Part 6

Health
and well being of children

As an Early Years practitioner there are a huge number of different
factors which you have control over that will influence a child’s health
and well being. Many people think that well being is only connected to
food and nutrition but this is not the case and there are huge numbers
of things that have an impact on children. Each should be understood
and the methods of the practitioner need to revolve around giving the
best possible environment for children in your care.

Providing a welcoming environment

The environment which a child is raised in will have a huge impact on
their development. Since the environment in a setting will influence the
care that a child receives as well as their learning and their
opportunities, it will most probably have the largest affect on a child’s
well being.

Providing a loving and warm environment for all children in your care
will ensure that each feels welcomed and supported. This will help
children to develop and grow quickly in your care and fulfill their
potential while in a positive and encouraging environment. Part of
providing a good environment for children is ensuring that there are
many play opportunities available as well as having strong partnerships
with parents/carers to provide continuity of care.

Promote resilience, value and self worth

By empowering children to make their own choices they will become
confident and their self worth will be increased. This is a great way to
ensure the well being of children is high as each child will be
comfortable and feel valued as part of a group. Encouraging children to
complete certain tasks such as getting their own plates at meal times,
brushing their teeth or cleaning up after themselves will increase their
self-esteem and promote a positive self image.
CACHE Level 3 Award in Childcare and Education

Acknowledging cultural and religious differences

Each child you care for will come from a different background with a
family that has their own values and culture. Although each child should
be treated equally and fairly as part of the group, you must also ensure
that everyone is seen as a unique individual. Working with families and
getting to know their cultural or religious differences will ensure that
you can work with children to provide care that increases awareness of
their own background. This may be in the form of working with children
of different faiths as well as nationalities, preferences and individual
attitudes.

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National and local incentives promoting well being

Within early years there are a huge number of different incentives which
can be used in settings to promote health and well being. As with health
and well being, these incentives can relate to a number of different
aspects of childcare but do focus mainly on healthy eating and nutrition.
The main national incentives in place include:

! 5 a day campaign- this initiative is funded by the Department of
Health and is designed to encourage children to eat 5 portions of fruit
or veg every day. This is thought to reduce the risk of cancer, prevent
people from becoming overweight and give a general good level of
health to all individuals.
! Schools fruit and veg scheme- this is part of the 5 a day scheme and
aims to give children from 4 to 6 years a free piece of fruit or veg
while in school. This is often given as a snack and tries to give every
child access to fruit and veg so that they will get to like these foods
even if they are not available at home.
! Start4life- this initiative is designed to give help and advice
throughout pregnancy and promotes health and well being of women
while carrying children. This is organised by the NHS and childcare
practitioners can give advice and information regarding this initiative
to women who are pregnant and may be thinking of enrolling their
baby into the childcare provision.
! Change4life- this incentive is designed to promote health and
exercise in families and ensure that they make healthy choices. It is
centred around adults making healthy choices and trying to ensure
that children follow this example.
! Food labelling- the use of traffic light systems on food labelling is
another great incentive for healthy eating. This will give a very clear
indication to people how much of each ingredient a food contains to
make healthy eating easy and ensure that each person understands
the dangers with certain foods.

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How practitioners maintain a healthy environment

Early years practitioners can work in a number of different ways to
support healthy eating and well-being during their stay in a setting.
Working closely with parents/carers is a great way to ensure that health
and well being are promoted at all times. To ensure that the right
standards are upheld at all times both parents and practitioners must
agree on the promotion of exercise and ensure that play activities are
accessible at all times for children.

When in the childcare setting, practitioners must set a good example for
children and ensure that they are healthy as well as encourage the
eating of fresh fruit and vegetables. The environment that a child is
immersed in will have a huge influence on the way in which they react to
health and well being incentives so childcare practitioners must
constantly uphold these standards.

Working in partnership with parents/carers for good nutrition

Information should be gathered by Early Years practitioners from
parents relating to a number of factors such as:

! Dietary requirements
! Likes and dislikes of certain foods
! Any allergies
! Special preferences

Through working in partnership with parents and carers, a good diet and
nutrition can be implemented and maintained which does not contradict
any culture preferences or allergies of the child.

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Food and nutrition

Encouraging children to lead a healthy life style is very important. By
instilling the importance of being healthy from a young age we can help
to combat obesity and encourage children to take responsibility for their
own healthy lifestyle. Learning about healthy eating and exercise early
on in life should help children to make the right choices and understand
why these choices are necessary for their long term health.

Children are often naturally interested in their own bodies. They are
curious about how their bodies work, how the heart beats, what the
lungs are for and how their muscles move. By encouraging children to
develop this interest and curiosity it will be easier to explain to them
why a healthy lifestyle i.e. a balanced diet, fresh air and exercise are
important.

Firstly, children need to learn about healthy eating. Most children enjoy
sweets, chocolate and fizzy drinks however we now know that these
foods, although nice to eat, do not provide our bodies with any
nutritional value and therefore it is important that sweets and fizzy
drinks are kept to a minimum and are offered rarely, perhaps as a treat,
rather than regularly or in place of meals.

Some children are ‘fussy eaters’ and will moan and complain if they are
not given the snacks and sugary foods they desire. However it is
important that we realise that children will only ‘crave’ these foods for a
short time until the body has been weaned off this need for sugar.

In order to provide children with a healthy diet we need to understand
what constitutes ‘nutritional’ food and how we can go about planning
and preparing a menu which will both appeal to children and provide
them with the necessary nutrients their bodies need.

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The main food groups

Foods are divided into five main groups and, in order to maintain a
healthy diet, it is important that we understand the basis of these food
groups and know how much food from each of the groups should be
consumed.

