Healthy eating

Top tips:

• Stick to a routine with meals and snacks so children know when to expect food, and eat in the same place if possible so they feel comfortable.
• Eat together as a family at mealtimes to make them more enjoyable for children and eating the same meals shows them that you enjoy eating healthy meals too.
• Encourage children to feed themselves, it might be messier but they will feel more in control and will develop fine motor skills.
• Children's main drink should be water. Use an open cup where possible. Milk, fruit juice, and squash (no added sugar) can be offered in small amounts. Avoid sugary or fizzy drinks.
• Give children familiar foods alongside new foods to try.
• New foods should be tried several times as studies show children may need to try a food more than 10 times before they accept it.
• Offer children smaller portions and more if they are still hungry. Avoid negative comments or behaviours when they choose not to eat all of their food. This helps children to learn to listen to their bodies.
• Avoid using food as a reward for good behaviour.
• Try not to worry about your child's eating, every child is different and their eating habits will change as they grow.

Other useful support and resources

• NHS Healthier Families (previously Change4Life)
• British Nutrition Foundation
• British Dietetic Association
• The European Food Information Council

Fruits and vegetables should make up around a third of what we eat because they're filled with a range of vitamins and minerals which keep our bodies healthy, and have lots of fibre which keeps us feeling full. It's important to eat a variety of different fruits and vegetables, aiming for at least five different portions of fruits and vegetables every day. Remember that fruit juice and smoothies should be limited to no more than a combined total of 150ml a day.

Starchy carbohydrates should also make up around a third of what we eat because they're our main source of energy. It's usually best to choose wholegrain versions like brown bread, as these contain more vitamins, minerals and fibre. The fibre in wholegrains helps our bodies release the energy from these foods slowly, keeping you feeling full. However in young children this fibre can fill up their tummies too quickly so it's a good idea to give a mixture of white and wholegrain varieties to children under 5.

Protein-rich foods should be eaten every day as they're important for helping us grow. Protein is used in the body for growth and maintenance of our cells, like in our muscles and skin. Protein can come from both plant and animal foods, and it's good to eat plant-proteins (legumes, tofu, Quorn) because they are low in fat, more sustainable and often cheaper.

 Milk and dairy foods are important for our bodies as they contain protein and important vitamins and minerals, like Calcium and B-vitamins. If choosing milk-free alternatives look for products fortified with these key vitamins and minerals. The amount of dairy foods the body needs changes as we grow. 

Oils and spreads provide our bodies with fats and help us absorb fat-soluble vitamins. It's usually best to choose unsaturated fats (e.g. vegetable and olive oil). Oils and spreads are very high in energy (calories) so it's important to make sure we only consume a small amount.

These foods are not needed within our diets so they are shown separately on the Eatwell Guide. It's important to eat these foods less often, and only in small amounts. Using the traffic light labels on foods should help you identify foods high in fat, salt and sugar. Try to choose foods with mainly green labels, and less red labels, and remember the labels are based on an adults diet and children can tolerate less fat, salt and sugar than adults. More information on reading food labels. NHS Healthier Families have suggestions of healthier food swaps.

Children in the UK on average have too much saturated fat, salt and sugar and not enough fruits and vegetables, fibre and oily fish.

Babies grow and develop at a very rapid rate during the first year and so it is important that they receive good nutrition. Babies go through various stages - from being solely breast and/or formula fed, to the introduction of complimentary foods and then the transition to family foods. Each stage can present its own challenges and can be a learning experience for both infants and parents/carers. Resources provide information and support but remember, you can always contact your health visitor if you need more advice.

Breastfeeding: Breastfeeding is recommended as it contains the nutrients your baby needs, and there are many health benefits for both the mother and baby. For the first 6 months, exclusive breastfeeding is recommended, then from 6 months your baby can be introduced to food alongside breastfeeding up to 2 years, or beyond. Whilst breastfeeding it's important that the mother eats a healthy, balanced diet.

