Nutrition

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.

Emphasising healthy eating and healthy choices with children and with their parents and carers can help establish healthy habits for life. Early childhood is a unique opportunity to lay the groundwork for healthy eating and a time when parents may be open to considering healthier choices for the whole family. It is important that early years practitioners consider nutrition a topic that can be influenced in many different settings including childcare settings, school, and after school clubs.

Why is nutrition important in children aged 5-8 years?

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), (SIGN Guideline 115: Management of Obesity(external link).

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

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 children aged 5-8 years

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 children aged 5-8 years

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:

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 5-8s?

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

  • Twenty-seven percent of children whose mother had Higher grades or above ate four or more types of fruit per day, compared to 12% of children whose mother had no qualifications.
  • Children in semi-routine and routine households, in the lowest income group and in deprived areas were much less likely to eat four or more types of fruit per day.
  • Forty-two percent of children from semi-routine or routine households ate crisps or savoury snacks once a day or more, compared to only 17% of children from managerial or professional backgrounds.
  • Well over half (56%) of children from low income households drank non-diet soft drinks once a day or more, in contrast to only 30% of children from households in the highest income bracket.
  • Over a third (34%) of children from households in the most deprived areas ate crisps and savoury snacks compared to 13% of children from the most affluent areas.
  • Fifteen percent of children in managerial and professional households were classified as having a relatively poor diet, in contrast to 34% of children in Semi-routine and routine households.
  • Thirteen percent of children in the highest income group were also in the poorest diet group, in contrast to 39% of those in the lowest income group.
  • Nineteen percent of children of mothers with Higher Grades or above had a poor diet, compared with 40% of children whose mothers had no qualifications.

There are similar associations between inequalities and levels of breastfeeding and the introduction of solid foods (complementary feeding or weaning). See section 0-3 years.

How can I help address inequalities and support nutrition in 5-8s?

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Articles in this topic

Policy

Evidence

  • External Resource

    Food allergy in children and young people NICE 116

    New guidelines on the diagnosis and assessment of food allergy in children and young people. The guidelines have been published by the National Institute for Clinical Excellence.

    • When was this published? 2/24/2011
  • External Resource

    Foresight Tackling Obesities: Future choices [11.3MB]

    This report gathered evidence from a wide range of sources, with the aim of developing a sustainable strategy to combat obesity.

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

    Growing up in Scotland: Sweep 3 Food and Activity Report [900KB]

    This report uses data from the Growing Up in Scotland study to explore the many issues related to food and activity in Scotland, specifically in relation to young children.

    • When was this published? 9/17/2010
  • External Resource

    Preventing overweight and obesity in Scotland: A route map towards healthy weight [288KB]

    A report on tackling obesity in Scotland.

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

    Recipe For Success - Scotland's National Food and Drink Policy (Scottish Governement 2009)

    Sets out actions to support the growth of our food and drink Industry; ensure we make healthy and sustainable choices;make our public sector an exemplar for sustainable food procurement; make food available and affordable to all and ensure that our people understand more about the food they eat.

    • When was this published? 4/1/2014
  • External Resource

    Scot PHO: Obesity in Scotland [2.2MB]

    This report looks at obesity in Scotland, describing geographical and social variations in obesity, health inequalities and related morbidity and mortality.

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

    ScotPHO: Obesity - Clinical risk factors

    Obesity has important health consequences, increasing the risk of disability, impaired quality of life, and chronic disease. This review outlines some of the risk factors associated with obesity.

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

    ScotPHO: Obesity morbidity [870KB]

    Obesity has important health consequences, increasing the risk of disability, impaired quality of life, and chronic disease. This review outlines some of the diseases that can be attributed in part to obesity.

    • When was this published? 5/27/2013
  • External Resource

    Scottish Health Survey 2013

    The continuous Scottish Health Survey began in January 2008 and is running from 2008 - 2015. An annual report is published for each year of the survey (the latest published being 2012). A contract was awarded in 2011 to continue the survey for for a further four years, from 2012-2015.

    • When was this published? 6/11/2014
  • External Resource

    What is known about maternal and infant nutrition in Scotland? [1.6MB]

    This review describes what is known about maternal and infant nutrition in Scotland, using routine data sources wherever possible, to inform the Scottish Government’s development of a strategy to improve maternal and infant nutrition.

    • When was this published? 4/1/2014

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