The Scientific Advisory Committee on Nutrition (SACN) published new nutrition recommendations for young children, after it found that the current diet of young children in the UK (as captured in both the Diet and Nutrition Survey of Infants and Young Children, 2011 and the National Diet and Nutrition Survey) does not meet current dietary recommendations for several nutrients.
The Committee carried out a detailed review of the scientific basis of current dietary recommendations for feeding children aged 1-5 years. It also looked at evidence from large national surveys and data from the National Child Measurement Programme for England and similar programmes in Scotland and Wales. The researchers also took into account data from systematic reviews, meta-analyses of randomised controlled trials, prospective cohort studies, and non-randomised studies of interventions.
Yogurts and Desserts Marketed for Kids
The SACN researchers found evidence that the food group of sugar-sweetened yogurts, fromage frais, and dairy desserts was among the top contributors to free-sugar intake for children aged 12-18 months, providing approximately 18% of all free sugars.
It also indicated that children in this age group who consumed foods and drinks specifically marketed for infants and young children were getting 20% of their free sugars from these products.
The SACN report recommended that from 12 months old, free sugars should not exceed 5% of total dietary energy intake. It also recommended that dairy products like yogurts and fromage frais given to children aged 1-5 should ideally be unsweetened.
Formula, Fruit Juice, and Milk
There was evidence that formula milks, particularly follow-on formula, known as 'toddler' or 'growing up' milks, were consumed by 36% of children aged 12-18 months and contributed to 50% of free-sugar intake, even though these are not required by children after the first year of life.
In the 18-months to 4-year age range, fruit juice and smoothies contributed to nearly 11% of free-sugars intake.
The SACN report said that children aged 1 to 5 years should not be given sugar-sweetened drinks. It recommended that milk or water, in addition to breast milk, should be the main drinks given to children aged 1-5 years.
It said that pasteurised whole and semi-skimmed cows' milk could be given as a main drink from age 1 year, as could goats' and sheep's milk. But pasteurised skimmed and 1% fat cows' milk should not be given as a main drink until 5 years of age, though these low-fat milks could be used in cooking.
Too Much Salt and Lack of Vitamins
The SACN found data indicated that 76% of children aged 18 months to 4 years had more than the target salt intake. It recommended that salt should not be added to foods given to children aged 1-5 years. Target intake for children aged 1 to 3 years should, on average, be no more than 2 g of salt a day, rising to 3 g a day for children aged 4-6 years.
The data showed that certain groups of children, including children from lower socioeconomic status households and some ethnic groups, might not be getting enough iron, zinc, vitamin A, and vitamin D, and were also at risk of low vitamin D status.
Evidence also indicated that use of vitamin D supplements in young children was low, while the latest available data indicated variable uptake of 'healthy start' vitamins (containing vitamins A, C, and D).
The SACN report recommended that children aged 1-5 years should be given a daily supplement of 10 μg (400 IU) vitamin D and 233 μg Vitamin A – unless, contrary to recommendations, they were consuming more than 500 ml of formula milk a day.
Vegetables and Variety
Other recommendations made by the committee include:
- Children aged 1-5 years should be offered unfamiliar vegetables, as many as 8 to 10 times or more for each vegetable, to encourage them to try them
- Deliberate exclusion of peanuts or hens' eggs (and foods containing these) beyond 12 months of age may increase the risk of allergy to the same foods. Importantly, once introduced, these foods should continue to be consumed as part of the child's usual diet in order to minimise the risk of allergy developing after initial exposure
- Children aged 1-5 years should continue to be offered a wide range of foods that are good sources of iron. They do not require iron supplements unless advised by a health professional
The SACN report recommended developing and giving advice on what is the correct age-appropriate portion size in food and drink for children aged 1-5, as often snacks and meals offered to kids are too high in calories for young children.
It also suggested strategies to support parents or caregivers of children who follow vegetarian, vegan, and plant-based diets to make sure the nutritional requirements (including for iron, iodine, calcium, and vitamin B12) of their children are met.
'Important' and 'Timely' Report
Commenting on the report, Dr Ada Garcia, a senior lecturer in public health nutrition at University of Glasgow, told the Science Media Centre it was "quite an important report that is welcomed and timely".
"There a couple of aspects I want to remark on. One is the quality of available evidence, which is deemed mostly moderate or adequate, – this is largely due to the difficulty of conducting good quality studies like randomised controlled trials in children. There is also the issue of outdated population-based data on dietary intake. For example, existing data for young children (12-18 months) from DNSYC [Diet and Nutrition Survey of Infants and Young Children] dates back to 2011. The food environment has shifted greatly in the past years, in particular for higher availability of foods targeted to young children which are in a large proportion not nutrient dense or are high in sugars."
Professor Carmel Houston-Price, professor of language and cognitive development and head of the School of Psychology and Clinical Language Sciences at University of Reading, also pointed out that research published at the same time as the report has altered understand of child nutrition.
"This evidence-based and balanced report provides some useful pointers to help parents develop healthy eating habits with their children. This includes highlighting the importance of repeatedly offering pre-school children the foods we want them to eat," Prof Houston-Prince told the Science Media Centre.
"Research has established that repeated taste exposure is a particularly effective way to introduce vegetables into young children’s diets. However, parents can find it hard to keep offering food to their child when they don't seem to like it, especially when the food they reject ends up on the floor or in the bin," she said, adding "there is now a substantial body of research showing that familiarity with vegetables outside of mealtimes can make children more amenable to tasting them at mealtimes."