laying the table - children's food...

This document has been prepared by the Advisory Panel on Food and Nutrition in Early Years for consideration by the Early Years Foundation Stage review (EYFS). It does not necessarily represent the policy of the Department for Education (DfE).

Laying the Table

Recommendations for National Food and Nutrition Guidance for Early Years Settings in England

Volume 2: Appendices

Advisory Panel on Food and Nutrition in Early Years

5 November 2010


List of Appendices

Appendix 1. Terms of reference for the Advisory Panel on Food and Nutrition in Early Years (APFNEY) ......................................................................................................... 6

Appendix 2. List of key policies and publications relating to provision of food and drink in early years settings......................................................................................... 8

Appendix 3. Diversity of provision within early years settings................................... 11

Appendix 4. Overview of food provision in nurseries in Europe................................ 21

Appendix 5. Summary of content of guidance on food and drink provision in early years settings in the four devolved countries of the United Kingdom ....................... 22

Appendix 6. Prevalence of normal weight, overweight and obesity in boys and girls from a sample of 7,504 children aged between 2-5 years reported by the Health Survey for England in 2007....................................................................................... 23

Appendix 7. National Child Measurement Programme (NCMP) prevalence of underweight, overweight and obesity in England: 2005-2009................................... 24

Appendix 8. National Child Measurement Programme (NCMP) prevalence of underweight, overweight and obesity in England by deprivation and ethnicity in 2008-2009 .......................................................................................................................... 25

Appendix 9. Two case studies taken from ‘Learning, Playing and Interacting – Good Practice in the EYFS (2009)’..................................................................................... 28

Appendix 10: Overview and critique of submissions of evidence ............................. 30

Appendix 11: Summary of findings from the on-line survey of views on current guidance.................................................................................................................... 35

Appendix 12: Summary of findings from the practitioners’ questionnaire ................. 37

Appendix 13: Summary of findings from the local authority interviews ..................... 39

Appendix 14: Summary of findings from focus groups with providers, parents and children...................................................................................................................... 42

Appendix 15: Summary of findings from scoping the finances, procurement, and costs of food provision in early years childcare settings ........................................... 46

Appendix 16: Existing policies and guidance covering the nutrition of children from birth to the age of 5 years ......................................................................................... 48

Appendix 17: Other key issues important in the development of guidance on food and drink for children under the age of five years ............................................................ 53

Appendix 18: Summary of options relating to standards/guidance for food and drink provision in early years settings ................................................................................ 54


Appendix 19: Guidance for the provision of food and drink in early years settings... 61

Appendix 20: Example menu plan over one week which meets suggested food-based guidance and meets the average energy and nutrient needs of children aged 1-4 years. ........................................................................................................................ 83

Appendix 21: Nutritional analysis of half-size portions of meals that meet nutrient-based standards for primary schools compared to the Caroline Walker Trust nutrient-based standards for children 1-4 years old ............................................................... 85

Appendix 22: Nutrient-based guidelines compiled by The Caroline Walker Trust to be used as a possible framework for food-based guidelines for food and drink provided in early years settings ............................................................................................... 86

Appendix 23: Summary of current good practice to encourage children in early years settings to eat well..................................................................................................... 94

Appendix 24: Ofsted: Using the early years evaluation schedule ........................... 102

List of Tables

Table 1 Minimum staff to children ratios for early years setting ................................ 13

Table 2 Food and Nutrition Mapping: Level 2 Qualification ...................................... 16

Table 3 Food and Nutrition Mapping: Level 3 Qualification ...................................... 17

Table 4 Overview of food provision in nurseries in Europe....................................... 21

Table 5 Comparison of guidance for food provision in early years ........................... 22

Table 6 Prevalence of overweight and obesity in boys and girls from a sample of 7,504 children aged between 2-5 years reported by the Health Survey for England in 2007 .......................................................................................................................... 23

Table 7 Annual prevalence (%) of underweight, overweight and obesity amongst reception year and Year 6 children, by sex, in England reported by the NCMP between 2005-2009 .................................................................................................. 24

Table 8 Current policy related to food and drink for children under the age of 5 years.................................................................................................................................. 48

Table 9: Other key food and drink related recommendations for children under the age of 5 years ........................................................................................................... 53

Table 10: Summary of options relating to guidance and standards for food and drink provision in early years settings ................................................................................ 54

Table 11: Comparison of nutrient based framework with menu analysis of example menu ......................................................................................................................... 84

Table 12: Comparison of guidance for food provision in early years ........................ 85


Table 13: Estimated average requirements (EARs) for energy for children under the age of 5 years ........................................................................................................... 87

Table 14: The dietary reference values (DRVs) for children aged 1-2 years, 3-4 years and 1-4 years which are an average of those aged 1-2 and 3-4 years..................... 88

Table 15: SACN (2003) salt recommendations: the reference nutrient intakes (RNI) for sodium and target average salt intakes (g/d) for infants and children ................. 88

Table 16: The proportion of nutrients that each eating occasion should achieve for children under five in childcare.................................................................................. 90

Table 17: The recommended nutrient content of an average day’s food and drink over a period of one week or more (1-4 year old children) ....................................... 91



Table 20: Summary of current good practice to encourage children to eat well in early years settings ............................................................................................................ 94

List of Figures

Figure 1: Influential reports and specific health and education policies and programmes, which refer to children, introduced in the United Kingdom, by previous Governments over the last 30 years. ........................................................................ 10

Figure 2: Modules of Level 3 Diploma for Children and Young People's Worforce .. 14

Figure 3 Modules of Level 2 Certificate for the Children and Young People's Workforce.................................................................................................................. 15

Figure 4: Prevalence of underweight, overweight and obese children in Reception Year against school area 2007 IMD group, England, 2008-2009 taken from the results of the National Child Measurement Programme31......................................... 26

Figure 5: Prevalence of underweight, overweight and obese children in Reception Year by ethnic category in England, 2008-2009 taken from the results of the National Child Measurement Programme12............................................................................. 27

Figure 6 How useful the respondents found the summary of existing food and nutrition guidance...................................................................................................... 36

Front cover photo: by kind permission Pre-school Learning Alliance


Introduction

The Appendices have key background information and documents, including:

• Terms of reference for the Panel

• Brief accounts of research findings, including questionnaires and telephone and focus group interview and topic schedules

• Full guidance on food and drink provision in early years settings recommended for consideration by the Department for Education (DfE).

These Appendices support Volume 1 of the Recommendations for National Food and Nutrition Guidance for Early Year Settings in England prepared by the Advisory Panel on Food and Nutrition in Early Years (The Panel). The Panel was set up at the request of the DfE to inform the review of the Early Years Foundation Stage (EYFS). The consultation was initiated in Summer 2010, and is due to report in Spring 2011.


Appendix 1. Terms of reference for the Advisory Panel on Food and Nutrition in Early Years (APFNEY) In September 2008, the Department for Children, Schools and Families (DCSF) launched the Early Years Foundation Stage (EYFS) framework to be used in early years settings. The EYFS sets out a framework for learning and development in children from birth to 5a. The Statutory Framework makes reference to legal requirements concerning the types of food and drink providers offer, but it does not specify details. The independent review of the framework began in September 2010, and will provide an opportunity to evaluate current guidance on food provision in early years and to consider how it can be strengthened. Latest figures show that, in England, there are 1,770,000 children under five in formal childcare and early years provision (DCSF, 2008).

The current health and nutritional status of children in England, the increasing number of children now attending childcare from birth to five, and the positive outcomes associated with nutritional standards in primary and secondary schools, suggest a need to ensure that children from birth to five years are also provided with a healthy, balanced and nutritious diet.

A preliminary review of current guidance, undertaken by the School Food Trust, has highlighted the need for more comprehensive, detailed, and coherent food and nutrition guidance that can be readily accessed and delivered in all early years (EY) settings, in Englandb.

The three devolved administrations have published guidance: Wales (2009), Scotland (2006) and Northern Ireland (2006). Existing EY food and nutrition guidance, for England, was published in 2005 and relates to the 2001 standards. There is a need to consider how this guidance may be revised and developed to ensure that toddlers and young children are provided with healthy food in every early years setting that they attend.

In relation to the provision of food and drink in early years settings, the members of the Panel will be expected to: 1. Gather, develop and consider evidence on the need for provision of improved

guidance and/or standardsc. 2. Provide expert advice. 3. Work in sub-groups to develop evidence and recommendations relating to

nutrition, catering practices, procurement, training, administration, monitoring, funding and other areas agreed by the Panel; to seek the views of those with relevant experience or practice in relation to food and nutrition in early years settings, and to make oral and written presentations to the Panel, as appropriate.

a Defined as ‘children from birth to 31 August following their fifth birthday’ b Excluding foster home and care home settings c Nutritional standards exist for infants from birth to 12 months, but practical assessment of consumption against the standards is not feasible in this age group because of variations in feeding practices and rapid developmental changes. It is more appropriate, therefore, to provide general guidance for this age group. Nutritional standards in EY settings can, more readily, be set for children aged between 1-5 years, with guidance on how to assess consumption in relation to the standards.


4. To make recommendations to the DCSF Early Years Foundation Stage framework review, including recommendations on timetables for implementation of revised guidance and/or standards. The Panel will be asked, amongst other actions, to: • Consider the need for revised guidance and/or standards on food and drink in

early years settings, and how they might be implemented. The Panel may use existing guidance from Wales, Scotland, and Northern Ireland and from the Caroline Walker Trust, and other similar bodies, as a starting point. The Panel would be expected to bear in mind feasibility and implementation issues including the administrative burden, procurement implications, cost, training requirements, monitoring, and other factors that this might involve for different types of early years settings.

• Consider the benefits, limitations and implementation issues relating to the introduction of different types of guidance e.g. food-based only, combination of food-based and nutrient-based, adherence to Food Standards Agency (FSA) voluntary technical specifications for food. The experience of the School Meals Review Panel (SMRP) provides a useful reference in this regard.

• Advise on nutritional or other grounds for restricting choice, restricting or eliminating certain groups of foods (e.g. confectionery, savoury snacks), or controlling food ingredients, within early years settings. Advise on health or environmental grounds, the need to recommend controls on the proportion of fresh or unprocessed food used in catering in early years settings.

• Align any revised or newly developed guidance and/or standards on food and drink for early years settings to current guidance on infant feeding, and physical activity.

• Identify what practical advice and support might be required for successful implementation.

• Review current arrangements for training in relation to nutrition in early years settings, and to consider the implications for training if further guidance and/or standards were to be introduced.

• Provide a view on the need in the early years sector, generally, for an audit or inspection process relating to (a) food and nutritional standards and provision and (b) the quality and impact of training. It is acknowledged that any work in this area would need to fit in with the regulatory framework currently operated by Ofsted.

• Present a review of current procurement and funding arrangements for catering in early years settings, and to consider the implications for funding if further guidance, standards or requirements for training were to be introduced.

• Formulate advice by drawing on the experiences of, and welcoming submissions from, food providers who have successfully followed a healthy eating model in early years settings and others with relevant experience or practice in food provision in early years settings. The Panel will also be encouraged to seek the views of parents and children. The Panel will evaluate its recommendations in light of recommendations made in Wales, Scotland and Northern Ireland, by the Caroline Walker Trust, and other guidance. School Food Trust February 2010


Appendix 2. List of key policies and publications relating to provision of food and drink in early years settings

Health policies

In 1980, the Black Report: ‘Inequalities in Health’1 highlighted the need for early intervention to improve children’s short and long-term health outcomes. In 1998, the Acheson Report, ’Independent Inquiry into Inequalities in Health’,2 recommended that specific actions were needed to improve nutrition and breastfeeding. It also recommended an investigation aimed at tackling the wider socio-economic issues facing deprived families, and the introduction of Sure Start Children Centres. ‘Shifting the Balance of Power’3 and ‘Choosing Health’4 further altered the structure of the National Health Service (NHS) with more money and decision-making power moving to Primary Care Trusts (PCTs) who could tailor initiatives to their populations. Each PCT had different priorities and children’s services were not always their main concern. Both the ‘Marmot Review’5 and the ‘Audit Commission Health Report’6 highlighted the need for a more coherent policy approach in children’s services, and indicated that government should work with local areas to improve health outcomes by developing evidence-based solutions.

The Every Child Matters (ECM) programme developed by the previous Labour Government was based on legislation set out in the Children Act 2004.7 'Every Child Matters: Change for Children'8 sets out a national framework with the aim of shifting the focus from dealing with consequences of the difficulties children face, to preventing these difficulties from occurring. The Every Child Matters programme identifies five outcomes that are essential for the wellbeing and achievement of individuals in childhood and later life. One of these is ‘to be healthy’. Following the ECM programme, the National Service Framework for Children, Young People and Maternity Services (NSF) was developed, in 2004, to ensure that improvements to children’s health and wellbeing are part of local change programmes which in turn are part of a long-term plan.

Nutrition Policy for under five year olds

There are several policy documents, developed by the Government and relevant scientific advisory committees that cover topics such as dietary sugars, breastfeeding, weaning and balanced diets. Two examples include the Department of Health's (DH), Dietary Sugars and Human Disease 19899 and SACN's (Scientific Advisory Committee on Nutrition) Salt and Health 2003.10 Significant reports include the 1991 Dietary Reference Values for Food Energy and Nutrients for the United Kingdom11 which is used when formulating dietary advice for healthy people of different ages. In 1994, COMA published its report on Weaning Diets12 and recommended the introduction of solids between 4-6 months, although its recommendations were sometimes misinterpreted as indicating that all infants should be given foods other than breast milk or infant formula from four months of age.

Further publications by the DH indicated a move towards personal responsibility for one’s own health and more emphasis on supporting the public in making healthier choices for themselves and their families. In 1994 The Balance of Good Health13 (now superseded by the Eatwell Plate) was published by the Health Education Agency (HEA) as a common pictorial tool which could be used by all health


professionals to explain the concepts of a balanced diet. In 2000, the NHS Plan launched the School Fruit and Vegetable Scheme providing all 4-6 year olds with a piece of free fruit or vegetable per day in infant and primary schools only. The scheme only applies to nurseries attached to primary schools, and not to other early years settings.14

In 2003, after the World Health Organisation (WHO) had updated its policy on breastfeeding and weaning, the Department of Health revised its Infant Feeding Recommendations15 to state that infants should be exclusively breastfed for six months and that solids should not be introduced until infants were around six months old, and at a time and pace appropriate to the developmental stage of the infant.

In 2005, the Child Health Promotion Programme was introduced. This aimed to increase the prevalence of breastfeeding and prolong its duration, and prevent obesity by educating parents about portion sizes, limiting high fat and sugar snacks and promoting a healthy active lifestyle. In the same year, the National Child Measurement Programme (NCMP) began to monitor trends in obesity and growth of children across England. Children in reception and Year 6 are now being weighed and measured annually.

In 2006, the Healthy Start scheme replaced the Welfare Food Scheme.16 This programme aimed to improve the diets of children 0-4 years, and their pregnant or breastfeeding mothers, by providing eligible parents with vouchers to buy milk, fresh fruit, fresh vegetables or formula milk and coupons for suitable vitamins for pregnant and breastfeeding mothers and their children. An important aspect in achieving this aim was the requirement for eligible mothers to register for the benefit in early pregnancy through contact with a health professional, thereby introducing new opportunities to achieve behavioural change.

In 2007, advertising of high fat, sugar and or salt (HFSS) food and drinks in and around children’s television programmes was banned.17 The use of licensed characters, celebrities, promotional offers and health claims in advertisements for HFSS products targeted at pre-school or primary school children has also been prohibited.

Education policies: Early education and childcare

The organisation of childcare and early education services in local authorities (LAs) has changed considerably over recent years. Before the 1990s, there was a clear division in the organisation of these services. Childcare fell under LA Social Services Departments and early education services fell under Education Departments. The responsibility for childcare services then moved from the Department of Health to the Department for Education and Skills (DfES) resulting in many authorities moving their childcare services to their Education Department. Following the development of the Every Child Matters programme,18 the Children Act 20047 and the Ten Year Childcare Strategy, the responsibility for early years provision now tends to sit with Early Years and Childcare Services19 in local authorities.

The above policies are outlined in Figure 1

Advisory Panel on Food and Nutrition in Early Years. Volume 2: Appendices


General population policy

Black Report: Inequalities in Health

Paper on Proposals for Nutritional Guidelines for Health Education in Britain

COMA Report Dietary Sugars and Human Disease

Dietary Reference Values for Food Energy and Nutrients for the United Kingdom.

The Balance of Good Health The Eatwell Plate

Acheson Report Independent Inquiry into Inequalities in Health

Saving Lives: Our Healthier Nation

The NHS Plan

COMA Report Nutritional Aspects of Cardiovascular Disease

1980 1983 1989 1991 1994 1998 1999 2000 Children’s health related policy

COMA Report Weaning and the Weaning Diet

Sure Start unit launched Sure Start Local Programmes

Extension of Sure Start Children’s Centres

Education policy SACN Report The

Nutrition Wellbeing of the British Population

Tacking Health Inequalities: 2002 Cross-cutting Review

SACN Salt and Health

Choosing Health: Making Healthy Choices Easier

Choosing a Better Diet

Our Health, Our Care, Our Say

Health Inequalities: Progress and Next Steps

Marmot Review General population policy

Securing Our Future Health: Taking a Long Term View

Tacking Health Inequalities: a Programme for Action

Securing Good Health for the Whole Population

Strong and Prosperous Communities

Healthy Weight, Healthy Lives: A Cross Government Strategy for England

Tackling Health Inequalities: Ten Years On

2002 2003 2004 2005 2006 2007 2008 2009 National Service Framework for Children,

Healthy Child programme

World Health Organisation Global Strategy for Infant and Young Child Feeding

Young People and Maternity Services

Child Health Promotion Programme

Maternal Health and Nutrition

OFCOM Television Advertising of Food and Drink Products to Children – Final Statement

Food Matters. Towards a Strategy for the 21st Century.

Healthy Lives, Brighter Futures

Children’s health related policy

DH Infant Feeding Recommendations

National Child Measurement Programme

Healthy Start Scheme Change4Life

Education policy The Children Act The Childcare Act Children’s Plan Early Years Foundation Stage Framework

Every Child Matters

Ten Year Strategy for Childcare

Figure 1: Influential reports and specific health and education policies and programmes, which refer to children, introduced in the United Kingdom, by previous Governments over the last 30 years.

Source: Adapted from the Audit Commission (2010) Health Report ‘Giving Children a Healthy Start’6



Appendix 3. Diversity of provision within early years settings

Staffing ratios

In the Early Years Foundation Stage (EYFS)20, there are clear, specific, legal requirements that specify the ratios of staff to children depending on the type of settings and the level of qualification of staff. The requirements set the minimum number of staff that must be present to supervise a maximum number of children, at any time, and the appropriate levels of competence. The EYFS20 specifies that for children under the age of two there must be at least one member of staff for every three children; at least one member of staff must hold a Level 3 qualification; and half of the other staff must hold a Level 2 qualification and must have received specific training on caring for babies under two years old. The member of staff responsible for the babies’ room must be sufficiently experienced. For children aged two years old there must be one member of staff for every four children. At least one member of staff must hold a Level 3 qualification. Half of the remaining staff must hold a Level 2 qualification.

For children aged three and over, where a member of staff working with the children has a relevant Level 6 qualification, there must be one member of staff for every 13 children. At least one other member of staff must hold a Level 3 qualification. Where a member of staff with a Level 6 qualification is not available there must be at least one member of staff for every eight children. One member of staff must hold a Level 3 qualification, and half of the other staff must hold a Level 2 qualification.

For children over the age of three, in a maintained nursery school, the group must be led by a schoolteacher. There should be one member of staff for every 13 children and at least one member of staff with a Level 3 qualification. In a reception class, in a maintained school, the class size is subject to infant class size legislation which states that the maximum class size should be 30 pupils where a single schoolteacher is leading the class. Childminders are allowed to care for a maximum of six children under the age of eight. No more than three of these children may be under five years oldd.

The minimum staff to children ratios for early year settings are outlined in Table 1.

d Defined as ‘children from birth to 31 August following their fifth birth day



Qualifications

EYFS includes statutory guidance to which providers should conform.20 This states that:

• Wherever possible, childminders should have attended a training course prior to, or shortly, after registration

• The manager should have at least two years’ experience of working in an early years setting, or have at least two years’ of other suitable experience.

• All practitioners should have a clear understanding of their roles and responsibilities

• Providers should support their staff in improving their qualification levels. In particular, those staff without qualifications should be supported in obtaining a relevant qualification at a minimum of a full and relevant Level 2 qualification (as defined by CWDC)

• Induction training should be provided for new staff to help them understand how the provision operates and their role within it. Induction training should include matters such as evacuation procedures and child protection and health and safety issues

• Regular staff appraisals should be carried out to identify the training needs of staff. A programme of continuing professional development should be applied so that these needs are met

• Providers should use training made available by the local authority and other sources.20

In 2009, 72% of staff across all types of provision were qualified to at least Level 3 and 13% were qualified to Level 6. Staff working in maintained settings were more likely to hold a higher level of qualification than those in the private voluntary and maintained sectors. The EYFS framework does not set a minimum qualification requirement for childminders, although 49% hold at least a Level 3 qualification 31% do not hold any relevant qualifications. Staff working in settings providing full daycare are more likely to have a Level 3 qualification than those working for other providers. Across the whole workforce nearly three-quarters (72%) are qualified to at least Level 3 and one in eight (13%) to at least Level 6.21

An outline of these requirements can be found in Table 1.



Table 1 Minimum staff to children ratios for early years setting Nursery schools, primary schools with nursery and reception classes, primary schools with reception but no nursery classes

Minimum Ratios Age of children

Qualification Level of Setting Leader Staff Child 3 1 8 3-5 6 1 13

Maintained: Full daycare, full daycare in children's centres, sessional, holiday clubs, and after-school clubs


Qualification Level of Setting Leader Staff Child

Under 2 3 1 3 6 1 3 2 3 1 4 6 1 4 3-5 3 1 8 6 1 13

Private, Voluntary or Independent: Full daycare, full daycare in children's centres, sessional, holiday clubs, and after-school clubs


Qualification Level of Setting Leader Staff Child

Under 2 3 1 3 6 1 3 2 3 1 4 6 1 4 3-5 3 1 8 6 1 13

Qualifications for the Children and Young People’s Workforce

The Children’s Workforce Development Council (CWDC) has developed the Early Years Professional Status (EYPS) to enable people working with children under the age of five years to demonstrate the excellence of their personal practice and their ability to lead the practice of others. In addition, the CWDC has led on the development of units for the Level 3 Diploma for the Children and Young People’s Workforce (early years pathway). This is designed to establish an early years ‘climbing frame’ built around Level 3 and Level 6, with Foundation Degrees providing a bridge for those wanting to achieve EYPS.22



The Level 3 Diploma for the Children and Young People’s Workforce (early years pathway) will be the only qualification that the CWDC will state confers with occupational competence in the Qualifications and Credit Framework (QCF). All existing Level 3 full and relevant qualifications (e.g. National Vocational Qualifications or current equivalents) will still be considered full and will meet the requirements of the National Minimum Standards (NMS). The new Level 3 has been developed for future learners entering the early years workforce

The Panel requested the CWDC to provide the structure for the Level 2 Certificate for the Children and Young People’s Workforce (Figure 3) and for the Level 3 Diploma for Children and Young People’s Workforce (Figure 2). The CWDC also mapped the current food and nutrition content within the Level 2 and Level 3 qualification (Table 2 and Table 3).

