Module 03: Promoting Health and Well Being Through Food and Mealtimes

A well-balanced diet for children

As a responsible adult, it is up to you to organise children’s food and drink intake so that over the days the children have a well-balanced diet. You are also responsible for helping children to develop healthy eating habits.

Why is food important? 

Food matters because:

  • A well-balanced diet is essential for good health, energy levels and to fuel all the growing that children have to do.
  • Diet also affects children’s teeth.
  • If children do not have enough food or a very poor diet, they can be tired, lethargic and unable to enjoy the day.
  • Good diet supports children in resisting illness and recovering more swiftly after being ill.

Childhood is the best time to establish good eating habits in terms of what and how children eat.

  • Enthusiasm for good food is likely to last, as are habits of eating plenty of fruit and vegetables.
  • Children can learn about feeling hungry, feeling full and enjoying their food. Some of the later problems for children who are overweight seem to arise from constant snacking rather than proper meals.
  • Children can enjoy what they eat and learn to savour taste, texture and smell. You can share these sensations with children, at the actual mealtime and smelling the food as it is about to arrive.
  • Mealtimes are also a good opportunity for children to learn social skills: enjoying a relaxed conversation as well as eating, helping others with dishing up and using physical and intellectual skills applied to lay the table and clearing up afterwards.
  • Food and enjoyable mealtimes are important to children. Several consultation projects have shown that children spontaneously mention ‘nice food’ as part of what they like at nursery and they recall special mealtimes like picnics with affection.
  • Food and eating are part of a child’s identity within the family. When children eat home-cooked food, meals are part of the cultural tradition for any family. In some families, special meals are part of the family faith or shared traditions of this individual family.

You will find it difficult, if not impossible, to balance a child’s overall diet unless you have a clear meal and snack times. Children need an intake of food and drink spread throughout their day. The usual pattern is three meals: at the beginning of the day, around midday and towards late afternoon or early evening. Children will vary in how much they eat and some also welcome a drink or a small snack at mid-morning and mid-afternoon. Your setting needs some sit-down mealtimes but there can be flexibility about drink and snack times.

A well-balanced diet works together with the healthy physical exercise of children. Children who eat well have the energy they need to dash about as well as concentrate on their play. The enjoyable physical activity burns up the calories, as well as strengthening bone and muscles, and leaves children hungry for the next meal.

A healthy diet

Food is an area where there is no shortage of advice from the media and advertising industry. Newspapers and magazines regularly seem to pronounce new rules about diet or challenge previous guidelines. The advertising and packaging of convenience foods and drinks are also aimed at making consumers accept that this food is ideal for healthy eating or better at delivering necessary nutrients than a rival food.

Despite all the media headlines on diet, in reality, the basic issues are much as they have been for a long time:

  • Are children eating an adequate amount of food and drinking enough liquid in total – not too much and not too little?
  • Are children eating and drinking a healthy balance between different kinds of food and drink?

Do you go organic?

Some early years settings and family homes will use organic produce. As an early years practitioner, you will fit in with the established pattern. This chapter is not recommending that children should all be fed organic food because the quality varies depending on the source of food. Some of the marketing claims about ‘better taste’ or ‘free of chemicals’ have been very misleading. ‘Organic’ produce has now also spread into snack food but organic popcorn should no more form a major part of a child’s diet than non-organic!

Hygiene and food preparation

A healthy diet is promoted when, over the days, children’s food intake includes enough from all the different food groups. A well-balanced diet is also promoted through good practice in the preparation and cooking of food. If you work in a group setting, then the cook may take responsibility for meal preparation. However, you will ideally do some food preparation and cooking with the children. If you work as a nanny or childminder, you will do the meal planning and cooking.

  • Use fresh ingredients as often as you can. Healthy diets have freshly cooked food in preference to processed convenience foods.
  • Children and adults benefit from eating fresh fruit, salad and some vegetables in their raw state, not always cooked.

Most incidents of food poisoning are caused by people breaking the basic rules of kitchen hygiene and food handling.

  • Cooked food that has not all been used needs to be allowed to cool swiftly and then placed in the fridge or freezer as appropriate.
  • Food needs to be stored with care and used before the ‘use by’ date.
  • The only store cooked food that is left untouched in the cooking or serving dish. Do not store leftover meals from plates or bowls, because once saliva has mixed with food it starts the digestive process.
  • Defrost food properly when it is then taken out of the freezer.
  • Re-warm only once and then ensure that food is thoroughly heated to ‘piping hot’. If necessary, let it cool a little before the children start.
  • Defrosted or partially defrosted food should now be used, not re-frozen.

