

minds

Source: WHO (2013)

Scaling up nutrition

Priorities for improving nutrition

Source: Francesco Branca et al. BMJ 2015

Range of interventions at different stages of the life course

8

Early years

settings - vital

route to

encourage

young children

and their

families to eat

well

Importance of children’s early years

• Children’s early years influence their health,

development, learning, attainment and

economic participation

• Eating habits during children’s early years,

influence growth, development and academic

achievement in later life

• Giving every child the best start in life is

crucial to reducing health inequalities for life.

The early years of a child’s life are critically important:

- in their own right

- as a foundation of success at school and for all adult life

9

10

Helping children eat better

in childcare

Education

• 3-4 year olds: 15 hrs free education (universal)

• 3-4 year olds: 30 hrs free childcare (working

parents, pilot Sep-16, roll out Sep-17)

• Two year old 15 hrs funded early education

(means tested)

• Early Years Pupil Premium (EYPP)

• Early Years Foundation Stage (EYFS) –

includes a welfare requirement for food and

drink

• Ofsted Common Inspection Framework includes

a judgment on personal development, behaviour

and welfare which looks at the extent that

settings promote and support healthy eating

Health

• Early Years High Impact Area 4

– Healthy weight, nutrition

• Healthy Child Programme

• 2-year integrated reviews

• Childhood Obesity Plan

Why early years settings?

11

11

Early years settings - vital route to encourage young children and their families to eat

well, so it’s important to make every contact count.

11

Children’s Food Trust

recommendations

Our recommendations:

• Guidance: encourage childcare providers

to use evidence-based, age appropriate

nutrition guidance

• Training: encourage local authorities to

increase access to accredited training

• Resources: ensure nurseries, pre-

schools, children’s centres and

childminders delivering free childcare

schemes have the resources and support

they need to provide good food.

Children’s Food Trust (2015)

12

Need to empower the whole childcare workforce to promote healthy lifestyles.

13

• Provide guidance and support to caregivers on

appropriate nutrition, diet and portion size for this

age group

o encourage the consumption of a wide variety of

healthy foods

o avoid specific categories of foods (e.g. sugar-

sweetened milks and fruit juices or energy-dense,

nutrient-poor foods) to help prevent of excess

weight

• Ensure only healthy foods, beverages and snacks

are served in formal child care settings or institutions.

• Ensure food education and understanding are

incorporated into the curriculum in formal childcare

settings or institutions. WHO (2016)

World Health Organisation

recommendations

Provide guidance on, and support for healthy diet, sleep and physical activity in early

childhood to ensure children grow appropriately and develop healthy habits.

Childhood Obesity - A Plan for Action

Supporting early years setting

14

HM Government (2016)

• Early years:

– crucial time for children’s development.

– One in five: overweight or obese

– One in ten: 2-4 olds years meets the UK Chief

Medical Officers’ physical activity guidelines.

• Plan of action:

– Update the Early Years Foundation Stage

Framework (EYFS) to make specific reference to

the UK Chief Medical Officers’ guidelines for

physical activity in the early years (including active

play).

– Public Health England: commissioned the Trust to

develop revised menus for early years settings.

– Campaign to raise awareness of these guidelines

amongst both early years practitioners and parents.

Aim: to significantly reduce England’s rate of childhood

obesity within the next 10 years.

15

Rationale for and development of the

Voluntary Food and Drink Guidelines

for Early Years Settings in England

Early Years Foundation Stage -

welfare requirements

Food and drink 3.47. Where children are provided with meals,

snacks and drinks, they must be healthy, balanced

and nutritious.

Before a child is admitted to the setting the provider

must also obtain information about any special

dietary requirements, preferences and food

allergies that the child has, and any special health

requirements.

Fresh drinking water must be available and

accessible at all times.

Providers must record and act on information from

parents and carers about a child's dietary needs

16

Department for Education

(2017)

Recommendations for guidance

Laying the Table report recommended

‘Government should introduce guidance

that helps practitioners meet the welfare

requirement for the provision of healthy,

balanced and nutritious food and drink’.

Advisory Panel on Food and Nutrition

in Early Years (2010)

17

“I recommend that the Government act

on the report of the Advisory Panel for

Food and Nutrition in Early Years and

consider providing further advice and

good practice for practitioners”.

