Importance of good nutrition for 1- to 5-year olds

• Ensures optimal growth and development

• Encourages children to develop a taste for healthy foods

in preference to fatty, sugary and salty foods.

• Regular meals and snacks are essential in helping

young children to establish healthy eating patterns that

will last into adulthood.

• Planning meals, snacks and drinks around the four food

groups mentioned will help you to provide a variety of

foods to provide a healthy, balanced diet and meet the

nutritional requirements of the child.

Setting the Table http://www.healthscotland.com/uploads/documents/30341-

Setting%20the%20Table.pdf

These foods should be offered at every meal and can make up part of a

snack.

Food Group: Starchy Carbohydrates

Includes all types of bread, rice, pasta, potatoes and cereals. Chooselow sugar, low salt breakfast cereals such as porridge, wheat bisks, puffed wheat or shredded wheat

These should be offered at meals and snacks. Children should

be encouraged to try at least 5 different fruits and vegetables

Food Group: Fruit and vegetables

Includes fresh, frozen and canned varieties (avoid fruit canned in syrup and vegetables canned in added salt). 1 portion of fruit or veg= 40g Only serve dried fruit with meals & offer once daily (1 portion = ½-2 tablespoons).

Milk, dairy and dairy alternatives should be offered at 2-3 meals and

as snacks each day.

Food Group: Milk and dairy foods (and dairy alternatives)

Includes milk, yoghurts, cheese and milk/yoghurt alternativesAvoid yoghurts and fromage frais high in sugar (≥15 g sugar per 100g)

What milk?1-2 years Whole milkOver 2 years semi-skimmed.Skimmed milk should not be given to under 5s

How much?1-4 year olds about 300ml throughout day

These foods should be offered

at the main meal.

Food Group: Protein

Includes Meat, fish, eggs, pulses, nuts, seeds and meat alternatives.Avoid processed meat and fish e.g. Burgers, pies and sausages as these are high in saltEggs can now be safely eat raw, runny of softly boiled as long as they are stamped with the British red Lion code mark.

Iron

• Children have very high iron requirements for their size

• Iron from animal sources eg. Red meat, eggs, oily fish are good sources of iron and easier to absorb

• Non-animal sources include dark green leafy vegetables, beans and pulses are good sources but are less easily absorbed

• Vitamin C helps absorption of non-iron sources of iron, eg. A tangerine, kiwi, pineapple, most fruit (not apples or pears), citrus fruits and berries can be taken with a meal to increase iron absorption (this can include fruit juice but will only count to 1 of their 5 a day)

• All teas inhibit iron absorption and should not be given to children

Vitamins

• Vitamin supplements containing vitamins A and C are recommended for babies and children aged 6 months to 5 years old, unless they're getting more than 500ml (about a pint) of infant formula a day

• Some over-the-counter supplements contain other vitamins or ingredients. Talk to your pharmacist about which supplement would be most suitable for your child.

• Having too much of some vitamins can be harmful. Keep to the dose recommended on the label, and be careful not to give your child 2 supplements at the same time.

• For example, don't give them cod liver oil and vitamin drops, as cod liver oil also contains vitamins A and D. One supplement on its own is enough.

https://www.nhs.uk/conditions/pregnancy-and-baby/vitamins-for-children/

Vitamin D

• It is not possible to get enough vitamin D through diet alone

• Everyone in Scotland over one year of age should take a 10μg/d vitamin D supplement daily

• As a precaution, breastfed babies from birth up to one year of age should also be given a supplement of 8.5 to 10μg/d vitamin D per day.

• Babies who are formula fed do not require vitamin D if they are having 500ml/day of infant formula or more, as infant formula already has added vitamin D.

Scottish Government, november 2017

Positive Family Mealtimes

• Eat together

Sitting together, sharing a meal is a great opportunity for parents to support and help

their children pick up healthy eating habits.

• Introducing foods

Parents should introduce a wide variety of different foods , including foods they might

not like themselves but which can be part of a healthy diet. It’s a good opportunity for

children to try a new food which they might see others eating and enjoying. This can

later reduce food fussiness. Parents should encourage the children to try new food

• Be positive and talk about foods you enjoy

Commenting on foods that you like can help direct children's attention to that food

and encourage them to try it too.

• Avoid making negative comments about foods

We don't all like the same foods but avoid negative comments like "urgh, I don't like

celery at all" as this can make them much less likely to try these foods. Keep

thoughts about disliked foods to yourself.

