Get Up & Grow Healthy Eating and Physical Activity for Early Childhood directors/coordinator book



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Family foods (Guideline 4-9)


Adequate nutrition is essential for the active growth and development that takes place in early childhood. Having good eating habits and a balanced diet supports children’s health and wellbeing, and minimises the risk of illness. Eating habits developed in the early years are likely to have a lifelong influence.
Healthy eating in childhood minimises health risks and improves health throughout life. Many lifestyle diseases such as obesity, cancer, heart disease and diabetes can have their beginning in poor nutrition habits early in life.
The 2007 Australian National Children’s Nutrition and Physical Activity Survey identified that less than 25 per cent of young children eat the recommended number of serves of vegetables on a regular basis. There is considerable room for improvement in young children’s nutrition.
Experiences in early childhood settings can influence young children’s eating behaviours and nutritional intake. Work with parents and families to support and encourage healthy eating for children. Whether a setting provides meals and snacks for children or children bring them from home, there are many opportunities to encourage good eating habits.

Key components of a healthy diet for children aged one to five years


HEALTHY EATING GUIDELINE 4

Make sure that food offered to children is appropriate to the child’s age and development, and includes a wide variety of nutritious foods consistent with the Australian Dietary Guidelines (see page 4).

Foods from the basic food groups provide the nutrients essential for life and growth. These foods may also be called ‘everyday foods’. Each group of these foods provides a variety of nutrients and plays various roles in helping the body function. In particular, vegetables, legumes and fruit protect against illness and are essential to a healthy diet.


Whether a setting provides meals and snacks or children bring food from home, ensure that all children eat a variety of foods from the basic food groups each day.
‘Discretionary choices’ (see page 24) on the other hand have little nutritional value and are not essential for good health. Eating a lot of discretionary choices is associated with ill health, being overweight and obesity. Research shows that overweight or obese children are likely to become overweight or obese adults, leading to increased risk of chronic illness. A healthy weight in childhood reduces these risks for later life.
Water is essential for life and should be the main drink each day. Young children in particular are at risk of thirst and dehydration, and should have access to drinking water at all times.

The basic food groups


A balanced diet provides all of the essential nutrients for a child’s growth, development and overall health. A balanced diet is one that includes a variety of foods from each of the food groups, and offers different tastes and textures.
The food groups are:
Vegetables and legumes/beans

Fruit


Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley

Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans

Milk, yoghurt, cheese and/or alternatives, mostly reduced-fat (reduced-fat milks are not suitable for children under the age of two years)

Breads, cereals, rice, pasta, noodles and other grains




Key component: Carbohydrates

Carbohydrates are a good source of energy and play a significant role in a balanced diet. Carbohydrate foods include bread, rice, pasta, noodles and other grain-based foods.


The best choices from this group are wholemeal and wholegrain breads, breakfast cereals, oats and plain, dry biscuits – products that are less processed. Other good choices include brown rice, couscous, wholegrain pasta and polenta.

Vegetables and legumes




Key components: Vitamins and minerals

Vegetables, including legumes, provide vitamins, minerals and fibre to the diet. Adequate intake of vegetables and legumes is linked with maintaining a healthy weight, and a reduced chance of developing heart disease, diabetes and some types of cancer. A variety of vegetables should be provided in children’s meals and snacks each day.



Fruit




Key components: Vitamins and minerals

Fruit is a good source of vitamins, minerals and fibre. Eating fruit is also linked with maintaining a healthy weight, and a reduced chance of developing heart disease, diabetes and some types of cancer. Fruit should be included in children’s meals and snacks each day.



Milk, yoghurt, cheese and/or alternatives




Key components: Calcium and protein

Calcium is a mineral that is essential for bone development in children. An adequate amount of calcium is necessary for healthy bones and teeth. Plain milk and other dairy products such as cheese and yoghurt are the main sources of calcium. These foods also provide some protein, which is important for growth in children.