Supermarkets promote a range of anti-bacterial products for supporting hygiene in the kitchen. You need good standards of cleanliness in the kitchen, but using anti-bacterial products will not correct the situation when basic rules are broken.

  • Wash your hands before cooking and food preparation. Wash your hands again if you stop to go to the toilet yourself or to change a child.
  • Use a different knife and cutting board for raw meat and poultry than for other foods. Or else wash the items thoroughly before re-use.
  • In a fridge, raw meat or poultry should be covered and placed on the lowest shelf, never allowed to drip over other foods.
  • In a family home with pets, you should have separate bowls and spoons for dealing with the animals’ food. If you store part-used tins of pet food in the fridge, keep them well covered and away from the family food.

Balanced drink and food

Drinks

Children need liquid from different sources:

  • Water: tap or filtered, depending on what you use in the setting or family home. Spring and bottled waters may have too much sodium (salt) for babies or very young children.
  • Milk: once babies are a year old they can drink cow’s milk or soya if children cannot have dairy products. Children need nutrients from whole milk. They should certainly drink this until they are at least two years old. They can move onto semi-skimmed if they prefer the taste. But in a well-balanced diet, there is no reason why children should not continue to drink whole milk if that is what they enjoy. Skimmed milk is not suitable for children.
  • Water and milk can be supplemented by fruit or vegetable juices. Dilute the drinks for younger children. However, do not overdo the fruit juice, since teeth do not distinguish between natural sugars in the juice and added sugar in squashes.

Children do not need squashes, fortified fruit drinks, carbonated drinks or colas. An occasional drink of squash or cola will not unbalance a healthy diet but their teeth are under threat when these drinks form much of their liquid intake. Sugary drinks are especially risky when they are put into bottles for very young children or when young children have cartons with straws and they swish the drink around in their mouth for some time.

Food groups

Menus should include foods each day from each of the four basic food groups. Children, like adults, need variety in their diet, so it is wise to draw from all the possibilities within each group. Some foods, like cheese or beans, fit into more than one group because of the blend of nutrients they contain.

Carbohydrates form a food group that occurs as sugars and starches. Some foods are also a useful source of fibre – but see the comment below about children and fibre. Children gain carbohydrates from:

  • all the different kinds of leavened bread and rolls (bread that has yeast to
  • make it rise). Children can become enthusiastic about the taste of proper bread when they experience more than the pre-sliced variety
  • different kinds of unleavened bread (that remains flat), like chapatis, puris or pitta bread
  • cereals, beans and lentils
  • dishes made from maize, millet and cornmeal
  • the many different kinds of pasta and noodles
  • plantains and green bananas
  • potatoes – that can be served in so many different ways
  • rice
  • sweet potatoes.

Children should not be given extra fibre and the high-fibre diets promoted for adults are unhealthy for children. Young children’s digestive systems are not yet well equipped to process fibre and any excess fibre can also interfere with their body’s absorption of zinc and iron.

Children need the sugar sources of carbohydrates and their diet is unbalanced if adults try to remove this food entirely. The problem in unbalanced diets, for adults as well as children, is when this source of carbohydrate is too dominant.

  • Sugar is present naturally in many fruits, both fresh and dried. Sugar, or other sources like honey, is an ingredient in puddings and cakes.
  • The problems arise when sweet foods dominate the menu or have unbalanced a child’s diet because of excessive consumption of confectionery and biscuits, perhaps as regular ‘treats’ or filling up between meals.
  • Children do not need the added sugars that are in ready-made juice and carbonated drinks or in many shop-bought biscuits and cakes. Some convenience foods claim to be reduced or low sugar, but they often have artificial sweetener, otherwise, the product has no taste.

Children need protein and this food group can be found in two broad types. Some foods provide protein in a form that can be fully used by the body even when the food is eaten by itself. These are called ‘complete proteins’ and sometimes ‘first class proteins’. These foods include:

  • milk and cheese
  • eggs
  • fish
  • meat
  • poultry.

