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Med J Aust 2000; 173 Suppl 7 August: S14-S15

Supporting healthy eating behaviours in children

• Parents are important as role models for eating healthily and increasing physical activity; thus, health education for both parents and children is important.

• The NHMRC Dietary guidelines for children and adolescents⁴ should form the basis of meal and snack composition for children.

• Children of normal weight over the age of five years can be offered reduced-fat dairy products. However, these children should still obtain approximately 35% of their energy from fat, including mostly unsaturated fats found in nuts, seeds, olives and their oils, monounsaturated and polyunsaturated margarines, and some fish.

• Snacks are just as important as meals in ensuring adequate energy and nutrient intake. Snacks should be planned so that a variety of healthy choices are offered. See Box 6 for nutritious snack choices for children.

• Water should be encouraged as the preferred drink, with soft drinks and fruit juices used occasionally. During periods of vigorous physical activity children may rehydrate more effectively with the use of an electrolyte-replacement drink.

• Very active children require additional energy and carbohydrate to meet growth demands and satisfy fuel requirements to optimise athletic performance.

• Many studies show that increasing the intake of fresh fruit and vegetables is linked with better health. This habit needs to be established early in childhood.

• Recommended quantities of the core food groups and extra foods (treats) for children can be found in Box 7.

Promotion of physical activity in children

• Increasing physical activity is of primary importance for overall cardiovascular fitness, bone health and body composition. It may also help to improve self-esteem.

• Physical activity, particularly weight-bearing activities, when combined with enough dietary calcium, is the best way to build a healthy skeleton during the growing years.

• Parents need to limit the time children spend watching television, videos and playing computer games.

• Parental modelling of an active lifestyle is a powerful influence on children's levels of physical activity.

• Playing with children -- even just catching and throwing a ball -- can increase their skills and lead to less peer criticism and improved self-esteem.

• Children need a safe environment in which to be active and the opportunity to develop the skills fundamental to improving their perceived physical competence and rewarding participation in physical activity.

• Prior to puberty, a variety of activities or sports should be encouraged.

• Creating a community environment which facilitates safe incidental physical activity (eg, walking or cycling to school) is essential for increasing activity in the primary school age population.

Management of a healthy body weight in children

• It is important that a healthy weight is maintained through a nutritionally balanced diet and adequate physical activity. Both underweight and overweight are associated with increased health risks.

• Body mass index (weight/height²), based on accurately measured height and weight, is the most convenient way to assess a child's degree of fatness (an international chart will soon be available).

• Growth measures, such as height and weight, should be monitored for early detection of overweight or obesity, especially within families with a high risk of type 2 diabetes or early atherosclerosis.

• Long term success in weight management requires a family-based approach which incorporates increased physical activity, a reduction in energy and fat intake and behaviour modification.

• Childhood obesity management is about long term change. In overweight children, the overall goal is to maintain weight while the children grow in height.

• Planning meals, snacks and physical activity helps to maintain compliance and success with weight maintenance.

• Parents need to be consistent in setting limits, saying "no", observing and praising their children to reinforce positive behaviours.

• The use of motivational tools such as charts, stars, stickers or other non-food items helps to encourage and support behaviour change. Motivational tools should be aimed at positive behaviour, not directly at weight or weight change.

6: Nutritious snacks for children Bread and bread-based snacks such as crumpets, English muffins, sandwiches, fruit loaf, fruit buns Breakfast cereals and cereal bars (eg, muesli bars) Fruit (fresh, cooked, canned and dried) Fruit sticks Dairy products (eg, milk [plain and flavoured], milk shakes and fruit smoothies, yoghurt, cheese) Home made popcorn Baked goods (eg, low fat fruit muffins, scones, pikelets, pancakes) Plain crackers with dips or spreads Nuts* and dry roasted legumes (eg, chick peas) *Nuts are not suitable for children under 5 years.

7: Healthy eating guide for children aged 4-11 years (adapted from The Australian guide to healthy eating5,84) Eating a wide variety of foods has a positive effect on health, and a healthy diet is made up of a variety of foods within each of the food groups, below. The ranges of servings for some food groups are wide, partly because of the broad range of ages (4-11 years) covered. At the lower end of the range, the guide provides for nutrient needs. At the high end, the guide aims to cover increased energy requirements for growth and varied levels of physical activity. More information can be found in The Australian guide to healthy eating.5 Food group Recommended no. of serves daily and sample serving sizes Bread, cereal, rice, pasta, noodles* 3-9   2 slices bread; 1 medium bread roll; 1 cup cooked rice, pasta or noodles; 1 cup porridge; 11/3 cup breakfast cereal flakes or 1/2 cup muesli Vegetables, legumes 2-5   75 g or 1/2 cup cooked vegetables; 75 g or 1/2 cup of cooked dried beans, peas or lentils; 1 cup salad vegetables; 1 small potato Fruit 1-2   1 medium piece (eg, apple, banana, orange or pear); 2 small pieces (eg, apricots, kiwi fruit, plums); 1 cup diced pieces or canned fruit; 1/2 cup juice; Dried fruit (eg, 4 dried apricot halves, 11/2 tablespoons of sultanas) Milk, yoghurt, cheese 2-3   250mL (1 cup) milk; 40g (2 slices) cheese; 200g (1 small carton) yoghurt; 250mL (1 cup) custard Meat, fish, poultry, eggs, nuts, legumes 1/2-11/2   65-100g cooked meat, chicken (eg, 1/2 cup lean mince, 2 small chops or 2 slices roast meat); 1/2 cup cooked (dried) beans, lentils, chick peas, split peas or canned beans; 80-120g cooked fish fillet; 2 small eggs; 1/3 cup peanuts or almonds; 1/2 cup sunflower seeds or sesame seeds Extra foods* 1-2   Margarines and oils (1 tablespoon, 20g)†; 4 (35g) plain sweet biscuits; 1 slice (40g) plain cake; 11/2 scoops (50g scoop) ice cream *Some foods do not fit into the core food groups as they do not provide essential nutrients and some contain too much added fat and sugars. Small amounts of these foods, however, can add to the enjoyment of eating a healthy diet. For a list of more nutritious snacks see Box 6. †In addition to the 1-2 serves for margarine and oils under "extra foods", the guide also recommends modest consumption of margarine on foods like bread and toast and modest amounts of margarine or oil in food preparation.

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