The mapping exercise shows that the Level 3 Diploma for Children and Young People’s Workforce contains a mandatory learning outcome unit about food and nutrition. This makes sure that candidates taking the early years pathway will 'understand how to ensure children in their early years, receive high quality, balanced nutrition to meet their growth and development needs'. The assessment criteria which underpin the units include the following: • identify and plan balanced meals, snacks and drinks for children in their early

years, following current Government guidance on nutritional needs; • recognise why it is important to follow parents' and carers’ instructions in respect

of their children’s food allergies or intolerances; • describe methods of educating children and adults in effective food management.

Figure 2 Modules of Level 3 Diploma for Children and Young People's Workforce

SfCD Mandatory Unit

Promote Effective Communication

3 credits

SfCD Mandatory Unit

Equality, Diversity & Inclusion (Values)

3 credits

SfCD Mandatory Unit

Personal Development

3 credits

7 Option Group A Units – mandatory for all learners (C&YP Workforce)

18 credits

Option B Units

Mandatory Pathway – Early Years

22 credits

Option C Units

Mandatory Pathway – Children & Young

People’s Social Care

13 credits

Option D Units

Mandatory Pathway – Learning &

Development Support Services

13 credits

or or

Optional Units – Allowance will vary dependent on pathway



Figure 3 Modules of Level 2 Certificate for the Children and Young People's Workforce



CWDC Level 2 and Level 3: Food and Nutrition Mapping

Table 2 Food and Nutrition Mapping: Level 2 Qualification Unit Learning outcome Relevant Assessment Criteria Mandatory/

Optional Children and young people’s development

2. Understand the kinds of influences that affect children and young people’s development

Describe, with examples, the kind of influences that affect children and young people’s development including a) background b) health c) environment

Mandatory

Contribute to the support of positive environments for children and young people

4. Understand how to support the nutritional and dietary needs of children and young people

Define the basic nutritional requirements of children and young people to ensure a balanced diet and meet Government guidance Explain how to establish the different dietary requirements of children and young people Describe basic food safety when providing food and drink to children and young people.

Mandatory

The learner will: 1. Know the principles of healthy eating for children and young people

The learner can: 1.1 Outline the nutritional requirements of a healthy diet for children and young people 1.2 Describe examples of healthy meals and snacks for children and young people 1.3 Describe how culture, religion and health conditions impact on food choices

2. Know the benefits of healthy eating for children and young people

2.1 Describe the benefits of healthy eating for children and young people 2.2 Describe the possible consequences of an unhealthy diet 2.3 Describe how to recognise and deal with allergenic reactions to food 2.4 Describe where to get advice on dietary concerns

Support children and young people at meal and snack times

3. Know how to encourage children and young people to make healthier food choices

3.1 Describe the food policy of the setting 3.2 Describe with examples ways of encouraging children and young people: a) to make healthier food choices b) to eat the food provided for them

Optional



Unit Learning outcome Relevant Assessment Criteria

Mandatory/ Optional

4. Be able to support hygiene during meal or snack times

4.1 Explain the importance of hygiene at meal and snack times 4.2 Demonstrate good hygiene practice in relation to own role in food handling and waste disposal 4.3 Demonstrate ways of encouraging children and young people’s personal hygiene at meal and/or snack times

Support children and young people at meal and snack times

5. Be able to support the code of conduct and policies

5.1 Describe the setting’s code of conduct and policies for meal and snack times 5.2 Apply skills and techniques for supporting and encouraging children and young people’s positive behaviour in the dining area including table manners 5.3 Apply skills and techniques for dealing with inappropriate behaviour in the dining area

Table 3 Food and Nutrition Mapping: Level 3 Qualification Unit Learning outcome Relevant Assessment Criteria

Mandatory/ Optional

Understand Children and young people’s Development

2. Understand the factors that influence children and young people’s development and how these affect practice

2.1 Explain how children and young people’s development is influenced by a range of personal factors 2.2. Explain how children and young people’s development is influenced by a range of external factors 2.3 Explain how theories of development and frameworks to support development influence current practice.

Mandatory

3. Be able to support the provision of environments and services that promote the development of children or young people.

3.1. Explain the features of an environment or service that promotes the development of children and young people 3.2 Demonstrate how own work environment or service is organised to promote the development of children or young people.

Promote children and young people’s development

4. Understand how working practices can impact on the development of children and young people.

4.1. Explain how own working practice can affect children and young people’s development 4.2. Explain how institutions, agencies and services can affect children and young people’s development

Mandatory



Unit Learning outcome Relevant Assessment Criteria Mandatory/ Optional

1. Understand how the social, economic and cultural environment can impact on the outcomes and life chances of children and young people

1.1. Describe the social, economic and cultural factors that will impact on the lives of children and young people 1.2. Explain the importance and impact of poverty on outcomes and life chances for children and young people 1.3. Explain the role of children and young people’s personal choices and experiences, on their outcomes and life chances

Mandatory Understand how to support positive outcomes for children and young people

2. Understand how practitioners can make a positive difference in outcomes for children and young people

2.1. Identify the positive outcomes for children and young people that practitioners should be striving to achieve 2.2. Explain the importance of designing services around the needs of children and young people 2.3. Explain the importance of active participation of children and young people, in decisions affecting their lives 2.4. Explain how to support children and young people according to their age, needs and abilities to make personal choices and experiences, that have a positive impact on their lives

Mandatory

3. Understand the importance of promoting positive health and well being for early years children

3.1 Explain how to promote children’s health and well being in an early years work setting 3.2. Describe the roles of key health professionals and sources of professional advice in promoting positive health and wellbeing for early years children and their families and carers

Promote children’s welfare and wellbeing in the early years

4. Be able to support hygiene and prevention of cross infection in the early years setting

4.1 Demonstrate how equipment and each area of the setting are kept clean and hygienic. 4.2. Demonstrate and evaluate measures taken in the setting to prevent cross infection. 4.3. Explain how to prepare and store food, formula and breast milk safely according to health and safety guidelines.

Mandatory




Promote children’s welfare and wellbeing in the early years

5. Understand how to ensure children in their early years receive high quality, balanced nutrition to meet their growth and development needs

5.1 Plan balanced meals, snacks and drinks for children in their early years, following current Government guidance on nutritional needs 5.2. Recognise why it is important to follow carers’ instructions in respect of their children’s food allergies or intolerances 5.3. Identify balanced meals, snacks and drinks for children in their early years following current Government guidance on nutritional needs 5.4. Describe methods of educating children and adults in effective food management

Mandatory

1. Be able to provide respectful physical care for babies and young children

1.1. Demonstrate culturally and ethnically appropriate care for babies and young children

• Skin • Hair • Teeth • Nappy area

1.2. Demonstrate in own practice, how to take into account the preferences of carers in the provision of physical care and explain why this is important 1.3. Demonstrate in own practice, how you engage with babies or young children in a respectful manner and provide personalised physical care tailored to their needs. 1.4. Explain organisational or regulatory procedures that protect babies, young children and practitioners when providing personal care and why these are necessary.

Care for the physical and nutritional needs of babies and young children

2. Be able to provide routines for babies and young children that support their health and Development

2.1. Plan daily and weekly routines for babies and young children, suitably personalised to meet individual needs 2.2. Demonstrate in own practice how to treat babies or young children with respect and sensitivity during everyday care routines 2.3. Explain the principles of effective toilet training and how this is incorporated into routines

Optional




5. Be able to provide for the nutritional needs of babies under 18 months

5.1. Identify, using current Government guidance, the nutritional needs of babies until they are fully weaned and using information from carers plan a programme of weaning 5.2. Prepare formula feeds hygienically and following current guidance 5.3. Evaluate the benefits of different types of formula that are commonly available

6. Understand how to provide for the nutritional needs of young children from 18-36 months

6.1. Plan meals for young children that meet their nutritional needs based on current Government guidance and information from carers 6.2 Explain food allergies and intolerances that a young child may experience and the importance of following carers instructions on the needs of their child

Optional

Source: Children’s Workforce Development Council (CWDC), July 2010

Learning outcome relevant and explicit and focussed on early years

Learning outcome implicitly linked to food and nutrition

Learning outcome relevant or implicit but possibly not specific to early years



Appendix 4. Overview of food provision in nurseries in Europe Table 4 Overview of food provision in nurseries in Europe Countries Structural Factors Nutritional Standards Educational factors Parental involvement

% children present at lunchtime have lunch

Meals normally prepared on or off the premises?

Kitchen staff trained if prepared on the premises?

Mandatory Nutritional standards

Different diets catered for?

Agency sets standards

Time for eating lunch (mins)

Staff eat with children

Children in the kitchen/food preparation

Food on the curriculum

Parents consulted about menu?

Cost per day Reduced cost for low incomes

Austria 50% Off n/a Yes Yes Health 30-60 Yes No Yes No €2.50-€5.50 Yes

Belgium Flemish 100% Off n/a Yes Yes Child welfare As needed No No

Yes Yes Included in fees Lower fees

Belgium French 100% Both No No Yes for health n/a As needed No No No No Included in

fees Lower fees

Denmark

50% < 3, 2% 3-5 On Yes Yes Yes Agriculture and

food 30-45 Yes Yes Yes Yes No under 3s, yes 3-5s Yes for 3-5s

France 100% Off Yes Yes Mostly, not all for health Agriculture Varies Sometimes Occasionally No

curriculum No Included in fees Lower fees

Italy 100% On Yes Yes + Taste Yes Health 60 Yes Not always / yes Yes Yes €5.00 Yes

100% On Yes Yes +Taste Yes Health 30 Yes Yes Yes Yes Included in fees Lower fees

Spain 60% Both Yes Yes Yes for health; other varies n/a No (sit with

children) Yes / sometimes No No Varies Yes

Sweden 100% Both No No Yes 40 Yes Yes / no No No No n/a

Switzer land 100% Both Yes No Yes 60 + Yes No /

sometimes Yes No Included in fees Lower fees

England n/a

Scotland Yes n/a Yes Varies

Source: Extracted from Cremaschi F. (2006)23



Appendix 5. Summary of content of guidance on food and drink provision in early years settings in the four devolved countries of the United Kingdom Table 5 Comparison of guidance for food provision in early years

Guideline/standard England24 Scotland25 Wales26 Northern Ireland27

Compulsory food-based standards maintained nursery schools and nursery units

2007

Food group

Non-Statutory 2006 2009 2006 Recommended daily portions

Recommended/example portion sizes

Preparation & service recommendations

Fruit and vegetables

Commodity definitions Recommended daily portions



Commodity definitions Daily provision of bread stipulated

Starchy Carbohydrates

Product restrictions Recommended daily portions



Commodity definitions Recommended fish portions Provision of oily fish stipulated

Meat, fish and alternatives

Product restrictions Recommended daily portions


Dairy

Commodity definitions Provision of confectionary not allowed

Provision of chocolate products not allowed

Confectionery and savoury snacks

Restrictions on savoury snacks

Recommendations on the types of drinks allowed

Specifications on fruit juices Recommendations on milk based drinks

Provision of fresh water throughout the day stipulated

Drinks

Age specific recommendations for milk

Restrictions on condiments Recommended restrictions on salt and products high in salt

Other

Age specific advice

Guideline/standard stated



Appendix 6. Prevalence of normal weight, overweight and obesity in boys and girls from a sample of 7,504 children aged between 2-5 years reported by the Health Survey for England in 2007

Table 6 Prevalence of overweight and obesity in boys and girls from a sample of 7,504 children aged between 2-5 years reported by the Health Survey for England in 2007 2 yrs 3 yrs 4 yrs 5 yrs Boys Normal weight 71 74 72 75 Overweighte 15 9 15 13 Obese 14 16 13 11 Overweight and Obese

29 26 28 25

Girls Normal weight 75 73 72 76 Overweight 11 15 15 11 Obese 14 12 13 13 Overweight and Obese

25 27 28 24

Source: Health Survey for England in 200728

e Overweight and obesity prevalence and trends have been produced using the 85th and 95th BMI centiles of the UK 1990 reference curves as cut-offs respectively for overweight and obesity



Appendix 7. National Child Measurement Programme (NCMP) prevalence of underweight, overweight and obesity in England: 2005-2009

Table 7 Annual prevalence (%) of underweight, overweight and obesity amongst reception year and Year 6 children, by sex, in England reported by the NCMP between 2005-2009

Year 2005/06 2006/07 2007/08 2008/09

Sample size 538,400 876,416 973,073 1,003,849

Sex Under-

weightf g

Over-weighth

Obesei Under weight

Over-weight

Obese Under-weight

Over- weight

Obese Under- weight

Over weight

Obese

Males 13.4 10.7 13.6 10.7 1.5 13.6 10.4 1.2 13.8 10.2 Females 12.3 9.2 12.4 9.0 1.0 12.3 8.8 0.8 12.6 8.9 Reception Both sexes 12.8 10.0 13.0 9.6 1.3 13.0 9.6 1 13.2 9.6 Males 13.8 18.9 14.2 19.0 1.2 14.4 20.0 1.1 14.4 20.0 Females 13.8 15.4 14.1 15.8 1.6 14.2 16.6 1.6 14.2 16.5 Year 6 Both sexes 13.8 17.3 14.2 17.5 1.4 14.3 18.3 1.3 14.3 18.3

Source: National Child Measurement Programme 2005/06, National Child Measurement Programme: 2006/07school year, headline results29 National Child Measurement Programme: 2007/08 school year, headline results30 National Child Measurement Programme: 2008/09 school year, headline results31

f Underweight was not examined in this survey since no accepted underweight BMI threshold had been published for the UK National BMI percentile classification g Underweight is defined as a BMI less or equal to the 2nd centile of the UK 1990 BMI reference. h Overweight is defined as a BMI greater than or equal to the 85th centile but less than the 95th centile of the UK 1990 BMI reference. i Obese is defined as a BMI greater than or equal to the 95th centile of the UK 1990 BMI reference.



Appendix 8. National Child Measurement Programme (NCMP) prevalence of underweight, overweight and obesity in England by deprivation and ethnicity in 2008-2009

Results from the National Child Measurement programme 2008-200931 show that prevalence of obesity increases with level of deprivation (Figure 4). The highest prevalence of children being underweight is also apparent in the areas of highest deprivation. This demonstrates a need for intervention and support to address these health inequalities.

Although the sample is not entirely representative of the ethnic profile of the population, the National Child Measurement Programme also gives an indication of the prevalence of underweight, overweight and obesity by seven different ethnic groups (Figure 5). The prevalence of overweight and obese children is highest in the black and black British population and second highest in the white population.

The prevalence of underweight is highest in the Asian and Asian British population, being two percentage points above the national average.



Figure 4: Prevalence of underweight, overweight and obese children in Reception Year against school area 2007 Index Multiple Deprivation (IMD) group, England, 2008-2009 taken from the results of the National Child Measurement Programme31

g Underweight is defined as a BMI less or equal to the 2nd centile of the UK 1990 BMI reference. h Overweight is defined as a BMI greater than or equal to the 85th centile but less than the 95th centile of the UK 1990 BMI reference. i Obese is defined as a BMI greater than or equal to the 95th centile of the UK 1990 BMI reference. .



Figure 5: Prevalence of underweight, overweight and obese children in Reception Year by ethnic category in England, 2008-2009 taken from the results of the National Child Measurement Programme12 g Underweight is defined as a BMI less or equal to the 2nd centile of the UK 1990 BMI reference. h Overweight is defined as a BMI greater than or equal to the 85th centile but less than the 95th centile of the UK 1990 BMI reference. i Obese is defined as a BMI greater than or equal to the 95th centile of the UK 1990 BMI reference.



Appendix 9. Two case studies taken from ‘Learning, Playing and Interacting – Good Practice in the EYFS (2009)’.



Appendix 10: Overview and critique of submissions of evidence

On 16th March 2010, the Panel invited all those working with, or in, early years settings to submit by 18 June 2010 any evidence they considered relevant to the Panel’s work. The invitation was positioned on the School Food Trust website and evidence was submitted, via a dedicated mailbox ([email protected]) or by post, to the School Food Trust. A total of 35 submissions of evidence, on a varied number of topics, were received.

The evidence submitted provided insight into current local food provision practices in early years settings, particularly the development of guidance, award schemes, and training programmes. In addition, a few recent research reports were submitted. The following section provides an overview of the evidence received. It has been categorised under five core themes, namely guidance, provision, practice, training and research.

From the evidence submitted to the Panel, it was possible to identify a number of strengths, weaknesses, opportunities and threats related to existing work aimed at improving food and drink provision in early years settings. Through identifying these, the Panel was able to learn from the successes of others and the problems that they had encountered.

Guidance

There were eight submissions32 33 34 35 36 37 38 39 of food and nutrition guidance that had been developed regionally or locally as a resource for early years settings. These were designed to support the settings in providing “nutritious” meals as required by the EYFS welfare requirements for food and drink. An additional piece of guidance was received from a company sponsored by a food manufacturer.40 This was aimed at parents, rather than at early years practitioners and providers.

The guidance varied in content, length and format; the majority of the guidance submitted included information on the following key areas:

• Feeding babies 0-12 months • Feeding children 1-5 years old • Drinks • Feeding children on special/restricted diets • Oral health • Food safety and hygiene.

The Panel considered the range of guidance that had already been developed to help support early years settings provide healthy food and drink to young children as positive and encouraging. However, it was noted that there has been limited assessment of the impact of these pieces of guidance and the Local Authorities Coordinators of Regulatory Services (LACORS) study41 showed that early years settings commonly fail to meet the nutritional needs of the children in their care. In addition, some of the submissions of evidence stated that early years settings require consistent centrally-produced guidance.

Critique of guidance

A number of the pieces of guidance submitted to the Panel were incorporated into healthy award schemes and/or were supported by training courses.32 34 36 37 38 39 Integrating food and nutrition guidance into an award scheme or coupling it with a training course ensures that guidance is interpreted and implemented more accurately, and settings are recognised for their achievements. In addition, the Panel recognises that it is important for guidance to

mailto:[email protected]�



include all the relevant information an early years setting might need to provide healthy and appropriate food for the children in their care.

Inaccuracies were found in some of the guidance and this was one of the main weaknesses identified. For example, some guidance provided information more appropriate to feeding older children and adults than children under the age of five years. It is essential for early years settings to receive accurate, clear and consistent guidance enabling them to provide nutritionally appropriate food for the children in their care. Research presented in section 3.11 in volume 1 suggests that settings are currently failing to do this, due to the lack of guidance currently available.

Many submissions stated the view, also held by members of the Panel, that it would be useful for food and nutrition guidance to be incorporated in the existing structures within which early years settings operate, for example, the Early Years Foundation Stage (EYFS) framework and Ofsted inspection processes.

There was a great deal of variation in the length of the guidance documents submitted to the Panel (from two to115 pages). It is essential that guidance is appropriate in terms of content and length. Whilst there is a need to give information sufficient to enable practitioners to provide a healthy diet for children under the age of five, guidance must not be daunting and time-consuming to read and understand. Provision

Three submissions of evidence41 42 43 dealt with ‘provision’. Two, provided an insight into the current provision of food in early years settings both nationally41 and at a regional level.43 Both of these supported the need for a single source of consistent, clear guidance.

The third submission was a 4-week menu cycle,42 fully compliant with the Caroline Walker Trust (CWT) guidelines.44 This was accompanied by supporting evidence of compliance in the form of a bar-chart produced from a menu planning and nutritional analysis software. Although recent Nursery Surveys41 43 have reported that many early year settings fail to meet the CWT guidelines, this menu cycle demonstrated that guidelines can be met when settings are supported by appropriate knowledge and resources.

Practice

A total of nine submissions45 46 47 48 49 50 51 52 53 on regional healthy award schemes for healthy eating early year settings were sent for consideration. Some of these award schemes adapted the Healthy Schools Scheme47 49 50 criteria to the needs of early year settings and to local health priorities. Some schemes had been developed in conjunction with other resources to support each criterion. Supporting materials included food and nutrition guidance, checklist tools and training courses aimed at early years providers and practitioners. Several awards were currently being piloted and were therefore still in development. Where they had been piloted, evaluation reports46 49 50 52 highlighting the successes and the weaknesses of the award schemes were also submitted.

One submission outlined observations of poor practice made by a dietitian who had conducted training with early years staff. Examples included providing excessive amounts of high fibre foods, dried fruit as a snack, and menus which were developed based on the



staff’s own likes and dislikes. This further supports the need for more consistent, clear guidance.

Having a food and drink policy features as a criterion of all the award schemes submitted to the Panel. In addition, a regional healthy eating and drinking policy54 was submitted. This had been developed for Local Children’s Centres and applied to every individual and group using them. The policy aimed to ensure that all children’s centre staff and external agencies engaging with children or parents and carers provided a consistent and positive approach to food and drink.

Critique of evidence relating to practice

The award schemes submitted had been developed using the Healthy Schools Scheme as a basis. The main benefits of award schemes are:

• They are tailored to address the health needs of the local area • They provide recognition to settings that are providing a healthy environment to

children and offer reassurance to parents • They set out clear structures and processes that settings can adopt and implement.

Another strength of the award schemes submitted was that they were linked to the existing requirements of the Early Years Foundation Stage (EYFS) and supported settings in meeting and surpassing them. Some of the awards schemes were offered at different levels, thus motivating settings to improve even further whilst recognising achievements to date. There were two main weaknesses in the award schemes submitted. The first was a lack of food and nutrition guidance that would support effectively an early years setting trying to meet the criteria. Where guidance was available, it was often too long and sometimes inaccurate or inappropriate. The second weakness was heavy dependence on self-assessment. This required practitioners to have the required knowledge and time to complete self-assessment forms which were often lengthy. Reassessment occurred from every six months to only once every three years in the award schemes submitted. Both timescales may be associated with problems; every six months is very resource intensive, whereas a three-year period risks failure to maintain standards. Ensuring that settings are adequately resourced to meet the award criteria, therefore, requires the provision of food and nutrition guidance that is accurate, clear and consistent, together with the training necessary for its implementation. These steps can give practitioners the confidence to make changes that are appropriate to the needs of the children in early years settings. One submission50 identified the need for a Food in Schools dietitian to work closely with each setting as critical to the achievement of the award. One evaluation of a pilot healthy eating award scheme found that settings did not progress if this support was withdrawn. Dietetic support seemed a costly component of the small pilot in question but might have been more cost-effectively provided had the pilot been rolled-out to more settings. Training The Panel received seven submissions55 56 57 58 59 60 61 related to training of early years staff. Training courses had been developed by a profit making company, a local nutrition and dietetic service, and a charity working on local health initiatives and programmes. As mentioned above, some of the courses were developed to support the introduction of award schemes or food and nutrition guidance. The content of the courses was varied and covered



topics such as: healthy eating for babies; healthy eating for children 1 up to 5 years; food safety and hygiene; cookery, menu planning; and dealing with food allergies.

