By TV’s Dr. Hilary Jones, GP and medical broadcaster
The information in this article is correct at date of publication: November 2011
Opinions expressed by the author are not necessarily those of the publisher or editorial staff.
A healthy, practical, well-balanced diet for a toddler should include all of the 5 food groups in the right proportions. These should be consumed as 3 meals, supplemented by 2 satisfying and refreshing snacks each day.
Bread, rice, potatoes, pasta or other starchy foods should be eaten at each meal, together with a variety of fruit and vegetables. Toddlers should also have 3 servings of milk a day (this includes cheese or yoghurt), and 2 or 3 of fish, meat, eggs, nuts or pulses, with just small amounts of the food and drinks which contain higher levels of fat and sugar. A regime like this should provide any active, growing toddler with the essential nutrients they require at this time in their life and development: between the ages of 1 and 3, a toddler gains around 40% in height and weight, growing faster than at any other time of their life. This is equivalent to a 9st 5 foot 6 inch adult growing to 12st 6lb and 7 foot 8 inches tall.
Toddlers are different from adults
Throughout this period of rapid growth, there is significant development of the brain, liver, heart and other organs
2 and consequently, toddlers have very different nutritional requirements from older children and adults.
They need, for example, 4.7 times the amount of iron per kilo body weight compared to an adult, and 2.8 times the amount of energy, 2.9 times the amount of calcium and 4.4 times the amount of vitamin C. Conversely, certain healthy adults’ choices would not be suitable for toddlers. Skimmed milk for example, other low fat dairy products and a preponderance of high fibre foods would not be appropriate. The modern science is unequivocal in informing us what a healthy toddler needs. Regrettably however, the reality of today’s average UK toddler diet bears little resemblance to this ideal.
Information from the UK National Diet and Nutrition Survey on 1.5 to 4.4 year olds4
revealed that fewer than 50% of children surveyed had eaten leafy green vegetables over a 4 days study period. Another recent infant/toddler forum survey showed that 81% of parents offered their toddlers pre-prepared foods designed for adults, that 65% never cooked fresh meals cooked from scratch, and almost every day, 29% of the toddlers ate chocolate and sweets, 23% ate crisps and 16% drank fizzy drinks. Even more concerning was the fact that 15% of toddlers are consuming high fat, high salt adult-ready meals or takeaways for the majority of their meals. Despite this, 83% of the parents still believe their child has a healthy balanced diet. How can this be
4.
Eating well can be challenging
As a father of 5 children myself and possessed of a medical degree, it is not hard to acknowledge that meeting a toddler’s nutritional requirements perfectly can prove a difficult challenge. Modern day parents have become more reliant on convenience foods, cookery skills have waned and the pressures of dual careers on mothers particularly, long working hours and distractions at meal times from the TV or electronic games all contribute. We spend less time sitting down to eat as a family, more time snacking on manufactured foods, and lead a more sedentary existence generally. We can be confused by conflicting controversial advice or left unsupported by a paucity of sound consensual nutritional guidelines, particularly for children aged under
3. Our own bad habits as adults are often picked up by our offspring and with children’s parties, starting nursery, domestic stress, tiredness, illness, teething, faddy eating and food refusal all getting in the way, it is hardly surprising that it can be difficult for parents to know for sure if their toddlers really are getting what they need.
Long-term implications
As a result of this, we are faced with a plethora of physical, psychological and behavioural problems in our society to which poor eating habits learned in early childhood massively contribute. An epidemic of childhood and adult obesity is paving the way for ever increasing numbers of people to die prematurely from coronary heart disease and diabetes. Iron is a trace mineral which is so vital in supporting rapid growth and development in a toddler’s brain and in forming haemoglobin for oxygen transportation around the body
5 but it can be difficult for a toddler to achieve the recommended daily intake of iron due to the lack of iron rich foods within their typical diets.
If enough iron is not consumed within the toddler diet, conditions such as anaemia may arise. This is a condition associated with cognitive and motor deficits, some of which may not be reversed unless quickly corrected6. According to the latest National Diet & Nutrition Survey, toddlers receive just over ¼ of the recommended daily allowance of vitamin D through their food8. If inadequate intakes of vitamin D are either consumed or synthesised by the skin from UV sunlight, this can lead to poor bone mineralisation and rickets - the unmistakeable bowing of the legs once common during famines in previous centuries, and now shockingly making a comeback in Britain’s inner cities where lack of exposure to sunlight combined with poor diet both contribute8 9 10 11 12.
