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Research Report

Pre-school food survey

Jo Nicholas, Lesley Stevens, Laura Briggs and Lesley Wood

Children’s Food Trust

Sheffield

February 2013

Pre-school food survey 2012

Contents

Summary ............................................................................................................................................... 4

Introduction ............................................................................................................................................ 5

Background ......................................................................................................................................... 5

Aims .................................................................................................................................................... 6

Methods .................................................................................................................................................. 7

Survey partners ................................................................................................................................... 7

Sampling and recruitment .................................................................................................................. 7

Selecting the settings ...................................................................................................................... 7

Recruitment of settings................................................................................................................... 7

Setting response rate and sample characteristics .......................................................................... 7

Data collection and tools .................................................................................................................... 8

Statistical analysis ............................................................................................................................... 9

Analysis of food provision and consumption ...................................................................................... 9

Data checking .................................................................................................................................... 10

Results ................................................................................................................................................... 10

Setting type ....................................................................................................................................... 10

Participating children ........................................................................................................................ 10

Meal occasions .................................................................................................................................. 11

Provision and consumption .............................................................................................................. 11

Breakfast ....................................................................................................................................... 11

Lunch ............................................................................................................................................. 13

Tea ................................................................................................................................................. 17

Snacks ............................................................................................................................................ 19

Food and drink consumed by children .............................................................................................. 20

Consumption by food group ......................................................................................................... 20

Fruit and vegetable consumption ..................................................................................................... 22

Meeting the voluntary food and drink guidelines for early years settings ....................................... 22

Nutrient content of provision ....................................................................................................... 22

Food and nutrient provision in full daycare settings. ................................................................... 23

Meeting selected food and drink guidelines ................................................................................ 24

Guidelines relating to meal occasions .......................................................................................... 26

Other guidelines ............................................................................................................................ 31

The eating environment.................................................................................................................... 32


Discussion.............................................................................................................................................. 32

Food and drink provision in relation to guidelines ........................................................................... 32

Energy and nutrient provision and consumption in relation to the guidelines ................................ 33

Energy ........................................................................................................................................... 33

Fat and dietary fibre ...................................................................................................................... 33

Protein and micronutrients ........................................................................................................... 34

Limitations ........................................................................................................................................ 35

Conclusions ........................................................................................................................................... 36

Appendix 1 ............................................................................................................................................ 37

References ............................................................................................................................................ 38


Summary Voluntary food and drink guidelines for early years settings in England were

introduced in September 2012 to support settings to provide ‘healthy, balanced and nutritious meals and snacks’, as required by the Early Years Foundation Stage (EYFS) framework.

The survey was designed to provide information on the range of catering provision and practices in early years settings in England, to assess food consumption and wastage, and to assess the extent to which the provision of food and drink in early years settings met the national guidelines for food and nutrient provision.

Fifty-seven settings (including childminders, Children’s Centres, full day care and sessional providers, and nursery classes in primary schools) were recruited across three local authorities in England. Food and drink provision, consumption, and wastage; provision by parents/carers; and setting characteristics were measured over five days in each setting.

The food provided reflected societal norms for specific meals. Food provided by settings at lunch was typically healthier than that provided by parents: more protein, fibre, vitamin A and folate, less sodium and less sugar. Mean fruit and vegetable consumption was 1.2 portions per meal or snack.

Settings were generally meeting many of the food and drink guidelines. Areas for improvement included providing the appropriate balance of white and wholegrain starchy foods across the week at breakfast, lunch and tea (afternoon meal), providing fruit and/or vegetables at breakfast, providing starchy foods as part of at least one snack each day, providing a wider variety of foods at tea, and using products lower in salt.

Compared to the nutrient framework underpinning the guidelines, lunch provided less energy, carbohydrate, iron and zinc than recommended, enough protein, vitamin A, vitamin C and calcium, and too much sodium. Provision at teatime met most of the standards apart from iron, zinc, and sodium.

To further improve food provision, settings and caterers should consider including a wider variety of foods in their provision to increase dietary diversity, and selecting manufactured products with healthier nutrient profiles (such as those lower in sodium). Increasing the iron and zinc content of menus and recipes is also important. There is a need to embed food policies which promote healthier food being brought into the setting from home, and to improve communication and consultation with parents, and staff training in relation to healthy eating.

The survey provides some important insights into the characteristics of food provision in early years settings. It provides a baseline measure against which the impact of the introduction of the voluntary food and drink guidelines can be assessed.


Introduction

Background Each year, over one and a half million young children in England receive early education and

child care in one of over 90,000 registered settings.1 Many of these settings provide food

and drink. Early years settings clearly provide an ideal opportunity to help children learn

about and practice healthy eating, as well as to engage parents and catering providers.

However, by the time children in England enter Reception class, nearly one-quarter of them

are either overweight or obese. By Year 6, that proportion has grown to one-third.2 It is clear

that eating habits and life styles established early in childhood persist into school years.3 4

In January 2010 the Children’s Food Trust (formerly the School Food Trust) set up and

provided the secretariat for the Advisory Panel on Food and Nutrition in Early Years (‘the

Panel’). The purpose of the Panel was to provide insight into the needs of early years

settings for improved food and drink guidance, the food and nutrition needs of young

children in early years settings, and to make recommendations regarding best practice.5 The

final report ‘Laying the Table: Recommendations for National Food and Nutrition Guidance

for Early Years Settings in England’ was published in November 2010.6 The Panel made a

total of 11 recommendations to DfE, and these informed the Early Years Foundation Stage

framework review published in 2011.7 Two key recommendations were that the guidance on

healthy food provision in the Early Years Framework be improved and made more

accessible to providers of childcare in early years; and that its impact on food provision,

catering practice and consumption in early years settings be assessed nationally.

Since September 2012, all regulated early years settings in England have been required to

follow the revised Early Years Foundation Stage (EYFS) framework.8 This includes welfare

requirements relating to food and drink. The review of the EYFS by Claire Tickell

recommended the adoption and promotion of voluntary guidance for healthy eating (as

drafted by the Panel). The new voluntary food and drink guidelines were developed to

ensure practitioners had clear, consistent, practical, evidence-based guidance on how to

meet the EYFS welfare requirement for food and drink “to provide healthy balanced and

nutritious meals and snacks” and encourage young childrena to eat well. The guidelines

provide food-based guidance within a nutrient framework,b and are detailed in a practical

guide 9 developed as part of the Trust’s Eat Better Start Better programme.c

The Panel recommended that “Nutritional provision should be evaluated systematically to

measure the changing patterns of both food provision and consumption throughout the

child’s journey across the diverse range of settings attended.”

The Panel found little published evidence on the provision of food and drink in early years

settings, and none that had been conducted in nationally representative samples of different

types of setting. Available findings were based on small regional or larger voluntary samples.

a The guidance relating to children aged 1-4 years includes children up to their fifth birthday.

b The nutrient framework sets out the total amount of energy and nutrients required by young children each day

according to sex and age. Intakes are divided across breakfast, lunch, tea/dinner and snacks. The energy and nutrient content of the food and drink provided in an early years setting for a particular meal or snack should accord with the requirements of the children eating the food, and contribute proportionately to the total daily intake. c http://www.childrensfoodtrust.org.uk/advice/eat-better-start-better

http://www.childrensfoodtrust.org.uk/advice/eat-better-start-better


They assessed the adequacy of provision in relation to the Caroline Walker Trust nutrient-

based guidance,10 and were based either on menu analysis across the week11 or on

chemical analysis.12 13 The National Diet and Nutrition Survey (NDNS)14 includes findings on

the food consumption and nutrient intake of young children aged 1.5-3 years; but sample

sizes of young children in the NDNS take several years to accumulate, and the survey itself

does not provide detailed information on either the setting or on provision or catering

practices.

Aims The purpose of the pre-school food survey was to provide information on food and drink

provision in early years settings in England; to examine the extent to which current provision

meets the newly developed voluntary food and drink guidelines (a ‘baseline’ measure, as the

survey was completed before the revised EYFS was implemented); to understand which

factors were associated with healthier provision and consumption; and to explore the

relationships between food and drink provision and the promotion and adoption of healthy

eating habits in young children. The survey was also intended to provide information on how

food provision in early years settings prepared children for primary school, both in terms of

the food itself and the approach to food provision (for example the social and educational

benefits of children sitting and eating meals together).

Specifically, the aim was to recruit 63 early years settings (including childminders, Children’s

Centres, sessional and full day care providers, nursery schools and nursery classes in

primary schools), and collect data over five daysd in each setting to assess:

The types and amounts of food and drink provided by settingse

The profile of children for whom provision was made in each setting on each meal occasion, by age and sex

Food consumption and wastage in an estimated maximum sample of 2070 children,f including food provided by the setting and food brought into the setting from home

The extent to which the provision of food and drink in early years settings met the national guidelines for food and nutrient provision, including analysis by meal occasion

A comparison of setting-provided and parent/carer provided food and drink provision

The characteristics of the settings and provision, including information on the times when meals were served, the nature of the dining environment, procurement, contracts and finances, catering practices, support for healthier eating (including staff training, healthy eating awards, quality improvement processes, etc.), and engagement with parents and children.

A nationally representative sample survey of early years settings would have been the most

appropriate method to gather, describe and evaluate the information detailed above. The

present survey was conducted on a smaller scale, in line with available resources, and

provides useful information (from selected settings in three local authorities) on food and

d Data over five consecutive days were needed to fully evaluate provision against guidelines for food and drink

provision, which are based on a minimum one-week menu cycle.. e Settings in which food is provided only by parents or carers and not by the setting provider were identified at

screening, but not included in the final sample. f This assumed 5 meal occasions per day for childminders and full day care, 4 per day for sessional day care, and 2 per day for schools; and 1 child sampled per meal occasion for childminders and 2 for other settings


drink provision in early years settings prior to the implementation in September 2012 of the

food and drink guidelines for early years settings, part of the revised EYFS framework.

Methods

Survey partners The survey was commissioned and funded by the Children’s Food Trust, in collaboration

with TNS-BMRB.

Ethical approval was granted by Kings’ College London Research Ethics Committee,

reference BDM/11/12-29.

Sampling and recruitment

Selecting the settings

Three local authorities (LAs) were approached to participate in the research. The LAs were

identified using a combination of data on obesity prevalence and deprivation,g and LAs

participating in the Trust’s Eat Better Start Better programme were excluded.h Approaches

were made to Coventry, Oldham and Suffolk. LAs were asked to provide details of all

Ofsted-registered early years settings in their area, from Family Information System records

where possible. From these data, TNS-BMRB selected an initial random sample of 63

settings in each LA, with the aim of achieving a participating sample of 21 settings in each

area.i Reserve samples were prepared for each LA.