The training courses varied in length. Sessions ranged in duration from one hour to 5-6 hours and one course provided a total of 30 hours of teaching time. This point is considered further below.

Critique of evidence relating to training

A key strength of one training course submitted was that it was provided to all staff within an early years setting. Another of the courses extended the availability to parents. This helps to ensure that children learn consistently both in the setting and in the home. In one case there were two different levels of training: one for all early years staff and a further course for the staff responsible for planning menus.

The main weakness identified was the length of some training courses. The Panel recognised that early years practitioners have limited opportunities to leave their settings to attend training courses. Therefore, a course that requires six hours absence may not be appropriate. On the other hand, it is important that training courses are sufficient in length to cover required information, so getting the correct balance between learning hours and content is essential.

To ensure the successful transfer of knowledge and information it would be advantageous to offer food and nutrition guidance that complements training. This would offer settings with a point of reference following the training, and so reinforce the messages given.

Training courses submitted to the Panel were funded in a variety of ways, for example by Primary Care Trusts (PCTs), through Lottery funding, or through other channels. Many were not sustainable streams of funding, therefore creating a risk that they may be lost.

Research

Five research reports62 63 64 65 66 were submitted to the Panel. Two were the regional reports of the national coordinated survey on nutrition in nursery schools conducted by LACORS.63 These identified the problems and good practices observed in each region. The results were incorporated within the national report also submitted to the Panel.

The remaining three pieces of research 64 65 66 submitted were conducted across the Merseyside area. Two were carried out in Liverpool 64 65 and one across Merseyside and Cheshire.66 The two studies carried out in Liverpool looked at the provision of food and drink in early years settings. The main findings from these pieces of research were that: • There was little knowledge about what constitutes a healthy diet for children under the

age of five and a lack of awareness of any guidance available to support them • Menus did not meet the Caroline Walker Trust (CWT)44 guidelines • There was reliance on pre-packaged foods. The third piece of research evaluated an initiative in Merseyside and Cheshire.66 This consisted of a training course and a programme of support for early years settings. The training course improved the knowledge of individuals attending and this change was accompanied by the provision of more appropriate food and drink.



Conclusions drawn from the evidence submitted

The evidence submitted to the Panel demonstrates how committed the early years sector is to providing children in its care with appropriate food and drink. However, it also shows that the workforce requires guidance, training and support with implementation to achieve its objective. There is a limited evidence base on the nutritional quality of food and drink provision currently being provided to children in early years settings. The research reports submitted generally involved small sample sizes. Furthermore, the survey by LACORS was conducted in private nurseries only, and half of the research received submitted was from one area of the country. It is unclear, therefore, whether findings are representative of all early years settings. The evidence submitted nevertheless gave the Panel insight into the problems associated with providing appropriate food to children in early years settings. The many examples of good practice submitted offered the Panel a platform on which it could build its recommendations.

The Panel wishes to record its appreciation to all those who submitted evidence in response to its call for submissions.



Appendix 11: Summary of findings from the on-line survey of views on current guidance

Background

The Panel was set up to gather, develop and consider evidence on the need for provision of improved food and nutrition guidance and/or standards for children from 1 up to the age of 5 years.

The Panel were asked to 'Evaluate current guidance to see if its presentation and style is appropriate for the target audiences, including food providers, parents and carers, and those providing facilities for early years care'.67

In February 2010, the Panel requested the secretariat to collate and draft a document summarising existing consistent guidance on food and drink provision for children aged 1 up to 5 years. This was currently available from the Department of Health (DH), the Food Standards Agency (FSA), the Caroline Walker Trust (CWT) and Change4Life. This document, titled ‘Guidance for food and drink provision in early years settings’, was intended to provide a clear and consistent point of reference for early years providers, practitioners and parents which could help them meet the food and drink requirements of the EYFS framework. The electronic guidance was published on the School Food Trust68 and the National Strategies69 website on 16 March 2010.

In order to ascertain whether the guidance succeeded in it is objectives, an on-line form was developed to gather feedback on its content, format and tone. This was available, through the School Food Trust website, between June and September 2010.

Aims The survey used an on-line feedback form to gather the views of those working in early years settings on the content, format and tone of the School Food Trust ‘Guidance for food and drink provision in early years settings’ published electronically in March 2010.

Objectives The objectives of the feedback form were: • Evaluate whether the presentation and style of current guidance was appropriate for the

target audiences, including early years practitioners and providers and health professionals. Specifically it was important to know where it helped early year settings and parents and carers to meet the EYFS welfare requirements

• Evaluate whether the content of current guidance provided sufficient detail to support early years settings in providing the children in their care with nutritionally appropriate food and drink

• Ask what additional food and nutrition guidance was required by those working in early years settings.

Methods

A short on-line feedback form consisting of eleven questions was developed using ‘Survey Monkey’. The form was openly accessible for three months from 16 June –17 September 2010 via a survey link on the School food Trust website.68



Results

A total of 98 individuals completed the questionnaire; just over half (45 respondents) answered all eleven questions. Forty nine respondents answered the question ‘Who are you?’ from which it was possible to identify three main groups: Nursery managers/head teachers (14; 29%); health professionals (12; 25%); and childminders (9; 18%).

Sixty three (91%) of 70 respondents found the summary of existing guidance either ‘very’ or ‘quite useful’. Fifty two respondents then indicated which sections they found most useful. Twenty eight (54%) found the section on ‘Healthy food and drink for children aged 1-5 years’ the most useful, followed by examples of foods to avoid or limit and links to references and where to find more information each indicated by 17/52 (33%) respondents.

Fifty respondents suggested how the guidance could be made more useful. They responded as follows: by including ‘more practical ideas’ (34/50; 68%), together with ‘more case studies’ (18/50; 36%). Some also suggested that it would be helpful to make the guidance shorter (9/50; 18%).

Of these 50 respondents, 28 (56%) indicated they would like more guidance which should include: example menus (13/28; 46%),;suitable portion sizes (12/28; 43%); example recipes (12/28; 43%); suitable food and drink provision for children aged 1-4 years (12/28; 43%); providing food for children with allergies and intolerances (9/28; 32%); suitable food and drink for children under one year (9/28; 32%).

Que stio n 2: Ho w use ful d id you find this summa ry o f e xis ting fo o d and nutritio n g uid a nce fo r Ea rly Yea rs se tting s? (tick o ne o p tio n)

37%

54%

6% 3%

Very useful Quite useful Not very useful Not at all useful

Figure 6 How useful the respondents found the summary of existing food and nutrition guidance

Discussion

The data show that the majority of respondents found the guidance document useful. However, most respondents considered the information provided insufficient detail. Health professionals, nursery managers and head teachers in particular said they would like more practical tools such as suitable portion size information, sample menus and recipes to support their interpretation, and implementation of the existing guidance.



Appendix 12: Summary of findings from the practitioners’ questionnaire

Background

The Panel was set up to gather, develop and consider evidence on the need for the provision of improved food and nutrition guidance and/or standards for children from 1 up to the age of 5 years.

In particular it was asked to consult with a wide range of early years practitioners and providers to see what steps had already been taken to provide healthy food and drink provision, assess whether the format, content and tone of current guidance was appropriate for practitioners, and consider the training needs of those working in early years settings, as well as the costs of providing food and drink in these settings.

Aims The overall aim of the survey was to provide an overview of the provision of food in early years settings, including current levels of training and knowledge of providers, food procurement, facilities for food preparation, challenges to providing 'healthy' food options, and details of any food policies.

Sampling A total of 2,400 early years providers were selected for the sample on the assumption that the response rate would be 25%. Details of providers were obtained from Ofsted. The sampling was stratified by type of provision, but the numbers drawn were not proportional to the sampling frame in order to maximise the chances of receiving sufficient responses from each provision type and permit sub-group analysis. The final sample comprised 2079 early years settings. Provision types (numbers included; percentages of the total sample) were:

• Childcare - Non-Domestic (402; 19%) • Child-minder (400; 19%) • Independent school nursery (72; 3%) • Nurseries (404; 19%) • Primary schools with nursery classes (401; 19%) • Sure Start Children's Centre (400; 19%).

Providers and practitioners who had a valid email address (n=1098) received an email on 24 August 2010 explaining the purpose of the survey and the web link to the on-line questionnaire. The remaining 981 received the same information via a letter.

Methods The questionnaire was developed and pilot tested by the Secretariat in consultation with the Panel and was designed to be completed by the named recipient using the web-link supplied. The questionnaire, administered via Survey Monkey, was designed so that each question had to be answered to allow progress to the next question. The questionnaire consisted of 31 questions and took an average of 20 minutes to complete.

Results Of the 2079 providers, to whom the survey was sent, only 92 responded, giving a response rate of 4.4%. The majority of respondents were nursery managers (32; 35%), childminders (21; 23%) and head teachers (20; 21%). The low response rate obviated analysis by provider type and further limited the extent to which the results could be generalised to all childcare providers.



Every respondent reported offering at least one snack or meal during the time for which they provided childcare. The majority (77; 94%) offered a mid-morning snack and more than two thirds (66; 72%) provided at least one meal.

Almost half (44; 48%) reported relying on their own experiences, or those of friends or families, as the main source of information for menu planning for children under five years. Just under a quarter (21; 23%) used published guidance, with the same number using magazines or on-line material. Of the 77 respondents who expressed an opinion about the sufficiency of guidance, 23 (30%) said they wanted more guidance to support them in providing healthy food and drink to children under five years. When asked what they would like, most wanted advice on suitable food and drink provision for children aged 1-4 years, examples of menus and advice on how to help fussy eaters. Sample recipes and information about food for children with allergies and intolerances was also requested by many. Of the 75 individuals who completed the second half of the questionnaire, 39 (52%) thought that simpler guidance explaining the concept of 'healthy and nutritious meals and snacks’ would be useful in encouraging good eating habits amongst under fives. Thirty seven (40%) thought that standards should be compulsory and 22 (24%) thought they should be only voluntary.

Forty two (61%) of the 70 who responded to a question on the facilities available for food preparation reported having full kitchen facilities. There were 11 'other' responses which mostly described regeneration or partial facilities, or meals cooked in a school kitchen. Less than one third of the settings (32%) had a dedicated dining room or eating area, (although childminders who responded probably used the same room for play and eating). The majority (75%) of respondents did not charge separately for each meal or snack provided.

Sixty one (81%) had a food policy, and in most cases it was a written policy. The policy statements varied considerably with the commonest element being 'To cater for all children including those with special dietary needs/religious/cultural needs'.

When asked what challenges were faced in providing healthy food, cost of ingredients was the main factor cited by 31 (55%) of the 56 people who responded to this question. Children's dislike of, or parental disinterest in, healthier options were both reported by almost a quarter (13; 23%) of respondents.

Those responsible for menu planning had a range of EYFS qualifications from none to NVQs and degrees. The most predominant food qualifications were in food hygiene or food safety at various levels. Of the 66 individuals who responded to the question on training courses attended by staff, 33 (50%) attended a locally organised course in food and nutrition, although 29 (44%) had not attended any. The main barriers to training were reported to be cost and lack of available training programmes. These were reported by 33 (51%) and 32 (49%) of the 65 respondents, respectively.

Discussion

Although the majority of early years settings who responded were providing children with at least one snack or meal during the time for which they provided childcare, there was limited use of published food and nutrition guidance to support menu planning. The majority of respondents appeared to plan on the basis of their own, or friends’ experiences. Coupled with this, there appeared to be a shortage of practitioners with any appropriate qualification in food and nutrition. These findings suggest that early years practitioners need more supporting information and training if they are to provide healthy food and drink appropriate for children under five years. The cost of ingredients and constraints on access to training also need to be addressed; practitioners highlighted these as the main barriers to improving food and drink provision.



Appendix 13: Summary of findings from the local authority interviews

Background

The Panel was set up to gather, develop and consider evidence on the need for provision of improved food and nutrition guidance and/or standards for children from 1 up to the age 5 years.

In order to be able to frame recommendations to the DfE, the Panel needed to understand local authorities’ perspectives, their role and responsibilities, and the current structures and systems within LAs that support settings in achieving the EYFS welfare requirements related to food and drink. The requirement states that “Where children are provided with meals, snacks and drinks, these must be healthy, balanced and nutritious”; and “Fresh drinking water must be available at all times”. 20

In order to understand these issues the School Food Trust conducted 15 telephone interviews with local authority representatives during the period16 August to 22 September 2010.

Aims The aim of the telephone interviews was to collect information from local authorities about their perspectives on food provision, practice, procurement and training in a range of early years settings.

Sampling

A stratified sample of 15 was selected from the 152 local authorities in England. The stratification was based on two variables: i) Government Office region and ii) Unitary status. The Panel secretariat worked with the early years National Strategies team to identify the name of the early years consultant in each LA. Four of the LAs initially selected were replaced, one because the LA declined to be interviewed and three because the responsible individual was ill or no-one was in post.

Methods

The named early years consultant was sent an invitation to participate in the telephone interview. The interview schedule was attached to explain the background for conducting the interviews; it included a confidentiality clause and an outline of the 17 questions which would be asked. Recognising that the responsibilities for food provision, practice and training, straddle more than one local authority department the early years consultant was encouraged to consult within the early years team and nominate the most appropriate person (or persons) to participate in the telephone interview. A follow-up call was made to address any queries and confirm the interviewees and the date and time of the interview. Fifteen local authority interviews were eventually conducted, recorded and transcribed.

Results

There was no one person responsible within local authorities for the provision of food and drink in early years settings; responsibility was usually shared out amongst teams. The line of responsibility for food and nutrition practice was clearer but the structure varied between authorities. Local authority maintained nurseries attached to primary schools received direct support from the Food in Schools co-ordinators and as a result were more rigorously



monitored. The responsibility for early years food and nutrition training was more structured, falling with the Workforce Development Team or the School Improvement Team in the majority of cases.

There was no clear description of how individual teams involved in food provision, practice and training, worked together when expert nutritional advice was required, but the local authorities reported that they collaborated well with local PCTs who were generally responsible for providing such input.

The types of food and nutrition guidance used by the local authorities varied; a large proportion cited the Caroline Walker Trust (CWT) 44 guidelines but over half used the FSA’s Eatwell Plate. Interestingly, five of the fifteen local authorities had developed, or were in the process of developing, their own guidance. In one case this was linked to an Early Years Healthy Eating award.

A third of LAs had their own guidance but 13 out of the 15 interviewed said they would welcome more about suitable food and drink provision both for children aged 1 up to 5 years and those under one year. The need for more advice on suitable portion sizes, sugar and salt intake was particularly mentioned.

When asked what they would like, if further guidance and/or standards on food and nutrition were introduced in the future, local authorities generally wanted simpler guidance that would explain more practically what 'healthy and nutritious meals and snacks' means. More detailed guidance, offering practical examples in the form of menu plans, portion sizes and recipes was requested. Many local authorities wanted these options incorporated into a set of guidelines that would reflect the current spectrum of food and drink provision within the authority. Many local authorities felt that there would be a very wide range in the ability of different childcare settings to understand guidance, and that care would be needed to ensure it would be accessible to all.

A recurrent theme was that guidance should have a universal format to enhance accessibility to all settings. It should be as simple and practical as possible, including advice pertinent to the different age groups and eating occasions in the day. Of the 15 LAs interviewed, 13 said that standards for food and nutrition provision in EY settings, if introduced, should be compulsory for all early years settings.

Although a number of local authorities undertook some monitoring against the EYFS welfare requirements for food and drink, there was no universally standardised approach. Maintained nurseries attached to primary schools tended to be captured in the monitoring carried out under the National Healthy Schools criteria and School Food Regulations.

All but one local authority provided training and support to all settings. This tended to include food hygiene, food and nutrition and support for settings, and how to communicate healthy eating information to parents and others. The training was mostly delivered by health professionals and varied considerably in length from two hours to half or full day courses. The charges made for attending training sessions ranged from nothing to between £5 and £20 per course. Training was open to LA maintained early years settings, Private Voluntary and Independent (PVI) settings, and childminders. It was taken up by all three groups in similar proportions.

The majority of respondents interviewed suggested that all staff within a setting, irrespective of their position, should receive some training in food hygiene and preparation as settings often do not have access to a chef or cook throughout the day. This lack of access was especially true at tea-time.



Discussion

Although there are no designated structures within local authorities to support early years settings in providing healthy food and drink to children under five years, it is evident that a number of local authorities are engaged in this task. Some have already developed, or were developing, their own food and nutrition guidance, as well as providing free training to all early years settings including childminders.

Several LAs used published food and nutrition guidance to support their early years settings in providing healthy nutritious meals and snacks. It is important to note that over half of them were using the FSA ‘Eatwell Plate’, in some cases to give advice to parents about healthy eating at home but in other cases to advise on the proportion of foods from different groups to offer children under five years. The latter is inappropriate. The majority of local authorities interviewed would welcome further guidance to support them in feeding children under five healthily and, if standards were to be introduced in the future, the majority wanted them to be compulsory.

Based on the information collected from the LA interviews it is recommended that pathways of responsibility for food and nutrition in early years should be defined more clearly. Clearer and more consistent guidance should be made available and accessible to all. Local authorities would also need clearer guidance to ensure that settings are consistent and that implementation is accurate. The approach to monitoring of food and nutrition provision and practice in early years should be standardised and monitored at regular intervals in order to evaluate the impact of implementing any future food and nutrition guidance.



Appendix 14: Summary of findings from focus groups with providers, parents and children

Background

The Panel was set up to gather, develop and consider evidence on the need for provision of improved food and nutrition guidance and/or standards for children from 1 up to the age of 5 years.

In doing this the Panel was encouraged to seek the opinions of early years providers/practitioners, parents and children. On behalf of the Panel, the Secretariat commissioned the Centre for Research in Early Childhood (CREC) to carry out a total of 18 focus groups with early years practitioners (n=6), parents (n=6) and children (n=6) to collect their opinions and views on food and drink provision in early years settings.

Aims The aim of the focus groups was to collect opinions and views on food provision, practice and training in early years settings. Specifically, the focus groups explored and documented different perspectives (providers/practitioners, parents and children) on: • The provision of healthy food and drink in early years settings • Major issues associated with food and drink provision and practice in the different types

of early years settings listed above • The main barriers to provision of healthy food and drink and practice in the different

types of early years settings.

Sampling Three different focus groups were run in each of six geographically and socio-economically diverse local authorities in England were selected to dovetail with other local authority level data gathering already being undertaken by the Panel (Appendix 13). The three sets of discussants taking part in each focus group were: • Providers/practitioners: from LA maintained nurseries, nurseries in the independent

sector, private nurseries, children’s centres and childminders • Parents of children attending the early years settings • Children aged between 3-5 years attending the early years settings. In total the focus groups included: • 32 practitioners (from private day care nurseries, children’s centres, nursery schools,

Childminders) • 35 parents

• 42 children (aged three to five years).

Methods In each location the focus groups were facilitated by the local authority early years consultant who had identified the children’s centre hosting the focus groups. A CREC fieldwork team consisting of two experienced CREC researchers supported the Children’s Centre in setting up and administering the three focus groups (providers/practitioners, parents and children) over one day. Ethical agreements with participants were negotiated before the focus group discussions were conducted.



A range of focus group techniques were employed to promote engagement in the process, particularly to ensure that a range of parents and young children were able to have a ‘voice’ in the process and respond fully to the study prompts. Question prompts were raised in an open and neutral way and a free-flowing discussion was encouraged around the points raised.

The discussions from each of the 18 focus groups were recorded and subsequently transcribed; the information was then analysed and collated to summarise the main findings. The full report is available, on request, from the School Food Trust on request.

Results

Although all providers offered some kind of food in their settings and saw it as an important learning opportunity, there was a lack of awareness and application of any national food and nutrition guidance for early years settings. In general, providers stated that they were currently reliant on their own knowledge and desire to promote healthy lifestyles as opposed to knowing where to access reliable information relevant to health and nutrition in the early years. Practitioners and parents indicated that they had very limited knowledge about tailoring portion sizes to the age of the child, and all practitioners said they would particularly welcome guidance on this.

All the providers agreed that national guidelines on food and nutrition would be beneficial and most of the providers and parents (over 90%) strongly supported the suggestion that standards on food and nutrition should be statutorily applied to all early years settings, including childminders. They wanted concise, consistent, national guidance which would be readily available and easily understood by both parents and practitioners. It was suggested that such national guidance should be incorporated into the Early Years Foundation Stage (EYFS) framework, with no exemptions, and should be inspected by Ofsted. In contrast, some individuals raised a concern that if standards were compulsory, some settings might be less willing to provide food. They believed this would be a retrograde step, particularly in economically deprived areas with vulnerable children and families.

All parents and providers highlighted the importance of food and nutrition as a key element in the service provided by early years settings. All practitioners expressed the view that the ‘social’ aspect of eating was very important; with some saying it was almost the most important element of their provision. Practitioners stated that mealtimes gave them an opportunity to talk to children about healthy choices and also encouraged children to try different foods, which they may not eat at home.

The key barriers to healthy eating which were cited included the lack of national guidelines and statutory standards, confusing information, poor role-models in the home, poor facilities in settings and the home and the cost of providing a range of healthy and nutritious food. Conversely, settings that were strong advocates of healthy food were adamant that it was not more expensive to provide sustainable, locally sourced, healthy food.

Six practitioners said they had no access to advice from a dietitian or nutritionist and that their local authorities provided little training or information on health and nutrition. Practitioners and parents felt that better information and more access to, and support for, training was needed to assist early years settings in providing healthy food and drink.

All practitioners stated that they had some form of policy relevant to food and nutrition but policies varied in terms of their formal status. Some taking the form of a written document whereas others were informal protocols. There was also variation in the way policies were



used to inform practice. It is also important to note that the majority of policies were not based on available guidance.

Practitioners and parents felt that there was a good level of communication between them regarding the food provided and consumed by the children. However, the vast majority of parents said they were unaware of a food policy and only a minority said they had been consulted about one.

In all settings children talked confidently and knowledgeably about a variety of fruit and stated that they had fruit as their snack in nursery. The children’s confidence in recognising and talking about vegetables was more varied across settings. Children who had the greatest knowledge of vegetables were generally those who had been involved in growing them, either with their parents or at nursery. A high percentage of children said they would eat things at nursery that they did not eat at home.