The cost to society
The cost, in both economic and human terms to the NHS and society general, of failing to improve our toddlers’ diets is already immense, and will only improve with the concerted and unstinting coordinated efforts of parents, health visitors, doctors, dietitians and government combined. The overall cost of obesity to the NHS is currently around 1 billion pounds with a further 2.3 billion for the economy as a whole. According to the London Assembly, about 7.1 million pounds a year is currently spent tackling childhood obesity in London alone, with the figure estimated to rise to 111 million pounds if such children become obese adults. Diabetes costs the NHS 1 million pounds per hour, 10% of its yearly budget, whilst type 2 diabetes in children increases alarmingly year on year as a result of more prevalent childhood obesity. Heart disease, cancer, kidney failure, blindness and psychological problems are all consequences of these major health issues and for the first time, children are running the risks of dying before their parents from preventable lifestyle associated conditions. The resurgence of rickets, particularly in certain minority ethnic groups, is leading to deformity, stunted growth and general ill health, and behavioural disorders are increasingly reported, which can result in educational failing, domestic stress, disharmony and anti-social behaviour with consequences into adulthood. The causes of many of these issues are multi-factorial but we are all what we eat, and our children will eat what we buy.
We can also talk about the importance of a diet based on the food pyramid, encompassing all of the five food groups every day with vitamin, mineral and omega 3 supplementation in addition. If necessary, another practical, toddler-friendly solution is growing-up milk, specifically developed for toddlers and made from cows’ milk but enriched and fortified with the essential nutrients they need.
For further guidance, for both health visitors and for parents, there are several good sources of information available, among them Little People’s Plates, Dr Alex Richardson’s book They Are What You Feed Them: How Food can Improve Your Child’s Behaviour, Learning and Mood, and In Practice magazine.
The impact of these early toddler years cannot be underestimated and as Professor Mike Gibney, Professor of Food and Health at the University College Dublin says ‘Getting it wrong at year one. That’s it…you’ve got one chance to get it right. If you do, it’s terrific. If you don’t…it’s goodbye.’ What he means is that it is goodbye to ever having another chance to truly maximise a child’s growth and developmental potential. That’s why it’s so important that we all take toddler nutrition so very seriously.
Click here to download the Food Pyramid, a handy factsheet on healthy eating for toddlers.
References
1. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006; 450: 76-85
2. Koletzko B (ed): Kinderheilkunde und Jugendmedizin, ed 13 Berlin: Springer 2007.
3. Department of Health. Report on Health and Social Subjects No. 41. Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. London. HMSO, 1991.
4. Gregory JR et al. National Diet and Nutrition Survey: Children aged 1.5 to 4.5 years. Column 1: Report of the diet and nutrition survey. London: HMSO, 1995.
5. Freeman VF et al. A longitudinal study of iron status in children at 12, 24 and 36 months. Public Health Nutrition; 1998; 1 (2): 93-100.
6. Lozoff B et al. Poorer behavioural and developmental outcomes more than 10 years after treatment for iron deficiency in infancy. Pediatrics 2000; 105 (4): E51
7. Department of Health & The Foods Standards Agency. National Diet and Nutrition Survey: Headline results from Years 1 & 2 (combined) of the Rolling Programme (2008/2009 – 2009/10). 2011. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/ListOfSurveySince1990/Surveylistlifestyle/DH_128165 [Accessed: November 2011]
8. Scientific Advisory Committee on Nutrition. Update on Vitamin D. Position Statement by the Scientific Advisory Committee on Nutrition. London. TSO, 2007.
9 Pearce S, Cheetham T. Diagnosis and Management of Vitamin D Deficiency. BMJ 2010;340:b5664
10. Lawson M, Thomas M. Vitamin D concentrations in Asian children aged 2 years living in England: population survey. BMJ. 1999;318(7175):28
11. Lawson M et al. Dietary and lifestyle factors affecting plasma Vitamin D levels in Asian children living in England. Eur J Clin Nutr. 1999;53(4):268-72.
12. Wagner CL, Greer FR, Prevention of Rickets and Vitamin D Deficiency in Infants, Children and Adolescents. Paediatrics. November 2008; 122(5) 1142-52
13.Gesch CB et al. Influence of supplementary vitamins, minerals and essential fatty acids on the anti-social behaviour of young adult prisoners. Randomised, placebo controlled trial. British Journal of Psychiatry 2002; 81:22-8
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