Healthy Eating In School-Aged Children
Article by Rachel Suzette
Between the age of 1 and 5 years old, children start to consolidate their early experiences with food and become more independent (3). Food habits developed during childhood build foundations for their approach to diet and nutrition for the rest of their life (6). When children start school at the age of 4 years old, their eating behaviours begin to be increasingly influenced by factors outside of their home environment (22). So, how can you ensure that your child is getting a healthy and balanced diet which also supports their growth and development until they become adults?
What do growing children need to eat?
Children will grow steadily during childhood up to adolescence, increasing 10cm in height and 2.5kg in weight per year – this reflects their increased need for nutrients (7). In young children, growth rates are slower, therefore their appetite will be smaller, so the nutrient density of meals is really important to ensure they are getting everything they need (8). The body tends to store certain nutrients during this time, which then become available to fuel pubertal growth spurts – most notably body fat (providing energy for growth) and calcium (needed for bone growth) (4,16).
During adolescence, children will grow a lot quicker than at any other time of life, except early infancy (13,7). Growth spurts for girls begin between the ages of 10 to 13 years old and 12 to 15 years old in boys (7). Growth takes place over the duration of 3 years, meaning they will need to increase their nutrient intake to reflect this rapid growth (16). If energy needs are not met, it can slow down or delay growth of children. Once the growth spurt is over, nutrient requirements settle down to adult levels (13,16).
Important nutrients to consider
Carbohydrates – These provide the greatest and preferred source of energy for your child. Examples include; potatoes, bread, rice pasta, breakfast cereals, oats and other grains.
Protein – Supports growth and repair of the body. Examples include; Lean meat, fish, dairy products, eggs, pulses, beans and soya products.
Fat – Try to include healthy unsaturated fats in your child’s diet to support growth. Fat can also be used as a source of energy too. Try to limit sources of unsaturated fats which could lead to developing serious health conditions later on in life. Examples of unsaturated fats; olive, sunflower and corn oils, oily fish, nuts and seeds.
Calcium – For healthy bones and teeth. Examples include; Milk, yogurt, cheese, soya beans, tofu, green leafy vegetables, bread and fish with edible bones.
Iron – For healthy blood and transporting oxygen around the body. Examples include; Lean meat, wholegrain cereals, dark green leafy vegetables and dried fruit.
Vitamin A – For healthy skin, eyes and immune system. Examples include; Milk, yoghurt, cheese, eggs and orange, red and green leafy vegetables such as carrots, sweet potato and spinach.
Vitamin C – For healthy skin, bones and teeth. Examples include; Citrus fruits, berries, peppers, tomatoes and potatoes.
Vitamin D – Helps the growth, development and maintenance of bones and teeth, also keeps the immune system healthy. Examples include; Eggs, oily fish, fortified foods products. The main source of vitamin D in the UK is from sunlight but it's only strong enough to use in the summer months. It is recommended that children aged 4 and above should take a daily vitamin D supplement in the winter months (October through to early April).
(1, 16,21)
Activity levels
Apart from growth, physical activity is the other main influence on appetite in this age group (9). Children of primary school age tend to be relatively more active, with levels of activity often declining in large proportions of adolescence (10,20).
Recommendations for levels of activity in children between the age of 5-18 years (10,20);
Moderate to vigorous intensity activity for at least 60 minutes per day
Vigorous intensity activities, specifically those that strengthen bone and muscle should be incorporated at least 3 days a week.
All children and young people should minimise the amount of time spent being sedentary.
The school environment
The school environment plays an important role in children’s diets and overall health. Eating is a social activity and having lunch with friends can provide children with important socialisation activity, also teaching them about food habits by learning from others (11). The introduction of universal infant free school meals in 2014 means that children from Reception to year 2 are eligible for a hot school meal for free daily (2). Free school meals are also available to children from low-income families receiving certain benefits. The school food standards ensure that meals provided by schools and school caterers meet a certain standard in terms of nutrition as well as creating a culture of healthy eating within schools (21,24). In some schools breakfast clubs are established to provide food to children before the school day even starts (8). Also, the school fruit initiative provides all primary school children with a piece of fruit each day.
Studies have shown that the dietary quality of lunches eaten at school improved when children had meals at school, compared to a packed lunch (18). Typically, packed lunches tend to contain higher levels of ultra-processed foods, and this has been identified as a factor influencing rates of childhood obesity (15). If you are preparing a packed lunch for your child to take into school, try to ensure it’s well balanced and includes the essential nutrients they need to tackle the school day. In some schools, older children are allowed to leave the premises at lunchtime to purchase foods and these tend to be less healthy and more energy dense (22,25).