With the exception of soya beans, the plant proteins are ‘incomplete proteins’. They are sometimes called ‘second class proteins’, but this term can be misleading and causes non-vegetarians to claim that children must have meat in order to be healthy. The plant proteins just need to be eaten in combination to provide the completeness within each meal. Choose from:

  • cereals
  • chickpeas
  • lentils
  • nuts – cut up very finely for nut roast or rissoles, do not give them loose to young children, especially the under threes.
  • beans.

These foods work in combinations that make ordinary meals. Baked beans on toast is a good example in which the cereal in the bread and the beans combine to give a complete protein. Some grated and melted cheese on top makes a very nutritious child meal or adult snack. Other examples include breakfast cereals with milk, millet milk pudding, rice mixed with lentils (and obviously other ingredients like vegetables if you wish), bread with cheese or hummus (made with chickpeas and sesame seeds).

You can try textured vegetable proteins, such as Quorn, as an alternative to meat. But children from vegetarian families may not find this food palatable, especially if it is made to look like a meat or poultry dish.

The food group of fats is equally necessary. Children need this source of nutrition. The fats that are necessary for a balanced diet have been confused with excessive use of fat in cooking or being ‘too fat’. There is nothing ‘bad’ about fats as a nutrient and this food group is as important as the other three groups. Children can get the fats they need from:

  • lean meat and poultry
  • dairy products including cheese, milk, yoghurt and fromage frais
  • nuts (but not loose for children)
  • fats like butter and margarine as ingredients in cakes, biscuits and pastries.

Of course, children’s diets can become unbalanced if any of these foods come to dominate their diet, for instance, if children are allowed to fill up on biscuits or cakes between meals and then have little appetite for the other foods. Do not use low- or no-fat products for children, they need the nutrients. Also, very low-fat products often have very little taste and will make it harder for you to encourage young children to enjoy their food. Obviously, you do not load them up foolishly with fats:

  • cut the excess fat from meat
  • use yoghurt or fromage frais for toppings rather than cream
  • use vegetable oils for cooking rather than animal fats like lard and this will mean your menus are suitable for vegetarian children too
  • watch out for the hidden fats that enter a child’s diet with the regular eating of crisps and biscuits.

Some of the advice over the last 10–15 years about adult diet will be very inappropriate if applied to children. Unlike fully grown adults, children’s diet has to fuel their growth as well as maintain their general health. Babies and children need three to four times as many calories per day in proportion to their body size, in comparison with adults. Children also have different nutritional requirements from adults because their bodies work differently.

The low-fat diets generally promoted for adult are unhealthy for children because they need the fat content, for instance from full and not skimmed milk. Children can be missing vital nutrients and be malnourished amidst plenty of food. Children’s bodies also seem to be designed to use fat more efficiently than adults are.

There is a wide range of vitamins and minerals that children need in their diet, often in small amounts. They will get a balanced diet if they eat a range of fruit, vegetables and salads. Children can enjoy a wide range when they are introduced to different foods and these are presented in an attractive way. Children will get the best from these foods when they eat as much as possible in its raw state (a few foods have to be cooked). Fruit, carrots, peas, salad vegetables, white cabbage, cauliflower and broccoli can all be eaten raw.

When you cook fruit or vegetables many of the vitamins and minerals are reduced or end up in the cooking water. It is, therefore, best to cook lightly by steaming or microwaving so that minimum liquid is needed and wherever possible use the water as juice or to make a sauce or gravy. Go easy on added salt or sugar and avoid practices like adding bicarbonate of soda to keep the colour of vegetables because it destroys vitamin C.

Consequences of dietary deficiencies

If children eat a well-balanced diet of raw and freshly cooked food, they should not have nutritional deficiencies. Problems can arise when children:

  • are fed a diet heavy in processed and convenience meals
  • have become very restricted in what they are prepared to eat
  • have allergies or a health condition that seriously limits their range of possible foods
  • share a family diet that has removed many kinds of foods. A vegan diet needs very careful balancing for children.