Formula feeding: Some parents may be unable to breastfeed or choose not to breastfeed, and will use formula milk instead. Formula is normally used up to 1 year, then babies can transition to whole cow's milk, or a milk-free alternative.

Weaning: Babies are usually introduced to foods from around 6 months, which is often called weaning or complimentary feeding. Solid foods help provide additional nutrients alongside their usual milk. At first babies start with only a very small amount of food, once a day, and gradually this can be increased to 3 meals a day. Some days your baby may eat more than others which is normal.

Some parents choose to wean babies onto smooth purees first, followed by lumpier textures, whilst others choose finger-sized pieces of food which the baby can feed themselves. Either option is fine but it's important to introduce your baby to a range of different foods, tastes and texture. Babies should be introduced to all of the food groups, to ensure a wide range of nutrients. Babies do not need any salt or sugar added to their food, honey should be avoided up to 1 year, and be aware of food such as whole nuts or grapes which your baby could choke on. Start4Life have lots of recipe suggestions.

Allergens: For children with no known allergies, it's important to expose babies to allergens early on in their weaning journey. Start with small amounts, gradually increasing in size, with only one allergen at a time, to help identify any reactions. Common allergens include: milk, egg, soya, wheat, legumes, nuts, seeds, fish and shellfish. Allergy UK have useful advice on introducing foods that commonly cause allergies.

If your baby has a higher risk of allergies, it's important to speak to your health visitor or GP. Find out more about allergies, including symptoms to look out for.

Premature Babies: In some cases, babies born prematurely may have additional nutritional needs such as being tube fed, given supplements or a high energy catch-up formula.

When weaning premature babies, we recommend starting no earlier than 3 months corrected age and 5-8 months actual age. It is important to ensure your baby is showing signs of being ready including sitting and holding their head, showing an interest in food and opening their mouth for food. Bliss is a useful website for premature babies.

Vitamins: From birth, most babies should be given an age appropriate multivitamin liquid or drops, containing Vitamin D, including those who are breastfed. Breastfeeding mothers should also consider taking a Calcium and Vitamin D supplement. Babies who have more than 500ml of infant formula, do not require a supplement. You can check if you're eligible to free Healthy Start Vitamins. If eligible for Healthy Start you can also receive money towards buying milk, fruits and vegetables for your child.

Important things to consider for toddlers between 1 and 4 years include providing the right amount of nutrients for normal growth and development, the right amount of energy for a healthy weight and a balanced diet with lots of variety to help young children develop a liking for healthy foods. Young children have small stomachs and eat smaller amounts, often in the form of regular meals and snacks. Young children are naturally good at managing their own hunger and fullness cues, and their appetites can vary day-to-day. Thus it's important to allow your child to decide how much they eat.The Eatwell guide is not the best tool to use for under young children as some of the advice does not apply.  A more appropriate tool for this age group is British Nutrition Foundation's 5532-a-day.

• Starchy Carbohydrates: 5 portions of starchy carbohydrates should be offered a day, within meals and snacks. It's important to choose a mix of white & wholegrains in under 2s, as wholegrains contain more fibre which can fill small tummies quickly. From 2-5 years, increase to mainly wholegrains.
• Fruits & Vegetables: 5 or more portions of fruits and vegetables should be offered a day. It's important to include a wide variety to help expose children early on, helping them develop a liking for different flavours. A fruit or vegetable portion is likely to be around the size of your child's fist or handful. Fruits and vegetables can be offered as a snack, with a main meal, or mixed into a meal. Dried fruit should only be offered at mealtimes due to the sugar content.
• Dairy: 3 portions of dairy foods should be offered daily, the equivalent of a total of 350ml of milk, to help meet children's calcium requirements. Whole milk should be given up to 2 years, and semi-skimmed can be offered from 2 years. Milk-free alternatives like soya or oat milks, must be fortified with calcium and other nutrients, and rice milk must be avoided due to the high levels of arsenic. Other dairy foods include yoghurts, cheeses and more.
• Protein: 2 portions of protein should be offered daily, 3 if vegetarian. These foods are often high in iron including red meat, pulses and nut butters. Fish should be included at least twice a week, processed meats limited due to salt content and whole nuts should be avoided due to the choking risk.

