‘Probably the single most important thing you can do for your child’s Future Health & Happiness is to give them Optimum Nutrition’ (Patrick Holford, 2010).
Why it matters?
Nowadays, an alarming number of children suffer from overweight, obesity, and Type II Diabetes, previously seen in adults, and according to research, the current generation is expected to be the first one that will probably live shorter than their parents.
According to the WHO (2024), ‘Overweight is a condition of excessive fat deposits, and Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Obesity can lead to increased risk of type 2 diabetes and heart disease, affect bone health and reproduction, and increase the risk of certain cancers.’
Diets rich in vegetables, fruits, whole grains, legumes, nuts, and seeds can help reduce the risk of chronic diseases compared to typical Western diets, which often have higher levels of processed foods and animal products. Additionally, adopting such diets can contribute to more sustainable food systems by reducing the environmental impact associated with animal farming (Koletzko, 2022).
So, what matters?
Preschoolers in early years require a decent mix of nutrients, such as Macronutrients (proteins, carbohydrates, & fats) and essential Micronutrients, including minerals and vitamins. Macronutrients serve as a source of energy, while micronutrients play an essential role in biochemical processes in the body.
And why is it important?
Because a Well-Balanced Diet is essential for:
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- Dynamic Growth and Development: Preschool children are rapidly growing. Thus, a balanced diet ensures they get the necessary nutrients to develop physically, mentally & emotionally.
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- Cognitive Function: Proper nutrition supports brain health, affecting learning, memory & behavior.
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- Immune System Support: A well-rounded, nutritious diet helps strengthen the immune system, thus reducing the risk of infections.
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- Establishing Healthy Habits that can decrease the risk of diet-related chronic diseases & promote long-term health in future life.
The daily caloric requirement for children is calculated based on their age, sex, and activity status & growth charts are essential for guiding nutritional counseling in children.
The table summarizing the caloric intake needs is based on age and weight (Faizan & Rouster, 2023).
Essential nutrients crucial for preschoolers’ growth and development include:
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- Macronutrients:
Carbohydrates (CAH):
Provide energy to keep kids active and are necessary for learning & focus.
- ~45-60% of the Energy intake should come from carbohydrates. (*Less than 10% from Added Sugars) (Koletzko, 2022).
- Focus on Complex Carbohydrates (‘Slow-releasing CAH’), including wholegrains (brown rice, quinoa, oats), vegetables, fresh fruits, legumes, & beans.
- These contain Fiber and essential nutrients and have a low Glycemic Load, so they steadily increase blood glucose levels. (*GL measures the effect of food on glucose levels in the blood or how much sugar is in the food).
- * Dietary fiber recommendations are as follows: children should consume 10 g per day until age 3, 14 g per day between ages 4 and 6, and 16 g per day between ages 7 and 10 (Koletzko, 2022). (Fiber improves digestive health by creating bulk in the stool and stimulating peristalsis. It prevents constipation and diarrhea and is a protector against colon cancer).
- Try to avoid Refined simple sugars (such as white sugar, brown sugar, maltose, fructose, or dextrose…which can be hidden in white bread, biscuits, processed cereals, chocolate, or sugar-sweetened beverages). They release sugar into the bloodstream quickly, causing blood sugar to spike, which is responsible for the surge in energy known as the ‘sugar rush’ (a sudden increase in physical or mental vitality). This follows the release of the insulin hormone in the blood necessary for Glucose uptake by the cells used for energy, leading to a drop in blood sugar level with the subsequent crush of energy often manifesting as irritability, mood swings, poor concentration, and memory, & sugar cravings in children (Holford & Colson, 2010).
- Start with easy SWAPS:
- White toast & jam->Wholegrain toast and hummus
- Cornflakes->Oat porridge with berries
- Croissant/ Baguette-> Wholegrain rye bread
- Read Food Labels carefully. You are looking for ..’ oses.. such as sucrose, maltose, dextrose..or glucose
Proteins:
Provide energy and build muscle, skin, enzymes, hormones & neurotransmitters (chemical messengers transmitting signals between brain nerve cells and the nervous system).
- Recommended Protein serving depends on the age of the child.
- For toddlers, the protein reference intake is 1.14 g per kg of body weight per day at 1 year of age, decreasing to 0.97 g per kg by age 2.
