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3 -a-day. airy FoodsServe 3 port. ons a day. Children under 2 years should have whole milk. or yogurt. Choose plain, unsweetened or lower sugar versions of yogurt wher. possible. Those eating well can be given semi-skimmed milk aft. r 2 years. Skimmed or 1% milk is not suitable as a drink for childr.
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- Background
- Terms of reference
- Methods
- Assessment of the systematic review evidence
- Limitations of the evidence base
- Conclusions
- Recommendations
- Research recommendations
Between 1974 and 1994, the Committee on Medical Aspects of Food and Nutrition Policy (COMA) published a series of reports on infant feeding practices in the UK and made recommendations for infant and young child feeding. The last of these reports, ‘Weaning and the weaning diet’, was published in 1994 and has been the basis for much of the advice on feeding young children in the UK (DH, 1994b).
Subsequent recommendations made by the Scientific Advisory Committee on Nutrition (SACN) and by international expert committees have carried implications for current infant feeding policy. These include the adoption of World Health Organization (WHO) Growth Standards (SACN/RCPCH, 2007; WHO MGRS, 2006a; WHO MGRS, 2006b) and revisions to energy requirements (FAO, 2004; SACN, 2011a).
Accordingly, SACN requested its Subgroup on Maternal and Child Nutrition (SMCN) to review recent developments in this area. To complement this work, the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) was asked by the Department of Health and Social Care to conduct a review of the risks of toxicity from chemicals in the diets of infants and young children. COT was also asked to examine the evidence relating to the influence of the infant diet on development of allergic and autoimmune disease.
This report covers the period from 1 to 5 years of age (12 to 60 months) and accompanies the ‘Feeding in the first year of life’ report, which was published in 2018 (SACN, 2018).
The terms of reference as they apply to this report are to:
•review the scientific basis of current recommendations for feeding children aged 1 to 5 years (12 to 60 months)
•consider evidence on developmental stages and other factors that influence eating behaviour and diversification of the diet in the early years
•make recommendations for policy, practice and research
The key dietary factors considered in this report are:
•energy requirements
SACN’s Framework for the Evaluation of Evidence (SACN, 2012) was used as the basis for considering appropriate evidence for inclusion in the review. An updated version of this framework has since been published in 2023.
Consideration of the evidence was primarily focused on systematic reviews (SRs) and meta-analyses of randomised controlled trials, prospective cohort studies and non-randomised studies of interventions.
SACN also considered evidence on young child feeding from large national surveys. The report includes data on food and drink consumption, and nutrient intakes and status in young children living in the UK from the 2011 Diet and nutrition survey of infants and young children (DNSIYC) for children aged 12 to 18 months (Lennox et al, 2013) and the National Diet and Nutrition Survey rolling programme (mainly from years 2016 to 2019) (NDNS) for children aged 18 to 60 months (Bates et al, 2020).
The report also includes data on the prevalence of overweight and obesity in children entering primary school (aged 4 to 5 years) from the National Child Measurement Programme (for England), the Child Health Surveillance Programme School system (for Scotland) and the Child Measurement Programme for Wales (there are currently no comparable data in children aged under 5 years for Northern Ireland).
The methodological quality of individual SRs was assessed using SACN’s Framework for the Evaluation of Evidence (SACN, 2012) and the quality assessment tool, AMSTAR 2 (AMSTAR, 2021).
The certainty of evidence from SRs was assessed using modified methods based on those outlined in the SACN reports ‘Carbohydrates and health’ (SACN, 2015) and ‘Saturated fats and health’ (SACN, 2019).
The certainty of the evidence was graded ‘adequate’, ‘moderate’, ‘limited’, ‘inconsistent’ or ‘insufficient’.
Evidence that was graded ‘adequate’ or ‘moderate’ was used to inform conclusions and recommendations of this report (alongside findings from national dietary surveys). These are summarised in Table S1.
General limitations of the systematic review evidence
There was either no or insufficient SR evidence for a number of dietary exposures (including saturated fat and dietary fibre) and health outcomes (including paediatric cancers, allergy and autoimmune diseases, and bone and skeletal health) that were included in the scope and literature search for this risk assessment. Many of the SRs identified for this report had a broad search strategy that included population groups outside the age range of interest for this report (children aged 1 to 5 years) and it was difficult to determine whether their search strategy for the target population was comprehensive. Most of the SR evidence that was specific to children aged 1 to 5 years was observational (from prospective cohort studies) or from non-randomised studies of interventions, and may have been subject to confounding and selection bias. The evidence base on many topic areas was highly heterogeneous in terms of exposures, dietary assessment methods, outcome measures, populations, settings, and study designs, which prevented the pooling of results by meta-analysis or other methods of quantitative synthesis. Due to the lack of quantitative syntheses in the included SRs, risk of publication bias was seldom formally assessed. The SR evidence identified on micronutrients was drawn almost exclusively from supplementation and food fortification trials designed for populations in low income, lower-middle or upper-middle income countries (defined according to the World Bank classification system) and therefore may not be generalisable to children living in the UK. Primary studies, particularly those conducted in high-income countries, seldom considered whether the impact of dietary exposures on nutritional status (for example, vitamin D) or health outcomes differed among different ethnic groups. The majority of primary studies had short follow-up periods, limiting the ability to draw conclusions about the longer-term health effects of nutrient or dietary intake in children aged 1 to 5 years.