Dame Clare Tickell (2011)

Meeting the welfare requirement

for food and drink

Statutory Framework for the Early

Years Foundation Stage (EYFS)

section 3.47 states ‘Where children are

provided with meals, snacks and drinks,

they must be healthy, balanced and

nutritious’. (2017) 18

National guidance Voluntary Food and Drink

Guidelines for Early Years Settings

in England (2012, updated 2017)

19

Revised menus for

early years settings in England

Public Health England - commissioned the Children’s Food Trust to develop revised

menus for early years settings in England, to reflect recent changes to government

dietary recommendations.

Why develop new early years menus?

Menus need updating to reflect current

government dietary recommendations:

• Lower energy intakes

• Reductions in the amount of ‘free

sugars’* (added sugars)

• Increases in the amount of dietary fibre

Outcome: to help promote appropriate amounts and types of food for young children, thereby

helping to support key national priorities including reducing childhood obesity, addressing health

inequalities, and ensuring the best start in life for all children.

SACN (2011) SACN (2015)

*Free sugars’ includes all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus

sugars naturally present in honey, syrups and unsweetened fruit juices. Under this definition lactose (milk sugar) when naturally

present in milk and milk products and sugars contained within the cellular structure of foods (particularly fruits and vegetables)

are excluded.

20

21

Development of the Government’s new example

menus for early years settings in England

Scope of the work – Deliverables

1. Establish an external reference group (ERG) to help inform the development of the menus. The

ERG included a diverse range of representative bodies with knowledge and experience of

working in early years settings, as well as public health nutritionists, representatives from across

government.

2. Organisation of a series of meetings to discuss the development of the menus.

3. Collection of wider sector feedback on the draft menus via an online feedback form.

4. Development of two seasonal menus (and recipes) which meet the revised nutrient

requirements of infants and young children (6 months-4 years*). Menus to be three week

rotation period (based on 5 day week), adjusted to meet different care provision scenarios.

5. Publication of a technical report which outlines the options considered, the agreed set of

nutrition and menu planning principles applied. Details the revisions made to the nutrient

framework and the protocol used to develop the menus for early years settings in England and

highlights any changes made to the Voluntary Food and Drink Guidelines for Early Years Settings

in England to ensure current dietary requirements were met.

22

*The scope of the menu guidance covers the age range six months to four years (up to a child’s fifth birthday).

Developing the new example menus for early years settings was a collaborative effort.

23

Government’s new example menus

for early years settings in England

HM Government (2017) HM Government (2017) Children’s Food Trust (2016)

The technical report and new example menus for early years settings in England can be

downloaded from www.gov.uk

24

Technical report

• Outlines the agreed set of nutrition and menu

planning principles used to develop the example

menus and the rationale.

• Details the protocol used to develop the menus for

early years settings in England and the revisions

to the nutrient framework.

• Lists the changes made to the Voluntary Food

and Drink Guidelines for Early Years Settings in

England to ensure current dietary requirements

were met.

• A summary of dietary recommendations

applying to infants and children 6 months to four

years in the UK. Children’s Food Trust (2016)

The technical report and minutes from the meetings can be downloaded from www.gov.uk

25

Recommended updates to the

Voluntary Food and Drink Guidelines for

Early Years Settings in England

• Fruit juice: should be avoided in early years

settings (even if diluted)

• Cakes, biscuits and desserts: strengthening the

good practice guidance to recommend limiting the

provision of cakes and biscuits at the main meal

(e.g. lunch), and to avoid provision of cakes and

biscuits with lighter meals (e.g. tea)

• A further 12 guidelines were amended to make

them clearer and aligned to government advice

Children’s Food Trust (2016)

Rationale: the recommended updates to the food and drink guidelines help limit intakes of free

sugars, and promote healthier dessert options for young children. Encouraging the provision of fruit

and dairy desserts as part of meals can aid the development of healthy eating habits from an early

age, by reducing the expectation that meals are always finished with a sweet dessert option.

26

Part 1: Guidance

HM Government (2017)

This document includes:

• Principles underpinning the development of the example menus

• ‘At a glance’ information for meals and snacks - based on the

Voluntary Food and Drink Guidelines for Early Years Settings in

England, published in 2012 with revisions to reflect current dietary

recommendations for children aged one to four years.

• Advice on

o eating well for children aged 1-4 years and infants aged 6-12

months

o menu planning

o food safety

o managing food allergies

o reading food labels

• Sign posts to other resources which give more detailed information

on how to encourage children to eat well.

Includes menus and useful information for early years settings to help them to meet the Early

Years Foundation Stage (EYFS) welfare requirement to provide “healthy, balanced and

nutritious” meals for children.

27

Part 2: Recipes

This document includes:

• two example three-week seasonal menus for

early years settings in England plus additional

recipes

• all recipes for breakfasts, snacks, lunches and

teas; and additional recipes that can be

substituted into the example menus.