Settings selected for sampling included childminders, children’s centres, sessional care, full

day care, nursery schools and nursery classes in primary schools.

Recruitment of settings

Settings were initially contacted by letter in February 2012. Information sheets were provided

for setting managers, childminders and head teachers, together with screening and consent

forms. Follow-up calls were then made to settings to confirm participation.

Setting response rate and sample characteristics

A total of 316 early years settings were sampled across the three LAs (189 in the initial

samples, and 127 in the reserve samples). Table 1 shows the recruitment process. 54

settings were found not to provide food and were therefore excluded, leaving an eligible

sample of 262 settings. Of these, it was not possible to contact 20, there was no reply from

33, 118 declined to participate, and 24 were deemed surplus to requirements as sufficient

numbers of some types of settings had been recruited. 67 settings (26% of the eligible

sample) agreed to participate, but 10 settings subsequently withdrew, resulting in a final

g Data from the National Child Measurement Programme (obesity prevalence in Reception year) and the School

Census (free school meal eligibility at primary level) were merged at LA level and ranked, where 1 was the highest prevalence/eligibility. The mean rank was computed and LAs were ordered by region and mean rank. h LAs recruited to the Trust’s Eat Better Start programme

http://www.childrensfoodtrust.org.uk/advice/eat-better-start-better were excluded, and three LAs with the

highest mean rank and with sufficient numbers of early years settings for sampling purposes were selected (from different regions). i Anticipated response rate was 50%. The sample allowed for around 25% of settings to be screened out because they did not provide food.

http://www.childrensfoodtrust.org.uk/advice/eat-better-start-better


sample of 57 settings (22% of the eligible sample, 85% of those initially agreeing to

participate).

Reasons for non-participation (where given) included practical issues such as new staff,

rebuilding or modernisation of facilities, expansion or closure, limited food provision (47

settings provided only snacks) and, particularly for childminders, only 1 or no children

currently being cared for. Settings were also concerned about the capacity of their staff to

collect data on provision and consumption at all meal occasions for 5 consecutive days.

Table 1. Recruitment process Sampling stage or issue Number of settings Balance of sample %

Initial sample 189 Reserve sample 127 Total sample 316 Food not provided 54 Eligible sample 262 100% Could not contact 20 7.6% No reply 33 12.6% Declined to participate 118 45.0% Surplus to sample requirements* 24 9.2% Agreed to participate 67 25.6% Withdrew after start of survey 10 Final sample 57 21.8% *Sampling was on a quota basis, and when sufficient number of a given type of setting had been recruited, subsequent settings were excluded from selection

Table 2 shows planned and actual numbers of participating settings.

The three selected LAs had few nursery schools (only three in the combined samples), none

of which was recruited. Primary schools with nursery classes were particularly difficult to

recruit, mainly because they considered their food provision (if any food was provided) as

part of their primary school provision and so did not feel that the survey was applicable to

them. Of the 11 children’s centres recruited, 6 offered full day care provision, and were

therefore reclassified as full day care provision for the purpose of analysis.j

Table 2. Planned and participating settings Planned Actual All LAs LA 1 LA 2 LA3 All LAs

Childminders 18 5 6 6 17 Full day care 9 6 4 3 13 Children’s centres 9 2 2 7 11 Sessional care 9 3 4 5 12 Nursery schools 9 0 0 0 0 Primary schools with nursery classes

9 2 1 1 4

All settings 63 18 17 22 57

Data collection and tools Fieldwork was conducted between April and July 2012 in each setting over one week, for the

number of days on which provision was available. Fieldworkers completed a one-day

training session on the background and aims of the survey, how to use the data collection

tools, how to sample children, and how to support settings to complete records of food

provision and consumption.

j Full day care provision at Children’s Centres is often provided by private or voluntary providers.


Fieldworkers visited each setting in the week prior to fieldwork to complete interviews with

the setting manager and the person responsible for food provision. These interviews

gathered information about when food was provided at the setting,k number of children

catered for, procurement, staff training in relation to food or nutrition, and policies and

practices around food. Information on catering practices was obtained to inform food coding

and recipe analysis. Fieldworkers also provided instruction for setting staff on how to

complete food provision and consumption records, including how to select children randomly

for sampling.

Fieldworkers then visited each setting three times during the fieldwork week. They checked

that the provision and consumption records had been completed correctly, collected menu

and recipe information, and carried out an assessment of the eating environment.l

Each day, setting staff were asked to record all items of food and drink provided at each

meal occasion, together with portion sizes (assessed using a photographic food atlas15) and

portion numbers. They were also asked to record the number of children aged 1-2 years and

aged 3-4 years for whom meals or snacks were being provided on each occasion.

At each meal occasion, setting staff were asked to select 1-2 children randomly, following

the agreed sampling protocol,m and to record all food and drink items taken, together with

portion sizes. Age and sex were also recorded. The random selection process included all

children eating on an occasion, and therefore children eating setting-provided food and drink

and those eating parent-provided food and drink were sampled where such instances

occurred. When children had finished eating, leftover portion sizes were recorded.

Statistical analysis All data management and statistical analyses were carried out using SPSS.16

Analysis of food provision and consumption The Children’s Food Trust version of the Food Standards Agency Nutrient Databank was

used to provide the energy and nutrient data on food composition.

A unique code was allocated to each food and drink item provided by the setting, and to

each item chosen by children. Where possible, an existing databank code was used,

otherwise a new code was created. Information from the provision and consumption sheets

and from the interview with the person responsible for food provision, together with product

specifications and recipe information, was used to allocate the most appropriate code.

Sandwiches, and other bread-based items such as toast with spread, were split into their

component parts prior to coding.n

Food and drink items were classified into one of 38 different food groups. These 38 ‘narrow’

food groups were further aggregated into 17 ‘broad’ food groups (Appendix 1).

k Settings specified the meal occasions where food was provided, classifying their provision into breakfast,

morning snack, lunch, afternoon snack and tea categories. Criteria were not supplied to inform this classification, and so ‘tea’ in one setting may differ from ‘tea’ in another. l This was designed to assess whether dining environment practices were encouraging children to eat well (Practical Guide p.46). m Childminders were asked to select 1 child at each meal occasion; 2 children were selected at each meal

occasion in all other settings. n The portion weight atlas does not contain photos of sandwiches.


It was possible to complete missing portion weights using information from the same meal

occasion on other days within the setting, or a different meal occasion within the setting for

items such as drinks.

Missing portion numbers at lunch and tea were completed by estimating from the portion

numbers recorded for that meal occasion. This was determined by whether the item

appeared to be available for every child, or was available only for some of the children, with

the remaining children receiving a different food item, or whether it appeared to be an item

provided for just one child. Reference was made to the number of children served by the

setting.

Children’s nutrient intakes were calculated, and compared with the nutrient-based standards

included in the nutrient framework underpinning the food and drink guidelines for early years

settings.o Although the guidelines do not include nutrient-based standards for saturated fatty

acids (SFA), fibre and folate, values for these nutrients have been reported for consistency

with previous reports on primary schools,17 18 and because the guidelines emphasise limiting

SFA and ensuring that levels of fibre are not too high.

Data checking All records of food and drink provision and consumption were checked and coded by

Children’s Food Trust nutritionists.

Consistency and accuracy of food coding was checked for all items by comparing food

codes from provision and consumption records with food names from the nutrient databank.

Results

Setting type Of the 57 participating settings, 17 were childminders, 19 were full day care providers,p 12

were sessional care providers, 5 were Children’s Centres and 4 were primary schools with

nursery classes. When broadly grouped, 36 settings offered full day care (childminders and

full day care providers), with the remainder (21) offering sessional care.

Participating children Information on food and drink consumption was collected for a total of 1457 children.q Age

and sex for the sample are shown in Table 3.

Table 3. Distribution by age and sex of 1457 participating children Age Girls Boys Sex not specified

n % n % n % 1 131 20 139 18 3 10 2 179 27 227 30 8 26 3 169 26 217 28 11 36 4 181 27 179 23 8 26

Age not specified 0 0 4 1 1 3

o As described on pages 66-68 of the practical guide http://www.childrensfoodtrust.org.uk/assets/eat-better-start-

better/CFT%20Early%20Years%20Guide_Interactive_Sept%2012.pdf p This includes the 6 children’s centres which were reclassified as full day care providers.

q This is less than the estimated maximum of 2070 children due to the difference in profile between planned and

participating settings (), and some settings providing food on fewer meal occasions than expected.

http://www.childrensfoodtrust.org.uk/assets/eat-better-start-better/CFT%20Early%20Years%20Guide_Interactive_Sept%2012.pdf

http://www.childrensfoodtrust.org.uk/assets/eat-better-start-better/CFT%20Early%20Years%20Guide_Interactive_Sept%2012.pdf


Meal occasions

Table 4 shows the provision and consumption data collected at each meal occasionk across

the 57 participating settings.

Snack provision was the most common type of provision amongst the participating settings,

with nearly all settings (96%) providing a morning snack, and nearly three-quarters (74%)

providing an afternoon snack. Six out of ten settings (61%) provided lunch, and just over

one-third (37%) provided tea.r Two of the participating settings did not provide food.s There

was very little parent-provided food at times other than lunch in the participating settings. As

settings were recruited on the basis that they provided food, this pattern of food provision

may not be representative of early years settings generally.

Table 4. Summary of food provision and consumption data collected in 57 early years settings Meal occasion Provision Consumption

Number of settings providing

food at meal occasion specified

Number of data collection

occasions*

Number of children having setting-provided

food only

Number of children having parent-provided

food only

Number of children having

mixed food provision

Breakfast 27 120 185 2 4 Morning snack 55 244 392 10 5 Lunch 35 156 260 118 3 Afternoon snack 42 176 294 2 1 Tea 21 98 181 0 0 Total 55** 794 1312 132 13 * Not all settings provided food every day

** Not additive – settings provided food on more than one occasion across the day; 2 settings did not provide food

Provision and consumption Results are presented by meal occasion. Morning and afternoon snacks are combined. Food provision refers to setting-provided food. Consumption of setting-provided food and parent-provided food is compared for lunch only. Results are presented for children aged 1-4 years. Details of the types of food and drink items included in each food group are shown in Appendix 1. It is important to note that for young children, the recommended percentage energy from fat (around 35%) is on average meant to be higher than that for adults (less than 35%), recognizing their need to have energy dense meals, as their gastric capacity is smaller than an adult’s in relation to their energy needs. The corollary is that the percentage energy from carbohydrate needs to be around 50%, whereas the recommendation for adults is that it be above 50%.

