We all want our children to eat healthily but the reality is that there are often multiple barriers to implementing this such as a lack of understanding around healthy eating for children, time constraints, the appeal of unhealthy foods and cost. For instance, a survey carried out this year found that children across Britain are suffering worsening levels of tooth decay, anxiety and stunted growth as the cost of food has risen.^1,2

The survey, which was conducted among school nurses from the School and Public Health Nurses Association (SAPHNA) and members of the British Dental Association (BDA) revealed that 65% of the respondents noticed a deterioration in children’s health and wellbeing, which was attributed to the worsening of living standards over the past year.

In addition, the 2023 Broken Plate report by the Food Foundation demonstrates how difficult it is for children to eat healthily and sustainably when the affordability, availability and appeal of unhealthy and unsustainable foods point us in the opposite direction.³ 

This is worrying as suboptimal nutrition during the critical development period of childhood can have lifelong implications affecting dental health, growth and development, mental health, weight, and a healthy life expectancy. So faced with many barriers, how can we as parents ensure our children are eating healthily? In this week’s blog we explore the factors at play when it comes to our children’s diet and offer some nutrition and lifestyle recommendations.

Understanding what constitutes a healthy diet for children

Many of us struggle to give our children a healthy diet, despite it being predominantly under our control. A lack of understanding as to what constitutes a nutritious diet can often prohibit us from implementing a good diet despite good intentions. It is therefore recommended to apply some basic principles: 

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Nutrient-dense diet

Children need a nutrient dense diet to support growth, development, learning and their immunity, although the food consumed by the majority of children in the UK does not currently meet requirements for a nutritious diet.¹

Most adults and children consume in excess of the maximum recommended intakes for sugar, saturated fat and salt, and do not meet recommendations for fruit and vegetables, fibre or oily fish consumption.¹

These recommendations include at least 5 portions of a variety of fruits and vegetables every day. For fibre, as a minimum, 2- to 5-year-olds need about 15g of fibre a day, 5- to 11-year-olds need about 20g and 11- to 16-year-olds need about 25g.

The NHS recommends giving your child at least 1 portion of oily fish (such as mackerel, salmon and sardines) a week.

What is consistent among all of the most evidence-based ways of eating is a diet which is high in fibre from vegetables, fruit and wholegrains and includes healthy fats (such as avocado, olive oil, flax and chia seeds, oily fish) and lean protein.

This should therefore be the focus when planning a food shop. For children who do not like fish, follow a vegan diet, or if there are concerns over pollution or sustainability then an omega 3 supplement for children can help.

Furthermore, for those whose diets are low in fruits and vegetables, a good quality multivitamin and mineral formulated specifically for children can help to safeguard against any nutritional shortfalls.

Minimise or cut out processed foods

Conversely - processed foods (especially ultra-processed foods) are usually devoid of nutrients and often contain ingredients that promote inflammation and poor health.

Highly processed foods can also deplete nutrients, meaning they take out of the body more than they put in!

Ultra-processed foods often contain high levels of saturated fat, salt and sugar. It’s also suggested that the additives in some of these foods may be responsible for negative health effects in children.

Examples of common processed foods include most breakfast cereals, microwave or ready meals, cakes and biscuits, ham, ice-cream and savoury snacks. Switching from these types of foods to wholefoods is recommended. 

Anti-inflammatory diet

In our modern world, there is an abundance of diet and lifestyle factors that can generate inflammation such as processed food, food sensitivities, chronic stress, and toxic exposures. These factors can lead to low grade and persistent inflammation. Over time ongoing inflammation can damage cells and tissues and have a negative effect on health; it is often at the root of countless health problems.

An anti-inflammatory diet follows the same principles as a nutrient dense diet - omitting processed foods and including a colourful and diverse range of whole foods, including plenty of fruit and vegetables, nuts and seeds, and pulses.

Healthy fats can help to dampen down inflammation and fruits and vegetables contain an array of vitamins, minerals and phytonutrients, which can also help to protect our children against inflammation. 

Cut the sugar

British children now consume 25 times more confectionery and 30 times more soft drinks than they did in 1950¹ and on average, children in the UK consume at least double the recommended amount of sugar.²

This contributes to two of the major health issues facing children here in the UK: an unhealthy weight and tooth decay.⁶ In fact, almost a quarter of 5-year-olds have dental decay.³

Dental conditions can impact on children’s ability to eat, talk, play and learn, as well as their self-esteem and quality of life.⁴ Other impacts include pain, infections, poor diet and impaired nutrition and growth. A recent report revealed the majority of retailers are not actively assessing the volume of sugar they sell, let alone reducing it.^3,5 

Aside from often having detrimental effects on children’s behaviour, mood and concentration, sugar can also impact on their immune system.