HM Government (2017)

The example menus and recipes illustrate the types and amounts of food and drink that can

be provided to meet the nutritional requirements of infants and children aged six months to

four years.

28

Example menus

HM Government (2017)

Example menus for early years settings

in England (children aged 1-4 years)

Example menus for early years settings in

England (infants aged 7-12 months)

HM Government (2017)

The example menus shows how meals for 1-4 year olds can be adapted for infants aged 7-12

months. For information on the modification in texture and further adaptations required to each

recipe for infants aged 7-9 months and 10-12 months see Part 2- Recipe document. For full

guidance on introducing complementary foods for infants see the Start4Life website

www.nhs.uk/start4life for information and resources.

29

• Ingredients: given for 5 or 20 portions and are in line with

dietary advice and good practice guidance

• Typical portion sizes: for children aged one to four

years.

• Allergen information: given on each recipe for the 14

allergens covered by EU and UK food labelling legislation

are present (based on allergens typically included in

commonly available brands of each ingredient)*.

• Recipe adaptations for infants aged 7-12 months: with

a typical portion sizes and any additional information for

preparation and serving of the recipe for this age group

for example if particular ingredients should be omitted.

Recipes

*Allergy information is included as a guide only; always check labels to find out which

allergens are included in each ingredient and product you are using by checking product

packaging ingredient lists. Even if you have used them before, don't assume.

Practical resources to help

early years settings provide

‘healthy, balanced and nutritious’

meals and snacks

30

The importance of healthy eating

for young children

Eating well for children aged one to four years

• A healthy, balanced diet and regular physical activity

are essential for children’s health and wellbeing.

• Guidance describes how often, how much, and

which different types of food and drink to provide

for meals and snacks

• Based on a wide range of foods from four food

groups below:

• potatoes, bread, rice, pasta and other

starchy carbohydrates

• fruit and vegetables

• beans, pulses, fish, eggs, meat and other

proteins

• dairy and alternatives

Eating a wide variety of foods from these groups will provide children with the good

balance of nutrients they need.

31

HM Government (2017)

7 steps to menu planning

• Step 1: Plan menus for all meals and snacks

• Step 2: Plan menus covering between one and four weeks

to ensure children are given a variety of foods.

• Step 3: Use the ‘at a glance’ section of the early years

menus guidance to plan each meal and snack.

• Step 4: Plan menus to include a variety of foods, tastes,

textures and colours.

• Step 5: Make sure you cater for the cultural and dietary

needs of all the children in your care.

• Step 6: Introduce new menu cycles at least twice a year to

incorporate seasonality and give children the chance to try

different foods.

• Step 7: Share the menus for meals and snacks with parents

to help them provide balanced meals and snacks at home.

32

Planning menus in advance can help to reduce time, control ingredient costs. Using tried

and tested recipes can help source ingredients, and keep track of allergens.

HM Government (2017)

‘At a glance’ information by

meal occasion

• ‘At a glance’ food and drink

guidelines by meal

occasion

• Breakfast

• Mid-afternoon and

mid-afternoon snacks

• Lunch

• Tea

• Particularly useful if

catering for one meal or

snack

33

The ‘At a glance’ infographics provide only a summary of the food and drink guidelines by meal

occasion, use the ‘at a glance’ section (pages 11-15) in the early years menu Part 1 guidance

document to plan each meal and snack to meet the food and drink guidelines.

HM Government (2017)

34

• Exclusive breastfeeding is recommended for around the first

six months of a baby’s life.

• Most infants are developmentally ready for complementary

feeding - the addition of solid foods alongside breastmilk (or first

infant formula), at around six months of age.

• Offering a wide variety of different foods is important to

ensure that sufficient energy and nutrients are added to the diet.

• The first aim of introducing solids is to familiarise infants with

new tastes and textures and get them used to moving foods

around their mouths and swallowing them.

• Once food has been introduced, infants can gradually move

towards eating three meals a day, including a mixture of soft

finger foods, and mashed or chopped foods.

Texture progression

HM Government (2017)

Infants develop at different rates. Progression from the introduction of first foods (at about six

months), to a range of blended or mashed foods, and then to a wider range of chopped or

minced foods should be a gradual process, based on each infants’ developmental readiness,

rather than a staged process based on age alone.

35

Useful resources

Action for Children (2017) First Steps Nutrition Trust (2017)

www.foundationyears.org.

uk/eat-better-start-better/

www.firststepsnutrition.org

www.nhs.uk/start4life/

Start4life (2017)

Thank you – any questions?

36