Breakfast

Food provision

Figure 1 shows the pattern of food and drink provision at breakfast. Each bar in the figure shows how many different types of food or drink were provided in a given food group as a percentage of all items provided by the setting.t For example, 30% of all types of food and drink provided were breakfast cereals, and 7% were fruit. Just over half of breakfast cereals

r On at least one day per week. Not all settings providing food at a meal occasion provided it every day – this applied mainly to childminders and children’s centres. s This only came to light following the commencement of fieldwork, and so data from these settings were

included. t Based on a count of the types of food and drink offered.


and nearly a quarter of bread and bread-based items were wholegrain. Desserts at breakfast were yogurts, and cakes and biscuits were croissants or fruit scones.

Figure 1. Percentage of types of food and drink items provided by settings at breakfast, by food group. Base: 27 settings, 120 breakfast occasions

Food consumption Figure 2 shows the percentage of children choosing specific foods at breakfast. Of 185

children having breakfast provided by the setting, the majority (73%) had cereal, with 39%

having bread or bread-based items. 10% of children had fruit, and 8% had fruit juice

(including diluted). Two children had eggs. Children having other drinks had mainly squash.

Four children (all at the same setting) had crisps as part of breakfast.

Figure 2. Percentage of children having specific items of setting-provided food and drink at breakfast. Base (children): 185

On average, children were consuming about 12% of their daily energy requirement at breakfast,u compared with the 20% stated in the nutrient framework (Table 5). Despite this, the average breakfast consumed provided sufficient amounts of protein, vitamin C and

u Based on an average requirement of 1290 kcal/day for children aged 1-4 years.

0 5 10 15 20 25 30 35

Breakfast cereals

Bread and bread based items

Fat spread

Fruit

Water

Milk

Other drinks

Main dishes

Cakes and biscuits

Desserts

Crisps

Sweet and savoury condiments

0 20 40 60 80 100

Breakfast cerealsBread and bread based items

Fat spreadFruit

Vegetables and saladBaked beans

WaterMilk

Other drinksStarchy foodMain dishes

Cakes and biscuitsDesserts

ConfectionerySavoury biscuits and snacks

CrispsSweet and savoury condiments


calcium to meet recommendations. Percentage energy from fat was lower than recommended, at 28%, with carbohydrate higher than recommended (57% compared with about 50%). Table 5. Mean energy and nutrient intake from setting-provided breakfast, 1-4 years, taken and eaten

Nutrient As taken As eaten

Nutrient framework recommendation

mean sd** mean sd

Energy (kcal) 169.9 83.6 157.3 84.1 258 Protein (g) 6.1 3.4 5.6 3.3 3.1 Carbohydrate (g) 25.6 14.8 23.8 14.6 34.4 NMES (g)

* 3.8 5.6 3.6 5.4 7.6

Fat (g) 5.5 3.5 5.1 3.5 10 SFA (g) 2.6 1.9 2.4 1.8 - Fibre (g) 1.1 0.9 1.1 0.9 - Sodium (mg)

* 197.3 164.9 185.4 162.8 180

Vitamin A (µg) 50.8 35.4 46.7 34.5 90 Vitamin C (mg) 8.4 17.7 7.7 16.8 6 Folate (µg) 37.9 30.2 35.0 29.8 - Calcium (mg) 157.5 104.3 142.3 97.3 70 Iron (mg) 1.4 1.0 1.3 0.9 1.7 Zinc (mg) 0.7 0.4 0.7 0.4 1.4 Percentage energy from: Protein 14.6 4.1 14.3 4.2 - Carbohydrate 57.3 14.3 57.4 15.0 ≈50% NMES

* 8.5 10.5 8.5 11.0 ≤11%

Fat 28.3 12.3 27.8 12.6 ≈35% SFA 13.7 7.8 13.4 7.9 -

Base (children): 185 *To meet the nutrient framework recommendation, mean nutrient content should be below the value shown

**sd: standard deviation

- No standard

Lunch

Food provision

At lunch, main dishes, vegetables and salad and desserts were the items most commonly provided by settings (Figure 3). Water was the most commonly provided drink. Vegetables made up two-thirds of the vegetables and salad provided, and 59% of the starchy food was not cooked in oil. The most common types of main dishes were meat or meat-based, followed by fish or fish-based dishes (see Appendix 1 for details of the types of foods provided). Yoghurt or fromage frais (mostly full fat rather than low fat) was the most common type of dessert, and gravy was the most common condiment. Fruit represented 9% of provision at lunchtime. Settings provided main and dessert options on virtually all lunch occasions.


Figure 3. Percentage of types of food and drink items provided by settings at lunch, by food group. Base: 35 settings, 156 lunch occasions

Food consumption

Figure 4 shows the percentage of children choosing specific foods at lunch. Of 260 children

having lunch provided by the setting, 95% had main dishes, 59% had discrete portions of

starchy food and 54% had discrete portions of vegetables or salad (for some children,

starchy food and vegetables were a component of the main dish, for example chicken and

vegetable pasta bake). Two-thirds of children (67%) had desserts (including fruit-based

desserts), and one-third (36%) had discrete portions of fruit. Water was the most common

drink, had by 56% of children. Two children (at different settings) had crisps, and one child

had an item of chocolate confectionery. Fruit and vegetable consumption including the

contribution from composite dishes is discussed on page 22.

Figure 4. Percentage of children having specific items of setting-provided food and drink at lunch. Base (children): 260

On average, children were consuming about 21% of their daily energy requirement at lunch, compared with the 30% on which the guidelines are based (Table 6). Despite this, the average lunch consumed provided sufficient amounts of protein, vitamin A, vitamin C and

0 5 10 15 20

Bread and bread based itemsFat spread

FruitVegetables and salad

Baked beansWater

MilkOther drinksStarchy foodMain dishes




0 20 40 60 80 100


Fat spreadFruit


WaterMilk






calcium to meet recommendations. Percent energy from carbohydrate and NMES were in line with recommendations, while percent energy from fat was 31%, lower than the recommended level of about 35%. Iron and zinc intakes were lower than recommended, partly due to energy being low. Sodium intakes exceeded the recommended maximum level. Table 6. Mean energy and nutrient intake from setting-provided lunch, 1-4 years, taken and eaten



mean sd** mean sd


* 7.9 8.2 7.1 8.1 11.4

Fat (g) 11.5 8.6 9.9 8.5 15.0 SFA (g) 5.0 4.4 4.3 4.3 - Fibre (g) 2.9 1.7 2.4 1.5 - Sodium (mg)

* 326.4 245.5 279.2 237.6 270


* 9.5 8.5 10.1 11.3 ≤11%

Fat 31.4 12.0 31.0 12.9 ≈35% SFA 13.4 6.7 13.3 7.2 -



- No standard

Comparing consumption of setting-provided and parent-provided food at lunchtime

Sufficient data were collected at lunch to be able to compare consumption of food provided

by early years settings with food provided from home. A total of 378 children had lunch, of

whom 260 had food provided by the setting, and 118 had food provided from home.

There were several important differences in food consumption between food provided by settings and food brought from home at lunchtime (Figure 5). Unsurprisingly, children who brought food from home were more likely to have bread or bread-based items (mainly bread as part of sandwiches), cakes and biscuits and fruit, whilst children having setting-provided food had more main dishesv and vegetables. Water was the most common drink for children having a setting-provided lunch, whilst other drinks (mainly squash) were more common amongst children having food from home. Fewer than 1% of children having a setting-provided lunch had crisps or confectionery, whereas these items were common among food brought from home (42% of children had crisps and 24% had confectionery). Children having food from home had more food and drink items than children having setting-provided food (6.2 items vs. 5.5 items).

v Main dishes from home consisted mainly of ham and cheese (often as sandwich fillings).


Figure 5. Percentage of children having specific items of food and drink at lunch, by source (setting-provided or home-provided). Base (children): setting-provided food 260; home-provided food 118

The average lunch brought from home provided 26% of daily energy intake, compared with the 21% from setting-provided lunch and the 30%recommended in the guidelines (Table 7). Nutrient intakes from food brought from home met recommended levels for protein, carbohydrate, vitamin C and calcium, but not for NMES or sodium (too high), or iron and zinc (too low). Percentage energy from NMES was 15%, well above the recommended maximum of 11%, whilst percentage energy from fat was lower than recommended (31% compared with 35%). Compared with the average setting-provided lunch, the average lunch brought from home had more energy, both as taken and as eaten, although children consumed less of their home-provided lunch (76% of energy as taken) compared with a setting-provided lunch (91%). Home-provided lunches as taken and as eaten had levels of NMES around 15%, higher than the recommended maximum (11% of food energy), whereas NMES in setting-provided lunches met the recommendation (around 10%). Despite a lower energy content, the average setting-provided lunch as consumed had more protein, fibre, vitamin A and folate, the same amount of zinc, and nearly as much iron as the average home-provided lunch. Sodium as eaten in packed lunches (431mg) was over 50% greater than that in setting-provided meals (279mg). These differences in nutrient intakes reflect in part the greater variety of food within setting-provided lunches, resulting in a more favourable nutrient intake profile.

0 20 40 60 80 100

Sweet and savoury condimentsCrisps

Savoury biscuits and snacksConfectionery

DessertsCakes and biscuits

Main dishesStarchy foodOther drinks

MilkWater

Baked beansVegetables and salad

FruitFat spread

Bread and bread based itemsBreakfast cereals

Setting

Home


Table 7. Mean energy and nutrient intake from home-provided lunch, 1-4 years, taken and eaten



mean sd** mean sd


* 16.7 11.3 13.6 10.9 11.4


* 567.6 288.1 430.8 245.0 270


* 14.6 8.8 15.3 10.3 ≤11%

Fat 30.5 10.3 31.5 11.5 ≈35% SFA 12.7 5.8 13.2 6.5 -



- No standard

Tea

Food provision

Main dishes (18% of items) and vegetables and salad (15%) were the most common items provided at tea, followed by fruit (11%) and bread and bread-based items (10%, mainly as components of sandwiches) (Figure 6). Cakes and biscuits represented a greater proportion of provision than desserts. The majority of the vegetables and salad provided at tea was salad and raw vegetables (92%) rather than cooked vegetables and side vegetable dishes (8%). Cheese was the second most common type of main dish provided (often as part of sandwiches) after meat dishes, portions and products (over half of which were ham, turkey slices or chicken, again often as part of a sandwich). Water was the most common drink. The data show that provision at tea was more likely to be a cold sandwich, salad and fruit type meal than lunch, which was predominantly cooked main dishes, vegetables and desserts.