There are five main food groups. These are:-

! Bread, cereals and potatoes
! Fruit and vegetables
! Meat, fish and pulses
! Milk and dairy products
! Products containing fat and sugar

Bread, cereals and potatoes – this category includes bread, pasta, oats,
rice, noodles and breakfast cereals. Every meal offered to children
should contain at least one of the food products from this group.
Wholemeal bread and brown rice are preferential to white bread and
white rice as they contain more vitamins, minerals and fibre.

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Fruit and vegetables – this category includes all fruit and vegetables,
except potatoes which are included in the above mentioned food group.
You should be aiming to provide children with at least five portions or
fruit and vegetables per day. Food from this category can be fresh,
canned or frozen or even served as juices. If choosing canned fruit, make
sure that you purchase fruit in their natural juices rather than in syrup as
the syrup contains a high level of sugar. Canned vegetables should be
purchased in water rather than brine which contains a high level of salt.

Meat, fish and pulses – this category contains all types of meat products
such as burgers and sausages, poultry, fish and eggs. Vegetarians would
include soya products and tofu in this category. Lentils and pulses are
also included. You should be aiming to provide two portions of food
from this category per day.

Milk and dairy products – this category includes milk, cheese and
yoghurt. For a healthy balanced diet you should be aiming to offer
children two or three servings from this category per day.

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Products containing fat and sugar – this category includes butter,

margarine, oil, biscuits, cakes, ice-cream, chips and other fried foods,
sweets, jam and fizzy drinks. You should be aiming to serve only small
quantities from this food group on an occasional basis.

The amount of food which we should consume from each of the main
food groups is dependent on several factors including:-

! Age
! Gender
! State of health
! Level of physical activity

Eating too little or too much food from each of the food groups may lead
to problems including malnutrition and obesity.

Although in some cases foods are easy to ‘categorise’, for example milk
and cheese are easy to label as dairy products, other foods may be more
difficult to recognise.

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The Eat Well Plate

The Eat Well Plate (below) shows how much of what you eat should
come from each food group. This plate includes everything you eat
throughout the day including all meals and snacks.

Depending on age, we should be aiming to eat the following number of
portions per day from each of the above categories:-

! Bread, cereals and potatoes – A third of your day’s intake
! Fruit and vegetables – A third of your day’s intake
! Milk and dairy – 2 to 3 portions
! Meat, fish and pulses – 2 to 3 portions
! Fats and sweets – occasionally

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Good health and Five-a-day recommendations

The 5-a-day campaign is probably one of the best known health
campaigns in the UK and it is a programme devised by the government
to encourage the consumption of fruit and vegetables.

The 5-a-day programme has become increasingly popular with children
and schools across the country also recognise the importance of eating
healthily and they can now apply for National Healthy School Status
(NHSS) if they meet certain criteria which promotes the four main
themes i.e.

! Personal, Social and Health Education
! Healthy Eating
! Physical Activity
! Emotional Health and Well-being

As part of the five-a-day campaign the School Fruit and Vegetable
Scheme makes one free piece of fruit or vegetable available each school
day to all children aged between four and six years attending LEA
maintained schools.

The 5-a-day campaign is however not solely targeted at children and it is
recommended by nutritionists and doctors that everyone eats five
portions of fruit and vegetables each day.

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Portion sizes are often an area of confusion, however broadly speaking,

a portion could be the equivalent of:-

! 1 medium sized apple, pear, banana etc.
! 2 smaller pieces of fruit such as a plum or tangerine
! A handful of grapes or cherry tomatoes
! A bowl of salad
! 1 tablespoon of raisins or sultanas
! 3 heaped tablespoons of peas, beans etc.

Fruit and vegetables can be eaten fresh, frozen or tinned and may be
raw, cooked, pureed, blended, chopped or used as part of an ingredient
in a recipe.

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Body mass index

The energy our body uses comes from the food we eat. The amount of
energy we get from each food is shown by the amount of kilo calories or
kilo joules. 1 calorie is roughly the same as 1 kilo joule. The more kilo
calories or kilo joules a food has, the more energy it contains.

Every time we move our bodies we use energy. If we consume more
energy than we need then the extra energy will be stored as fat,
however if we consume less energy than we need then we will lose body
fat. Consuming the same amount of energy that we actually need will
result in our body weight remaining static. Therefore to summarise:-

! If energy going into the body is more than we use we will Gain
Weight
! If energy going into the body is less than we use we will Lose Weight
! If energy going into the body is the same as we use we will Remain
the Same Weight.

Appetites will fluctuate and although some days you may consume more
energy than you need, on other days this will be counteracted if your
appetite is not as good because you may feel less hungry. In order to
work out a person’s Body Mass Index (BMI) you will need to know:-

! Their height in metres
! Their weight in kilograms
! You need to divide their weight by their height squared (this means
multiplying it by itself).

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For example a person weighing 50 kg who is 1.40m tall would have a

BMI of:-

50 50
= = 25.5 (BMI)
1.40 × 1.40 1.96

By using the chart below you can see that this person falls into the
overweight category.

CLASSIFICATION BODY MASS INDEX
Underweight < 18.5
Normal 18.5 – 24.9
Overweight 25 – 29.9
Obese 30 +

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Weaning and feeding babies

The first twelve months of a child’s life are very important as this is
when you start building the foundations for good health. It is
paramount that you understand how to provide the proper nutrition and
the right activities for children during their first year.

When a baby cries parents instinctively feed them as they assume that
this is the reason for the child’s distress however this may not always be
the case and, as a baby cannot say whether they are hungry or not, we
need to look for other signs which may point to the fact that the child
has had enough or is not hungry such as refusing a bottle or turning their
head away.

New born babies change dramatically with regard to their calorie intake
in the first year of life beginning by needing around 300-350 calories
they will require more in the region of 1000 calories by the end of their
first year as their bodies grow and develop. Parents will learn in time to
spot the signs which tell them that their child is hungry or satisfied and

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they will be able to modify feeding patterns and amounts of food

offered accordingly.