- The recommended protein intake for children aged 3 to 10 years is approximately 0.90 g per kg of body weight per day (Koletzko, 2022).
- Excellent sources include Plant-based proteins such as beans, pulses, nuts, seeds, quinoa, brown rice, and vegetables (broccoli, dark green leafy vegetables), which are also excellent meat alternatives. High-quality animal sources include lean meats, fish, eggs, and dairy, preferably focusing on organic quality. Avoid processed meats such as bacon, burgers, chicken nuggets, fish fingers, and sausages.
- Eating the right amount of Protein daily, even with snacks (fresh fruit + nuts), can support blood sugar regulation, which is also essential for kids’ emotional balance.
Fats:
They are excellent energy sources, essential for brain development, healthy skin & tissues, and necessary for the absorption of fat-soluble vitamins- A, D, E, & K.
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- Fat intake should be 35–40% of total energy (E) until age 3, then reduced to 20–35% (Koletzko, 2022).
- Focus on healthy fats from avocados, nuts, seeds, and extra virgin olive oil (EVOO), and sources of Omega-3 fatty acids from fresh or frozen fatty fish (sardines, mackerel, or organic salmon) and flax/ hemp/ pumpkin seeds & walnuts.
- Choose Omega 6 fatty acids from plant-based sources such as sunflower or sesame seeds.
- *Interestingly, The optimal n-6/n-3 ratio for children has not yet been established due to the lack of conclusive data from research studies.
- Try to limit sources of Saturated fats (lard, fatty meats, pastries, cakes), and Trans fats as much as possible (margarine, cookies, crackers, cereals, chips, biscuits, fried foods).
Graphical representation of meal composition and eating behavior, modified and adapted for pediatric age from Harvard Medical School (2021):
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- Micronutrients: (Vitamins & Minerals):
They are essential in small quantities, ensuring that the body and the life-maintaining biochemical processes required for a healthy life are up and running.
Choose whole foods (whole grains, fresh fruits, & vegetables, nuts & seeds) & animal sources (lean meat, eggs, fish) that are natural sources of vitamins, minerals, and antioxidants over foods artificially fortified with these nutrients.
Vitamins:
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- Vitamin A: Important for normal vision, skin health, and immune function.
Plant-based Yellow- Orange Sources: carrots, sweet potatoes, peppers, apricots, squash, and green leafy greens (spinach, watercress). Animal origin sources: liver, meat, eggs, cheese.
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- Vitamin C: Supports the immune system and aids in iron absorption.
Sources: citrus fruits, strawberries, kiwis, berries, tomatoes, broccoli, and bell peppers.
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- B- vitamins family (B1, B2, B3, B5, B6, B7, B9, & B12): Essential for Energy production, the formation of red blood cells, brain development & synthesizing neurotransmitters.
Sources: whole grains (oats, barley), vegetables (spinach, watercress), pulses. *Vitamin B12 can be found only in animal sources such as eggs and fish.
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- Vitamin D: Crucial for bone health & teeth as it can help the body utilize calcium.
*It plays also a key role in prevention of allergic, autoimmune & infectious diseases.
Sources: mushrooms, oily fish, eggs, & sunlight exposure.
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- Vitamin E: Important for skin health & immune system.
Sources: seeds, seed oils, nuts, oily fish, & wheatgerm
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- Vitamin K: involved in blood clotting.
Sources: broccoli, cauliflower, cabbage, and potatoes & can also be produced by healthy gut microflora.
Minerals:
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- Calcium: Necessary for bone development and healthy teeth.
Sources: leafy greens, broccoli, almonds, pumpkin seeds, walnuts, sardines, and dairy products.
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- Chromium: Keeps blood sugar levels stable and decreases sugar cravings. The refining process can remove it, thus prefer whole grains instead of white rice, pasta, or bread.
Other sources: potatoes, peppers, chicken, eggs.
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- Iron: A vital component of hemoglobin, which is responsible for transporting oxygen in the human body’s bloodstream and thus is especially important during the preschool age when children are growing most rapidly.
Sources include meat & eggs, beans, leafy greens, pumpkin seeds, & almonds.
