Nutrition

A healthy diet for adults and older children based on the Eatwell plate, which is a diet based on starchy foods, fruit and vegetables, with some meat fish and alternatives, some milk and dairy foods, and a small amount of food and drink high in fat and/or sugar. Healthy eating should be promoted and encouraged to all pre-pregnant, pregnant and breastfeeding women and children.

However, healthy eating guidelines recommended for older children and adults are not appropriate for young children, particularly those under the age of 2 years.   A low-fat, high fibre diet recommended for older children and adults based on the proportions set out in the ‘eatwell’ plate  is not suitable for young children as it may not provide enough energy, fat and other nutrients essential for growth and development. Between the ages of 2 and 5 years children should gradually be introduced to foods lower in fat and higher in fibre so that by the age of 5 years they are able to eat a wider variety of healthy food items. In practical terms this means that gradually introducing lower fat and higher fibre foods between the ages of 2-5 years e.g. providing a mixture of white, brown and wholemeal bread is a good combination.

Healthy eating and physical activity are essential for proper growth and development in childhood. To help children develop patterns of healthy eating from an early age, it is important that the food and eating patterns to which children are exposed – both at home and outside the home – are those which promote positive attitudes and enjoyment of food that promotes good health.  Children’s early experiences of food play an important part in shaping later eating habits, and good eating habits support healthy growth and development, including achieving and maintaining a healthy weight and the foundations for good oral health.

A poor diet is one of the main causes of ill health and premature death in Scotland. Evidence suggests that a healthy diet, being physically active and maintaining a healthy weight may substantially reduce the risk of chronic diseases such as cardiovascular disease, diabetes and some cancers.  Although we normally think of these chronic diseases as ‘adult diseases’ there is more and more evidence to show that the origin of these diseases are partly established in childhood.  What we eat and drink also has an impact on our oral health, particular in early childhood

It is the responsibility of the early years workforce to help address the nutritional needs of young children in many settings, with particular focus on families with additional needs, by raising the importance of a healthy diet and helping parents and carers access support should they need it. Supporting parents and carers to lay the groundwork for a healthy lifestyle for their children is key. 

Why is nutrition important in 0-3s?

Early nutrition affects the immediate health of infants, with potential long-term implications for both mothers and infants, and can be a source of major health inequalities.

Infants grow rapidly during the first months of life and it is a crucial period for brain development. It is therefore essential that they are able to consume enough nutrients and energy.

Improving Maternal and Infant Nutrition - A Framework for Action (external link) provides a useful summary of current evidence in this area:

Feeding choices from have an impact on both immediate and the future health of the infant.  Breastmilk provides both nutrients and other constituents not found in formula milk. We know that breastmilk protects an infant against infections (gasto-intestinal, middle ear and respiratory infections) in the short term and diabetes in the longer term. Infants who are breastfed have different growth patterns to formula fed infants and this has been linked to a reduction in obesity in children who have been breastfed.

The choice of feeding methods also has important influences on maternal health. Breastfeeding  can result in a swifter return to pre-pregnancy healthy weight and is associated with a reduced risk of type-2 diabetes, with lower rates of breast and ovarian cancers.  Weaning too early may increase the risk of asthma, eczema, digestive problems, allergies and obesity in later life

Before the age of four months an infant’s bowel is immature therefore they are not able to digest and absorb food normally. There is evidence of increased risk of eczema if complementary foods are given before four months and evidence of increased risk of type 1 diabetes if foods containing gluten are given before the age of three months. Infants who receive complementary foods too early are more likely to suffer from respiratory and gastrointestinal illness compared to those given complementary foods at a later stage. There is also evidence, from the Millennium Cohort Study, to suggest that infants who receive complementary foods early are more likely to be overweight later in childhood

Nutrition and health inequalities in 0-3s

Under and over nutrition in mothers, infants and children can be both a cause and result of inequalities.

Breastfeeding protects maternal and child health, while appropriate weaning can help prevent many infant health problems.

Rates of formula feeding, inappropriate weaning and poor early years diet are higher in deprived areas.

Quick links:

What are health inequalities?

The WHO defines health inequalities as "differences in health status or in the distribution of health determinants between different population groups."

For a general discussion of health inequalities and the early years, please see Inequalities in the early years.

Policy context

Activity in this area is consistent with commitments and priorities detailed in:

Supporting breastfeeding also contributes to the aims of the UNICEF UK Baby Friendly Initiative (external link).

How do inequalities relate to nutrition in 0-3s?

The second birth cohort (BC2) of the Growing Up in Scotland survey of 6127 demographically representative families with children at 10 months of age (at time of interview) has recently published findings on infant feeding and nutrition.

The survey found that breastfeeding was strongly associated with multiple socio-economic factors:

  • 60 per cent of degree-educated mothers exclusively breastfeed to six weeks or more compared with 18 per cent of those with Standard Grades.
  • 53 per cent of mothers living in the least deprived areas breastfed exclusively to six weeks compared with 21 per cent in the most deprived areas.
  • 45 per cent of mothers in their thirties at the child's birth and 41 per cent of those aged 40 or older exclusively breastfed to six weeks or more compared to 35 per cent of mothers in their twenties and only 12 per cent of teenage mothers.

There was a key relationship between breastfeeding and child age at introduction of solid foods. The youngest weaning ages were reported by mothers who had never breastfed, the highest among those who breastfed for six months or more. This relationship was still evident among mothers living in the most deprived areas.

Waiting until five months or more until introducing solid food was also associated with:

  • mothers who had a degree or 'other' qualification
  • older mothers
  • living in a less deprived area
  • living in a large urban or remote rural area.