Figure 6. Percentage of types of food and drink items provided by settings at tea, by food group. Base: 21 settings, 98 tea occasions

0 5 10 15 20

Bread and bread based itemsFat spread

FruitVegetables and salad

Baked beansWater






Food consumption

At tea, 81% of children had main dishes (often ham or cheese), and 57% had bread or based-based items (mostly sandwiches) (Figure 7). 43% had fruit and 41% had vegetables or salad. 39% had cakes or biscuits. Two children had chocolate confectionery, and six had crisps. Water was the most common drink, had by 46% of children.

Figure 7. Percentage of children having specific items of setting-provided food and drink at tea. Base (children): 181

On average, children were consuming about 20% of their daily energy requirement at tea, in line with the 20% recommended in the guidelines (Table 8). The average tea consumed provided sufficient amounts of protein, carbohydrate, vitamin A, vitamin C and calcium to meet recommendations, and NMES were within the recommended level. Sodium intakes were nearly twice the recommended maximum level, whilst iron and zinc intakes were not sufficient to meet recommendations. In terms of macronutrient balance, percentage energy from fat was a little lower than recommended (30% compared with 35%), and percentage energy from carbohydrate a little higher (55% compared with 50%).

Table 8. Mean energy and nutrient intake from setting-provided tea, 1-4 years, taken and eaten.



mean sd** mean sd


* 6.7 7.2 6.1 6.2 7.6

Fat (g) 10.5 8.7 9.0 7.8 10 SFA (g) 4.4 4.0 3.8 3.6 - Fibre (g) 2.4 1.7 2.1 1.5 - Sodium (mg)

* 401.1 322.9 353.8 298.8 180


* 9.1 8.2 9.9 10.8 ≤11%

Fat 30.8 13.0 30.3 14.1 ≈35% SFA 12.7 7.2 12.7 7.8 -



- No standard

0 20 40 60 80 100


Fat spreadFruit


WaterMilk






Snacks

Food provision

Snack provision consisted mainly of fruit, with some savoury biscuits and snacks and bread and bread-based items (Figure 8). Milk was the most common drink. Cheese was the most common protein source provided as a snack; few meat, vegetable, or meat alternative items were provided.

Figure 8. Percentage of types of food and drink items provided by settings at snacks, by food group. Base: 55 settings, 420 snack occasions

Food consumption

Nearly three-quarters of children (74%) had fruit at snack time (Figure 9). Just over a quarter (28%) had savoury biscuits or snacks, and about one-fifth (19%) had bread or bread-based items. One in ten children had cakes or biscuits. Two children had crisps. Milk was the most common drink, consumed by 55% of children, followed by water (28%).

Figure 9. Percentage of children having specific items of setting-provided food and drink at snack time. Base (children): 686

0 5 10 15 20 25 30 35 40


Fat spreadFruit

Vegetables and saladWater





0 10 20 30 40 50 60 70 80


Fat spreadFruit


WaterMilk






There were some small differences between the types of food consumed at morning and

afternoon snack times. 26% of children had bread or bread-based items at morning snack,

compared with 11% at afternoon snack. At afternoon snack, more children had savoury

biscuits and snacks (30% compared with 27%), and cakes and biscuits (12% vs. 8%) than at

morning snack.

The energy content of the average snack consumed by children was close to the

recommended level (10% of daily energy intake) (Table 9). Mean intakes of protein,

carbohydrate, NMES, vitamin A, vitamin C, calcium and zinc met the standards. Snacks

contained sodium above the recommended levels, and too little iron. In relation to

macronutrients, percentage energy from fat was again lower than recommended (26%

compared with 35%), whilst carbohydrate was higher (61% compared with 50%).

Table 9. Mean energy and nutrient intake from setting-provided snacks, 1-4 years, taken and eaten.



mean sd** mean sd


* 1.9 3.9 1.8 3.8 3.8


* 116.2 125.2 106.1 118.1 90


* 5.8 12.0 6.0 13.0 ≤11%

Fat 26.6 18.1 26.2 18.3 ≈35% SFA 13.7 10.1 13.5 10.3 -



- No standard

Food and drink consumed by children

Consumption by food group

Table 10 shows the percentages of children who had setting-provided food and drink from

specific food groups, the average amounts of food and drink taken and eaten by those who

had the items,w and plate wastage (g, and the percentage of food weight ‘as taken’ not

eaten). In total, nearly half (49%) of the children sampled had discrete portions of fruit, with

about 10% having discrete portions of vegetables, and slightly more (12%) having raw

vegetables or salad.x Mean weights of fruit as taken were larger,y and vegetables and salad

as taken smaller than the recommended portion sizes specified in the guidelines (40g). With

the exception of fruit juice, mean weights as taken for drinks were generally close to that

w Weight as taken may include second helpings.

x These figures may not include children who consumed fruit or vegetables as part of composite dishes.

y In some instances, weight for fruit as taken included inedible elements such as core or skin, meaning that

average weight as taken and plate wastage are overestimated.


recommended (100ml). Generally, mean weights of food taken were lower than portion size

recommendations in the guidelines.

Of the food and drink taken, children left about 11% as plate waste. Wastage varied by item,

and was greatest for raw vegetables and salad, cooked vegetables, vegetable dishes and

fish dishes.z

Table 10. Percentage of children taking specific food and drink items, weight as taken, weight as eaten, and wastage, by food group

Food Group

Children taking Weight as taken Weight as eaten Plate wastage*

n % g g g g

g % mean sd

** mean sd

Wholegrain breakfast cereals 90 6.9 26.8 30.7 24.9 29.9 1.9 7.7 Non-wholegrain breakfast cereal 53 4.0 8.7 3.9 8.2 4.0 0.6 9.0 Wholegrain bread-based items 90 6.9 30.1 17.4 26.8 17.0 3.4 10.4 Non-wholegrain bread-based items 255 19.4 36.0 22.5 32.8 23.6 3.2 10.8 Fat spread 258 19.7 5.7 4.6 5.2 4.7 0.4 9.8 Fruit

† 646 49.2 72.4 58.7 66.5 56.9 5.9 9.0

Dried fruit 79 6.0 12.3 9.3 11.7 9.3 0.6 8.3 Cooked vegetables & side vegetable dishes 132 10.1 32.1 23.4 25.6 25.0 6.5 24.0 Raw vegetables & salad 152 11.6 30.6 23.2 22.6 21.4 8.0 26.1 Baked beans 46 3.5 50.0 23.9 45.1 26.9 4.9 12.4 Fruit juice , including diluted 55 4.2 233.0 125.1 222.8 119.2 10.2 4.2 Water 466 35.5 127.8 55.4 107.4 57.8 20.4 14.3 Whole milk 358 27.3 114.4 59.8 104.6 62.5 9.8 8.7 Semi-skimmed & skimmed milk 223 17.0 135.1 61.4 124.9 63.5 10.2 7.2 Milk alternatives eg soya 1 0.1 217.0 - 217.0 - 0.0 0.0 Other drinks 196 14.9 153.1 63.9 127.7 66.9 25.1 14.0 Starchy food, NOT cooked in oil 111 8.5 84.5 50.8 73.5 52.6 11.0 15.0 Starchy food, cooked in oil 76 5.8 47.3 43.9 42.0 45.1 5.3 15.3 Meat dishes, portions and products 178 13.6 65.2 53.3 56.8 52.3 7.8 13.2 Vegetable dishes and products 53 4.0 72.1 44.8 58.3 39.6 13.8 16.9 Meat alternative dishes, portions and products 34 2.6 74.7 62.7 61.2 58.3 13.5 15.9 Fish dishes, portions, and products 66 5.0 47.3 38.2 38.4 35.4 8.9 16.0 Eggs and egg dishes 18 1.4 63.9 25.7 49.6 27.1 14.3 19.6 Cheese 144 11.0 16.9 11.8 14.7 12.5 2.2 14.2 Pizza 25 1.9 116.4 93.2 97.6 73.4 18.8 9.4 Soup 16 1.2 102.5 60.9 94.9 63.9 7.6 8.7 Cakes and biscuits 192 14.6 26.1 14.4 24.3 14.9 1.8 6.2 Desserts 57 4.3 56.4 35.9 46.1 41.1 10.3 22.4 Milk-based dessert 66 5.0 61.9 31.1 53.1 37.7 8.8 17.9 Yoghurt & fromage frais 99 7.5 76.0 47.4 67.5 43.4 8.5 10.5 Ice cream / frozen yoghurt 30 2.3 47.6 28.5 43.9 27.1 2.5 3.6 Pudding accompaniment 18 1.4 40.2 51.2 31.6 50.5 8.6 32.6 Confectionery 3 0.2 24.7 6.6 17.7 16.4 7.0 33.3 Savoury snacks & biscuits 211 16.1 10.8 10.5 9.9 9.6 0.9 6.2 Crisps 14 1.1 22.3 11.5 21.0 12.4 1.3 7.4 Gravy 18 1.4 27.7 15.1 19.5 14.0 8.1 25.4 Savoury condiments 27 2.1 11.7 6.8 8.1 8.1 3.6 37.0 Sweet condiments 98 7.5 8.6 5.1 8.2 5.2 0.4 6.8

Base (children): 1,312 * The differences between the weight as taken and the weight as eaten were computed item by item within each food group, so the values are not equal to the differences between the averages as given in the table. ** sd: standard deviation

† Weight as taken and plate wastage for whole fruit (e.g. banana, apple) may include, for example, skin and core, meaning that

weight as taken and plate wastage for fruit will be slightly overestimated.

z Food groups with fewer than 50 instances of consumption have not been mentioned here as the number of

observations is considered to be too small to provide a reliable estimate of wastage.


Fruit and vegetable consumption Table 11 shows the average number of portionsaa of fruit and vegetables taken and

consumed at each meal occasion. Nearly all children (95%) having lunch provided by the

setting had fruit and/or vegetables with, or as part of their meal, taking an average of 1.8

portions. Fewer children having lunch from home had fruit and vegetables (76%), and on

average they ate fewer portions (1.2 compared with 1.4 for children having a setting-

provided lunch). More than 80% of children had fruit and/or vegetables as part of tea and

snacks. On average, children were eating more than one portion of fruit and vegetables at

lunch, tea, and on both snack occasions. This suggests that children attending a setting all

day are likely to eat at least the recommended 5 portions of fruit and vegetables per day.