Cow’s milk should not be given as a main drink to infants before 12 months of age. It can however be used in small amounts in other foods from around six months such as in breakfast cereal, and other dairy products such as yoghurts, custards and cheese can be offered. Fullcream cow’s milk is recommended for children aged one to two years, and reduced-fat plain milk is suitable for children over the age of two years. Calcium-fortified soy drinks are an alternative for children over 12 months who do not drink cow’s milk or cow’s milk products. Rice and oat milks can be used after 12 months of age if calcium enriched and full fat. Health professional supervision is recommended.

Lean meat, fish, poultry, eggs, nuts and legumes




Key components: Protein, zinc and iron

Protein is important for the structure and function of muscle and other tissues, and especially important for growth in young children. Protein can be found in animal products such as meat, fish and poultry, and also plant products such as cereals and legumes.


Iron, which is essential for growth and moving oxygen around the body, is mainly found in meat, fish and chicken. Red meat, fish and chicken provide haem iron, which is absorbed readily by the body.
Eggs, plant-based foods (including legumes), green leafy vegetables and some breakfast cereals also provide some iron. This form of iron is non-haem iron, which is not as easily absorbed into the system. Vitamin C can help the body absorb non-haem iron, so it is important for children to have a food rich in vitamin C with meals or snacks containing these foods. Foods rich in vitamin C include green leafy vegetables, tomatoes and citrus fruit.

Vegetarian and vegan eating practices


Families who are vegetarian typically avoid eating animal products such as meat, poultry and fish. They may still eat some animal-related products such as eggs, milk, cheese and yoghurt.
Vegetarians need to eat a variety of legumes, nuts, seeds and grain-based foods, which provide the nutrients that would otherwise be provided by meat, poultry and fish. Remember that nuts and seeds are potential choking hazards for young children and care must be taken if these foods are offered.
Vegans typically avoid eating any foods that have an animal origin. It is very difficult to meet children’s nutritional needs through vegan eating practices, in part because the amount of food needed to provide sufficient nutrients may be too large for the child to manage. Families must plan carefully for children on a vegan diet. It may be difficult for a setting to offer meals and snacks that conform to vegan eating practices. Families may need a referral to an Accredited Practising Dietitian for further information.

A note about fats


Fats also play a role in a balanced diet, as they provide energy and essential fatty acids for growth and development. A balanced diet that includes foods from all the basic food groups will include an adequate amount of fats, including essential fatty acids which come from basic foods such as lean meat, fish, wholegrain cereals and vegetables.
Young children under two years should not have reduced-fat milks. For children over two years, reduced-fat milk is suitable. Special low-fat products should not be provided to young children.
Eating lean meat and skinless chicken, avoiding fried foods and using added fat (e.g. margarine, cream) sparingly are good ways to ensure that children’s diets do not contain too much fat.

The place of ‘discretionary choices’


‘Discretionary choices’ are foods not included in the basic food groups. Discretionary choices are foods high in kilojoules, saturated fat, added sugars and/or salt. They typically have very little nutritional value and are often processed and packaged. Eating discretionary choices too frequently can result in too much fat, sugar or salt in the diet and can lead to poor eating habits and poor health.
Examples of discretionary choices include:
chocolate and confectionary

sweet biscuits, chips and high-fat savoury biscuits

fried foods

pastry-based foods such as pies, sausage rolls or pasties

fast food and takeaway foods

cakes and ice cream

soft drinks, fruit drinks, cordial, sports drinks, energy drinks, flavoured milk and flavoured mineral water.
Limit the amount of discretionary choices children eat, and avoid offering these foods as prizes or rewards, or as comfort foods. Success in encouraging healthy eating habits in children is more likely when parent, staff and carers work collaboratively. Staff and carers can create opportunities to teach children the difference between everyday and discretionary choices.

Food provided by the setting


Many settings provide a substantial percentage of a child’s daily nutritional intake through the meals and snacks they provide for children.
Sound menu planning incorporates foods from the basic food groups in each meal and snack, and does not include discretionary choices.
Incorporating a variety of foods from different cultures enriches everyone’s experience. Families can be involved in creating opportunities for children, staff and carers to learn about and appreciate a variety of foods and customs.