The children had mixed views about what was healthy and unhealthy food. A small number of children were able to distinguish between healthy and unhealthy options but most were not confident to talk about why they were ‘good or bad for you’. Most of the children easily recognised the unhealthier options of food displayed e.g. crisps, coca cola, sweets, but there was less consistency in their recognition of healthy foods, with the exception of fruit. All children said that they ate fruit in their nursery and did not eat sweets or crisps, and drank water, juice or milk. Most children knew that sugar was bad for teeth. However when asked about their favourite dinner a high proportion chose pizza, sausages and a selection of less-healthy foods.

Discussion

Although most practitioners and parents felt that it would be beneficial to have statutory nutritional guidelines incorporated into the EYFS, some practitioners had concerns that this could discourage settings from providing any food at all. Both practitioners and parents cited as the main barrier the increased cost associated with healthier food. It was also apparent that there maybe a lack of training and support available to practitioners which may have implications for the implementation of food and nutrition guidance. These barriers could be overcome by providing food and nutrition training together with guidance on how to procure healthy food that is affordable.

The views of children, parents and practitioners across the focus groups suggest there are a number of issues that need to be addressed. These were: • There is strong demand for statutory requirements/standards on food and nutrition for all

early years settings. • There is a need for clear, concise and consistent, national guidelines about healthy

eating in young children to support practice in settings and in the home. • There is a lack of training, support and information for practitioners and parents on

healthy eating in young children, and how appropriate food may be simply and cheaply prepared.

• There is very varied knowledge, among young children and parents, about what constitutes healthy and unhealthy foods. Some children and parents were very aware of its importance whereas others seemed totally unaware.

• Early years settings can have a positive impact on food and nutrition practice in the home if practice in the setting is high quality and food and nutrition is given high status and resourced appropriately.

• There is a need for all children to experience eating meals and snacks within a more pleasurable, relaxing and thoughtfully prepared social context.



• There is a need to address poor environments and facilities in some early years settings, if they are to support better food and nutrition practice and incorporate this into their programme

• There is a common perception that healthy and nutritious food is expensive to provide, and there are too few incentives in settings, homes and communities (including retailers/supermarkets) to encourage healthy eating.

• The media and advertising could play an important role in discouraging poor eating habits and the over consumption of foods with low nutritional value.



Appendix 15: Summary of findings from scoping the finances, procurement, and costs of food provision in early years childcare settings

Background

The Panel was set up to gather, develop and consider evidence on the need for provision of improved food and nutrition guidance and/or standards for children aged 1-5 years.

The Panel were asked to work in sub-groups to develop evidence and recommendations relating to a number of different areas on food and drink provision in early years setting, one of which was funding and procurement. To this end economists, from the Department for Education (DfE), were commissioned to undertake an ‘in house’ small-scale qualitative study within a six-week period to improve the understanding of the way in which the procurement and financing of food provision is organised in different early years settings.

Aims The aim of the project was to collect, analyse and report on the finances, procurement and costs of food and drink provided across a range of early years childcare settings. The study posed four core research questions: • Who provides the food (including source)? • Who prepares the food? • Who pays for the food? • What are the costs of preparation (including ingredients, energy and

equipment/facilities)?

Time and budgetary constraints meant that the project was scoping in nature, providing insight rather than reaching definitive or quantitative conclusions.

Sample The original aim was to interview 12 early years settings comprising two organisations from each of the following settings or ownerships: LA maintained; independent schools; Sure Start Children’s Centres; voluntary organisations; and independent provision (childminders and nursery schools). The early years settings were sourced from the Ofsted database. Eighteen interviews were conducted from which 15 were considered to provide sufficient detail. A minimum of two interviews was achieved in each setting.

Methods The School Food Trust and the DfE economists agreed that the method of data collection would be qualitative. Data were collected, in telephone interviews, using a semi-structured interview schedule that was developed with Trust. In order to elicit the most detailed information a follow up email was sent to offer respondents an opportunity to provide further information on the questions they were unable to answer immediately on the telephone.

After the interviews the researchers held debriefing meetings to share thoughts on responses and the questionnaire. The data were sorted into analytical categories using a framework to conduct content analysis.

Results The majority of settings reported having a food policy or set of guidelines that related to diet and hygiene. In some cases these were developed using information provided by the FSA70,



the Caroline Walker Trust44 and the Healthy Schools Scheme71. However, most of the participants did not discuss their food policy in relation to costs or value of food.

When asked where they bought their food some settings listed only supermarkets or cash and carry outlets, while others used only smaller local shops; some settings used both. The local shops used included the greengrocers, fishmongers, butchers and a farm. Two settings grew their own vegetables on site, encouraging the children to get involved with the planting, picking and preparation. In these cases additional vegetables were purchased from external sources.

The scale of food provision varied significantly, from an independent childminder preparing meals for one child to a nursery catering for up to 140 children per day, so arrangements and facilities for the preparation of food also varied. With the exception of childminders who prepared the food for the children in their care, meals were predominantly prepared in-house most often by dedicated cooks and kitchen staff but in a few cases by non-catering staff who were also involved with preparation. For example, lunchtime supervisors sometimes supported catering staff, and practitioners by preparing snacks, baby food or heating previously prepared food.

The majority of providers preparing hot food on site had purpose-built kitchens. Childminders prepared food in their home kitchens. In most settings meals were eaten in individual nursery rooms, with the children sitting together around the classroom tables that were cleared and cleaned in preparation for meal times.

The two LA maintained nurseries used funding from the local authority and asked parents to pay for, or contribute towards, snacks. Private, voluntary and independent providers all used parental fees to fund food and drink. None of the settings interviewed used the money from the Government’s early educational entitlement funding to purchase food, as this is not permitted. Settings also stated that they were not allowed to charge top-up fees to cover the cost of food and drink so they had to absorb these costs themselves or ask parents to provide a packed lunch. Settings often made arrangements for low-income families who struggled to pay for meals though this was not a consideration where low-income families were rare within the setting.

Only five settings could provide specific information on current food and drink spend per child, per day. This ranged from £1.45-£5.00 and covered a varied number of meals and snacks across settings. Respondents were better able to report the charges made per day, per child. These ranged from 13p for a biscuit and 50p for a snack to £5.00 for a mid-morning snack, lunch and tea.

Discussion The information gathered shows that there is great variation between early years settings in the arrangements made for food and drink provision not only in terms of finance and procurement but also with regard to facilities and staffing. This demonstrates a need for all early years staff to be adequately trained in food hygiene and preparation. It is interesting to note that settings neither include reference to the cost and value of food and drink in their food policies nor have much awareness of the costs associated with food and drink provision. As settings have to absorb the cost of food and drink it is important to provide guidance on procuring healthy food at low cost. Cost should not be perceived as a barrier to healthy food and drink provision.



Appendix 16: Existing policies and guidance covering the nutrition of children from birth to the age of 5 years Table 8 Current policy related to food and drink for children under the age of 5 years Food or nutrient issue

Age that this applies to

Current food or nutrition policy Source

1. Breast milk 1st year of life Breast milk should be the food of choice during the first six months of life and exclusive breastfeeding is recommended until an infant is around six months of age. Breast milk remains a suitable main milk drink throughout the first year of life alongside complementary foods and for as long as the mother chooses to continue breastfeeding.

DH72

2. Infant formula 1st year of life If the mother does not breastfeed, infants should be given an appropriate infant formula as their sole source of nutrition during the first six months of life and as the main drink throughout the first year of life. First formula milks (milks suitable from birth) are appropriate throughout the first year and follow on formulas are not required.

DH72

3. Soy based infant formula

1st year of life It is recommended that soy based infant formulas are only given to infants on the advice of a health professional.

DH72



Table 8 Current policy related to food and drink for children under the age of 5 years Food or nutrient issue



4. Other types of milks

Birth to 5 Only breast milk or appropriate infant formula milk should be used as the main milk drink during the first year of life. Pasteurised whole cow’s milk can be the main milk given from one year of age. Semi- skimmed milk is appropriate for children who eat well from two years of age. Skimmed milk or 1% fat milk is not appropriate as the main drink for children under five years. Pasteurised goat’s milk or sheep’s milk or calcium fortified soya milk can be given as the main drink from one year of age. Rice milk should not be given to children under five years of age.

DH72

5. Water 1st year of life For babies under six months of age, water used for reconstituting infant formula or offered as a drink should be taken from the kitchen tap, and boiled before use. Water should be allowed to cool before giving it. Bottled water should not be used unless it is specifically stated that it is suitable to make up infant formula safely. Water should not be used if it has been boiled in the kettle more than once or been drawn from bathroom taps where water may have been in a storage tank for longer periods. Instructions for making infant formula safely can be found in the Department of Health’s guidance ‘Birth to Five’.72 For babies over six months, it is not necessary to boil water for them to drink (unless it is to be used to make up infant formula).

FSA73






6. Introducing foods complementary to breast milk

From about six months

Foods complementary to breast milk or infant formula should be introduced into an infant’s diet at around six months of age. Breastfeeding or infant formula feeding should continue alongside appropriate types and amounts of solid foods.

DH72

7. Early introduction of solids: foods to avoid

If parents or carers choose to introduce complementary foods before six months

If foods complementary to breast or formula milk are introduced before six months of age it is recommended that the following foods are avoided: peanuts, other nuts, seeds, cow’s milk (not including formula), eggs, fish, shellfish, liver, soft and un-pasteurised cheeses, foods containing wheat or gluten.

DH72 and FSA73

8. Foods to avoid between six months and one year of age

From about six months

Salt: salt should not be added to the foods for babies. A young baby’s kidneys are unable to cope with it. Some foods are high in salt so it is advisable to check labels and choose lower salt versions. Foods and ingredients high in salt should not be used. These include: stock cubes, gravy powders and salted flavourings such as soya sauce and ketchups. Sugar: sweet puddings, biscuits, sweets and ice creams are not recommended for babies under a year. Sugar should not be added when preparing foods for infants. Fat: full-fat dairy foods should be used, not lower fat alternatives. Fibre: high-fibre versions of foods, especially those with added bran, are unsuitable for babies.

FSA73

9. Choice of drinks

1st year of life If offered fruit juice should always be diluted one part juice to ten parts of water and offered in a feeding cup (not a bottle) at mealtimes only. The following drinks are not suitable for babies: • Juice drinks, fizzy drinks, sugary drinks, squashes, diet drinks, low-

calorie drinks, no-added-sugar drinks • Flavoured milks or flavoured waters • Herbal drinks • Any drink with added stimulants such as caffeine • Tea and coffee

FSA73






10. Artificial sweeteners

Birth to three years

The use of sweeteners is prohibited in any foods for infants and young children. The sale of such products containing sweeteners is also prohibited.

Sweeteners in Food Regulations 1995, as amended by the Sweeteners in Food (Amendment) Regulations 1996, 1997, 1999, 2001* and 2002 EU Council Directive 89/398/EEC

11. Artificial colours


The use of colours is not permitted in any foods specially prepared for sick or healthy infants and young children. This includes infant formulae, follow-up milk and other follow-up foods and baby foods. Beta-carotene E160a, riboflavin and riboflavin-5’-phosphate E101 are permitted if their primary function is for vitamin fortification, as in that instance they are not considered colours under the regulations.

Colours in Food Regulations 1995, as amended by the Colours in Food (Amendment) Regulations 2000 and 2001

12. Permitted additives


Only miscellaneous additives listed in Schedule 8 and certain gases listed in Schedule 1 may be used in foods specially prepared for infants and young children, under the conditions of use specified, and to the maximum permitted levels. The list currently applies to foods for all infants and young children, including those not in good health.

Miscellaneous Food Additives Regulations 1995, as amended by the Miscellaneous Food Additives (Amendment) Regulations 1997, 1999, 2001 and 2001 (No. 2)*

13. Liver and liver containing foods

From six months or when solids introduced

Liver and liver products should not be fed to babies under six months of age Liver and liver products should not be served more than a few times each week to children aged 1 up to 5 years.

FSA73






14. Certain types of fish

From six months or when solids introduced

Shark, swordfish or marlin should not be used because the levels of mercury in these fish can affect a baby’s growing nervous system. Oily fish dishes should be given no more than twice a week as oily fish can contain low levels of the pollutants dioxin and polychlorinated biphenyls (PCBs).

FSA73

15. Honey First year of life Honey should be avoided during the first year of life. Very occasionally it contains bacteria that can produce toxins which cause a very serious illness called infant botulism.

FSA73

16. Food safety Children under five

The following foods should be avoided: • Raw eggs and raw shellfish • Un-pasteurised dairy foods • Whole nuts as they may cause choking

FSA73



Appendix 17: Other key issues important in the development of guidance on food and drink for children under the age of five years

Table 9: Other key food and drink related recommendations for children under the age of 5 years Food or nutrient issue



First Foods 1st year of life First foods should be introduced complementary to breast milk or formula milk from six months. In the first few weeks these need to be simple foods that can be easily digested. Babies should be gradually introduced to a wide range of different flavours and textures. Get them used to chewing to develop their speech muscles.

DH72

Offer finger foods to infants

1st year of life Around six months of age babies can eat finger foods (foods that are big enough to hold in their hand and stick out of the top of their fist, e.g. food cut into the size of an adults finger).

DH72

Drinking from a cup 1st year of life An open-top cup (that does not require the child to suck) should be introduced from about six months of age. By the time a baby is one he or she should have stopped using bottles with teats. Where a bottle is used drinks other than milk or water in a bottle should not be given.

FSA73

Offer a varied diet

From six months

A wide variety of healthy foods should be offered at meals and snacks. DH72

Timing of meals and snacks

From nine months

Babies should be taking three meals a day and healthy snacks in between meals.

DH72

Follow food hygiene and food safety guidance

Under five Young children should never be left alone when eating as they could choke. DH72



Appendix 18: Summary of options relating to standards/guidance for food and drink provision in early years settings

Table 10: Summary of options relating to guidance and standards for food and drink provision in early years settings Option No.

Type of standards/ guidance

Description

Issues discussed Summary and priority for consideration

1 Narrative extension of the current EYFS Framework

The current welfare requirements for food and drink could be extended with further explanation and detail in a narrative format. For example, there could be explanation of what defines ‘healthy, nutritious and balanced meals and snacks for children 1-4 years’, with a checklist of key items for providers to consider.

Are providers able to use this information to prepare nutritionally appropriate meals and snacks in early years? Is such a simple checklist a sufficiently robust way of ensuring that food is given appropriate priority in early years settings? Does this approach extend knowledge and expertise about food and nutrition in early years settings? What support would providers need? Providers are likely to be able to manage these changes independently if resources are provided which offer greater explanation of how to use the checklist appropriately. How would this be monitored? Inspectors could look at the way that any checklist is kept and acted upon and review the checklist against menu plans and observations.

There would not be sufficient detail to provide an adequate basis for guidance. Priority: Low





Description


2 Food-based standards

Food-based standards make a series of suggestions about how meals and snacks are organised throughout the day in terms of the types of foods and drinks that are appropriate to serve. Food-based standards could, for example, suggest that all main meals included a protein component (and how that is defined), that each main meal should contain two portions of fruit and vegetables (and how they are defined), that only milk and water should be offered between meals.

Are food-based standards alone able to ensure nutritionally adequate food is served? Will portion sizes be appropriate? Can interpretation of food-based standards lead to highly variable provision between providers? Are menu plans alone a suitable vehicle for showing adherence to standards? What support would providers need? Additional support in menu planning in many settings would be needed to ensure that all the criteria are met appropriately. How would this be monitored? Menu plans and checklists could be evaluated against the food-based standards as part of the inspection process

Food-based standards with suitable detail about provision of foods in specified food groups may be more usable. More information may be needed in relation to guidance on portion sizes and food composition in order to provide balanced provision across the day. Priority: Low/Medium





Description


3 Food-based standards with more detailed specifications for specific foods and ingredients

Food-based standards could be expanded to list particular ingredients or foods which should not be served in early years settings, or which must comply with certain compositional standards.

Is it easy to define ingredients and foods that should not be served? Does a restricted list of foods ensure that nutritional needs are met? Does ‘restricting’ certain foods confuse the message and make eating well all about avoiding ‘bad foods’? What support would providers need? Greater support around how to ensure that specific food ingredients or foods are avoided in foods purchased and in preparing appropriate menu plans. How would this be monitored? More detailed investigation of menu plans, recipes and foods purchased and served would be needed and a checklist could be used to review restricted foods and ingredients.

More detail regarding menu plans, and recipes would still be helpful. Target nutrient specifications may complicate procurement and monitoring. More specific information about foods to include or exclude increases likelihood of balanced provision across a number of settings, but would not achieve this on its own Priority: Medium





Description


4 Food-based standards, specifications for foods and ingredients and specified serving size/ amounts

This extends the concept of food-based standards and requires providers to show that they are following guideline portion sizes that achieve the balance of foods in the diet in the right proportion to meet nutritional requirements. This idea of using portion size and food type can be seen in the menu planner programme ‘little people’s plates’. 74

Does this ensure that nutritional needs are met? Is the idea of serving sizes restrictive in terms of variable appetites? Is this likely to mean a move to the minimum portion size? Is it possible to simply specify portion sizes in this way and can we do this easily? What support would providers need? Greater support to understand portion sizes, recipes and scales and learn how to use monitoring tools. How would this be monitored? Providers could be offered support and example menu plans, or potentially a simple computer programme, which would show how food types and portion sizes meet standards. Meeting serving sizes would be self-monitoring.

More detail regarding portion sizes is helpful in meeting nutritional needs but it needs to be based on evidence from menus meeting average nutrient requirements. Target nutrient specifications may complicate procurement and monitoring, but more specific information about foods to include or exclude increases likelihood of balanced provision across a number of settings. Raises the importance of the need for supporting software, self-monitoring and associated training. Priority: Medium to high





Description


5 Food-based standards in a nutrient framework Food-based standards, specification for foods and ingredients, portion size information based on menu plans developed using nutrient- based standards.

In addition to food-based standards and some restriction on ingredients and foods to be used in early years settings, nutrient-based standards could be used as the framework for ensuring portion sizes and food types suggested in guidance are appropriate.

Is this more likely to ensure that menus are appropriate compared to offering food-based standards and serving size information alone? Does this require additional expertise in determining suitable menus? Can practitioners use food-based guidance with portion size information to plan menus which meet needs appropriately? What support would providers need? Training in how to look at menu plans and use a simple monitoring tool. How would this be monitored? A checklist to help settings check their menus meet the guidance on food-based standards in a nutrient framework

The use of a nutrient-based framework to plan menus would help to improve the balance of food provision in different settings across the day. Provides an evidence base for the food type and portion size guidance suggested and would allow example menu plans to be based on the best evidence. Provides guidance which compensates for higher provision of some nutrients and lower provision of others evidenced in current provision. Priority: High





Description


6 Food-based standards, specifications for foods and ingredients and nutrient-based standards

This was the model used to develop current school food standards. Here it is adapted by increased specification of ingredients and foods for early years. Providers need to ensure that they meet food-based standards and that menus achieve, on average over a period of a week or more, a set of nutrient-based standards. Standards such as the CWT standards fit this model. Scottish guidance has nutrient-based standards as appendices, Welsh standards use CWT nutrient based guidance for menu planning examples.

Are nutrient-based standards the best way of promoting better food in early years settings? Are detailed nutrient-based standards needed in early years to ensure that early years nutrition is seen as equally important to school age nutrition? Are nutrient-based standards easier to implement in early years settings than in schools as there is less variability in standards by age and gender? Do we need this detail of standards to ensure nutritionally appropriate food? Is the burden on providers too great for the benefits that this type of system can bring? Is sufficient training and support likely to be available to ensure that these standards can be met by all providers? What support would providers need? This requires the use of menu planning tools to model menus over a period of a week or more using a database of appropriate meals and snacks. Menu planners have been developed (and have been available and widely used since 2001) and also allow providers to look for ideas and recipes to enhance their menus and cost their menus. Training around menu planning and around cooking skills may be required in some settings How would this be monitored? By using a system similar to that currently used for school meals.

Increases specificity of recommendations regarding amounts of energy and nutrients appropriate to each type of meal, but complicates issues about cross-setting provision and monitoring. Heavy burden on providers and might reduce flexibility to meet the needs of each individual child and to be responsive to local needs. Requires specific tools and expert support and training. Priority: Medium





Description


7 Nutrient- based standards alone

This would allow menus to be compiled from any foods, providing that the overall balance of the menu met the average energy and nutrient requirements of children aged 1 up 5 years.

Does having only nutrient-based standards mean greater flexibility among providers to serve different foods and drinks and promote the idea that it is the overall diet over a period of week or more, rather than good or bad food choices that is important? If food served over a period of time covers all children’s nutritional requirements are food-based standards or standards which restrict certain foods necessary as well?

Potentially increases flexibility of provision, but increases problems regarding appropriateness for all settings since the burden of menu planning falls on providers. It would also be difficult to ensure parity of provision across different meals and monitor across settings. Priority: Low



Appendix 19: Guidance for the provision of food and drink in early years settings

Guidance for food and drink provision in early years settings (October 2010) This document supports early years settings in meeting the food and drink requirements of the Early Years Foundation Stage framework (2008). This guidance has been developed and piloted in order to support early years settings to offer food and drink choices that are likely to provide all the energy and nutrients needed by children aged 1 up to 5 years. It summarises existing food and nutrition guidance to offer a clear and consistent point of reference for early years providers, practitioners and parents. The aim of this guidance is to allow individuals to plan and provide meals, snacks and drinks for the children they look after, helping to ensure that every child eats well, enjoys a varied diet and develops healthy eating patterns to take forward into their school years. The Early Years Foundation Stage (EYFS) welfare requirements for food and drink The Early Years Foundation Stage (EYFS) framework sets out a welfare requirement which states:

“Where children are provided with meals, snacks and drinks, these must be healthy, balanced and nutritious.” “Fresh drinking water must be available at all times”

In addition to the requirements of the EYFS framework, maintained nursery schools and nursery classes within maintained primary schools, are required to meet the current mandatory food standards for school lunches outlined in Schedule 5 of the Statutory Instrument (2007) No. 2359 Education Regulations 2007 (Nutritional Standards and Requirements for School Food) (England)j (amended 2008 Statutory Instrument No. 1800).k The food regulations state:

“One item from each of the four food groups (fruit and vegetables, starchy foods, meat, fish and alternatives, and milk and dairy foods) should be provided for each pupil at lunchtime each day”

j Statutory Instrument 2007 No. 2359. The Education (Nutritional Standards and Requirements for School Food) (England) Regulations 2007.

London: TSO k Statutory Instrument 2008 No. 1800. The Education (Nutritional Standards and Requirements for School Food) (England)(Amendment)

Regulations 2008. London: TSO.



