A healthy diet, based on the Food Standards Agency Eatwell plate 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. The eatwell plate shows the types and proportions of foods required for a healthy diet for the general population. As discussed earlier, the balance of foods set out in the eatwell plate is not suitable for children under the age of 2 years. Children between the age of 2 and 5 should gradually be introduced to more low-fat, high-fibre foods so that by the time they are 5 they are eating a diet that represents the balance set out in this model.  Healthy eating should be promoted and encouraged to all pre-pregnant, pregnant and breastfeeding women and children.

Healthy eating and physical activity are essential for proper growth and development in childhood. It is important that the food is offered in a caring way 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. This promotes good health and helps children develop patterns of healthy eating from an early age. 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 a wide variety of settings and with particular focus on families with additional needs  Support for parents and carers in laying the groundwork for a healthy lifestyle for their children is also important.

Why is nutrition important in 3-5s?

Early nutrition affects the immediate health of young children and has potential long-term implications for health.

Under-nutrition can cause permanent stunting and cognitive impairments. Meanwhile, 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)).

More recently, the World Health Organisation has published recommendations for tackling inequalities in obesity link:

This guidance highlights the importance of nutrition in the early years in tackling inequalities related to overweight and obesity.

For more information on this topic, please see our section on Child Healthy Weight and Inequalities in the early years.

Poor diet presents risks to oral health in children, with diets high in sugar being the single greatest risk factor for development of dental decay. Guidance for professionals, including those who work with children and families, is contained in Oral Health and Nutrition Guidance for Professionals (external link).

For more on oral health, please see our section on Oral Health and inequalities in the early years.

Interventions that promote good nutrition in 3-5s

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

Multi-faceted interventions for mothers with children over 4 years of age reported significant increases in the consumption of fruit and vegetables by the family and significant improvements in the quality and diversity of foods consumed by the family. Multi-faceted approaches included those that were tailored to the educational needs of the mother and to family resources and that involved hands-on food skills development.

Interventions which focused on home visits by health visitors to low-income mothers of young children reported significant improvements in children’s daily intake of healthy foods.

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 and vegetables) improves their acceptance and intake.

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. Presenting the foods in a positive manner was also important.

Evidence from a large systematic review found that nutrition education for pre-school children is more effective when behavioural approaches are used without didactic teaching; when teaching levels are developmentally appropriate and when food based activities are included.

Teacher-led classroom-based interventions are more effective than parent-led home-based interventions (although these also show good results) in improving nutritional knowledge and eating behaviours. Reinforcing classroom learning at home appears to enhance the effectiveness of classroom teaching.

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

Nutrition and health inequalities in 3-5s

Under and over nutrition in children can be both a cause and a result of inequalities and can affect health in the short and the long term.

Evidence supports a range of interventions that can improve outcomes.

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:

  • Children and Young People Act 2014 – The Act includes provisions that will increase the amount and flexibility of free Early Learning and childcare; Provide Free School Lunches to all children in primary 1–3; Ensure better permanence planning for looked after children;  enshrine elements of the Getting it Right for Every Child (GIRFEC) approach in law; create new duties in relation to the UNCRC and strengthen the Children’s Commissioner role and Strengthen existing legislation that affects children.

The nutritional content of food and drink offered to children in schools is governed by the Schools (Health Promotion and Nutrition) (Scotland) Act 2007 and by The Nutritional Requirements for Food and Drink in Schools (Scotland) Regulations 2008 (external links).

How do inequalities relate to nutrition in 3-5s?

The Growing Up in Scotland Sweep 3 Food and Activity Report (external link) highlighted multiple associations between socioeconomic factors and nutrition in children:

  • Children in the lowest income group and those living in deprived areas were much less likely to eat four or more types of fruit and vegetables per day, and more likely to eat sugary snacks and drinks, than were children from affluent backgrounds.
  • Half mothers in the highest income bracket knew ‘a great deal’ about healthy eating, compared to 30 per cent in the lowest income bracket.
  • The cost of food affected food provided to children for 41 per cent of the lowest income group and 34 per cent of those in deprived areas, compared to only 11 per cent of those in the top income group and 19 per cent of those in the least deprived areas.
  • 41 per cent of children in the most deprived areas had eaten a takeaway in the last week, compared to only 23 per cent of children in affluent areas.

Although breastfeeding has ceased for almost all breastfed children by the age of three, there is a strong association between higher rates and longer duration of breastfeeding and higher levels of maternal education, living in a less deprived area and older maternal age. Breastfeeding is in turn associated with better diet in older childhood and a slightly reduced risk of obesity in childhood.

Similar relationships exist between breastfeeding and appropriate timing of the introduction of complementary foods ('weaning') and maternal education, living in a less deprived area and older maternal age. Appropriate weaning practices are associated with a reduced risk of gastrointestinal and respiratory illness and with better diet and fewer feeding problems later in childhood.

Growing up in Scotland: Health Inequalities in the Early Years (external link)

This report investigates health inequalities in the early years in terms of risk factors and outcomes. It also examines which factors correlate with the avoidance of negative early health outcomes among families from disadvantaged backgrounds.

Growing Up in Scotland Report Overweight obesity and activity (external link)

The following parental factors were associated with a greater likelihood of the child being overweight and/or obese:

  • mother’s overweight or obesity (mothers who were overweight or obese were more than twice as likely as mothers of healthy weight to have obese children)
  • frequent snacking on sweets or crisps at toddler age
  • skipping breakfast
  • not eating the main meal in a dining area of the home
  • low parental supervision

Healthy Start

Healthy start is a UK-national programme that provides food vouchers for milk, fresh and frozen fruits and vegetables and supplies 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).

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