Nutrition and Oral Health - NHS Lanarkshire

NUTRITION AND ORAL HEALTH
STRATEGY INTO PRACTICE IN THE EARLY YEARS

The Department of Public Health
NHS Lanarkshire
14 Beckford Street
HAMILTON ML3 0TA
Telephone: 01698 206335
Fax: 01698 424316
www.nhslanarkshire.org.uk
© Lanarkshire NHS Board
Published March 2010
We encourage the use by others of information and
data contained in this publication. Brief extracts
may be reproduced provided the source is fully
acknowledged. Proposals for reproduction of large
extracts should be sent to the address above.
ISBN 978–0–905453–26–2

NUTRITION AND ORAL HEALTH
STRATEGY INTO PRACTICE IN THE EARLY YEARS
Contents
1 Preface 3
2 Acknowledgements 4
3 Summary 5
4 Policy Context 6
5 Introduction 9
6 Eating Well for Babies Under One 10
7 Eating Well from One to Five Years 14
8 Developing a Healthy Eating Policy 21
9 Food Safety and Hygiene 23
10 Drinks and Snacks at Home or in Nursery 27
11 Ideas for Healthy Lunchboxes 29
12 Common Festivals and Religious Celebrations 30
13 Food for Religious and Cultural Celebrations 32
14 Food for Parties 39
15 Recipe Ideas for Parents 41
16 The Age of Independence 51
17 Making the Most of Mealtimes 52
18 Happy Healthy Smiles 53
19 On the Move 58
20 Curriculum Links 61
21 Working in Partnership 66
22 Parent Prompts 68
23 Topic Sacks 77
24 Resources from Health Promotion 79
25 Useful Contacts & Further Reading 81
26 References 85
27 Appendices 86
Contents 1

2 Nutrition & Oral Health

Preface
Acknowledgements
Summary
Policy Context
1–4

1: PREFACE
The nutrition and oral health of young children is fundamental to their
physical, mental, social and educational development and wellbeing. Eating
for Health – A Diet Action Plan for Scotland (1996) and Towards a Healthier
Scotland (1999) identified the need for a combined partnership effort to
address some of the major health issues in Scotland at an early age.
As a result, in 2002, a multi-agency and multi-disciplinary steering group
comprising staff from all the key services worked together to produce this
resource pack on nutrition and oral health for nurseries across Lanarkshire.
Members of the group included those who worked in NHS Lanarkshire, North
Lanarkshire Council, South Lanarkshire Council and Early Years
Establishments.
Since then, we have seen the publication of many national policy documents
such as An Action Plan for Improving Oral Health and Modernising NHS
Dental Services in Scotland (2005) and the Nutritional Guidance for Early Years
(2006), the passing of the Schools (Health Promotion and Nutrition) (Scotland)
Act 2007 in the Scottish Parliament, the development of Childsmile, a national
oral health improvement programme for children, the publication of the Early
Years Framework (2008) and the roll-out of our new national curriculum, A
Curriculum for Excellence (2009).
In 2009, key agencies of the original steering group reconvened to update this
resource. The aims remain the same; to work together to lay the foundations
for lifelong healthy habits at an early stage of development.
This pack gives updated factual information on a range of issues relating to
healthy eating and oral health and provides practical advice for incorporating
food into the formal and informal curriculum.
Strategy into Practice in the Early Years
Preface 3

2: ACKNOWLEDGEMENTS
Thank you to all who were involved in the writing of the first edition of the
Nutrition and Oral Health Pack (see members of original steering group) and
to those involved in the update and reprint of this second edition.
This second edition was edited by Ruth Campbell, Celia Watt and Ashley
Goodfellow who would like to thank all the children who allowed their
drawings to be included and to the nurseries who provided photographs and
evidence for the updated Curriculum for Excellence section.
Thanks to all who contributed to or reviewed the second edition: Albert Yeung,
Jennifer McCormick, Helen Hodge, Pamela Lippiatt, Tracy Williamson,
Lorna Carlyle, Wendy McPhillie, Janette Rose, Liz Keenan, Margaret Swan,
Gillian Lindsay, Craigneuk Nursery Centre, Cathkin Community Nursery and
Linda Muncie.
Members of the original Steering Group
These are the members of the original steering group which produced the first
edition of this resource. Their affiliations are as at 2002 when the first edition
was printed:
Sarah Caldwell Health Visitor, Lanarkshire Primary Care Trust (Blantyre)
Allison Campbell Curriculum Development Officer, NLC (seconded)
Irene Campbell Depute Area Dental Health Co-ordinator, Lanarkshire
Primary Care Trust (until January 2002)
Ruth Campbell Public Health Nutritionist, Lanarkshire NHS Board (Chair)
Ann Marie Crielly Nutrition and Oral Health Development Worker, NLC (from
May 2002)
Anne Dunlop Projects Manager, Health Promotion Department,
Lanarkshire NHS Board
Irene Griffin Health Visitor, Lanarkshire Primary Care Trust (Newarthill)
Karen Harkins Nursery Owner, Little Treasures Nursery, Cumbernauld
Yvonne Johnston Nursery Nurse, Glenlee Nursery Class, Hamilton
Anne Marie Lee Breastfeeding Co-ordinator, Health Promotion Department,
Lanarkshire NHS Board
Anne McKim Senior Nursery Nurse, Coatholm Nursery, Coatbridge
Eileen Moffat Nursery Nurse, Drumpark Nursery, Coatbridge
Eileen Mullen Adviser: Technology, NLC
Marie Nicolson Pre-5 Worker, Ailsa Nursery, Motherwell
Maria Reid Public Health Nutritionist, Lanarkshire NHS Board
(September 2001 – March 2002)
Andrea Reilly Depute Head of Centre, Blantyre Nursery, Blantyre
Sarah Reilly School Nurse, Drumpark School, Coatbridge
Catherine Starkey Area Dental Health Co-ordinator, Lanarkshire Primary Care
Trust (from April 2002)
Ellen Ward First Assistant, Westburn Nursery School, Cambuslang
4 Acknowledgements Nutrition & Oral Health

3: SUMMARY
The aim of this pack is to provide guidelines on good nutrition and oral health
to agencies, staff, parents and carers of young children. As a health promoting
establishment, you will already be incorporating healthy lifestyle messages into
your daily activities. It is intended that this pack will complement existing work
and provide assistance in building this further. The information is presented in
a format that can easily be shared with parents.
There are two key elements to this pack and supporting materials:
1:The pack itself as guidance and a factual resource
• The pack contains a range of information including nutritional requirements
of children under five years, food safety and hygiene, oral health, ideas for
snacks and special occasions.
• The pack provides a basis for the development of nutrition and oral health
policies within your own establishment.
2:Topic sacks
• Topic sacks have been developed to support this pack and encourage
children’s learning about food, nutrition and oral health through play and
the everyday activities that take place in a nursery.
For nurseries in North Lanarkshire topic sacks are available from North
Lanarkshire Education Resource Service, Clyde Valley High School, Castlehill
Road, Wishaw ML2 0LS. Tel: 01698 403510.
For nurseries in South Lanarkshire topic sacks are available from the
Childcare Information Service, Early Years Development Team,
Chatelherault Primary School, Silvertonhill Avenue, Hamilton ML3 7NT.
Tel: 01698 476745.
Other groups and individuals can borrow this pack and the topic sacks from
the Health Improvement Library, Law House, Airdrie Road, Carluke ML8 5ER.
Tel: 01698 377600.
Strategy into Practice in the Early Years
Summary 5

4: POLICY CONTEXT
National Policy Context
National Care Standards (2005)
The Regulation of Care (Scotland) Act 2001 was introduced to ensure a
greater standard of care provision and requires certain care services to be
regulated. Those providing care services to children are regulated by the Care
Commission against a set of National Care Standards. These set out the
quality of care that care services should provide. Standard 3 of the National
Care Standards: early education and childcare up to the age of 16 stipulates
the standard an early education or childcare setting should provide in terms of
a child’s health and wellbeing.
Let’s Make Scotland More Active – A Strategy for Physical Activity (2003)
Let’s Make Scotland More Active sets out a variety of actions to encourage
and enable children and adults to take part in regular physical activity.
An Action Plan for Improving Oral Health & Modernising NHS Dental Services
in Scotland (2005)
The Dental Action Plan saw the beginning of Childsmile, a national
programme designed to improve the oral and general health of children in
Scotland and to reduce inequalities, both in dental health and access to dental
services. It is funded by the Scottish Government and has four main elements:
• Childsmile Core programme – available across Scotland.
• Childsmile Practice.*
• Childsmile Nursery.*
• Childsmile School.*
* To be rolled out across Scotland 2008–11
Nutritional Guidance for Early Years (2006)
Nutritional Guidance for Early Years: food choices for children aged 1-5 years
in early education and childcare settings is a national guidance document
which supports the implementation of National Care Standard 3. The
guidance sets out nutrient standards for lunchtime food provision, as well as
providing information on healthy snacks and drinks for children in early years
establishments and childcare settings.
Schools (Health Promotion & Nutrition) (Scotland) Act 2007
The Schools (Health Promotion & Nutrition) (Scotland) Act places a duty
on local authorities to ensure that all schools, including nursery
establishments, are health promoting. Local authorities had to implement this
duty by January 2008.
6 Policy Context Nutrition & Oral Health

Curriculum for Excellence (2009)
Curriculum for Excellence provides a framework for learning and teaching
which promotes successful learners, confident individuals, responsible citizens
and effective contributors. It takes a holistic approach to health and
wellbeing, which includes experiences and outcomes for children around food
and nutrition.
Local Policy and Activity
NHS Lanarkshire Breastfeeding Policy
The overall aim of the Breastfeeding Policy is to ensure that all mothers have
the right information to make a fully informed choice as to how they feed and
care for their babies, and to enable health care staff to create an environment
where more women choose to breastfeed and are supported to breastfeed
exclusively for the first six months and then as part of the baby’s diet beyond
the first year. The policy will support breastfeeding in all public areas of NHS
Lanarkshire and partner premises.
Lanarkshire Health Promoting Nursery Award Scheme
A Health Promoting Nursery is one in which all members of the nursery
community work together to provide children with integrated positive
experiences within the nursery structure that promote and protect their health.
Lanarkshire’s Health Promoting Nursery Award Scheme has been developed
to support co-ordinated and sustainable health promotion activity in nurseries.
It encourages a partnership approach to health promotion and aims to
improve the health of children, parents, staff and the wider nursery community.
Lanarkshire Children’s Healthy Weight Strategy
This strategy has been developed to address the increasing levels of childhood
obesity in Lanarkshire. The strategy targets children from birth to eleven years
of age and aims to reduce the high prevalence of obesity in children. The
focus of activity is in four key areas: antenatal/postnatal, early years, schoolaged
children, and community treatment programmes.
North Lanarkshire Council Diet and Nutrition Policy
North Lanarkshire Council has developed a Diet and Nutrition Policy spanning
2008–2012. The Policy has been developed with the whole North Lanarkshire
population in mind; however, specific commitments have been made in the
following areas: breastfeeding mothers, children and young people, older
adults, individuals requiring special diets, communities, individuals and families
who are temporarily accommodated. The Policy also commits to improving
food provision for employees, as well as raising awareness of and promoting
healthy eating to staff and customers.
Strategy into Practice in the Early Years
Policy Context 7

High Five for Fruit
In partnership with Lanarkshire Community Food and Health Partnership and
NHS Lanarkshire, North Lanarkshire Council delivers High Five for Fruit. This
initiative provides all children in nurseries and partnership nurseries with free,
fresh fruit and vegetables three times per week. High Five for Fruit engages
with children and their families to encourage good eating habits from an early
age in both the nursery and at home through the delivery of health promotion
activity in the nursery setting.
Hungry for Health
North Lanarkshire Council, in partnership with Focus on Food, has developed
a food and health curriculum pack for nurseries and schools - Hungry for
Health. As well as raising awareness among children of the importance of
positive dietary habits, nutrition and health, the pack also aims to encourage
the development of food preparation and cookery skills in children from a
young age.
8 Policy Context Nutrition & Oral Health

Introduction
Eating Well for Babies Under One
Eating Well from One to Five Years
5–7

5: INTRODUCTION
The importance of good nutrition
Healthy eating and physical activity are essential for proper growth and
development in children. Good eating habits formed early in life are likely to
be carried into adulthood and therefore impact upon future health. This also
applies to other health-related behaviours such as physical activity and
toothbrushing.
To help children develop patterns of healthy eating from an early age, it is
important that their experiences of food and eating are positive. Whether at
home or in nursery, it is crucial that these positive messages are reinforced by
the snacks, drinks and meals provided, as well as any adult’s attitude and
behaviour towards food.
Increasing numbers of children under the age of five are being cared for
outside the home in local authority nurseries, private nurseries or with
childminders. Many children are spending longer periods of time in childcare
and will therefore consume a greater proportion of their daily food intake
within these establishments.
Nurseries and childminders are in an ideal position to help shape children’s
eating habits and play a key role in encouraging children to enjoy food.
Current eating patterns
Sadly, the evidence available suggests that, in general, many children’s
diets are:
• too low in several essential vitamins and minerals such as zinc and iron;
• too low in fibre, starchy carbohydrates, fruits and vegetables;
• too high in foods that are high in fat, sugar and salt; and
• for an increasing number, too high in calories for their low level of physical
activity.
Research has shown there is a link between a poor diet in early life and the
development of coronary heart disease, stroke, cancer, diabetes and obesity.
All of these are high in Lanarkshire.
Strategy into Practice in the Early Years
Introduction 9