The food regulations will help maintained nursery schools to meet the current requirements of the EYFS framework. These regulations do not apply to settings other than maintained nurseries or to food provided at times other than lunch. Why is healthy food and drink essential for children in early years? Healthy eating habits in the years before school are important because they impact on growth, development and achievement in later life l m n. Research confirms that eating patterns are established early in life o p q therefore intervening in the early years is key to preventing obesity. Interventions to promote the initiation and duration of breastfeeding and good nutrition in early years should also reduce the risk of chronic diseases, such as cardiovascular disease, diabetes and some cancers, in later life. A healthy, varied, balanced diet and regular physical activity are identified as fundamental determinants of general health and wellbeing. Involving children and their parents in all aspects of provision is a central principle of the EYFS since it helps to reinforce good life-long eating habits. It also helps practitioners to become aware of cultural, religious or medical factors that might affect a particular child’s dietary requirements. Food and drink for children up to 12 months Advice about feeding children between birth and 12 months of age differs from that which applies to children aged from 1 up to 5 years old. For more information on providing healthy food and drink to children from birth to 12 months, please refer to the Department of Health’s document ‘Birth to Five’: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107303 Or, the resources developed by the Start4Life campaign: www.nhs.uk/start4life

l Feinstein L, Sabates R, Sorhaindo A, Rogers I, Herrick D, Northstone K, Emmett P. (2008). Dietary patterns related to attainment in school: the

importance of early eating patterns. J Epidemiology and Community Health. 62. 734-739.

m Gardner DS, Hosking J, Metcalf BS, Jeffery AN, Voss LD, Wilkin TJ. (2009). Contribution of early weight gain to childhood overweight and

metabolic health: a longitudinal study (EarlyBird 36). Pediatrics. 123. (1). 67-73

n Wiles NJ, Northstone K, Emmett P, Lewis G. (2009). ‘Junk food’ diet and childhood behavioural problems: results from the ALSPAC cohort.

European Journal of Clinical Nutrition. 63. 491-498.

o Northstone K, Emmett P, ALSPAC Study Team, (2005). Multivariate analysis of diet in children at four and seven years of age and

associations with socio-demographic characteristics. European Journal of Clinical Nutrition. 59. 751-760

pNorthstone K and Emmett, P M (2008). Are dietary patterns stable throughout early and mid-childhood? A birth cohort. British Journal of

Nutrition. 100. 1069-1076.

q Skinner. J. D, Carruth. B. R, Bounds. W, Ziegler. P, Reidy, K. (2002). Do food related experiences in the first 2 years of life predict dietary

variety in school aged children? Journal of Nutrition Education and Behaviour. 34. 310-315

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107303�

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107303�

http://www.nhs.uk/start4life�



Healthy food and drink for children aged 1 year up to 5 years old Young children aged from 1 up to 5 years old are developing rapidly and are usually very active, so it is important to ensure that they are getting a balanced and varied diet which provides all the energy and nutrients their bodies need. Children in this age group eat smaller meals than adults, so it is important to provide them with regular meals and snacks rich in nutrients and containing sufficient energy (calories) to meet their needs for physical activity and growth. Children should be encouraged to enjoy different foods. To achieve this they should be provided with foods from each of the four food groups everyday:

• bread, rice, potatoes, pasta and other starchy foods • fruit and vegetables • milk and dairy foods • meat, fish, eggs, beans and other non-dairy sources of protein.

The following information provides guidance for food and drink, provided throughout the day, by food group. Although the length of time that children are in childcare may vary, it is important to take this guidance into consideration when providing, even only a part of a child’s daily food intake. The guidance explains: why the food group is important for health; good food choices to serve and foods or practices to avoid, limit or restrict. The suggested portion sizes are given as a guide and have been taken from meals and snacks in menus which have been designed to meet nutrient-based standards at each of the meals served in a whole day of childcare. There is a range of portion sizes given, the smaller amount is appropriate for children aged 1-2 years and the higher amount for 3-4 year olds – but the appetite of children will vary and young children should be encouraged to eat healthy food to appetite needsr. The guidance is also given by meal and snack to provide additional ideas and guidance on how to plan appropriately. The guidance tables have been compiled to help menu planners put together menus. The information is based on best practice and the Panel was specifically asked to offer clarity of guidance over the foods to choose and the foods to avoid. The foods, listed to avoid for safety reasons, are based on current health and safety guidance from the Food Standards Agency (FSA). (www.eatwell.gov.uk/keepingfoodsafe/) Explanations about why some foods and ingredients should be avoided or restricted are given after the guidance tables on pages 82-88.

r Note this guidance has been written to ensure the nutritional requirements of children aged 1 up to 5 years are met. The nutrient-based standards have been derived from the DRV’s for children aged 1-4 years. This includes children up to their fifth birthday.

http://www.eatwell.gov.uk/keepingfoodsafe/�



Guidance on food and drink provision for children aged 1-5 years by food group (October 2010)

Food Group Good choices of foods to serve How frequently and how much of this food and drink should I provide at each meal occasion during the day?

Menu planning guidance

Bread, rice, potatoes, pasta and other starchy foods

Foods from this group provide energy, carbohydrates, fibre and B vitamins.

Bread: includes white, wholemeal, granary, brown, wheatgerm and multigrain breads, soda bread, potato bread, chapattis, plain naan bread, plain rotis, rolls, plain bagels, pitta bread, wraps, tortilla. Potatoes or sweet potatoes includes boiled, mashed, baked or wedges Other starchy root vegetables includes: boiled, mashed or baked yam, plantain, cocoyam, cassava Pasta and noodles includes boiled white and wholemeal spaghetti, noodles and pasta shapes Rice includes boiled white and brown rice Other grains includes couscous or bulgur wheat, maize (polenta) and cornmeal Low sugar and low salt breakfast cereals includes: porridge, puffed wheat, wheat bisks, crisped rice or flaked wheat. Fortified breakfast cereals can be a good source of iron.

Starchy foods should be offered at every meal and are useful foods to offer as part of snacks.

Starchy foods should make up about a third of the diet

Wholegrain varieties of bread and cereals such as rice and pasta provide fibre and can be gradually introduced into the diets of children from the age of two years.

Typical portion sizes to offer: Sliced bread: 1½ small slices (20-30g) 1 large slice (20-30g) Bread muffins/pitta bread/ rolls etc: ½-1 or a mini version (25-50g) Other: Breadsticks 2-4 (8g-10g) Crackers 1-2 (8g-16g) Oatcakes 1-2 (10-20g) Potatoes and other starchy root vegetables: 1 small baked or 1-2 boiled potatoes or starchy root pieces (80-100g) 2-3 tablespoons mashed starchy vegetable (80-100g) 3-4 tablespoons pasta/rice/grains (80g-100g) Breakfast Cereals: 3-5 tablespoons (20g-30g) 1-1½ wheat bisks (20g- 30g) 1/3 – ½ mug (100-110g) porridge made with milk

Aim for a variety of wholegrain and white breads and cereals across meals and snacks each week

Some foods in this group can be high in salt. If food contains more than 1.5g salt per 100g (or 0.6g sodium) it is classed as high in salt. If it contains less than 0.3g salt per 100g (or 0.1g sodium) it is classed as low in salt.

Choose bread and bread products with a lower salt content where available

Avoid dried or canned ready prepared sauces, canned pasta in sauce, flavoured dried rice, pasta or noodle products as these are high in salt

Some foods in this group can be high in added sugar. Avoid breakfast cereals with added sugar e.g. sugar coated flakes and chocolate flavoured cereals and aim for those that contain less than 10g sugar per 100g cereal.

Some processed potato products can have added fat and salt. Avoid processed potato products such as potato smiley faces or potato waffles, French fry style or skinny chips can be very high in fat.

Restrict the intake of starchy foods which have been fried




Food Group Good choices of foods to serve How frequently and how much of this food and drink should I provide at each meal occasion during the day?


Fruits and vegetables

Fruits and vegetable are important sources of many vitamins including vitamin A and C, minerals, mainly zinc and iron and also fibre

Vegetables: includes all types of fresh, frozen and tinned varieties served with meals and in cooked dishes, such as carrots, green beans, broccoli, cauliflower, cabbage, spring greens, courgettes, peppers, leeks, onions, parsnips, swede and sweetcorn Salad vegetables: includes lettuce, other leaves, watercress, celery, cucumber, tomato, raw carrot, raw pepper, radish, beetroot Fresh fruit: includes apples, bananas, pears, grapes, kiwi fruit, oranges, plums, berries and melon Tinned fruit in natural juice: includes peaches, pears, pineapple, mandarin oranges, prunes, guava or lychees Stewed fruit without added sugar: includes stewed apple, stewed dried fruit, stewed plums. Some sour fruits such as stewed currants or stewed rhubarb may need a small amount of sugar added to make them palatable. Dried fruit: includes raisins, dried apricots, dates, dried figs, prunes Fruit juice: includes orange juice, apple juice, pineapple juice. Fruit juice should be 100% fruit juice and diluted 1 part fruit juice to 1 part water and provided at meal times only. Pulses such as beans, peas and lentils count as vegetables but are also useful meat alternatives, and cannot count as a meat alternative and a vegetable in the same meal. Potatoes are classified as a starchy food and are not included in the fruit and vegetable group

If children are in a child care setting all day aim to offer 4-5 different types of fruit/vegetables throughout the day

Ensure a variety of fruits and vegetables are offered at every meal and with snacks.

Typical portion sizes to offer: Vegetables: 1-2 tablespoons cooked vegetables (40g) 4-6 raw vegetable sticks (40g) small bowl homemade vegetable soup (150g) Fresh fruit: ½ large piece of fruit (40g) such as half an apple or pear 2-3 small fruits such as apricots(40g) 1-2 tablespoons berries such as raspberries (40g) 1-2 tablespoons fruit tinned with juice (70-100g) 2-5 pieces of dried fruit with meals (25-30g) Fruit juice: Pure 100% juice, diluted half fruit juice (e.g. 50ml fruit juice and 50ml of water mixed together) Smoothies made from pureed 100% fruit and juice should also be diluted half fruit juice, half water.

Choose tinned vegetables and fruit without added salt or sugar/syrup.

Dried fruit and fruit juices contain sugars and if consumed between meals can cause tooth decay and contribute to tooth erosion

Choose lower salt, lower sugar

baked beans and if used as a vegetable, only serve these once a week

Preparing and cooking fruits and vegetables

Cut up vegetables and fruit just before they will be eaten or cooked. If fruit and vegetables are prepared in advance, left to soak in water or cooked and then reheated it can reduce the amount of vitamins they contain.

Food safety

All fruit and vegetables served raw should be washed thoroughly Some fruit may contain stones/pips which are a choking hazard to children. Ensure stones and pips are removed before offering to children. Cut grapes in half, offer slices of apple rather than small chunks which could be a choking hazard and never leave children alone when eating.



Guidance on food and drink provision for children aged 1-5 years by food group (October 2010) Food Group

Good choices of foods to serve How frequently and how much of this food and drink should I provide at each meal occasion during the day?


Meat and fish Foods from this group provide protein, iron and zinc. Oily fish provide long chain omega 3 fatty acids, vitamin D and A

Meat: includes beef, lamb, pork Poultry: includes chicken and turkey White fish: includes cod, haddock, plaice, coley, pollack, saithe and blue whiting. Tinned tuna is included in this group Oily fish: includes herring and mackerel, salmon, trout, sardines, sprats and pilchards. Shellfish: includes prawns, mussels. Choose fish labelled as coming from sustainable fish stocks where possible.

Main meals (lunch and tea) should always contain meat, fish or a suitable alternative from this food group (see the food group eggs, beans and other sources of non-dairy protein).

Using these foods as part of a snack will increase the amount of iron and zinc provided

Oily fish such as salmon, mackerel or sardines should be included on the menu at least once every 3 weeks. Tinned tuna does not count as an oil-rich fish but is a good source of nutrients.

Typical portion sizes to offer:

Meat, fish served alone - 1 slice (30-40g), ½ fillet, 1-2 tablespoons

Meat, fish in sauces and stews – 2-3 tablespoons (90g-120g)

Processed meat products: e.g. sausages, burgers, nuggets and other coated/crumbed chicken products, pies and tinned meat should not be served more than once a week.

Processed fish products e.g. fish fingers, fish bites or other coated products should not be served more than once a week.

Where meat products are served, good quality versions should be chosen, These are those that adhere to the legal minimum meat content levels set out in the Meat Products (England) Regulations 2003

Food safety

Make sure fish dishes are free of bones. Avoid shark, swordfish or marlin because the levels of mercury in these fish can affect a child’s developing nervous system. Avoid serving oily fish dishes more than twice a week as oily fish can contain low levels of the pollutants dioxin and polychlorinated biphenyls (PCBs) Avoid raw shellfish to reduce the risk of food poisoning and make sure all shellfish is thoroughly cooked




Food Group Good choices of foods to serve How frequent and how much of this food and drink should I provide at each meal occasion during the day?


Eggs, beans and other non-dairy sources of protein

Foods from this group provide protein, iron and zinc.

Eggs: includes boiled, scrambled or poached eggs and omelettes Pulses: includes all sorts of beans, peas and lentils such as butter beans, kidney beans, chick peas, red and green lentils, processed peas or baked beans.

Meat alternatives: includes soya bean products, such as soya mince or tofu, textured vegetable protein, QuornTM

Ground nuts/peanuts and nut butters: includes ground almonds, ground hazelnuts, ground brazil nuts peanut butter, cashew butter

Main meals (lunch and tea) which do not contain meat, poultry or fish should include eggs, beans or other non-dairy sources of protein.

If children in your care do not eat meat or fish or avoid all animal products it is important they receive two or three portions per day of an alternative source of protein and nutrients such as iron and zinc, for example eggs, pulses or other meat alternatives.

Using these foods as part of a snack will increase the amount of iron and zinc provided

Typical portion sizes to offer:

Meat alternatives served alone –

1 egg, 1-2 tablespoons pulses, ground nuts/peanuts or meat alternatives such as vegetable protein mince, tofu, quornTM pieces (30-50g)

Pulses and meat alternatives in sauces and stews – 2-3 tablespoons (90g-120g)

Some processed products made from meat alternatives can also be high in salt and fat

Processed products made from

meat alternatives such as vegetarian sausages, burgers and pies should be served no more than once in a week.

Choose tinned pulses with no

added salt and sugar.

Choose lower salt and sugar baked beans

Dahl and other dishes made from

pulses should be made without adding a lot of oil and salt

Food safety

Avoid giving raw eggs, or food containing raw or partly cooked eggs. Make sure the eggs are cooked until both the white and the yolk are solid. Nuts: Do not give whole peanuts or any type of whole nuts to children under 5 years old because they could cause choking Nuts, especially peanuts, and a number of other foods can cause severe allergic reactions in some children. Early years settings should have an allergy plan in place to deal with these situations. It is recommended that you visit the www.allergyuk.org website for accurate and reliable information on managing allergies in early years settings

http://www.allergyuk.org/�




Food Group



Milk and dairy foods

Foods from this groups are a good source of energy, calcium, vitamin A and fat

Milk: includes pasteurised cow’s, goats or sheep milk. Milk alternatives such as plain soya milk drinks enriched with calcium Cheese: includes hard cheeses and soft cheeses. Use vegetarian cheese for children who avoid animal products Yoghurt and fromage frais

Children over the age of one year should have three servings of milk per day (300ml-400 ml milk/day), either as a drink or milk-based dishes.

It is useful to offer milk as a drink at mealtimes or with snacks but water should always be available to quench thirst.

Typical portion sizes to offer: Milk drinks (including cows milk and milk alternatives such as plain soya milk drinks enriched with calcium) ½ cup ( 100ml-150ml) Hard cheese (15g-20g) Soft cheese (20g-25g) Yoghurt, fromage frais, custard: small pot (60g), ½ large individual pot (half of 125-140g), 2-3 tablespoons (50-75g)

Full fat milks should be the main milk drink for children up to two years of age as children under two years need the extra fat and vitamins in full-fat dairy products.

Semi-skimmed milks, are appropriate for children over two years if the child is growing well and eating a healthy balanced diet

If only one type of milk is available in early years settings this should be whole milk

Avoid skimmed milks, oat milk, rice milk, nut

milk and canned milk as the main milk drink

Avoid sweetened milk drinks and milkshakes

Milk can be used in desserts such as rice pudding or semolina

Full-fat varieties of yoghurts and fromage frais

should be provided to children up to the age of two years old. Use natural yoghurt and fromage frais and add fruit to naturally sweeten. Some yoghurts and fromage frais have high sugar contents. If the sugar content on a yoghurt or fromage frais label says it has more than 15g of sugar per 100g, it is high in sugar.

Ice cream and sweetened frozen yoghurts can

be high in sugar and should be avoided between meals, but can be served occasionally with fruit- based desserts

Plain calcium fortified soya milk can be used

as a non-dairy alternative to cow’s milk as the main drink for children over one year of age

Food safety Avoid unpasteurised milk, milk drinks, cheese and mould ripened (blue veined) cheese as these may contain bacteria which can cause ill health in under five’s.

Avoid rice milks as they have been found to contain small amounts of arsenic. u



Guidance on food and drink provision for children aged 1-5 years by food group (October 2010) Food Group



Foods high in fat, salt and sugar Foods from this groups should be provided in small quantities

Fats and oils are needed in cooking and can be used as spreads on bread. The best oils to cook with are those high in monounsaturates, such as rapeseed oil, olive oil or peanut (groundnut) oil. Choose fat spreads which are made from vegetable oils and which are high in unsaturated fats, or butter in small amounts. Puddings that are made with cereals, milk and fruit can be included in a healthy balanced diet for young children but these should only be served with meals and not as snacks.

Offer a variety of puddings with main meals each week

Puddings which include fruit should aim to include 40g of fresh fruit or 20g dried fruit per portion.

Typical portions to offer: Fat spread on bread or toast, ½ teaspoon per slice (4-6g) Puddings made with 40g fresh fruit or 20g dried fruit per portion, 60g-75g Rice or milk puddings, 2-3 tablespoons (70-90g) Other puddings served with meals 30-45g

Use small amounts of fat in cooking and restrict the amount of fried foods served.

Avoid sweet foods such as cakes, biscuits,

sweet muffins, cookies, flapjacks, pastries, chocolate or other confectionery as snacks between meals.

Avoid salty foods such as crisps and other

savoury snacks and salted biscuits both as snacks and at mealtimes

Use fruit and fruit puree to sweeten dishes

Avoid soft drinks, squashes, fruit-based drinks

(other than diluted fruit juice or 100% diluted fruit smoothies with meals), energy drinks, flavoured water, and artificially sweetened drinks.

Avoid the use of foods/ingredients that are high

in salt such as ready prepared sauces, soups, condiments such as soy sauce, ketchups and other sauces and flavouring powders.

Food safety Nuts especially peanuts, and a number of other foods can cause severe allergic reactions in some children. Settings should be aware of this if using nut based oils in cooking. It is recommended that you visit the www.allergyuk.org website for accurate and reliable information on managing allergies in early years settings.

http://www.allergyuk.org/�



Guidance on food and drink provision for children aged 1-5 years by food group (October 2010) Menu planning guidance

Foods and drinks to avoids Specific foods and ingredients

Children should be able to get all the energy and nutrients they need from a balanced diet made of foods that are easily available to buy and prepare. Functional and fortified foods, or foods advertised specifically for children are not needed to ensure that children can eat well.

Avoid artificially sweetened foods and drinks

Avoid foods with added ingredients designed for adults (e.g. cholesterol lowering products, very high fibre products, foods or drinks with added nutrients or added ingredients).

Avoid ready meals designed for adults and older children as these are often

high in fat, sugar and salt.

Avoid take away foods designed for adults and older children as these are often high in salt, fat and sugar

Tea, coffee, cola and drinks or foods with added caffeine or any other stimulant are not suitable for under fives

Alcohol should not be given to children under 5

Avoid food which contains the artificial colours: tartrazine (E102), guinoline yellow (E104), sunset yellow ( E110) carmoisine ( E122), ponceau (E124), allura red ( E129). In addition avoid foods which contain, E211 (Sodium benzoate)

s The rationale for these recommendations can be found on page 76.



Considering food and drink choices by meal occasion Meal occasion

Guidance

Breakfast A variety of breakfast cereals including whole/multi grain should be offered, select low salt and low sugar options Different types of bread, toast and other bread products should be offered each week, including wholegrain, brown and white varieties Milk or another dairy food such as yoghurt should be offered (or a calcium fortified non-dairy equivalent) Breakfast should include at least 1 fruit or vegetable portion e.g. fruit with cereal, mushrooms with egg Diluted 100% fruit juice (1 part juice to 1 part water) can be served with breakfast

Example breakfasts: • Wheat bisk cereal (20g) with milk (100ml) and raisins (10g), brown toast (20g) with fat spread (4g) and jam (5g), diluted orange juice (50ml juice and

50ml water) • Flaked corn cereal (20g) with milk (100ml) and banana (100g) and diluted orange juice (50ml juice and 50ml water) • Low salt/sugar baked beans (60g) on ½ toasted muffin (30g) spread with fat spread (4g) and diluted orange juice (50ml juice and 50ml water) • Scrambled egg (50g) with sliced cherry tomatoes (10g) on white toast (20g) with fat spread (10g) and diluted orange juice (50ml juice and 50ml water) • Porridge made with milk (100g) with jam (10g), toasted fruit bread (25g) with fat spread (4g) and diluted orange juice (50ml juice and 50ml water)

Snacks: one snack should be provided mid-morning and one snack should be provided mid-afternoon

To avoid damaging children’s teeth, foods and drinks served between meals should be non-erosive (non-cariogenic) and free from added sugar. Offer milk or water to drink. A wide range of savoury foods, milk and fruit snacks can be offered Snacks should be varied every day and planned as part of the weekly menu. Snacks should include more than just fruit or vegetables: starchy foods, dairy foods and meat and alternatives should be included to ensure that snacks

provide energy and other important nutrients. Include a variety of textures and tastes at snack times, using both cooked and raw fruit and vegetables

Example snacks: • Breadsticks (8g), houmous dip (30g), cherry tomatoes (40g), milk (100ml) • Brown roll (20g), soft cheese (20g), carrot sticks (40g), milk (100ml) • Pancake (25g), butter (4g), strawberries (40g), milk 100ml • Oatcakes (20g), cottage cheese (30g), apple chunks (40g), milk (100ml) • Potato wedges (65g), tomato salsa (30g), milk (100ml) • Whole milk yoghurt (70g), apricots tinned in juice (70g), (milk 100ml)



Meal occasion

Guidance

Lunch If early years settings are provided food from a primary school, half size primary school meals are not sufficient for an average child in child care and are likely to be too low in energy, carbohydrate, iron and zinc. Portion sizes for those in early years settings should be approximately 60-70% of the size of those offered to average primary school children and the fruit and vegetable portions offered should be the same as those offered in primary schools (40g per portion)

Lunch should be varied across each week, and across a series of weeks, to ensure a good variety of different foods are served. Remember to balance the food provided at lunch with that provided at tea Meat, poultry, fish or appropriate alternatives (eggs, beans or other non-dairy alternatives) should be served at every lunch. All children should be offered at least one lunch each week which uses eggs, beans or other non-dairy meat and fish alternatives Vegetarian children should be offered at least 4 different non-dairy meat or fish alternatives each week (e.g. pulses, eggs, ground nuts, other meat

alternatives) Different vegetables should be served every day at lunch and baked beans should be offered no more than once each week as a vegetable A variety of starchy foods should be offered across the lunch menu e.g. potatoes, other starchy root vegetables, rice, pasta, bread, other cereals Diluted 100% fruit juice (1 part juice to 1 part water) can be served at lunch

Example lunches: • Cottage pie (180g), carrots (40g), banana custard (100g), diluted fruit juice (50ml juice and 50ml water) • Chicken fajitas (75g), cucumber and cherry tomatoes (40g), sweetcorn salsa (30g), apricot fool (100g), diluted fruit juice (50ml juice and 50ml water) • Mixed bean casserole (110g), new potatoes (80g), peas (40g), baked apple (80g), water • Pasta (80g), vegetarian Bolognese (90g), broccoli (40g), stewed fruit (80g) with Greek yoghurt (50g), diluted fruit juice (50ml juice and 50ml water) • Channa aloo (95g), vegetable pilau (80g), dahl (45g), fresh pineapple (40g), diluted fruit juice (50ml juice and 50ml water) • White fish and broccoli pie (180g), green beans (40g), rhubarb crumble (60g) with custard (50g), water • Mackerel curry (95g), cassava (80g), spinach (40g), mango sorbet (60g), water

Tea Make sure that the timing of this meal meets the needs of children in each setting and it is treated as a main meal if children will not eat again when they arrive home

Tea should be varied across each week, and across a series of weeks, to ensure a good variety of different foods are served. Remember to balance the food provided at tea with that provided at lunch Meat, poultry, fish or appropriate alternatives (eggs, beans or other non-dairy alternatives) should be served at every tea even if this is a cold meal. All children should be offered at least one tea each week which uses eggs, beans or other non-dairy meat and fish alternatives. Vegetarian children

should be offered at least 4 different non-dairy meat or fish alternatives each week (e.g. pulses, eggs, ground nuts, other meat alternatives) Different vegetables should be served every day at tea and baked beans should be offered no more than once each week as a vegetable A variety of starchy foods should be offered across the tea menu e.g. potatoes, other starchy root vegetables, rice, pasta, bread, other cereals Diluted 100% fruit juice (1 part juice to 1 part water) can be served at tea.

