Behind the hype: Supporting young children to eat well - NPA278

Behind the hype: Supporting young children to eat well

Eating behaviours are learned from the food environments around young children. Parents and caregivers have an important role to support and guide the development of healthy eating behaviours at an early stage. This includes offering a wide variety of foods to reduce the chance of allergies, and feeding age-appropriate safe food to prevent choking.

Pregnancy and breastfeeding

A child’s acceptance of a wide variety of vegetables (including less-sweet tasting vegetables) can be supported by including a wide range of foods and flavours during pregnancy and breastfeeding, as these will pass through to the baby¹. Support from a women’s whānau before and after birth has been shown to have a positive effect on breastfeeding initiation and length of breastfeeding². Involvement of support people in breastfeeding education is beneficial.

Introducing solids (around six months)

Encourage parents and caregivers to look for the signs when babies are hungry, and when they have had enough (Table 1)³.

*Babies show an interest in solid foods well before they are ready or need to eat them, as part of their growing interest in the environment and behaviour of those around them.

A wide variety of foods from the four food groups† need be offered to children to increase exposure to a range of different flavours, irrespective of parental preferences. Ensure iron-rich foods are given daily from six months. Allow children to self-select from a variety of foods, and encourage them to ‘take one bite’ of unfamiliar foods. Unfamiliar foods may need to be offered 10-15 times before acceptance. Limit wastage by offering small amounts of new foods. More information on how to support infants to start solids can be found in the Behind the Hype: Starting Solids fact sheet.

† 1. Vegetables and fruit, 2. Breads and cereals, 3. Milk and milk products, 4. Lean meat, poultry, seafood, eggs, legumes, nuts and seeds.

Choking: Young children can choke easily, but a range of steps can be taken to reduce the risk. Make sure the infant is sitting upright while eating, supervise eating and drinking, and match food texture with chewing ability. Be mindful of foods that may be more likely to cause choking in young children. These include small hard foods (eg, nuts, raw carrot or apple), small round foods (eg, grapes and raisins), foods with skins, compressible foods (eg, sausages), thick pastes (eg, peanut butter), fruit with pips or stones, foods with small bones, and fibrous or stringy foods (eg, celery)4. Risk of choking can be reduced by altering the texture, for example grating, and removing skins. Foods being offered to infants in the early months of baby-led weaning should be soft enough for the parent or caregiver to squash them on the roof of their mouth with their tongue.

How to reduce the chance of allergy

There is now scientific agreement that the introduction of foods that may cause allergy should not be delayed⁵. Foods that can cause allergy (Table 2) should be introduced one at a time and before the child is 12-months-old. Once introduced, continue to offer the foods regularly (twice a week) to maintain the baby’s tolerance to them as this greatly reduces the chance of an allergy developing. This advice includes children with an increased risk of allergy. A doctor or specialist dietitian can provide advice for concerned parents.

Table 2: Foods most likely to cause an allergic reaction in New Zealand children

Manufactured infant foods available for sale in New Zealand supermarkets do not contain the full range of food allergens, so it is important that parents and caregivers prepare foods at home for baby⁶.

In a nutshell

• Supportive whānau can increase initiation and duration of breastfeeding.
• Encourage parents/caregivers to use hunger and satiety cues when feeding young children.
• Expose infants to foods that may cause allergies, and continue to give these foods regularly, including children at higher allergy risk, before 12 months.
• Supervise young children when eating, make sure they are sitting upright, and match food texture to chewing ability to prevent choking.
• Regular meals as a family/whānau, without screens, where adults can role model healthy eating, supports the development of healthy eating behaviours.
• Delay the introduction, and limit the amount and frequency, of foods high in salt and sugar.

Moving on to family meals (around 12 months)

Mealtimes should be happy and relaxed. Infants and young children need to be fed slowly and patiently, with plenty of positive praise to eat vegetables and fruit⁵. There is good evidence that a parenting style that is supportive, reassuring, and encouraging will help children to eat well⁵.

Fussy eating is common in young children. If parents are concerned that their child is not eating a variety of healthy foods, non-food rewards such as praise and encouragement, together with repeated exposure (10-15 times), can be helpful². Coercive practices such as forcing or restricting a child’s eating are not recommended and often make the issue worse².

Tips to encourage happy and healthy mealtimes

1. Eating regular meals as a family (including breakfast), without access to screens, supports children to eat well⁷.
2. Adult role modelling of healthy eating, in particular consumption of vegetables and fruit and having just plain water or milk at mealtimes will increase children’s preferences for healthy foods and drinks².
3. Advise parents/caregivers to find a balance between restrictive rules around food and allowing children to choose their own food².
4. Delaying the introduction, and limiting the amount and access to, energy-dense foods and sugary drinks for young children is advisable, because consumption of these foods displace nutrient-rich foods important for growth and development.

References

1. Nehring I, Kostka T, von Kires R, et al. (2015). Impacts of in utero and early infant taste experiences on later taste acceptance: a systematic review. Journal of Nutrition, 145(6):1271-1279.
2. Gerritsen S, Wall C (2017). How We Eat: Review of the evidence on food and eating behaviours related to diet and body size. Wellington: Ministry of Health.
3. Prell C, Koletzko B (2016). Breastfeeding and Complementary Feeding. Deutsches Arzteblatt International, 113(25):435-444.
4. Ministry of Health (2015). Food-related choking in young children https:// www.health.govt.nz/your-health/healthy-living/food-activity-and-sleep/ healthy-eating/food-related-choking-young-children (Accessed January 2021).
5. Ministry of Health, Infant and toddler dietary guidelines (In Press).
6. Padarath S, Gerritsen S, Mackay S (2020). Nutritional Aspects of Commercially Available Complementary Foods in New Zealand Supermarkets. Nutrients 12(10):2980.
7. Marsh S, Ni Mhurchu C, Maddison R (2013). The non-advertising effects of screen-based sedentary activities on acute eating behaviours in children, adolescents, and young adults. A systematic review. Appetite, 71:259-273