You should talk with parents if you are concerned about a child’s health linked with their diet. Some possibilities include:

  • Children may develop iron-deficiency anaemia, or be borderline if their diet does not include sufficient sources of iron. Children may be tired and listless, get out of breath easily and have a lowered resistance to infection. If children eat meat, then good sources of iron include red meats, liver and kidney. Non-meat sources of iron are egg yolks, peas, pulses, chocolate, bran and wheat germ, parsley, some dried fruits and shellfish. Watch out for an excessive milk intake by children, because milk is low in iron and a quantity of drink before food makes children feel full.
  • Calcium deficiency can lead to reduced growth, badly formed teeth and rickets (a disease in which children’s bones do not harden properly). Vitamin D deficiency also puts children at risk from rickets because this vitamin helps the absorption of calcium. Children obtain calcium from milk, cheese, sardines and bread. Vitamin D is available from dairy products and oily fish and the effects of sunlight on the oils in our skin.
  • Vitamin C deficiency can lead to depression, low resistance to infection, poor skin and slow healing of cuts and scrapes. Our bodies cannot store vitamin C, so children need a daily intake from fruit and vegetables: fresh and ideally eaten raw when appropriate. Some vitamin C is lost as soon as you cut the food and more is lost in the heat of cooking. Of course, children who are tired or prone to infection are not necessarily having an unbalanced diet. Anaemia, for instance, can be a warning sign of leukaemia or sickle cell anaemia.

Vitamin supplements

Manufacturers try every trick in the book to persuade parents and carers that their drink or food product has crucial added vitamins or that a sugary drink is somehow ‘good’ for the development of children’s teeth.

  • If children have a well-balanced diet, they will get all their vitamins from meals. They do not need ‘vitamin-enriched’ drink or food.
  • If children have nutritional deficiencies (see above), then these need to be addressed directly through meals that provide the missing vitamins or minerals.
  • There is some concern now from the United States that children can experience a potential overdose of some nutrients because of the ploy of adding them to non-essential products in order to persuade parents or carers to purchase.

There are many vitamin supplements on the market but as a general rule vita-mins are best absorbed through meals. The process is not entirely understood, but vitamin pills do not seem to offer an equivalent level of nutrition as the same vitamins eaten as food.

  • You should not give a child any supplement without consultation with their parents.
  • Some babies or children may take a supplement but as they get older a balanced diet should offer what they need. Vitamins are a supplement, in addition, to a healthy diet; they do not solve the problems of an unbalanced diet for children.
  • If children do have vitamin or mineral supplements, you must always use products that are suitable for their age, follow the instructions and never exceed the suggested dose.
  • It is possible to overdose on some vitamins or minerals, for example, vitamins A and D, that are stored in the body. Excessive amounts of some nutrients can interfere with the effective digestion of other important food groups.
  • A well-balanced diet is key. It is not the case that, because something is healthy in small amounts, it must be even healthier in larger amounts!

When children are ill

As you will be aware of yourself, one consequence of illness can be a reduced interest in food. Healthy children are more likely to relish their food when it is attractively presented and mealtimes are happy occasions. When a child feels ill or is recovering, it is doubly important that their interest is encouraged:

  • Offer small helpings of what you know the child likes, from a range of nutritional foods.
  • Present it attractively and help the child to eat and drink if they need this support.
  • If children find it hard to chew or to swallow, then choose more mushy or liquid foods or cut up food very small.
  • Talk with children about what they would like. For instance, homemade soups can be very nutritious and are an easy way to get food when you feel ill.
  • Consult with parents, who will in turn talk with the family GP, about whether this is an occasion when children would benefit from a vitamin and mineral supplement.

Do you need to provide ‘children’s food’?

At different times over the past decades, the prevailing advice has been that children need very different food to adults. Some of their nutritional requirements are different from adults but not so dramatically that children require completely different meals.

The idea of ‘traditional children’s food’ that now prevails has been created by fast food outlets and convenience food manufacturers. Non-vegetarian children can learn to relish fish or chicken in different meals; it does not have to be fish fingers and chicken nuggets all the time, if at all. Children develop an enthusiasm for pasta, mixed with different other ingredients. It does not have to come to ‘fun’ shapes or lurid colours.

The best approach is to give young children experience of the kind of food eaten by adults, in smaller portions as appropriate and cut up smaller if necessary. Food should be presented in an attractive way and children encouraged to dish up for themselves, at least sometimes. If they are not keen on food, then try again another time but do not insist if children’s opinion does not change.

Partnership with parents

A conversation with parents about what their children like to eat, any known allergies and details of the family diet should be part of your early information gathering about a family whose child is about to join your setting. In some cases, you may need to have a further conversation about a child’s diet, perhaps because you are unsure what parents would prefer. If you work with slightly older children, in primary school, breakfast or after-school club, you will be able to talk over the details with the children themselves.

