1. Best foot forward – Getting good nutrition right from the start
New Voluntary Food and Drink Guidelines for infants in Early Years Settings in England
Best foot forward – Getting good nutrition right from the start
First Steps Nutrition Trust conference, 26 April 2017
Dr Patricia Mucavele, Head of Nutrition
Children’s Food Trust

2. Today’s presentation
Current nutritional status of infants and young children
Importance of investing in nutrition in early childhood
Helping children eat better, in childcare
Voluntary Food and Drink Guidelines for Early Years Settings in England
Rationale and evidence
Overview of practical resources to help settings
Eat Better, Start Better programme
Pre-school Food Survey - findings
Childhood Obesity Plan - supporting early years settings
30 hours free childcare

3. We all have a duty of care
Children’s Food Trust
On a mission to get every child eating well, wherever they are eating
Spreading the skills, knowledge and confidence to cook from scratch
Helping everyone who provides food for children to do a great job
Encouraging industry to help children and their families make better food choices
We all have a duty of care

4. infants and young children
Nutritional status of
infants and young children
Diet and Nutrition Survey of Infants and Young Children, 2011
Food consumption, energy and nutrient intakes and nutritional status of infants and young children 4-18 months
Survey suggested infants and young children consumed a varied diet, with dietary recommendations generally met by the majority
Estimated average energy requirements for energy exceeded by three quarters; mean protein intakes well above RNI*
Mean intakes of most key vitamins and minerals above RNI*
Proportion of children over 6 months with intakes of vitamins/minerals below LRNI low, except for iron.
*RNI: Reference nutrient intake values are set at levels of intake considered likely to meet the requirements of 97.5% of the population

5. Nutritional status of young children
National Diet and Nutrition Survey (years 1-4; to )
Food consumption, energy and nutrient intakes and nutritional status of children aged 18 months to three years.
Mean daily energy intake =114% of estimated average requirement for age group
% energy from carbohydrate (50.7) and fat (33.9) in line with dietary guidelines
% energy from non-milk extrinsic sugar (11.9) above 2015 SACN recommendation (as free sugars)
Intakes of salt (3.3g) higher than SACN recommendation for children aged 1-3 years (2g)
Intakes of many micronutrients appear adequate, but more than 5% children had intakes of vitamin A and iron below the LRNI (therefore unlikely to be adequate).
*LRNI: Lower Reference Nutrient Intake is amount of nutrients sufficient for only a small number of people; those below LRNI likely to have insufficient intakes

6. Percentage of children by age group with insufficient intakes (<LRNI*) of selected vitamins and minerals
Nutrient
7-9 months (1)
10-11 months (1)
12-18 months (1)
1.5-3 years
(2)
Vitamin A 2 6
Folate 1
Vitamin C
Iron 14 10 13 9
Zinc 3 5 4
Calcium
Source: (1) DNSIYC (2) NDNS rolling programme
*LRNI: Lower Reference Nutrient Intake is amount of nutrients sufficient for only a small number of people; those below LRNI likely to have insufficient intakes

7. Current health status of one to five-year-olds
more than a fifth of children are either overweight or obese by the time they join reception class (NCMP, 2016)
poor dental health in many young children
12% of 3-year olds had experienced tooth decay in 2013 (PHE, 2014)
28% of 5-year olds in England had tooth decay in 2012 (PHE, 2013)
RCPCH (2017)

8. Importance of children’s early years
Children’s early years influence their health, development, learning, attainment and economic participation
Eating habits during children’s early years, influence growth, development and academic achievement in later life
Giving every child the best start in life is crucial to reducing health inequalities for life
Key message
The early years of a child’s life are critically important:
- in their own right
- as a foundation of success at school and for all adult life 8

9. Priorities for improving nutrition
Early years settings - vital route to encourage young children and their families to eat well
Source: Francesco Branca et al. BMJ 2015
Range of interventions at different stages of the life 9