Example teas: • Chicken and vegetable couscous (145g), salad (25g), semolina (90g), pears (40g), diluted orange juice (50ml juice and 50ml water) • Savoury omelette (70g), baby jacket potatoes (80g), fresh fruit salad (100g), water • Sardines (40g), toast (20g), tomatoes (40g), orange and lemon rice (90g), diluted fruit juice (50ml juice and 50ml water) • Spicy chickpea salad (55g), chapatti (20g), vegetable sticks (40g), natural fromage frais with fruit (105g), water • Lamb burger (40g), burger bun (45g), lettuce (20g), tomato (40g), fruit jelly (60g), water • Egg and cress sandwiches (80g), vegetable sticks (45g), apple cake (45g), diluted fruit juice (50ml juice and 50ml water)



Other specific advice on menu planning and food provision:

It is important that young children obtain enough iron and zinc to meet their needs for growth and well-being. Studies show that children often have too

little of these nutrients. These nutrients are found in a variety of foods and there is no need to buy fortified foods. In order to ensure that menus provide children with good sources of iron and zinc regularly, include good sources every day.

Additional ideas for iron and zinc rich meals and snacks can be found at www.schoolfoodtrust.org.uk/recipes

Good sources of iron

Wholemeal bread, beef, lamb, sardines, pilchards, soya beans, chick peas, lentils, green leafy vegetables (broccoli, spinach, spring greens), dried apricots, raisins, fortified breakfast cereals, baked beans, salmon, tuna, poultry, egg, tofu.

Good sources of zinc

Lean meat, poultry, sardines, tofu, whole grain and wheat germ breads and cereals, ground nuts, tuna, pilchards, eggs, cheese, beans, peas and lentils, plain popcorn, sesame seeds

http://www.schoolfoodtrust.org.uk/recipes�



Menu planning checklist It is recommended that the following checklist is used by all early years settings to help providers/practitioners review their menu plans Menu planning review Tick if

completed I have put together a food policy for my early years setting and the menus are consistent with that policy

I have planned menus for a period of a week or more (preferably for 3 weeks)

I have included all the meals and snacks each day that the children that I care for, may receive

I have checked that the children that I care for will be offered a meal or a snack regularly (at intervals of no more than about three hours)

I have liaised with the parents and carers of the children that I care for, to make sure they understand the timing of meals and snacks in this setting and that they fit in with the routines that children will have at home.

I have listened to, and worked with, the children that I care for, when planning my menu

I have checked that I am able to meet any special dietary or other requirements a child may have (if needed I have checked this with a health professional)

I have planned different snacks every day following the guidance

I have planned lunches every day following the guidance

I have planned teas every day following the guidance

I have planned a menu which includes good sources of iron and zinc every day following the guidance

I have planned a menu which includes dairy foods following the guidance

I have planned a menu which includes fruit and vegetables following the guidance

I have offered a range of different tastes, colours and textures in the food and meals planned every day



Rationale for the menu planning guidance in the food-based guidance In the guidance table it is suggested a number of foods are restricted or avoided, more information is given here to explain why these recommendations have been made. Generally, if foods and ingredients high in salt and sugar are regularly included in menu plans, it is less likely that the food and drink provided will meet the energy and nutrient requirements for children under five years and ensure that their needs are met across the day during all periods of childcare. Why should salt and sugar be restricted? Salt How much do we need? Salt (sodium) is needed to maintain fluid balance in the body and for nerve and muscle function. Too much salt can cause high blood pressure, which may lead to conditions such as stroke, heart disease and kidney problems. Young children, in particular, should not have high salt intakes as their kidneys are not yet fully developed and cannot excrete excess amounts of sodium, which may accumulate and cause harm. Children aged from 1-4 years old should have no more than about 2-3g of salt per day (about 800-1200mg of sodium). Sources of salt in the diet: Most salt eaten is found in processed food. Foods such as ready-prepared sauces, ready-made soups, condiments such as soy sauce, ketchups and other sauces and flavouring powders, smoked foods, salted snacks and biscuits, takeaway foods, pizzas, burgers, coated chicken and fish products and some meat products are frequently high in salt. How to limit salt intakes Cook from raw ingredients: meat, poultry, fish, eggs, pulses, fruits, vegetables and many starchy foods are naturally low in salt. Do not add salt during cooking for children aged from 1 up to the age of 5 years old, instead flavour savoury dishes using a variety of vegetables and herbs and/or spices. Use small amounts of well-flavoured cheese and look for lower salt varieties of foods such as breads, breakfast cereals and baked beans. When choosing prepared products check the label and choose products lower in salt. FSA guidance on labelling states that:

• 1.5g salt (0.6g sodium) per 100g is ‘high’ • 0.3 g or less of salt (0.1g sodium) per 100g is ‘low’.

Sugar How much do we need? The sugars that can damage teeth are known as non-milk extrinsic sugars, (NME) sugars, and it is recommended that children from 1-4 years old limit the amount of energy they get from these sugars to about 10% of their total energy intake. Food and drinks high in sugar often provide calories but few essential nutrients. Dental decay is widespread among children aged from 1 up to 5 years old in England and children who have sugary foods



regularly have been reported to have higher incidence of decay.t Dental decay is caused by having sugary food and drinks too often as bacteria in the mouth consume sugar and produce acids, which attack tooth surfaces. If these acid attacks happen frequently holes form in the teeth. The teeth of children under the age of five are vulnerable to decay as teeth are developing and the enamel is not as strong as in adult teeth. Decay in the first teeth can impact on the development of the permanent teeth. Sources of sugars in the diet The main sources of the sugars that damage the teeth of children aged under five years are table sugar, soft drinks, squashes and fruit juices, sweetened cereals and cereal products like cakes and biscuits and confectionery. How to limit intakes of sugars that damage teeth If you follow the guidance in this document and the tips below you will reduce the amount and frequency of foods high in sugar children consume: • Avoid sweet snacks and any drinks other than milk or water between meals. • Provide fresh fruit juice or fruit smoothies made with only fruit or fruit juice diluted 1:1

with water. These drinks should be only offered at mealtimes. It is important to be aware that fresh fruit juices and smoothies contain the type of sugars that can damage teeth as the sugars have been released from the fruit itself.

• Provide dried fruit at mealtimes only, not as a snack. Dried fruit is sticky, and when chewed the sugars from the fruit are released and these can stick to teeth and provide a source of sugar for bacteria.

• If sweet foods are served regularly then children may be reluctant to eat other foods therefore try not to add sugar to foods. To add sweetness use foods that are naturally sweet such as fruit or sweeter vegetables such as, carrots, sweetcorn and sweet potatoes.

Tooth erosion Tooth erosion (wearing away of the enamel) is also a problem affecting children aged 1 up to 5 years old. Erosion of the dental enamel will make teeth thinner and more prone to decay. Acidic drinks such as fruit-based drinks and carbonated drinks can contribute to tooth erosion and should, therefore, be restricted to meal-times only. All soft drinks, regardless of whether they say sugar-free, no-added-sugar or reduced sugar can contribute to tooth erosion and should not be provided. Fat Fat is a concentrated source of energy and provides essential fatty acids. Some fat is needed in the diet to make it palatable and to provide energy. Children under five years need nutrient dense diets and should not therefore be given a low-fat diet. A very high-fat intake can lead to excess energy intake however and may not provide all the other nutrients needed. Use the guidance provided to help make choices about the sort of foods to serve but it is useful to restrict the amount of fried foods served.

The table below considers the menu planning guidance given and provides a rationale for the menu planning guidance given. Information about why salt and sugar should be limited has also been given below.

t Hinds K, Gregory J (1995) National Diet and Nutrition Survey: Children aged 1½ to 4 ½ Years. Volume 2: Report of the Dental Survey. London. HMSO.



Food Group Menu planning guidance Rationale Bread, rice, potatoes, pasta and other starchy foods

Food from this group provides energy, carbohydrates, fibre and B vitamins

• Some foods in this group can be high in salt. If food contains more than 1.5g salt per 100g (or 0.6g sodium) it is classed as high in salt. If it contains less than 0.3g salt per 100g (or 0.1g sodium) it is classed as low in salt.

• Choose bread and bread products

with a lower salt content where available

• Avoid dried or canned ready prepared

sauces, canned pasta in sauce, flavoured dried rice, pasta or noodle products as these are high in salt

• Some foods in this group can be high in added sugar. Avoid breakfast cereals with added sugar e.g. sugar coated flakes and chocolate flavoured cereals and aim for those that contain less than 10g sugar per 100g cereal.

• Some processed potato products can

have added fat and salt. Avoid processed potato products such as potato smiley faces or potato waffles. French-fry style or skinny chips can be very high in fat.

• To ensure the energy and nutrient requirements of children under five years old are met across the day, during all periods of childcare, it is necessary to avoid including foods that are high in salt and sugar in menu plans.

• Some processed foods high in salt and/or sugar may also have limited nutritional value, therefore if offered to children these products will fill them up and compromise their intake of other more nutritionally balanced foods.


Fruits and vegetable are important sources of many vitamins including vitamin A and C, minerals such as zinc and iron and fibre.

• Choose tinned vegetables and fruit without added salt or sugar/syrup.

• Dried fruit and fruit juices contain

sugars and if consumed between meals these can cause tooth decay and contribute to tooth erosion.

• Choose lower salt, lower sugar baked

beans and if used as a vegetable, only serve these once a week

• Preparing and cooking fruits and

vegetables: Cut up vegetables and fruit just before they will be eaten or cooked. If fruit and vegetables are prepared in advance, left to soak in water or cooked and then reheated it can reduce the amount of vitamins they contain.

• This guidance is given to reduce the amount of salt and sugar in the diets of children aged 1 up to 5 year olds for the reasons specified on page 74.

• Guidance on preparing fruit and vegetables

is designed to minimise the loss of nutrients through oxidation by the air or leaching into cooking water



Food Group Menu planning guidance Rationale

Meat, fish and alternatives

Foods from this group provide protein, iron and zinc.

• Processed meat products: e.g. sausages, burgers, nuggets and other coated/crumbed chicken products, pies and canned meat should not be served more than once a week.

• Processed fish products e.g. fish

fingers, fish bites or other coated products should not be served more than once a week.

• Processed products made from

meat alternatives such as vegetarian sausages, burgers and pies should be served no more than once in a week.

• Choose tinned pulses with no added

salt and sugar. • Choose lower salt and sugar baked

beans. • Dahl and other dishes made from

pulses should be made without adding a lot of oil and salt.

• Where meat products are served,

good quality versions should be chosen, These are those that adhere to the legal minimum meat content levels set out in the Meat Products (England) Regulations 2003.

• Avoid serving oily fish dishes more

than twice a week as oily fish can contain low levels of the pollutants dioxin and (polychlorinated biphenyls) PCBs.

• Processed products in this group should be restricted as they can be high in salt, fat and saturated fat and do not contain sufficient levels of the important nutrients such as iron and zinc that are provided by unprocessed meat, fish and alternatives to these foods. This is because these essential nutrients have been ‘diluted’ by the addition of crumbs, batter or pastry.

• Restricting the intake of processed meat,

fish and meat alterative products will make it easier for menu plans to meet current guidance for salt intake.

• Good quality meat products with high meat

contents should be chosen as these will have higher protein and lower salt contents therefore helping to ensure the nutritional requirements of children are met.

• Oily fish can contain low levels of the

pollutants dioxin and polychlorinated biphenyls (PCBs) which can build up in the body over time. High levels of dioxins and PCBs in women could affect the development of a baby in the future.




Milk and dairy foods

Foods from this group are a good source of energy, calcium, vitamin A and fat.

• Full-fat milks should be the main

milk drink for children up to two years of age

• Semi-skimmed milks, are

appropriate for children over two years if the child is growing well and eating a healthy balanced diet

• If only one type of milk is available

in early years settings this should be whole milk

• Avoid skimmed milks, oat milk,

rice milk, nut milk and canned milk as the main milk drink

• Avoid sweetened milk drinks and

milkshakes • Milk can be used in desserts such

as rice pudding or semolina • Full-fat varieties of yoghurts and

fromage frais should be provided to children up to the age of two years old

• Use natural yoghurt and fromage

frais and add fruit to naturally sweeten. Some yoghurts and fromage frais have high sugar contents. If the sugar content on a yoghurt or fromage frais label says it has more than 15g of sugar per 100g, it is high in sugar.

• Ice cream and frozen yoghurts can

be high in sugar and should be avoided between meals, but can be served occasionally with fruit based desserts

• Plain calcium fortified soya milk

can be used as a non-dairy alternative to cow’s milk as the main drink for children over one year of age

• Full-fat milk and full-fat milk products are needed for children under two years to ensure they get sufficient energy and other nutrients.

• Skimmed milks and 1% fat milk do not provide

sufficient energy for children under the age of five years as the main drink and are low in fat soluble vitamins.

• Semi-skimmed milks have about 1.7% fat and

these can be appropriate when children over two years are eating and growing well. If there are a mixed group of children however and only one milk is served, it should be whole milk to make sure that younger children or those who do not eat well do not miss out on important nutrients.

• Some milks available as alternatives to cows

milk or calcium fortified soya milk are not suitable as the main drink for children under the age of five years as they may not be good providers of easily absorbed calcium and other nutrients and may have added sugar.

• Rice milks have been found to contain small

amounts of arsenic, and it is currently recommended by the FSA that toddlers and young children between 1 and 4.5 years old should not have rice drinks as a replacement for cows’ milk, breast milk, or infant formula.u

• Canned milks and other milk substitutes may

also have added sugar or be very concentrated and therefore could encourage excessive energy or sugar intake among young children.

• Sugary foods should be avoided between meals

and where possible foods should be sweetened naturally. Small amounts of some foods can however be used as part of a meal to offer variety and different tastes and textures,

• Soya milk drink and soya milk products such as

yogurts are not dairy products but if dairy foods are avoided then calcium fortified plain soya milk should be given as the main drink.

u Food Standards Agency (2009). Survey of total and inorganic arsenic in rice drinks. [online] available at: www.food.gov.uk/science/surveillance/fsisbranch2009/survey0209 [accessed on 29th October 2010]




Drinks • Milk or water should be the only

drinks that are provided between meals

• Soft drinks, squashes, fruit-based

drinks (other than 100% diluted fruit juice with meals), energy drinks, flavoured water, and artificially sweetened drinks should not be provided to children under five years old.

• Avoid artificially sweetened foods

and drinks • Avoid Tea, coffee, cola and drinks

or foods with added caffeine or any other stimulant

• Alcohol should not be given to

children under five years old.

• Avoid all soft drinks, regardless of whether they say sugar-free, no-added-sugar or reduced sugar as these can contribute to tooth damage and provide little nutritional value.

• The School Food Trust recommends that

artificial sweeteners are not appropriate as a means to help children to regulate energy balance and they may encourage children to desire very sweet foods and should not be included in drinks provided in schools. It would seem sensible to avoid the use of these in early years settings since their inclusion offers no nutritional advantage.

• It is recommended that children under the age of

five years old should avoid high amounts of caffeine as this can contribute to disturbed sleep and may impact on behaviour and concentration. Tea and coffee should be avoided in the diet of children under five years old as the tannins contained in these drinks can interfere with iron absorption. Drinks that have added caffeine are not suitable for children aged under five years old as many of these drinks also contain sugar and acid that can damage teeth.

• Alcohol can damage the brain and other organs

of children. It is illegal in the UK to give an alcoholic drink to a child under five.



Specific foods and ingredients

• Avoid foods with added ingredients designed for adults (e.g. cholesterol lowering products, very high fibre products, foods or drinks with added nutrients or added ingredients).

• Avoid artificially sweetened foods

and drinks • Avoid ready meals designed for

adults and older children as these are often high in fat, sugar and salt.

• Avoid takeaway foods designed for

adults and older children as these are often high in salt, fat and sugar

• Avoid food which contains the

artificial colours: • tartrazine (E102), guinoline yellow

(E104) sunset yellow ( E110) carmoisine ( E122) ponceau (E124)

• allura red ( E129). • In addition avoid foods which

contain • Sodium benzoate (E211)

• These products may not be appropriate for children under five years old and are unlikely to have been safety tested for use in this group.

• The addition of high amounts of some vitamins,

minerals or other substances to foods for adults could mean that young children consume amounts that could be potentially dangerous.

• The School Food Trust recommends that

artificial sweeteners are not appropriate as a means to help children to regulate energy balance and they may encourage children to desire very sweet foods and should not be included in drinks provided in schools. It would seem sensible to avoid the use of these in early years settings since their inclusion offers no nutritional advantage.

• The rationale for avoiding foods and drinks high

in salt, sugar and fat has been given on page 74.

• Recent research published by Southampton

University (2007) suggests that eating or drinking some artificial food colours or preservatives could be linked to a negative effect on some children’s behaviour. When colours are used in food, they must be declared in the list of ingredients as 'colour', plus either their name or E number. These colours are used in a wide range of foods that tend to be brightly coloured, including for example some soft drinks, sweets, cakes and ice cream. For up to date information go to the Food Standards Agency (FSA) website www.food.gov.uk/news/newsarchive/2007/sep/foodcolours

Further information can be found at:

Food Standards Agency (FSA) Eatwell website www.eatwell.gov.uk

Caroline Walker Trust (CWT) website: www.cwt.org.uk/publications.html#under5

http://www.food.gov.uk/news/newsarchive/2007/sep/foodcolours�

http://www.food.gov.uk/news/newsarchive/2007/sep/foodcolours�

http://www.eatwell.gov.uk/�

http://www.cwt.org.uk/publications.html#under5�



Case study: Eating through the day Meals Hannah’s journey through the day 08:30: Breakfast

Hannah is three years old and attends a day nursery from 8am to 6pm each day. Today, her mother drops her off at 8am and Hannah has breakfast at the nursery at about 8.30am with some of the other early arrivals. She has a bowl of flaked corn cereal with raisins and milk, some sliced banana, and a cup of diluted orange juice

10:30: Mid-morning snack

At 10.30am the children stop their activities for a snack, which some of them help to prepare and carry to the table. Today, they have some mini cheese and pineapple sandwiches with some extra pieces of pineapple on the side and a cup of milk.

12:30 Lunch

At 12.30pm the children get their hands washed for lunch and sit around small tables in groups of five with a nursery helper sitting with them. Today, they have fish and broccoli pie with sweetcorn and crunchy apple bake. Children are offered a cup of diluted orange juice or a cup of water with their lunch.

15:00 Afternoon snack

At 3pm the children have an afternoon snack which the older children help to lay out. They have some breadsticks, cherry tomatoes and houmous dip, with a cup of milk

17:00: Tea

Some of the children leave the nursery in the afternoon and have their evening meal with their families, but for those who are not picked up until 6pm, and who will be too tired to eat when they get home, tea is served at 5.15pm. Today, Hannah has some fruity couscous with chickpeas and a side salad and apricot fool with chopped apricots. Children are offered a cup of diluted orange juice or a cup of water with their tea.

