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
Diet and Nutrition Survey of Infants and Young Children (2011) Measured food consumption, energy and nutrient intakes and nutritional status of infants and young children aged between 4-18 months 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 DH, FSA, NatCen (2011) * 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
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) National Diet and Nutrition Survey (years 1-4; 2008-9 to 2011-12) Measured food consumption, energy and nutrient intakes and nutritional status of children aged 18 months to three years. 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). PHE, FSA (2016) *LRNI is amount of nutrients sufficient for only a small number of people; those below LRNI likely to have insufficient intakes. 5
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) 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). National Statistics (2017) 6
Why invest in nutrition? Because when.. Girls & women are wellnourished and have healthy newborn babies Children receive proper nutrition and develop strong bodies & minds Communities & nations are productive & stable The world is a safer, more resilient & stronger place Adolescents learn better & achieve higher grades in school Source: WHO (2013) Scaling up nutrition Families & communities emerge out of poverty Young adults are better able to obtain work & earn more
Priorities for improving nutrition Early years settings - vital route to encourage young children and their families to eat well Source: Francesco Branca et al. BMJ 2015 Range of interventions at different stages of the life course 8
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
Why early years settings? 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 11 Health Early Years High Impact Area 4 Healthy weight, nutrition Healthy Child Programme 2-year integrated reviews Childhood Obesity Plan 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 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, preschools, children s centres and childminders delivering free childcare schemes have the resources and support they need to provide good food. 12 Children s Food Trust (2015) Need to empower the whole childcare workforce to promote healthy lifestyles.
World Health Organisation recommendations 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. sugarsweetened 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) Provide guidance on, and support for healthy diet, sleep and physical activity in early childhood to ensure children grow appropriately and develop healthy habits. 13
Aim: to significantly reduce England s rate of childhood obesity within the next 10 years. 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. Childhood Obesity - A Plan for Action Supporting early years setting 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. HM Government (2016) 14
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 Department for Education (2017) 16
Recommendations for guidance 17 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) 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 18 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) National guidance Voluntary Food and Drink Guidelines for Early Years Settings in England (2012, updated 2017)
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. 19
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 SACN (2011) SACN (2015) 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. *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
Development of the Government s new example menus for early years settings in England 21
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. *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. 22
Government s new example menus for early years settings in England Children s Food Trust (2016) HM Government (2017) HM Government (2017) The technical report and new example menus for early years settings in England can be downloaded from www.gov.uk 23
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 24
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 25 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.
Part 1: Guidance 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. HM Government (2017) 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. 26
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. 27 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.
Example menus 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) 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. 28
Recipes 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. *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. 29
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 HM Government (2017) Eating a wide variety of foods from these groups will provide children with the good balance of nutrients they need. 31
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. HM Government (2017) 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. 32
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 HM Government (2017) 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. 33
Texture progression 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. 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. 34
Useful resources Action for Children (2017) First Steps Nutrition Trust (2017) www.foundationyears.org. uk/eat-better-start-better/ www.firststepsnutrition.org Start4life (2017) www.nhs.uk/start4life/ 35
36 Thank you any questions?