Babies grow rapidly in their first year of life and may have even doubled
in weight by the time they are around five or six months of age. During
the first year of a baby’s life there is also significant growth in the brain
and it is therefore essential that the right balance of nutrition is
achieved in order for the child to grow and develop adequately.

There are certain factors which may have an immediate and long-term
effect on the health of a child and these are:-

! Babies who are born to mothers who are undernourished. These
mothers are more likely to produce smaller babies and have difficulty
in producing sufficient breast milk to feed the baby.
! Babies who are born to mothers who smoke or have a history of
alcohol or drug abuse are more likely to produce underweight babies
who may have developmental delays and feeding difficulties.
! Undernourished children are more likely to succumb to illness and
will be less likely to be able to fight infection.
! Babies who do not receive an adequate amount of milk will have
problems gaining weight and may not grow to be as tall as other
adults in later life.

During the first few months of life, a baby needs only one food – milk.
The new-born baby can suckle and swallow and should be offered either
breast milk or formula milk.

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Breast feeding

Breast milk has exactly the right composition to meet the necessary
nutritional needs of a baby and it is for this reason that medical experts
strongly recommend that mother’s breast feed their off-spring.
Some of the advantages to breast feeding are:-

! Breast milk contains all the necessary nutrients needed by the baby
and these nutrients are correctly balanced.
! Breast feeding can be an excellent way for mothers to bond with
their babies.
! Breast milk contains antibodies produced by the mother. These
antibodies protect the baby against infections when breast fed for
the first two or three days after the birth.
! Breast milk is easily digested and absorbed.
! Feeding on demand is easier when breast feeding.
! The milk does not require any preparation i.e. measuring or warming.
! Breast fed babies are less likely to develop food allergies.
! There is no need to sterilise or prepare equipment or bottles.
! Breast feeding is a cheaper option to formula milk.
! Breast feeding helps a new mother to regain her pre-pregnancy
weight sooner than if she doesn’t breast feed.
! Breast feeding reduces the mother’s risk of developing breast cancer
in later years.

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Although the list of advantages to breast feeding is quite long it is

important to remember that breast feeding is only beneficial if the
mother who is breast feeding her baby eats a diet following the balance
of good health guidelines. The mother’s diet is imperative to the
standard of milk she produces.

If breast milk is expressed to be fed to the baby at a later time either by
the mother or by someone else in the mother’s absence it is important
that the milk is stored correctly to avoid contamination.

Breast milk can be stored:-

! In a refrigerator for between three and five days. It must be stored at
a temperature of 4°C or cooler.
! In the freezer compartment of a refrigerator for up to two weeks.
! In a separate freezer for up to three months.

The best way to store breast milk is in the refrigerator as, although still
more beneficial than formula milk, freezing breast milk can alter the
protection it provides against disease.

It is also important to remember that the milk produced by mothers in
the first few weeks of the baby’s life should not be stored for long as this
milk will not be suitable for the baby when it reaches three or four
months old. Breast milk which is produced by the mother changes to
meet her child’s nutritional needs as they grow and develop.

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Breast milk production

Milk production is initially driven by hormones. It isn’t simply a supply
and demand process. In other words, as long as the correct hormones
are in place, a mother will start making colostrum about halfway
through pregnancy this is known as Lactogenesis I. A mother’s milk will
increase in volume around 30-40 hours after birth Lactogenesis II.

Colostrum is a form of milk produced by the mammary glands of

mammals (including humans) in late pregnancy. Humans generate
colostrum just prior to giving birth. Colostrum contains antibodies to
protect the new-born against disease and infection. In general,
protein concentration in colostrum is substantially higher than in
milk.

In the later stages of pregnancy, the breasts begin making colostrum.
Due to high levels of progesterone milk secretion is reduced therefore
the volume of milk in the breasts is low. At birth, the placenta leaving
the body results in a drop in progesterone/oestrogen/HPL levels. This
sudden change in progesterone levels combined with the presence of
high prolactin levels cues Lactogenesis II. Other hormones (insulin,
thyroxine, cortisol) are also involved in milk production but their roles
are less established. According to biochemical markers, Lactogenesis II
commences approximately 30-40 hours after birth, but most mothers do
not begin feeling increased breast fullness until 50-73 hours (2-3 days)
after birth.

After Lactogenesis II, there is a switch from endocrine system to the
autocrine (or local) control system. This is known as Lactogenesis III- the
maintenance stage. In this stage, the breast is the control point of milk
synthesis — milk removal is the primary control mechanism for the
increase or decrease in supply. Although hormones can interfere with
milk supply, milk production is primarily driven by the baby’s hunger and
appetite.

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Feedback Inhibitor of Lactation (FIL) – the role of FIL appears to be

to slow milk synthesis when the breast is full. Thus milk production
slows when milk accumulates in the breast (and more FIL is
present), and speeds up when the breast is emptier (and less FIL is
present).

Factors affecting breast feeding

A big factor that affects a lot of areas of motherhood is postpartum
depression. Postpartum can begin as early as three to four days after the
baby’s birth. It may affect a mother’s decision and/or ability to
breastfeed. Not only can postpartum depression medications not be
compatible with breastfeeding, anxiety and feeling low can make
breastfeeding difficult.

Earlier research says that milk volume is typically greater in the morning
hours and lessens as the day progresses. As the volume of breast milk
decreases the fat content rises. More recent research indicates that fat
content of the milk is also determined by how empty the breast is

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(emptier breast = higher fat milk), rather than by the time of day or
stage of the feed. Babies on a routine feeding schedule will sleep more
through the night and feed during the day leaving the breast to be in
constant need of refilling.

Not many women realise that their delivery method can affect the
duration of breastfeeding. A study published in a 2006 issue of the
"Journal of Preventative Medicine and Public Health" found that women
who delivered vaginally were more likely to breast feed their children
than those who delivered via caesarean section. This could be attributed
to a number of factors, such as the healing process or a baby with a low
birth weight. While you can't necessarily choose the way you deliver,
you can prepare yourself for added challenges should you deliver via C-
section.