General limitations of the evidence from dietary surveys
DNSIYC was conducted in 2011. Dietary patterns may have changed significantly in the period since the data were collected. The number of children that provided blood samples for status measures in NDNS was small and may not be representative of the wider population. Children who gave a blood sample were more likely to come from higher socioeconomic status households. Misreporting of food consumption, specifically underreporting, and therefore underestimation of total dietary energy intake (TDEI) in self-reported dietary methods is a well documented source of bias and is an important consideration when interpreting survey data.
The current diet of young children in the UK, as captured in both DNSIYC and NDNS, does not meet current dietary recommendations for several nutrients.
The following conclusions are informed by the main findings from DNSIYC and NDNS together with SR evidence that was graded ‘adequate’ and ‘moderate’ (see Table S1 above).
The following recommendations are suitable for children aged 1 to 5 years who are able to consume a varied diet and are growing appropriately for their age.
Between 1 to 2 years of age, children’s diets should continue to be gradually diversified in relation to foods, dietary flavours and textures. A flexible approach is recommended to the timing and extent of dietary diversification, taking into account the variability between young children in developmental attainment and the need to satisfy their individual nutritional requirements (SACN, 2023; SACN 2018).
Current UK dietary recommendations as depicted in the Eatwell Guide should apply from around age 2 years (SACN, 2023), with the following exceptions:
•UK dietary recommendations on average intake of free sugars (that free sugars intake should not exceed 5% of total dietary energy intake) should apply from age 1 year (SACN, 2023)
•milk or water, in addition to breast milk, should constitute the majority of drinks given to children aged 1 to 5 years (SACN, 2023)
•pasteurised whole and semi-skimmed cows’ milk can be given as a main drink from age 1 year (SACN, 2023), as can goats’ and sheep’s milks (SACN, 2023; COMA, 1994)
Throughout the development of this report, SACN identified a number of significant gaps in the evidence relating to infant and complementary feeding, as well as limitations in the study design for some of the available research.
The committee has therefore made a number of recommendations for research, which are described in chapter ‘13. Research recommendations’ of the full report.
One pint of milk or 3 things from this list: Beaker of milk (120ml) 0g) one yoghurt (100-120g) potMeat, fish, eggs, and pulses such as beans, dhal, lentils, and peas), and foods made from pulses such as tofu, hummus, and soya mince); at least twice a day (3 po. ions a day for a vegetarian child).Fruit and vegetables (fresh, tinn.
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- From birth to 1 month old. Breastmilk: typically you'll need to feed a newborn every 2 to 3 hours. Newborns should be fed on demand but, as you'll find out, they demand a lot!
- From 1 to 3 months old. After 1 month old, a baby's tummy is bigger so they'll be able to eat more each time, typically about 4 oz (120ml) per feeding. They'll also eat slightly (only slightly...)
- From 3 to 6 months old. By that stage your baby will sleep better and, if you're one of the lucky ones, even sleep through the night! This means they'll be eating less often, only about 5 feedings a day.
- From 6 to 9 months old. After 6 months old you can start to introduce solids in your little one's diet. The very best thing to start with is oatmeal mixed with breastmilk (or formula if that's what you're using).
so limit serving sizes to those indicated. Milk should be given in a cup, mug or glass - not a bottle. See Factsheet 1.2 Semi skimmed milk can be used from two years of age and skimmed milk from five years of age for children who eat a wide variety of foods. 125ml pot of yogurt. MILK Range of portion sizes Breast milk 5 - 10 minutes breastfeeding
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As your child gets bigger, it can be tricky to balance giving solid food with how much milk your child should have. If they are full with milk, they will not be motivated to have food. As a general guide: • 6 – 12 months: 500 – 600ml (1 pint) of milk a day. Babies who are breast fed or who are drinking less than 500ml formula a
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Vegetarian or vegan children will need up to 4 servings per day. Average portion sizes of protein for 1-5 year olds; 1⁄2 - 3 tablespoons of chopped meat/chicken/fish. 1⁄2 - 1 egg. 1⁄2 - 2 fish fingers. 1⁄2 - 3 tablespoons of beans/pulses/lentils. These foods are often the major contributor of iron in a child's diet and children under ...