HFSS: It is recommended that toddlers should avoid consuming sugar and salt, avoiding all foods with added sugar and limiting salt intake to no more than 2g/day. Rather than lots of crisps, sweets and biscuits, it's important to choose healthier foods.

Hydration: Toddlers should be drinking around 1L/day, split across 6-8 drinks of 120-150ml, and should mainly be water and plain milk. Young children may need to be reminded to have regular drinks. Fruit juice should be limited, and no tea, coffee, fizzy or sugary drinks should be given.

Vitamin: All toddlers are recommended to have a multivitamin, to ensure they are meeting their requirements. Drops or liquid are recommended for babies & toddlers, and a chewable vitamin can be given from 3 years. You can check if you're eligible to free Healthy Start Vitamins. If eligible for Healthy Start you can also receive money towards buying milk, fruits and vegetables for your child.

Children between 5 and 11 are developing habits for life. It's important to encourage your child to eat a diet full of variety, meeting all of their nutrient requirements. Children are beginning to make more choices about what they eat and it's important to give your child some choice, such as offering peas or carrots with their dinner. Getting children involved with shopping for food, preparing meals and talking about foods can make trying new foods a more enjoyable experience.

Children 5-11 years can follow the Eatwell guide for advice on healthy diets and food groups. The nutrients found in these food groups are important for children and should be offered every day, including;

• Fruits & Vegetables: Children should be having 5 or more portions a day, with one portion being about the size of your child's fist or handful.
• Starchy Carbohydrates: Children over 5 should be having mainly wholegrains as these contain more fibre so are healthier and more filling. It's a good idea to base every meal around starchy carbohydrates to make sure your child is getting enough energy, as children are growing rapidly and can be very active.
• Protein: A variety of protein sources should be eaten 2-3 times a day, including oily fish once a week as they contain omega-3s which are essential for normal brain development.
• Dairy: Calcium-rich foods are important for children of this age so try to aim for three servings a day. Lower fat options like semi-skimmed milk can be introduced as theses tend to have the same amount of calcium and other nutrient compared to full fat varieties. If using milk-free alternatives, choose ones fortified with calcium and other nutrients. Various alternatives (including rice milk) are appropriate for children in this age range.
• Oils & Spreads: Choose mainly unsaturated and in small amounts.

The Eatwell guide shows how much of each food should be eaten, e.g. a third fruits & vegetables, a third carbohydrates, and the final third spilt between protein, dairy and oils & spreads. The overall amount of food your child needs to eat will depend on many things including their age and how active they are. Children are usually good at managing how hungry or full they are and using your child's hand as a guide for portion sizes is a good place to start.

HFSS: Foods high in fat, salt and sugar should be eaten less often. Avoid adding salt to children's meals and limit salt intake to no more than 5g/day. Sugar should be limited to no more than 5-6 cubes of added sugar/day (19g-24g). We do not need to worry about natural sugar in whole fruits and vegetables, or plain milks and yoghurts.

Hydration: Children should be drinking around 1.1-1.4L/day, split across 6-8 drinks of 150-200ml, and should mainly be water and plain milk. Children may need to be reminded to have regular drinks. Fruit juice should be limited, and no tea, coffee, fizzy or sugary drinks should be given. Fizzy drinks can harm children's teeth, including sugar-free because of the acid in them.

Vitamins: You may wish to consider buying an age-appropriate multivitamin for your child, to ensure they are meeting their requirements.