6: EATING WELL FOR BABIES UNDER ONE
Breastfeeding
Getting children off to a good start
Research shows that children who are breastfed have a better nutritional start
in life. Breastmilk is superior to formula milk as it contains anti-infective
properties and antibodies that protect babies from infection and boost their
immune system. Evidence also shows that breastfeeding offers protection from
a range of childhood infections, reduces hospital admissions in the first year of
life and continues to give added protection into the teenage years. The
protective effect of breastfeeding is dose-related i.e. the longer and more
exclusive the breastfeeding is, the greater the protection.
Breastfed babies do not need any other foods or drinks for the first six months
as breastmilk alone provides all the nutritional requirements and fluids a baby
needs for healthy growth. Breastmilk changes constantly to meet the growing
baby’s needs. Babies should be breastfed exclusively until they are six months
old, although breastfeeding is encouraged as part of the baby’s diet until they
are two years of age.
Babies who are exclusively breastfed are:
• protected against diarrhoea, gastro-enteritis and tummy upsets;
• protected against chest infections and wheezing;
• protected against ear infections;
• protected against colds, flu and sore throats;
• less likely to have eczema and other allergies;
• less likely to develop diabetes; and
• more likely to have prolonged natural immunity to mumps, measles, polio
and other diseases.
Breastfeeding is good for mothers too; they have a reduced risk of breast
cancer, ovarian cancer, hip fractures, and breastfeeding aids an earlier return
to pre-pregnancy weight.
Despite the growing evidence for the health benefits of breastfeeding, fewer
children in Lanarkshire are breastfed compared with other areas in Scotland.
To ensure that more children and women experience the full benefits of
breastfeeding, a number of local partnership initiatives are in place to
encourage and support more mothers to choose breastfeeding.
Childminders and nursery staff are in an ideal position to promote the benefits
of breastfeeding and to support any mother wishing to breastfeed her baby
while they are at nursery or with the childminder. Nursery establishments are
encouraged to participate in the NHS Lanarkshire Breastfeeding Friendly
Campaign which requires organisations to adopt a Statement of Intent that
ensures a welcoming atmosphere for breastfeeding mothers. ‘You’re
Welcome To Breastfeed Here’ posters should also be displayed in public areas
of the premises. More information about the campaign can be found on
10 Eating Well for Babies Under One Nutrition & Oral Health

www.lanarkshirebreastfeeding.org.uk. Posters can be ordered from the
NHS Lanarkshire Health Improvement Library.
Breastmilk
Many breastfeeding mothers express their breastmilk and store it in the fridge
or freezer until their baby needs it. Provided the milk has been collected in a
sterile container, breastmilk is safe to use when:
• Stored in a fridge for up to five days.
• Stored in the ice box of a fridge for up to two weeks.
• Stored in a *** freezer for up to six months.
Frozen breastmilk should be thawed overnight in the fridge or more quickly in
a jug of warm water. A microwave oven should not be used to thaw or heat
breastmilk as this may heat the milk unevenly and could scald the baby.
Refrigerated or frozen milk should be clearly labelled with the child’s name
and date, especially if taken to the nursery. Any unused milk should be
discarded after five days.
For more information about breastfeeding and breastfeeding support in
Lanarkshire visit www.lanarkshirebreastfeeding.org.uk
Formula Feeding
For mothers who choose to feed their baby with formula milk there is a large
variety of products to choose from. There are four main types of formula milk:
whey based, casein based, follow-on milk and soya based. It is recommended
that whey based formula milk (often referred to as ‘first stage milk’) is used
from birth until the baby is one year. There is no need to switch from whey
based to casein based (or ‘second stage’) formula milk. Follow-on formula is
only suitable from six months, however, for most babies, there is no evidence
of any benefit compared to standard formula. Soya milk should only be used
under medical supervision.
‘Good night’ milk products are marketed for infants of six months and over to
help ‘settle’ them at bedtime as a bedtime liquid feed to be given from a
bottle or feeding cup. However, there is little published scientific evidence to
support these claims. Additionally, if infants are put to bed immediately after
feeding, as suggested by the product, the infant will be exposed to rich
carbohydrates over a prolonged period of time which can lead to the
development of nursing bottle caries.
Formula milk should always be prepared following the manufacturer’s
instructions and a fresh bottle made up for each feed. Any milk left from the
feed should be discarded. (See Appendix 2 for information on preparing
formula milk and Appendix 3 for information on sterilising equipment).
Childminders and nursery staff should ensure formula milk is clearly labelled
with the baby’s name and the date and time of the day that the milk was
prepared. Once prepared, the feed should be given as soon as possible.
Strategy into Practice in the Early Years
Eating Well for Babies Under One 11

Weaning
The introduction of solids into the diet (complementary feeding or weaning)
is an important step in a baby’s development. During this stage, there is a
period of rapid growth so it is essential that the diet provides all the nutrients a
baby needs.
The Scottish Government recommends that the age of introduction of solid
foods is around six months for all babies. After six months, breast or formula
milk alone cannot provide sufficient energy for proper growth from this age.
Before the age of six months (26 weeks) a baby’s digestive system and kidneys
are still developing. Research shows that introducing solids too soon can
result in problems such as wheezing or cough, and can increase risk of
asthma, eczema, digestive problems, allergies and obesity in later life.
Weaning from four months was the advice given for a number of years
however the new guidance of weaning from six months is based on more
recent research. Babies should never be weaned before the age of four
months (17 weeks).
During the weaning process babies are learning to accept and enjoy new
foods with a variety of flavours and textures. They may already be finger
feeding some foods but are also learning to take food from a spoon, which is
more difficult than it may sound! At first when introducing food, it is a normal
reaction for all babies to spit food out and screw up their face, but this does
not necessarily mean that the food is disliked. Ideally, the same foods should
be offered on several occasions to allow babies to adjust to the new taste.
Gradually, between six to twelve months, a wide variety of flavours and textures
should be introduced to ensure an adequate intake of all the nutrients needed
for growth and development.
Ideal first foods are:
• Mashed fruit such as banana, stewed apple or pear.
• Mashed cooked vegetables such as potato, carrot, parsnip, turnip or
cauliflower.
• Small pieces of soft fruit or cooked vegetables.
• Toast, bread, pitta bread or chapatti, rice cake or breadsticks.
• Cheese, slices of hard boiled egg, chunks of cooked fish, which can be
picked up.
• Baby rice or other cereal mixed with the baby’s usual milk – (expressed
breastmilk or formula) always in a bowl, not in a bottle.
• Mashed up healthy family foods wherever possible.
How much and how often?
A few teaspoons of well mashed food at one meal a day is enough to start
with. The amount given should be gradually increased over a few days.
Parents should be guided by their baby’s appetite and should encourage their
baby to feed themselves. At this stage milk is still the most important part of
the baby’s diet so the same amount of breast or formula milk should be given.
By the time babies reach the age of twelve months, they should be eating the
12 Eating Well for Babies Under One Nutrition & Oral Health

same healthy meals as the rest of the family. From the age of twelve months,
full fat cow’s milk can be introduced as a main drink. Breastfeeding mothers
should be encouraged to continue breastfeeding for as long as they wish. Semi
skimmed milk is unsuitable for children under the age of two years (see later
section on drinks and snacks).
The level of salt that is naturally present in fresh foods will be enough to meet
babies’ nutritional needs. Salt should not be added to babies’ food because
their kidneys, at this stage, are unable to cope with added salt.
Avoid foods and drinks that are high in sugar and salt, and low in vitamins
and minerals e.g. sweetened drinks, fizzy drinks, fruit squashes, chocolate,
sweets, crisps or corn snacks, biscuits or pastries and cakes.
Sugar should not be added to foods as this is likely to cause tooth decay and
may also encourage the development of a preference for sweet foods, which
can be hard to change at a later stage. Breastmilk, formula milk, cow’s milk
and water are the only safe drinks for teeth so all other drinks, including baby
juices, herbal drinks, diluting squashes, fizzy drinks and flavoured milk, should
be avoided.
Breastfed babies do not need additional fluids. In hot weather, formula fed
babies may need extra water; for babies less than six months, cooled, boiled
tap water should be used.
Parents should be encouraged to prepare their own foods as much as possible,
as this gives much greater control over the addition of ingredients. Readymade
jars and packets of baby foods can be expensive and often contain
added sugar and thickeners, which are of little nutritional value. Ready-made
foods, can, however, be useful on occasions where a parent is going out for
the day or has little time to prepare a home-made meal.
For more information on healthy weaning, see the NHS Health Scotland
booklet Fun First Foods – An easy guide to introducing solid foods. This is
available from the NHS Lanarkshire Health Improvement Library.
Strategy into Practice in the Early Years
Eating Well for Babies Under One 13

7: EATING WELL FROM ONE TO FIVE YEARS
The right stuff
Healthy eating does not mean denying children or adults the foods they enjoy.
It is the balance of foods in our diet that is important. To make sure children
get all the energy (or calories) and nutrients they need for growth and
development, they should eat as wide a range of different foods as possible.
Getting the balance right
Children under five, particularly those under two years, have specific nutritional
requirements, and therefore not all healthy eating recommendations for adults
apply to this age group. Because children under two years have smaller
stomachs and often smaller appetites, they are not able to eat as much at any
one meal. Relative to their size, children need higher amounts of some
nutrients than adults e.g. vitamin C and iron. Fat is necessary to provide
essential fatty acids that the body cannot make itself and to provide fat-soluble
vitamins, so for children under five do not cut out all the fat. However, it is still
desirable to limit fried foods and foods that are high in fat.
• Make sure children get enough energy for growth by giving nutrient dense
foods, in other words, foods that are high in nutrients like protein or
carbohydrate.
• Give children under five years full fat varieties of milk and dairy products, not
low fat varieties. From the age of two, if a child enjoys a varied diet then
semi-skimmed milk can be used at home.
• Children need regular meals and may need small healthy snacks in
between.
• High fibre foods such as wholemeal bread, pasta and brown rice are bulky
so can fill some children up too quickly. From the age of two years higher
fibre foods can be introduced gradually, so that by the time they reach age
five, children are eating the same healthy foods as the rest of the family.
Each day children should be encouraged to eat foods from the four main food
groups:
1 Bread, rice, potatoes, pasta and other starchy foods: this includes all types
of bread and rolls (white, brown, wholemeal, granary), pitta, baps and
bagels, potatoes, pasta, rice and breakfast cereals. These foods are good
sources of starchy carbohydrate, so supply energy. They are packed with
vitamins like thiamin, riboflavin, niacin and folate, and also provide fibre.
Children should have an item from this group at each meal.
2 Fruit and vegetables: a long list includes grapes, cherries, melons, pears,
kiwis, bananas, pineapples, oranges, strawberries, apples, peaches, plums,
nectarines, sweetcorn, broccoli, peas, beans, cabbage, spinach, mushrooms,
lettuce, parsnip, cauliflower, Brussels sprouts - the list goes on and on!
Frozen, tinned (in own juice and not in syrup) and dried fruit and vegetables
14 Eating Well from One to Five Years Nutrition & Oral Health

are just as valuable as fresh. Fruit and vegetables are good sources of a
wide range of vitamins especially A, C and folate. Children should have five
child-size servings each day. A serving is the amount that can fit in the palm
of a child’s hand.
3 Meat, fish, eggs, beans and other non-dairy sources of protein: this
includes beef, lamb, pork, chicken, turkey, fish, eggs, pulses such as beans,
chickpeas and lentils, tofu and soya products. These foods are all good
sources of protein and iron, therefore essential for growing children.
Children should have two foods from this group each day.
4 Milk and dairy foods: these include milk, yoghurt, cheese and fromage frais.
Not only are these foods rich in protein, they are high in calcium which is
needed for the development of strong bones and teeth. Milk should be
encouraged as a main drink and can also be used in meals, for example, in
a pasta sauce or milk-based puddings. Milk and dairy products should form
part of all meal and snack combinations.
Foods containing sugar
Foods such as cakes, sweets, chocolate, and biscuits are high in sugar. They
are low in nutritional value because they do not contain nutrients such as
vitamins or minerals and are high in calories. These foods need not be avoided
completely, but when they are given, they should be offered after mealtimes
rather than between meals to avoid tooth decay (tooth decay is discussed in
more detail later).
Foods containing salt
Some salt (or sodium chloride) is necessary in everyone’s diet, although too
much can be harmful for babies and young children as their kidneys are not
able to cope with a high intake. If children from an early age become
accustomed to a high amount of salt they will develop a taste for it in their diet
making it difficult to change. A high salt intake is linked with high blood
pressure and increases the risk of stroke later in life. Convenience foods
(tinned products, ready-made meals and sauces) are all high in salt.
• Limit snacks such as crisps and corn snacks to no more than 2–3 times per
week as these are salty and high in fat.
• Smoked foods e.g. bacon, fish and cheese are high in salt so try not to have
more than one of these foods per day.
• Children get enough salt from the amount that is naturally present in food
so avoid adding it during cooking or at the table.
• When reading food labels look out for ‘sodium’ and ‘monosodium
glutamate’. Products containing these are likely to be high in salt.
Vitamins
Vitamins are necessary in our diet for a variety of functions, for example: to
maintain healthy skin, hair, bones and teeth; maintaining our immune system;
Strategy into Practice in the Early Years
Eating Well from One to Five Years 15

and protection against chronic diseases such as heart disease and cancers.
Vitamins are split into two groups: fat-soluble and water-soluble.
• Fat-soluble are vitamins A, D and E - these can be stored by the body.
• Water-soluble are B vitamins (including thiamin, riboflavin, niacin, B6 and
B12), folate and vitamin C - these cannot be stored by the body so a daily
intake of these is important.
Table 1 in Appendix 4 lists the main functions and food sources of key
vitamins.
Children under the age of five, particularly those who are fussy eaters or have
a limited diet, should be given vitamin drops containing A, C and D - these
are free to some families as part of the Healthy Start scheme. Encourage
parents to discuss the need for vitamin drops with their Health Visitor/Public
Health Nurse.
Minerals
Like vitamins, minerals are required in our diet for a range of functions: to
develop strong teeth and bones; maintain healthy blood; to help breakdown
carbohydrate and fat and for a healthy immune system. There are a number
of important minerals, but for children the key minerals are iron, calcium
and zinc.
Iron
Iron is involved in the formation of red blood cells which carry oxygen around
the body. A deficiency of iron in the diet leads to anaemia, which is common
in young children. As many as a quarter of children under the age of five years
in the UK have an iron intake below the recommended amount. Children with
anaemia may appear pale, tired, lethargic and have a poor appetite.
Prevention of iron deficiency is important as it affects intellectual achievement
and is linked to poorer development and health overall.
There are two forms of iron: haem iron and non-haem iron.
Haem iron is easier for bodies to absorb and is found in meat and meat
products such as red meat e.g. beef and lamb, white meat e.g. chicken and
turkey and some fish such as sardines. Liver, in particular, is a rich source
of iron.
Non-haem iron is harder for bodies to absorb than haem iron. Non-haem iron
is found in plant foods such as pulses e.g. peas, beans and lentils, dark green
vegetables, dried fruit e.g. apricots and raisins, fortified breakfast cereals,
bread and eggs.
• Vitamin C helps the body absorb iron so encourage children to have a
small glass of fresh fruit juice such as orange or apple (diluted for younger
children, one part juice to one part water), vegetables or some fruit with
a meal.
16 Eating Well from One to Five Years Nutrition & Oral Health

