Eating well for under 5s in child care Dr Helen Crawley The ...

1. Eating well for under 5s in child careDr Helen CrawleyThe Caroline Walker Trust

4. and from the mouths of professionals�� � Can you believe it , one nursery I went to served the children bread and butter pudding � and they even allowed seconds!� � I have told the nurseries I work with that the way to prevent children getting fat is to cut out fruit juice and make portion sizes smaller�

5. So where are we really �.? Do we have enough information about the actual diets of under 5s in the UK and how food in nursery contributes? What information is available to child care settings about what eating well means for under 5s? What should we, as health professionals, lobby for in terms of standards: what have we learnt from school meals?

6. What do our under 5s eat? We have data from the 1995 National Diet and Nutrition Survey of children aged 1.5-4.5yrs � this is the most comprehensive dataset but is now out of date The FSA plan a new dietary study of children 4-18mths in the next 2 years Since the data was collected 15 years ago we have seen a changing population demographic, a sea change in awareness about nutrition and the rise and rise of �convenience food� for toddlers.

7. From the data we do have ...... It is suggested that almost a quarter of pre-school children in the UK are overweight or obese (2003 data England; 2005 Scotland) Underweight is suggested for about 10% children Both are related to inequalities of health and deprivation Focus is considerably greater on overweight than underweight

8. Iron deficiency and low iron status are still likely to be common, although there have been changes in the use of cows milk under 1 year of age and the use of formula milk in the second year In some inner city areas where there is evidence of late and inappropriate weaning, levels of iron deficiency in toddlers at 2 years are estimated at 30-40% In the population as a whole it is likely that about 1 in 8 under 5s have low iron status

9. Vitamin D Increasing evidence about the low vitamin D status of a number of population groups Darker skinned children, those who spend little time outside, those with poor diet/early introduction cows milk/late weaning at greater risk of rickets 25% of women of child bearing age have low plasma vitamin D levels

10. No significant new data since NDNS........ On status of under 5s with regard to vitamin B6, folate, calcium and zinc: all highlighted in NDNS as areas of concern On food intakes � much has changed in the last 15 years in terms of foods available and public awareness of nutrition �Reluctant eating� is however much more widely reported and advised upon

11. Added confusion.... Omega 3 fatty acids and their role in children�s behaviour and learning

13. Added confusion ........ �Organic food� Food allergy Artificial colours and preservatives

14. Is it really a minefield for parents and carers?

15. �Children�s food� The market for children's snacks was valued at �480 million in 2005. This represents a rise of 28% between 2000 and 2005 Does having special food for children give parents and carers the impression that healthy eating is �difficult�? One child carer emailed CWT with the question: �is it safe to give a 6 month old ordinary mashed potato?�

18. Under 5s in child care Approximately 1.5 million children under 5 are looked after outside the family home by paid carers The amount of time children spend outside the home, and the proportion of their nutritional needs that are met in childcare is highly variable Many children may receive 70%+ of their nutritional needs outside the home

19. What do we know about food and nutrition in child care settings? Ofsted data collected in 2006 reported that the majority of providers offered a �healthy balanced diet� Some concerns were noted about the infrequent serving of fruit and vegetables, lack of variety in snacks, the use of sweets as a reward and the lack of integration of food service and information about healthy eating

20. Other surveys�� In 2005 a survey of 165 child care providers in West Yorkshire reported that only half of nurseries and a quarter of childminders offered fruit and vegetables at meals every day Few providers had training or guidance on what healthy eating means � and tensions between parents and carers were also noted

21. Current regulations National Standards for Childcare For full-day, sessional care, creches, out of school cae and childminders Standard 8 provides guidance on food and drink: a lot more standards relate to drinking water than food �provide healthy and nutritious meals and snacks for all children�

22. What the inspector looks for�� Records of children with special needs Arrangements for providing food and drink How you find out about and meet children�s dietary needs Arrangements made when parents provide food and drink

23. Inspectors make judgements on�.. Access to fresh water Regular provision of drinks Children�s knowledge they can have a drink Staff awareness of children�s need to drink Staff awareness of special dietary needs �..if snacks and meals are provided that these are �healthy and nutritious�

24. Advice for child care settings? Nutrition Guidelines for the Early Years (Scotland, 2006) Nutrition Matters for the early years. Healthy eating for the under fives in childcare (Northern Ireland, 2006) Eating well for under 5s in child care (CWT, 2006)

27. CWT nutritional guidelines These are quantitative � based on different periods in child care and nutritional needs expressed as a proportion of appropriate reference nutrient intakes (RNI) and new SACN salt guidance They are similar to the new school meal guidelines now being implemented � and are based on mixed groups of children aged 1-4 years

28. Are they practical? Software to plan menus to meet these guidelines was also made available in 2006 (see www.nutmeg-uk.com) It is challenging to meet the guidelines � but that is in part the purpose of nutrient based standards � which aim to raise the nutritional value of food served to vulnerable population groups

29. Should these standards become regulatory? ? Pros? Everyone works to the same standards � there is an economy of scale in terms of support, training, advice and best practice They become part of monitoring strategies and promote the role of better nutrition on equal terms with other health and safety issues The nutritional quality of food served will rise � and could make a significant difference to the most vulnerable children

30. Should these standards become regulatory? ? Cons? Insufficient support and expertise to encourage child care settings to make appropriate changes will create a climate of fear and anxiety among providers who will see not meeting standards as �punishable� It could all become a tick box exercise: providers show bar charts to inspectors to show their menus meet guidelines and it becomes an exercise in software wizardry rather than a fundamental change in provision

31. Should we lobby for new nutritional standards for child care settings � or more detailed national standards?

32. Helen@cwt.org.uk www.cwt.org.uk