Refined sugar has been shown to decrease the performance of white blood cells and increase inflammation. Phagocytes are immune cells that help to protect the body by engulfing bacteria and viruses and destroying them; research has shown that sugar can decrease phagocytic capabilities. Sugar can also lead to weight gain and obesity, which can create a chronic state of low-grade inflammation, further negatively impacting on the immune system over time.

Sugar also feeds the bad bacteria in the gut, giving rise to inflammation and immune dysfunction. Including a high-quality probiotic for children can help to support a healthy-balanced microbiome.

Most processed foods will contain high amounts of hidden sugars so try to be mindful of this and focus on a wholefood anti-inflammatory diet (as mentioned).

In contrast to foods like cakes and biscuits, yogurt and cereal are foods that we may often give to our children in the belief that they are part of a healthy diet, not realising that hidden sugars are one of the main ingredients.

 Worryingly, a survey conducted by Action on Sugar found that 97% of snacks marketed towards babies and toddlers feature a nutritional or health claim on the front of the packaging despite often being high in sugar.³ Of the snack foods surveyed, 26% would provide half of the maximum recommended sugar intake for a 2-year-old in a single portion.

Tips to reduce sugar intake:

• Instead of flavoured yogurts with added sugar, opt for plain yogurt and add fresh, fruit for sweetness
• Choose porridge in the morning with added fresh fruit and nuts instead of breakfast cereals which are high in sugar and low in fibre
• Replace sugary drinks with plain water, or fruit infused water
• Switch sugary snacks for chopped veg with houmous, nuts and seeds, or fresh fruit

Time constraints

Perceived lack of time for healthy eating is a common reason for eating fast food and convenience foods and is associated with lower fruit and vegetable intake. Below we offer some practical tips to help you manage your time:

• Making a shopping list and planning family meals ahead of time can help to minimise the reliance on fast and convenient foods and sugary snacks when time is minimal

• If your child has packed lunches aim to factor this in when planning the food shop and prepare the night before so there is no last-minute rush in the morning, which may affect preparation time and choice. Including your kids in the planning of their own lunch may help to ensure they will eat it!

• Preparing meals in large batches every week ensures that you have plenty of nutritious meals ready even when you’re too busy to cook. Cooking large batches of stews, casseroles, and curries and freezing in individual batches can help to save time in the long-run and take the stress out of mealtimes

• Grabbing a processed snack when time is short is the easier option. Keeping cupboards stocked with plenty of portable, nutritious snacks can make it much easier to make healthy choices on the go

How to eat well with cost in mind

Rapidly rising food prices have been headline news throughout the past year, with food inflation hitting a high of 19.1% in April 2023 according to government figures.¹ The rising cost of living has generated worry for many of us, where the need to survive may often over-ride supporting long-term wellness. Many of us have no doubt felt the need to squeeze our budgets, making it increasingly likely for us to opt for less healthy options. The abundance of cheap, commercially produced foods further drives these harmful choices.

Statistics reflect this with children in the most deprived fifth of the population being twice as likely to be living with obesity.³

It is important for children to eat well to prevent lasting damage to their health and wellbeing and so we have made some recommendations on how to eat well with cost in mind:

Fruit and veg  - if cost is a barrier then seasonal and local fruit and vegetables are usually much cheaper. Many supermarkets will also have offers on a number of vegetables at different times of the year so maximise on these, which will encourage dietary diversity too.

Some supermarkets have “wonky” vegetables, which are often cheaper but have the same nutrient quality. Vegetables such as onions, carrots, mushrooms and cabbage are good options as they are low in cost but extremely high in many healthful nutrients; they can also be easily included in most dishes.

Frozen fruit and vegetables can be a great way to save money and avoid waste - the freezing process also preserves levels of many nutrients.

Make soups – use slightly “old” vegetables left in the fridge or cupboard to make soups. Onion and celery can be a great base and then simmer any other vegetables in stock for 20-30 minutes. You can add pulses for extra protein and fibre, plus tinned tomatoes to make it go further.

This prevents waste of any vegetables that may otherwise be thrown away. Again, you can freeze in batches if needed.

Protein - is really important for children’s growth and development. Legumes such as chickpeas are often the cheapest of all options and also score well across a range of different health indicators offering an affordable, healthy and sustainable alternative to meat.¹

Eggs are also a great source of protein and fat and are fairly economical. Omelettes and frittatas are therefore a good way to obtain protein and of which you can add in a high variety of vegetables.