• Tannin, found in tea and coffee, hinders the absorption of iron so avoid
giving these drinks to children. If parents do give tea or coffee, advise them
to offer these between meals, without sugar, make them as weak as possible
and add lots of milk.
• Bran or foods containing added bran can hinder the absorption of iron so
for young children these should be avoided. Giving wholewheat breakfast
cereals, some wholemeal bread, plenty fruits and vegetables will ensure
children get all the fibre they need. Don’t forget to offer plenty of water
throughout the day to prevent dehydration.
Calcium
The main function of calcium is to form and maintain strong bones and teeth
as well as to build muscle and maintain the nervous system. Whilst the
evidence available suggests that most children in the UK under the age of five
years have an adequate calcium intake, older children, particularly teenagers,
have a worryingly low calcium intake. This is likely to lead to problems later in
life with osteoporosis, or thinning of the bones, which can be very debilitating.
• It is recommended children who are formula fed continue on this until
twelve months. Breastfeeding should be supported for as long as the
mother wishes.
• Encourage children to eat rich sources of calcium including milk and milk
products e.g. yoghurt, cheese and fromage frais, sardines, pilchards, pulses,
eggs, spinach and dried fruits.
• For children with cow’s milk allergy or intolerance, a soya formula milk
should be given and used only under medical supervision. Soya milks sold
in supermarkets are not the same as soya infant formulae, as they do not
always contain the full range of nutrients required for growth and
development. Advise parents to talk to their Health Visitor/Public Health
Nurse about soya milk.
Zinc
Zinc plays a part in a variety of functions including breakdown of protein,
fat and carbohydrate, wound-healing and maintaining the nervous and
immune systems.
Encourage children to eat rich sources of zinc including milk and milk
products, meat, eggs, pulses and wholegrain cereals.
Strategy into Practice in the Early Years
Eating Well from One to Five Years 17

Vegetarian diets
By excluding meat and animal products from the diet, consideration has to be
given to alternative sources of key nutrients such as protein, iron, calcium and
some vitamins. Staff should ask parents of vegetarian children for information
about the foods that the child should/should not be given, for example, some
vegetarians will eat eggs or fish while others will not. It should not be
assumed that all vegetarians follow the same diet or exclude the same foods.
Some people exclude animal products completely and follow a vegan diet.
For children under the age of five years, this requires very special attention and
staff should request that parents provide them with detailed information on the
foods their child will eat.
To ensure an adequate protein intake, food such as milk, cheese, fish and
eggs should be included. However, if these are not eaten then pulses such as
chickpeas, beans (butter, haricot, broad, pinto) and lentils are good sources of
protein. Similarly for calcium, milk and dairy products are the best sources
although spinach, pulses, dried fruit, oranges, white bread and tofu are good
alternatives. Non-meat sources of iron must be included in a vegetarian child’s
diet on a daily basis to prevent anaemia (see above section on iron).
Remember that vitamin C helps the body absorb iron so include fruits,
vegetables or fruit juices with meals.
Children with special dietary requirements
Fortunately, very few children require a restricted diet and, often, any
restriction may only be for a short period of time. Children with special dietary
requirements should be under the supervision of a Registered Dietitian or
another health professional. Parents or carers should provide staff and
childminders with a copy of any relevant dietary information specific to their
child. In some cases it may be necessary to request that parents or carers
provide specific food items such as milk, snacks or packed lunches. Some of
the more common conditions that staff may encounter in children in their care
are outlined below.
Coeliac disease – This is a condition where gluten (protein found in wheat) is
not tolerated by the digestive system. Here, the child would need to avoid all
foods containing wheat, rye, barley and oats. These may be contained in
foods such as biscuits, puddings, cakes, soups, some tinned and packet foods.
Parents should be able to provide a comprehensive list of fresh, tinned and
packet foods that are gluten free. Further information can be obtained from
Coeliac UK (see Useful Contacts section for details).
Food allergy – Food allergy involves an adverse response of the immune
system and affects fewer than 2% of children in the UK. The effects of an
allergic response can be minor, although in some cases, can cause a severe
reaction or even be life-threatening. Research shows that many people
perceive they have a food allergy when in fact it is food intolerance.
Food intolerance – Intolerance to a number of foods, or a specific food, can
result in a range of symptoms from wheezing to gastrointestinal upset or
discomfort.
18 Eating Well from One to Five Years Nutrition & Oral Health

In all cases of suspected food allergy or intolerance in children, it should be
recommended that parents seek medical advice for accurate diagnosis and
future dietary management. It could be harmful for parents to exclude foods
from their child’s diet without proper advice, as this could lead to malnutrition
and be unnecessarily restrictive.
Foods which can result in an adverse reaction caused by allergy or intolerance
described above are: hen’s eggs, cow’s milk, fish, shellfish, soya beans, wheat
(gluten), peanuts, some other types of nuts and products containing any of
these foods.
Diabetes – Fortunately, diabetes is rare in children under the age of five.
Diabetes is a condition where the hormone insulin is not produced, resulting in
the body’s inability to control blood sugars. Children with diabetes may require
two or three injections of insulin daily. A healthy and varied diet should be
encouraged. The timing and frequency of meals and snacks for these children
is crucial to ensure good control of their blood sugars. A regular intake of
carbohydrate (bread, fruit, crackers), usually every two hours or so, will ensure
a steady blood sugar.
If children with diabetes miss a snack or a meal, are ill, or are more active
than usual, this can increase their need for foods containing carbohydrate.
At these times, children with diabetes may need extra snacks containing
carbohydrate to prevent hypoglycaemia (low blood sugar level).
Hypoglycaemia (a ‘hypo’) can present in different ways for different children.
Nursery staff should ask parents or carers for information on recognising
symptoms in their child and appropriate action that should be taken.
Generally, if a child is hypoglycaemic, they require sugar, glucose or a sugary
drink quickly, followed by a more substantial snack or meal. For general
information on diabetes, staff can contact Diabetes UK (see Useful Contacts
section for details).
Overweight and obesity in children
Following a healthy diet and taking part in regular physical activity in
childhood will help reduce the likelihood of excess weight gain. The Scottish
Health Survey has shown that children in Scotland are doing less exercise and
regularly consuming foods high in fat and sugar. As a result, 36% of boys and
27% of girls aged two to fifteen years are overweight or obese. Of these
children, 17% of boys and 13% of girls are classified as obese (Scottish
Government, 2009). Additionally, the prevalence of overweight and obesity is
often greater in those living in areas with high levels of deprivation.
The health consequences associated with weight gain in childhood include
high blood pressure, increased blood lipids, increased risk of developing type-2
diabetes, exacerbation of asthma, low self-esteem and negative self-image.
Evidence suggests that excess weight in childhood is more likely to lead to
being overweight or obese as an adult, therefore increasing the likelihood of
developing chronic diseases, such as coronary heart disease and cancer, in
later life.
Strategy into Practice in the Early Years
Eating Well from One to Five Years 19

Both North and South Lanarkshire Councils are part of the concordat between
the Scottish Government and Convention of Scottish Local Authorities. This
commits, by 2018, to reducing the rate of increase in the proportion of
children with their body mass index outwith a healthy range. For most children
who are overweight and obese, weight maintenance, rather than weight loss,
is recommended. Over time, it is hoped that children will grow in height and,
in conjunction with following a healthy, balanced diet and being physically
active, fall back within a healthy weight range. In addition, NHS Boards are
required to work towards achieving a target which details the number of
children completing a Scottish Government approved healthy weight
intervention programme. As detailed within the Policy Context, Lanarkshire has
developed a Children’s Healthy Weight Strategy which sets out a variety of
actions in relation to the prevention and treatment of overweight and obesity
in children from birth to eleven years of age.
Nursery staff and childminders have an active role to play in the prevention of
weight gain in children, by helping them to develop good habits in the early
years. If staff have concerns about a child’s weight, this should be raised with
the parent or carer in a sensitive and tactful manner. Staff may also wish to
raise their concerns with an appropriate health professional. Likewise, if a
parent expresses concern over their child’s weight, staff should suggest that
they contact their Health Visitor/Public Health Nurse for further advice.
Children with additional support needs
Children, depending on their type of disability, may not be able to chew, eat
and enjoy a wide range of textures and foods. Working with parents to agree
an individualised feeding plan to be used is essential. This may involve input
from a range of professionals, including a Registered Dietitian, a Speech and
Language Therapist, Occupational Therapist or Physiotherapist. Children may
require foods modified in texture, specialised feeding equipment, safe seating
and positioning for eating and a high level of one-to-one support to eat and
drink. If a parent expresses concern over their child’s eating or drinking, staff
should suggest that they contact their Health Visitor/Public Health Nurse, or an
appropriate Therapist for further advice.
Children with chronic illness may require regular, frequent medication and
therefore should be under the continuing care of a Dentist. As with all
children, parents should be encouraged to request sugar-free medicines and
pay attention to maintaining good oral hygiene.
If nursery staff and childcare providers require further information about
healthy eating for children aged one to five years, they should refer to the
national guidance document Nutritional Guidance for Early Years: food choices
for children aged 1–5 years in early education and childcare settings. This is
available to download from the Scottish Government website (see Useful
Websites section).
20 Eating Well from One to Five Years Nutrition & Oral Health

Developing a Healthy Eating Policy
Food Safety and Hygiene
8–9

8: DEVELOPING A HEALTHY EATING POLICY
Developing a policy does not have to be complicated. It can be a way to
ensure everyone is clear about the healthy eating messages a nursery or
childminder aims to promote. It can be used to provide information to both
staff and parents and it should be written in agreement with parents.
Several nurseries and childminders across Lanarkshire already have their own
Healthy Eating Policy. For those who do not, the following example, adapted
from Eating well for under-5s in child care by the Caroline Walker Trust, can be
used as a starting point and adapted for local use. It should be borne in mind
that a number of points may not be applicable in some nurseries or
childminders’ homes depending on circumstances, and that not all
establishments will require such a detailed policy.
Sample Healthy Eating Policy
• Mothers wishing to continue breastfeeding their child will be supported to do
so by all staff.
• The weekly menus will be on display in advance. Recipes will be available to
parents.
• The weekly menu will provide children in childcare with a varied diet.
• All the children in childcare will have suitable food made available for them.
• Children who do not eat breakfast at home will be offered this when they
arrive at nursery or childminder’s home.
• Milk will be served with morning and afternoon snacks and this will be full
fat milk.
• All dairy products will be full fat.
• Soya drinks will only be given as a substitute for cow’s milk with the parent’s
agreement and then only those fortified with calcium will be given.
• Water will be available at all times.
• Diluted fruit juice will be served only with the main meal.
• Children will have access to bread or fruit if they are hungry between meals.
• Children will be allowed to have second helpings of fruit or milk-based
desserts.
Strategy into Practice in the Early Years
Developing a Healthy Eating Policy 21

• Children will still be given dessert if they refuse their main course.
• Parents will be advised if their child is not eating well.
• Parents of children on special diets will be asked to provide as much
information as possible about suitable foods and in some cases may be
asked to provide the food themselves.
• Staff/carers will sit with children while they eat and will provide a good rolemodel
for healthy eating.
• Withholding food will not be used as a form of punishment.
• Children will be encouraged to develop good eating skills and table manners
and will be given plenty of time to eat.
• Advice will be given to parents about suitable foods to bring from home.
• Outdoor play will be encouraged every day, in all weathers, with suitable
clothing. This will ensure that children have an opportunity to be exposed
to sunlight, which helps their bodies to make vitamin D. Parents will be
advised to provide suncream for their child and apply when necessary.
Alternatively, and with the parent’s consent, suncream application will be
carried out by staff.
22 Developing a Healthy Eating Policy Nutrition & Oral Health

9: FOOD SAFETY AND HYGIENE
Participation in food preparation is a valuable learning experience for children
and provides a great opportunity to reinforce basic personal and food hygiene
procedures. It is essential that children who are involved in the preparation of
snacks are always closely supervised.
The Elementary Food Hygiene Certificate
The Elementary Food Hygiene Certificate is required for the level of food
preparation discussed in this pack and we strongly recommend that at least
one member of staff from the nursery, or a childminder, who is involved in food
or snack production completes the course.
A number of colleges in North Lanarkshire run the Elementary Food Hygiene
course on behalf of Environmental Services. The course is subsidised by the
local authority and therefore will be offered at a reduced rate for North
Lanarkshire nursery staff. It is free of charge to voluntary organisations. Staff
should contact Coatbridge, Cumbernauld or Motherwell Colleges directly.
Nursery staff in South Lanarkshire should contact the local authority
Environmental Health Department for further information on the Elementary
Food Hygiene course. Nurseries may be offered this training free of charge,
depending on the level of food production on the premises.
We recognise that the majority of establishments will not provide lunches and
will only handle a limited range of snack foods. However, it is intended that the
information below can be shared with parents, as it gives advice on the
appropriate handling of high risk foods such as raw meat and poultry.
If your nursery is responsible for providing lunches or cooked meals we
recommend that you consult with your local Environmental Health Officer for
advice on food hygiene training, registration and risk assessment. Depending
on the type of foods you prepare in your nursery, you may be required to
complete a food registration form. You should contact your Environmental
Health Officer in your local authority for advice on whether this is necessary for
your establishment. For North Lanarkshire Council contact 01236 616522,
and for South Lanarkshire Council contact 01355 806915.
Strategy into Practice in the Early Years
Food Safety and Hygiene 23