Societal pressures
The diet of school age children is increasingly affected by external influences. Pressures from friends will increasingly influence food intake as a child goes through school, and this becomes more notable in adolescence (17). In addition, societal pressures linked to body image have a major impact on the food intake of some individuals (5). It’s important that children are able to exercise choice about food and be able to experiment, however, having balanced meals and a variety of food provided at home gives them a sound foundation about food, which can help them make healthier choices. However, in adolescence this does not necessarily translate into behaviour (14,23).
Establishing good habits
A positive eating environment at home is the key to encouraging good eating behaviours, and exposing children to new foods is also important.
Helpful ways to establish good eating habits;
Get children involved in cooking
Expose your child to lots of different foods
Don’t give up trying new foods
Don’t pressurise children to eat foods as they are less likely to eat their meal
Limit bribery using ‘treats’, as this can lead to ideas that certain foods are better than others
Be a role model for eating a variety of different foods
Sit down together and eat, make the meal times more about just eating.
Giving your child a good foundation in healthy eating and behaviours will allow them to make educated decisions as they grow up. Nutrition is very personal, even in children so there is no one size fits all approach. Find what works with your child and more importantly what your child enjoys to eat. If you are concerned or need advice then it’s always a good idea to speak to your GP or a registered nutritionist/dietitian.
This blog was written by Rachel Suzette who is a third year student at Birmingham City University. She is a real foodie, having nearly 10 years of experience within the hospitality sector as a chef. Using her knowledge as a volunteer with Bags of Taste and The Message Community Grocery, to help people understand how they can cook healthy, balanced meals on a budget. Passionate about nutrition, health and lifestyle she uses her website and social media platforms to share easy ways to change your lifestyle habits to lead a healthier and longer life. She will be studying an MSC in Dietetics and Leadership at Coventry University after graduating this year. Find her online: @thelifestyledietchef / www.thelifestyledietchef.com
References:
(1) British Nutrition Foundation (2022) Children - British Nutrition Foundation [online] available from <https://www.nutrition.org.uk/life-stages/children/> [9 October 2022]
(2) Cohen, J.F.W., Hecht, A.A., McLoughlin, G.M., Turner, L., and Schwartz, M.B. (2021) ‘Universal School Meals and Associations with Student Participation, Attendance, Academic Performance, Diet Quality, Food Security, and Body Mass Index: A Systematic Review’. Nutrients 13 (3), 911
(3) ‘Corrigendum for “Retail Food Environment around Schools and Overweight: A Systematic Review.” Nutrition Reviews 2020; Https://Doi.Org/10.1093/Nutrit/Nuz110’ (2020) Nutrition Reviews 78 (7), 611–611
(4) Daniels, L.A. (2019) ‘Feeding Practices and Parenting: A Pathway to Child Health and Family Happiness’. Annals of Nutrition and Metabolism 74 (Suppl. 2), 29–42
(5) Dimitri, P. (2018) ‘Fat and Bone in Children – Where Are We Now?’ Annals of Pediatric Endocrinology & Metabolism 23 (2), 62–69
(6) Gow, M.L., Tee, M.S.Y., Garnett, S.P., Baur, L.A., Aldwell, K., Thomas, S., Lister, N.B., Paxton, S.J., and Jebeile, H. (2020) ‘Pediatric Obesity Treatment, Self-Esteem, and Body Image: A Systematic Review with Meta-Analysis’. Pediatric Obesity 15 (3), e12600
(7) Haines, J., Haycraft, E., Lytle, L., Nicklaus, S., Kok, F.J., Merdji, M., Fisberg, M., Moreno, L.A., Goulet, O., and Hughes, S.O. (2019) ‘Nurturing Children’s Healthy Eating: Position Statement’. Appetite 137, 124–133
(8) Koneru, G., S. Sanjeeva Rao, N., and S.R.Sai, T. (2020) ‘A Qualitative Study on Dietary Habits and Nutritional Awareness among School Children’. The Journal of Community Health Management 6 (4), 105–112
(9) Kupka, R., Siekmans, K., and Beal, T. (2020) ‘The Diets of Children: Overview of Available Data for Children and Adolescents’. Global Food Security 27, 100442
(10) Lambie-Mumford, H. and Sims, L. (2018) ‘“Feeding Hungry Children”: The Growth of Charitable Breakfast Clubs and Holiday Hunger Projects in the UK’. Children & Society 32 (3), 244–254