Wholegrains  - low glycaemic load wholegrains can help to support energy production and provide fibre. They are also low cost and can help add bulk to a meal. Choose wholegrains such as oats (porridge is an excellent low-cost breakfast) and brown rice, over processed or refined carbohydrates.

Add bulk – include pulses, wholegrains, starchy vegetables (e.g., sweet potato, butternut squash, carrot) to help produce go further.

Non-organic - If you need to switch from organic to non-organic to keep costs down then you can use a veg wash or apple cider vinegar in water to help remove pesticides.

Also, you can choose the products that are most associated with being clean/fewer pesticides (clean 15) and avoiding those with the most pesticides (dirty dozen). However, remember fresh wholefoods are still a better option than processed foods.

Savings where possible  - consider purchasing extra nonperishables such as tinned goods when they are on offer. Use coupons where possible. Buying own-brand products are often the same as more expensive brand-name ones.

Supplementation - even when considering budget, it is important to consider maintaining optimal levels of nutrients and so safeguarding against any shortfalls in the diet by including a multivitamin and mineral specifically formulated for children can help. 

Appeal of unhealthy foods

Cost and convenience maybe two of the factors which increase the appeal of healthy foods but be mindful of the food industry itself. Junk food marketing to children encourages children to choose unhealthy foods and undermines their ability to choose wholesome foods and our efforts to feed them healthily.

It also significantly contributes to normalising unhealthy foods in society. For example, just over a third of food and soft drink advertising spend goes towards confectionery, snacks, desserts and soft drinks compared to just 1% for fruit and vegetables.¹  

There is also a fast-food outlet for approximately every 1,200 people in the UK – a similar number to that seen in the US, and much more numerous than many other countries of similar economic status.¹

Ultra processed food intake in the UK appears to be higher than in many other countries, leaving UK citizens particularly vulnerable to the potential damaging health impacts.^2,3

One of the most valuable ways to reduce exposure to advertising is to reduce the amount of screen time your child has. Not only will this minimise the number of harmful messages getting through, but reduced screen time is associated with a number of additional benefits to your children’s health.

Educating children is also key so they can become empowered to make informed choices regarding food themselves. Knowledge is power!

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References Introduction

1. PRESS RELEASE: Health Practitioners Survey – Child Hunger Leading to Deterioration In Children’s health. [Online] Available at: https://saphna.co/news/press-release-health-practitioners-survey-child-hunger-leading-to-deterioration-in-childrens-health/ Accessed 11^th August 2023
2. https://www.theguardian.com/society/2023/jun/28/cost-of-living-worsening-health-children-uk-school-nurses
3. The Broken Plate 2023 Digital Summary [online] Available at: https://foodfoundation.org.uk/publication/broken-plate-2023. Accessed 11^th August 2023

Nutrient-dense diet

1. The Broken Plate 2023 Digital Summary [online] Available at: https://foodfoundation.org.uk/publication/broken-plate-2023. Accessed 11^th August 2023

 Sugar

1. Blythman, J., (2010) Bad Food Britain. Fourth Estate. London.
2. UK Government, 2020. NDNS: results from years 9 to 11 (2016 to 2017 and 2018 to 2019).
3. The Broken Plate 2023 Digital Summary [online] Available at: https://foodfoundation.org.uk/publication/broken-plate-2023. Accessed 11^th August 2023
4. PHE, 2014. Commissioning Better Oral Health for Children and Young People, an evidence informed toolkit for local authorities, June 2014
5. Feedback, 2023. Sugar rush: How UK supermarkets drive high sugar sales..
6. World Health Organization, 2018. Oral Health.

Cost

1. UK Government, 2023. Consumer Price Inflation, UK: April 2023. 

Appeal of unhealthy foods

1. The Broken Plate 2023 Digital Summary [online] Available at: https://foodfoundation.org.uk/publication/broken-plate-2023. Accessed 11^th August 2023
2. Madruga, M. (2022). Trends in food consumption according to the degree of food processing among the UK population over 11 years. British Journal of Nutrition.
3. Vandevijvere S, 2019. Global trends in ultraprocessed food and drink product sales and their association with adult body mass index trajectories. Obes Rev. 2019 Nov;20 Suppl 2:10-19.

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If you have questions regarding the topics that have been raised, or any other health matters, please do contact our team of Nutritional Therapists.

nutrition@cytoplan.co.uk
01684 310099