Safe Food Preparation
• Always wash hands thoroughly with running water and a bactericidal liquid
or clean soap in a wash hand basin or nominated sink, and dry using
disposable towels, before preparation of food, between preparation of raw
meat or vegetables, after going to the toilet, blowing your nose, changing
nappies, handling waste or handling pets.
• Make sure food is kept at safe temperatures: for hot food this is above 63°C,
for cold food this is below 5°C.
• Do not use unpasteurised milk or milk-based products such as goat’s cheese
or milk products made from unpasteurised milk. If a parent supplies such
milks or foods check if it requires to be boiled.
• Fresh shelled eggs should be used with caution within the nursery setting
and often, dried or pasteurised eggs are recommended as a suitable
alternative. Contact your local authority Early Years Department for
further advice.
• Wash all fruits and vegetables thoroughly before eating. Take extra care
when washing vegetables, especially if eating raw. Always use a clean
chopping board and knife. Vegetables for young children should be washed
and peeled.
• Wash the sink with a bactericidal detergent after cleaning vegetables or food
preparation. Separate sinks should be used for food preparation and other
activities e.g. washing paint brushes.
• Wash dishes, cutlery, worktops, equipment and tabletops with hot water and
a bactericidal detergent and rinse in designated sinks, preferably twin sinks,
or use a dishwasher if available.
• Separate chopping boards and knives, preferably colour coded, should be
used for ready to eat foods and vegetables and for the preparation of fruit.
• Change cloths or sponges often. Always disinfect worktops and tabletops
before and after food preparation. Wipe the tops of cans before
opening them.
• Bring milk indoors as quickly as possible and place in the fridge. Any
damaged cartons should be discarded. Provide a covered holder for any
deliveries of food to your nursery to avoid contamination from birds.
• Take off jewellery such as rings or bracelets before preparing food to avoid
germs getting into food.
• Always cover cuts or sores with a blue waterproof dressing.
• If you are unwell, avoid handling food especially if you have been sick or
have diarrhoea. Report any such illness to your supervisor.
• Clean protective clothing should be worn when preparing food.
• Never smoke when handling food.
• Ensure long hair is tied back.
24 Food Safety and Hygiene Nutrition & Oral Health

Storage
• Perishable foods such as meat and poultry will be labelled with a ‘use by’
date and should not be kept beyond this date. Foods that can be kept for
longer such as bread will be labelled with a ‘best before’ date. When this
date runs out it doesn’t mean that the food is dangerous but it may no
longer be at its best. So, to enjoy food at its best, use it before the ‘best
before’ date.
• Always store food in accordance with the labelling instructions.
• The fridge should be cleaned with a bactericidal spray and defrosted
following the manufacturer’s instructions. The fridge should be fitted with a
thermometer. The fridge should be capable of storing perishable foods at a
temperature of between 0°C and 5°C. Adhere to any recommended storage
temperatures marked on food labels and check and record temperatures of
chilled foods regularly and of fridges daily.
• Don’t overload the fridge as this will increase the temperature.
• Part-used canned food should be transferred to an airtight container and
stored in the fridge.
• Raw meat and fish should be kept covered at the bottom of the fridge.
• Raw and cooked food should be stored and prepared separately.
• Packed lunch boxes should be refrigerated if possible. If not, they should
always be stored in a cool place with a cool pack inside. Ensure the child’s
name is clearly marked on the lunch box.
• Don’t use any leftover food.
• Insulated cool boxes, or a cool box with cool packs, should be used for
carrying food when taking children on trips or outings.
• Ready to eat foods such as cooked meats, dairy products and pasta dishes
provided by parents and intended to be shared by nursery children should
not be accepted as it is not possible to verify the conditions under which the
food was prepared. However, foods brought in for snacks such as fruits,
vegetables, bread and rolls are acceptable.
• Expressed breastmilk can be stored for up to five days in the fridge. Parents
should clearly label bottles with the child’s name and date. Any unused milk
should be discarded after five days.
If you require further clarification or advice on any of these points, you should
contact your local Environmental Health Officer within your local authority.
Strategy into Practice in the Early Years
Food Safety and Hygiene 25

26 Food Safety and Hygiene Nutriton & Oral Health

Drinks and Snacks at Home or in Nursery
Ideas for Healthy Lunchboxes
Common Festivals and Religious Celebrations
Food for Religious and Cultural Celebrations
Food for Parties
Recipe Ideas for Parents
10–15

10: DRINKS AND SNACKS AT HOME OR IN NURSERY
Drinks
It is very important for infants and young children to have plenty of fluids to
drink, as they help their body to function properly and to prevent constipation.
• Plain milk and plain water are the only safe drinks for teeth so can be
recommended between meals. Drinking water should be encouraged at
all times.
• From the age of two years children can be given semi-skimmed milk at
home providing they have a wide and varied diet, but children eating only a
limited range of foods should continue to have full fat milk until the age of
five. Skimmed milk is not recommended for any child under the age of five.
• Full fat milk should be the milk used in a nursery.
• Remember that cow’s milk is unsuitable as the main milk for children under
one year.
• Fresh fruit juice is a good source of vitamin C but is best given with
breakfast or a main meal to help with the absorption of iron. Fresh fruit
juices are quite acidic, so can be harmful to teeth; these should be diluted
with water (one part juice to one part water). More water can be added if a
larger thirst quenching drink is needed.
• Squashes are best avoided, especially between meals. If offering squash with
a meal then offer ‘no added sugar’ varieties and dilute well (one part squash
to at least eight parts water). Squash should always be served in a feeding
cup, not a bottle, to minimise risk of tooth decay.
• Fizzy drinks (either ‘diet’ or sugar-containing) should be avoided as these
are not suitable for children. If they are given, these should only be given
at mealtimes.
• Six months of age is a good time to encourage the use of a drinking cup
instead of a bottle for water, formula milk or expressed breastmilk. For all
children, milk and water are the only safe drinks for teeth. However, if
diluted juice is given as a treat and given in a drinking cup, a straw should
also be given to minimise risk of dental erosion or tooth decay.
Strategy into Practice in the Early Years
Drinks and Snacks at Home or in Nursery 27

• Tea and coffee are not recommended for children under five years as the
tannin present can hinder the absorption of iron. However, if tea is given to
encourage a child to drink milk, make the tea as milky as possible and don’t
add sugar.
• All fizzy drinks and squashes (whether diet or otherwise) provide little in the
way of nutrition and drinking them between meals may reduce a child’s
appetite for food at mealtimes.
Snacks
Children need a varied diet to ensure they get all the nutrients they require for
growth and development. Nursery aged children often have small appetites
and need regular meals with small snacks in between. Snacks should be as
nutritious as possible and sugar-free to prevent tooth decay. Chocolate bars,
sweets, cereal bars and sweet biscuits should be saved for mealtimes and as
treats rather than taken between meals.
Here are some suggestions for healthier snacks:
• Fruit – mouth size chunks, cubes or slices of apple, pear, satsuma, orange,
banana, kiwi, melon, strawberries and grapes.
• Raw vegetables – carrot, pepper, celery, cucumber, cherry tomato, red
cabbage, turnip, radish and courgette.
• Toast, bread rolls, baps, French bread with a small amount of
polyunsaturated spread.
• Small sandwiches with marmite, cheese, tuna, thin slices of meat.
• Pitta bread pockets – on their own or with a filling.
• Bread sticks – on their own or with a dip or soft cheese e.g. Dairylea,
Philadelphia or cottage cheese.
• Oatcakes, rice cakes, crackers, crispbreads.
• Natural yoghurt with fruit or fromage frais.
• Home-made pizza triangles.
• Muffins, plain, potato or cheese scones, crumpets, pancakes, plain buns.
• Plain microwave popcorn.
28 Drinks and Snacks at Home or in Nursery Nutrition & Oral Health

11: IDEAS FOR HEALTHY LUNCHBOXES
It’s easy to get stuck in a rut with lunchboxes, especially if children insist on
having the same sandwich filling day after day. Changing a few items in a
lunchbox over the course of a week can help to provide a range of important
nutrients and encourage children to try new foods.
With a little careful planning, a healthy lunchbox can be prepared in just a few
minutes. Don’t forget that the contents of a lunchbox have to survive until the
middle of the day and by that time may have been dropped a few times!
There are many novelty lunchboxes and bags to choose from, but remember a
plain plastic box does the job just as well.
• Sandwiches are an easy choice for a packed lunch. To give a little variety, try
different breads and rolls such as wholemeal, granary, poppy seed, sesame
seed, pitta bread, bagels and baps. Try some breadsticks or crackers too.
• For sandwich fillings, include ham, turkey, chicken, fish, egg, banana, edam,
mozzarella or cottage cheese. Add plenty of salad, but avoid too much
mayonnaise or salad cream, as these are high in fat.
• Home-made pasta and rice salads are ideal for packed lunches.
• Include some chopped raw vegetables such as carrots, cucumber, peppers or
cherry tomatoes.
• An apple every day can soon become boring so include a variety of fruit.
Choose fruits that are in season as this will be more economical. Include a
pot of fruit salad as a change to a whole fruit. Try some dried fruit such as
raisins, sultanas, mango or apricots.
• For a dessert include milk-based puddings such as yoghurt, fromage frais, a
small pot of custard or mousse.
• Choose fruit scones, pancakes or fruit loaf as healthier alternatives to
sweets and chocolate. The inclusion of sweets and chocolate in a child’s
lunchbox should be actively discouraged. However, if parents insist on
including these items, then fun-sized chocolate bars should be
recommended. Ensure any sweets and chocolate are eaten at mealtimes to
reduce the risk of tooth decay.
• For a drink include milk or water. Small cartons of pure fruit juice are easy to
carry but remember these should be given at mealtimes only. Squashes
should be diluted to one part juice to at least eight parts water. Fizzy drinks,
‘diet’ or otherwise, are not suitable for children, so ask parents to include
milk, water or fruit juice at lunchtime instead.
Strategy into Practice in the Early Years
Ideas for Healthy Lunchboxes 29

12:
COMMON FESTIVALS AND
RELIGIOUS CELEBRATIONS
Different festivals are celebrated throughout the year. Some of these originate
from religious beliefs, while others are based on events from history. The
celebration of festivals is often a child’s first introduction to understanding and
appreciating the beliefs of children from other cultures. They can begin to
learn to appreciate, respect and value the beliefs of their peers.
‘Festival’ derives from ‘feast’ and often a feast can be a delightful introduction
to multicultural awareness. Nurseries can involve parents from different
cultural backgrounds as they often appreciate being asked to contribute to an
activity involving their own culture, for example, a baking activity.
Dates of festivals often change from year to year and it would be impossible to
celebrate them all, so be selective and decide which ones are appropriate to
your own establishment, taking into account the needs of the children and
their parents. It is a good idea to celebrate a cultural event that may not be
represented among children, as this may be the only occasion they have to
learn about this particular culture.
January
1st New Year
6th Epiphany: Three Kings Day (Christian)
7th Rastafarian New Year
25th Burns Night
Late January/
Early February
Chinese New Year
Jewish New Year for Trees
February
3rd Japanese Bean Scattering
14th St Valentine’s Day
Pancake Day (Shrove Tuesday – Christian, 40 days
before Easter)
Late February/
Caribbean Carnival
30 Common Festivals and Religious Celebrations Nutrition & Oral Health

Early March
March
March/April
April
May
Chinese Lantern Festival
Purim (Jewish)
1st St David’s Day
17th St Patrick’s Day
Baha’i New Year
Holi (Hindu Spring Festival)
Mothering Sunday
Passover (Jewish festival of Pesach)
Easter (Christian)
23rd St George’s Day
1st May Day
Wesak Buddhist festival, first day of full moon in May
Late May/June
August
September/
Early October
Shavuot: Jewish Festival of Weeks
Tuan Yang Chieh: Chinese Dragon Boat Festival
Raksha Bandhan: Indian celebration of brother/sisterly love
Jewish New Year: Rosh Hashanah
Yom Kippur: Day of Atonement (Jewish)
Harvest Festival
October
October/
November
November
December
31st Halloween
Diwali (Sikh/Hindu Festival of Lights)
5th Guy Fawkes
Thanksgiving (American)
30th St Andrew’s Day
6th St Nicholas (European)
Hanukkah (Jewish Festival of Lights)
25th Christmas Day (Christian)
26th Boxing Day (Christian)
Festivals such as Eid-Ul-Fitr, Islamic festival of fast breaking linked to
Ramadan, occur at a different time each year. Parents will be able to advise of
these dates. Contact the Education Resources Departments of North or South
Lanarkshire Councils for a current calendar of festivals.
Strategy into Practice in the Early Years
Common Festivals and Religious Celebrations 31

13:
FOODS FOR RELIGIOUS AND CULTURAL
CELEBRATIONS
Chinese
The Chinese New Year is seen as a time to celebrate the end of winter. It is a
very colourful occasion and a time when Chinese people traditionally right
their wrongs, discard negative thoughts, words and deeds and wish each other
good luck for the coming year. It is a very important time for the family.
Although many Chinese people in Britain have adopted a western lifestyle, at
New Year they honour the ancient Chinese customs.
Chinese foods are readily available from supermarkets. Suitable snack foods
might include water chestnuts, beansprouts, lychees, cooked noodles, dates
and mandarin oranges. Children love to experiment with chopsticks but this
can become quite a messy business!
The traditional Chinese New Year cake is ‘Nian gao’. The children could help
to make this.
Ingredients for Nian gao:
18 oz (500 g) brown sugar
18 oz (500 g) glutinous rice flour
Method:
• Boil 1 litre water, add sugar and mix well until it becomes syrupy.
• Pour the rice flour into a bowl, add syrup a little at a time, stirring the
mixture until smooth.
• Pour the mixture into a 15 cm round cake tin.
• Boil plenty of water in a large pot, place the cake tin on a steaming rack,
cover and steam for an hour until cooked.
• Cut into slices and eat hot or cold.
N.B. This is a very sweet cake, serve small slices and keep for after a meal
if possible.
32 Food for Religious and Cultural Celebrations Nutrition & Oral Health

Shrove Tuesday
‘Pancake’ day or Shrove Tuesday, the day before Ash Wednesday marks the
start of Lent, a Christian celebration. The period of Lent, which leads up to
Easter is a time when Christians used to abstain from meat, fat, eggs and
dairy products. Shrove Tuesday was traditionally a time when people used up
all the ingredients from their store cupboards and making pancakes has
become a popular way of doing this. Pancakes can be made with many tasty
fillings. A basic recipe would be:
Ingredients for pancakes:
4 oz (100 g) flour
Pinch salt
1 egg (or dried egg equivalent)
Approx. ½ pint (300 ml) milk
Method:
• Sieve flour and salt into bowl.
• Make a well in the centre and add the egg.
• Add the milk a little at a time, mixing with a wooden spoon, drawing in all
the flour.
• Beat the batter mixture until smooth.
• Heat a little fat in a heavy-based frying pan until hot. Pour batter into the
pan until the base of the pan has a thin, even covering of batter.
• Place pan over a moderate heat and cook until the bottom side of the
pancake is golden brown.
• Carefully turn the pancake to cook the other side.
Try fillings such as cheese, mushrooms, tomatoes or vegetables.
Strategy into Practice in the Early Years
Food for Religious and Cultural Celebrations 33