(11) Marker, A.M., Steele, R.G., and Noser, A.E. (2018) ‘Physical Activity and Health-Related Quality of Life in Children and Adolescents: A Systematic Review and Meta-Analysis.’ Health Psychology 37 (10), 893–903
(12) Messing, S., Rütten, A., Abu-Omar, K., Ungerer-Röhrich, U., Goodwin, L., Burlacu, I., and Gediga, G. (2019) ‘How Can Physical Activity Be Promoted Among Children and Adolescents? A Systematic Review of Reviews Across Settings’. Frontiers in Public Health [online] 7. available from <https://www.frontiersin.org/articles/10.3389/fpubh.2019.00055> [9 October 2022]
(13) Micha, R., Karageorgou, D., Bakogianni, I., Trichia, E., Whitsel, L.P., Story, M., Peñalvo, J.L., and Mozaffarian, D. (2018) ‘Effectiveness of School Food Environment Policies on Children’s Dietary Behaviors: A Systematic Review and Meta-Analysis’. PLOS ONE 13 (3), e0194555
(14) Murphy, M., Pallan, M., Lancashire, E., Duff, R., Adamson, A.J., Bartington, S., Frew, E., Griffin, T., Hurley, K.L., Parry, J., Passmore, S., Ravaghi, V., Sitch, A.J., Spence, S., Rowland, M.K., Wheeldon, S., and Adab, P. (2020) ‘The Food Provision, CUlture and Environment in Secondary SchooLs (FUEL) Study: Protocol of a Mixed Methods Evaluation of National School Food Standards Implementation in Secondary Schools and Their Impact on Pupils’ Dietary Intake and Dental Health’. BMJ Open 10 (10), e042931
(15) Norris, S.A., Frongillo, E.A., Black, M.M., Dong, Y., Fall, C., Lampl, M., Liese, A.D., Naguib, M., Prentice, A., Rochat, T., Stephensen, C.B., Tinago, C.B., Ward, K.A., Wrottesley, S.V., and Patton, G.C. (2022) ‘Nutrition in Adolescent Growth and Development’. The Lancet 399 (10320), 172–184
(16) Palla, L., Chapman, A., Beh, E., Pot, G., and Almiron-Roig, E. (2020) ‘Where Do Adolescents Eat Less-Healthy Foods? Correspondence Analysis and Logistic Regression Results from the UK National Diet and Nutrition Survey’. Nutrients 12 (8), 2235
(17) Parnham, J.C., Chang, K., Rauber, F., Levy, R.B., Millett, C., Laverty, A.A., von Hinke, S., and Vamos, E.P. (2022) ‘The Ultra-Processed Food Content of School Meals and Packed Lunches in the United Kingdom’. Nutrients 14 (14), 2961
(18) Payne, V.G. and Isaacs, L.D. (2020) Human Motor Development: A Lifespan Approach. 10th edition. New York, NY: Routledge
(19) Prayogi, A.S., Maulida, U., Induniasih, Ratnawati, A., Majid, A., and Harmilah (2021) Relationship Between Body Image and Eating Pattern in Woman Adolescents: in ‘4th International Conference on Sustainable Innovation 2020–Health Science and Nursing (ICoSIHSN 2020)’ [online] held 2021 at Yogyakarta, Indonesia. available from <https://www.atlantis-press.com/article/125951211> [9 October 2022]
(20) Sabinsky, M.S., Toft, U., Sommer, H.M., and Tetens, I. (2019) ‘Effect of Implementing School Meals Compared with Packed Lunches on Quality of Dietary Intake among Children Aged 7–13 Years’. Journal of Nutritional Science 8, e3
(21) Scaglioni, S., De Cosmi, V., Ciappolino, V., Parazzini, F., Brambilla, P., and Agostoni, C. (2018) ‘Factors Influencing Children’s Eating Behaviours’. Nutrients 10 (6), 706
(22) Singh, A.S., Saliasi, E., Berg, V. van den, Uijtdewilligen, L., Groot, R.H.M. de, Jolles, J., Andersen, L.B., Bailey, R., Chang, Y.-K., Diamond, A., Ericsson, I., Etnier, J.L., Fedewa, A.L., Hillman, C.H., McMorris, T., Pesce, C., Pühse, U., Tomporowski, P.D., and Chinapaw, M.J.M. (2019) ‘Effects of Physical Activity Interventions on Cognitive and Academic Performance in Children and Adolescents: A Novel Combination of a Systematic Review and Recommendations from an Expert Panel’. British Journal of Sports Medicine 53 (10), 640–647
(23) Tenjin, K., Sekine, M., Yamada, M., and Tatsuse, T. (2020) ‘Relationship Between Parental Lifestyle and Dietary Habits of Children: A Cross-Sectional Study’. Journal of Epidemiology 30 (6), 253–259
(24) Valizadeh, P. and Ng, S.W. (2020) ‘The New School Food Standards and Nutrition of School Children: Direct and Indirect Effect Analysis’. Economics & Human Biology 39, 100918
(25) Ziauddeen, N., Page, P., Penney, T.L., Nicholson, S., Kirk, S.F., and Almiron-Roig, E. (2018) ‘Eating at Food Outlets and Leisure Places and “on the Go” Is Associated with Less-Healthy Food Choices than Eating at Home and in School in Children: Cross-Sectional Data from the UK National Diet and Nutrition Survey Rolling Program (2008–2014)’. The American Journal of Clinical Nutrition 107 (6), 992–1003