• What Can I Do? Try to modelling healthy eating behaviours in front of your child. If

you want your child to eat a new food, they need to see you eating it too. If you don't

want your child to eat a particular food, don't eat that food in front of them.

https://www.childfeedingguide.co.uk/tips/common-feeding-pitfalls/role-modelling-tbc/

Tips for mealtimes• Have regular mealtimes – set up a daily mealtime routine, ideally 3 meals per day and try to

avoid snacks before mealtimes• Have meals together as a family – Toddlers’ learn a great deal about mealtimes through

watching others• Be prepared for messy eating –stay calm when toddlers food goes everywhere, some mess is

expected• Get everything you need ready – be prepared and ready before bringing the child to the high

chair or table.• Serve small, manageable portions and let the child ask for more• Introduce new foods one at time – name the food and praise the child for trying. If the child

dislikes the food, leave it a few weeks and try it again• Offer finger foods – may have introduced this already • Encourage the child to use a spoon – the toddler may let you know when they are ready to

try a spoon by grabbing the plate or spoon. Praise the child when they manage to get food on the spoon. You may need to gently guide the toddler through the actions.

• Managing mealtime experiences – Remember the non- verbal cues we give can be more powerful than what we actually say so it’s important to look positive about the food offered–even if it’s something you are not fond of.

• The toddlers’ non-verbal cues are also important, so look for those gestures that mean they want more or have had enough. This could be baby opening their mouth, looking towards you, turning their head away from you, clamping their lips together or blinking really hard

• Encourage desirable mealtime behaviour – Pay attention to the child and praise them during mealtimes. Recognising your baby’s non-verbal cues during mealtimes builds a sense of trust and is more likely for the toddler to enjoy future mealtimes

Think about how you would want to be fed!

• The things that are important to us as adults at mealtimes are not that dissimilar to a baby’s desires.

• We like to see our food in from of us and need to be able to reach it and be in control of what we put in our mouth next.

• We like to be comfortable in order to feel relaxed and enjoy the experience and we like to have enough time so that it doesn’t feel like a race towards indigestion.

Mini Meals (by 1 year of age)

• Most children are ready to join in with healthy family meals by the age of

one year.

• Encourage as varied a diet as possible.

• Snacks would include milk drinks and suitable finger foods including fruit,

soft cooked vegetables, bread, toast, cooked pasta shapes.

• Infants who have had appropriate family foods introduced at an early age

tend to be less fussy eaters as adults.

• A new food can be offered 10-15 times before it is accepted

• It is important to avoid offering smooth mashed foods for too long as this

can lead to refusing lumpy foods

• Encourage family meal times as babies learn by example

• Finger foods should be offered and babies encouraged to feed themselves

Meal Ideas• Breakfast

• unsweetened porridge or cereal mixed with milk, topped with mashed ripe pear

• wholewheat biscuit cereal with milk and unsweetened stewed fruit

• toast fingers with mashed banana

• toast fingers with a hard-boiled egg and slices of ripe peach

• unsweetened stewed apple and breakfast cereal with plain, unsweetened yoghurt

• Lunch or tea

• cauliflower cheese with cooked pasta pieces

• mashed pasta with broccoli and cheese

• baked beans (reduced salt and sugar) with toast

• scrambled egg with toast, chapatti or pitta bread

• cottage cheese dip with pitta bread and cucumber and carrot sticks

• plain fromage frais with stewed apple

• Dinner

• mashed sweet potato with mashed chickpeas and cauliflower

• shepherd's pie (made with beef or lamb) with green vegetables

• rice and mashed peas with courgette sticks

• mashed cooked lentils with rice

• minced chicken and vegetable casserole with mashed potato

• mashed canned salmon with couscous and peas

• fish poached in milk with potato, broccoli and carrot

https://www.nhs.uk/conditions/pregnancy-and-baby/childrens-meal-ideas/

Fruit andvegetablesPepper slices

Starchy foodCrumpet

Dairy food oralternativeSoft cheese

Crumpets with soft cheeseand pepper slices

Sardines on toast with celery

Fruit andvegetablesCelery

Starchy foodToast

Protein foodSardines

Scotch pancakes with slicedbanana and strawberries

Starchy foodScotch pancake

Fruit andvegetablesBanana andstrawberries

Healthy Snack Ideas

(First Steps Nutrition)

Mealtime planningYES

• Routine

• Set time & place (20-30mins)

• Limit distraction (e.g. tv)

• Give notice for mealtimes

• Involve child in preparation

• Praise any eating & ignore mis-behaviour

• Encourage to smell & lick new food

• Model eating• Expose to new food repeatedly

(up to x 20)

NO

• Don’t withhold/restrict preferred food

• Don’t mix new food with preferred food

• Don’t force feed or accidental rewards

• Don’t offer high energy snacks, drinks or supplements

Toddler Diet Comparisons

Unhealthy

• Breakfast:

• Coco pops with milk, orange squash

• Snack:

• Crisps, fruitshoot

• Lunch:

• Sausage roll, yoghurt, orange squash

• Snack:

• Chocolate biscuit, orange squash

• Evening Meal:

