The Importance of a Healthy Diet Throughout Childhood

Childhood is a time of learning and developing. In its first year of life, a baby will have its first experience with food. After infancy, a child is growing fast and needs a healthy diet. What is best to give children at different phases of their life? How much do they need and what should not be given? In this article you will learn how nutrition can impact growth and development.

Infants

In this first phase of life, a baby will grow considerably. It is, therefore, important that the baby receives sufficient nutrients. Breastfeeding is the optimal method of infant feeding and is recommended worldwide for the first 6 months of life. The composition of breast milk automatically changes over time to meet the baby’s needs. Breast milk for instance, contains both omega-3 and omega-6 fatty acids (PUFAs) which are of critical importance for the development of the brain and nervous system. Breast milk also protects the baby from illness as it contains antibodies and other active substances. For example, breastfed infants are less likely to have respiratory infections and digestive problems, and it has also been linked to a lower risk of obesity later in life.

Formula milk is the alternative if a woman is not able or chooses not to give breastfeeding. Its composition is strictly regulated by the European legislation, to ensure that infant formulas contain the recommended amounts of nutrients. For both breast-fed and bottle-fed infants, vitamin D supplementation is necessary. Babies who receive breast milk also need vitamin K supplementation.

By around 6 months of age, breast or formula milk alone will no longer be sufficient to meet a baby’s needs and the process of weaning should begin. During weaning, milk feedings are gradually replaced by solid foods. In the initial phase the infant gets used to the sensation of food, with different tastes and textures. Around its first birthday, the child should eat three meals a day in addition to healthy snacks. It is important that babies are offered a wide range of foods to make sure they obtain all the vitamins and minerals they need. It will also make them less likely to become fussy eaters later on.

Whole cow’s milk is not suitable as a drink before 12 months of age, as the immune system is not completely developed yet. Frequently consuming fruit juice and other sugar-containing drinks is also not recommended, as this can lead to tooth decay. Overall, water and lukewarm tea are best to give to young children, as they do not contain calories. Honey should not be given to babies under one year either, because there is a risk of bacterial contamination that can cause infant botulism. Salt should be limited to 1 gram per day as the kidneys cannot cope with very much salt. Especially processed foods can be high in salt and should therefore be avoided.

Toddlers

Toddlers and pre-school children are growing fast and start moving more frequently. Therefore, their energy requirements are high compared to their body size. As a toddler’s stomach capacity is relatively small, a large supply of nutrients must be offered in small volumes several times a day. A healthy diet for toddlers (See table 1 in attachment below) consists of, for example: whole-wheat or brown bread, potatoes, rice, pasta, legumes, vegetables, fruit, milk (products), cheese, meat (products), fish, chicken, egg, meat substitutes, margarines and oils and water. Foods such as chips, crisps, cakes, biscuits, chocolate, and fried foods which are high in fat and sugars/salt but low in other nutrients, should not be given too often.

Developing healthy eating habits is essential in this phase. It is best not to use food as a reward, as this can encourage children to think more positively about (sweet) foods and stimulate their preference for sweet foods (even more). Children also need to learn to listen to their natural feelings of hunger and satiety. It is, therefore, better not to force children to eat or to empty their plate if the child has a normal appetite. This can lead to a higher food intake than necessary, and children will get used to exceeding their limits, leading to a higher risk of childhood obesity.

With a healthy and varied diet, toddlers will get enough vitamins and minerals. However, additional supplementation of vitamins differs between countries. For example, in the UK vitamin A, C and D supplementation is recommended until the age of 5, whereas in The Netherlands only supplementation with vitamin D is advised until the age of 4.

School children

Children from 5 to 12 years grow very rapidly and can be very active when they start school. Therefore, having a balanced diet with adequate energy and nutrients is important. Energy requirement can vary among children, as some children may be more physically active or are taller than others. Similar to infants and toddlers, school children should limit the intake of salt and sugar.

When children get older, they will begin to accumulate different experiences that may shape their food preferences and dietary patterns. Key among these will be the habits and preferences of their friends at school and those with whom they socialize. Many other influences will also begin to take hold, including food habits associated with role models. As children increasingly make food choices for themselves, a basic understanding of the principles of healthy eating can help them to make sensible choices.

Physical activity in childhood can be beneficial in terms of social interaction and wellbeing, and it is important for healthy growth and body weight. At least 60 minutes of moderate intensity physical activity each day is recommended, such as walking or cycling. At least twice a week, this should also include activities that improve bone health, muscle strength and flexibility, for example running, swimming, or dancing.

Teenagers

Once children have left primary school and are teenagers, the need for extra energy will increase again. A child in puberty goes through a strong physical growth. It gets longer and heavier. In general, boys will need more protein than girls as they are often taller and have more lean body mass. Girls will need more iron than boys after menstruation begins, to replace menstrual losses. Calcium and vitamin D are especially important during the growth period of a teenager for bone development. Also, physical activity has long-lasting effects on bone health and will help to maintain a healthy energy balance. Adolescents are advised to engage in at least 60 minutes of moderate to vigorous intensity physical activity every day, and avoid too much sedentary activities, such as watching TV, playing video games or travelling by car, bus or train.

In this phase, teenagers are more likely to eat out and make their own food choices. In many cases, this means that they will opt for snacks and fast food instead of choosing healthy meals, which they may conveniently skip at times. Therefore, school meals can make an important contribution to the energy and nutrient intake of teenagers. Also breakfast is sometimes skipped. However, after a night of sleep it is important to provide the body with new energy through food and drink. Starting the day with breakfast also promotes concentration at school.

Some teenagers will try to find their own identity through their diet, which may result in vegetarianism or adherence to certain diets. In this phase, teenagers also become conscious of their weight and body image, which, for some, can lead to eating disorders or other unhealthy behaviours. Eating disorders –such as anorexia nervosa, bulimia nervosa or binge eating disorder – are serious mental illnesses that have a big impact on someone’s physical, mental, and social wellbeing. In this phase teenagers might also start smoking or drinking, out of curiosity or because it is exciting. However, the brains of young people still develop until the age of 25, and alcohol consumption hinders this growth. This can lead to behavioural and learning problems. Education about a healthy lifestyle and the risks of unhealthy behaviour remain, therefore, important in every life phase.i

Author: Dr. Tim van Zutphen