Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
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