Nutrition matters for the early years Guidance for feeding under fives in the childcare setting 2 Introduction What we eat can play a critical role in determining our health, whatever our age. The eating patterns established in the first few years of life influence our health during childhood and adulthood. Encouraging good nutrition during the early years of life is therefore an investment in the health of our population for years to come. With more parents working, increasing numbers of children are spending long periods of time in childcare outside their own homes. This has implications for their dietary intake, as a large proportion of meals and snacks is now eaten away from home. Childminders and the staff in nurseries and playgroups therefore have a crucial role to play in promoting healthy nutrition among young children. In recognition of this, the Public Health Agency has revised and updated this publication, Nutrition matters for the early years, which was originally developed by the former Health Promotion Agency for Northern Ireland (HPA) in partnership with the former Health and Social Services Trusts, the Early Years organisation and the Northern Ireland Childminding Association (NICMA). This updated version outlines straightforward practical advice and information on a range of nutritional issues relating to children up to the age of five, based on current government guidelines. Information about the importance of encouraging physical activity and ensuring the safe handling and storage of food is also included. Nutrition matters for the early years is a valuable resource for all staff within day nurseries, playgroups and crèches and for childminders providing childcare within the home setting. 3 4 Contents Page Why good nutrition is important 6 A guide to weaning 8 - Foods to avoid giving to babies..................................................................................8 - Weaning before six months...................................................................................... 10 - Weaning: from 6 months........................................................................................... 11 - Weaning: from about 7 months............................................................................... 12 - Weaning: from 9 months........................................................................................... 13 - Drinks for babies up to 12 months old................................................................... 14 A varied balanced diet for children aged one to five 15 - Bread, rice, potatoes, pasta and other starchy foods........................................ 17 - Fruit and vegetables................................................................................................... 19 - Milk and dairy foods.................................................................................................... 21 - Meat, fish, eggs, beans and other non-dairy sources of protein...................... 23 - Foods and drinks high in fat and/or sugar............................................................. 25 Planning meals and snacks for children 26 - Meal and snack suggestions.................................................................................... 27 - Sample menu for a full day........................................................................................ 31 Children with individual dietary needs 32 - Children following a vegetarian diet........................................................................ 32 - Children from ethnic communities following a traditional diet.......................... 33 - Children with special dietary needs........................................................................ 33 - Fussy eaters.................................................................................................................34 Food safety 35 Rewards and celebrations 36 - Encouraging good behaviour...................................................................................36 Physical activity for children 37 Preparing a nutrition policy 39 Nutrition checklist 41 Contacts for more information 45 5 Why good nutrition is important Good nutrition is essential during childhood, as it is a time of rapid growth, development and activity. This is also a vital time for healthy tooth development and prevention of decay. General eating habits and patterns are formed in the first few years of life. Poor nutrition during these years is associated with an increased risk of obesity, hypertension, diabetes and coronary heart disease. Childcare providers therefore have a key role to play in introducing children to a wide variety of foods and establishing a pattern of regular meals and healthy snacks. 6 The arrangements for children’s meals and snacks will of course vary considerably between different childcare providers. Some nurseries and childminders may provide all meals, snacks and drinks. This document offers them straightforward guidelines on how to ensure they are giving the children in their care a healthy diet. In other cases, where parents provide drinks and snacks, or all foods and drinks for their child, childcare providers can use the document to help in any discussions they may have with parents about the food that they are providing. When providing food for young children, consideration must be given to the following points: • Children’s appetites may vary, not only from day to day, but also from one meal to the next. • Young children are very active and have high energy (calorie) and nutrient needs in proportion to their small body size. • Children have small stomachs and may be physically unable to eat large meals. • Every day, children need three meals plus snacks. Use the ideas given in this document to provide nutritious meals and snacks. • Children should be encouraged to drink adequate amounts of fluids. • A frequent intake of sugar and sugary foods and drinks between meals causes tooth decay. Snacks and drinks taken between meals should be sugar-free. • Foods and drinks containing sugar should only be given occasionally and should be limited to mealtimes. Sugar may also appear on labels as sucrose, glucose, syrup, fructose or dextrose. • Puddings offered each day should be nutritious and based on milk and/or fruit (fresh, stewed or tinned). • Avoid low fat or diet products, as young children need the extra calories from fat to grow and develop properly. Full fat spreads and whole milk dairy products are recommended. • A diet high in fibre is not suitable for young children. It can fill them up without providing all the nutrients they require. Foods of varying fibre content should be offered, eg both white and wholemeal breads and pasta; a variety of breakfast cereals, eg Corn Flakes, Rice Krispies, Weetabix, porridge, etc. Children between the ages of two and five should gradually be encouraged to increase their intake of higher fibre foods. • Dry, unprocessed bran should never be used as it can reduce the absorption of important nutrients and can cause bloating, wind and loss of appetite. • Do not add salt to food either in cooking or at the table, as babies’ kidneys are not fully developed. Too much salt is linked with high blood pressure later in life and may encourage a preference for salty food, which is difficult to change. Salty snacks such as crisps should be avoided for babies and young children, and given only very occasionally for older children. • Whole nuts are unsuitable for children under the age of five years because of the risk of choking. It is recommended that peanuts and products containing them, eg peanut butter, are not provided within the childcare setting. This is to protect children who may be at risk of nut allergy. 7 A guide to weaning All the nourishment a baby needs during the first six months comes from either breastmilk or infant formula milk. Based on current research, health experts recommend that babies should begin to take solid foods from six months in addition to breastmilk (or the baby’s usual formula milk) to allow them to grow and develop.