Table 11. Number of portions of vegetables and fruit taken and eaten, by food group, by meal occasion, early years settings, 2011 Number of portions taken Number of portions eaten

%

taking Consumers

only All

children*

% eating

Consumers only

All children*

Breakfast (n=185) All fruit

** 15.7 2.3 0.4 15.7 2.1 0.3

All vegetables/salad***

- - - - - - All fruit, vegetables and salad 15.7 2.3 0.4 15.7 2.1 0.3

Lunch (setting provided) (n=260) All fruit 51.2 1.3 0.7 45.8 1.2 0.6 All vegetables/salad 91.5 1.2 1.1 86.5 1.0 0.9 All fruit, vegetables and salad 94.6 1.9 1.8 91.2 1.6 1.4

Lunch (home provided) (n=118) All fruit 69.5 2.4 1.7 58.5 1.9 1.1 All vegetables/salad 21.2 0.8 0.2 14.4 0.6 0.1 All fruit, vegetables and salad 76.3 2.5 1.9 65.3 1.8 1.2

Tea (n=181) All fruit 52.8 1.3 0.7 52.2 1.3 0.7 All vegetables/salad 72.2 0.9 0.6 66.1 0.8 0.5 All fruit, Vegetables and salad 87.2 1.5 1.3 84.4 1.4 1.2

Snacks (n=686) All fruit 76.6 1.8 1.4 74.1 1.7 1.3 All vegetables/salad 9.6 0.5 0.0 8.6 0.4 0.0 All fruit, vegetables and salad 80.2 1.7 1.4 77.4 1.7 1.3

All setting-provided food (n=1312) All fruit 59.7 1.7 1.0 57.2 1.6 0.9 All vegetables/salad 33.1 1.0 0.3 30.7 0.8 0.3 All fruit, vegetables and salad 74.9 1.8 1.3 72.4 1.6 1.2

Base (children): 1,430 * All children sampled at the meal occasion

**Includes fresh, tinned, dried fruit and fruit juice

***Includes beans and pulses

Meeting the voluntary food and drink guidelines for early years settings The food and drink guidelines for early years settings are underpinned by a nutrient

framework. Providing the types and amounts of food and drink outlined by the guidelines will

ensure that children receive appropriate amounts of energy and nutrients.9 This section

assesses the food and drink provided by settings against the food and drink guidelines and

the nutrient framework.

Nutrient content of provision

The mean energy and nutrient content of an average setting-provided meal was calculated

for lunch and tea, and compared with the nutrient framework underpinning the food and drink

aa

One portion of fresh/tinned fruit = 40g; one portion of dried fruit = 20g. One portion of vegetables/salad = 40g. One portion of fruit juice = 50ml (as specified in the food and drink guidelines for early years settings p.19). One portion of beans and pulses = 40g. Fruit juice and beans and pulses count as a maximum of one portion per day regardless of the amount over 50ml or 40g. The fruit and vegetable content was calculated for each composite dish.


guidelines for early years settings (Table 12). The average lunch was lower in energy,

carbohydrate, iron and zinc than recommended in the nutrient-based standards included in

the nutrient framework. Despite energy content being lower than recommended, levels of

protein, vitamin A, vitamin C and calcium were sufficient to meet the standards. The sodium

content of an average lunch was higher than the maximum set by the standards. The

average tea provided met most of the standards apart from iron and zinc, and sodium, for

which levels were nearly double the recommended maximum. As expected, these findings

are consistent with those reported for food consumption in previous sections (Table 6, Table

8).bb

Table 12. Mean energy and nutrient content of an average setting-provided meal for children aged 1-4 years, compared with nutrient framework recommendations

Nutrient Lunch


Tea Nutrient framework

recommendation mean sd

** mean sd

Energy (kcal) 305.5 133.9 387 279.4 165.1 258 Protein (g) 12.5 5.8 4.7 10.1 6.6 3.1 Carbohydrate (g) 40.8 19.7 51.6 38.3 21.6 34.4 NMES (g)

* 7.9 6.4 11.4 6.9 6.0 7.6

Fat (g) 11.4 7.2 15.0 10.6 8.5 10 SFA (g) 5.0 7.6 - 4.5 3.8 - Fibre (g) 2.9 1.8 - 2.3 1.5 - Sodium (mg)

* 324.0 201.2 270 351.5 256.7 180

Vitamin A (µg) 230.6 201.3 130 179.0 225.0 90 Vitamin C (mg) 17.9 17.6 9 14.0 14.3 6 Folate (µg) 42.1 28.0 - 37.8 25.5 - Calcium (mg) 155.4 112.8 110 150.8 115.4 70 Iron (mg) 1.5 0.7 2.4 1.3 0.8 1.7 Zinc (mg) 1.4 0.8 1.9 1.1 0.8 1.4 Percentage energy from:

Protein 17.1 6.5 - 14.9 6.0 - Carbohydrate 50.5 11.9 ≈50% 53.6 12.6 ≈50% NMES

* 9.8 7.2 ≤11% 9.8 8.0 ≤11%

Fat 32.5 10.9 ≈35% 31.6 11.9 ≈35% SFA 14.0 6.1 - 13.3 6.7 -

Base: 156 lunch occasions; 98 tea occasions *To meet the nutrient framework recommendation, mean nutrient content should be below the value shown


- No standard

Food and nutrient provision in full daycare settings.

Eleven settings (9 nurseries, 2 childminders) provided food on 5 meal occasions per day on

at least some days of the week. Data were collected for a total of 51 days across these 11

settings.

The balance of food provided across the day for these settings is shown in Figure 10. Fruit represented nearly one-fifth of total provision, and fruit and vegetables together represented one-quarter of all types of foods provided (not including fruit and vegetables in composite dishes). Milk and water each represented about 10% of provision, compared to 1% for fruit juice.

bb

The nutrient content of meals ‘as taken’ (as reported in Table 6 and Table 8 does not include wastage, and therefore is a proxy for, but is not the same as food provision.


Figure 10. Percentage of types of food and drink items provided by settings at snacks, by food group. Base: 11 settings, 51 days of full provision

The mean energy and nutrient content of full day provision is shown in Table 13, compared

with the nutrient-based standards. On average, full day provision (comprising 5 meal

occasions) provided less than the level of energy recommended in the guidelines, providing

979kcal or 76% of EAR compared with the recommended 1160 kcal or 90% of EAR. Levels

of iron and zinc were substantially lower than the standards, whilst sodium was substantially

higher. The average full day provision easily met standards for protein, vitamin A, vitamin C,

calcium and NMES, with more than 80% of days meeting the standards for all except vitamin

A (59%). Only five days of provision met the standard for zinc, and only one for iron. A

quarter of days met the standard for sodium.

Meeting selected food and drink guidelines

There are 76 individual guidelines in the voluntary food and drink guidelines for early years

settings. Most apply to all early years settings providing food, whilst others apply just to full

day food provision (four or five meal occasions per day). The guidelines are explained in

detail and set out in a Menu Planning Checklist in the practical guide (p.61-65).9

Of the 57 settings sampled, two did not provide any food, and three provided meals on fewer

than three days per week; these settings were therefore excluded from the following

analysis. Where a setting provided the same meal type on three or four days per week, a

judgement about meeting the guidelines that apply across a full week was made - where a

setting clearly met the weekly guideline on the days the meal was provided it was classed as

‘guideline met’; where a setting would not be able to meet the guideline it was classed as

‘guideline not met’; where it was not possible to determine if a guideline would be met it was

classed as ‘guideline maybe met’. The number of settings providing food at a meal occasion

on at least three days per week is shown in Table 14.

0 5 10 15 20 25

Sweet and savoury condiments

Crisps

Savoury biscuits and snacks

Confectionery

Desserts

Cakes and biscuits

Main dishes

Starchy food

Other drinks

Milk

Water

Baked beans

Vegetables and salad

Fruit

Fat spread

Bread and bread based items

Breakfast cereals


Table 13. Energy and nutrient content of average full day food provision for children aged 1-4 years, compared with nutrient-based standards, based on actual provision of food and drink across 5 meal occasions Nutrient

Days meeting the nutrient-based standard

Standard Nutrient content of full day provision

Met Within ±10% of standard

Not within ±10% of standard

mean se* n % n % n %

Energy (kcal) 1160 978.5 33.3 † † 11 22 40 78

Protein (g) 14.0 35.9 1.6 51 100 0 0 0 0 Carbohydrate (g) 155.0 138.7 4.7

† † 12 24 39 76 NMES (g) 34.2 23.9 1.5 42 82 1 2 8 16 Fat (g) 45.0 35.0 1.7

† † 4 8 47 92 SFA (g) - 15.9 0.9 Fibre (g) - 8.1 0.4 Sodium (mg) 810 1055.5 47.7 13 25 5 10 33 65 Vitamin A (µg) 390 566.9 48.3 30 59 3 6 18 35 Vitamin C (mg) 27 61.9 5.5 44 86 4 8 3 6 Folate (µg) - 163.6 9.2 Calcium (mg) 330 669.2 38.8 45 88 2 4 4 8 Iron (mg) 7.2 4.8 0.2 1 2 4 8 46 90 Zinc (mg) 5.7 4.2 0.2 5 10 8 16 38 74 Percentage energy from: Protein - 14.7 0.4 - - - - - - Carbohydrate ≈50% 53.7 1.0

† † - - - - NMES ≤11% 9.5 0.7 39 76 - - - - Fat ≈35% 31.7 0.9

† † - - - - SFA - 14.4 0.6 - - - - - - Base (days): 51 * se: standard error - no standard † standard is an approximate value (rather than a minimum or maximum) therefore ‘met’ could not be derived

Table 14. Number of settings providing food at a meal occasion at least three days per week. Breakfast Snacks Lunch Tea

Childminders 8 16 9 3 Full day care providers 14 19 18 16 Sessional care providers 1 11 3 1 Children’s Centres - 2 1 - Primary schools 1 4 2 - Total 24 52 33 20

The food and drink guidelines describe how often, how much, and which types of food from

each of the four food groups (starchy foods; fruit and vegetables; meat, fish, eggs, beans

and non-dairy sources of protein; and milk and dairy foods) should be provided for children

aged one to five years. The guidelines are split into 12 sections – four meal occasions

(breakfast, snacks, lunch and tea), the four food groups, and four other categories (portion

weights; drinks; reducing saturated fat, sugar and salt; other foods to avoid). If the food and

drink guidelines are used to plan meals and snacks for children it will help to make sure that

all children eat a healthy, balanced diet, whether they attend full-day care in one setting, or

attend several settings throughout the week.9


Guidelines relating to meal occasions

This section describes how many settings met selected guidelinescc applying to the four meal

occasions.