• Chicken nuggets with chips, custard, orange squash

• Supper:

• Toast with chocolate spread, bottle of milk

Healthy• Breakfast:

• Rice krispies with milk, fresh orange juice (50:50 with water)

• Snack:

• Bread sticks with chopped fruit and cup of milk or water

• Lunch:

• Soup with bread, yoghurt, no added sugar squash

• Snack:

• Cracker and cheese with cup of milk or water

• Evening Meal:

• Spaghetti bolognese (hidden veg), custard, no added sugar squash

• Supper:

• Toast and banana, cup of milk

Family Behaviours

Eating alone vsEating Together

Family Time –Inactive vsActive

Eating Fast Food vsCooking Meals Together

Parent Led Feeding vs Self Feeding

Most Common Challenges• Child refusing to eat

• Force feeding/pressuring to eat

- May result in less liking for the food, less willingness to eat the food & exacerbate

feeding difficulties. Can lead to overweight and obesity later in life

• Preference for sweet/salty foods over savoury meals

- May be less willing to eat healthy foods and can lead to long term health

consequences later in life (overweight/obesity, T2DM, cancer)

• Avoid using food as a reward

– Your child may start to think of sweets as nice and healthy foods as nasty.

Instead, reward them with a trip to the park or promise to play a game with them.

– Using food as a reward may lead to decreased liking for non-reward foods eg.

meals, and increased liking for reward foods (high sugar/fat foods). This can

contribute to poor diet and may lead to unhealthy eating habits later in life

https://www.childfeedingguide.co.uk/tips/common-feeding-pitfalls/

Typical Toddler or Fussy Eating?

Typical or Fussy Eating?

• It’s perfectly normal for toddlers to refuse to eat or even taste new foods.

• The trick is not to worry about what your child eats in a day or if they don't

eat everything at mealtimes. Instead, try to think about what they eat over a

week.

• If your child is active and gaining weight and they seem well, then they're

getting enough to eat.

• Gradually introduce other foods and keep going back to the foods your child

didn't like before. Children's tastes change. One day they'll hate something,

but a month later they may love it.

• Keep offering a variety of foods – it may take lots of attempts before your

child accepts some foods.

• Offer foods in different consistencies. For example, they may hate raw

carrot sticks but love grated carrot

• As long as your child eats some food from the 4 main food groups you don't

need to worry.

https://www.nhs.uk/conditions/pregnancy-and-baby/fussy-eaters/

Tips for parents of fussy eaters

• Give your child the same food as the rest of the family

• The best way for your child to learn to eat and enjoy new foods is to copy you. Try to eat with them as often as you can.

• Give small portions and praise your child for eating, even if they only eat a little.

• If your child rejects the food, don't force them to eat it. Just take the food away without saying anything. Try to stay calm, even if it's very frustrating. Try the food again another time.

• Don't leave meals until your child is too hungry or tired to eat.

• Your child may be a slow eater, so be patient.

• Don't give your child too many snacks between meals – 2 healthy snacks a day is plenty.

• Make mealtimes enjoyable and not just about eating. Sit down and chat about other things. .

• Ask an adult that your child likes and looks up to to eat with you. Sometimes a child will eat for someone else, such as a grandparent, without any fuss.

• Changing how you serve a food may make it more appealing. For example, your child might refuse cooked carrots but enjoy raw grated carrot.

https://www.nhs.uk/conditions/pregnancy-and-baby/fussy-eaters/

Tips for encouraging a child to eat• Having a period away from the stress of feeding can help to restore a positive

relationship between mum and child rather than having an on-going battle between them everyday.

• Time away from stress can help a mother re-gain perspective and rational thinking. Also challenges idea that forcing a child to eat is actually their way of dealing with anxiety.

• Parents need a lot of support in this phase-it’s almost like weaning them off their unhelpful coping strategy. After two weeks, you can then gradually work on one things at a time with mum

• Set a period of 1 to 2 weeks of “doing nothing” to diffuse situation & reduce anxiety (e.g. offer preferred food, accept food refusal)

• Encourage Mum to observe child eating in other places

Food Allergies

• Foods that are more commonly associated with food allergies include:– Cow’s milk – egg, – Wheat– gluten – soya – Fish– Shellfish– sesame and other seeds– peanuts and tree nuts

• Delaying introduction past 12 months may increase a child’s risk of developing an allergy to that food

How should I introduce foods that commonly cause allergies?

• Introduce them one at a time for three days • If baby has no symptoms, the next new food can

be introduced. – In the rare case that an immediate or delayed type

allergic reaction happens it will be easier to identify the suspected food.

• Once potential allergens, such as egg and peanut, have been introduced continue to include them in your baby’s diet at least twice a week, to ensure that your baby remains tolerant to that food.