Photos: Kind permission of Caroline Walker Trust (www.cwt-chew.org.uk)



Appendix 20: Example menu plan over one week which meets suggested food-based guidance and meets the average energy and nutrient needs of children aged 1-4 years. The weights of food portions used in the menu analysis have been included in brackets after the names of the meals and snacks. [Whole milk is used as the main milk drink in this menu and water is freely available throughout the day]

Meal Monday Tuesday Wednesday Thursday Friday Breakfast

Wheat bisks[20g] Milk [100ml] Dried apricots [20g] Wholemeal toast [20g] Fat spread [3g] Diluted orange juice [100ml]

Porridge [100g] Dried mixed fruit [20g] Wholemeal toast [20g] Fat spread [3g] Diluted orange juice [100ml]

Wholemeal toast [30g] Fat spread [4g] and jam [10g] Banana [40g] Diluted orange juice [100ml]

Flaked corn cereal [20g] Milk [100ml] Apple [40g] Wholemeal toast [20g] Fat spread [3g] Diluted orange juice [100ml]

Crisped rice [20g] Milk [100ml] Raisins [20g] Wholemeal toast [20g] Fat spread [3g] Diluted orange juice [100ml]

Mid-morning snack

Half a pear [40g] Natural whole milk yoghurt [60g] Milk [100ml]

Fruit platter: Banana [40g] Mango [20g] Pineapple [20g] Milk [100ml]

Honeydew melon [40g] Rice cakes [8g] Milk [100ml]

Tuna pâté [15g] Breadsticks [8g] Carrot sticks [40g] Milk [100ml]

Orange segments [40g] Oatcakes [20g] and cream cheese [10g] Milk [100ml]

Lunch

Beef Lasagne [150g] Celery and salad leaves [40g] Ginger pear upside-down pudding [40g] with custard [60g] Diluted orange juice [100ml]

Red kidney bean dahl [100g] Chapatti [20g] Tomato salad [40g] Baked apple [80g] Diluted orange juice [100ml]

Roast vegetable tart [90g] Boiled new potatoes [80g] Peas [40g] Fresh fruit salad [80g] with ice cream [20g] Diluted orange juice [100ml]

Quorntm and vegetable chilli [100g] Rice [80g] Mixed salad [40g] Citrus cheesecake [40g] with lemon sauce [15g] Diluted apple juice [100ml]

Salmon fishcakes [60g] Potato wedges [60g] Carrots [40g] and broccoli [40g] Chocolate banana brownie [35g] Diluted orange juice [100ml]

Mid-afternoon snack

Oatcakes [20g] with houmous [20g] Cherry tomatoes [40g] Milk [100ml]

Breadsticks [8g] Carrot sticks [40g] and avocado dip [20g] Milk [100ml]

Cream crackers [7g] with cottage cheese [15g] Cucumber and pepper sticks [40g] Milk [100ml]

Yoghurt [60g] with raspberries [40g] Milk [100ml]

Rice cakes [8g] with peanut butter [10g] Apple slices [40g] Milk [100ml]

Tea

Egg and cress sandwiches with wholemeal bread [75g] Celery and cucumber sticks [40g] Banana custard [100g] Diluted orange juice [100ml]

Spicy beef pizza slices [65g] Sweet potato wedges [40g] Sweetcorn [40g] Tinned mandarin oranges in juice [70g] Diluted apple juice [100ml]

Chicken risotto [100g] Cherry tomatoes [40g] Natural yoghurt [60g] with chopped dates [30g] Diluted orange juice [100ml]

Broccoli quiche [60g] Bean salad [40g] Roll [20g] and butter [3g] Mixed fruit platter [80g] Diluted orange juice [100ml]

Mini falafels [30g] Houmous [20g] Mixed salad [40g] Wholemeal pitta bread [30g] Dried apricots [20g] Fruity flapjack [35g] Diluted orange juice [100ml]



Menu analysis compared with the nutrient based framework of energy and nutrient requirements for 1-4 year olds

Table 11: Comparison of nutrient based framework with menu analysis of example menu

Nutrients Min/Max Average energy and nutrient recommendations for 1-4 year olds in early years settings for a whole day

Average intake from example menu if all meals and snacks eaten

% of whole day recommendations achieved

Energy (kcals) Approx 1160 kcals

1184 102

Fat (g) Approx 45g

44 98

Carbohydrate (g) Approx 155g

166 107

Non-milk extrinsic sugars (NMES; added sugars) (g)

Approx 34.2g

27 79

Protein (g) Approx 14g

41 293

Iron (mg) Min 7.2mg

8.1 113

Zinc (mg) Min 5.7mg

5.8 102

Calcium (mg) Min 330mg

720 218

Vitamin A (µg) Min 390µg

1030 264

Vitamin C (mg) Min 27mg

121.1 449

Sodium (mg) Max 810mg 1010 125



Appendix 21: Nutritional analysis of half-size portions of meals that meet nutrient-based standards for primary schools compared to the Caroline Walker Trust nutrient-based standards for children 1-4 years old

Table 12: Comparison of guidance for food provision in early years

NUTRIENT Min/Max Half primary meal over 1 week

CWT guidance for main meal 1-4 year olds

Comparison CWT with half primary meal portion

Energy (kcals) Approx 310.4 387 ↓

Fat (g) Approx 9.8 15 ↓

Carbohydrate (g) Approx 46.2 51.6 ↓

Non-milk extrinsic sugars (NMES; added sugars) (g)

Approx 7.0 11.4

Protein (g) Approx 11.6 4.7

Iron (mg) Min 1.9 2.4 ↓

Zinc (mg) Min 1.5 1.9 ↓

Calcium (mg) Min 118.1 110

Vitamin (Aug) Min 176.9 130

Vitamin C (mg) Min 19.4 9

Sodium (mg) Max 249 270



Appendix 22: Nutrient-based guidelines compiled by The Caroline Walker Trust to be used as a possible framework for food-based guidelines for food and drink provided in early years settings

Nutrient-based standards Nutrient-based standards have been compiled by the Caroline Walker Trust (CWT)44 using the UK wide reference nutrient intakes for energy and nutrients compiled in 199111 and the recommended target salt intake to be achieved by populations of infants and children recommended by SACN in 2003.10 This salt target does not represent an optimal or ideal consumption level for infants and children but an achievable population goal.10

Dietary Reference Values for energy and nutrients for under five year olds In 1991 the Department of Health Committee on Medical Aspects of Food and Nutrition Policy (COMA) published Dietary Reference Values (DRVs) which define the amounts of energy and nutrients that would meet the daily needs of most people in the UK.11 The Dietary Reference Values include 'Estimated Average Requirements' (EAR), and 'Reference Nutrient Intakes' (RNI). These terms are explained below.

Dietary reference values (DRVs) Dietary reference values (DRVs) are benchmark intakes of energy and nutrients. They indicate the amount of energy or individual nutrients needed by a group of people of a certain age range (and sometimes gender) for good health. They are not designed for working out a diet for an individual; eating less of a nutrient than is specified cannot tell us that an individual is deficient. However, if more than quite a few people in a group fall below the reference values, this suggests that some individuals in that population may be at risk of deficiency. The DRVs for energy are described as the estimated average requirement (EAR). Most other nutrients have an EAR and also a reference nutrient intake (RNI) and a lower reference nutrient intake (LRNI). These terms are described below. Estimated average requirement (EAR): The average amount of energy or nutrients needed by a group of people. Half the population will have needs greater than this, and half will have needs below this amount. Reference nutrient intake (RNI): This is the amount of a nutrient which is enough to meet the dietary requirements of about 97% of a group of people. If people get more than this amount they will almost certainly be getting enough. Lower reference nutrient intake (LRNI): This is the amount which is sufficient for the 3% of a group of people with the smallest needs. Most people will have needs greater than this.



Energy

The current (1991) Estimated Average Requirements (EAR) for energy for children aged six months to four years, that is how many calories a day they require are shown below.

Table 13: Estimated average requirements (EARs) for energy for children under the age of 5 years Age of child Estimated average requirement in kcal (kJ) per day* Boys Girls 6 months 760 (3,200) 710 (2,980) 9 months 880 (3,680) 820 (3,420) 1 year 960 (4,020) 910 (3,800) 1½ years 1,080 (4,520) 1,020 (4,260) 2 years 1,190 (4,960) 1,130 (4,720) 2½ years 1,280 (5,370) 1,230 (5,140) 3 years 1,490 (6,230) 1,370 (5,730) 4 years 1,600 (6,730) 1,460 (6,120) * In practice, the intakes of energy and of nutrients needs to be averaged over several days to take account of variations in appetite and in the diverse foods in a diet from day to day. The energy required every day is determined, both by a basic level of requirement to keep the body functioning (called the basal metabolic rate or BMR) and by the amount of physical activity (for example moving around, walking, or exercising). Young children also require a small amount of energy to grow. People who are inactive have lower energy requirements and will eat less food to maintain their body weight. It becomes much harder to get all the nutrients needed for good health if less food is eaten.

Fat and carbohydrate There are no recommendations for children under five years of age which state the proportions of dietary energy that should come from fat and total carbohydrate. If children under five years have too little fat, this may adversely affect their growth and development because their diet may be too low in other essential nutrients. Between the ages of two and five years children's diets should move towards the recommendations currently made for those over five years. However, the Caroline Walker Trust (CWT)44 suggests that diets which provide about 35% of energy from fat are likely to be suitable for children aged 1-4 years. The recommendation currently made to restrict the amount of non-milk extrinsic sugars (NMES) in the diet to no more than 11% of energy intake is, however, appropriate for children under five years of age.



Derived nutrient values used for calculating the nutrient-based standards in this report The energy and nutrient values that have been used to create the nutrient-based standards in this report are based on the current dietary reference values (DRVs) for the UK11 and additional recommendations on salt intakes.10 Energy values are based on the following dietary reference values:

• 1-2 year olds: average for boys and girls at 12 months, 18 months, 24 months and 30 months

• 3-4 year olds: average for boys and girls aged three years and four years. Values for other nutrients are based on the following dietary reference values:

• 1-2 year olds: as for 1-3 year olds • 3-4 year olds: 50% as for 1-3 year olds and 50% as for 4-6 year olds.

Table 14: The dietary reference values (DRVs) for children aged 1-2 years, 3-4 years and 1-4 years which are an average of those aged 1-2 and 3-4 years Nutrient 1-2 year olds 3-4 year olds 1-4 year olds Energy (kcals) (MJ)

1,100 4.6

1,480 6.2

1,290 5.4

Fat (g) 42.8 57.6 50.2 Carbohydrate (g) 146.7 197.3 172.0 Non-milk extrinsic sugars (NMES) (g)

32.3 43.4 37.8

Protein (g) 14.5 17.1 15.8 Iron (mg) 6.9 6.5 6.7 Zinc (mg) 5.0 5.8 5.4 Calcium (mg) 350 400 375 Vitamin A (ug) 400 450 425 Vitamin C (mg) 30 30 30 Sodium (mg) 800 1000 900 Salt (g) 2 2.5 2.3 Table 15: SACN (2003) salt recommendations: the reference nutrient intakes (RNI) for sodium and target average salt intakes (g/d) for infants and children Nutrient 0-6

months 7-12 months 1-3 years 4-6 years 1-4 years

Salt (g) <1 1 2 3 2.3 Sodium (g) <0.4 0.4 0.8 1.2 0.90 Sodium (mg) 400 400 800 1200 900 To convert sodium to salt, multiply by 2.5 To convert salt to sodium, divide by 2.5.



The nutrient-based standards compiled divide up the meals and snacks across the day and make a number of assumptions: The energy requirements are suggested as being realistically spread across the day as follows:

• Breakfast 20% • Mid-morning snack 10% • Lunch 30% • Mid-afternoon snack 10% • Tea 20%

This leaves 10% of energy and nutrients for an additional drink, or drink and snack, in the evening.

Children in full-day childcare (8 hours or more) Children in childcare for a full-day will receive the majority of their food while in childcare and therefore CWT44 and the Panel recommends that the food provided gives the children 70% of their daily requirement for energy and no more than 70% of the maximum recommended amount of non-milk extrinsic sugars and sodium/salt. The remaining 30% of energy and other nutrients will come from breakfast and from any drinks, snacks or light meals the child receives at home. Children in childcare for a whole day should receive not less than 80%of their requirements for iron and zinc, since the diets of some children under the age of five years are low in these nutrients. All children are encouraged to have breakfast and where this is provided it is assumed that 20% of a child’s energy and nutrient requirements should be met by breakfast.

Children in half-daycare Half-daycare involves either a morning or afternoon session and is likely to include one meal and at least one snack. Lunch is likely to be the major provider of food during the day and therefore children who have lunch and a snack should receive 40% of their daily requirement for energy and at least 40% of their daily needs for most nutrients (and no more than 40% of the recommended maximum amount of non-milk extrinsic sugars or sodium/salt) from these meals, and not less than 45% for iron and zinc. Those having a snack and tea should receive not less than 30% of their needs (and not less than 35% for iron and zinc).

Children having a snack only Children in childcare for a morning or afternoon session which does not include a meal should receive a snack during this session if the period of care exceeds two hours. They should have two snacks if the session is five hours or more but does not include a meal – for example 12.30pm to 5.30pm care, missing lunch and leaving before tea. The derived nutrient based standards for children 1 up to 5 years in a variety of childcare sessions are shown in Table 16.



Nutrient-based standards for food prepared for 1-4 YEAR OLDS in childcare based on dietary reference values (DRVs): summary of recommendations The table below summarises the proportion of nutrients that each eating occasion should achieve for children in childcare. The figures are for the recommended average nutrient content of meals and snacks provided for children under five years old over a one-week period. Table 16: The proportion of nutrients that each eating occasion should achieve for children under five years old in childcare Nutrient DRV Full daycarev Morning

session: Snack and Lunch

Afternoon session: Snack and Tea

Snack only

Lunch only

Tea only

Energy % of the Estimated Average Requirement (EAR)

70% of EAR 40% of EAR 30% of EAR 10% of EAR 30% of EAR 20% of EAR

Fat % of food energy About 35% About 35% About 35% About 35% About 35% About 35% Total carbohydrate

% of food energy About 50% About 50% About 50% About 50% About 50% About 50%

Non-milk extrinsic sugars

% of food energy Not more than 11%

Not more than 11%

Not more than 11%

Not more than 11%

Not more than 11%

Not more than11%

Protein % of the Reference Nutrient Intake(RNI)

At least 70% At least 40% At least 30% At least 10% At least 30% At least 20%

Iron % of the RNI At least 80% At least 45% At least 35% At least 10% At least 35% At least 25% Zinc % of the RNI At least 80% At least 45% At least 35% At least 10% At least 35% At least 25% Calcium % of the RNI At least 70% At least 40% At least 30% At least 10% At least 30% At least 20% Vitamin A % of the RNI At least 70% At least 40% At least 30% At least 10% At least 30% At least 20% Vitamin C % of the RNI At least 70% At least 40% At least 30% At least 10% At least 30% At least 20% Sodium % of the SACN

target average Not more than 70%

Not more than 40%

Not more than 30%

Not more than 10%

Not more than 30%

Not more than 20%

Salt % of the SACN target average

Not more than 70%

Not more than 40%

Not more than 30%

Not more than 10%

Not more than 30%

Not more than 20%


Aim to offer 4-5 different types.

During the day carers should offer children 4-5 different types of fruits and vegetables at meals and snacks.

% of food energy = Percentage of calories consumed; EAR = Estimated average requirement; RNI = Reference nutrient intake SACN = Scientific Advisory Committee on Nutrition

v The remaining 30% of energy and other nutrients will come from breakfast and from any drinks, snacks or light meals the child receives at home.



How do the standards translate into specific nutrients for groups of children of different ages?

Nutrient-based standards for food prepared for 1-4 YEAR OLDS in childcare Table 17: The recommended nutrient content of an average day’s food and drink over a period of one week or more (1-4 year old children) Nutrient Min/Max Full daycare Morning session:

Snack and lunch Afternoon session: Snack and tea

Snack only

Lunch only

Tea only

Energy (kcals) Approx 903 516 387 129 387 258 Fat (g) Approx 35.0 20.0 15.0 5.0 15.0 10.0 Total carbohydrate (g) Approx 120.4 68.8 51.6 17.2 51.6 34.4

Non-milk extrinsic sugars (NMES) (g)

Approx 26.6 15.2 11.4 3.8 11.4 7.6

Protein (g) Approx 11.0 6.3 4.7 1.6 4.7 3.1 Iron (mg) Min 5.5 3.1 2.4 0.7 2.4 1.7 Zinc (mg) Min 4.3 2.4 1.9 0.5 1.9 1.4 Calcium (mg) Min 260 150 110 40 110 70 Vitamin A (µg) Min 300 170 130 40 130 90 Vitamin C (mg) Min 21 12 9 3 9 6 Sodium (mg) Max 630 360 270 90 270 180 Salt (g) Max 1.6 0.9 0.7 0.2 0.7 0.5 Fruit and vegetables Aim to offer 4-5

different types. During the day carers should offer children 4-5 different types of fruits and vegetables at meals and snacks.

Numbers have been rounded up or down where necessary, to ensure that figures for different periods of childcare add up appropriately.



Nutrient-based standards for food prepared for 1-2 YEAR OLDS in child care Table 18: The recommended nutrient content of an average day’s food and drink over a period of one week or more (1-2 year old children) Nutrient Min/Max Full daycare Morning session:

Snack and lunch Afternoon session: Snack and tea

Snack only

Lunch only

Tea only

Energy (kcals) Approx 770 440 330 110 330 220 Fat (g) Approx 30.0 17.1 12.8 4.3 12.8 8.5 Total carbohydrate (g)

Approx 102.7 58.7 44.0 14.7 44.0 29.3


Approx 22.6 12.9 9.7 3.2 9.7 6.5

Protein (g) Approx 10.2 5.9 4.4 1.5 4.4 2.9 Iron (mg) Min 5.5 3.1 2.4 0.7 2.4 1.7 Zinc (mg) Min 4.0 2.3 1.8 0.5 1.8 1.3 Calcium (mg) Min 245 140 105 35 105 70 Vitamin A (µg) Min 280 160 120 40 120 80 Vitamin C (mg) Min 21 12 9 3 9 6 Sodium (mg) Max 560 320 240 80 240 160 Salt (g) Max 1.4 0.8 0.6 0.2 0.6 0.4 Fruit and vegetables



Numbers have been rounded up or down where necessary, to ensure that figures for different periods of childcare add up appropriately.



Nutrient-based standards for food prepared for 3-4 YEAR OLDS in childcare Table 19: The recommended nutrient content of an average day’s food and drink over a period of one week or more (3-4 year old children) Nutrient Min/Max Full daycare Morning session:

snack and lunch Afternoon session: snack and tea

Snack only

Lunch only

Tea only

Energy (kcals) Approx 1,036 592 444 148 444 296 Fat (g) Approx 40.3 23.0 17.3 5.7 17.3 11.6 Total carbohydrate (g)

Approx 138.1 78.9 59.2 19.7 59.2 39.5


Approx 30.3 17.3 13.0 4.3 13.0 8.7

Protein (g) Approx 11.9 6.8 5.1 1.7 5.1 3.4 Iron (mg) Min 5.3 3.0 2.3 0.7 2.3 1.6 Zinc (mg) Min 4.6 2.6 2.0 0.6 2.0 1.4 Calcium (mg) Min 280 160 120 40 120 80 Vitamin A (µg) Min 315 180 135 45 135 90 Vitamin C (mg) Min 21 12 9 3 9 6 Sodium (mg) Max 700 400 300 100 300 200 Salt (g) Max 1.75 1.0 0.75 0.25 0.75 0.5 Fruit and vegetables



Numbers have been rounded up or down where necessary, to ensure that figures for different periods of childcare add up appropriate



Appendix 23: Summary of current good practice to encourage children in early years settings to eat well Table 20: Summary of current good practice to encourage children to eat well in early years settings What good practice to encourage Why do this? Examples of how to achieve this Listening to children: • It is important to involve children in discussions

about the food and drink served in childcare settings and to encourage them to talk about their likes and dislikes and to let them be involved in menu planning.

• Carers have an important role in listening to children and encouraging them to become involved in making decisions about food. Research has shown that pre-school children often want to be involved in menu planning and food choice and this is an important part of their development.75

• Encourage children to look at pictures, photographs or models of different foods, and use these in games and activities.

• Tell children what is on the menu each day and explain what different dishes contain. Allow children to see the ingredients for new dishes and to watch food being prepared.

• Involve children in growing food, shopping for food, basic food preparation, laying the table and clearing up after meals as appropriate.

• Give children an opportunity to talk about the meals and snacks they have had and to offer their opinions about them.

Listening to and working with parents and carers: • A real partnership between parents, carers and

childcare settings will ensure everyone is working together to best meet the needs of each child.

• Children will spend different proportions of the day in childcare settings and may be in more than one setting over a day or week. It is essential that the needs of each child remain at the centre of everything a childcare setting does to support each child to eat and drink well, and therefore good communication with parents and carers is essential.

• Many parents and carers also welcome support and information about eating well for their children. Childcare settings can play an important role in ensuring that good practice in their setting is also passed on to parents and carers in the home environment.

• Make sure all those using the childcare setting know that it is committed to providing healthy, varied and enjoyable food and has a clear food policy for the setting.

• Make information about menus, recipes and ingredients used easily accessible to parents and carers and offer parents menus at the beginning of each week so they can plan meals to complement these at home. If changes are being made to the foods served make sure parents and carers are given notice of this and are given the opportunity to comment on and discuss the changes.

• Ask parents and carers for suggestions of meals and snacks to serve and invite parents and carers to share meals with the children and staff on special occasions.

• Give parents a summary of what children have eaten and drunk in their childcare setting each day.



Table 20: Summary of current good practice to encourage children to eat well in early years settings What good practice to encourage Why do this? Examples of how to achieve this Respecting our children’s future: • Sustainable development is about enabling

people throughout the world to satisfy their basic needs and enjoy a better quality of life, without compromising the quality of life of future generations and the ability of future generations to meet their own needs.

• All settings should consider how they can contribute to a more sustainable future for all through the foods they buy and the meals and snacks they offer to children in their care

• The UK is committed to significantly reducing its carbon emissions by 2020.

• All Government departments and local authorities have plans and policies in place which will support sustainability, and which make suggestions about ways in which settings can become more energy efficient, reduce waste, recycle and encourage low energy transport and activities.

• Everyone can contribute to reducing carbon emissions for example, by reducing the amount of food that is wasted, by choosing food that is grown locally and seasonally, hasn’t travelled long distances, by considering the energy cost of food preparation or by buying foods like fish which come with a guarantee that they are not from dwindling or endangered fish stocks.

• When planning meals and snacks consider the importance of buying locally produced and seasonal food, minimising food waste and recycling packaging. Buy fish from sources approved by the Marine Stewardship Council (MSC).

• For information about using seasonal food see www.schoolfoodtrust.org.uk/resources/seasonalitychart

• Buy fish from sources approved by the Marine Stewardship Council (MSC).

• Include sustainable food plans in your setting food policy. Refer to DEFRA Government buying standards: www.defra.gov.uk/sustainable/government/advice/public/buying/index.htm

• For more information about sustainable food in early years settings see www.cwt.org.uk/publications.html#sustain

Food for all: • All children and their parents and carers should

be respected as individuals and religious and cultural food requirements should be accommodated.

• It is important to be inclusive in early years settings and to appreciate the importance of food in defining culture and lifestyle in many families.

• Children gain rich experience though sharing food with others and learning about culture and food.

• Holidays and festivals provide a valuable opportunity to celebrate differences in food experiences.

• Consult parents and carers about the cultural or religious requirements around food for each child, and make sure appropriate food is provided to meet both these and the recommended guidance.

http://www.defra.gov.uk/sustainable/government/advice/public/buying/index.htm�

http://www.defra.gov.uk/sustainable/government/advice/public/buying/index.htm�



Table 20: Summary of current good practice to encourage children to eat well in early years settings What good practice to encourage Why do this? Examples of how to achieve this Supporting children with special needs: • The needs of each child should be at the

centre of good care, and as far as possible all children, regardless of any physical or learning disability or need for a special diet should be able to eat a healthy diet in the same way as any other child.