School Meals: School-aged children usually eat at least one meal a day at school. School meals can be a good choice as they have to meet national standards around healthy food. Children in Reception, Year 1 and Year 2 receive Universal Infant Free School Meals. Families on lower incomes should check if they're eligible for benefit-based free school meals.

If choosing to give your child a packed lunch, it's important to make sure it's healthy by having at least one of their 5-a-day, and limiting treats. NHS Healthier Families have some brilliant information including lunchbox recipes and tips.

Teenagers have quite a good understanding of healthy eating, and they may have much more choice over what they eat, such as choosing their school lunch, or visiting a shop while out with friends. The Eatwell guide is the best tool for understanding what a healthy, balanced diet looks like for teenagers, as this contains information about food groups, hydration and traffic light labels.A healthy balanced diet is important during this stage of growth. As teenagers begin to become more independent they may choose less healthy options, and/or may become more aware of their bodyweight. If you are concerned about your teenager's bodyweight you can use the NHS BMI calculator to check if they're a healthy weight.

Top tips for teenagers:

• Ensure three balanced meals, plus healthy snacks - teenagers often skip breakfast, but it's important they meet their energy and nutrient requirements throughout the day.
• Teenagers may choose less healthy snacks when out with friends, so making sure there is a range of healthy snacks at home, that they can take out with them can help teenagers make healthier choices.
• Talk to teenagers about reading labels on foods so they can see which foods are high in fat, sugar and salt. Foods high in fat, salt and sugar should be eaten less often. Limit salt intake to no more than 6g/day and sugar to no more than 7 cubes of sugar/day (30g). We do not need to worry about natural sugar in whole fruits and vegetables, or plain milks and yoghurts.
• Calcium is a key nutrient for teenagers - bones are continuing to grow and strengthen during teenage years. More information on calcium can be found here.
• Iron is a key nutrients for teenagers, especially in girls due to periods and almost 50% of teenage girls don't get enough iron. Iron is important for red blood cells which carry oxygen. More information on iron can be found here.
• Teenagers sometimes choose energy drinks which contain high amounts caffeine, which can cause headaches, tiredness and sleeping issues. It's important for teenagers to limit their caffeine intake and focus on mainly drinking water (2-2.5L/day).

School Meals: Teenagers usually eat at least one meal a day at school. School meals can be a good choice as they have to meet national standards around healthy food, but there is a lot more flexibility and choice in Secondary schools, which can mean teens choose less nutritious options. Families on lower incomes should check if they're eligible for benefit-based free school meals.

If choosing to give your child a packed lunch, it's important to make sure it's healthy by having at least one of their 5-a-day, and limiting treats. NHS Healthier Families have some brilliant information including lunchbox recipes and tips.

Vitamins: You may wish to consider buying an age-appropriate multivitamin for your teenager, to ensure they are meeting their requirements.

Calcium

Calcium is the most abundant mineral in the body. Although most people are aware of how essential it is for strong teeth and bones, it is also required to maintain a normal heartbeat, muscle function and blood pressure. If there is not enough calcium in the diet, the body will remove this from the bones and over time, this can lead to bones becoming weak and brittle.

Requirements and sources

Calcium requirements vary throughout life, with more being needed during periods of rapid growth like infancy and adolescence.

Many people are aware that dairy is a great source of calcium, but there are also many dairy alternatives and other foods that are fortified with calcium that can contribute to meeting requirements.

The BDA Calcium resource shows us how much calcium is needed for each age group and contains a list of foods that contain calcium, as well as how much each of these provide. This can be a helpful tool to help you meet daily calcium requirements.

If requirements are unable to be met from the diet, an age-appropriate calcium supplement can be taken. There are many over the counter options available. Your doctor or pharmacist can advise on suitable options.

Absorption

Without adequate Vitamin D, even if calcium requirements are being met, calcium cannot be absorbed (and thus used) properly. The BDA vitamin D resource provides information on Vitamin D and how to ensure requirements are met.