Food brought from home


Support parents to provide a variety of foods from the basic food groups in snack and lunchboxes each day. Settings should have policies about healthy eating. These policies can encourage parents to give their child fruit, vegetables and other nutritious foods, as well as a clear water bottle labelled with the child’s name. Families and staff or carers can exchange healthy recipes and ideas.

Religious and cultural practices


Everyone working with children and families needs to respect and take into account the values and lifestyles of families. Cultural and religious beliefs must be respected when planning, preparing and discussing food and meals.
Some families and settings will follow religious and cultural beliefs that guide their eating practices, for example those that eat Kosher or Halal food. The nutrition guidelines described above are still relevant in settings that follow particular religious or culturally based eating practices. Discussing with individual families who adhere to particular practices about the best way to offer food for their child will lead to mutually agreed outcomes. This may involve the family providing food, or an agreement about specific food items that can be included or avoided. Using interpreters when families and staff or carers do not speak the same language will allow better communication.


HEALTHY EATING GUIDELINE 5

Provide water in addition to age-appropriate milk drinks. Infants under the age of six months who are not exclusively breastfed can be offered cooled boiled water in addition to infant formula.

Water is essential for many important bodily functions, including digestion, absorption of nutrients and elimination of waste products. Water accounts for between 50 and 80 per cent of a human’s body weight. Young children in particular are at risk of dehydration.


To stay hydrated, toddlers need to drink around 1 litre of fluid a day, and three- to five-year-olds around 1.2 litres a day.
Babies under six months who are not exclusively breastfed can be offered cooled boiled water. From six to 12 months, cooled boiled water can supplement breastmilk or formula. For children one to five years, water and cow’s milk should be the main drinks offered. Children should have access to drinking water at all times during the day. Where available, offer clean, safe tap water to children – purchasing bottled water is generally not necessary. Water should be available to children at all times, and plain milk should be offered at meal or snack times. It is important to avoid offering too much plain milk, especially just before meals, as children can easily fill up on milk and not be hungry for meals. From around one year, children need around 500ml of milk per day. This includes milk they drink in the setting and at home.
Sweet drinks are not part of a healthy diet, as they do not provide much nutrition and can fill children up, leading to a decreased appetite for other foods. Young children are more likely to expect sweet drinks if exposed to them early. Sweet drinks may also contribute to tooth decay, and are one of the strongest dietary links to excess weight gain in children.
Sweet drinks include soft drinks (including those that are artificially sweetened), flavoured mineral water, sports drinks, flavoured milk, cordial, fruit juice drinks and fruit juice. None of these should be offered to children in the setting.
Water should be provided with each meal and snack, and available for children to drink at any time during the day. Older children can pour their own water or plain milk from a jug on the table at meal and snack times. At other times, each child should have their own accessible, clear water bottle with their name on it. A clear bottle allows staff and carers to easily identify whether the bottle is filled with water or a sweet drink.
It is important for all staff and carers to also have water bottles and to eat nutritious foods in order to model healthy eating for the children.


HEALTHY EATING GUIDELINE 6

Plan mealtimes to be positive, relaxed and social.

Early childhood settings play a key role in promoting healthy eating habits in young children. Children are sensitive to the messages from adults close to them, and practices such as using food for rewards or as threats, intervening to determine the amount of food a child eats or making critical comments about eating, body size or shape may all have negative long-term impacts on eating practices.



The environment for eating


Meal and snack times provide an opportunity for children to develop good eating behaviours, enjoy eating and learn about nutrition and different varieties of foods. They are also a good time for social interaction. Staff and carers should use these times to talk with children, to encourage them to talk with each other, and to share information about nutrition and healthy eating. Children can also develop language and communication skills through talking with adults and peers.
Set the scene for a positive mealtime. Children should always sit down to eat at meal and snack times. Encourage children to help pack away play materials and set the table. Using tablecloths or placemats can also make mealtimes more special.
A little mess is to be expected at meal and snack times, and the younger the children the more likely the mess. Staff and carers should not react negatively to the inevitable mess that comes with children’s exploration of food. However, playing with food, for example throwing or spitting it, should not be allowed. Young children should be allowed to eat with their fingers, especially if they are still learning to use utensils.
Some children refuse particular foods, or sometimes many foods. This should not be a cause of stress or concern at mealtimes. Children can be encouraged to try foods in a positive manner, but should never be forced or pressured to eat. Some help with feeding may be needed for younger children, but only if they are clearly still hungry.