• Some children in childcare settings may have special dietary needs (foods or ingredients they must avoid for example) and some children may have difficulties in eating or drinking and need extra support.

• In order that every child feels valued and included, and is given the opportunity to access healthy food and drink choices appropriate to their needs, it is important that childcare settings work with parents, carers and health professionals to offer as an inclusive environment as possible to any child with special needs.

• If children require special diets for specific medical conditions then advice on supporting these children should be available via the dietitian or paediatrician responsible for the child’s care.

• An allergy plan should be considered in all settings to ensure that children with food allergies are managed appropriately. Information on this is available in FSA’s Allergy training and allergy advice http://allergytraining.food.gov.uk/english/

• Encourage children with special needs and physical disabilities to eat the same healthy diet, in the same way, as other children in the setting.

• Ensure appropriate seating arrangements, cutlery and crockery are available for children who may need extra support at mealtimes.

• Seek appropriate advice and support from dietitians and other health professionals as appropriate to ensure that every individual child’s needs are met.

• Put an allergy plan in place to manage children with food allergies.

http://allergytraining.food.gov.uk/english/�



Table 20: Summary of current good practice to encourage children to eat well in early years settings What good practice to encourage Why do this? Examples of how to achieve this Timing of meals, snacks and drinks • Children should be offered food and drink at 3

meals and 2 snacks during the day (one in the morning and one in the afternoon), and meals and snacks should be no more than 3 hours apart.

• Young children need to eat regularly as they have high energy requirements for growth and may need to eat nutritious food little and often to ensure they obtain all the energy and nutrients they need.

• Plan menus for each week with details of the timings of meals and snacks.

• Breakfast is an important meal for children. • Breakfast foods offer good sources of fibre, carbohydrate, vitamins and minerals and all children should be encouraged to eat breakfast. Some children may miss out on breakfast if they are being transported to childcare settings or are later risers and it is important that children with different routines do not miss out on this meal.

• Parents, carers and child carers should work together to ensure that children have breakfast either at home or when they arrive in childcare.

• Carers should check if children have had breakfast if they arrive for morning childcare and be able to offer appropriate food and drink where needed.

• Children need regular drinks. • Children need to drink fluid at regular intervals to replace that lost in energetic activities and play and to ensure they do not become dehydrated. Dehydration is associated with tiredness, irritability and difficulties in going to the toilet and can lead to infections and serious health problems.

• Fresh, chilled water should be freely available to children in child care settings in a variety of ways, such as in covered jugs, water fountains, cooled water units using mains water or tap water placed in bottles in the fridge.

• Provide suitable cups and mugs for the children and encourage them to help themselves to water to drink where appropriate.

• Offer drinks at mealtimes as well as in-between meals and check with other carers and parents when children have been offered drinks each day.

• Children can sometimes be slow eaters so give them enough time to eat.

• Children will eat at different paces and some children who are slow eaters may miss out at mealtimes if food is removed too quickly.

• If children are slow eaters enable them to finish their meals and snacks by continuing to sit with them and encourage them at mealtimes.



Table 20: Summary of current good practice to encourage children to eat well in early years settings What good practice to encourage Why do this? Examples of how to achieve this Celebrations and special events • Celebrations and special occasions are an

important part of everyone’s lives and childcare settings should support and encourage families to enjoy these occasions within their eating well policy.

• Special foods and drinks are often given to mark special occasions such as birthdays, religious festival days or special cultural events.

• These occasions often provide an

opportunity for rich experiences for young children in childcare settings and to involve families and carers. It is, however, likely that children will have the opportunity to celebrate many of these events, and to have special foods and drinks associated with them, outside the childcare setting. It is unlikely that children will miss out on ‘treats’ if these are not offered in settings.

• There are many ways to celebrate events

without the need for lots of foods high in sugar, fat or salt and when there are a number of children in settings the number of special occasions can make this an ordinary, rather than extraordinary occurrence.

• Celebrate birthdays, festivals and special occasions with special craft activities, songs and stories, dressing up, decorating the rooms, playing special games and encouraging children to find out more about a wide range of events from a variety of cultures.

• Ask parents and carers to save sweet treats, cakes or

other celebration foods for the children to have at home and not bring them to the childcare setting.

• Ask parents and carers who wish to send in a special

treat for the children to celebrate an event to send in stickers, pencils or balloons that all the children can enjoy.

• Provide special foods for celebrations that fit in with

the setting’s eating well policy. For example, birthday children can have the chance to blow out candles on a special non-edible cake and to choose party foods they would like from a healthy party snacks book.



Table 20: Summary of current good practice to encourage children to eat well in early years settings What good practice to encourage Why do this? Examples of how to achieve this Bringing food and drink from home and promoting breastfeeding

• Encourage parents to continue breastfeeding their infants and young children. Offer a supportive environment for parents and parents-to-be which promotes breastfeeding.

• If parents and carers want to supply their own

food and drink to children in childcare settings, it is important that this fits in to the eating well policy of the setting and can be stored safely until consumption. Parents should be encouraged to offer the same healthy food choices as would be available in the setting.

• Breastfeeding is the ideal way to feed infants in the first six months of life and can be continued throughout the first year of life alongside complementary food, and longer if the parents wish. Breastfeeding has many advantages for the infant and the mother and more information can be found at Department of Health.76

• Parents may wish to provide expressed breast milk for an infant in a childcare setting and this should be encouraged and enabled by all settings. Details of how to support parents to provide breast milk and how to store this safely can be found in NICE guidelines77 or UNICEF Baby Friendly Initiative.78

• Parents and carers who provide infant formula milk for their infant should provide this as either ready to feed formulation or as dry powder (unopened tins) that can be made up freshly for each feed. Instructions for the safe preparation of infant formula can be found in the DH document ‘Birth to Five’.72

• It is helpful if all children are eating similar foods. If children bring food from home that is very different to the food offered in settings this may disrupt the benefits associated with children sharing the same food and eating together.

• Support parents to continue offering their infants breast milk and have a clear policy promoting breastfeeding.

• Work with local UNICEF breastfeeding coordinators or other breastfeeding support organisations to promote breastfeeding in your setting.

• Store food brought into the childcare setting safely and reheat following clear guidance on food safety.

• Where possible ensure all children in the setting can eat together and eat similar food. Where food is brought in from home, parents and carers can be asked to ensure that it fits in with the settings healthy eating policy in terms of both the types of foods offered, and the amounts of foods offered.

• Ensure food that comes into the setting is safe for all the children who may have contact with it.



Helping fussy eaters: • Pre-school children may often be fussy about

what they eat, or how they eat, and settings should work with parents and carers to ensure that all children access healthy food that they enjoy and are encouraged to try new foods even if these are initially rejected.

• Periods of fussy eating among under 5s are not unusual. Children should be gently encouraged to try new foods but not forced to eat them, and a variety of healthy foods should be offered to ensure that children will have something they like at each meal and snack.

• There are simple suggestions on how to tackle food refusal in section 5.7 of the final report

• Encourage children to try a variety of foods, by offering a very small amount at first, but respect individual preferences.

• Try and ensure that meal and snack times are relaxed and friendly and children are given lots of praise when they try new foods and eat well.

• Children should be offered a variety of foods at every meal, even if they have previously rejected them, as sometimes foods become liked when they have been offered and tasted a number of times.

• Children should never be punished or rewarded with food of any kind.

• Children can be encouraged to grow food, shop for food, taste foods and help prepare meals and snacks as appropriate to encourage them to become familiar with different foods and ingredients.

Learning through food: • Childcare settings provide an opportunity for

children to learn about food, healthy eating, the seasons, growing cycles, the importance of protecting the environment and other people’s way of life.

• Research suggests that even very young children are keen and ready to learn more about food and healthy eating and that learning how to choose and enjoy many different foods can provide a firm foundation for later good food choices.7980

• Lots of activities can help children find out more about food and eating well. Craft activities, gardening projects, role playing and imagination games, food tasting, cooking, singing and poetry can all involve children in discussions and hands on activities related to food.

• All children can be encouraged to take part in food preparation, in laying tables and clearing up after meals and in planning menus.



Food safety and good hygiene practices • Food served to all pre-school children should

be stored, prepared and presented in a safe and hygienic environment.

• Young children have weaker immune systems and are more vulnerable to food poisoning.

• It is very important that all carers are aware of the latest guidance on preventing food-borne illnesses and understand preventative food hygiene.

• All staff should have a completed a food hygiene certificate.

• Children should never be left alone when eating at any age.

• Children in highchairs should always be safely strapped in and supervised at all times.

• Any milk or food brought into the childcare setting by parents should be stored following appropriate guidance

• All children should be enabled to wash their hands with soap and water before eating and after toileting or taking part in other activities which may encourage the spread of germs.

• All staff should wash their hands with soap and water before preparing food, serving food, helping children to eat, after toileting children, blowing or wiping noses, sneezing or any other activity which may spread germs.

• All fruit and vegetables served to children raw should be thoroughly washed



Appendix 24: Ofsted: Using the early years evaluation schedule

'The extent to which children adopt a healthy lifestyles’ in early years settings’: Summary of grade descriptors 1. Judgements

Ofsted’s 2009 guidance ‘Using the early years evaluation schedule’ requires inspectors to make a number of judgements when inspecting registered early years settings delivering the Early Years Foundation Stage. These are:

• The overall effectiveness of the early years provision • Leadership and management of the early years provision • The quality of the provision in the Early Years Foundation Stage • Outcomes for children in the Early Years Foundation Stage.

2. Outcomes for children in the Early Years Foundation Stage

2.1 Inspectors should evaluate:

• The extent to which children enjoy their learning and achieve well; feel safe; learn to lead healthy lifestyles; make a positive contribution; and develop their skills for the future.

2.2 Inspectors make judgements on, 'The extent to which children adopt a healthy lifestyle' within this section and should evaluate:

• The extent to which children know and understand how to lead a healthy lifestyle.

2.3 Inspectors should take account of:

• The extent to which children understand and adopt healthy habits such as good hygiene practices

• The extent to which children are active and understand the benefits of physical activity

• The extent to which children make healthy choices about what they eat and drink.

2.4 Ofsted inspects against the requirements and statutory guidance of the EYFS and inspectors will record any relevant evidence against the outcome of ‘being healthy’. Inspectors focus on what it is like for a child in the setting, and this is the starting point for all inspections. For example, if inspectors were present during mealtimes, and they found that the quality and nutritional value of food provided was particularly good, or particularly poor, then this would be reflected in their evidence and included in their report. This may affect the judgement they give for ‘outcomes for children in the Early Years Foundation Stage’ (personal communication).

2.5 Ofsted's guidance ‘Using the early years evaluation schedule’ is on Ofsted’s website and sets out what inspectors will look for and the evaluation schedule they use will also guide them towards making relevant judgements against the outcomes. The link to the relevant page of Ofsted's website is www.ofsted.gov.uk/Ofsted-home/Forms-and-guidance/Browse-all-by/Care-and-local-services/Childcare/Inspection

http://www.ofsted.gov.uk/Ofsted-home/Forms-and-guidance/Browse-all-by/Care-and-local-services/Childcare/Inspection�

http://www.ofsted.gov.uk/Ofsted-home/Forms-and-guidance/Browse-all-by/Care-and-local-services/Childcare/Inspection�



3. Grade descriptors on the extent to which children adopt a healthy life

The grade descriptors on the extent to which children adopt a healthy lifestyle

Outstanding (1)

All children show an exceptional understanding of the importance of following good personal hygiene routines. They show an excellent understanding of healthy eating and make healthy choices at snack and meal times. Children have innovative opportunities to engage in a wide range of physical activities, both indoors and out and gain a secure understanding about the importance of regular exercise as part of maintaining a healthy lifestyle. Children have ownership of their health and well-being and demonstrate they are well informed about healthy living. Babies and very young children are extremely content and settled because their individual health, physical and dietary needs are met to an exceptional standard.

Good (2) Most children show good awareness about what constitutes a healthy lifestyle. They adopt good personal hygiene routines and understand the importance of healthy eating. Children engage in a wide range of physical activities, both indoors and out, increasing their understanding about the importance of regular exercise as part of maintaining a healthy lifestyle. Babies and very young children appear content and settled because their health, physical and dietary requirements are well met.

Satisfactory (3) Children are beginning to show an understanding about healthy lifestyles. They follow appropriate personal hygiene routines, although sometimes need prompting by adults. Some children, although not all, show an understanding about the importance of regular exercise and they enjoy opportunities to engage in physical activities, both indoors and out. Overall, babies and very young children’s health, physical and dietary needs are adequately met.

Inadequate (4) Children have little or no understanding about what contributes to a healthy lifestyle

and/or

Children have few opportunities to engage in physical activities on a regular basis and are not helped to understand the benefits of regular exercise and the importance of a healthy diet

and/or

Children are not helped to understand the importance of adopting healthy habits and hygiene practices, which compromises their ability to keep themselves safe and healthy

and/or

Babies and very young children appear fractious, tired and unsettled because adults fail to meet their health, physical and dietary requirements to a satisfactory standard.

Source: Ofsted (2009) Using the early years evaluation schedule: Guidance for inspectors of registered early years settings required to deliver the Early Years Foundation Stage Reference No. 080124



References

1 DHSS. (1980). The Black Report Inequalities and Health. [online]. Available at: www.sochealth.co.uk/Black/black.htm [accessed on 1st September 2010] 2 Acheson, D. (1998). Independent enquiry into inequalities in health (The Acheson Report). Department of Health 3 Department of Health. (2001). Shifting the balance of power within the NHS: Securing delivery. [Online] available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009844 [accessed on 1st September 2001] 4 Department of Health (2004). Choosing Health: Making healthier choices easier. (Cm 6374). 5 Marmot. M, Allen. J, Goldblatt. P, Boyce. T, McNeish. D, Gradym. M and Geddes. I. (2010). Fair Society, Health Lives: The Marmot Review. 6 Audit Commission. (2010). Giving children a healthy start: Health report. Audit Commission, London 7 Children Act 2004. (c.31), London: HMSO 8 DfES (2004). Every Child Matters: Change for Children. HM Government. 9 Department of Health (1989). Dietary Sugars and Human Disease. London: HMSO 10 Scientific Advisory Committee on Nutrition (2003). Salt and Health. London: TSO 11 Department of Health. (1991). Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report on Health and Social Subjects No. 41. London. HMSO 12 Department of Health. Committee on the Medical Aspects of Food Policy ( COMA) Report on Weaning and the Weaning Diet. HMSO, London, 1994 13 Health Education Authority. (1994). The Balance of Good Health. [Online]. Available at: www.food.gov.uk/multimedia/pdfs/bghbooklet.pdf [Accessed on 1st September 2010] 14 Department of Health. (2000). The NHS Plan: a plan for investment, a plan for reform. (Cm 4818-I). HMSO: London 15 Department of Health. (2003). Infant Feeding Recommendations. [Online]. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4097197 [accessed on 1st September 2010] 16 The Healthy Start Scheme and Welfare Food (Amendment No. 2) Regulations. (2006). SI 2006/2818, London:HMSO. 17 Ofcom. (2006). Television advertising of food and drink products to children: Executive Summary. [Online]. Available at: http://stakeholders.ofcom.org.uk/consultations/foodads/summary [accessed on 1st September 2010 18 Department for Education and Skills (2004). Every Child Matters: Change for Children. HM Government. 19 Department for Education and Skills (n.d,). Ten Year Strategy. [Online]. (updated 30th April 2009). Available at: www.dcsf.gov.uk/everychildmatters/earlyyears/surestart/aboutsurestart/strategy/10yearstrategy/ [accessed on 1st September 2010] 20 Department for Children, Schools and Families, (2008). Statutory Framework for the Early years Foundation Stage. Every Child Matters: Change for Children 21 Phillips. R, Norden. O, McGinigal. S, Oseman. D, TNS-BMRB and Coleman, N. (2009). Childcare and Early years Providers Survey 2009. Department for Education. 22 Children’s Workforce Development Council (CWDC (2010). EYPS explained. [online[ Available at: www.cwdcouncil.org.uk/eyps/explained



23 Cremaschi F. (2006). Food for thought. Children in Europe 10: 2-5 24 Department for Education and Skills (2005). Healthy school lunches for pupils in nursery schools/units: Guidance for school caterers on implementing national nutritional standards. Nottingham. 25 Scottish Executive (2006). Nutritional guidance for Early years: food choices for children aged 1-5 years in early education and childcare settings. Edinburgh. 26 Welsh Assembly Government (2009) Food and Health Guidelines For Early years and Childcare Settings. 27 Health Promotion Agency (2005). Nutrition matters for the early years: Healthy eating for children under five in childcare. Northern Ireland. 28 The NHS Information Centre (2008). Health Survey for England 2007. [online]. Available at: www.ic.nhs.uk/pubs/hse07healthylifestyles Accessed on 5th October 2010 29 Department of Health (2007). National Child Measurement Programme 2006/2007 school year. [Online]. Available at: www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/obesity/national-child-measurement-programme:-results-from-the-2006-07-school-year. [Accessed on 21.12.2009] 30 Department of Health (2008). National Child Measurement Programme 2007/08 school year headline results. [online]. Available at: www.ic.nhs.uk/statistics-and-data-collections/supporting-information/health-and-lifestyles/obesity/the-national-child-measurement-programme/national-child-measurement-programme-2007/08/ncmp-2007-08-report. [Accessed 30/11/2009]. 31 Department of Health (2009). National Child Measurement Programme: England, 2008/09 school year. [Online]. Available at www.ic.nhs.uk/ncmp [Accessed 16/12/2009]. 32 Barnsley’s Children’s Trust (2009). Food and Nutrition Guidelines for Early Years and Children’s Settings 33 Public Health North East. (2009). North East Infant Feeding, weaning and Nutrition Guidelines for Babies and Children under 5. 34 Knowsley’s Early Years Healthy Weight Group (2008). Knowsley’s Early Years Healthy Eating guidelines. 35 Trading Standards East Midlands and Department of Health. (2010). Nutrition in Nursery Schools, East Midlands Regional Guidance 36 BANES council (2009). Healthy Early Years Toolkit 37 NHS Community Health Stockport, Sure Start Children’s Centre’s Stockport and Stockport Metropolitan Borough Council. (n.d) Nursery nutrition: A Helpful Guide to Food and Drink 38 Leicestershire healthy tots programme. (2010). Nutrition for Healthy tots 39 Cornwall Council (2008). Eating well for under five’s: a toolkit for early years settings and childminders 40 Infant and Toddler Forum. Ten Steps to Healthy Toddlers. 41 LACORS. (2010). LACORS coordinated survey of nutrition at nursery schools. [Online] Available at: www.lacors.gov.uk/lacors/ContentDetails.aspx?id=23562 [accessed on 18th august 2010] 42 Chartwells (2010). Nursery menu - Autumn 43 Stockport NHS Primary Care Trust, Stockport MBC Environmental Health & Trading Standards, (2010). Nursery Nutrition Project Report 44 Crawley, H. (2006). Eating well for under-5s in childcare: Practical and nutritional guidelines. 2nd ed. Caroline Walker Trust 45 Cornwall Council (2008). Cornwall Healthy Early Years Award



46 NHS Kensington and Chelsea (n.d.) Case Study: Healthy Eating Awards 47 Birmingham Community Nutrition and Dietetic Service, Food Net team (n.d) Healthy Eating Standard 48 Early Childhood Services Community Nutrition Service Children and Young People Service

London Borough of Newham (n.d) Early Years Healthy Eating Scheme 49 Barnsley Children Young People & Families Directorate (2009) Barnsley Healthy Early Years Award 50 Kent County Council (2010) Kent Healthy Early Years Pilot 51 Bedfordshire Community Health Services (n.d.) The Healthy Under 5s Standards 52 Gloucestershire PCT (2010). Early Years Food Award: Report on the pilot 54 Stockport PCT (n.d.) Healthy eating and drinking policy 55 Childcare Consultancy Ltd 56 Birmingham Community Nutrition and Dietetic Service, Food Net team 57 TFA Group – “Grub 4 Life” 58 Vision culture CIC (2009/10). Early Years First Food Programme Evaluation 59 BANES council (n.d) Powerpoint presentation ”EARLY YEARS – Healthy Eating Toolkit: The training” 60 Heart of Mersey (2010). Wellbeing Pre-School Nutrition Project Report 61 Nutrition and Dietetic Service, Bradford 62 Department of Health and Trading Standards East Midlands (2010). Nutrition in Nursery Schools: East Midlands Regional Report 63 East of England Trading Standards Association (2010). A Survey of The Nutritional Content of Nursery Meals in The East of England Region 64 Lloyd-Williams. F, Bristow. K, Capewell. S and Mwotswama. M. (2010. Young children’s food in Liverpool day care settings: a qualitative study of pre-school nutrition policy and practice: Executive Summary. 65. Parker. M, N. Dexter, A. Kelly, G. Weston. (2010). Nursery Nutrition and Food Provision in Liverpool: Final report. Liverpool First For Health and Wellbeing Partnership 66 Mwatsama. M. (2006). Nursery food provision, policy and practice across Cheshire and Merseyside: Report of a survey of food provision in nurseries across Cheshire and Merseyside to support the Big Noise social marketing project. Heart of Mersey. 67 Sharp. L, Mucavele. P, and Nelson, M. (2010). Preliminary Review of Early Years Food, Nutrition and Healthy Eating Guidance in England. School Food Trust 68 School Food Trust Early Years website www.schoolfoodtrust.org.uk/apfney 69 National Strategies website http://nationalstrategies.standards.dcsf.gov.uk/node/346693 70 Food Standards Agency (2008-09). Safer Food Better Business for Childminders. 71 National Healthy Schools Programme http://home.healthyschools.gov.uk/ 72 Department of Health (2009). Birth to Five. COI [online] Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107303 [accessed on 25th October 2010] 73 Food Standards Agency (FSA) Eatwell website www.eatwell.gov.uk/agesandstages/baby/



74 Little peoples plates website www.littlepeoplesplates.co.uk/index.html 75 McAuliffe AM, Lane J (2005) Listening and Responding to Young Children’s Views on Food. London. National Children’s Bureau.

76 Department of Health www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_107706.pdf 77 National Institute for Health and Clinical Excellence. (2008). Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households. London: NICE. www.nice.org.uk/nicemedia/live/11943/40097/40097.pdf 78 UNICEF The Baby Friendly Initiative www.babyfriendly.org.uk/items/resource_detail.asp?item=455 79 Singleton JC, Achterburg CL, Shannon B (1992) The role of food and the nutrition awareness of preschool children. J American Dietetic Association, 92; 67-70. 80Anliker JA, Laus MJ, Sammonds KW, Beal VA (1990) Parental messages and the nutrition awareness of pre-school children. J Nutr Educ, 22; 24-29

laying the table - children's food...

Documents