It is important for children to get enough iron in their diet. Iron is needed to make red blood cells which carry oxygen around the body. It also plays a role in brain development and the immune system.

Iron deficiency anaemia

If the iron levels in the body fall, children can develop iron deficiency anaemia. Sometimes children don't show any symptoms but common ones include:

• Tiredness, pale skin, breathlessness, frequent infections, poor appetite or eating non-food items e.g. soil (called pica).

Children often develop iron deficiency anaemia due to a lack of iron in their diet. This may be because they have a poorly balanced vegetarian or vegan diet, consume a large amount of cow's milk (it does not contain iron and makes children feel full, so they eat less iron rich food), or due to heavy periods. It can also less frequently be caused by an underlying condition.

If you suspect your child has anaemia, speak to their GP who can diagnose this with a blood test and assess the possible cause. If a diagnosis of iron deficiency anaemia is made, your child may be prescribed iron medication. This is best absorbed on an empty stomach, however this may make your child feel sick. Your child may prefer having it after a meal with something high in Vitamin C (like orange juice) to help with absorption. Your GP may advise an age-appropriate multivitamin, containing iron, to be taken daily after the course of iron medication is finished.

Requirements and sources

It is important to make sure your child has enough iron in their diet to try and prevent levels falling, even if iron medication is prescribed. North East London NHS Foundation Trust have a brilliant resource on iron requirements by age, including dietary sources.

There are 2 types of iron found in food - haem and non-haem iron. Haem iron is found in meat, chicken and fish and is absorbed best. Non-haem iron is found in plant sources and is not as well absorbed.

• Haem iron sources: Red meats (e.g. beef, pork, lamb), offal (e.g. kidney and liver - limited to once a week), chicken, turkey, fish (especially oily fish like salmon, mackerel, sardines) and fish paste
• Non-haem sources: Iron-fortified foods including (breakfast cereals, breads and drinks), eggs, pulses, beans and lentils, hummus, Quorn, tofu, dried fruit (apricots), dark green leafy vegetables (spinach, kale, broccoli), nuts, nut butters and seeds (consider choking risk and allergies if applicable)

Having a source of vitamin C with these foods, helps with iron absorption. Options include citrus fruits and juices (e.g. orange, grapefruit, satsuma), berries (blackcurrants, raspberries, strawberries), tropical fruits (mango, papaya, guava, kiwi), green vegetables (cabbage, broccoli), peppers and tomatoes.

Caffeine in tea, coffee and fizzy drinks can reduce iron absorption. Unprocessed bran, calcium supplements and antacids can have the same effect. Don't let your child consume these with/near iron rich meals, or supplements.

Avoid excessive cow's milk consumption, as this makes children feel full, reducing their intake of iron-rich foods. Consider buying an iron fortified milk (e.g. growing up/'big' milk) if your child drinks a lot of milk and is struggling to eat iron rich foods.

Vitamin D is essential for strong bones due to helping calcium absorption and is important for muscle strength. Very few foods naturally contain enough vitamin D to meet our requirments. Our main source is through sunlight on our skin, in spring/summer months.

Requirements and sources

Although sunlight is our main source of vitamin D, some foods are also naturally high in vitamin D, or fortified. These include;

• Oily fish (salmon, sardines and mackerel)
• Egg yolks
• Breakfast cereals fortified with Vitamin D (check food labels)
• Mushrooms enriched with Vitamin D (check food labels)

All babies under one year should be given a supplement of 8.5 - 10μg (micrograms), daily, unless they have more than 500ml of fortified formula milk.

For children over one year the recommendation is 10μg (micrograms).

The department of health recommend all babies and children under the age of 5 are given an age-appropriate multivitamin containing vitamin D, to help them meet their requirements. All children and teenagers over the age of 5 should consider taking a daily supplement containing Vitamin D, especially during autumn and winter (October to March), where skin exposure to sunlight in the UK is less.