Children who are overweight

It is unlikely that children will get overweight if they develop good habits about what they eat and drink, as outlined in this chapter and if they are allowed to run about as children normally wish. Food and exercise work in a healthy partnership.

Toddlers are naturally rounded and some are quite chubby but they grow into a more childlike shape. Health practitioners can judge whether a child is overweight

by the growth charts but a child who is genuinely overweight can be judged by looking at her or him. Children should not normally have rolls of fat, especially around the thighs and abdomen, nor should they have to have clothes that are two or three age sizes larger because the items will not do up around their waist or wrists.

There is an increasing problem with obesity in children in the western world, including especially the United States. Obesity is defined as weighing at least 20 per cent heavier than the recommended body weight for height. The problem seems to have two closely related causes:

  • Children are allowed to develop poor eating habits, with excessive use of convenience foods, snacks like different kinds of crisps, high sugar drinks and sweets.
  • Poor diet is often then combined with a severe lack of physical exercise and far too many hours of passive activity watching television or playing computer games.

Obesity in childhood is a serious issue, not only because obese children grow into obese adults, with related health risks. Children who are very over-weight are often also unhappy about their size and shape and may be bullied by other children. Serious obesity and the often related lack of physical exercise also brings the risk of health problems that are more usually associated with middle age: lack of muscle and bone strength, respiratory problems and the appearance of type 2 diabetes that usually affects adults over 50 years of age.

A rare condition, Prader-Willi syndrome, can affect children’s eating patterns. The syndrome is a genetic disorder that, amongst other symptoms, causes a chronic feeling of hunger, so that children will continue to eat unless firmly guided by adults. The syndrome is unusual, but it is worth considering if children eat excessively and there is no other likely explanation, such as eating as a source of emotional comfort or a family pattern of substantial eating.

Refusal to eat and faltering growth

Sometimes the problem is one of the children not eating enough. Understandably, adults can become anxious about this situation and the efforts to get children to eat, or to eat more than they wish, can worsen the situation. If children’s limited eating goes on for some time, then they can become tired or recover less well from illness or ordinary childhood scrapes. If they fail to put on weight, the children may be said to have faltering growth, the term now used instead of ‘failure to thrive’.

The majority of children with faltering growth are in caring for family homes; they are not being neglected. What has usually happened is that a baby, toddler or child has for some reason become hard to feed or resistant to eating much at mealtimes. There is sometimes a related, temporary health or family problem that may seem to explain what has happened, but often there is not.

More usually, the parents, or other carers, have become anxious or have been told by the health visitor or clinic that they must get more calories into the child. Sometimes this direction by medical professionals is accompanied by some sensible advice, but sometimes there are no helpful hints, only a sense of pressure. The continued weighing of the child raises anxieties even further and parents resort to tactics that make food and mealtimes even more stressful. A vicious circle has then been established.

A positive way forward for you as a carer, or to advise to parents is as follows:

  • Establish proper mealtimes if the child has been grazing. Anxious parents sometimes keep offering food or leaving meals around in the hope that the child will eat. Children then get confused between mealtime and playtime and adults have little idea of what children have actually eaten in total.
  • A discrete food diary may sometimes help and be a way of tracking improvement.
  • Sit with children and make mealtimes a social occasion but not extraordinarily drawn out. Ensure that all the food and drink offered is nutritious and ideally take at least some meals with the child.
  • Give young children, or let older ones, serve themselves a small helping. Support them in eating if they need. They can have a second helping if they want.
  • Avoid complex rituals to try to persuade a child to eat but offer sensible flexibility. For instance, sandwiches can taste nicer with the crusts off or children really may like their apple peeled and sliced.
  • Avoid giving attention for refusal to eat or pushing food around on the plate. Keep calm and avoid nagging – not easy for parents or carers who have become worried!
  • Give simple encouragement when a child has eaten – mainly at the end of the mealtime, not for every spoonful. Say something like, ‘Would you like some more fish pie? (When the child has indicated they would.) Yes, I thought that was tasty as well.’ Alternatively, if you are the cook, perhaps, ‘It’s better with more cheese on top, isn’t it?’ You could also simply comment, ‘Well done, you had a good lunch’ or ‘Looks like you enjoyed the chicken and rice.’
  • If children do not eat much, then after a reasonable mealtime, call a halt. Say something like, ‘Are you finished then? Alright, the next meal is teatime’. If children complain later, ‘I’m hungry’, say simply, ‘I’m sorry you weren’t in the mood for food at lunch. There will be plenty at tea’. Avoid the temptation to let them fill up in between mealtimes.
  • As a child becomes more enthusiastic or cooperative about food, then involve them in plans for meals and choices.