Milk production and breastfeeding management is also affected by the
mother’s milk storage capacity. A mother’s storage capacity is the
amount of milk that can be stored between feeds. This can vary widely
and also between a woman’s breasts. Breast size does not determine
storage capacity, although having small breasts can limit the amount of
milk that can be stored. Whether there is a large or small storage
capacity, a mother can produce plenty of milk for her baby. A woman
with a larger milk storage capacity may have the ability to go longer
between feeds without it having an impact on milk supply and baby’s
growth. On the other hand, a mother with a less ample storage capacity,
may need to nurse baby more often to satisfy their appetite and
maintain milk supply since her breasts will become fuller more quickly.
According to a 2009 study published in the "International Breastfeeding
Journal", having the full support of a partner helps increase a woman’s
chance of success when trying to breastfeed. An effective support
system can be key to boosting a woman’s chances of successfully breast
feeding. If a woman lives in an area where breast feeding is widely
accepted and encouraged it may help her be more knowledgeable and
less self-conscious when having to breast feed her baby. Sometimes

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professional support in the form of lactation consulting can help

overcome any obstacles to breastfeeding.

Not many women realise that their delivery method can affect the
duration of breastfeeding. A study published in a 2006 issue of the
"Journal of Preventative Medicine and Public Health" found that women
who delivered vaginally were more likely to breast feed their children
than those who delivered via caesarean section. This could be attributed
to a number of factors, such as the healing process or a baby with a low
birth weight.

Factors, such as maternal education level, disposable income level and
maternal unemployment can play a role in the decision to breastfeed. In
issue of "European Journal of Public Health" published in 2007 a study
showed evidence that a lower level of a mother’s maternal education
and less disposable income negatively affected the chance of a mother
breastfeeding her child. This was despite breastfeeding being the most
economical choice.

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How breast milk nourishes

There are many benefits to breastfeeding a baby. The benefits of
breastfeeding extend past basic nutrition. In addition to containing all
the vitamins and nutrients a growing baby needs in the first six months
of life, breast milk is packed with disease-fighting substances that
protect the baby from a variety of illness. Providing a baby with nothing
but breast milk is recommended for about the first six months (26 weeks
of life. When the baby is older than 6 months, it is advisable to move the
baby onto breast milk alongside family foods for preferably the first two
years.

Due to its ability to boost immune systems, numerous studies have
shown that stomach viruses, lower respiratory illnesses, ear infections
and meningitis occur less often in breastfed babies and should they
occur they are less severe. The recommendation of 6 months exclusively
seems to provide the best protection. The main immune boosting factor
at work is secretory immunoglobulin A (IgA). It is present in large
amounts in colostrum. Secretory immunoglobin forms a protective layer
on the mucous membranes in the baby's intestines, nose, and throat
providing an effective barrier against invading germs. When a woman
breastfeeds, the milk she produces is specifically tailored to her child.
Amazingly, a woman’s body responds to pathogens (virus and bacteria),
it then makes secretory IgA that's specific to those pathogens, creating
protection based on factors that a mother is exposed to. For example, if
the mother or someone close has a cold, the breast milk will have
secretory IgA to fight those pathogens to prevent her child getting ill.
The positive effects of breastfeeding's protection against illness lasts
longer than the breastfeeding stage. Studies have shown that
breastfeeding can reduce a child's risk of developing certain childhood
cancers. While it is still unclear how, the most prevalent thought is that
it is down to antibodies in breast milk giving a baby's immune system a
boost. Breastfed babies may also help children avoid a host of diseases
that strike later in life, such as type 1 and type 2 diabetes, high
cholesterol, and inflammatory bowel disease. Premature children fed on

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breast milk as babies are less likely to have high blood pressure by the
time they're teenagers.

Babies who are fed on a formula based on cow or soy milk tend to have
more allergies than breastfed babies. As Secretory IgA is only available in
breast milk, it helps prevent allergic reactions to food when it provides a
layer of protection to a baby's intestinal tract. Without this protection,
inflammation can develop and the wall of the intestine can become
"leaky." This allows undigested proteins to cross the gut where they can
cause an allergic reaction and other health problems.

A variety of studies have found a link between breastfeeding and
cognitive development. In a study of more than 17,000 infants followed
from birth to 6 1/2 years, it was concluded from IQ scores and other
intelligence tests that prolonged and exclusive breastfeeding
significantly improves cognitive development.

Another study that included around 4,000 children, showed that babies
who were breastfed had significantly higher scores on a vocabulary test

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at 5 years of age than children who were not. The longer the period of
breast feeding the higher score.

When preterm infants who were born with extremely low birth weights
received breast milk shortly after birth improved their mental
development scores at 18 months when compared with preterm infants
who were fed on other milk. A later study found that babies who
received breast milk were also less likely to be hospitalised again
because of respiratory infections. Some experts say that it may be the
emotional bonding that takes place during breastfeeding that could
contribute to some of the brainpower benefits, but others believe that
the fatty acids in breast milk may play the biggest role.

The U.S. Centers for Disease Control and Prevention (CDC) recommends
breastfeeding for as long as possible to reduce the risk of SIDS. One large
study by the National Institute of Environmental Health Sciences showed
that children who are breastfed have a 20% lower risk of dying between
the ages of 28 days and 1 year than children who weren't breastfed.

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Making formula and warming milk

All baby’s bottles, whether containing breast or formula milk, will need
sterilising. Sterilising will kill germs that can gather on the bottle and
may get in the milk. These germs could make your baby ill. Before
making a feed, all bottles, teats, retaining rings, and caps should be
washed in clean, hot, soapy water, and then sterilised. This should be
done every time they are used. It's also a good idea to wash and sterilise
the manufacturer's scoop, which comes with the formula.