Breakfast

Table 15 shows that of the 24 settings that provided breakfast on at least three days per

week, 92% provided starchy food every day (guideline 1.1), and of these, 59% provided

three different varieties of starchy food across the week (guideline 1.2). About a quarter

(23%) of settings providing starchy food each day provided a variety of wholegrain and non-

wholegrain starchy food across the week; three-quarters of the remainder provided

wholegrain food too frequently (wholegrain varieties should be served once or twice per

week, guideline 1.3).dd More than half of settings provided only low or medium sugar

breakfast cereals (less than 15g/100g, guideline 1.4). Most settings (88%) did not provide a

portion of fruit and/or vegetables at breakfast time (guideline 1.5).

Snacks

Fifty-two settings provided one or two snacks per day. Where a setting provides two snacks

a day, a starchy food should be provided at one of these snack occasions (guideline 2.1). Of

the settings providing snacks twice each day (34 settings), half met this guideline (Table 16).

More than three-quarters of settings provided a portion of fruit or vegetables as part of some

snacks across the week (guideline 2.3). It is recommended that dried fruit is not provided at

snack time (as it contains sugar that can stick to and damage children’s teeth), however one-

third of settings provided dried fruit at one or more snack occasions per week (guideline 2.4).

Most settings (73%) did not provide sweet foods at snack time (guideline 2.7), but 39% of

settings provided squash (which should be avoided at all meal occasions) or fruit juice

(which should be avoided at snack times) (guideline 2.6). A greater proportion of

childminders than of full day care nurseries provided squash or fruit juice at snack time (data

not shown).

Lunch

Table 17 shows that of the 33 settings that provided lunch, 82% provided a portion of starchy

food every day (guideline 3.2),ee 82% provided a portion of fruit and/or vegetables (guideline

3.6),ff and 58% provided a portion of protein foodggevery day (guideline 3.7). Where settings

met (or nearly met) these guidelines, they all provided a variety of fruit and vegetables

across the week, 95% provided a variety of protein food across the week (limiting cheese to

once per week), and 83% provided a variety of starchy food across the week (guidelines 3.3,

3.6 and 3.8). Most settings (83%) did not provide a variety of wholegrain starchy items every

week (wholegrain items should be provided once or twice per week, guideline 3.4), with most

cc

Those possible to assess using the data collected in the survey; those similar to or consistent with the school food standards dd

It is good practice to provide wholegrain starchy foods for at least one breakfast, lunch and tea each week. Young children can have some wholegrain starchy foods, but should not eat only wholegrain options, as they can fill up before they have taken in the energy they need. ee

Where this guideline was not met, starchy foods were not served on one or two days of the week rather than every day. More than half of the settings which did not meet this guideline were childminders. ff Where this guideline was not met, fruit and vegetables in most cases were not provided on one or two days of

the week. All of the settings which did not meet this guideline were childminders. gg

Where a setting did not meet this guideline, either a setting did not provide a protein source every day, or cheese was used as the protein source more than once. Limiting cheese to once per week is not explicit in this guideline, but it is suggested good practice. Of the 9 childminders providing lunch, 6 did not meet this guideline.


not providing any wholegrain starchy items. Nearly two-thirds (64%) of settings limited fried

starchy food at lunchtime to a maximum of once per week (guidance 3.5).

Tea

Twenty settings provided tea on at least three days per week. Table 18 shows that 70%

served a portion of starchy food each day at tea (guideline 4.2), with a further 25% nearly

meeting this guideline. 70% served a portion of fruit and/or vegetables at tea each day

(guideline 4.6). In relation to providing a protein food every day (guideline 4.7), fewer than

half met this guideline, either because they did not provide a protein food every day, or

because they provided cheese as the protein source more than once per week. A higher

proportion of settings met the wholegrain variety guideline (4.4) at tea than at lunch (50% vs.

15%). This was due to the type of starchy foods being provided at each of the meal

occasions - more toast and sandwiches at tea (some of which used wholemeal bread),

compared with more potatoes and white pasta at lunchtime. Nearly all settings (95%) limited

their serving of fried starchy food to a maximum of once per week (guideline 4.5).


Table 15. Settings meeting selected guidelines for breakfast

Guideline Fully met Not met Nearly met Maybe met Not applicable

n % n % n % n % n %

1.1 Provide a portion of starchy food at breakfast each day 22 92 2 8 - - - - - - 1.2 Provide at least three different varieties of starchy food across

breakfasts each week 13 54 7 29 2 8 - - 2 8

1.3 Provide a variety of wholegrain and white starchy foods each week 5 21 17 71 - - - - 2 8 1.4 Choose breakfast cereals with low or medium sugar content 13 54 9 38 - - - - 2 8 1.5 Provide a portion of fruit and/or vegetables as part of breakfast each

day 3 13 21 88 - - - - - -

Base: 24 settings providing breakfast on at least 3 out of 5 days Nearly met – for example, food provided once more than permitted Maybe met – insufficient information available Not applicable – where starchy food was not provided (1.1), other guidelines for starchy food (1.2, 1.3, 1.4) could not be met

Table 16. Settings meeting selected guidelines for snacks


n % n % n % n % n %

2.1 Provide a starchy food as part of at least one snack each day

14 27 17 33 2 4 1 2 18 35

2.3 Provide fruit or vegetables as part of some snacks and provide a variety across the week

40 77 11 21 1 2 - - - -

2.4 Dried fruit should not be provided as part of snacks 33 63 16 31 3 6 - - - - 2.6 Water and milk are the only drinks that should be provided between

meals and as part of snacks 31 60 20 38 1 2 - - - -

2.7 Avoid sweet foods such as cakes, biscuits and confectionery between meals

38 73 12 23 2 4 - - - -

Base: 52 settings providing at least one snack on at least 3 out of 5 days Nearly met – for example, food provided once more than permitted Maybe met – insufficient information available Not applicable – guideline only applicable to settings providing 2 snacks each day


Table 17. Settings meeting selected guidelines for lunch


n % n % n % n % n %

3.2 Provide a portion of starchy food as part of lunch every day 27 82 3 9 3 9 - - - - 3.3 Provide at least three different starchy foods as part of lunches each

week 21 64 5 15 3 9 1 3 3 9

3.4 Provide a variety of wholegrain and white starchy foods each week 5 15 25 76 - - - - 3 9 3.5 Limit starchy foods which have been fried, to once a

week at lunch 21 64 10 30 2 6 - - - -

3.6 Provide a portion of fruit and/or vegetables as part of lunch every day

27 82 5 15 1 3 - - - -

Provide a variety of fruit and/or vegetables per week 28 85 - - - - - - 5 15 3.7 Provide a portion of meat, fish, meat alternative, eggs or pulses as

part of lunch every day 19 58 12 36 2 6 - - - -

3.8 Provide a variety of meat, fish and meat alternatives as part of lunch across the week

20 61 1 3 - - - - 12 36

Base: 33 settings providing lunch on at least 3 out of 5 days Nearly met – for example, food provided once more than permitted Maybe met – insufficient information available Not applicable – for example, where starchy food was not provided (3.2), other guidelines for starchy food (3.3, 3.4) could not be met

Table 18. Settings meeting selected guidelines for tea


n % n % n % n % n %

4.2 Provide a portion of starchy food as part of tea every day 14 70 1 5 5 25 - - - - 4.3 Provide at least three different starchy foods as part of tea each

week 13 65 3 15 2 10 1 5 1 5

4.4 Provide a variety of wholegrain and white starchy foods each week

10 50 9 45 - - - - 1 5

4.5 Limit starchy foods which have been fried, to once a week at tea

19 95 - - 1 5 - - - -

4.6 Provide a portion of fruit and/or vegetables as part of tea every day 14 70 4 20 2 10 - - - - Provide a variety of fruit and/or vegetables per week 13 65 3 15 - - - - 4 20

4.7 Provide a portion of meat, fish, meat alternative, eggs or pulses as part of tea every day

9 45 11 55 - - - - - -

4.8 Provide a variety of meat, fish and meat alternatives as part of tea across the week

7 35 1 5 1 5 - - 11 55

Base: 20 settings providing tea on at least 3 out of 5 days Nearly met – for example, food provided once more than permitted Maybe met – insufficient information available Not applicable – for example, where starchy food was not provided (4.2), other guidelines for starchy food (4.3, 4.4) could not be met


Table 19. Settings meeting selected guidelines applying to lunch and/or tea

Guideline Fully met Not met Nearly met Maybe met

n % n % n % n %

6.3 Limit canned pasta in sauce (such as spaghetti hoops) 29 88 4 12 - - - - 7.5 Choose fruit canned in natural juice without sugar 29 88 3 9 1 3 - - 7.6 Choose reduced salt and sugar baked beans 13 39 18 55 1 3 1 3 8.2 Limit bought and homemade meat products to no more than once a

week* 27 79 4 12 3 9 - -

8.3 Limit bought and homemade fish products to no more than once a week

30 91 2 6 1 3 - -

8.4 Limit bought and homemade products made from meat alternatives to no more than once a week

30 91 3 9 - - - -

11.2 Avoid salt when cooking, and do not provide salt for children to add to their food

30 91 2 6 1 3 - -

11.3 Limit the use of ready made sauces, soups, stocks and gravy granules

21 64 10 30 1 3 1 3

11.4 Limit use of condiments such as ketchup 32 97 1 3 - - - -

Base: 33 settings providing lunch and/or tea on at least 3 out of 5 days Nearly met – for example, food provided once more than permitted Maybe met – insufficient information available * Base is 34 – includes one setting only serving snacks (classified as ‘not met’).

Table 20. Settings meeting selected guidelines applying to all food provision

Guideline Fully met Not met Nearly met Maybe met

n % n % n % n %

10.1 Children must have access to drinking water throughout the day 48 92 - - 1 2 3 6 11.5 Avoid salty snacks such as crisps 42 81 9 17 - - 1 2 11.7 Limit confectionery such as chocolate chips and use

only as part of cakes or desserts 46 88 5 10 1 2 - -

Base: 32 settings providing food on at least 3 out of 5 days Nearly met – for example, food provided once more than permitted Maybe met – insufficient information available


Other guidelines

This section describes how many settings met selected guidelines in the remaining eight

sections - portion sizes; starchy foods; fruits and vegetables; meat, fish, eggs, beans and

other non-dairy sources of protein; milk and dairy foods; drinks; reducing saturated fat, sugar

and salt; and other products to avoid.