Growing Up in Scotland - Birth Cohort 2. Infant Feeding: Breastfeeding and weaning amongst mothers in Scotland (external link).

Much evidence suggests that not breastfeeding is associated with an increased risk of obesity in later childhood. A recent review by the World Health Organisation concluded that a small reduction of 10% in the prevalence of overweight in children exposed to longer duration of breastfeeding.   The Foresite report Tackling Obesities estimates that a child who is obese age 1-2 years is 30% more likely to be obese as an adult.  Obese children are at greater risk of cardiovascular disease, diabetes, non-alcoholic fatty liver disease and psychological distress (SIGN Guideline 115: Management of Obesity (external link).

Adults who were obese as children are more likely to be obese themselves and are at greater risk of associated health problems including cardiovascular disease, diabetes and cancer (Growing Up in Scotland - Overweight, Obesity and Activity (external link).

For more on Child Healthy Weight, please see our section on Child Healthy Weight and inequalities in the early years.

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Healthy Start

Healthy start is a UK-national programme that provides food vouchers for milk, fresh or frozen fruits and vegetables and vitamin supplements to breastfeeding mothers and children under the age of 4 who are in receipt of certain benefits.

To receive these supports, a midwife, health visitor or other health professional must countersign the application form.

Find out more about the programme at the Healthy Start website (external link) and Making the most of Healthy Start (external link).

Interventions that promote good nutrition in 0-3s

In 2012, NHS Health Scotland published a review of available evidence on interventions that promote good maternal and child nutrition.

Breastfeeding

It found good evidence of effectiveness for the following interventions in supporting initiation and duration of breastfeeding:

  • One-to-one breastfeeding education delivered in the antenatal period.
  • Breastfeeding peer support programmes - interventions delivered soon after birth and where women did not have to request the support to receive it.
  • Volunteer breastfeeding counsellors - telephone contact initiated within 48 hours of hospital discharge by a lactation consultant, breastfeeding advisor or a trained, skilled and knowledgeable professional.
  • Professional support - generally, professional support (e.g. midwives, paediatricians, etc.) improves breastfeeding initiation and prevents early cessation with a trend towards an increase in breastfeeding duration.

Evidence on group-based antenatal breastfeeding education was equivocal while that on postnatal breastfeeding education was positive but limited.

In general, support delivered by a lactation consultant, breastfeeding advisor or a trained, skilled and knowledgeable professional was most successful. Breastfeeding specific training for professionals may also have a potentially positive impact on initiation and duration.

Weaning and post-weaning nutrition

Intensive home visiting to disadvantaged and low-income families as a means of supporting timely introduction of solid foods was supported by limited evidence of effectiveness.

Dietary interventions with mothers and children designed to avert food allergies and intolerances in families with a history of atopic disease resulted in fewer symptoms over time.

Repeated exposure of infants and children to target foods (e.g. fruits an vegetables) improves their acceptance and intake.

Peer support increases mother's knowledge of good weaning and feeding practices and confidence in following advice from health professionals.

Parent-led interventions where children aged 2-6 were asked to taste a previously disliked vegetable for 14 days increased the children's acceptance of the vegetable. Here, presenting the foods in a positive manner was also important.

Evidence Summary: Public health interventions to promote maternal and child nutrition (PDF Download - 631KB).

A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families.

 

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Articles in this topic

Policy

Evidence

Professional support materials

Information for the public

  • External Resource

    Eatwell: Healthy eating section for growing children

    Advice on diet and nutrition for infants and young children.

    • When was this published? 7/17/2012
  • External Resource

    First Teeth, Healthy Teeth: A guide for health professionals, parents and carers (NHS Health Scotland, 2010) [2.7MB]

    A guide to oral health care for infants and young children.

    • When was this published? 8/17/2010
  • External Resource

    La Leche League (Great Britain)

    This charity offers friendly mother-to-mother breastfeeding support from pregnancy through to weaning.

    • When was this published? 8/17/2010
  • External Resource

    Off to a good start [2.3MB]

    This booklet aims to help pregnant women, new mums and their families make decisions about how they will feed their baby.

    • When was this published? 3/18/2015
  • External Resource

    Ready Steady Baby!

    A website for the public providing information and advice through pregnancy and the baby's first days.

    • When was this published? 8/18/2010
  • External Resource

    Ready Steady Toddler!

    A website for the public with information, tips and advice for bringing up toddlers.

    • When was this published? 9/30/2010
  • External Resource

    Take life on website

    This website contains handy tips to help you improve your health and wellbeing

    • When was this published? 9/26/2010
  • External Resource

    The Breastfeeding Network

    The Breastfeeding Network is an independent source of support and information for breastfeeding women and those involved in their care.

    • When was this published? 8/17/2010
  • External Resource

    Women and alcohol [819KB]

    This leaflet aimed at the public covers the issues surrounding women and alcohol, in particular regarding pregnancy, breastfeeding and gender-based violence within the home.

    • When was this published? 8/18/2010
  • External Resource

    You and your baby

    A book for new parents with learning disabilities. This book is available free of charge to Early Years professionals in Scotland as an alternative to Ready Steady Baby! To order contact nhs.HealthScotland-EarlyYears@nhs.net.

    • When was this published? 2/15/2011
  • External Resource

    You and your little child

    Book for parents with learning disabilities with children aged 1 - 5 years. This book is available free of charge to Early Years professionals in Scotland from NHS Health Scotland as an alternative to Ready Steady Toddler! To order contact nhs.HealthScotland-EarlyYears@nhs.net.

    • When was this published? 2/15/2011