Supporting diversity in diet

All around the world, a family’s diet is influenced by cultural tradition and any religious considerations, as well as by what food is easily available locally. Your own view of a ‘normal’ diet will have been influenced by your own upbringing.

  • Part of your professional development is to become more aware of the variety in different social and ethnic groups: both in your local area and in the UK as a whole.
  • You certainly should not talk about ‘restricted’ diets when you actually mean that a child or family does not eat the same foods as you do. A genuinely restricted diet is when a child, for reasons of allergy or ill health, cannot follow the family pattern of eating.
  • Also, it is better to avoid the weird phrase ‘ethnic food’. Everybody belongs to an ethnic group, so the phrase has to apply to every possible world cuisine. Fish and chips or steak and kidney pie are, therefore ‘ethnic food’ just as much as tandoori chicken or couscous. The phrase is used inappropriately to apply to food other than the diet that the speaker regards as normal.

People who confidently announce, ‘But I eat anything!’ rarely do eat absolutely anything. Families who eat meat as part of their diet do not usually eat happily every possible kind of animal or fish. Some families, of course, avoid particular animals for religious reasons or require that animals be killed in a particular way. However, families who have no religious reservations often draw the line at some animals. For instance, English families will probably be outraged at the suggestion that they eat horse, yet this is an item on the menus in parts of mainland Europe. In contrast, some European countries think it very odd to eat lamb: traditional meat in the UK and Greece.

A vegetarian diet

Strictly speaking, vegetarians will not eat any food that requires the killing of animals, poultry or fish. If you are planning menus for children who are vegetarian, then you need to get into the habit of checking the ingredients on convenience foods. For instance, some cheaper ice cream contains animal fat and some ready-made desserts are set by gelatine, an animal product. You should also use vegetarian cheese since some cheeses are made with rennet, derived from animals. The use of ‘suitable for vegetarian’ symbols has made buying easier.

Some families who describe themselves as vegetarians nevertheless eat fish or are not that concerned about hidden ingredients in convenience foods. As with any other practical care issue, you need to check with parents so that you understand what they would like for their child.

A vegan diet

Vegans go further than vegetarians in that they will not eat any animal products, even those that do not require killing the animal. So a vegan family will avoid all dairy products, eggs and some vegans will not eat honey. A balanced vegan diet needs careful attention, especially if you are not used to menu planning for vegans. For example:

  • Vitamin B12 is largely found in animal products. Vegans can get traces of
  • B12 in sea vegetables (edible seaweeds) but children will need a supplement.
  • Calcium can be a problem with the loss of dairy produce. Babies and young children who are not yet on a very mixed diet may need a calcium supplement. Soya bean milk is sometimes fortified with calcium.
  • Fat is only present in traces in fruit and vegetables, so vegans need to ensure they get enough fat from other sources, such as all kinds of nuts and soy flour.

Talk with children’s parents about how they balance their child’s diet. You certainly should not give children nutritional supplements without discussion with the family.

Religious beliefs and diet

All of the major world faiths have some rules about food or food preparation. Every faith includes different sects and families may also vary in how strictly they follow the rules. So, it is not accurate to follow predictions like, ‘Surely all Hindus …’. Also, some parents may no longer practise their faith but are more comfortable following the dietary rules in which they were raised. A good guideline for early years practitioners is, ‘if in doubt – ask’ on a child’s diet as with any other aspect of their care. What follows is a general guide.