Appropriate use of food


At no time should staff or carers use food as a reward or deny it as a punishment for behaviour. Praise and encouragement are what children need from adults. Also, using food to comfort a child can contribute to unhealthy eating habits and a reliance on food for comfort.

Children and body image


Children should learn to see food as important for a healthy body and growth, and not focus too much on weight or body shape. Staff and carers can make sure that discussions about food are positive and focus on the health benefits of nutritious foods as well as the taste, shape, colour and variety. It is important to avoid labelling particular foods as ‘good food’ or ‘bad food’.
Talking about diets, dieting and restricting food is not helpful. It is not appropriate for children to diet or to have their food intake restricted, unless parents have indicated that this is under the supervision of a health professional.
Early childhood staff and carers can help children have a positive body image by encouraging and praising them for what they can do, refraining from making comments about their weight and not relating weight to a child’s worth. This point also applies to carers, who should refrain from talking about their own body shape or weight in a negative manner.


HEALTHY EATING GUIDELINE 7

Encourage children to try different food types and textures in a positive eating environment.

The early childhood years are a critical time for experiencing different foods and developing eating behaviours and food preferences. The greater the variety of foods that children are exposed to in their early years, the greater the likelihood that they will eat a wide range of foods as an adult. Adults who include a wide variety of foods in their diet are more likely to be healthy, and increase their defence against lifestyle diseases such as diabetes and heart disease.



Variety of foods


Mealtimes should provide a safe environment for children to try a variety of new foods. Appealing meals that offer a variety of tastes and textures allow children to experience and become familiar with many different foods. Regularly offering new foods, from a range of textures, flavours and colours, along with familiar ones will encourage children in their eating. New foods may not be tasted on the first few occasions, but can continue to be offered. Group situations can be an incentive for children to try new foods, as they may be more inclined to try them when they see their peers enjoying them. Praise children for tasting new foods, even if they do not eat much of the food.
In early childhood settings where food is not provided, but brought from home, parents can be encouraged to provide a variety of foods for their children. The mealtime environment can still be supportive of children eating a variety of foods. Although sharing foods is not recommended, it can be helpful to discuss with children the variety of foods brought in lunchboxes, without singling out particular children. Settings can use their food and nutrition policies to outline how they will support parents to provide a variety of nutritious foods for their children each day.

The role of adults


Adults are role models – children learn a lot from watching and listening to what goes on around them. By sitting with children at meals and encouraging healthy behaviours, staff and carers can support children’s healthy eating habits.
Some things for adults to keep in mind include:
sitting with children during meal and snack times

where meals are provided, eating the same foods as the children

not discussing personal likes and dislikes

encouraging children to taste all foods offered

letting children choose what and how much they eat from what is available

allowing children to serve themselves

never giving or denying food as a reward or punishment

maintaining a relaxed and positive social environment.


Staff and carers can work in partnership with parents to encourage healthy eating behaviours in children. Discussions about children’s eating can provide valuable opportunities for parents, staff and carers to learn about children’s exploration of new foods and skills related to eating.


HEALTHY EATING GUIDELINE 8

Offer an appropriate amount of food, but allow children to decide themselves how much they will actually eat.

Healthy eating in childhood comes from a division of responsibility between children and adults. Parents and staff or carers are responsible for providing appropriate amounts of food that are safe and nutritious. Children can then decide what and how much they will eat from the foods offered. Children know when they are hungry or full, and should be allowed to stop eating when they are full. They should not be encouraged to finish a meal, or be praised for finishing everything on their plate. This allows them to eat according to their appetite and learn to respond to their body’s signals of hunger and fullness.