10. Why early years settings?
Education
3-4 year olds: 15 hrs free education (universal)
3-4 year olds: 30 hrs free childcare (working parents, pilot Sep-16, roll out Sep-17)
Two year old 15 hrs funded early education (means tested)
Early Years Pupil Premium (EYPP)
Early Years Foundation Stage (EYFS) – includes a welfare requirement for food and drink
Ofsted Common Inspection Framework includes a judgment on personal development, behaviour and welfare which looks at the extent that settings promote and support healthy eating
Health
Early Years High Impact Area 4 – Healthy weight, nutrition
Healthy Child Programme
2-year integrated reviews
Childhood Obesity Plan 10
Early years settings - vital route to encourage young children and their families to eat well, so it’s important to make every contact count. 10 10

11. Helping children eat better in childcare

12. Our recommendations Children’s Food Trust (2015) Our recommendations:
Guidance: encourage childcare providers to use evidence-based, age appropriate nutrition guidance
Training: encourage local authorities to increase access to accredited training
Resources: ensure nurseries, pre-schools, children’s centres and childminders delivering free childcare schemes have the resources they need to provide good food.
Children’s Food Trust (2015)

13. World Health Organisation: recommendations
Provide clear guidance and support to caregivers to avoid specific categories of foods (e.g. sugar-sweetened milks and fruit juices or energy-dense, nutrient-poor foods) for the prevention of excess weight gain.
Provide clear guidance and support to caregivers to encourage the consumption of a wide variety of healthy foods.
Provide guidance to caregivers on appropriate nutrition, diet and portion size for this age group.
Ensure only healthy foods, beverages and snacks are served in formal child care settings or institutions.
Ensure food education and understanding are incorporated into the curriculum in formal childcare settings or institutions.
WHO (2016) 13

14. Childhood Obesity: A Plan for Action Supporting early years setting
Aim: to significantly reduce England’s rate of childhood obesity within the next 10 years
Early years:
crucial time for children’s development.
One in five: overweight or obese
One in ten: 2-4 olds years meets the UK Chief Medical Officers’ physical activity guidelines.
Plan of action:
Public Health England: commissioned the Trust to develop revised menus for early years settings.
Campaign to raise awareness of these guidelines amongst both early years practitioners and parents
Update the Early Years Foundation Stage Framework (EYFS) to make specific reference to the UK Chief Medical Officers’ guidelines for physical activity in the early years (including active play).
HM Government,
(August 2016)

15. Rationale for and development of the Voluntary Food and Drink Guidelines for Early Years Settings in England

16. Advisory Panel for Food and Nutrition in Early Years
Research findings and submission of evidence on current food provision in early years settings suggested:
under-provision of energy, carbohydrate and some essential minerals such as iron and zinc
over-provision salt and added sugars
too many fruit and vegetables.
Children’s Food Trust
(2010)

17. Advisory Panel recommendations
Maintain Early Years Foundation Stage welfare requirements for food and drink
Develop clear, practical guidance and support tools
Deliver a comprehensive training package
Provide a consistent approach to quality improvement/benchmarking for parents
Conduct a survey of food provision and consumption in early years settings.
Children’s Food Trust
(2010)

18. Recommendations for guidance
Laying the Table report recommended ‘Government should introduce guidance that helps practitioners meet the welfare requirement for the provision of healthy, balanced and nutritious food and drink’. Advisory Panel on Food and Nutrition in Early Years (2010)
“I recommend that the Government act on the report of the Advisory Panel for Food and Nutrition in Early Years and consider providing further advice and good practice for practitioners”.
Dame Clare Tickell (2011) 18

19. Early Years Foundation Stage - welfare requirements
Food and drink
3.47. Where children are provided with meals, snacks and drinks, they must be healthy, balanced and nutritious.
Before a child is admitted to the setting the provider must also obtain information about any special dietary requirements, preferences and food allergies that the child has, and any special health requirements.
Fresh drinking water must be available and accessible at all times.
Providers must record and act on information from parents and carers about a child's dietary needs
Department for Education
(2017) 19