Eid-ul-Fitr
This Muslim festival means ‘festival of fast breaking and happiness forever’
and marks the end of the fast during Ramadan. During this festival Muslims
fast through daylight hours by not eating or drinking anything at all. During
this period of fasting Muslims are preparing themselves to face the difficulties
of life which lie ahead and the regime is followed by rich and poor alike. This
enforces an important rule of Islam – to give to charity, ‘Zakat’.
A traditional Eid dish is Wedhmi. This can be simply made by the children with
some help from an adult.
Ingredients for Wedhmi:
Pastry:
Filling:
4 oz (100 g) plain flour 8 oz (200 g) desiccated coconut
Pinch of salt
(soak in water for 30 minutes)
4 oz (100 g) butter or margarine 4 tbsps sugar
Small bowl of water (1–2 tbsp would ½ tsp cardamom seeds
be plenty)
½ tsp cinnamon powder
Sunflower oil
Method:
To make pastry:
• Mix flour and salt, rub in butter or margarine and mix to stiff dough with
water.
To make the filling:
• Mix the desiccated coconut, sugar, cardamom seeds and cinnamon powder.
• Melt a little oil in a saucepan and gently shallow fry the ingredients.
• Divide the dough into fairly large pieces, roll out, fill with the coconut
mixture and deep fry in oil.
N.B. This is a sweet cake, serve small slices and keep for after a meal
if possible.
34 Food for Religious and Cultural Celebrations Nutrition & Oral Health

Holi
Holi is a Hindu spring festival when thanks are given for a good harvest.
As well as a religious and social occasion, Holi has cleansing elements too.
Hindu people traditionally ‘spring clean’ at this time.
At Holi the coconut is thrown on bonfires to symbolise triumph over evil. As a
result coconuts often feature in religious ceremonies. Children could be given
the opportunity to investigate a coconut and be told about its uses. They could
taste some of the juice and flesh and decorate whole coconuts for display.
Sweets are traditionally eaten at Asian festivals and a popular sweet at Holi is
Gulab Jaman, although it is high in fat and sugar. Here is a healthier
alternative. The children could help to prepare this.
Ingredients for Carrot Pudding:
1 lb (400 g) carrots, grated
2 pints (1.2 litres) semi-skimmed milk
4 tbsp sugar
4 tbsp basmati rice
Method:
• Mix all the ingredients together in a pan and bring to the boil.
• Simmer for 20 minutes or until the mixture becomes a ‘pudding’ consistency.
• Top with raisins or almonds if desired.
Easter
The Christian festival of Easter is traditionally a time for Easter eggs, but there
are other foods which have come to symbolise Easter. There are many
variations on the ‘bird’s nest’, including melted chocolate through shredded
wheat topped with mini chocolate eggs, but perhaps a healthier option would
be this recipe:
Ingredients for Easter ‘bird’s nest’:
Raw carrot (grated)
Lemon juice
Grapes
Cherry tomatoes
Raisins or sultanas
Button mushrooms
Method:
• Soak raw carrot in lemon juice and shape into a nest.
• Use other ingredients to represent the eggs in the nest.
Hot cross buns are also traditionally eaten at this time of year.
Strategy into Practice in the Early Years
Food for Religious and Cultural Celebrations 35

Halloween
This is a time for the pumpkin – for making lanterns or for pumpkin soup or
pumpkin pie. There are many recipes around for each, but here is a very
simple one for cream of pumpkin soup:
Ingredients for pumpkin soup:
1 pumpkin (approx. 1.4 kg) 3 tbsp flour
2 small onions 1 pint (568 ml) milk
1 tbsp (25 ml) sunflower oil Little grated cheese
3 fl oz (100 ml) vegetable stock ½ – 1 small carton of cream
Method:
• Lightly fry pumpkin and onions in oil for 5 minutes - do not colour.
• Add stock, cover and simmer for an hour or until vegetables are soft, adding
extra water as necessary.
• Sieve or puree soup and return to pan.
• Blend flour with a little of the milk to a smooth cream.
• Add the rest of the milk to the soup and reheat.
• Stir a little of the soup into the blended flour and milk and return this
mixture to the pan.
• Bring to the boil, stirring until it thickens and cook for a further 2–3 minutes.
• Stir in cheese and cream.
36 Food for Religious and Cultural Celebrations Nutrition & Oral Health

St Andrew’s Day
St Andrew is the Patron Saint of Scotland, and St Andrew's Day is celebrated
by Scots around the world on the 30th November.
Ingredients for Stovies:
6 large baking potatoes, peeled and cubed (2.5 cm/1 inch)
8 fl.oz (240 ml) meat stock
1 oz (25 g) butter
1 large onion, roughly chopped
12 oz (350 g) diced cooked lamb (or beef if preferred)
Method:
1 Place the potatoes and stock in a saucepan, bring to the boil, then reduce
heat, partially cover and simmer for 25–30 minutes or until the potatoes
are tender.
2 Meanwhile, melt butter in a frying pan over medium high heat. Add the
onions and sauté gently until soft and transparent.
3 When potatoes are cooked, add the cooked onions and lamb. Mix well
and continue to cook for 10 minutes, or until thoroughly heated through.
Serve hot (serves 4).
Ingredients for Scotch Broth:
1oz (25 g) pearl barley
2 pints (1.1 litres) lamb stock
3 oz (75 g) leeks, sliced
8 oz (225 g) carrot, diced
8 oz (225 g) turnip, diced
2 oz (50 g) cabbage, shredded
Method:
1 Place the barley in a pan of cold water, bring to the boil then drain.
2 Return the barley to the pan together with 2 pints (1.2 litres) of stock. Bring
to the boil then simmer for 1 hour.
3 Add the leeks, carrot, turnip and continue to simmer for a further hour.
After this time, add the cabbage and cook for a further 20 minutes.
Serve hot (serves 4).
Strategy into Practice in the Early Years
Food for Religious and Cultural Celebrations 37

Christmas
This is probably the most celebrated time in the nursery and there are literally
hundreds of food ideas. The children could make mincemeat pies using readymade
pastry. They could also make biscuits in Christmas shapes. A very simple
recipe for oatmeal biscuits is:
Ingredients for oatmeal biscuits:
4 oz (100 g) sunflower margarine
2 oz (50 g) caster sugar
4 oz (100 g) porridge oats
4 oz (100 g) plain wheat flour
Method:
• Cream the margarine and sugar. Add the porridge oats and flour.
• Roll the mixture into small balls and flatten slightly.
• Put in oven at 180°C/350°F/gas mark 5 for 15 minutes.
These biscuits could be eaten after a meal or sent home with the children.
Fruit Salad
A winter fruit salad is a delicious quick and easy snack for the children to
make:
Ingredients for Fruit Salad:
4 ripe pears
3 bananas
6 tangerines
4 apples
Method:
Squeeze the juice and flesh from the tangerines. Chop the fruit into the juice
and mix together.
38 Food for Religious and Cultural Celebrations Nutrition & Oral Health

14: FOOD FOR PARTIES
A party is a time of great excitement and is the celebration of a happy
occasion. The quality of food at a nursery or childminders’ party should be as
high as it would normally be at any time.
Staff should use this opportunity to encourage children to continue to follow
the healthy eating patterns already in place. It is important to explain to
parents that the nursery has adopted a healthy eating policy. Instead of
sweets, encourage parents to provide fruit treats for the children.
Remember that it is important that the special occasion should look special.
Use visual tricks and keep to the healthy ingredients! Use strips of coloured
crepe paper, streamers and fancy drinking straws. The children could design
their own placemats in advance. Food can be attractively presented with
colours matching paper plates. There are many healthy foods that are ideal for
party times.
Birthdays are often celebrated in nursery or childcare. In a large nursery, there
could be several birthdays in one week and traditionally parents may provide a
birthday cake for their child to share. Many cakes are high in sugar and fat, so
as a healthier alternative, staff could arrange for the child celebrating a
birthday to take a small cake home instead. Birthdays can be celebrated in
other ways, for example, receiving a card, blowing out candles on a pretend
cake or wearing a birthday crown.
Breads
• Wholemeal, granary or multigrain bread.
• Malted, brown or white bread.
• Bagels, muffins or croissants.
• Tortilla wraps or pitta pockets.
• Crusty bread with sesame or poppy seeds.
• Finger rolls or baps.
Sandwich Fillings
Make interesting sandwiches using bread cut into various shapes. Try different
fillings. Here are a few suggestions:
• Tinned fish such as tuna, mackerel, pilchards and sardines.
• Grated cheese with cucumber or pickle.
• Roast beef and tomato slices.
• Cottage or cream cheese with pineapple.
• Thinly sliced ham and mustard.
• Hummus with grated carrot.
• Wafer thin turkey and coleslaw.
• Mashed banana.
• Chopped chicken in mayonnaise with mango or celery.
Strategy into Practice in the Early Years
Food for Parties 39

Make face-shaped sandwiches using circular cutters, fromage frais,
pasteurised curd cheese or sunflower spread as a base and add raisins,
sultanas, sliced or chopped vegetables for features.
Finger Foods
Children love finger foods. Try these served with healthy dips:
• breadsticks,
• pitta bread strips,
• cheese sticks,
• carrot batons,
• celery strips,
• courgette sticks,
• cucumber sticks,
• pepper batons.
Accompanying dips could include:
• Fish paté – this is quick and easy, just mix some mackerel or tuna with some
cottage or cream cheese.
• Curd cheese on its own or mixed with fromage frais and lemon juice.
• Cooked carrot mashed with orange juice.
• Avocado.
• Mayonnaise mixed with a little tomato ketchup.
Sweet Dishes
Try to avoid commercially produced party foods as these may be high in fat
and sugar. Instead offer healthier options:
• Banana bread or carrot cake (some cakes contain nuts, which may cause an
adverse reaction in a small number of children).
• Make lollipops by freezing yoghurt with fruit in plastic cups with a spatula in
each one.
• Dried fruit or dried fruit salad.
• Serve a Greek-style fruit salad – satsuma segments, pineapple wedges, small
bunches of seedless grapes, mango slices and bananas.
• Sugar-free jellies, frozen bananas on a stick, melon balls.
• Fruit kebabs.
Drinks
Parties may be a time when you decide to offer drinks other than milk or water.
• Diluted fresh fruit juice – orange, apple, grapefruit, pineapple or
mixed juices (one part juice to one part water).
• Nursery ‘punch’ – diluted concentrated pear juice with fresh lemon – gives a
lemonade-like flavour.
• Nursery Gluwein – as above, but using warm water. Serve in large bowls
with lemon slices as a winter treat.
• Fruit smoothies with bananas, fruit in natural juices e.g. tinned peaches or
pears, or fresh fruit in season such as raspberries or strawberries.
40 Food for Parties Nutrition & Oral Health

15: RECIPE IDEAS FOR PARENTS
Recipes in this section are based on adult portions and are intended for family
meals.
CHICKEN NOODLE SOUP (Serves 4)
2 chicken breasts
Marinade:
4 tbsp soy sauce 2 pints (1.2 litres) chicken stock
2 tsp sesame oil 8 oz (200 g) egg noodles
1 tsp grated fresh ginger 6 oz (150 g) frozen or canned
2 tbsp honey sweetcorn
1 clove garlic, crushed 6 spring onions, chopped
Method
Slice the chicken in half to make 4 thin fillets. Mix all the ingredients for the
marinade together and marinate the chicken for 30 minutes in the fridge.
Bring the stock to the boil, then reduce the heat and poach the chicken for
about 8 minutes. Remove the chicken and reserve the stock. Chop the chicken
as finely as possible. Cook the noodles until soft. Stir the sweetcorn, spring
onions and any remaining marinade into the stock. Bring to the boil, then add
the shredded chicken and noodles and heat through thoroughly.
CARROT & POTATO SOUP (Serves 4–5)
1 large onion, chopped ½ tbsp chopped parsley
2 medium potatoes, peeled and diced 2 pints (1.2 litres) vegetable stock
3 medium sized carrots, scraped and Black pepper
chopped
Method
Chop and prepare all the vegetables. Place in a large pan and add pepper
and parsley. Pour in the stock, bring to the boil and leave to cook over a low
heat, partly covered, for 30–40 minutes or until the vegetables are soft and
tender. Puree three quarters of the soup. With the remainder of the soup
reheat gently, taking care not to let the soup come to the boil.
Strategy into Practice in the Early Years
Recipe Ideas for Parents 41

PITTA POCKETS (Serves 2)
4 oz (100 g) cottage cheese
2 oz (50 g) cheddar cheese, grated
1 stick celery finely chopped
2 spring onions, sliced
half a 7 oz (198 g) tin sweetcorn and peppers
2 pitta bread
Method
Lightly brown pitta bread under grill until softened and warm. Then cut in half
and open to make a pocket. Leave to cool. In a bowl, mix together cottage
cheese, cheddar cheese, celery, spring onions, and sweetcorn. Divide mixture
between pitta pockets.
BAKED JACKET POTATOES (Allow 1 large potato per person)
Method
Preheat oven to 220ºC/425ºF/gas mark 7. Scrub and prick 2 or 3 times with a
fork. Place on a tray in preheated oven (if no tray, just place on centre rack in
oven). Bake until tender when gently pressed (time will vary from about 1 to
1½ hours depending on size). Remove from oven and cut a large cross on top
of potato. Squeeze gently to enlarge cut. Serve hot with one of the fillings
suggested below (or make 2 or 3 if cooking for several people).
Ideas for fillings:
cottage cheese and peach or pineapple
baked beans
grated cheddar cheese and chopped tomato/ham/onion
coleslaw
chilli
Microwave Method
Prick the potatoes with a fork then place on kitchen paper in the microwave
oven. Cook on high, turning them over halfway through cooking until soft
when gently squeezed. One potato will take 4–6 minutes, two will take 6–8
minutes, and four will need 10 or 12 minutes, depending on the wattage of
the microwave.
42 Recipe Ideas for Parents Nutrition & Oral Health

