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MRC News - December 2006

What should children eat?

One of a parent's biggest responsibilities is to provide the food a child needs to grow and be healthy. The way a parent does this affects not only the child's health, but also their relationship with food - a cornerstone of their future. NADIA BOWLEY and LUISE MARINO report.

What should children eatWith today's fast- paced lifestyle, how many of us find time to sit around the dinner table with our families? How many of us eat meals in relays in front of the TV?

Research indicates that the nutritional intake and growth rate of children between the ages of two and twelve can have a profound effect on their susceptibility to obesity and chronic diseases in later years.

This is especially important in such a rapidly developing country as South Africa, where there is both undernutrition - leading to stunted growth - and overnutrition. The latter has become a major cause for concern in South Africa, where there has been an alarming increase in the number of obesity- related diseases in children, including those younger than ten. A shocking example of this is the many children who have been diagnosed with type- 2 diabetes, a disease normally associated with overweight adults.

Pre- school children represent a particularly vulnerable sector of our society, as they are unable to make educated food choices and rely on adults for the provision of appropriate foods.

With that in mind, the Paediatric Food-based Dietary Guidelines working group, facilitated and chaired by Dr Lesley Bourne of the MRC Health and Development Research Group, is in the process of producing South African dietary guidelines for children up to seven years of age.

These guidelines, based on scientific evidence and public health concerns in South Africa, are aimed at children from all sectors of society and consist of ten food-based educational messages. Although a draft set of guidelines is available, the actual wording of the guidelines is still being tested on consumers in order to ensure that all South Africans will be able to understand and use them.

In brief, adequate nutrition intake for children aged 1-7 may be reached by providing three meals and two to three small, nutritious snacks. A child's total intake should be based on a wide variety of foods, including mainly cereals and starch-containing foods such as potatoes and rice, plenty of fruit and vegetables, dairy products, meat, chicken, fish and eggs. Sweet treats should be limited and sufficient water intake should also be ensured.

However, when discussing food intake in pre-school children, it is also necessary to address food behaviours that may affect food choices and consumption levels.

Children provided with a variety of healthy foods from an early age consume a nutritionally adequate diet, whereas those with unrestricted access to food tend to have a dietary intake high in fat, sugar and salt and low in micronutrients and dietary fibre.

Research has shown - and many mothers will agree - that children naturally prefer foods that are high in fat and sugar, and that contain fewer vitamins and minerals. Children won't eat food they dislike and usually eat their favourite foods first during the course of a meal.

If a child's hunger is appeased before his or her nutritional intake has been balanced, the overall nutrition of that child's diet may be adversely affected. Offering smaller portions of food at a time will negate this problem - parents can always give the child an additional portion once the first is finished.

It has been established that foods associated with a negative environment can be disliked. Conversely, foods associated with reward (such as desserts) or foods eaten on outings or holidays can become favoured foods. Conversely, giving normally disliked foods on outings or holidays can have the reverse effect, increasing the child's acceptance of this fare.

Many of us can remember being told that we could have ice cream once we finished our peas. But it is never a good idea to use a favoured food to bribe a child to eat a more unpopular food. This simply serves to reinforce a child's like for the food used to bribe them (the ice cream) and results in them disliking even more the food they are being encouraged to eat.

Once your child is a toddler and is not growing at such a fast rate, they may start to eat a little more erratically. It is perfectly normal for a child aged between one and four to eat two portions at one sitting one day and then relatively little for the next three days. A child may also graze, eating small amounts of food often during the day.

The only concerns arise when the child is only having luxuries as snacks, or is a milk-or juice-aholic, consuming three or four litres of fluid and leaving no room for healthy food.

Unrealistic parental expectations of age-appropriate food intakes can contribute to inappropriate or disruptive meal-time toddler behaviour. The table below gives an idea of realistic portion sizes for toddlers. Please remember that this is a guide - because of the erratic eating patterns that are synonymous with toddlerdom it is unrealistic to expect your child to eat exactly this amount at all, or even most, of their meals.

What children should eat

Between the ages of 1 and 4, eight out of ten children will display a tendency towards picky eating. To address this situation, parents must first look at themselves. If their expectations are realistic, then a system of positive reinforcement and patience has been shown to be the best way to change their child's behaviour. Force feeding and chastising children never works and only serves to make the situation worse.

Like other areas of development, children progress from total dependence to independence. Independent feeding is not just the ability to get food onto the spoon, move it to the mouth and chew, but also the ability to make sound food choices, and to eat for pleasure, health and satiety.

The feeding relationship between caregiver and child is complex. The infant progresses from being fed when they are hungry - trusting their caregiver to meet their needs - to being able to participate in the process at nine months. By six years of age it is reasonable to expect children to have adopted the basic family attitudes to eating and to participate in appropriate eating behaviours.

Incorporation of cereals and other starch-containing foods such as potatoes and rice, fruit and vegetables, dairy, meat, chicken, fish and eggs is a vital part of ensuring your child's health - not just now, but also for the future.

It may be tempting for tired, multi-tasking parents in a busy modern family to resort to bribing children to eat healthy food or just leaving children to take what they want. In the long run, however, it is vital to make the time to guide young children into healthy eating habits. Providing 1- 7-year-olds with a balanced range of nutritious foods will ensure their healthy growth and development. This will lay the foundation for the healthy adolescent and adult eating patterns essential for avoiding the chronic diseases currently on the increase in the South African population.

What children should eatGood mealtime habits
Mealtimes should be as quiet and peaceful as possible, as distractions such as television or toys can disrupt the formation of good mealtime habits.

From a young age, children can be allowed to sit on a high chair or later a chair at the table for the duration of the meal. Discourage children from climbing on the table, throwing food or utensils or generally disrupting the proceedings.

Including your child in conversation, even if their language skills are still developing, is important for them to feel part of the proceedings.

If it is not possible for your family and child to eat at the same time, you can start putting your child in a high chair at the table during meal times from as young as 7 months. This will allow your child to observe what is happening and begin to learn even if he or she is not actually eating.

If your child is eating with you, place the high chair on a plastic sheet or clean towel and protect the child's clothes with a bib. Encourage self-feeding by using some finger foods or giving them a spoon while you assist them with eating. At first most of the food on the spoon will not reach the mouth and will end up on the child, tray or floor. Do not be concerned about ‘ playing' with food; feeling and getting used to different textures and handling feeding implements is all a vital part of the learning experience. After all, that is what the towel is for!


CHECKLIST for a healthy diet

  • My child eats a variety of foods.
  • My child eats five meals/ snacks a day.
  • Starchy foods form the basis of my child's meal.
  • My child eats plenty of fruits and vegetables.
  • My child drinks milk every day.
  • My child eats chicken, fish, meat, eggs, beans, soya or peanut butter every day.
  • My child eats only small amounts of sweets or sugary drinks, and has them during meal times.
  • My child regularly drinks clean, safe water.
  • My child has regular check-ups at the clinic or paediatrician.
  • My child and I engage in active play every day.

Recommendations for the fostering of appropriate eating patterns in children

  • Provide a wide variety of foods for children to choose from.
  • Allow children to control the amount they eat at any given time.
  • Help children to adapt to the social timing of meals.
  • Stay away from the use of rewards, threats or coercion to get a child to eat.
  • Eat meals together as a family unit (when possible).
  • For young children, serve meals at an earlier time.
  • Control the amount of distraction during a meal.
  • Discourage the force feeding of children.
  • Only use fast foods, sweets and sugary drinks occasionally as a treat.

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Last updated:
11 July, 2011
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