20. Meeting the welfare requirement
for food and drink
Statutory Framework for the Early Years Foundation Stage (EYFS) section 3.47 states ‘Where children are provided with meals, snacks and drinks, they must be healthy, balanced and nutritious’. (2017)
National guidance
Voluntary Food and Drink Guidelines for Early Years Settings in England (2012, updated 2017) 20

21. Eat Better, Start Better programme to support young children and their families to cook and eat well
Working in partnership to implement the voluntary food and drink guidelines to improve health outcomes for children in the early years 21

22. Eat Better, Start Better programme
to support young children and their families to cook and eat well
Aim: to support healthier food provision in early years settings and families with young children.
Two year project ( )
Development ‘Voluntary Food and Drink Guidelines for Early Years Settings in England’ and practical tools.
Development and delivery of integrated training and evaluation package in 25 local authorities.
Three outcomes:
Improved healthier food provision for children under five in early years and childcare settings and at home.
Increased food, nutrition and healthy cooking knowledge and skills for the early years and childcare workforce.
Increased food and nutrition knowledge and practical cooking skills for parents and families attending early years.
Supported by Department for Education VSC grant ( )

23. Eat Better, Start Better
National guidance - Voluntary Food and Drink Guidelines for Early Years Settings in England
Accredited training to help childcare providers use the guidelines
Evaluation tools to monitor the outcome and impact of training, on:
practitioners knowledge and confidence
approach to and provision of food in settings
family eating habits
Early years settings - vital route to encourage young children and their families to eat well 23

24. Practical resources to help early years settings provide ‘healthy, balanced and nutritious’ meals and snacks

25. Voluntary Food and Drink Guidelines for Early Years Settings in England- a practical guide
Developed using recommendations from the Advisory Panel on Food and Nutrition in Early Years
Produced in collaboration with DfE, DH, public health nutritionist, early years organisations
Pilot-tested with early years settings
Designed to ensure that children’s nutritional requirements are met across the day:
providing appropriate amounts of energy
encouraging children to eat a wide variety of foods
limiting foods high in saturated fat, added sugar and salt
providing appropriate portion sizes of different foods
encouraging all children to eat well
National guidance
Voluntary Food and Drink Guidelines for Early Years Settings in England (2012, updated 2017)

26. Practical guide: contents
Seven sections
01 Eat better, start better: why healthy eating matters for young children
02 Planning menus
03 The food and drink guidelines
04 At a glance – the food and drink guidelines for each meal and snack
05 How to encourage children to eat well
06 Practical tools and resources
07 Where to find additional information
National guidance
Voluntary Food and Drink Guidelines for Early Years Settings in England (2012, updated 2017)

27. Balanced diet for children
aged one to four years
Guidelines describe how often, how much, and which different types of food and drink to provide for meals and snacks
Based on a wide range of foods from four food groups below:
Starchy foods
Fruit and vegetables
Meat, fish, eggs and other non-dairy sources of protein
Milk and dairy
Additional guidelines for:
desserts, puddings and cakes
drinks
fat, salt and sugar
food additives, ready meals and fortified foods
Key message:
Eating a wide variety of foods from these groups will provide children with the good balance of nutrients they need

28. Interpreting the guidelines
Key:
Definitions:
Limit: where the guidelines advise that food or drinks should be limited, these should be provided no more than once a week. This will help to decrease the amount of salt, sugar and saturated fat in children’s diets and increase the variety of food and drinks they are offered.
Avoid: where the guidelines advise that food or drinks should be avoided, these should not be provided as part of any meals or snacks.
Food and drink guidelines – use these to plan your meals and snacks
Good practice – consider these when planning your meals and snacks
Food safety – these list food safety issues for young children

29. Example food group guidance
For each food group, there is information to explain:
the types of food and drink included in the food group
why the food group is important
food safety information
guidelines for planning menus
typical portion size information
Use the portion size guidance when preparing and serving meals and snacks

30. ‘At a glance’ information by meal occasion
Lists the food and drink guidelines by meal occasion
Breakfast
Mid-afternoon and mid-afternoon snacks
Lunch
Tea
Particularly useful if catering for one meal or snack
This section also includes examples of meals and snacks meeting the food and drink guidelines
Menu planning checklist to plan your meals and snacks against the guidelines
Use the ‘at a glance’ information and menu planning checklist to plan meals and snacks

31. Example menus and recipes
Download the menus and recipes for ideas
Note: these menus have been revised - awaiting publication.