The best way to sterilise a baby's feeding equipment is with an electric
steam steriliser, or a microwave steriliser. Sterilisation solution can also
be used. A cheaper way to sterilise bottles is to boil the bottles and teats
in a covered pan for at least 10 minutes.

Making formula:

! To make up a bottle of powdered formula, follow the instructions on
the packet carefully.
! Boil tap water and leave it to cool for no longer than half an hour.
! Pour the exact amount of water into the bottle.
! Add the right number of scoops to the bottle with the scoop
provided, using a clean knife to level it off.
! Put on the teat and cover. Give the bottle a good shake until all the
powder has dissolved.
! Test the temperature by tipping a little milk out of the teat on to the
inside of your wrist. It should feel just warm, not hot.

When feeding a baby from a bottle, tilt the bottle slightly so the end of
the teat is always full of milk, not air. A baby may feed in short bursts of
sucking with a rest in between. Taking a break during feeds is how a
baby can establish whether they are full or not. Noisy sucking sounds
means the baby is taking in too much air. Hold the baby so they are
propped up a little, ensure that the teat and neck are always filled with
formula.

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How can I safely warm a bottle of milk?

Whether using expressed breastmilk or ready-made formula, the bottle
of milk can be warmed in a pan, jug, or bowl of warm water. Leave it in
the water for no more than 15 minutes. Electric bottle warmers are
another effective way to heat milk. It takes around four minutes to six
minutes to heat a bottle to the perfect temperature. Using a microwave
to heat a bottle of breastmilk or ready-made formula milk can create hot
pockets that could burn a baby’s mouth

It is safer to make a fresh feed every time a baby is hungry. This is
because milk powder is not sterile and bacteria can build up quickly. This
can only take a couple of hours’ even if the bottle is in the fridge.

There may be times when making a feed in advance is the only real
option. i.e twins. Ready-made cartons are available but can be costly.
If possible only one feed should be prepared in advance and should be
stored in the fridge for a maximum of 11 hours. There are also cool bags
available but milk should only be stored in them for 4 hours at the most.

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Bottle feeding

Not all mothers can or wish to breast feed their babies and in these
cases the baby will need formula milk. Formula milk, which is produced
in a factory, is made from a mixture of ingredients and it can be
purchased in either powdered form which will need mixing or liquid
form which can be used directly. Both types of formula milk should be
offered to the baby in a sterilised bottle.

Formula milk which can be purchased today has different constituents
from breast milk and some of it’s ingredients include:

! Cow’s milk
! Fish or vegetable oils
! Soya
! Synthetic chemicals which supply the baby with vitamins and
minerals in order for them to gain the nutrients necessary.

Some of the advantages of bottle feeding are:-

! It offers more freedom and flexibility for the mother as fathers and
other people can take over the feeding.
! It is easier to see how much milk the baby is getting.
! Formula milk is digested more slowly than breast milk which may
lead to some babies requiring fewer feeds.

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! Feeding in public is much easier.

Young babies should not be given cow’s milk as an alternative to breast
or formula milk. Cow’s milk should not be introduced to a baby’s diet
until they reach twelve months old unless otherwise instructed by a
medical expert. Cow’s milk is not a suitable food for babies because:-

! There is insufficient iron, or Vitamins A and C
! There is too much protein
! There is too much salt

Goat’s milk should not be offered to babies either.

As a baby grows it may become apparent that breast or formula milk is
not satisfying their hunger needs and at this stage you will need to
introduce solid food gradually to their diet. The process of introducing
solid food to a baby’s diet is known as weaning and often this will be
noticed if:-

! The baby starts to wake in the night for a feed having previously slept
through.
! The baby begins to wake early in the morning crying for a bottle.
! The baby appears unsettled after a milk feed.

The most common age to start weaning a baby is at around the five-six
month stage although it is important to remember that all babies are
individuals and very large babies may need solid food introduced earlier
whilst some babies may be content with just milk for seven or eight
months.

At around five or six months breast or formula milk may start to become
insufficient in meeting all of the baby’s nutritional needs and it will be
time to introduce solid food to their diet.

28

Between the ages of five and six months babies begin to learn how to
chew in addition to sucking and generally they will be receptive to new
tastes making it easy for you to introduce different flavours.

29

Weaning

Weaning is the process of changing from a milk diet to one that includes
solid food. Weaning lays the foundation for healthy eating habits and
relationships to be formed. As a child grows, food will eventually
completely replace milk in being the main provider of all the nutrients a
child needs. So weaning is about getting them used to new tastes and
textures.
Wean - In the UK, ‘weaning’ means ‘adding complementary foods’,

whereas in the States it means ‘giving up breastfeeding’.

Due to the sweeter flavour of milks and the structure of a baby’s mouth
a child is naturally more receptive to sweet tastes. Most people tend to
start the weaning process by focusing on fruits and sweeter vegetables.
The earlier in the process and more frequently other flavours are
introduced the better the child will be at accepting them. It’s important
to introduce different, less sweet flavours early in weaning without
adding anything to make them sweeter. It might not be a favourite but it
is worth pushing through to establish a more varied diet.
On average it takes around a month to work through the weaning
process but every baby is different. With perseverance they all get there
in the end. As a rough guide most weaning starts at around 6 months.
There are plenty of signals that a baby is ready to start the weaning
process.

! Sitting up and holding their head steady
! Bringing in objects towards their mouth and putting them in their
mouth
! Able to swallow food – getting more in, than around, their mouth

These signs are rarely seen in combination until around 6 months.
Simply waking up during the night or sucking their fists are not
considered to be signs of being ready for weaning.

30

Trying to force a child to wean before they are ready can cause negative
relationships with food. Children should be able to wean at their own
pace and parents and carers must be patient. Establishing a negative
relationship with food at the weaning stage can cause negative impacts
in later life.