Adults provide, children decide


As often as possible, food should be served at the table in ways that allow children to help themselves and decide how much they will eat. Making serving platters, bowls and utensils available and accessible encourages children to serve themselves. This helps them develop coordination, as well as skills such as pouring, serving and passing.
If two courses are offered at a meal, both should be nutritious and based on foods from the basic food groups. Children should be allowed to eat the second course regardless of whether they finish the first course. A child who refuses to eat should not be forced to do so.
When children bring their own meal or snack, they can decide how much they will eat. Any uneaten food should be sent home in the lunchbox.

Dealing with fussy eaters


Toddlers grow at a slower rate than babies and have irregular appetites. As a result, they can be fussy about food preferences. Some older, preschool-aged children may also be ‘picky’ eaters. As indicated previously, it is the responsibility of parents and staff and carers to provide healthy food options and to encourage children to taste each different food. It is up to children to decide how much food they will eat. It is important that adults do not make a fuss about eating, as this places extra focus on it and can make the situation worse. Reassure parents that fussy eating can be normal toddler behaviour. For most children that are healthy, active and growing well, there is no need to worry. However, if a child excludes an entire food group or eats a very limited range of foods for an extended period of time, a referral to an Accredited Practising Dietitian may be helpful.
Working with a fussy eater:
Make sure the child has not filled up on drinks or discretionary choices before a meal or snack.

Maintain a regular time routine for meals and snacks.

Make mealtimes enjoyable and not stressful.

Don’t bribe or punish a child who refuses to eat.

Ensure that adults are modelling appropriate eating behaviour.

Continue to offer foods that have been refused previously. Sometimes children need to be exposed to a new food a few times before it becomes familiar.

Set a time limit of 20 to 30 minutes for a meal. After this time, remove any uneaten food and let the child leave the table. Do not offer alternative food or drinks until the next planned meal or snack.

HEALTHY EATING GUIDELINE 9

Offer meals and snacks at regular and predictable intervals.

Establishing good mealtime routines in childhood makes it more likely that a regular meal pattern will be followed throughout adolescence and adulthood. A regular meal pattern contributes to having a healthy, balanced diet.


Children have small stomachs and their energy and nutritional requirements are best met through small and frequent nutritious meals and snacks.

Regular and predictable intervals


Offering regular opportunities to eat fits the concept of dividing the responsibilities of eating, which aims to encourage children to self-regulate their own appetites. A child can be confident about eating or declining food when they know that food will be offered again at a predictable time. Structured meal and snack times are helpful in developing good eating habits, as it is fine for children to wait a little while for the next scheduled meal or snack, even if they are hungry. Generally, children should not be offered alternative foods or an extra milk drink or early snack on the basis that they did not eat much at a scheduled meal or snack time.
Providing flexible snack times allows children to finish an activity, or snacks can be available over a short period of time if that suits the daily plan for the setting. Allowing children to become too hungry often leads to them becoming irritable. On the other hand, constant or unstructured ‘grazing’ interferes with children learning to recognise when they are hungry and eating in response to hunger.
Snacks and meals are both equally important to children’s nutrition. Young children have limited capacity at each mealtime, and need regular opportunities to eat in order to maintain energy levels and consume enough nutrients to stay healthy. Three meals and two snacks are ideal for young children, though children who may not have an evening meal until very late may need a small snack late in the afternoon. When this happens, a smaller amount may be eaten at the meal.
Snacks should make a contribution of nutrients in proportion to their energy value. Snacks that provide energy (kilojoules) without their fair share of nutrients should not be offered on a regular basis. These are ‘discretionary choices’.
Most foods offered at meals can also be offered as snacks. The most commonly provided suitable snacks include fruit, vegetables, bread or cereals, and milk-based drinks. Snacks do not have to be large – one or two biscuits with cheese, a small piece of fruit, steamed vegetable sticks with dip, or a small glass of fruit smoothie offered with water are ideal.

Breakfast


Breakfast is an important meal for many reasons:
It is difficult to have sufficient nutrients in a day without the nutritional contribution of breakfast.

Missing breakfast leads to hunger later, and often less nutritious snack foods are eaten because they are available at the time.