Most settings (88%) avoided canned pasta in sauce (guideline 6.3) and used fruit canned in

juice (guideline 7.5), but reduced sugar and salt baked beans were used in fewer than half of

settings (39%; guideline 7.6). Three guidelines limit the frequency that meat products, fish

products or meat alternative products should be provided (guidelines 8.2, 8.3 and 8.4).

Although these guidelines were met by most settings, two settings met only one of these

guidelines, with a further five meeting two (including one setting which only provided

snacks). Only two settings used salt in cooking (guideline 11.2) and one setting used

condiments more than once per week (guideline 11.4). Ten settings used ready made

sauces, stock or gravy more than once per week (guideline 11.3). (Table 19)

Most settings avoided salty snacks (83%; guideline 11.5) and limited confectionery to once

per week (90%; guideline 11.7) (Table 20). This is consistent with the low levels of crisps

and confectionery described in the food provision data. All settings allowed children access

to water throughout the day (guideline 10.1).

In relation to drinks, 26% of one year olds had milk during the survey, and of these the

majority (89%) were provided with whole milk. Of eight settings providing fruit juice at either

breakfast, lunch or tea, seven provided diluted juice.

Very rarely did a setting consistently provide amounts of food (portion sizes) consistent with

that recommended in the practical guide for a food group (starchy food, fruit and/or

vegetables, protein foods, milk or dairy foods) across meal occasions. In general, portion

sizes were more likely to be too low than too high. For example, Table 10 shows the mean

weight of non-wholegrain breakfast cereals (as taken) as 8.7g, well below the 20-30g

recommended for breakfast cereal.hh Weights as taken were also lower than recommended

for discrete portions of vegetables and salad (30g vs. 40g), and for cakes and biscuits (26g

vs. 50g). This is likely to be a contributing factor to energy intakes being lower than

recommended for breakfast and lunch, and for full day provision.

Eleven settings provided food on all five meal occasions on most days of the week. Of the

76 guidelines, nineii were not assessed during this survey, and there are some guidelines

that may not apply to a setting (for example if fruit juice is not served, the guidelines for fruit

juice will not apply). On average, for the 11 settings with full day food provision there were

60.6 guidelines against which food provision was assessed, of which 43.3 (71%) were met.

Settings ranged from 51% to 85% compliant with the guidelines.

hh

Although the weight as taken of wholegrain breakfast cereal seems to be consistent with that recommended, this is due to the inclusion of porridge which includes milk. The median value was 18.5g, lower than the recommended 20-30g. ii The nine guidelines which were not assessed were: 3.10, 4.10, 6.2, 8.1, 8.5, 9.1, 9.8, 12.1, 12.2.


The eating environment Fieldworkers completed eating environment questionnaires in 56 of the 57 participating

settings. Questionnaires were completed once fieldworkers had observed at least two meal

occasions. The eating environment in early years settings was generally used effectively to

encourage children to eat well (Table 21). Nearly all settings provided an appropriate

physical environment, gave children time to eat, provided food that was visually appealing

and used meals and snacks to develop social skills. Setting staff engaged with children in all

but one setting, but ate with children in only half. Children were encouraged to try new foods

in about two-thirds of settings.

Table 21. Using the eating environment to encourage children to eat well Element Yes No DK/NA n % n % n %

Eating areas are: Clean 56 100.0 - - - - Warm 56 100.0 - - - - bright 56 100.0 - - - - Furniture, crockery and cutlery are age-appropriate: Tables 51 91.1 3 5.4 2 3.6 Chairs 54 96.4 - - 2 3.6 Cutlery 52 92.9 2 3.6 2 3.6 Plates 53 94.6 3 5.4 - - Bowls 53 94.6 2 3.6 1 1.8 Hands are washed before eating: Children 51 91.1 4 7.1 1 1.8 Staff 49 87.5 3 5.4 4 7.1 Children are encouraged to: Set up 24 42.9 28 50.0 4 7.1 Clear away 41 73.2 14 25.0 1 1.8 Serve themselves 46 82.1 10 17.9 - - Help others 37 66.1 17 30.4 2 3.6 Make their own food choices 20 35.7 33 58.9 3 5.4 Try new foods 36 64.3 20 35.7 - - Children are aware of the food and drink choices available 50 89.3 3 5.4 3 5.4 Food is visually appealing 52 92.9 1 1.8 3 5.4 Setting staff: Eat with children 27 48.2 29 51.8 - - Engage with children 55 98.2 1 1.8 - - Children are given enough time to eat 55 98.2 1 1.8 - - Eating occasions are used as an opportunity to teach healthy eating 45 80.4 9 16.1 2 3.6 Meals and snacks are used to develop: Manners 51 91.1 3 5.4 2 3.6 Social skills 52 92.9 3 5.4 1 1.8

Base (settings): 56

Discussion The survey provides an overview of food and drink provision in a broad cross-section of

early years settings in England, and includes information on food and drink consumption in

settings by children aged 1-4 years. Whilst there have been previous surveys of food

provision (using different methodologies), little has been published to date on food

consumption in this age group.

Food and drink provision in relation to guidelines It is encouraging that early years settings appeared to be doing reasonably well in meeting

the food and drink guidelines, particularly as the research was carried out within only a few

months of the guidelines being published. It is unlikely, therefore, that many settings had

attempted to change their provision to meet the guidelines. Areas for improvement (where

fewer than half of settings met guidelines) include providing the appropriate balance of white

and wholegrain starchy foods across the week at breakfast, lunch and tea, providing fruit


and/or vegetables at breakfast, providing starchy foods as part of at least one snack each

day, providing a protein source each day at tea, and a variety across the week (not just

cheese), and using reduced salt and sugar baked beans. These changes will promote

dietary diversity, and help to improve the nutrient profile of food provision.

Energy and nutrient provision and consumption in relation to the

guidelines The data suggest that at breakfast and lunch, settings are not providing, and children are not

consuming, the levels of energy and nutrients set out in the nutrient framework underpinning

the food and drink guidelines for early years settings. Energy intakes were about 40% lower

than recommended at breakfast and about 30% lower at lunch, but were generally in line

with recommendations at tea and snacks. It is possible that some children arriving in the

morning may have already had something to eat at home, and so do not take or need a full

meal at breakfast. For younger children, eating at lunchtime may be affected by tiredness

(as they usually sleep shortly after lunch), and it is also possible that some settings provide

their main meal at tea rather than lunch, or provide similar-sized meals on both occasions.

Other factors such as the timing of snacks and meals (insufficient time between eating

occasions for children’s appetites to build), and levels of physical activity may also be

important.

Energy

The levels of energy, and the standards for fat, carbohydrate and non-milk extrinsic sugars

(which are based on energy) specified in the nutrient framework are calculated from COMA

Dietary Reference Values.19 In 2011 the Scientific Advisory Committee on Nutrition (SACN)

published revised Dietary Recommendations for Energy.20 For young children, the revised

Estimated Average Requirement (EAR) for energy is approximately 20% lower than the

COMA value on which the nutrient framework was based. It may be, therefore, that the

levels of energy provided and consumed in early years settings as described here, despite

being lower than recommended in the nutrient framework, may be considered appropriate

for young children, and may address concerns about over-provision of energy and risks of

overweight and obesity. There are, however, significant concerns about the ability of food

providers to provide food and drink sufficiently nutrient-dense to meet young children’s

nutrient requirements generally, and for iron and zinc in particular, at these lower levels of

energy. Modelling work undertaken by the Trust to inform the development of the food and

drink guidelines suggests that updating the nutrient framework in line with the revised energy

recommendations from SACN would make meeting standards for micronutrients more

challenging, and it is not certain whether settings would be able to meet the iron and zinc

recommendations included in the nutrient framework from a reduced energy content.

Fat and dietary fibre

Young children need fat in their diet to ensure they get enough energy. Whilst healthy eating

recommendations for adults state that no more than 35% of energy should come from fat,

young children need more of their energy from fat, so the guideline recommends about 35%.

In relation to nutrient intakes, percentage energy from fat was lower at all meal occasions

than recommended in the guidelines, with levels of about 31% at lunch and tea, and as low

as 26-28% at breakfast and snacks. This suggests that one of the reasons why children’s

energy intakes are lower than recommended by the guidelines may be because of the fat

content of the foods and drinks that settings are providing, particularly at snacks, where fruit


makes up a large part of food provision. Even though children are meeting guidelines for

energy intake at snack times, it may be that they are filling up on less energy dense but

higher fibre foods (e.g. fruit), and as a consequence not eating a sufficient amount on other

meal occasions. Although children need more of their energy from fat, it is important to

ensure that SFA intakes are not too high. The data suggest that children are getting 12-13%

of their energy from SFA, close to the 11% maximum recommended in dietary guidelines.

Protein and micronutrients

Intakes of protein, vitamin A, vitamin C, and calcium were generally sufficient to meet the

nutrient framework recommendations (with the exception of vitamin A intakes at breakfast).

In addition, average NMES intakes were lower than the recommended maximum on all meal

occasions for both provision and consumption. This can be attributed to settings providing

sufficient amounts of milk and dairy foods and fruit and vegetables, and appropriate amounts

of foods or drinks containing added sugar. Intakes of folate and fibre were roughly in line

with recommended levels for children aged 1-4 years. However, provision and intakes of

sodium were too high across all meal occasions, and iron and zinc too low, often

substantially less than that required by children aged 1-4 years.

Low intakes of iron are of concern as young children require substantial intakes to support

growth, and iron deficiency and anaemia can have lasting effects on their health and

development. Contributing factors to low levels of iron provision could be low portion sizes

for meat, oily fish and eggs, and the provision of these items too infrequently (particularly at

tea), limited provision of pulses (only 6% of children consumed pulses including those in

composite dishes), portion sizes of dried fruit, limited provision of wholegrain starchy foods,

and over provision or consumption of milk (not a good source of iron and common in young

children’s diets). Similar factors apply to zinc, although provision of adequate amounts of

milk and dairy foods meant that settings were closer to meeting standards for zinc (only

intakes at snack times met the standard).