  • Buddhists are sometimes vegetarian, but not always. Some Buddhist sects believe strongly that diet is a personal decision.
  • Most Christians do not follow particular rules for their diet, although some make a case against vegetarianism by quoting the Bible. However, a few Christian groups do avoid certain foods, for instance, Catholics may avoid meat on Fridays (the day of the death of Christ) and some give up one or two foods for Lent (the forty days leading up to Easter). Families from the Orthodox Church may avoid meat, eggs and milk products for Lent.
  • Jehovah’s Witnesses require that meat has been bled in the method of slaughter and avoid foods like black pudding because of the blood.
  • Mormons avoid black pudding and caffeine in any form, so children should not have cold drinks.
  • Some Rastafarians follow a vegetarian diet which is close to vegan – avoiding dairy products. If families eat meat, they will probably avoid pork and shellfish. (The Rastafarian faith is a blend of Biblical teachings and African cultural traditions.)
  • Some Hindus are vegetarian, but those who eat meat will avoid any beef and beef products since cows are regarded as sacred.
  • Orthodox Jewish families follow the laws of Kashrut that determine the permitted foods (kosher, meaning allowed) and the method of slaughter. Additionally, meat and dairy products have to be kept completely separate at all stages of food preparation, eating and washing up afterwards. Less strict Jewish families will ask that their children are not given pork in any form, nor shellfish.
  • Muslim families avoid pork in any form. As with meals for Jewish children, you have to watch out for unexpected pork products in processed foods. Any meat or poultry must be Halal (meaning lawful) which is produced by the method of slaughter that allows a body to bleed. If you cannot get Halal meat, then children from Muslim families will have to have fish and vegetarian meals.
  • Some Sikhs are vegetarian, but those who eat meat will probably avoid beef and pork. Families will want meat from a butcher that has not been bled in the Halal or Kosher method.

Fasting

Giving up foods at particular times or fasting for periods is part of religious practice in some faiths. However, you are most likely to encounter fasting if you work with children from Muslim families, who will fast throughout the daylight hours during the weeks of Ramadan. The Islamic year is based on the lunar calendar and so the exact date moves ‘earlier’ each year in terms of the western calendar. At the time of writing (2002) Ramadan falls from mid-November to mid-December, but it will make its way back to the summer months.

Families are careful about bringing children into the tradition slowly and younger children are not expected to fast. However, if you work in a primary school or after school club, then be aware that children may join the fast for some days or for a few hours within the day.

Food allergies

Some children need to avoid certain foods in order to stay well. You need to talk with parents at the beginning of your working relationship and understand what this means for the child’s diet. Some food allergies are life-threatening, so take seriously what parents say.

Food allergies are caused by an overreaction of the body’s immune system. When a child or adult eats a food to which they are allergic, they will become ill quickly. The food, even small traces, may cause skin rashes, very serious stomach upsets or even life-threatening reactions. Some children are allergic to egg, wheat, cow’s milk, nuts or fish. Milk and egg allergies sometimes pass when children get older, but many allergies last a lifetime.

Young children do not chew the nuts properly into smaller bits and the nut can get stuck in their throat. However, some children have an extremely serious reaction to nuts, especially peanuts, and some other foods. The term to describe a severe allergic reaction is anaphylaxis. An injection of adrenaline can be essential to reverse the reaction and a family should obviously alert you if this is the case. As with any medicines, you would need to know exactly what to do.

Some adverse reactions to food are less obvious and can be difficult for parents to track and demonstrate. Some children seem to have an intolerance of milk, wheat, caffeine, citrus fruits, chocolate, dairy products and food additives including some colourings. The impact includes rashes, stomach upsets, migraine and some behavioural changes such as hyperactivity and aggression.

Early years practitioners should follow parents’ requests where possible and be honest if you are struggling.

  • If you have difficulty in maintaining a balanced diet for a child, then ask for advice from parents. In early years setting you could ask parents to send food in with their child.
  • A well-balanced diet of fresh, non-processed food will deal with many of the food additive issues.

Learning around food and mealtimes

Food is an important part of the day for children and they look forward to meals when the experience is pleasant. There are plenty of opportunities for learning as a natural part of this routine when children are involved in social and friendly mealtimes.

Being appreciative about food

Part of helping children to enjoy their food can be expressing appreciation. A number of world faiths have some tradition of giving thanks for food – either at most mealtimes or on specific occasions. Unless your setting has a specific religious affiliation, it will be appropriate to find general ways of expressing thanks. Certainly, there is no justification for insisting on a specifically Christian ‘saying grace’.

It can be pleasant for the nursery cook to be thanked on occasion, not every day as a habit because that soon does not sound genuine. Children will have favourite meals or puddings or be appreciative that the cook has completed their own cooking of a cake. Encourage the children to say ‘thank you’ or communicate that today’s apple tart was the best ever.

Encouraging good eating habits

You can support children towards healthy eating by a positive approach to meal-times, creating a friendly atmosphere in which the main task is still to eat and drink.