When weaning a baby it is important to remember that solid food
should be offered in addition to milk feeds and not take the place of
them. Milk should still account for around 40% of a baby’s intake even
at the age of twelve months.

Start by offering very small amounts of soft pureed food on the tip of a
sterilised baby spoon. The initial foods offered may vary from country to
country and culture to culture depending on which foods are readily
available but as a starting point some ideal weaning foods include:-

! Banana
! Pear
! Carrot
! Potato
! Turnip
! Cauliflower
! Broccoli
! Baby rice
! Yam
! Butternut squash

When offering food it is important to introduce water and diluted juice.
These should be offered in a cup with handles and a lid. Over a number
of weeks and months the amount of food offered should be slowly
increased so that by the time the child reaches twelve months old they
are being offered a varied diet of prepared meals during the day which
are subsidised with milk feeds at the start and end of each day. New
foods should be offered one at a time with an interval of a few days
before offering anything else new so that you can see how your baby

31

copes with the food and whether it has caused any kind of adverse
reaction. The best way to do this and avoid confusion is to introduce
one new food a week and select a day for doing this. Sometimes a baby
may appear to dislike a certain food however it is important to keep on
trying them with it and you should re-introduce the food at subsequent
meals.

It is important when preparing weaning foods that you do not add any
sugar or salt to them nor should these foods include gluten as this can
be difficult for young babies to digest.

Although the initial weaning foods will be ‘sloppy and bland’ you should
be continually aiming to introduce a range of textures, tastes and smells
so that your child gets used to a varied menu. As the child gets older
and teeth begin to show you can introduce more texture to the food
finely chopping rather than pureeing foods to the required constituency.

32

It can sometimes be difficult to know how much solid food a child should
be having and children under twelve months should be continuing with
milk feeds with solid food given in addition. As a general rule, an
average twelve month old child should be following these portion
guidelines:-

Fruit – should be offered in small quantities 2-4 times a day. A portion
may be plum or half of a small apple.

Vegetables – 3-5 portions equivalent to a tablespoon each day.

Meat, fish – 2-4 portions equivalent to a tablespoon each day.

Potato, rice, cereal, bread – 4-6 portions equivalent to one tablespoon
or one slice of bread each day.

Weaning is an important part of a child’s development and it should be
thought through carefully. Foods should be planned and prepared so
that they contain the best nutritional value possible. Some important
factors to be considered when weaning a baby are:

! Do not introduce solid food too early. Five to six months is the
average age for babies to be introduced to solid food.
! Milk should account for 40% of a baby’s intake until they are twelve
months old.
! Don’t get up tight if your baby refuses solid food – take your time and
offer the food again in a day or so.
! Always supervise your baby when they are feeding to reduce any
choking risks.
! Under supervision allow babies to attempt to feed themselves – their
interest in food should be fostered at any early age.
! Introduce solid foods gradually – one meal at a time. Building up
over a period of weeks.
! Introduce different tastes and textures early on so that your baby
gets used to a variety of foods.

33

! Offer fruit and vegetables with each meal.

! Cooking and pureeing foods in batches and then freezing in ice cube
trays is a good way of being able to increase amounts to suit your
child’s growing appetite.

There are some foods which should not be offered to babies as these
can be potentially harmful and you should bear the following in mind
when weaning your baby:-

! Never offer shellfish, liver, citrus fruits or soft and unpasteurised
cheeses to babies.
! Never give babies raw eggs.
! Never give babies or children under the age of three years nuts. In
addition to the obvious choking threat these pose there is evidence
that they can trigger allergies in some children.
! Never give cow’s milk to children under one year old unless it is
introduced in the form of rice pudding, custard etc.
! Never add salt to foods prepared for babies.
! Never add sugar to foods prepared for babies.
! Never give soya based milks unless advised by a medical expert.
! Avoid giving babies honey it can carry harmful germs and has a high
sugar content.
! Avoid sweets, chocolate, cakes and biscuits when preparing meals for
babies.
! Avoid flavoured milk drinks, fizzy drinks and squashes as these reduce
appetite and contain high levels of sugar.
! Avoid wheat based products for babies under six months old.
! Avoid offering too much fibre to babies.

It is important to remember that all babies are different and, when it
comes to weaning, they should be treated individually. A baby’s
digestive system needs time to develop in order that they can cope
adequately with solid food and it is therefore important not to rush the
introduction of solid food.

34

Babies should be encouraged to ‘explore’ food, to hold it and handle it.

It is never a good idea to force food onto a child and therefore allowing
them to feed themselves in an unrushed manner is the best way of
getting started. Start with small pieces or teaspoons of food once or
twice a day. Some suitable ‘first foods’ which are ideal for weaning
include:-

! Mashed or softly cooked fruit and vegetables such as potato, carrot,
yam, apple or pear.
! Finger foods such as peach, melon and banana.
! Baby rice or baby cereal mixed with their usual milk.

Baby led weaning

Baby lead weaning is the idea of allowing the baby to feed themselves
from the start. It can be a more positive experience for the child and can
encourage healthy relationships with food.

The key difference between BLW and traditional weaning is the order
that children learn to eat. With traditional weaning, children learn first
to swallow then to chew. This works fine with puree but with anything
else poses complications. With BLW, the babies learn to chew first and
swallowing might come some time later.

The reason it is called ‘baby-led’ is the sense that the baby is allowed to
do what they need to do while they’re learning. Baby led weaning can be
a stressful time for a parent though as it can be difficult to tell how much
a baby has eaten. Parents should resist the urge to get stressed how
much they’re eating, whether they like the food if following BLW. BLW is
designed to give a child the freedom to explore textures and tastes in
their own way. A lot of parents follow BLW without even knowing. Most
usually this occurs when the child is not the first in the home as babies
love to copy. If they see siblings eating they may want to try their food
or copy the action by grabbing for food of others plates. This is why one
of the better ways to introduce BLW is at family meals times. Give a child

35

age appropriate foods they can hold in their hands while others are
eating they may soon learn to copy on their own.