32. Early Years Code of Practice for Food and Drink
Demonstrate approach to food and nutrition meets national guidelines and best practice
Seven principles
Food policy
Consultation
Varied, seasonal, sustainable menus
Meals, snacks and drink meet the new national guidelines
Catering for dietary requirements
Positive and welcoming eating environment
Adequate staff training .
Consider encouraging settings to sign up

33. How to encourage children
to eat well
Developing a food policy and putting it into practice Communicating with children and their families
The eating environment and social aspects of meal times
Celebrations and special occasions
Providing food for all
Encouraging fussy eaters to eat well
Food brought from home
Learning about and through food
Cooking with children
Food safety and hygiene
Sustainability
Protecting children’s health

34. Additional factsheets
Produced to support settings to adopt and demonstrate a whole setting approach to healthy eating
Outlines the different types of special diets and how to manage them
Explains how to meet the 2014 allergen labelling requirements
Download factsheets from our website 34

35. Evaluating the impact of the food and drink guidelines
Children’s Food Trust
(2013)
Children’s Food Trust
(2013)

36. What’s forthcoming?

37. Revised menus for early years settings in England
Public Health England - commissioned the Children’s Food Trust to develop revised menus for early years settings in England, to reflect recent changes to government dietary recommendations.

38. Why develop new early years menus?
Menus need updating to reflect current government dietary recommendations:
Lower energy intakes
Reductions in the amount of ‘free sugars’* (added sugars)
Increases in the amount of dietary fibre
SACN 2011
SACN 2015
Outcome: to help promote appropriate amounts and types of food for young children, thereby helping to support key national priorities including reducing childhood obesity, addressing health inequalities, and ensuring the best start in life for all children.
*Free sugars’ includes all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and unsweetened fruit juices.
Under this definition lactose (milk sugar) when naturally present in milk and milk products and
sugars contained within the cellular structure of foods (particularly fruits and vegetables) are excluded

39. Scope of the work: Deliverables
Establish an external reference group (ERG) to help inform the development of the menus. The ERG membership to include a diverse range of representative bodies with knowledge and experience of working in early years settings, as well as public health nutritionists, representatives from across government.
Organisation of a series of meetings to discuss the development of the menus.
Collection of wider sector feedback on the draft menus via an online feedback form.
Development of two seasonal menus (and recipes) which meet the revised nutrient requirements of infants and young children (6 months-4 years*). Menus to be three week rotation period (based on 5 day week), adjusted to meet different care provision scenarios.
Publication of a technical report which outlines the options considered, the agreed set of nutrition and menu planning principles applied. Details the revisions made to the nutrient framework and the protocol used to develop the menus for early years settings in England and highlights any changes made to the Voluntary Food and Drink Guidelines for Early Years Settings in England to ensure current dietary requirements were met.
*The scope of the menu guidance covers the age range six months to four years (i.e. up to a child’s fifth birthday).

40. 30 hours free childcare
Extension of free childcare = more children, eating more meals in early years settings
Practical steps and support
Promoting and supporting healthy eating
Adopting a 'whole setting approach’
Menu planning
Food provision meeting the food and drink guidelines
Packed lunch guidance for parents
Meeting allergen labelling requirements
Catering for children with special dietary requirements.
Children’s Food Trust
(2015)
Unprecedented opportunity to improve children’s eating habits? 40

41. Packed lunch guidance
Download packed lunch guidance from Trust’s website

42. Thank you – any questions?
Contact us for more information: