Childhood nutrition

Guidelines for a healthy diet

Childhood nutrition should be a balance between the high energy and nutrient content required for growth and development and establishing a healthy diet with weight control, in association with regular physical exercise. The balance between these two aspects changes from the very high-fat content of infancy to the low-fat, high-fibre diet of adulthood.

The diet for a child should be focused on natural, fresh sources of energy and nutrients. Drastic dieting and fad foods must be avoided. A positive attitude to healthy eating should be encouraged from an early stage.

Preschool children

See also the separate Infant Feeding article.

Energy¹

Children have a high energy requirement because they are growing quickly and becoming more active. They therefore require foods which are high in energy (as well as vitamins and minerals). Young children do not have large enough stomachs to cope with big meals and so should have small and frequent meals. A diet which is low in fat and high in fibre may not provide enough energy for a young child. A healthy family approach to diet and lifestyle should be encouraged, as food preferences are often established at this stage.

A diet which is low in fat and high in fibre will not provide enough energy for a young child but a family approach to a healthy diet is important at this stage because food preferences are often established very early in life. Ideally, children should restrict the number of times a day that they have foods and drinks containing sugar and then only have them at mealtimes.

Young children should not be put on weight reduction diets but a healthy family approach to food and regular physical activity are important in avoiding excessive weight gain and obesity.

Other nutritional requirements

The diet must also be high in vitamins and minerals. In particular, a good supply of protein, calcium, iron and vitamins A and D is required. Supplements of vitamins A, C and D in the form of liquid drops are recommended for all children from 6 months of age to 4 years .²

Whole cow's milk is recommended for children over the age of 12 months as a main drink, as it is a rich source of a number of nutrients. Semi-skimmed milk can be introduced after the child is 2, as long as the diet provides enough energy. Skimmed milk is not suitable for children under 5 years of age, as it does not provide enough energy and vitamin A for the growing child.

Iron
Iron-deficiency anaemia may be associated with frequent infections, poor weight gain and delay in development. Red meat is the best source of easily absorbable iron and can be offered to children from 6 months of age. Iron-rich foods, such as liver and red meat, are not usually popular with young children.

Other good sources of iron include green vegetables, pulses, bread and some breakfast cereals. Iron from plant sources is less well absorbed than iron from animal sources but can be improved by having vitamin C-rich foods or drinks with a meal.

Calcium
Young children need plenty of calcium in their diets for healthy bones and teeth. Dairy products have a high calcium content and other good sources include white bread, dark green leafy vegetables, pulses (eg, baked beans) and fortified cereals.

Diet-related problems

Constipation is common in young children. This can be helped by gradually increasing the amount of fibre in the child's diet. Foods high in fibre include vegetables, wholemeal bread, baked beans and high-fibre white bread. A high fluid intake is also important.

Diarrhoea in toddlers is also common and may be linked with too many sugary drinks and too much fruit juice, especially between meals. These drinks can make the child too full at mealtimes and prevent a proper balanced diet. They can also be harmful to teeth. If the child is having a high-fibre diet then it may be appropriate to reduce the fibre content in the diet.

Schoolchildren

Energy requirements

The energy requirements of schoolchildren are still high because of growth and activity. Therefore, there should be a progression towards an adult-style healthy diet but with continued emphasis on foods with a high energy and nutrient content. The progression should be gradual with an increase in fibre, reduction in fat and increase in starch content in the diet.

Younger children (eg, 4-6 year-olds) will still need smaller and more frequent meals as they do not have large enough stomachs to cope with big meals.

Childhood obesity is increasing at an alarming rate throughout the world.³ An estimated 39 million children under 5 years of age were estimated to have obesity in 2020.⁴ Schoolchildren should eat a healthy, varied diet and this should be combined with regular physical activity in order to maintain a healthy, stable body weight, as the child's height increases. It is recommended that children and young people should participate in at least 60 minutes of moderate-intensity physical activity each day.⁵

Other requirements

The diet should include a good supply of protein, vitamins and minerals. The same principles apply for schoolchildren as for preschool children, as summarised above.

The Food Standards Agency has provided guidance on the safe maximum consumption levels for oily fish:⁶

• It recommends that boys and girls under the age of 16 should not eat marlin, shark or swordfish.

• Boys aged under 16 can have up to four portions of oily fish a week and girls up to two portions.

• The lower recommendation in girls is because substances found in oily fish - eg, dioxins - can accumulate in the body and high levels may be detrimental if there is a pregnancy in later life, and the substances may be passed to the fetus .

Dietary salt for children

The daily maximum amount of salt children should eat varies with age:¹

• 4 to 6 years - 3 g salt a day (1.2 g sodium).

• 7 to 10 years - 5 g salt a day (2.0 g sodium).

• 11 years and over - 6 g salt a day (2.4 g sodium).

These are maximum levels so ideally the child should be eating less. Limiting salt in the diet will also help to ensure that they do not develop a taste for salt.

There is no need to add salt to a child's food. Salt is in many processed foods so always advise reading the food label to check how much salt it contains and choose lower-salt versions if available.

Vegetarian and vegan diets

If a child does not eat much meat, or a vegetarian or vegan diet is chosen, it is important to make sure that the diet is varied so that they get all the nutrients for growth and general health.

Energy - particularly for children on a vegan diet, foods that are nutrient dense may be needed to give them enough energy, protein, vitamins and minerals. You could try avocados, tofu, bananas and nut and seed butters (such as tahini and cashew or peanut butter). For extra energy, you could add vegetable oils or vegan fat spreads to foods.

Protein - good choices of protein include lentils, beans, soya and soya products, milk, cheese, nuts and eggs and they will need 2 to 3 portions of these a day.

Iron - meat is a good provider of easily absorbable iron so alternative sources of iron will need to be provided to ensure the growing child gets enough. Foods that provide iron include wholegrain cereals, dark green leafy vegetables, beans, lentils, bread, fortified breakfast cereals, dried apricots and figs. Advise that vitamin C helps the absorbtion of iron from non-meat sources so fruit and vegetables should be included at every mealtime.

Calcium - care needs to be taken that vegan children get enough calcium to support their growing bones and teeth. Milk, cheese, yoghurt, tofu, and some dark green leafy vegetables such as kale all provide calcium. Fortified soya drinks, as well as other dairy alternatives, often have added calcium, but remember to check the label.

Vitamin B12 - vitamin B12 is typically found in products from animal sources. Milk and eggs are important sources of vitamin B12 for vegetarians. For vegans, who cut out animal products, useful dietary sources include fortified foods such as some fortified breakfast cereals and yeast extracts.

Fluid intake

Although not strictly nutrition, fluid intake is important for health and has a role in appetite and satiety. Sugary drinks have been linked to childhood obesity, so having mostly water (or water-based drinks) is recommended.⁷

Encourage children with poor fluid intake to increase fluids to a recommended level. Approximately three-quarters of the daily fluid requirement in children is obtained from water in drinks. Higher intakes of total water will be required for children who are very physically active, exposed to very hot environments, or obese.

The following is a guide to adequate total water intake per day, including water contained in food:⁸

• Infants 0-6 months of age: 700 mL, assumed to be from milk.

• Babies 7-12 months of age: 800 mL from milk and complementary foods and beverages, of which 600 mL is assumed to be water from drinks.

• Children 1-3 years of age: 1300 mL (900 mL from drinks).

• Children 4-8 years of age: 1700 mL (1200 mL from drinks).

• Children 9-13 years of age:

  • Boys - 2400 mL (1800 mL from drinks).

  • Girls - 2100 mL (1600 mL from drinks).

• Young people 14-18 years of age:
  

  • Boys - 3300 mL (2600 mL from drinks).

  • Girls - 2300 mL (1800 mL from drinks).