STIR-FRIED BEEF (Serves 4)
2 tbsp sesame oil
1 clove garlic
1 large carrot, cut into matchsticks
1 courgette, cut into matchsticks
1 yellow pepper, cut into matchsticks
1 red pepper, cut into matchsticks
1 lb (450 g) beef, cut into strips
1–2 tbsp cornflour
10 fl oz (300 ml) beef stock
3 tsp brown sugar
3 tbsp soy sauce
Method
Heat the oil and stir-fry the garlic, carrot, courgette and pepper for 5 minutes.
Add the beef and continue to stir-fry for a further 5 minutes. Mix the cornflour
together with a tablespoon of water and stir into the beef stock. Stir this into
the pan and then add the sugar and soy sauce. Simmer gently until slightly
thickened. Serve with rice.
PAN-FRIED PIZZA (Serves 2)
4 oz (100 g) 1 heaped yoghurt pot wholemeal plain flour or 1 pot half
wholemeal, half plain flour
½ tsp baking powder
½ tsp bicarbonate of soda
3 tbsp plain natural yoghurt
3 tbsp milk
1 tbsp sunflower or olive oil
8 oz (200 g) tin tomatoes, drained
4 oz (2 good slices) lean cooked ham chopped into squares
or mixed vegetables if you want a meat-free dish
large pinch mixed dried herbs (if you have it)
3 tbsp cheese, grated
(You can also do this in the oven which reduces the fat used)
Method
Put flour, baking powder and bicarbonate of soda into a bowl. Mix to a smooth
dough with the milk and the yoghurt. Knead lightly until smooth. Pat or roll out
into a circle about 8 inches (20 cm) across. Heat the oil in your frying pan.
Add the circle of dough and fry for 3 minutes quite gently. Turn it over and fry
the other side. Preheat grill on medium. Roughly chop the tomatoes and
spread over the dough almost to the edge. Place ham or vegetables evenly
over the tomatoes and sprinkle on the grated cheese and mixed herbs. Place
pan under the preheated grill for 3 or 4 minutes until the cheese is bubbly and
turning to a golden brown.
If baking, don’t fry the base. Instead have oven heated to 220ºC/400ºF/gas
mark 6. Add toppings and bake for 15–20 minutes.
Strategy into Practice in the Early Years
Recipe Ideas for Parents 43

KEDGEREE (Serves 5–6)
12 oz (300 g) smoked haddock
½ pint (300 ml) semi-skimmed milk
pepper for seasoning
1 tbsp sunflower or olive oil
2–3 medium sized onions, chopped
2 peppers, chopped
3 eggs, hard boiled and chopped
2 tsp curry powder, or to taste
8 oz (200 g) brown or white rice, cooked
Method
Cook the fish gently in the milk and pepper for 5–8 minutes. Drain and keep
the milk to one side. Heat the oil in a frying pan and add the chopped onions
and peppers. Fry for about 10 minutes or until the onions are golden brown.
Add the chopped boiled eggs and the cooked fish and fry for a few more
minutes. Add curry powder, mix through and cook for a few more minutes.
Add the cooked rice and mix in with the rest of the ingredients. Use the
remaining milk from cooking the fish to moisten, as desired.
CHICKEN CURRY (Serves 5)
1 tbsp sunflower or olive oil
2 carrots, grated
2 apples, chopped
2 medium onions, chopped
1 tsp ground coriander
1 tsp chilli powder
1 tsp curry powder
1 tbsp flour
¾ pint (450 ml) hot vegetable or chicken stock
1 tbsp sweet pickle or chutney
1 lb (400 g) cooked chicken meat, chopped
½ tbsp lemon juice
1 oz (25 g) sultanas
Method
Heat the oil in a pan and cook the carrots, apples and onions for about 8
minutes or until soft. Add the spices, mix well and continue to cook for 2–3
minutes. Add the flour, mix well and cook for 1 minute. Add the hot vegetable
or chicken stock and the sweet pickle or chutney, stir well and bring to the boil.
Add the cooked chicken meat, return to the boil and simmer for 5 minutes.
Add the lemon juice and sultanas. Stir well. Serve with brown or white rice, or
pitta bread.
44 Recipe Ideas for Parents Nutrition & Oral Health

LASAGNE (Serves 5)
10 oz (250 g) lean minced beef
3 medium sized onions, chopped
3 medium sized carrots, grated
3 sticks celery, finely chopped
1 clove of garlic, crushed
1 tsp mixed herbs
1 bay leaf
14 oz (400 g) tinned chopped tomatoes
1 tbsp tomato puree
1 ¾ pints (1 litre) white sauce
10 sheets pre-cooked lasagne
2 oz (50 g) grated cheese
For white sauce (makes 1 litre):
1 onion
2 bay leaves
1 ¾ pints (1 litre) semi-skimmed milk
1 oz (25 g) cornflour
1 tsp black pepper
Add the onion and bay leaves to the milk and bring to the boil. Set aside for
10 minutes, then remove the onion and bay leaves. Mix the cornflour with a
little cold water. Add to the milk gradually, stirring all the time. Add the pepper
and simmer for 5 minutes.
Method for lasagne
Preheat oven to 190ºC/375ºF/gas mark 5. Brown the mince in its own juices
then drain off excess fat. Add onions, carrots, celery, along with garlic, herbs
and bay leaves. Add the chopped tomatoes and tomato puree. Simmer for
20–25 minutes. Coat the bottom of an ovenproof dish with a little white sauce.
Layer up one third of the meat sauce, lasagne sheets and white sauce. Repeat
the layers twice more finishing with a layer of white sauce. Sprinkle with grated
cheese. Cook towards the top of the oven for 30–40 minutes, until bubbling.
Strategy into Practice in the Early Years
Recipe Ideas for Parents 45

VEGETABLE GOULASH (Serves 4)
1 tbsp (25 ml) sunflower or olive oil
1 large onion, chopped
2 large carrots, chopped
1 green pepper, seeded & chopped
1 red pepper, seeded & chopped
8 oz (200 g) mushrooms, wiped & chopped
2 medium potatoes, diced
4 tbsp (60 ml) tomato puree
14 oz (400 g) tinned tomatoes
14 oz (400 g) tinned kidney beans
2–4 tbsp (30–60 ml) natural yoghurt
pinch of paprika
Method
Heat the oil, add the onion, carrots, peppers and paprika, and fry gently until
soft. Add the mushrooms, cover and cook gently for 15 minutes. Add the
potato, tomatoes, tomato puree and kidney beans. Simmer for 30 minutes or
until potatoes and carrots are soft, adding extra water if necessary. Serve on a
bed of rice, with yoghurt spooned over the top.
LENTIL HOT POT (Serves 4)
1 tbsp (25 ml) sunflower or olive oil
2 onions, chopped
1 clove garlic, chopped or crushed
2 large potatoes, cubed
4 carrots, diced
2 celery sticks, chopped
12 oz (350 g) red lentils, washed
14 oz (400 g) tinned tomatoes
1 tbsp (25 ml) tomato puree
1 bay leaf
1 tsp dried oregano
1 pint (600 ml) vegetable stock
Method
Heat the oil and fry the onion and garlic until soft. Add the potatoes, carrots,
celery and lentils, and stir to coat the vegetables with the oil. Add the
tomatoes, tomato puree, oregano, and the bay leaf. Stir and add the
vegetable stock. Bring to the boil, cover and simmer gently for 40–45 minutes
or until the vegetables are soft. Remove the bay leaf. Serve with new potatoes
and green vegetables.
46 Recipe Ideas for Parents Nutrition & Oral Health

BUTTERBEAN & LEEK GRATIN (Serves 4)
1 tbsp (25 ml) sunflower or olive oil
3 medium leeks, chopped
1 small cauliflower, cut into florets
1 large onion, chopped
1 clove garlic, chopped or crushed
1 tbsp (25 g) plain flour
2 tsp ground coriander
4 fl oz (125 ml) milk
4 fl oz (125 ml) vegetable stock
14 oz (400 g) tinned tomatoes
14 oz (400 g) tinned butterbeans
3 oz (75 g) Cheddar cheese, grated
Method
Simmer the cauliflower and leeks together in a small amount of water until
tender (about 10–15 minutes). Meanwhile in another pan, heat the oil and
cook the onions and garlic until soft. Sprinkle the flour over the onion and
cook for about 3 minutes. Add the coriander and stir in the milk and stock to
form a smooth sauce, adding the tomatoes. Stir in the beans, tomatoes,
cauliflower and leeks and simmer for 15–20 minutes or until some of the liquid
has reduced. Transfer the mixture to an ovenproof dish and sprinkle with
cheese. Bake in the oven at 180°C/350ºF/gas mark 4 for 30 minutes.
Strategy into Practice in the Early Years
Recipe Ideas for Parents 47

VEGETABLE BURGERS (Makes 6)
9 oz (225 g) potatoes, chopped
1 tbsp (25 g) sunflower or olive oil
1 small onion, chopped
2 oz (50 g) broccoli florets, chopped into small pieces
3 oz (75 g) leek, chopped
3 oz (75 g) mushrooms, finely chopped
3 oz (75 g) carrot, grated
2 oz (50 g) frozen or canned sweetcorn
1 tsp soy sauce
2 oz (50 g) Gruyere or Cheddar cheese, grated
1 tsp dried parsley
small pinch cayenne pepper
1 oz (25 g) plain flour
2 eggs, beaten
5 oz (125 g) wholemeal breadcrumbs
Method
Boil the potatoes until tender, drain then mash. Heat the oil and gently fry the
onion, broccoli and leek until soft, then add the mushrooms. Add the carrots
and sweetcorn and cook for 5 minutes. Mix in the mashed potato, soy sauce,
cheese, parsley and pinch of cayenne pepper. Coat with flour, dip in the
beaten egg and then dip in the breadcrumbs. Dip in the egg again and coat
with another layer of breadcrumbs to make a crispy coating. Heat a small
amount of vegetable oil and shallow fry until crisp and golden on both sides.
Serve on buns with lettuce and tomato.
BREAD & BUTTER PUDDING (Serves 5–6)
6 slices of wholemeal bread, spread thinly with sunflower margarine
4 oz (100 g) mixed dried fruit
Mixed spice
2 large eggs
1 pint (568 ml) semi-skimmed milk
Method
Preheat oven to 375ºF/190ºC/Gas Mark 5. Cut the bread slices into triangles
or halves. Place a layer of bread, margarine side down, in an ovenproof dish
and sprinkle with half the dried fruit. Add a pinch of mixed spice. Add another
layer of bread, margarine side up, sprinkle with the rest of fruit and another
pinch of mixed spice. Add another layer of bread, margarine side up. Whisk
the eggs into the milk and pour over the bread. Leave for 30 minutes. Sprinkle
with spice then bake for 35–40 minutes until set.
48 Recipe Ideas for Parents Nutrition & Oral Health

FRUIT KEBABS (Makes 12)
1 melon, cut into chunks
2 oranges, cut into quarters, then halved again
1 tin pineapple cubes in natural juice, or fresh pineapple, chopped
3 kiwi fruit, quartered
12 strawberries
2 bananas, chopped
Skewers
Method
Thread chunks of fruit onto skewers. Arrange the skewers on a plate and
encourage everyone to take as much as they want.
SCONES (Makes 24)
3 oz (75 g) sunflower margarine
1 lb (400 g) self-raising flour
½ pint (250 ml) semi-skimmed milk
Milk to glaze
Method
Preheat oven to 230ºC/450ºF/Gas Mark 8. Rub the margarine into the flour
until it resembles fine breadcrumbs. Make a well in the centre and stir in
enough milk to give fairly soft dough. Turn onto a floured board, knead very
lightly then roll out to about 2 cm thick, or pat it out with your hands. Cut out
the scones with a medium sized cutter. Place on a baking sheet, brush with
milk and bake near the top of the oven for about 10 minutes, until brown and
well risen.
Fruit Scones
Add 1 tbsp of castor sugar and 4 oz (100 g) currants, sultanas, raisins,
chopped dates, or cherries, or a mixture of fruit, after rubbing margarine into
the flour.
Cheese Scones
Add 3 oz (75 g) of grated cheese and 1 tsp of dry mustard to the dry
ingredients. Sprinkle with a little cheese after glazing.
Wholemeal Scones
Use 12 oz (300 g) self-raising wholemeal flour with 4 oz (100 g) plain flour.
Add 1 tsp of baking powder to the dry ingredients.
Strategy into Practice in the Early Years
Recipe Ideas for Parents 49

APPLE AND RAISIN MUFFINS (Makes 6)
2 oz (50 g) plain wholemeal flour
3 oz (75 g) unbleached plain flour
1 tsp baking powder
2 oz (50 g) sunflower margarine
4 tbsp skimmed milk
1 tsp ground cinnamon
pinch of salt
2 eggs
2 eating apples, peeled, cored and grated
2 oz (50 g) raisins
6 paper cake cases
Method
Beat together 50 g plain wholemeal flour, 75 g unbleached plain flour, 1 tsp
baking powder, 50 g sunflower margarine, 4 tbsp skimmed milk, 1 tsp ground
cinnamon, pinch of salt and 2 eggs. Stir in 2 eating apples (peeled, cored &
grated) and 50 g raisins. Spoon into 6 paper cases or a muffin tin and bake at
200ºC/400ºF/Gas Mark 6 for 25 minutes or until an inserted skewer comes out
clean. Cool on a rack for 10 minutes before serving while still warm.
The recipes in this section are adapted from a variety of publications:
Just For Starters – HEBS & Edinburgh Community Food Initiative, 1999
Hassle Free Food – NHS Health Scotland, 2006
Baby & Child Vegetarian Recipes, Carol Timperley, Ebury Press, London 1997
Superfoods for Babies and Children, Annabel Karmel, Ebury Press,
London 2001
50 Recipe Ideas for Parents Nutrition & Oral Health