Establishing a routine for young children that involves eating a healthy breakfast lays the foundation for a pattern in later life.

Children who do not eat breakfast are more likely to be overweight or obese.

If breakfast is not offered in the setting, have some healthy food available for children who arrive without breakfast.
Children will find it harder to manage their own behaviour and

enjoy their day if they start off hungry.
There are many reasons why children may occasionally arrive without having had breakfast. If a child arrives regularly without breakfast, it is important to discuss this with the child’s parents. Often parents who do not themselves have breakfast may not see it as being important for their child. Talk with the parents about the benefits of breakfast and the contribution it makes to a child’s wellbeing. If a number of children arrive frequently without breakfast, and food supply at home seems to be the problem, consider offering breakfast on a routine basis.
Breakfast does not need to be costly or time-consuming; rather, it can be simple, nutritious and easy. It can be as simple as wholegrain cereal, milk and fruit – a perfect meal in a bowl, and ingredients that are easy to keep on hand. This great meal provides protein, calcium, iron and vitamins.
When a setting offers breakfast daily, varying the menu occasionally adds interest. Healthy and easy alternatives to cereal include:
porridge with fresh or canned fruit and a glass of milk

yoghurt and fruit or a fruit smoothie

toast or a crumpet with cheese and slices of fruit

pikelets topped with ricotta or yoghurt and fruit.


During this busy time of day, offering breakfast can still be simple and easy.

Celebration food


Birthdays and other special occasions are important to young children and their families. In many cultures special occasions are celebrated with food. Promote healthy eating by using nutritious foods prepared and presented in special ways, rather than relying on ‘discretionary choices’. If discretionary foods are used for special occasions, small, children’s portions should be offered. Limit the number of discretionary foods served on any occasion, and offer something healthy at the same time. For example, one small piece of cake along with some fruit. In settings where children have food allergies, non-food celebrations will be more appropriate.
Celebrations do not have to focus on food – there are other ways to celebrate. For example, on their birthdays, children can wear a special party hat or a birthday badge or sticker. The group can sing ‘Happy Birthday’ and the birthday child can blow out a candle. Other occasions can be celebrated through art or craft activities where children paint, draw or make something, dress up or decorate in a special way.
Use the food and nutrition policy to explain the setting’s views on celebration food. The food and nutrition policy should be developed in conjunction with parents and reflect the views that have been agreed upon.

Checklist

Providing a variety of nutritious foods

Food provided by the setting is nutritious and includes a variety of foods from each of the basic food groups every day.

Parents are encouraged to send nutritious food, and include a variety of foods from each of the basic food groups, if children bring food from home.

Families are provided with information and ideas on how to provide nutritious foods for their children.

Water is offered as the main drink and is available at all times.

‘Discretionary choices’ are not included in planned menus and parents are discouraged from including them in lunchboxes.

Appealing meals and foods that offer a variety of tastes, colours and textures are provided. Food is offered in ways that encourage children to try new foods and enjoy eating.

Where meals are provided, diversity is explored through offering a variety of foods.

Families, staff and carers have access to information about the importance of good nutrition and healthy eating for children.




Mealtimes and behaviour

Food is never used as a reward or denied as a punishment, or used to comfort children.

Mealtimes are positive, relaxed and social.

Staff and carers model healthy eating behaviours by sitting with children at mealtimes and interacting with them.

If food is provided by the setting, staff and carers model healthy eating by eating the same foods as the children.

Meals and snacks are offered at regular and predictable intervals.

Food servings are of a suitable size, so children have control over their own choice to eat and the amount they eat.

Extra food is available if children are still hungry at the end of a meal or snack.

Food is seen as important for a healthy body, and not related to weight or body shape.

Fussy eating is dealt with in a relaxed way that encourages the child to try new foods, but does not use praise or rewards for eating.

Special occasions are recognised and celebrated with limited use of ‘discretionary choices’. Alternatives to focusing on food are considered for celebrations.

Cultural and religious beliefs are respected when planning, preparing and serving food in the setting.




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