The easiest finger foods for young babies are those that are chip-shaped,
or have a natural handle, such as cooked broccoli spears. When a baby
first tries solids, they won't yet have developed a pincer grip. The pincer
grip will develop in the next few months. Babies usually play with their
food at first but it’s all a learning experience for them. It may begin by
grabbing and sucking foods placed in front of them while they learn
what food is for. Remember a child who is beginning weaning is not used
to foods and their role so patience is key. Parents should not stop giving
their baby breastmilk or formula milk in between and as the baby
gradually eats more solids, parents can decrease the number of milk
feeds a day. As weaning progresses, a baby’s want for the bottle of milk
feeds will also start to decrease.

36

Healthy eating for children between 1 and 3 years

Many toddlers between the ages of 1 and 3 years become ‘picky eaters’.
This is when they begin to express their independence through what
they eat and do not eat and often mealtimes can seem like a battle.
Some children of this age group may refuse to try new foods or, if they
do agree to taste something different, they will invariably reject it.
Toddlers can become ‘fixed’ on certain foods and demand one particular
meal day after day.

The rate of growth for toddlers decreases dramatically in contrast to
babies who may grow as much as 8cm in just three months. A toddler,
pound for pound, actually requires less calories at 18-24 months than an
infant because of this decrease in growth. Many parents are confused
about how much food a toddler should eat in order to remain healthy
and the table below gives a guide to the size and number of servings
needed by an average toddler of 18-36 months in order to remain fit and
healthy.

37

FOOD GROUP SERVING PER DAY SIZE OF SERVING
Fruit Two 30-60g increase to between

45-85g for toddlers aged 24-
36 months
Vegetables Three 30-60g when cooked
increase to 30-115g for
toddlers aged 24-36 months
Foods containing Two 15-30g of meat or 1 egg.
protein Increase the amount of meat
to 30-55g for toddlers aged
24-36 months.
Dairy products Two 240ml of milk or yoghurt and
45g of cheese increase this
to 45g of cheese for toddlers
aged 24-36 months.
Grains Six ¼ -½ slice of bread, 30-60g
cooked rice or pasta increase
this to ½-1 slice of bread and
35-100g of rise or pasta

Generally speaking toddlers need between 1,000 and 1,200 calories per
day. These calories should be provided in small meals and snacks. A
toddler aged between 12 and 24 months is going through an important
transition and is moving from an infant diet which is high in fat to the
diet of a toddler which should be giving them only approximately 35% of
their daily calories in fat.

38

A toddler needs some important components to ensure that their diet is

healthy and balanced. These important components are:

Protein – A toddler should be getting approximately 1g of protein for
each kilogram of their body weight per day of protein. Therefore a
toddler weighing about 14 kg needs approximately 14g of protein each
day.

Fibre – approximately 6-8g per day

Iron – approximately 7mg per day

Calcium – approximately 500mg per day. This can easily be achieved if
the child is given two servings of dairy foods each day.

As an adult it is your job not only to provide your child with adequate
food but to ensure that the food you do provide is nutritious. By
introducing nutritious food early on in a child’s diet you will be ensuring
that they are less likely to reject these foods in later life. It is essential
that you introduce healthy foods from the start rather than at a later
date by which time the child may have already developed a taste for
sweet or fattening foods and reject those which provide them with the
essential nutrients they need to grow up strong and healthy.

Children’s preferences to foods change regularly and it is always a good
idea to reintroduce foods which have earlier been rejected as, quite
often, a child will like them second or third time around! Set a good
example yourself by eating lots of healthy foods and minimising your
own intake of biscuits and cakes. Trying to get a child to eat a plate full
of vegetables whilst you tuck into ice cream and cake will never be an
easy task.

Some children worry their parents by refusing to eat certain foods or
indeed refusing to eat anything at all. Rest assured that children will not
starve themselves therefore if they choose to skip a meal – let them –

39

they may simply not be hungry and it is important that you respect this
in order for the child to be able to respond to their own hunger cues and
not to eat simply because the food is in front of them. Learning to
respond to their own hunger cues is vital if children are to learn the vital
skill of maintaining a healthy weight. Having said this, children should be
taught to eat at proper mealtimes and with sensible time intervals
between meals rather than being allowed to eat on demand throughout
the day. Structured meals and snacks are important and these are the
times when your child should be allowed to choose whether or not to
eat. If they eat breakfast but refuse a snack let them - however do not
allow them to eat anything else until lunch. This will enable them to
develop a healthy eating pattern.

Toddlers love to feed themselves and, despite the mess they make, they
should be allowed to do this whenever possible. You should always
supervise children when they are eating or drinking and be on hand to
assist if necessary. Usually a toddler will begin feeding themselves with
‘finger foods’ which are easy to chew such as pieces of toast or bread,
small pieces of fruit etc. after which they will progress onto using a
spoon and fork. In order to minimise the mess made by toddlers feeding
themselves remember to:-

! Provide them with child sized cutlery which they can easily handle.
! Place a plastic mat on the floor underneath where the child is sitting
to protect the carpet.
! Use bibs.
! Have a damp cloth handy.

40

Health eating for per-school children between 3 and 5

years

Pre-school children typically eat between 1,200-1,600 calories per day
with a steady increase of about 100 calories per year between the ages
of two and five years. Their growth at this age is slow and steady rather
than fast as in the early years. Pre-school children need some important
components to ensure that their diet is healthy and balanced. These
important components are:-

Protein – A child between the ages of 3 and 5 years should be getting
approximately 1g of protein for each kilogram of their body weight per
day of protein. Therefore a toddler weighing about 18 kg needs
approximately 18-20g of protein each day.