The Age of Independence
Making the Most of Mealtimes
16–17

16: THE AGE OF INDEPENDENCE
Ask parents or staff at any nursery or childminders and they will know at least
one child who:
• examines the tuna sandwich before they eat it;
• accepts toast only if it has the crusts cut off;
• agrees to one bite of broccoli today and maybe two tomorrow;
• loves carrots at the nursery but not at home;
• insists on apple cut into slices not whole;
• drinks milk only if they can pour it into the cup; or
• says “I don’t like it” before even trying a new food.
Sound familiar? While extremely frustrating for parents and staff, be reassured
that these are all part of a child’s normal development!
At this age children are naturally curious and like to experiment, especially
with new foods. This inquisitiveness can help them to learn by seeing,
touching, smelling and tasting food. By age 2 most children have discovered
that they can decide whether they want to eat or not and that they can easily
control a whole mealtime! Again, these whims are normal and should be seen
as part and parcel of children gaining independence. Two and three year-olds
like routine. They prefer meals and snacks at regular times every day, in
familiar surroundings. This is why many insist on having their own cup or
plate, or food cut into certain shapes or the same food every lunchtime.
By age four or five, children like to help choose food when shopping and
then help prepare and serve it. They may be more likely to try different foods,
especially if their friends or family eat them too. From an early age children
pick up, often subtle, messages about how others view food and attitudes
to eating.
When hungry, children will focus on eating but, once satisfied, their attention
begins to wander. Playing with their spoon or watching others becomes more
interesting than finishing their meal or snack. Although parents may express
concern that a child is a slow eater, reassure them that children at this stage
have a short attention span and easily lose interest in any activity.
Strategy into Practice in the Early Years
The Age of Independence 51

17: MAKING THE MOST OF MEALTIMES
Staff and parents can be positive role-models and play an important part in
the development of a healthy lifestyle for children. Very young children who
are not mobile and cannot vocalise their needs depend on carers to make
healthy choices for them. As they grow older, children develop independence
and can start to make their own choices, so it is essential that they receive
healthy messages early in life.
• Make mealtimes sociable. Sit with children as a group or family during
meals or snacks – it’s a nice time to chat and talk about likes and dislikes,
or, involve the children in the preparation of the snack.
• A ‘rolling’ snack is now offered in the nursery setting to encourage
independence. As part of this, children help to prepare the snack and then
can approach the snack table when they feel hungry.
• Children will imitate important people in their life – this applies to eating and
drinking habits – so be a good role-model.
• Make mealtimes relaxed and calm by avoiding distractions such as television
and toys.
• Try not to hurry children to eat. They are still learning to master cutlery,
chew properly and explore new tastes and textures.
• Encourage children to try all the food offered to them; they will develop new
tastes as they experiment and will get a more balanced diet if they eat a
wide range of foods.
• Encourage good table manners as it will lead to pleasant mealtimes and
develop self-esteem.
• Be patient. Children need repeated exposure to an unfamiliar food in order
to learn to accept it and eat it. If an unfamiliar food is refused, use gentle
encouragement, but do not force a child to eat. If, after encouragement, the
food is still refused, take the food away without comment or a fuss – it can
be offered again at a later date.
• Remember, any food fads are not likely to last any longer than a couple of
weeks, so keep trying every so often with foods that have previously been
refused. Try to remain as relaxed as you can when a child refuses food or a
meal to avoid mealtimes becoming a battle of wits! Be reassured that most
children will come to no harm by a temporary food fad even if their intake
seems limited and often quite bizarre.
• Present the food in different ways, for example, offer vegetables raw instead
of cooked, cut vegetables into different shapes e.g. carrot sticks or cubes
instead of circles.
• Avoid using foods as rewards, for example withholding a dessert until all the
vegetables are eaten may establish a preference for the dessert and a dislike
of vegetables.
• Praise children when they try new foods.
• Whilst encouraging children to enjoy all food, remember they will have their
own likes and dislikes, so respect individual preferences.
• Aim to give meals and snacks at regular times as much as possible.
• Remember that breakfast is a very important mealtime and gives children a
good start to the day.
52 Making the Most of Mealtimes Nutrition & Oral Health

Happy Healthy Smiles
On the Move
18–19

18: HAPPY HEALTHY SMILES
Dental decay is the most common childhood disease, but it is also largely
preventable. In Lanarkshire, on average, half of children have had tooth
decay by the age of five years.
The Scottish Government target states that by the year 2010, 60% of five yearolds
should be decay free.
Although tooth decay can affect any child, those in the following groups are
most likely to be affected:
• Children living in more deprived areas.
• Children from low income families.
• Children from ethnic minority backgrounds.
In Lanarkshire, approximately 1100 children every year receive a general
anaesthetic (gas) for tooth extraction and over half of these are aged between
three and five. Tooth decay is the single most common reason for admitting a
child to hospital in Lanarkshire for a general anaesthetic. As general
anaesthetics carry some degree of risk, it is extremely important to try to
reduce the numbers of children receiving them.
Why do children’s baby teeth (deciduous teeth) decay?
Tooth decay occurs because sugars from the diet mix with plaque bacteria
(plaque is a sticky substance on the surface of the teeth) to form an acid. This
rots the tooth surface. This process is known as demineralisation.
If sugar is eaten often during the day, a greater amount of acid is produced
and the tooth will decay. The tooth will have to be checked by a dentist who
will decide whether to fill the cavity or remove the decayed tooth.
Strategy into Practice in the Early Years
Happy Healthy Smiles 53

Prevention of tooth decay
There are no hard and fast rules about how many sugar intakes per day will
be safe for teeth. The best advice is to reduce the amount of sugar consumed
and the frequency of sugar intakes and limit sugar-containing foods and drinks
to mealtimes. Mealtimes are regarded as the ‘safest’ time. When children are
snacking between meals, ensure these snacks are healthy and tooth friendly
(see earlier section on drinks and snacks at home or in nursery).
Toothbrushing
It is recommended that teeth should be brushed as soon as the first tooth
appears in the mouth, using a soft baby toothbrush and a smear of fluoride
toothpaste. Regular brushing morning and night is a good habit to establish
from an early age.
Fluoride toothpaste will help to strengthen the outer layer of the tooth
(enamel) and make it more resistant to acid. It also helps to repair the tooth
surface, but this will only work properly if a hole in the tooth is very small.
It is important that parents and carers help children to brush their teeth until
the child reaches the age of seven. Until then, most children are not able to
brush really well. Regular toothbrushing starting at a young age establishes a
good habit that will hopefully continue well into adulthood.
A smear (for baby) or a pea sized (from age two) amount of toothpaste should
be applied by a parent or carer. There is no need to use water and after
brushing the child should spit out the extra toothpaste but not rinse the mouth
– ‘spit don’t rinse’. Brushes should be rinsed afterwards with water.
It is recommended in Scotland that children use the family toothpaste.
The fluoride content should be at a concentration of at least 1000 parts per
million (ppm).
Toothbrushing in Early Years
Toothbrushing at the childminder’s home or in nursery and primary is an ideal
way to develop a good habit in young children. It also ensures fluoride is
applied to the surfaces of baby teeth daily.
54 Happy Healthy Smiles Nutrition & Oral Health

The aim of the toothbrushing programme is to:
• Influence behaviour and teach children a life skill.
• Establish a regular toothbrushing routine and apply fluoride to the enamel
surface of the teeth daily.
The children are taught by an Oral Health Educator to identify their toothbrush
by colour and animal symbol and how to brush their teeth well. Daily
supervision of the toothbrushing is then taken over by the nursery or primary
school staff, with periodic visits from the Oral Health Educator for support and
reinforcement. As part of the programme, standards are set nationally and
monitored on a regular basis.
The Salaried Primary Care Dental Service has a team of Oral Health
Educators who are employed to implement and monitor the toothbrushing
programme. They work very closely with nurseries and primaries and offer
professional advice on matters relating to healthy eating and oral health.
If you would like further details contact the Head of Oral Health Education on
01698 727861.
Fluoride
Fluoride helps strengthen the tooth enamel and gives protection from the
effects of plaque acid. Always check the toothpaste contains fluoride.
Children who are at high risk of tooth decay may be helped by fluoride
supplements. The Dentist can give advice on the use of fluoride drops or
tablets for some children. Other fluoride treatments can also be given during
dental visits.
Regular Dental Visits
It is important to promote regular dental visits from an early age, to begin a
healthy habit. Every child in NHS Lanarkshire born on or after 1st January
2005 can access the Childsmile Practice programme. Families are encouraged
and supported to attend the dental practice as part of this programme for
advice on keeping the child’s teeth healthy. As the child gets older, additional
preventive care such as fluoride varnish and fissure sealants are available.
Regular dental visits ensure that:
• Parents receive appropriate advice on healthy eating.
• Any signs of dental disease are recognised early.
• The child gets used to visiting the dental surgery.
Strategy into Practice in the Early Years
Happy Healthy Smiles 55

Teething
Baby teeth usually start appearing at around the age of 6 months. The signs
to look for are:
• dribbling;
• red cheeks;
• biting or chewing anything near the mouth;
• going off food; and
• obvious discomfort.
What should you do?
Sometimes teething pain can be helped by simply rubbing the gums with a
clean finger to help relieve the pressure. Teething gels and liquids may help.
Your local Pharmacist will give advice on sugar-free pain relief if necessary.
A cool, water-filled teething ring may also help to soothe. This should be kept
in the fridge – do not freeze it. Baby drinks are not suitable as they often
contain sugar. Offer something hard like a carrot stick to chew.
Drinking Cups
Drinking from a feeder cup should be encouraged from approximately six
months and the child should be weaned off a feeding bottle ideally from the
age of one year. No drinks, other than milk or water, should be given in a
bottle. Milk or water are the only drinks that should be offered between meals.
At mealtimes pure fruit juice (one part juice to one part water) or well-diluted,
no added sugar squash (one part juice to eight parts water) can be given.
Fizzy drinks, ‘diet’ or otherwise, are not recommended as these can contain a
high amount of sugar and/or acid. Using a straw can help to limit damage
caused by frequent drinks.
Dummies
Dummies can give relief and help to comfort a distressed child. Once the child
is asleep, remove the dummy. There are ‘good’ dummies and ‘bad’ dummies.
The good ones should have a small teat, which is flat in shape, as this does
not cause distortion of the mouth or palate. The shield or plastic rim should be
shaped, with ventilation holes, which prevent soreness around the mouth. DO
NOT dip the dummy into any sweet substances such as jam or honey, as this
will cause the teeth to decay. Ideally dummies should be discarded before the
age of three years.
Medicines
Children needing regular medicines should be under the care of a Dentist,
who will offer preventive advice and treatments as necessary. Parents and
carers should always request a sugar-free type. Almost all medicines supplied
today are available in a sugar-free form. Children on long-term medication
who are prescribed medicines with sugar in them can suffer very high levels of
tooth decay. Using a straw can minimise the damage to teeth.
56 Happy Healthy Smiles Nutrition & Oral Health

Sugars in foods and drinks
Parents should be advised to look out for the hidden sugars in foods and
drinks. The common ones are sucrose (refined from beet and cane), glucose,
maltose (from many foods) and fructose (from fruit).
The following sweeteners are added to some foods and drinks during
processing and have the potential to cause tooth decay:
Dextrose
Invert Sugar
Glucose
Lactose
Glucose Syrup
Maltose
Hydrolysed Starch
Sucrose
Fructose
Also, look out for the following products, which are basically a mixture of
sugars:
Brown Sugar Treacle
Maple & Golden Syrup Honey
Strategy into Practice in the Early Years
Happy Healthy Smiles 57

19: ON THE MOVE
The importance of physical activity in the under-fives
There’s more to healthy living than food! It is important that healthy eating
and active living are promoted. Research indicates that active children are
more likely to become active adults.
Young children are naturally active and enjoy physical activity through play;
this enthusiasm needs to be encouraged. A multitude of evidence illustrates
the many benefits to people if they maintain an active lifestyle.
Consistent physical activity in the early years is paramount for healthy growth.
Research suggests it helps prevent weight gain, promotes positive mental
health, and helps support social development. It is essential to embed positive
attitudes, skills and behaviours for lifelong physical activity and health. Many
children are spending more and more of their time in less active pursuits
including watching TV or playing computer and video games. These particular
pastimes can contribute to the development of childhood and adult obesity,
associated heart disease, teenage and adult depression and diabetes.
The UK Physical Activity Guidelines are currently being reviewed and although
the recommendations from the Physical Activity Task Force in Let’s Make
Scotland More Active (2003) are wholly still relevant, the new guidelines
Making the Case for UK Physical Activity Guidelines (2009) are expected to
go further. They differentiate the appropriate amount and type of physical
activity for different age groups: infants, pre-school children, children and
young people.
Infants
Infants should be encouraged from birth to be physically active on a daily basis
through floor based play in a safe environment. Sedentary behaviours should
be discouraged and time spent participating in sedentary activities should be
limited. Sedentary activities, such as the time in a high chair, small play pen or
pram, should be limited to no longer than one hour at a time.
58 On the Move Nutrition & Oral Health

Pre-school children
Pre-school children should be participating in daily physical activity for at least
180 minutes per day and this should be accumulated in smaller bouts
throughout the day. The activity should be at least light intensity but include
periods of more energetic activity. Again, sedentary behaviours should be
discouraged and time spent participating in sedentary activities should be
limited. Sedentary activities such as time spent in small play pen, pram,
watching television or playing video games should be limited to no longer than
one hour at a time.
Encouraging physical activity
On a daily basis there are a range of activities involving exercise, sports,
outdoor activities, play and dance that can be implemented to enhance and
encourage natural physical activity. Role-play amongst peers within the nursery
outdoor area or school playground or walking with an adult to nursery or the
shops are examples of integrating physical activity into everyday life.
It is also important to remember that young children cannot be expected to
follow an adult pattern of physical activity. Young children find balancing more
difficult, are less strong, and have shorter arms and legs in relation to the rest
of their bodies. They are not ready to carry out complicated movements that
involve many parts of their body such as catching a ball. Children under five
years also find rules and teamwork difficult to follow. It is important to help
children do things in ways they are currently physically capable of.
Play @ home is a series of three books aimed at encouraging children under
five years to start physical activity early and stay active for life. Each book
includes ideas and activities suitable for the child’s developmental stage and,
although aimed at parents, is packed with ideas that can also be used to
encourage physical activity in the nursery or childminder setting. Play @ Home
was developed by Fife Council Education Service and NHS Fife. Book One
covers babies from birth to one year, Book Two covers toddlers from one to
three years and Book Three the pre-school child from three to five years.
Copies of these books are available in the Health Improvement Library.
Strategy into Practice in the Early Years
On the Move 59