† This process is called weaning (sometimes referred to as complementary feeding). Solid foods should be offered initially 2–3 times a day, increasing to 3–4 times daily between 9–11 months. Weaning before six months is not recommended as babies’ digestive systems and kidneys are still developing. Weaning too soon may increase the risk of infections and allergies. The tables on the following pages outline the current recommendations for weaning. Foods to avoid giving to babies • Salt. Do not add any salt to foods for babies as their kidneys are not fully developed. You should also avoid foods that contain a lot of salt, eg packet soups, stock cubes, crisps, bacon, smoked meats. • Sugar. Do not add sugar to the foods or drinks you give a baby. Sugar could encourage a sweet tooth and lead to tooth decay when the first teeth start to come through. • Honey. Don’t give honey to a child under the age of one year, as it can contain a kind of bacteria which can produce toxins in the baby’s intestines and can cause a very serious illness (infant botulism). • Nuts. It is recommended that peanuts and products containing them are not provided within the childcare setting. This is to protect children who may be at risk of peanut allergy. Whole nuts should never be given to children under the age of five because of the risk of choking. † Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews 2002, Issue 1. (Updated in 2009) 8 9 Weaning before six months Baby led weaning Weaning before six months is not recommended; however, childcare providers will obviously have to follow the parents’ wishes about introducing complementary feeds. If the parents of a baby in your care are determined to wean before six months, there are a number of extra foods that should be avoided in addition to the list above. These are: Baby led weaning is becoming an increasingly popular way of introducing foods to children. It does not use the conventional weaning methods of purees and mashed foods; instead the child is offered bite sized pieces of food to suck, chew and explore. There are pros and cons to this style of weaning. If you would like more information please visit: www.rapleyweaning.com • Foods which contain gluten, eg wheat flour, bread, breakfast cereals made from wheat, rusks, spaghetti or other pastas (eg tinned pasta in tomato sauce). • Nuts and seeds. • Eggs. • Cow’s milk, either as a drink or mixed with food. • Fish and shellfish. • Citrus fruits, including citrus fruit juices, eg orange juice. • Soft and unpasteurised cheeses. • Tofu, Quorn, soya protein. More detailed guidance on weaning can be found in the Public Health Agency’s leaflet Weaning made easy: moving from milk to family meals. This leaflet is aimed at parents but childcare providers working with young babies will also find the information useful. You can download the leaflet from the publications section of our website www.publichhealth.hscni.net/publications or ask for a copy from your community midwife or health visitor. 10 Weaning: from 6 months First foods should be smooth or well mashed. At this stage the food doesn’t need to be quite so runny – you can start to leave a few soft lumps. Suitable first foods are: Notes Texture • plain baby rice mixed with baby’s usual milk; • smooth or well-mashed cooked potato, carrot, parsnip, turnip, cauliflower; • smooth or well-mashed banana, stewed fruits, eg apple, pear, apricots; • unsweetened custard (made using custard powder); • plain/natural yogurt. As babies get used to spoon feeds After a couple of weeks begin to add different foods and different tastes: • mashed or minced meat, chicken, fish (with bones removed), lentils, hard boiled egg (serve these with well-mashed potatoes, rice or pasta and veg); • foods made from wheat, eg bread, pasta, semolina; • breakfast cereals such as plain Ready Brek, Weetabix, porridge. Finger foods Finger foods encourage babies to feed themselves. Try: • soft fresh fruit, eg banana, melon, peeled pear; • pieces of cooked vegetables, eg green beans, cauliflower, carrot; Vitamin D Vitamin D is an essential vitamin for bone development. Our body creates most of our vitamin D from moderate exposure to the sun, however, a significant proportion of the UK population have low levels of vitamin D. Those at risk of deficiency include young children and it is therefore recommended that all children between the ages of 6 months and 5 years should be given vitamin drops or tablets which contain vitamins A, C and D, unless they are consuming 500ml (a pint) or • Cook vegetables or fruit (without added salt or sugar) until they are soft, then mash well. • Breastmilk or infant formula milk can be used to mix with cereals, potatoes etc to give a smooth consistency. Pasteurised whole cow’s milk can be used to mix into foods, such as mashed potato and breakfast cereal, but should not be given as a main drink until after 1 year. • At this stage the baby will continue to receive the usual amount of breastmilk (this may need to be expressed for use within the childcare setting) or infant formula milk each day. This should be provided in accordance with the parent’s guidance. • Cooled boiled water can be offered between feeds if the baby seems thirsty. • Use a cup for drinks of infant formula or water. • Introduce finger foods. • fingers of toast (with unsalted butter), unsalted breadsticks, pitta bread; • fingers of hard cheese; • low-sugar rusks (these should only be used occasionally, as even low-sugar varieties still contain a lot of sugar). more of infant formula a day at any time during this age range. Ordinary cow’s milk does not contain sufficient vitamin D. More detailed guidance on Vitamin D can be found in the Public Health Agency’s leaflet Vitamin D and you which can be downloaded from the publications section of our website www.publichealth.hscni.net/publications. The UK Chief Medical Officers’ advice on Vitamin D supplementation can be accessed at www.gov.uk/government/publications/vitamin-dadvice-on-supplements-for-at-risk-groups 11 Weaning: from about 7 months Texture From about 7 months just mash food with a fork. This will encourage the baby to learn how to chew. Suitable foods All family foods can be offered at this stage – remember not to add salt while cooking or at the table. Notes • By this age the baby should be having three meals a day and eating more at each spoon feed. • The amount of milk can be gradually reduced as the baby eats more solid food. The baby should continue to have breastmilk (this may need to be expressed for use in the childcare setting), or at least 500–600mls (16–20fl oz) of infant formula each day. • Encourage babies to hold spoons. Menu ideas Main meal ideas: • mashed baked beans with fingers of toast; • tuna and pasta bake with broccoli; • macaroni cheese with peas; • shepherd’s pie with carrots; • minced chicken with mashed potato and Brussels sprouts; • corned beef hash with sliced green beans; Dessert ideas: • pieces of fresh soft fruit, eg pear, banana, melon; • stewed fruit, eg apples, apricots, prunes (with stones removed); • tinned soft fruit in its own juice, eg strawberries, peaches, pears; • milk pudding, yogurt or fromage frais (do not use ‘diet’ varieties). • meat or lentil stew with mashed potato; • fish pie with peas. “Pieces of fresh soft fruit, eg pear, banana or melon” 12 Weaning: from 9 months Texture During this stage babies will move on from mashed to chopped foods. Suitable foods Continue to offer all family foods at this stage. Notes • Continue to give three meals a day plus 1–2 snacks. or about 500–600mls (16–20fl oz) of infant formula) each day. • Water or very diluted pure fruit juice (one part juice to 10 parts water) can be given as a drink at mealtimes. By now, most drinks (including the baby’s usual milk) should be given from a cup. From 12 months, the use of a bottle should be discouraged. • Encourage babies to eat a wide variety of foods. • For suitable drinks refer to page 14. • At this stage babies will continue to receive 3–4 breastfeeds each day (this may need to be expressed for use in the childcare setting) Menu ideas Some meal ideas to try Breakfast: Dinner: • unsweetened breakfast cereal with whole cow’s milk; • minced or chopped meat, mashed potatoes and carrots; • toast with well-cooked egg, either scrambled, poached or boiled. • fish fingers, peas and mashed potatoes; Lunch: • chicken casserole and rice; • lasagne with broccoli; • baked beans with fingers of toast; • vegetable risotto with grated cheese; • sandwiches filled with, for example, tuna, chicken, egg, hummus; • beef or lentil burgers, courgettes, sliced tomato and boiled potatoes; • soup, for example vegetable or lentil, with a sandwich; • cauliflower cheese, boiled potatoes and green beans. • pasta with tomato sauce and grated cheese. Snack ideas Healthy snacks to use between meals include: • chopped fruit and vegetables, eg peeled apple, pear, peach, banana, orange, carrot, cucumber; • bread, toast, scones, pancakes; • natural yogurt or plain fromage frais – add your own fruit for extra flavour; • cheese. Snacks that contain quite a lot of sugar are safest for teeth if taken at mealtimes and should be given as snacks only occasionally. These include: • flavoured yogurt, flavoured fromage frais; • low-sugar rusks; • plain biscuits, eg Rich Tea, Marie, Digestives. 