  • Mealtimes need to be relaxed. Taking your time at meals can mean that children are able to chat as well as eat and can come back for seconds if they wish. Mealtimes are more relaxed when you value them as times of learning and not just as routines to get done.
  • By all means, remind children courteously to keep eating or to eat up as far as possible. But definitely avoid nagging and any situation in which a child is told by different adults in succession to ‘hurry up’ or ‘finish your meal’. Help children with cutting up or spooning in the food as necessary.
  • It is worth having food in dishes or on serving plates that enable children to help themselves and their friends. Children can then see and choose the proportions of food they would prefer and add any sauces or savoury additions such as chutney, custard or yoghurt if they wish.
  • Sometimes there may be pressure from other staff, perhaps the cook. If you cannot easily resolve the issue with the other person, then it will be important that the manager of your centre addresses what is getting in the way of a relaxed mealtime.
  • You need a comfortable seating arrangement for everyone, including yourself. Adults will not be comfortable if perched on a child-sized seat.
  • You should sit down with the children and ideally eat with them, although you may not want to eat at every meal or snack time. This habit will model good eating habits and helps you to pay full attention and not be tempted to rush children.
  • Some children may not be used to a sit-down mealtime when they join your centre. Try to be flexible and understand that the child is not being awkward, she may genuinely have no idea how to sit and eat because her family lets her pick food and move about. With your patience and an attractive social mealtime, she will join you all soon.
  • Children also bring different experiences of how to eat. Using a knife and fork in the English way is far from a universal way of eating and some English families may live mainly on takeaway and finger food.
  • It is a useful social skill for children to learn to use cutlery as well as other ways of eating. But you need to be aware that some families will use other utensils, such as chopsticks or regularly use different kinds of bread as a form of utensil.
  • Eating with the fingers is a perfectly hygienic way to eat so long as children have washed their hands before a meal. You can help children in good habits of personal hygiene for meals and when they are involved in food preparation and cooking activities.

Helping children with tooth care

Children’s teeth develop during early childhood and good habits can be established from the early years. Healthy eating and drinking habits are one of the most important parts of the care of teeth.

Development of teeth

The first teeth appear in babyhood:

  • The first tooth is not usually much earlier than 6 months: incisors come first, with the two central top and two central bottom teeth.
  • At about 8 months: two more incisors to make a set of four top and bottom teeth.
  • 10–14 months: the first molars, these are the double teeth for efficient chewing.
  • 18 months: the canines, at the side of the front incisors.
  • Two to two and a half years: the second molars at the back of the mouth.
  • In total children have 20 milk teeth and these usually last until about six years of age when the second set starts to push out the milk teeth one by one until children have close to a full set of second teeth.
  • By the time they are 12–14 years old children will have 28 permanent teeth. The last four of a full set of 32 are the wisdom teeth, right at the back of the mouth and these do not always emerge until late adolescence or early adulthood.

Ways to prevent tooth decay

Dental decay is a serious problem for many young children in the UK and is largely preventable. The main ways to support good dental health for children are:

  • A balanced diet with limited sugar from confectionery and sweetened fizzy drinks.
  • Regular brushing of teeth with fluoride toothpaste. It used to be said that children should brush their teeth after every meal. But dentists expressed concern that over brushing can damage the tooth enamel and no more than twice a day is now recommended.
  • Regular visits to the dentist so that children can have their teeth checked and become familiar with the routine.

Caring for children’s teeth is primarily the responsibility of parents. As an early years practitioner you make an important contribution but should not take over that responsibility:

  • In early years setting or family home, your role is to organised and promote a healthy diet for the children.
  • You will find opportunities to help children learn about teeth as part of their body, through conversation, books or project work.
  • If you work as a nanny, then you may help with tooth brushing and may sometimes take the children to their dental appointments.

Poor diet, with excessive confectionery and sweet, fizzy drinks can cause cavities in the milk teeth, sometimes so bad that children have to have teeth extracted. Worse still, for some children, their second set of teeth actually rots in the gums. This level of dental decay is completely avoidable and definitely an adult responsibility.

In partnership with parents, you can promote healthy eating and explain how you use different methods of encouragement rather than rewarding children with sweets or biscuits. It would not be appropriate to ban all sweet foods from your early years setting. A birthday cake or special sweetmeats for some religious celebrations can be a change. You can, however, make suggestions to parents about a range of foods that would be welcome for parties and other celebrations, so that sweets are not the main contribution.