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- Zinc: essential for growth, proper immunity functioning, and energy production.
It is specifically needed during intensive growth, puberty, infections, & blood sugar imbalance.
Sources: nuts, seeds, whole grains, meat, & dairy products.
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- Magnesium is necessary for bone and tooth formation, energy production, and efficient muscle relaxation, which supports good sleep.
Sources: nuts, seeds (sesame, sunflower, pumpkin), green leafy veg.
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- Manganese: involved in blood sugar regulation, brain function, formation of healthy bones & cartilage, and red blood cell production.
Sources: pineapple, mango, berries, watercress, oats.
How to Provide Essential Nutrients?
These are included in:
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- Cereals & Other Starchy Foods: Try to focus on complex Carbohydrates: Brown/ Black/ Red rice, Basmati rice (is naturally white, not a result of stripping or processing), steel-cut oats, millet, amaranth, and quinoa. Good choices include bread, pasta, rice, noodles, potatoes & sweet potatoes.
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- Vegetables & Fruits: Eat all varieties of fresh (and local if possible), frozen (without added sugars or salts), or lightly boiled vegetables with minimum water (to prevent mineral & Vitamin loss). Eat at least five servings of fresh fruit and vegetables daily & ‘Eat the rainbow!’ (~40g/day)
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- Legumes: Beans (white, red, black, fava, kidney, lima, navy, pinto) & Lentils (green, orange, yellow), Soybeans/ non-GMO (edamame, miso, tofu), Peas (green, yellow).
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- Meat & Poultry: Prefer lean cuts and organically raised if possible (35-40g/day).
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- Eggs: Try to choose the organic quality of Eggs (1-2/weekly max).
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- Fish: Select low-mercury fish if possible: salmon, catfish, pollock, sardines,or mackerel once or maximum twice a week (35-50g/ per week).
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- Milk & dairy products: (prefer organic products): milk (330-350ml/day), unsweetened natural yogurt, cottage cheese, kefir, butter/ ghee. Avoid unpasteurized milk. *From around the age of 4 years, whole milk and dairy products can be replaced with reduced-fat options (Koletzko, 2022).
- Healthy Oils: EVOO (use extra-virgin, cold-pressed, organic) and plant-cold-pressed oils (sesame, sunflower, walnut, avocado); don’t use them for stir-frying and baking.
- Nuts and Seeds: Select raw and unsalted ones. *Interestingly, peanuts are called nuts, but they are, in fact, legumes. Nuts are almonds, Brazil nuts, cashews, chestnuts, hazelnuts, macadamias, pinenuts, pistachios, & walnuts. Seeds are pumpkin, sunflower, or flaxseeds.
Try to focus on:
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- Variety: Offer a range of healthy foods. This helps ensure children get the required nutrients and prevent nutritional deficiencies.
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- Meal Planning: Plan meals and snacks with a good balance of carbohydrates, proteins, and fats.
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- Healthy Snacks: Provide nutritious snacks like fruits, yogurt, and whole grains instead of processed snacks.
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- Involvement: Encourage children to participate in meal preparation, as this can increase their interest in healthy foods.
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- Modeling Behavior: Set a good example by eating various healthy foods yourself.
Also, an important topic is Hydration.
The daily recommended intake (DRI) of water depends on age, sex, weight, activity status, air temperature, and humidity. Plain water is the best way to fulfill this requirement.
To ensure preschoolers stay hydrated properly, it’s essential to encourage regular water intake throughout the day, not just during meals. Providing accessible water bottles, leading by example, and educating children on the importance of drinking water are effective strategies to stay well-hydrated. Additionally, offering water-rich foods like fruits and vegetables can also help.
- For infants weighing between 3.5 kg and 10 kg, the daily fluid requirement is 100 ml/kg.
- For children weighing 11 kg to 20 kg, the requirement is 100 ml/kg for the first 10 kg, and 50 ml/kg for each kg beyond that.
- For those over 20 kg, the fluid requirement starts at 1500 ml for 20 kg, with an additional 20 ml/kg for every kg above 20 kg; however, no more than 2400 ml should be given at one time (Faizan & Rouster, 2023). * Pure fruit juice should be provided only during mealtimes, and for this age group, it ought to be served as a mixture of half juice and half water (Koletzko et al., 2015).