Fibre – approximately 8-10g per day

Iron – approximately 10mg per day

Calcium – approximately 800mg per day by the time the child reaches
the age of four years. This can be quite challenging as many children of
this age take a dislike to milk however it is important to remember that
there are many other sources of calcium in dairy products such as
cheese and yoghurt.

Between the ages of 3 and 5 years are typically the times when meals
can be a battle with children often refusing to try out new foods. It is
important that adults realise how to present food so that it is both
attractive and appealing - making the child want to taste it. Many recipe
books written for children take this into account and you may have seen
recipes which encourage making faces from food to make the meals
more appealing for young children – everything is worth a try! It is
essential that adults work on table manners for children between these

41

ages – without making meal times a battle field – encourage children to

hold cutlery correctly and explain the importance of table manners.

It is important for children to:-

! Be offered a variety of foods – even those which have been rejected
in the past
! Be involved in meal planning and preparation – even young children
can be given jobs which they will enjoy when preparing meals for
example washing the lettuce or buttering the bread.
! Eat regular meals and snacks
! Sit at the dining table with the family and eat meals together – this is
vital for both healthy eating and for encouraging table manners.

The average pre-school age child will eat three meals a day with perhaps
two or three snacks in between. However, given the chance, they would
probably eat all day long, picking at food when they are bored. This is
not a good idea as the child who is allowed to feed continually will never
actually feel ‘hungry’ as they are having their appetite curbed by being
continually allowed to snack. In order to be able to regulate the amount
of food we eat it is essential that we know when we are hungry and
when we are full. Reasons for not allowing children to snack throughout
the day include:

! They are more likely to eat a proper meal if they are actually hungry
at meal times.
! They are more likely to try out new foods if they are hungry at
mealtimes.
! Snacks are usually foods which are higher in calories or fat for
example biscuits, cakes and crisps and these will put the child more
at risk of weight gain.

Meals should be taken at the table and without distractions such as the
television or mobile phones.

42

Healthy eating for school age children between 6 and

12 years

Children between the ages of six and twelve years will probably be
making many choices themselves about the type and amount of food
they eat, however, ultimately the control should be left to adults in
order for children to be led into a healthy eating lifestyle. Although
treats should be available, these should be given seldom and never in
place of nutritious, healthy meals. It is perfectly normal for children to
be influenced by their friends’ food choices and by advertising
campaigns and eating the odd burger or pizza and indulging in cake and
ice cream occasionally will not adversely affect children. However it is
when these foods are offered regularly and in place of healthy
nutritional choices when the problems will begin. Although eating
unhealthy foods occasionally whilst sticking mainly to a healthy diet will
not cause problems, this
can not be said if the roles
are reversed and an
unhealthy approach to
eating takes precedent over
healthy foods. Eating
healthy foods occasionally
cannot compensate for a
diet that lacks balance and
proper nutrition.

The daily calorie intake for children aged between six and twelve years
is:-

1,600 to 2,000 calories for a child aged between 6 and 8 years
2,000 to 2,500 calories for a child aged between 9 and 12 years

43

The diet for children of these ages should consist of the following
components:-

Component Children 6-8 years Children 9-12 years
Carbohydrates 200-250g 300g
Protein 22-30g 30-45g
Fat 48-60g 60-75g
Fibre 10-15g 14-17g

One of the easiest ways to teach children about the importance of
healthy eating and why they need to choose healthy food options is to
involve them in meal decisions and preparations. If you explain to them
why they can’t eat fast food all the time they are more likely to accept
your explanation than if you simply deny them the foods they ask for
without giving a reason. Invite your child to help you choose menus and
to assist in the preparation of the meals so that they can become
informed about healthy eating options together with healthy ways to
cook food. Offering healthy foods which they like will make it much
easier to encourage your child to follow a healthy diet plan.

All children will go through a ‘growth spurt’ this is usually during the
time of puberty and is, on average, likely to be around 10-11 years for
girls and 12-13 years for boys. During this time when growth increases
the child needs to increase the amount of calories they eat. In general
terms, children going through puberty need to increase their daily intake
of calories by around 200-300. This amount may need to be increased
further if the child is particularly active or sporty as they will inevitably
burn up more calories with the exercise they take part in. Athletic
children may need in excess of 2,500 calories per day during their
growth spurt period.

In addition to an increase in calories, children will also need to increase
their calcium intake prior to the onset of puberty. From around the age
of 9-10 years the recommended amount of calcium is around 1,300mg in
order to ensure the growth of healthy bones.

44

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Health

and well being of children

National and local incentives promoting well being

How practitioners maintain a healthy environment

Food and nutrition

The main food groups

Products containing fat and sugar – this category includes butter,

The Eat Well Plate

Good health and Five-a-day recommendations

Portion sizes are often an area of confusion, however broadly speaking,

Body mass index

For example a person weighing 50 kg who is 1.40m tall would have a

Weaning and feeding babies

they will be able to modify feeding patterns and amounts of food

Although the list of advantages to breast feeding is quite long it is

Breast milk production

Colostrum is a form of milk produced by the mammary glands of

Feedback Inhibitor of Lactation (FIL) – the role of FIL appears to be

professional support in the form of lactation consulting can help

How breast milk nourishes

Making formula and warming milk

How can I safely warm a bottle of milk?

! Feeding in public is much easier.

Wean - In the UK, ‘weaning’ means ‘adding complementary foods’,

! Offer fruit and vegetables with each meal.

Babies should be encouraged to ‘explore’ food, to hold it and handle it.

Healthy eating for children between 1 and 3 years

FOOD GROUP SERVING PER DAY SIZE OF SERVING

Fruit Two 30-60g increase to between

A toddler needs some important components to ensure that their diet is

Health eating for per-school children between 3 and 5

ages – without making meal times a battle field – encourage children to

Healthy eating for school age children between 6 and

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