13 Drinks for babies up to 12 months old Breastmilk or infant formula milk Breastmilk or infant formula milk should be the main drink during the first year. If a mother wishes to express breastmilk for her child to drink while in childcare, it should be stored in the fridge and brought up to room temperature in a jug of hot water before it is given to the baby. It is now recommended that powdered infant formula is freshly prepared for each feed. Use bottles that have been sterilised and always reconstitute the formula in water which has been boiled and is still hot (above 70ºC). Cool this rapidly to room temperature, then use immediately. Always discard any formula left over after the feed. If formula cannot be made up by childcare providers, parents could supply cartons of ready-to-feed liquid formula. If parents choose to make up formula at home, feeds should be made up and cooled in the fridge for at least one hour before transporting to the childcare facility. The feeds should be labelled and transported in a cool bag with an ice pack and on arrival transferred immediately to the fridge. They can then be used for up to 24 hours. Note: If the feeds are not cooled in the fridge or are transported without an icepack they must be used within two hours. Follow-on formula Follow-on formula is unsuitable for babies under six months and is unnecessary for older babies. Cow’s milk Whole cow’s milk should not be used as the main drink until after one year. If a child is eating a varied diet, semi-skimmed milk may be given from two years. Do not give skimmed milk to under fives. Other drinks A little cooled boiled tap water can be given if a baby seems very thirsty (after six months, water straight from the mains tap is suitable). Very dilute fruit juice (one part pure fruit juice to ten parts water) from a cup may be given occasionally with meals. Drinks that are not recommended Baby juices, herbal drinks and sugary diluting juices These contain sugar and can damage developing teeth if they are used frequently or given from a Drinks that should not be given Colas, lemonades and fizzy drinks including ‘diet’ drinks and sugar-free squashes. bottle. Squashes should be very well diluted (one part squash to ten parts water). All of these drinks should be given from a cup at main meals. sugar and present a risk to dental health so it is advisable to choose low sugar varieties if possible. Tea and coffee These are acidic and can cause damage to teeth. These may reduce the absorption of iron. ‘Diet’ drinks are also high in artificial sweeteners which are unsuitable for babies and young children. Bottled mineral waters, still and sparkling Soya drinks Soya drinks (previously known as soya milk), which are not formula, should not be given to children under the age of 1 year. After this, choose fortified drinks to ensure an adequate vitamin and mineral intake. Many of these drinks also contain 14 These may contain high levels of minerals which make them unsuitable for babies under one year. Goats’ and sheep’s milk These lack essential vitamins and minerals needed for babies’ growth and development. A varied balanced diet for children aged one to five Growing children need plenty of energy (calories) and nutrients, eg protein, fat, carbohydrates, vitamins and minerals. These needs can be met by including a variety of foods from each of the main food groups. The following tables outline the recommended number of servings, per child, from each of the four food groups for a whole day. The actual number of servings provided will depend on the length of time the child is in childcare. 15 16 Food group: Bread, rice, potatoes, pasta and other starchy foods What’s included This group includes: • all types of bread, eg wholemeal, wheaten, granary, multigrain, white, brown, soda bread, potato bread, rolls, baps, chapattis; • crispbreads, savoury crackers, crumpets, pancakes; • breakfast cereals without added sugar, honey or chocolate, eg Weetabix, Ready Brek, porridge oats, Corn Flakes, Rice Krispies; • boiled, mashed or baked potatoes (chips should be limited to once a week); • pasta, noodles, rice and couscous. Recommended servings Offer a minimum of one portion per child with each meal. Examples of one portion are: • 1 slice of bread; • 1 small potato; • 8 oven chips; • 3 tbsp cooked pasta or 2 heaped tbsp cooked rice; • 2 tbsp breakfast cereal. Portion sizes should be increased according to appetite. Key nutrients The main nutrients provided are: • energy (calories); • B vitamins (needed for growth and activity); • fibre (needed for healthy bowels). Some breakfast cereals are fortified with iron (needed for healthy blood). Notes These foods should also be offered as snacks. 17 18 Food group: Fruit and vegetables What’s included This group includes: • all types of fresh, frozen and canned vegetables, eg broccoli*, Brussels sprouts*, cabbage*, carrots, cauliflower*, mushrooms, parsnips, frozen peas, peppers*, swede, sweetcorn, turnip; • all types of salad vegetables, eg lettuce, cucumber, tomato; • all types of fresh fruit, eg apples, bananas, grapes, kiwi fruit*, oranges*, strawberries* blueberries; • all types of tinned fruit in juice, eg peaches, pears, pineapple, prunes; • stewed fruit; • dried fruit. * All these are good sources of vitamin C. Recommended servings Five child-sized portions should be offered each day. Examples of one child-sized portion are: • ½ apple, ½ pear, ½ banana or ½ orange; • 1 tbsp fruit salad, tinned or stewed fruit; • ½ cup of strawberries or grapes; • 1 tbsp cooked vegetables; To reduce the risk of choking, cut up small fruits and vegetables like grapes and cherry tomatoes, remove any stones and pips and cut large fruits into smaller pieces. • 1 tbsp chopped or raw salad vegetables. Key nutrients The main nutrients provided are: • vitamins, especially vitamin C (needed for general good health and to help absorb iron); • fibre; • iron (from dark green vegetables, eg broccoli and spinach). Notes • Fruits and vegetables make good snacks and are ideal as finger foods. • Dried fruits such as raisins or dates can be included in main meals but are not recommended as snacks between meals because they are concentrated sources of sugar, which may cause tooth decay. • Frozen vegetables are high in vitamins. • Vegetables can be added to soups, casseroles and stews. • Do not overcook fruit and vegetables, as this will reduce the vitamin content. 19 20 Food group: Milk and dairy foods What’s included This group includes: • milk; • cheese; • yogurt. Recommended servings Each day allow 350–600mls (½–1 pint) of milk from one year of age onwards or 2–3 servings of foods from this group should be provided, for example: • 25g (1oz) of hard cheese; • 125g carton of yogurt – avoid ‘diet’ varieties; • a bowl of milk pudding. Each of these provides equivalent amounts of calcium. Key nutrients The main nutrients provided are: • calcium (needed to build strong bones and for nerve and muscle function); • protein (for growth); • fat (for calories); • vitamin A (needed for growth, healthy skin and eyes, a healthy respiratory system (lungs and breathing tubes) and a healthy digestive tract (including mouth, stomach and bowel); • vitamin D (needed to help absorb calcium and to build strong bones). Notes • Children aged one to two years should have whole cow’s milk as their main drink. From two years children can have semi-skimmed milk if they are eating a varied diet. • Skimmed milk should not be given to children under five years. • Milk can be used in drinks, on breakfast cereals, in milk puddings or sauces. • Cheese can be added to jacket potatoes, spaghetti or toast. Grated cheese, cottage cheese, cheese portions or spreads can be used as sandwich fillers or on toast. • The length of time the child is cared for will determine how much of the daily requirements should be provided within the childcare setting. 21 22 Food group: Meat, fish, eggs, beans and other non-dairy sources of protein What’s included This group includes: • all types of meat including beef, lamb, pork, bacon, ham, liver, chicken and turkey; • white fish, oily fish (eg tuna and sardines), fish cakes, fish fingers; • baked beans, mushy peas, butter beans, kidney beans, chickpeas; • eggs including boiled, scrambled, poached, omelette; • meat alternatives, eg soya mince, textured vegetable protein (TVP); • bean curd, Quorn; • processed meats/meat products, eg chicken nuggets, sausages, sausage rolls and burgers. Recommended servings Two servings of these foods should be taken every day, ie at lunch and evening meal. Examples of one serving include: • 40–50g (1½–2oz) beef, pork, lamb, chicken or fish; • 2 fish fingers; • 1 egg; • 2–3 tbsp baked beans. Processed meat products should be given no more than once a week in the childcare setting. Examples of one serving are: • 4 chicken nuggets; • 4 fish bites; • 2 sausages; • 1 junior (50g/2oz) burger. Key nutrients The main nutrients provided are: • protein; • iron (to prevent anaemia); • vitamins, especially B vitamins. • Omega 3 fatty acids in oily fish. Notes • Whole nuts are unsuitable for children under the age of five years because of risk of choking. • It is recommended that peanuts and products containing them, eg peanut butter, are not provided within the childcare setting. This is to protect children who may be at risk of peanut allergy. • Ensure that all meat and fish dishes are free from bones to prevent choking. Be aware that chicken nuggets can sometimes contain small bones. • Red meat should be included as it is a good source of iron. Mince is acceptable as a red meat. Minced meat may be used for shepherd’s pie, meatballs and spaghetti bolognaise. Where possible use leaner cuts of meat and trim off visible fat. Processed meat products contain less protein and iron. • All eggs must be well cooked. Foods rich in vitamin C (eg tomatoes or orange juice) taken at the same meal, help the body absorb the iron in eggs. • Vegetarian choices could include omelette, cheese quiche, bean and pasta bake, macaroni cheese, vegetable lasagne. • It is important to include good sources of iron regularly, eg beef, lamb, pork, eggs, sardines, baked beans, mushy peas. Soya mince is a good source of iron for those who want to avoid meat. 23 24 Food groups: Foods and drinks high in fat and/or sugar Foods in this group taste good and add extra interest to what we eat, but should not replace foods from the four main food groups outlined earlier. They should form the smallest part of the overall diet. What’s included This group includes: • spreading fats, such as butter, margarine and spreads; • cooking fats, such as olive, rapeseed, sunflower, corn oils; • cream, sour cream and crème fraîche; • cakes, biscuits, pastries; • crisps, corn snacks, roasted nuts; • chocolate, sweets, cereal bars; • puddings, jelly, ice cream; • sugar, jam, honey; • sugary squash and fizzy drinks, ice lollies. Key nutrients • Energy (calories) provided by the fat and sugar in these foods. • Fat soluble vitamins (provided by the foods rich in fat): -- Vitamin A (needed for growth, healthy eyes, a healthy respiratory tract (lungs and breathing tubes), and digestive tract and maintenance of skin); -- Vitamin D (needed to help absorb calcium and to build strong bones); -- Vitamin E (to protect body cells from damage and reduce the risk of some cancers); -- Vitamin K (for healthy blood). • Essential fatty acids – necessary for brain development, retinal (eye) development and heart health in later life. Notes Many of the foods in this group are high in sugar (eg sweets, chocolate, biscuits, cakes, puddings, sugary drinks) and can cause tooth decay. Try not to offer these foods too often, and especially not between meals, as this is when they are most damaging to teeth. Many of the foods in this group are also high in fat, eg cooking and spreading fats, biscuits, cakes, fried foods etc. Some fat is essential for everyone, but it is important to remember that too much fat (for example by eating foods such as biscuits, cakes, fried food and chips frequently or in high amounts), can lead to unwanted weight gain and increases the risk of health problems such as obesity and diabetes. Young children under five years have high energy (calorie) needs in proportion to their small body size. This means they need concentrated sources of calories, so the healthy eating advice for adults (for a diet that is low in fat and high in fibre), is unsuitable for this age group. Children under two years should be given the full-fat versions of foods such as spreads and butter (from this food group) and full fat milk products such as whole milk and yogurts (from the food group: milk and dairy foods). From two years onwards children can begin to move towards the healthy eating guidelines, by having some of the lower-fat versions, eg semi-skimmed milk. From five years onwards, children should follow the healthy eating guidelines set out for adults. 25 Planning meals and snacks for children The following points will be helpful when planning meals for children. • Children need to eat regularly and it is recommended that they are offered something to eat at least every three hours. • All children need a breakfast – either at home or provided in childcare. • Children cared for all day will receive most of their food whilst in childcare. The number of meals and snacks provided will vary depending on the length of time the child is cared for. In general it is recommended that children being cared for over a normal working day receive at least one main meal and two snacks. In some instances childcare providers may also need to offer breakfast and/or an evening meal. • A variety of foods from the four main food groups should be provided daily. • A main meal must include a portion of food from the following food groups: • Choose combinations of colours to make food look attractive. Three or four defined areas of colour look good on a plate. • A combination of different textures increases appeal. Children will appreciate crispy, crunchy, chewy, smooth and soft foods. • Taste should be varied but meals containing too many new flavours may not be acceptable to children. • Providing finger foods, as well as foods that require cutlery, allows variation at mealtimes. This is also a good way to encourage children less than two years of age to eat independently and to try new foods. • Child-sized cutlery and crockery, and being able to sit comfortably and safely at mealtimes may make it easier for children to serve themselves and learn to eat independently. -- bread, rice, potatoes, pasta and other starchy foods; • Encourage children to try all the foods offered but never force a child to eat. -- fruit and vegetables • Meals are social occasions, so try to sit with children when they are eating and talk with them. If possible, eat with them. This can be used to help encourage good table manners and if you are eating healthily it sets a good example to the children. -- meat, fish, eggs, beans and other non-dairy sources of protein (see information on food groups, pages 15–25) • It is important to include 2–3 portions of foods from the milk and dairy foods food group, which can be given at either main meals, snack times or a mixture of the two. • Wherever possible healthier cooking methods should be used, eg baking, boiling, steaming, grilling, microwaving, etc. 26 • It is recommended that parents/guardians are given the opportunity to discuss their child’s food preferences and are kept informed about meals and snacks offered. • Some children eat slowly. It is important to ensure that they are given enough time to eat. • Avoid distractions such as television during meals and snacks. • Encourage children to try foods from other cultures to promote a respect for other cultures and traditions. Meal and snack suggestions Children need to eat a variety of foods every day to ensure that they get all the nutrients they need for healthy growth and development. This section outlines a number of ideas for meals including hot main meals, lighter meals, vegetarian choices and desserts. Suggestions for between-meal snacks and drinks are also included. Main meal ideas include: • Chicken casserole with leeks, carrots and mashed potatoes. • Chicken kebab with salad vegetables and pitta bread. • Chicken curry with rice/naan bread. • Beef casserole with carrots and turnip, plus boiled potatoes. • Spaghetti bolognese* (add extra vegetables into the bolognese sauce, eg mushrooms, tomatoes, peppers, onions etc). • Shepherd’s pie* (add onions and carrots to the pie) served with cauliflower, broccoli or green beans. • Mince lasagne* with salad vegetables (add grated vegetables eg onion, carrot, courgette to the sauce). • Beef stir-fry with noodles. • Potato topped steak pie and turnip. • Irish stew. • Chicken and broccoli bake. • Lamb casserole with baked potatoes and peas or sweetcorn. • Chicken fried rice (use a mixture of white and brown rice). • Pork, pineapple and pepper casserole served with boiled rice. • Chicken fajitas. • Boiled ham with cabbage and boiled potatoes. • Tuna, sweetcorn and pasta bake with sliced or cherry tomatoes. • Grilled fish fingers with baked beans and boiled potatoes. • Fish in white sauce or oven-baked fish in breadcrumbs with mashed potato and mixed frozen vegetables. • Roast pork or oven-baked pork steaks with roast potatoes, broad beans or peas plus gravy. • Sausages, mashed potatoes, peas and onion gravy. • Fish pie (potato topping) with peas. • Chickpea and vegetable casserole with pasta. • Oily fish (e.g. salmon) with champ and broccoli or spinach. • Vegetable lasagne with salad or vegetable sticks. • Kedgeree. • Vegetable risotto (add onions, peas, mushrooms, tinned tomatoes) topped with grated cheese. • Baked breaded fish with oven chips and mushy peas. • Roast chicken with carrots/parsnips and roast potatoes. • Savoury mince* with mashed potatoes, frozen peas and sweetcorn. • Homemade beef burgers* (grilled or oven baked) with a wholemeal or white bap, lettuce and tomato. • Vegetable curry with rice/naan bread. • Quiche with tomato and baked potato. • Pizza with extra vegetable topping (eg peppers, mushrooms, sweetcorn, onion). *Soya mince or textured vegetable protein (TVP) may be used to replace minced meat in these dishes. 27 Lighter meal ideas include: • Sandwiches, paninis or tortilla wraps with a variety of fillings, (for example egg and onion, cheese and tomato, cold chicken, beef or pork with salad vegetables, tuna and sweetcorn) served with vegetable sticks and/ or slices of fruit. • Baked potatoes with baked beans. • Scrambled eggs on toast with tomatoes. • Macaroni cheese with chopped fresh tomato. • Omelette with added mixed vegetables served with white, wholemeal bread or wheaten bread. • Homemade vegetable or lentil soup with bread or rolls. • Hummus on toast with sliced tomatoes and cucumber and carrot sticks. 28 • Slice of tortilla (Spanish omelette) made with egg, potato, mixed vegetables and chopped ham, served with salad vegetables. • Mini-pizza using a soda farl sliced in half and topped with chopped tomato and cheese. • Tuna melt made with tuna, chopped pepper, sweetcorn and grated cheese. • Couscous with roasted vegetables. Note: These, or similar ideas, can be used as substantial afternoon snacks if a child is not picked up until late in the evening and their evening meal is delayed. Dessert ideas include: • Chopped fresh or tinned fruit on its own or with natural yogurt or fromage frais. • Baked apple with custard. • Ice cream with tinned fruit. • Fruit crumble with custard. • Fruit salad. • Rice pudding and tinned peaches. • Milk-based instant dessert with banana. • Kiwi fruit served in an egg cup. • Sponge pudding topped with tinned fruit and fromage frais. • Bread and butter pudding. • Fruit jelly. Snacks Young children need snacks between meals, as they are not usually able to eat enough at mealtimes to meet their needs for energy (calories). The best snacks are those which are sugar-free or low in added sugar and packed with nutrients. However, it is important to ensure that children are not allowed to snack freely throughout the day as this can reduce the amount that they eat at mealtimes and also increase the risk of tooth decay. A variety of snacks should be offered, for example: • Toast or bread: offer wheaten, wholemeal, white, granary, potato bread, soda bread, scones, crumpets, bread muffins or pancakes with a little butter or spread. Avoid using sugary spreads, such as jam, honey or chocolate spread. • Sandwiches: suitable fillings include sliced banana, spreading cheese, egg, tomato, tuna and lean meat such as ham, chicken or turkey. • Pieces of fresh fruit: try sliced or chopped apples, bananas, pears, kiwi fruit, grapes, tomato and other seasonal fruits. Dried fruit is not recommended as a snack between meals as it contains concentrated sugar and may cause tooth decay. However, it can be included in main meals. 29 • Raw vegetables: carrot, cucumber, peppers, celery can all be sliced up or cut into sticks. • Natural yogurt or plain fromage frais – chopped fruit (eg banana, apple or mandarin orange) can be added to plain unsweetened yogurt. Fruit tinned in its own juice rather than syrup can also be used. • Cereal and milk: offer unsweetened varieties, eg Weetabix, Cornflakes, Ready Brek, Puffed Wheat. Foods and drinks which are high in sugar, eg sweets, biscuits, sweetened yogurts and desserts, are most damaging to teeth when they are taken between meals. This doesn’t mean that they should never be taken, but they are less damaging to teeth if they are taken at the end of meals. If you choose to offer biscuits occasionally, eg once or twice a week, these should be plain without chocolate or cream, eg Rich Tea, cream crackers or Digestives. Drinks • Milk or water is the recommended drink for young children. • Pure unsweetened fruit juice, well diluted (one part juice to ten parts water) can be given at main meals. • Sweetened juices, squashes and minerals/ fizzy drinks are not recommended. If used, they should be confined to main meals and squashes and juices should be well diluted. Sugar-free drinks contain artificial sweeteners, which are not recommended for young children. • Children should be introduced to a cup from six months to protect their developing teeth. From one year, all drinks should be from a cup and the use of a feeding bottle should be discontinued. 30 Note: It is recommended that these snacks and drinks should also be provided to any older children who are cared for after school. For guidance on suitable snacks and drinks for infants up to 12 months refer to pages 13 and 14. Sample menu for a full day The sample menu below shows an example of how a child’s daily nutritional requirements could be met. Monday Breakfast Porridge with sultanas and milk Glass of pure orange juice, well diluted Mid morning snack, eg at 10.00am Tuesday Weetabix with sliced banana and milk Glass of pure orange juice, well diluted Wednesday Thursday Friday Rice Krispies with milk Ready Brek with chopped apricots and milk Corn Flakes with milk Slices of apple Glass of pure apple juice well diluted Glass of pure orange juice, well diluted Mandarin orange Glass of pure orange juice, well diluted Milk Milk Milk Milk Milk Wholemeal toast Tinned fruit (in its own juice) Whole milk yogurt Pancakes Whole milk yogurt Kiwi fruit Finger food selection eg slices of grapes, celery, red pepper, tomatoes Fish pie Roast chicken Irish stew Vegetable curry Lasagne Peas Mashed potatoes Mixed vegetables Sweetcorn Salad vegetables Rice pudding Cabbage Milk fruit jelly Naan bread/rice Apple purée Fruit crumble and custard Stewed fruit and custard Midafternoon snack, eg at 3.00pm Milk Milk Milk Milk Milk Vegetable sticks Plain popcorn bread muffin toasted Breadsticks Fruit Cheese sticks Whole milk yogurt Tea, eg at 5.00pm Sandwiches, eg egg, onion and tomato Spanish omlette (onions, tomatoes and potatoes) Baked beans Sweetcorn Cheddar cheese Couscous salad (salad vegetables, mixed beans) Semolina and tinned pears (in their own juice) Dried fruit Sliced hardboiled egg Whole milk yogurt Jelly and tinned mandarins Banana Lunch, eg at 12 noon – 1.00pm Water and milk available to drink Water and milk available to drink Sliced pear Fruit salad Banana Banana and custard Tuna and sweetcorn pasta Vegetable sticks Fromage frais and raisins Toast Apple slices 31 Children with individual dietary needs Childcare providers may care for children with a variety of dietary requirements. The most common are outlined below. You should discuss each child’s particular needs with the parents. More detailed information and advice is available from either the child’s health visitor or local registered dietitian. The Early Years Team or the child’s health visitor can put you in contact with a registered dietitian. Children following a vegetarian diet People who follow vegetarian diets may eat or exclude a variety of different types of food. If you are caring for a child who is following a vegetarian diet it is essential to discuss with a parent what foods the child can eat. For example, some children may avoid only red meat, but eat chicken, fish, eggs, milk and dairy products such as cheese or yogurt, whereas strict vegans exclude all foods of animal origin. A vegetarian diet is a healthy diet providing that a wide variety of foods from all main food groups are eaten. When meat and animal products are excluded from meals it is important that the nutrients they provide are obtained from other foods. Vegetarian sources of protein should be provided at each meal. For more information and meal suggestions, refer to the notes on pages 22 (Meat, fish, eggs, beans and non-dairy sources of protein) and 27 (main meal ideas). To ensure that all nutrients are provided by vegetarian choices, a vegetable source of protein (eg pulses such as dried peas, beans and lentils) should always be eaten with a grain/cereal food (eg bread, rice, pasta), for example, chickpea casserole with pasta, lentil stew with rice or beans on wholemeal toast. Note: Nuts are also a vegetable source of protein. However whole nuts should not be given to under fives because of the risk of choking. It is also advised that peanuts and products containing them are not used within the childcare setting – refer to the section on peanut allergy on page 33. 32 Children from ethnic communities following a traditional diet When planning menus, childcare providers must accommodate the traditions and customs of ethnic communities. Childcare providers should take parental guidance on special dietary requirements as some families follow these traditions more strictly than others. Details of the foods traditionally avoided by particular groups are shown below: • Hindus do not eat beef and most are vegetarian. Periods of fasting are common. • Sikhs do not eat beef and many are vegetarian. Meat must come from other animals killed by ‘one blow to the head’. • Muslims do not eat pork, pork products or shellfish. Meat from other animals must be halal (killed in accordance with Islamic law). Uncertainty about the content of other foods would mean their exclusion from the diet, eg pastries and puddings which may contain pig fat. Many savoury baby products contain meat which is not halal, and these products are unacceptable to Muslims. Muslims observe regular periods of fasting, including the month of Ramadan. • Jews do not eat pork. All other meat must be kosher (ie slaughtered according to Jewish law). Meat and dairy foods must not be consumed together. Only fish with scales and fins are eaten. Products from animals that have not been prepared by the kosher method are also avoided, eg gelatine, animal fats. Jewish children should not be offered cheese that contains rennet or biscuits that contain animal fat. • Rastafarians do not consume any animal products except milk. No canned or processed foods may be eaten and no salt may be added to food. Food should be organic. • Chinese people generally exclude dairy produce. The Chinese community also believes that good health depends on a balance of two opposite elements in the body: yin (referred to as ‘cold’) and yang (referred to as ‘hot’). Infant formula milk is regarded as ‘very hot’. Where a mother has chosen to bottlefeed her baby, she may want to give her baby ‘cooling’ drinks such as cooled boiled water. Children with special dietary needs Providing special diets Special diets for children with coeliac disease (a gluten-free diet), diabetes or those who need to avoid milk or nuts and all products made from them can be quite complex. Parents should be able to provide a diet sheet about their child’s specific dietary needs which has been prepared by a registered dietitian. Food allergy Many parents believe that their child is sensitive to certain foods. However the true incidence of food allergy is likely to be much lower than reported. Parents requesting special diets for their children because of food allergy should be encouraged to seek medical advice. It is unwise to restrict food choice among young children without professional help and advice. Peanut allergy Peanut allergy is usually severe – sensitive individuals may even react to peanut dust. All nuts and nut products must be avoided, including peanut butter. Care should also be taken to prevent accidental consumption of food containing nuts or nut products or food that has come into contact with them. As a precautionary measure, it is recommended that childcare providers should not provide peanuts or foods containing them, eg peanut butter, to any child in their care. 33 Children with peanut allergy are advised to carry identification and may require a pre-filled syringe of adrenaline (eg epipen) which can be administered if they have a reaction. Recent advice from the Department of Health states that if there is a family history among parents, brothers or sisters of conditions such as asthma, eczema or hay fever, parents should speak to their GP, health visitor or medical allergy specialist before introducing peanuts to the child for the first time.† It has also been advised that those children who are breastfed should be breastfed throughout weaning and that high-allergen foods* should be introduced one at a time so that if a reaction occurs the specific food causing the response can easily be identified. * High-allergen foods include; milk, eggs, fish, shellfish, wheat, soya, peanuts, tree nuts, sesame seeds, celery and mustard. Fussy eaters It is quite normal for an infant or child to refuse a food occasionally. However, if a child continually refuses food, the parent or guardian should be informed. If a child refuses a snack or meal, gently encourage them to eat. If they refuse to eat even after gentle encouragement, the following suggestions may be helpful. • Remove the food without making a fuss or passing judgement and offer food at the next meal or snack time. • Keeping your attitude friendly and relaxed will help children to feel that eating is a pleasurable way to satisfy hunger rather than a battleground. • Small helpings may be better accepted. Second helpings can then be offered if appropriate. • Do not try to bribe children to eat food they do not want with the reward of a pudding or sweet snack. • It may be useful to adopt the approach that a food refused is ‘not liked today’. If a food is refused, try it again a few days later; changing the form a food is given in may make it more acceptable (eg offering tinned tomato in bolognese sauce instead of tomato sauce on a pizza). • Consider possible reasons for the food refusal, such as drinking continually throughout the day, or frequent large snacks between meals, as both of these can reduce the appetite for main meals. • Never force a child to eat. † Statement of the review of the 1998 COT recommendations on peanut avoidance last accessed 25.6.2012 http://cot.food.gov.uk/pdfs/cotstatement200807peanut.pdf 34 Food safety Food safety is an important issue when caring for the under fives. The areas where food is stored, prepared and served should be safe, clean and hygienic. Extra care is needed for babies and young children as they may have a lower resistance to food poisoning. Listed below are some general points on food safety: • Always wash hands (yours and the children’s) with soap and warm water before and after handling food and always after touching the dustbin, pets, changing nappies or going to the toilet. • Keep your kitchen clean and dry. • Don’t use the same knife or chopping boards for raw meat, cooked food and fresh vegetables without washing them between times. Ideally, keep a separate chopping board for raw meat. • When shopping, take chilled or frozen food home as quickly as possible. • Keep your fridge/freezer at the correct temperature – get a fridge thermometer. Fridges should be kept at 5°C or below and freezers at –18°C or below. • If parents are supplying food for their children, make sure anything perishable is stored in the fridge straight away. • Cook food thoroughly. • Do not eat or serve raw eggs. • Store raw and cooked food separately. • Check use-by dates and always use food within the recommended time. • Reheat food thoroughly and do not reheat it more than once. • Keep pets and their feeding bowls out of the kitchen. Note: More detailed information and advice on food hygiene is available from the environmental health department of your local district council. See page 14 for information on breast and formula milk. Further advice and information on bottle feeding including preparing feeds safely, sterilising equipment and practical tips can be obtained from either the child’s health visitor, the Early Years Team or the Public Health Agency’s leaflet, Bottlefeeding which can be accessed at: http://publichealthagency.org/sites/default/files/Bottlefeeding_2_2014.pdf 35 Rewards and celebrations Rewards for good behaviour and the celebration of special occasions, such as birthdays, often involve sugary foods and drinks. The frequent consumption of sugary foods and drinks can adversely affect dental and general health; therefore they should be limited. Encouraging good behaviour Children should be given encouragement for good behaviour. This can be in the form of smiles or praise, or simply giving the child attention. This form of positive encouragement is preferable to the practice of giving items such as sweets, chocolates, small toys etc. Parties and special occasions Depending on how frequently these are celebrated you may want to try some of the following: • Discuss with parents what foods and drinks are appropriate for them to provide – encourage healthier choices. • Offer some ideas for healthier party food, for example: - sandwiches cut into fancy shapes; - finger sized pieces of pizza and quiche; - cocktail sausages (oven-bake on a rack to allow fat to drain away); - plain, unsalted popcorn; - birthday cake (a plain sponge cake decorated with fruit by the birthday child); - fruit punch (diluted pure fruit juice – 1 part juice to 10 parts water – with chopped fruit added); - fruit and raw vegetables cut into fingers or fancy shapes. • Focus on the sense of occasion rather than simply the supply of party food. • Hold a theme party and encourage children to dress up. Theme days can also be used to encourage children to try foods from other cultures, and to promote a respect for other cultures and traditions, eg St Patrick’s Day, American Independence Day (4th July) , Pancake Tuesday, Indian festival of lights (Diwali), Chinese New Year etc. • Encourage children to play active party games, eg musical statues; blind man’s bluff; musical chairs; have a mini disco. 36 Physical activity for children There is good scientific evidence that being physically active is good for our health. For children and young people, being active has a wide range of benefits, for example it: • helps to develop physical skills such as agility, balance and coordination; • builds up muscle strength and overall fitness; • helps them develop social skills; • helps them to avoid becoming overweight or obese; • improves concentration in school; • contributes to a healthy appetite; • helps to reduce the risk of ill health in later life. New UK-wide Chief Medical Officer guidelines were published in 2011, which set out recommendations for physical activity for all age groups. These recommend that: • children should be encouraged to be active from birth, particularly through floor-based play and water-based activities in a safe environment; • all children of pre-school age, who are able to walk without help, should be active for at least 180 minutes each day, spread throughout the day; • the amount of time that young children are inactive, either restrained (eg in a high chair or car seat) or sitting (except time spent sleeping) should be kept to a minimum. 37 It has been shown that children who develop an active lifestyle when they are young are more likely to maintain a healthy active lifestyle as they get older. They should be encouraged to be active all year round and not just in the summer months. Visits to parks and play areas, going for walks and playing games both outdoors and indoors should all be encouraged. Outdoor play provides great opportunities for learning, for example children can learn about the environment around them. Playing with other children can develop their social skills and help build their confidence. Childcare providers should ensure that children have access to outdoor play every day. Exposure to summer sunlight in outdoor play helps to ensure an adequate supply of vitamin D, which is essential for healthy bone development. Childcare providers should agree guidelines with parents on how long children can remain outdoors and on the use of sunscreens and protective clothing such as sun hats. Babies under one year should be kept out of the sun. Older children should be kept in the shade during the hottest part of the day, between 11.00am and 3.00pm. 38 Preparing a nutrition policy Developing a nutrition policy is an excellent way to demonstrate your commitment to the children in your care. It also provides an opportunity to ensure that the recommendations and advice about healthy eating are agreed between you and the children’s parents or guardians. Writing a nutrition policy is not as difficult as it may sound. Most childcare providers will have a number of unwritten ‘rules’ about eating and drinking. Developing a policy is just a way of recording these ‘rules’ and provides an opportunity for you to discuss healthy eating with parents and how it will apply to their child/children. A policy may also be useful in cases where parents are providing their own food. It could, for example, be used to agree suitable alternatives should a child refuse the food the parent has provided. A policy should not be seen as fixed, but open to regular review. Some suggestions about the type of information that could be included in such a policy are outlined below. Introductory statement I aim to offer a high quality service to the children I care for and their parents. I recognise the need to encourage healthy eating habits from an early age to help children to reach their full potential in terms of growth and development. Meals • Well-balanced and nutritious meals are provided for the children. • All puddings provided are based on fruit and/or milk. • Fresh fruit is always available. • Processed meat products such as sausages, chicken nuggets, burgers and fish bites, if provided, are limited to once a week. • Healthier cooking methods are used, eg boiling, grilling, steaming, microwaving, stewing, rather than frying. • Special diets are respected. Parents will be asked to provide a copy of the diet sheet from a registered dietitian or specific guidance in agreement with the child’s doctor. • Cultural dietary habits are respected. Parents should provide details of these. • Mealtimes are used as an opportunity to encourage good table manners. For example, whenever possible children and adults eat together. 39 Snacks and drinks • Snacks provided are healthy and nutritious. • Sweets and fizzy drinks are not routinely offered. • Where possible, snacks are sugar-free to avoid causing damage to teeth. • Fresh fruit is regularly offered as a healthy snack. • Whole milk or water is provided for children as a drink between meals. • If juices and squashes are given, these are well-diluted and only given at mealtimes to avoid causing damage to teeth. For more ideas of what could be included see sections on Snacks and drinks on pages 13–14 and 29–30. Rewards and special occasions • Praise and attention are used to help develop children’s self-esteem and to act as a positive reward for good behaviour. • If other forms of reward are used, they do not conflict with the healthy eating principles that are in everyday use. For example, sweets and sugary drinks are not given as rewards. • On special occasions the focus will be on the occasion rather than providing fatty or sugary foods or drinks. For more ideas of what could be included see Rewards and celebrations, page 36. Activities A healthy lifestyle is promoted through a variety of activities including active play, outings, cookery, stories, music, etc. 40 Nutrition checklist This checklist has been provided to help childcare providers see at a glance that they are providing a healthy diet for the children in their care. As there is a great variation in the number of meals and snacks that children receive while in childcare, the checklist covers meals and snacks provided over a full day – select the ones which are relevant to you. This can also be used on its own or with a nutrition policy, to show parents what food/meals are provided, or as an agreement for an individual child which could include likes and dislikes or any other relevant information about the child’s eating habits. It is important to vary the meals and snacks served over the week, and between weeks, to ensure that children get the opportunity to try a variety of foods. Yes No Comments Breakfast Bread or toast is always available. Cereals are always available (unsweetened breakfast cereals are preferred, eg porridge, Weetabix, Cornflakes, Rice Krispies). Suitable choices are provided for babies and infants. Midday meal One portion of food from the Meat, fish, eggs, beans and other non-dairy sources of protein group is provided. At least one portion from the Fruit and vegetables group is provided. At least one portion is provided from the Bread, rice, potatoes, pasta and other starchy foods group. Desserts are based on fruit and/or milk. (See pages 43 and 44 for details of food groups) 41 Yes Evening meal (if provided) One portion of food from the Meat, fish, eggs, beans and other non-dairy sources of protein group is provided. At least one portion from the fruit and vegetables group is provided. At least one portion is provided from the Bread, rice, potatoes, pasta and other starchy foods group. Desserts are based on fruit and/or milk. (See pages 43 and 44 for details of food groups) Snacks between meals Morning and afternoon snacks are served at regular times. Recommended snacks include: - bread*, toast*, scone*, pancake*, crumpet*, bread muffin*; - sandwiches (eg meat, cheese, egg, fish); - fresh fruit; - raw vegetables; - cheese; - natural yogurt, unsweetened fromage frais; - low-sugar cereal and milk. (*all served without jam, honey, marmalade, chocolate spread). Children are not encouraged to snack freely. Suitable snacks are served for infants. Drinks These are sugar free. Water and milk are the most suitable drinks at all times. Unsweetened pure fruit juices and squashes, if used, are well diluted (1 part juice to 10 parts water) and only given at mealtimes. 42 No Comments Yes No Comments Milk and dairy foods 300–600ml (½–1 pt) of milk per day is provided for each child or 2–3 portions of milk-based foods are provided each day. One portion is 25g (1oz) of hard cheese or 125g carton of yogurt or a bowl of milk pudding. Breastmilk or infant formula is provided as the main drink for infants under 12 months. Meat, fish, eggs, beans and other non-dairy sources of protein One portion of food from the Meat, fish, eggs, beans and other non-dairy sources of protein group is provided at each main meal, eg: beef, lamb, pork, liver, kidney, ham, poultry, fish, fish fingers, egg*, cheese*, beans*, lentils*, Quorn*, Tofu*, TVP* (*suitable for vegetarians). Red meat should be included at least twice a week as it is a good source of iron. Mince is acceptable as red meat. Processed meat products, eg sausages, burgers, sausage rolls, fish/chicken nuggets are served no more than once each week. Cultural and religious preferences are catered for where appropriate. Bread, rice, potatoes, pasta and other starchy foods A variety of these foods is offered, eg bread, pasta, rice and potatoes. At least one portion is included at each meal. Extra servings are available if the child is hungry. Mashed potatoes are made with fresh potatoes and milk rather than instant potato. Chips or roast potatoes are served a maximum of once a week. 43 Yes Fruit and vegetables A total of five child-sized portions should be provided over the day, three of which should be provided in childcare. A child’s portion is smaller than an adult’s, eg ½ piece of fresh fruit, 1 tablespoon cooked vegetables. A variety of types is included. A vitamin C rich fruit is included daily, eg orange, kiwi fruit or strawberries. Desserts Desserts served at main meals are milk or fruit based (preferably both). Milk pudding is provided at least three days per week, eg custard, semolina, rice pudding, instant whipped dessert, yogurt. ‘Ready to eat’ custard or rice are suitable choices. Fruit is also included in the dessert at least three days per week. Fruit-based desserts include fruit crumble, fruit sponge, fruit tart, fruit jelly, stewed fruit. A variety of desserts is included over the menu cycle. Spreads Low fat spreads are not used. Salt No salt is added at the table. The minimum possible amount of salt is used in cooking. If stock cubes are used, salt is not added in cooking. 44 No Comments Contacts for more information Enquiries should, in the first instance, be directed to the Early Years Team in your local area. They can put you in touch with other health professionals such as community dietitians and dental staff. Health visitors can be contacted directly with the parent’s permission. The Northern Ireland Childminding Association is another source of information, training and support for childminders. Belfast Health and Social Care Trust Early Years Team 124 Stewartstown Road Belfast BT11 9JQ Tel: 028 9504 2811 Northern Health and Social Care Trust Causeway Early Years Team 1st Floor Route House 8e Coleraine Road Ballymoney BT53 6BP 028 2766 1340 Ballymena Early Years Team Raphael House 11B Fenaghy Road Galgorm Ballymena BT42 1HW Tel: 028 2563 5110 Magherafelt/Cookstown Early Years Team Magherafelt Community Health Clinic 44 King Street Magherafelt BT45 6AH Tel: 028 7930 2628 Carrickfergus Early Years Team Ellis Street Carrickfergus BT38 8AZ Tel: 028 9331 5112 Southern Health and Social Care Trust Early Years Team Lisanally House 87 Lisanally Lane Armagh BT61 7HW Tel: 028 3752 0616 Early Years Team The Bungalow Lurgan Hospital 100 Sloan Street Lurgan BT66 8NT Tel: 028 3831 6691 Early Years Team Drumalane House Drumalane Road Newry BT35 8AP Tel: 028 3082 5098 45 South Eastern Health and Social Care Trust Early Years Team Ward 25 Downshire Hospitals Ardglass Road BT30 6RA Tel: 028 4451 3807 Western Health and Social Care Trust Early Years Services Clooney Hall Centre 36 Clooney Terrace Londonderry BT47 6AR Tel: 028 7132 0950 Early Years Team Tyrone and Fermanagh Hospital Omagh BT79 ONS Tel: 028 8283 5108 Early Years Team 2 Coleshill Road Enniskillen BT74 7HG Tel: 028 6634 4000 Northern Ireland Childminding Association (NICMA) 16–18 Mill Street Newtownards BT23 4LU Tel: 028 9181 1015 www.nicma.org 46 Early Years – the organisation for young children 6c Wildflower Way Apollo Road Boucher Road Belfast BT12 6TA Tel: 028 9066 2825 ww.early-years.org 47 Tel: 0300 555 0114 (local rate). www.publichealth.hscni.net 06/16 Produced by the Public Health Agency, 12–22 Linenhall Street, Belfast BT2 8BS.
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