Patient professional reference
Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.
Childhood nutrition should be a balance between the high energy and nutrient content required for growth and development and establishing a healthy diet with weight control, in association with regular physical exercise. The balance between these two aspects changes from the very high-fat content of infancy to the low-fat, high-fibre diet of adulthood.
The diet for a child should be focused on natural, fresh sources of energy and nutrients. Drastic dieting and fad foods must be avoided. A positive attitude to healthy eating should be encouraged from an early stage.
See also the separate Infant Feeding article.
Children have a high energy requirement because they are growing quickly and becoming more active. They therefore require foods which are high in energy (as well as vitamins and minerals). Young children do not have large enough stomachs to cope with big meals and so should have small and frequent meals. A diet which is low in fat and high in fibre may not provide enough energy for a young child. A healthy family approach to diet and lifestyle should be encouraged, as food preferences are often established at this stage.
A diet which is low in fat and high in fibre will not provide enough energy for a young child but a family approach to a healthy diet is important at this stage because food preferences are often established very early in life. Ideally, children should restrict the number of times a day that they have foods and drinks containing sugar and then only have them at mealtimes.
Young children should not be put on weight reduction diets but a healthy family approach to food and regular physical activity are important in avoiding excessive weight gain and obesity.
Other nutritional requirements
The diet must also be high in vitamins and minerals. In particular, a good supply of protein, calcium, iron and vitamins A and D is required. Supplements of vitamins A, C and D in the form of liquid drops are recommended for children under 5 years of age if they are considered to be at risk of deficiency - eg, poor eaters or those who do not have much exposure to sunlight.
Whole cow's milk is recommended for children over the age of 12 months as a main drink, as it is a rich source of a number of nutrients. Semi-skimmed milk can be introduced after the child is 2, as long as the diet provides enough energy. Skimmed milk is not suitable for children under 5 years of age, as it does not provide enough energy and vitamin A for the growing child.
Iron-deficiency anaemia may be associated with frequent infections, poor weight gain and delay in development. Red meat is the best source of easily absorbable iron and can be offered to children from 6 months of age. Iron-rich foods, such as liver and red meat, are not usually popular with young children.
Other good sources of iron include green vegetables, pulses, bread and some breakfast cereals. Iron from plant sources is less well absorbed than iron from animal sources but can be improved by having vitamin C-rich foods or drinks with a meal.
Young children need plenty of calcium in their diets for healthy bones and teeth. Dairy products have a high calcium content and other good sources include white bread, dark green leafy vegetables, pulses (eg, baked beans) and fortified cereals.
Constipation is common in young children. This can be helped by gradually increasing the amount of fibre in the child's diet. Foods high in fibre include vegetables, wholemeal bread, baked beans and high-fibre white bread. A high fluid intake is also important.
Diarrhoea in toddlers is also common and may be linked with too many sugary drinks and too much fruit juice, especially between meals. These drinks can make the child too full at mealtimes and prevent a proper balanced diet. They can also be harmful to teeth. If the child is having a high-fibre diet then it may be appropriate to reduce the fibre content in the diet.
The energy requirements of schoolchildren are still high because of growth and activity. Therefore, there should be a progression towards an adult-style healthy diet but with continued emphasis on foods with a high energy and nutrient content. The progression should be gradual with an increase in fibre, reduction in fat and increase in starch content in the diet.
Younger children (eg, 4-6 year-olds) will still need smaller and more frequent meals as they do not have large enough stomachs to cope with big meals.
Childhood obesity is increasing at an alarming rate throughout the world.Schoolchildren should eat a healthy, varied diet and this should be combined with regular physical activity in order to maintain a healthy body weight. It is recommended that children and young people should participate in at least 60 minutes of moderate-intensity physical activity each day.
The diet should include a good supply of protein, vitamins and minerals. The same principles apply for schoolchildren as for preschool children, as summarised above.
The Food Standards Agency has provided guidance on the safe maximum consumption levels for oily fish:
- It recommends that boys and girls under the age of 16 should not eat marlin, shark or swordfish.
- Boys aged under 16 can have up to four portions of oily fish a week and girls up to two portions.
- The lower recommendation in girls is because substances found in oily fish - eg, dioxins - can accumulate in the body and high levels may be detrimental in later life to the developing fetus.
Further reading and references
Maternal and child nutrition; NICE Public Health Guidance, March 2008
Report of the Commission on Ending Childhood Obesity; World Health Organization, 25 January 2016
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