What else should be considered?
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- Prepare visually appealing (colorful fruits & veg) and simple meals.
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- Follow the eating schedule and serve meals and snacks daily at the same time to help manage hunger and prevent overeating. This includes breakfast, mid-morning snack, lunch, mid-afternoon snack, late-afternoon snack, early dinner, dinner, or bedtime snack.
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- Be aware of portion sizes. Preferably start with smaller servings, and do not insist on finishing everything on the plate to prevent overeating.
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- Prefer homemade foods prepared by steaming (which conserves mineral content), boiling (which allows you to recycle the mineral-rich vegetable cooking water for stews or soups), or baking instead of frying.
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- Children should be encouraged to eat breakfast daily, as skipping breakfast can be linked to obesity. This may be related to its role in maintaining energy balance and regulating dietary intake (Koletzko, 2022).
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- Preschoolers are under our control. They eat what we provide them to eat. So, they like French fries or candy because we only give it to them (Lipski, 2006).
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- Check nutrition labels on packed foods carefully for sugar and salt content. Some sugars occur naturally, such as in milk, fruit, or fruit juice; however, most are added. *Avoid products containing artificial sweeteners (aspartame, saccharine), additives, colorings, flavorings, trans-fats (hydrogenated/ partially hydrogenated vegetable oil or shortening), preservatives, GMOs, or foods with extended shelf-life of more than 1 year. *Artificial sweeteners can be part of jams, salad dressings, frozen desserts, and ice cream. * Trans fats can increase the risk of inflammation in the body and contribute to the development of chronic disease.
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- Encourage preschoolers from about age 5 to help you in the kitchen (e.g., washing green leafy vegetables for salad, putting the veg into the pot).
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- Eat and talk together as a family around the table without electronic devices to teach preschoolers manners and social skills and to prevent overeating.
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- Balance the lifestyle around essential pillars such as sleep, rest, and movement at least 60 minutes a day, preferably in nature.
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- Please don’t feel bad about special occasions such as kids’ birthday parties, as it’s not in your hands to control all meals provided. A birthday cake or ice cream is not a reason for panic unless your child is allergic to some ingredients.
Accepting new foods involves parents being patient, persistent, and ready to repeatedly present foods that have been previously declined. Research indicates that it may take 8 to more than 15 exposures to accept the new food.Offering various nutrient-dense foods at each meal and snack can help address these challenges, enabling young children to explore their preferences. “Responsive feeding” refers to the interaction between the child and parent during mealtime and is often recommended (Reverri et al., 2022).
References:
Faizan, U. & Rouster, A., S. 2024. Nutrition and hydration requirements in children and adults. In: StatPearls [online]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562207/
[Accessed 24 October 2024].
Harvard Medical School, 2021. Healthy eating plate. Harvard Health Publishing. Available at: www.health.harvard.edu [Accessed 28 October 2024].
Holford, P. and Colson, D., 2010. Optimum nutrition for your child. How to boost your child’s health, behavior, and IQ. London: Piatkus.
Koletzko, B., 2022. Pediatric nutrition in practice. 3rd ed. [e-book] Basel: Karger. Available at: https://www.nestlenutrition-institute.org/sites/default/files/documents-library/publications/secured/PNP%203rd%20Edition%20Book.pdf [Accessed 27 October 2024].
Lipski, E., 2006. Digestive wellness for children. How to Strengthen the Immune System & Prevent Disease ThroughHealthy Digestion. New York: McGraw-Hill.
Reverri, E., J., Arensberg, M., B., Murray, R., D., Kerr, K., W. and Wulf, K., L. 2022. Young child nutrition: Knowledge and surveillance gaps across the spectrum of feeding. Nutrients. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9370290/
(Accessed 28 July 2022).
World Health Organization (WHO), 2024 Overweight and obesity [online]. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [Accessed: 1 March 2024].
Bibliography:
Geissler, C. and Powers, H., 2023. Human nutrition. 14th ed. London: Pearson
National Health Service (NHS), 2024. Healthy Eating [online]. Available at: https://cambspborochildrenshealth.nhs.uk/feeding-and-eating/healthy-eating/ [Last reviewed 22 October 2024].