Although the majority of settings met guidelines designed to restrict salt provision and

consumption (such as limiting condiments and the use of ready-made stocks and sauces,

and avoiding salty snacks), levels of sodium were higher than recommended for both

provision and consumption at all meal occasions. This is likely to be due to the frequency of

provision of bread and bread-based products and cheese, particularly at tea. In

acknowledgement that current targets for sodium for children aged 1-4 years are difficult to

meet, the nutrient framework states that settings can provide food containing up to 125% of

the recommended level of sodium. Applying this to the provision data suggests that the level

of sodium in an average setting-provided lunch is acceptable, but the level at tea is still too

high. Settings could consider changing tea provision to a ‘light’ meal similar to lunch, rather

than a sandwich-based meal (which may also help to increase levels of iron and zinc).

Foods such as pasta salads, couscous, jacket potatoes and soups can be simple and quick

to prepare.

In relation to full day food provision, analysis suggests that levels of some nutrients are not

sufficient to meet the needs of children attending all day. Although the analysis of full day

provision was undertaken using data from only 11 settings, it is consistent with the analysis

of lunch and tea provision across all 57 settings. Fruit, vegetables, water and milk made up

nearly half of all the foods and drinks provided in full day provision, and the combination of

fibre (from fruit and vegetables) and volume (from drinks) may be a factor in preventing


children from eating sufficient amounts of other foods at snacks and meals. As full day

consumption data was not collected for individual children, it was not possible to determine

whether the pattern of nutrient intakes seen at single meal occasions would be seen across

full day provision.

The results reported here are generally consistent with those reported in previous surveys,

two conducted by Trading Standards officersjj in 10 nurseries in East Sussex (2007)12 and

118 early years settings in 29 local authorities across England,13 and another in 49 early

years settings in Liverpool.11 All found that the iron and zinc content of food provided by

settings was too low, and sodium too high. Low levels of energy and carbohydrate were also

highlighted, often attributed to inappropriate portion sizes of food. The data collected in the

present study provide a much more comprehensive picture of food provision and its impact

on children’s food consumption across a range of early years settings, and together with

information on the approaches taken to food by settings. The findings also provide a

baseline against which the impact of the implementation of the new food and drink

guidelines can be assessed.

Findings suggest that children having setting-provided food at lunchtime in early years

settings will be reasonably well-prepared for the food provision they are likely to encounter at

primary school. Both types of provision are characterised by little or no provision of

confectionary and crisps, mainly water, milk and fruit juice provided as drinks, and

vegetables, salad and fruit making up a substantial proportion of provision (38% in primary

schools and 23% in early years settings). Children’s fruit and vegetable intakes are similar

(mean of 1.6 portions eaten at lunch in primary schools and 1.4 portions in early years

settings), and intakes of protein, vitamin A, vitamin C and calcium all meet

recommendations. Primary schools are currently more successful in providing lunches with

sufficient iron and zinc content, but the expectation is that once the early years guidelines

become embedded then this element of provision in early years settings will improve.

It is significant that in both primary schools and early years settings, children having school

or setting-provided food tended to have more balanced nutrient intakes than those having

food brought from home. The food and drink guidelines recommend that settings should

include guidance on food brought in from home within their food policy; this would help to

encourage families to provide the same or similar healthy choices as offered by settings.

Limitations The extent to which the survey findings are representative of early years provision nationally

is limited. Firstly, settings were spread across only three local authorities, albeit in different

regions. In addition, the survey response rate was low, raising the possibility of a self-

selection bias. The survey was planned to include a variety of early years settings providing

food in order to get an acceptable quantity of information on provision, but due to the nature

of early years provision, not all settings provided food at all meal occasions on all days,

reducing the amount of usable data at individual meal occasions and making it difficult to

perform any subgroup analysis. The same issue applied to the number of children for which

consumption data was collected, which was limited to one or two children per meal occasion

in each setting. In relation to methodology, the majority of the food provision and

jj These surveys used chemical analysis of the food and drink provided on each of 5 days to determine average daily energy and nutrient content of the food provided.


consumption data collection was carried out by setting staff rather than trained fieldworkers

which may have reduced the accuracy of the data collected. Finally, feedback from some of

the fieldworkers (who completed some data collection and supported setting staff to record

data) was that the photographic food atlas was difficult to use, potentially resulting in

inaccurate estimates of portion size.

Conclusions Despite its limitations, the survey provides some important insights into the characteristics of

food provision in early years settings.

Whilst settings are meeting many of the food and drink guidelines, and doing fairly well in

providing food and drink that meets the needs of children aged 1-4 years, there are some

key areas for improvement. Dietary diversity is vital in providing a balanced diet, and settings

should consider how to include a wider variety of foods in their provision, particularly at

teatime. Selecting manufactured products with healthier nutrient profiles (such as those

lower in sodium) is also important. Alongside these elements, the embedding of food policies

which promote healthier food being brought into the setting from home, communication and

consultation with parents, and training staff in nutrition and wellbeing are important in

promoting healthier eating.

To further improve food provision in early years settings, it is recommended that setting

managers or head teachers should prioritize food and highlight its importance in relation to a

child’s health and academic achievement. Settings can sign up to the Early Years Code of

Practice for Food and Drink,kk and use this to show that their approach to food and drink

follows national best practice. Caterers should consider how to increase the iron and zinc

content of recipes and menus,ll and how to provide a wide variety of foods across the

menu.mm They should also review the products that they use to ensure that levels of fat,

sugar and salt meet the guidelines. Parents should be supported and encouraged to ask

questions about the settings food policy particularly in relation to food bought in from home,

food provided by the setting and meal routines. Settings are in a unique position to influence

healthier food provision at home and help establish children’s eating habits for life.

Further work by the Trust as part of the Eat Better Start Better programme will support early

years practitioners and health professionals to understand and implement the food and drink

guidelines, to evaluate approaches to food provision, and to support families to eat well.

Further research in a larger sample is needed to investigate differences between types of

setting, variations in portion sizes between meal occasions, and differences in provision and

consumption for younger (1-2 years) and older (3-4 years) children. It will also be important

to assess the impact of the guidelines over time.

kk

Practical guide, p.58 ll Practical guide, p.31

mm Examples of menus that meet the food and drink guidelines can be found in the practical guide, p.69-70


Appendix 1 Table 22. Food and drink items classified into narrow and broad food groups

Food group name Food group number Foods included Narrow Broad

Wholegrain breakfast cereals 1 1 Whole oats, rolled oats, oatmeal, wheat biscuits, shreddies, shredded wheat, bran flakes, fruit and fibre, cheerios, etc.

Non-wholegrain breakfast cereals

2 1 Corn flakes, rice crispies etc.

Wholegrain bread-based items

3 2 Wholemeal , granary, multi-grain bread and toast; whole wheat rolls; whole wheat tortilla wrap; whole wheat pitta breads

Non-wholegrain bread-based items

4 2 White bread and toast; white rolls; best of both bread (white bread with added wheatgerm); english muffins; tea cake/toasted tea cake; crumpets/pikelets; fruit loaf; malt loaf; bagel (any); plain brioche; hot cross buns; currant bun; white tortilla wrap; scotch pancake; white pitta bread;

Fat spread 5 3 All type of fat spreads and butter Fruit 6 4 100% fresh whole fruit; fresh fruit wedges; tinned fruit; fruit cups;

stewed fruit Dried fruit 7 4 100% dried fruit only e.g., raisins, sultanas, apricots Cooked vegetables & side vegetable dishes

8 5 100% cooked vegetable dishes: all vegetables and mixed vegetables e.g. mixed vegetable medley of peas, sweetcorn & carrots; ratatouille; vegetable tagine; stir-fried vegetables; roasted vegetables

Raw vegetables & salad 9 5 Tomato; cucumber; sweetcorn; raw pepper; raw carrot; lettuce; cress; beetroot; celery; radish; onion etc.

Baked beans 10 6 Baked beans only Fruit juice , including diluted 11 9 Fruit juice, unsweetened, diluted and undiluted Water 12 7 Water only Whole milk 13 8 Whole milk only Semi-skimmed & skimmed milk

14 8 Semi-skimmed and skimmed milk

Milk alternatives e.g. soya 15 9 Plain milk alternatives only e.g., soya, oat, rice milk Other drinks 16 9 Squash; milk shakes; carbonated drinks etc. Starchy food, NOT cooked in oil

17 10 Boiled pasta; boiled rice; jacket potato; boiled potatoes; boiled noodles; couscous; mashed potato etc.

Starchy food, cooked in oil 18 10 Chips (including oven chips); roast potatoes; potato waffles; savoury pancakes; poppadoms; fried noodles; potato croquettes; sauté potatoes; potato wedges; garlic bread; fried bread; fried rice; yorkshire puddings; hash browns etc.

Meat dishes, portions and products

19 11 Beef lasagne, chicken casserole, chicken pie, bacon, ham, roast meats, sausages, sausage rolls etc.

Vegetable dishes and products

20 11 Vegetable lasagne, vegetable curry, vegetable pasta bake, canned pasta etc.

Meat alternative dishes, portions and products

21 11 Quorn sausage casserole, mixed bean casserole, lentil pie, houmous, quorn slices etc.

Fish dishes, portions, and products

22 11 Fish pie, fish stew, grilled fish, fish fingers, fish cakes etc.

Eggs and egg dishes 23 11 Boiled , fried, scrambled eggs, quiches etc. Cheese 24 11 Cheddar, cream cheese, cheese spread, cheese strings etc. Pizza 25 11 Any pizza Soup 26 11 Any soup Cakes and biscuits 27 12 Any cake or biscuit Desserts 28 13 Crumbles; pies, jelly; sponge; bread and butter pudding etc. Milk-based dessert 29 13 Rice pudding; semolina; angel delight; custard (if made with milk)

etc. Yoghurt & fromage frais 30 13 Any yoghurt or fromage frais Ice cream / frozen yoghurt 31 13 Any ice cream or frozen yoghurt Pudding accompaniment 32 13 Custard (if made with water); chocolate sauce; cream; evaporated

milk etc. Confectionery 33 14 Any confectionery, including cereal bars Savoury snacks & biscuits 34 15 Crackers; oatcakes; breadsticks; rice cakes; nachos; prawn

crackers; whole nuts etc. Crisps 35 16 Any crisp-type item Gravy 36 17 Any gravy Savoury condiments 37 17 Tomato ketchup; mayonnaise; salad cream etc. Sweet condiments 38 17 Jam; chocolate spread; peanut butter, marmite, honey etc.


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