Pre-school children

See also the separate article on Infant Feeding.

Energy

• Children have a high energy requirement because they are growing quickly and becoming more active. They therefore require foods which are high in energy (as well as vitamins and minerals). Young children do not have large enough stomachs to cope with big meals and so should have small and frequent meals.
• The pre-school child should progress from the very high-energy diet of infancy (with about 50% of total energy coming from fat) to the the diet for a five year-old which should have much greater emphasis on a lower fat content (but still about 35% of energy from fat).
• A diet which is low in fat and high in fibre will not provide enough energy for a young child but a family approach to a healthy diet is important at this stage because food preferences are often established very early in life.
• Ideally, children should restrict the number of times a day that they have foods and drinks containing sugar and then only have them at meal times.
• Young children should not be put on weight reduction diets, but a healthy family approach to food and regular physical activity are important in avoiding excessive weight gain and obesity.

Other nutritional requirements

• The diet must also be high in vitamins and minerals. In particular, a good supply of protein, calcium, iron and vitamins A and D is required.
• Whole cows' milk is recommended for children over the age of 12 months as a main drink, as it is a rich source of a number of nutrients. Semi-skimmed milk can be introduced after the child is 2, as long as the diet provides enough energy. Skimmed milk is not suitable for children under 5 years of age, as it does not provide enough energy and vitamin A for the growing child.
• Supplements of vitamins A, C and D in the form of liquid drops are recommended for children under 5 years of age if they are considered to be at risk of deficiency - eg, poor eaters or those who do not have much exposure to sunlight.
• Iron:
  • Iron-deficiency anaemia may be associated with frequent infections, poor weight gain and delay in development.
  • Red meat is the best source of easily absorbable iron and can be offered to children from 6 months of age. Iron-rich foods, such as liver and red meat, are not usually popular with young children.
  • Other good sources of iron include green vegetables, pulses, bread and some breakfast cereals. Iron from plant sources is less well absorbed than iron from animal sources but can be improved by having vitamin C-rich foods or drinks with a meal.
• Calcium:
  • Young children need plenty of calcium in their diets for healthy bones and teeth.
  • Dairy products have a high calcium content and other good sources include white bread, dark green leafy vegetables, pulses (eg, baked beans) and fortified cereals.

Diet-related problems

• Constipation: common in young children. Can be helped by gradually increasing the amount of fibre in the child's diet. Foods high in fibre include vegetables, wholemeal bread, baked beans and high-fibre white bread. A high fluid intake is also important.
• Toddler diarrhoea: this is common and may be linked with too many sugary drinks and fruit juice, especially between meals. These drinks can make the child too full at mealtimes and prevent a proper balanced diet and can also be harmful to teeth. If the child is having a high-fibre diet then it may be appropriate to reduce the fibre content in the diet.

Schoolchildren

Energy requirements

• The energy requirements of schoolchildren are still high because of growth and activity. Therefore, there should be a progression towards an adult-style healthy diet, but with continued emphasis on foods with a high energy and nutrient content. The progression should be gradual with an increase in fibre, reduction in fat and increase in starch content in the diet.
• Younger children (eg, 4-6 year-olds) will still need smaller and more frequent meals as they do not have large enough stomachs to cope with big meals.
• An increasing number of children are overweight or obese. These children should not try to lose large amounts of weight but instead be encouraged to remain at a constant weight or increase weight slowly while their height increases. A healthy lifestyle for the whole family is very important for effective weight control, fitness and health of the child.

Other requirements

• The diet should include a good supply of protein, vitamins and minerals. The same principles apply for schoolchildren as for pre-school children, as summarised above.
• The Food Standards Agency has provided guidance on the safe maximum consumption levels for oily fish:^[2]
  • It recommends that boys and girls under the age of 16 should not eat marlin, shark or swordfish.
  • Boys aged under 16 can have up to four portions of oily fish a week and girls up to two portions.
  • The lower recommendation in girls is because substances found in oily fish - eg, dioxins - can accumulate in the body and high levels may be detrimental in later life to the developing fetus.