60 On the Move Nutrition & Oral Health

Curriculum Links
Working in Partnership
Parent Prompts
Topic Sacks
20–23

20:
CURRICULUM LINKS
Curriculum for Excellence
Since 2002 the Scottish Government has been working to improve the
curriculum in Scotland. Curriculum for Excellence provides a framework for
education for children and young people from 3–18 years old.
This resource is designed to help staff achieve a number of the experiences
and outcomes within the curriculum and aims to contribute to the
development of children as successful learners, confident individuals,
responsible citizens and effective contributors: the 4 capacities of Curriculum
for Excellence (CfE). In order to achieve these capacities, Learning and
Teaching Scotland has established 7 principles of curriculum design: Challenge
and Enjoyment; Breadth; Progression; Depth; Personalisation and Choice;
Coherence; and Relevance.
The following diagram shows the capacities and the linked overarching aims
from the health and wellbeing indicators.
Capacities of the Curriculum
successful learners
with
> enthusiasm and motivation for learning
> determination to reach high standards of
achievement
> openness to new thinking and ideas
and able to
> use literacy, communication and numeracy skills
> use technology for learning
> think creatively and independently
> learn independently and as part of a group
> make reasoned evaluations
> link and apply different kinds of learning in new
situations
confident individuals
with
> self-respect
> a sense of physical, mental and emotional
wellbeing
> secure values and beliefs
> ambition
and able to
> relate to others and manage themselves
> pursue a healthy and active lifestyle
> be self-aware
> develop and communicate their own beliefs
and view of the world
> live as independently as they can
> assess risk and take informed decisions
> achieve success in different areas of activity
To enable all young people to become:
responsible citizens
with
> respect for others
> commitment to participate responsibly in
political, economic, social and cultural life
and able to
> develop knowledge and understanding of the
world and Scotland’s place in it
> understand different beliefs and cultures
> make informed choices and decisions
> evaluate environmental, scientific and
technological issues
> develop informed, ethical views of complex
issues
effective contributors
with
> an enterprising attitude
> resilience
> self-reliance
and able to
> communicate in different ways and in different
settings
> work in partnership and in teams
> take the initiative and lead
> apply critical thinking in new contexts
> create and develop
> solve problems
Strategy into Practice in the Early Years
Curriculum Links 61

Health and Wellbeing is only one of the curriculum areas within Curriculum for
Excellence. However, establishments will have the freedom to address Health
and Wellbeing within the other 7 curriculum areas. These are Sciences,
Languages, Mathematics, Expressive Arts, Social Studies, Technologies, and
Religious and Moral Education.
The suggested learning contexts on the following pages highlight the cross
curricular links that could be explored under each of the eight curriculum
areas. Each demonstrates several of the Health and Wellbeing experiences and
outcomes under the following three broad headings of Physical Play, Nutrition
and Oral Health.
62 Curriculum Links Nutrition & Oral Health

Suggested Learning Context: Physical Play
Area of Curriculum
Health and Wellbeing
CfE Experience(s)/Outcome(s)
• In everyday activity and play,
I explore and make choices to
develop my learning and interests.
I am encouraged to use and share
my experiences.
HWB 0-19a
• I am enjoying daily opportunities
to participate in different kinds
of energetic play, both outdoors
and indoors.
HWB 0-25a
Area of Curriculum
Numeracy and Mathematics
CfE Experience(s)/Outcome(s)
• In movement, games, and using
technology I can use simple
directions and describe positions.
MTH 0-17a
Area of Curriculum
Language (Literacy and English)
CfE Experience(s)/Outcome(s)
• I listen or watch for useful or
interesting information and I use
this to make choices or learn
new things.
LIT 0-04a
• As I listen and take part in
conversations and discussions,
I discover new words and phrases
which I use to help me express my
ideas, thoughts and feelings.
LIT 0-10a
Area of Curriculum
Social Studies
CfE Experience(s)/Outcome(s)
• I make decisions and take
responsibility in my everyday
experiences and play, showing
consideration for others.
SOC 0-17a
• Within my everyday experiences
and play, I make choices about
where I work, how I work and who
I work with.
SOC 0-18a
Strategy into Practice in the Early Years
Curriculum Links 63

Suggested Learning Context: Baking Experience
Area of Curriculum
Health and Wellbeing
CfE Experience(s)/Outcome(s)
• Together we enjoy handling, tasting,
talking and learning about different
foods, discovering ways in which
eating and drinking may help us to
grow and keep healthy.
HWB 0-30a
• I explore and discover where foods
come from as I choose, prepare
and taste different foods.
HWB 0-35a
Area of Curriculum
Technologies
CfE Experience(s)/Outcome(s)
• Throughout my learning I share my
thoughts with others to help further
develop ideas and solve problems.
TCH 0-11a
• Through discovery, natural curiosity
and imagination, I explore ways to
construct models or solve problems.
TCH 0-14 a
Area of Curriculum
Language (Literacy and English)
CfE Experience(s)/Outcome(s)
• As I listen and talk in different
situations, I am learning to take
turns and am developing my
awareness of when to talk and
when to listen.
LIT 0-02a
• As I listen and take part in
conversations and discussions,
I discover new words and phrases
which I use to express my ideas,
thoughts and feelings.
LIT 0-10a
Area of Curriculum
Social Studies
CfE Experience(s)/Outcome(s)
• I make decisions and take
responsibility in my everyday
experiences and play, showing
consideration for others.
SOC 0-17a
• In real-life settings and imaginary
play, I explore how local shops and
services provide us with what we
need in our daily lives.
SOC 0-20a
64 Curriculum Links Nutrition & Oral Health

Suggested Learning Context:
Role Play – at the Dentist
Area of Curriculum
Health and Wellbeing
CfE Experience(s)/Outcome(s)
• I am developing my understanding
of the human body and can use
this knowledge to maintain and
improve my wellbeing and health.
HWB 0-15a
• In everyday activity and play,
I explore and make choices to
develop my learning and interests.
I am encouraged to use and share
my experiences.
HWB 0-19a
Area of Curriculum
Sciences
CfE Experience(s)/Outcome(s)
• I can identify my senses and
use them to explore the world
around me.
SCN 0-12a
Area of Curriculum
Language (Literacy and English)
CfE Experience(s)/Outcome(s)
• As I listen and talk in different
situations, I am learning to take
turns and am developing my
awareness of when to talk and
when to listen.
LIT 0-02a
• Within my real and imaginary
situations, I share experiences
and feelings, ideas and information
in a way that communicates
my message.
LIT 0-09a
Area of Curriculum
Social Studies
CfE Experience(s)/Outcome(s)
• I make decisions and take
responsibility in my everyday
experiences and play, showing
consideration for others.
SOC 0-17a
• Within my everyday experiences
and play, I make choices about
where I work, how I work and who
I work with.
SOC 0-18a
Strategy into Practice in the Early Years
Curriculum Links 65

21: WORKING IN PARTNERSHIP
Children enter nursery and childcare with varying degrees of abilities,
knowledge and experiences. Parents and carers are the prime educators of
their children and the nursery or childcare setting provides an extension to the
child’s home life. This is an important factor to remember when promoting
healthy habits. Working in a respectful partnership with parents, other
agencies, and children, in identifying needs and support, is key to a successful
partnership. Some of the professionals who can offer support are listed within
this pack.
The unique relationship staff have with children and parents provides a good
foundation for the promotion of healthy choices. Working in partnership with
parents can be achieved in many ways and below are a few suggestions.
Parent helpers
Parents can help with snacks and
promoting healthy messages.
Baby & child feeding diary To provide parents with information on
their child’s eating habits.
Parent enrolment day
Healthy choice displays, pre-entry
information including personal dietary
information.
Parents evenings/open days Consider parent activities that would
increase parents’ awareness of healthy
habits, and children’s self-help skills.
Parent groups using story sacks Story sacks on healthy choices.
Parent workshops
Workshops focusing on establishing
healthy habits.
Parent newsletters & focus leaflets Sharing information on healthy choices
within the curriculum (sample leaflets are
within the pack).
Promotional events For example, National Smile Month –
promoting good oral health habits, or
develop your own focus, for example
Low Salt week.
Snack & Lunch menu
Displayed for parents to view.
66 Working in Partnership Nutrition & Oral Health

Display boards
Fundraising opportunities
Use to display health promotion materials
or showcase health promotion events or
campaigns.
Encourage parents to continue to
promote the positive health messages
embedded in the nursery.
Strategy into Practice in the Early Years
Working in Partnership 67

22: PARENT PROMPTS
This section contains four ‘Parent Prompt’ leaflets:
• Helpful Hints for Healthy Habits – A Healthy Diet
• Helpful Hints for Healthy Habits – Making the Most of Mealtimes
• Helpful Hints for Healthy Habits – Happy Healthy Smiles
• Helpful Hints for Healthy Habits – Hygiene & Handwashing
The leaflets can be photocopied and given to parents when children are
learning about these topics in the nursery or childcare setting. Nurseries and
childminders can develop their own leaflets to add to this list.
68 Parent Prompts Nutrition & Oral Health

A Healthy Diet
Helpful Hints For Healthy Habits
Strategy into Practice in the Early Years
Parent Prompts 69

Healthy eating doesn’t mean missing out all the
foods you enjoy. It is the balance of foods in our diet
that is the most important thing.
Encourage your child to eat as wide a range of foods
as possible.
Each day children should be encouraged to eat foods
from the four main groups:
• Bread and cereals: bread, rolls, potatoes, pasta,
rice, breakfast cereals.
Aim for one item at each meal.
• Fruit and vegetables: fresh, tinned, dried, frozen or
as juice.
Aim for four to five child-size servings each day. A
serving is the amount that can fit in a child’s hand.
• Meat and alternatives: beef, lamb, pork, chicken,
fish, eggs, pulses (beans, chickpeas, lentils), and
soya products.
Aim for two foods from this list each day.
• Milk and dairy products: milk, yoghurt, cheese,
fromage frais.
These should be included as part of most meals
and snacks.

Making the Most of Mealtimes
Helpful Hints For Healthy Habits
Strategy into Practice in the Early Years
Parent Prompts 71

As a parent you play an important part in
the development of a healthy lifestyle for
your child. Your child depends on you to
make the right choices for them. As they
grow older children develop independence
and learn to make their own choices, so it
is important that they learn healthy
messages early in life.
• Make mealtimes sociable and eat as
a family.
• Make mealtimes relaxed by avoiding
distractions such as television and toys.
• Don’t rush children when eating because
they are learning to master cutlery,
chew properly and explore new tastes
and textures.
• Be patient. Children need time to get
used to new foods. Use gentle
encouragement to try new foods but
don’t force a child to eat.
• Encourage children to try all the food
offered to them. They will get a more
balanced diet if they eat a wide range
of foods.
• Make food look attractive by using a mix
of colours, shapes and textures e.g.
carrot sticks instead of cubes or circles.

Childsmile is a national programme, funded by the
Scottish Government, designed to improve the dental
health of children in Scotland and reduce inequalities
both in dental health and access to dental services.
Further information is available on
www.child-smile.org.
Happy Healthy Smiles
Helpful Hints For Healthy Habits
Strategy into Practice in the Early Years
Parent Prompts 73

Snacks and Drinks
When the wee one wants to eat,
Try not to give them food that’s sweet;
It’s better to give instead
Vegetables, crackers, fruit or bread.
Keep puddings and sweets
as mealtime treats;
If used as a snack,
they will turn teeth black.
When they’re dry and want a drink
Don’t give juice, please stop and think,
Child or toddler, son or daughter
It’s best to stick to milk or water.
For happy, healthy smiles remember to:
• Brush teeth twice a day (last thing at night and
on at least one other occasion during the day)
with a smear or small pea-size amount of
fluoride toothpaste.
• Register your child with a dentist as soon as
possible after birth and attend twice a year.
• Limit sugary foods and drinks and give them
at mealtimes only.

Frequent hand washing is one of the single most
important things we can do to help to reduce the
spread of infections and prevent ill health. For
example, good hand hygiene in children will help to
prevent the spread of common communicable
infections such as colds and tummy bugs.
For more information on hand washing and
hygiene visit www.washyourhandsofthem.com and
click on Hand Hygiene and You or look for the
Children’s Pack.
Hygiene and
Handwashing
Helpful Hints For Healthy Habits
Strategy into Practice in the Early Years
Parent Prompts 75

Wash your hands with soap and water
Every single day,
Before you eat your food
Or when you’ve just been out to play.
Wash your hands with soap and water
Every chance you get,
If you’ve just used the toilet
Or touched or clapped your pets.
Don’t forget to wash your hands
If you should cough or sneeze,
Cause soap and water on your hands
Will help to stop disease.
Children learn by watching the adults around them.
They will do what you do.
Adults can set a good example by washing their
hands.
Remember always wash your hands:
• After going to the toilet or changing nappies
• After touching pets or handling rubbish
• Before preparing food or sitting down to eat

23: TOPIC SACKS
A number of topic sacks, each containing resources (books, games, puzzles,
jigsaws), have been developed to complement and support the key messages
contained within this pack.
These topic sacks are available for nurseries and childminders to borrow.
For nurseries in North Lanarkshire Council contact:
North Lanarkshire Education Resource Service, Clyde Valley High School,
Castlehill Road, Wishaw, ML2 0LS.
Tel: 01698 403510
For nurseries in South Lanarkshire Council contact:
Childcare Information Service, Early Years Development Team, Chatelherault
Primary School, Silvertonhill Avenue, Hamilton, ML3 7NT.
Tel: 01698 476745
For other groups or individuals contact:
NHS Lanarkshire Health Improvement Library, Law House, Airdrie Road,
Carluke, ML8 5ER
Tel: 01698 377600
Other children’s books recently distributed to nurseries as part of the Health
Promoting Nursery Award Scheme:
• Katie Morag and the New Pier.
• Katie Morag and the Tiresome Ted.
• Katie Morag and the Grand Concert.
• Gimme Five.
• Safe in the Sun.
Strategy into Practice in the Early Years
Topic Sacks 77

78 Topic Sacks Nutrition & Oral Health

Resources from Health Promotion
Useful Contacts & Further Reading
References
Appendices
24–27

24:
RESOURCES FROM HEALTH PROMOTION
NHS Lanarkshire’s Health Promotion Department has a well-stocked resource
library for use by anyone who lives, studies or works in the Lanarkshire area.
The library provides a full lending service of books, videos, teaching packs and
equipment on all aspects of health education and health promotion. In
addition, a range of leaflets and posters are also available to order free of
charge. Please note that orders take up to 10 working days for completion.
For further information or to check availability please contact the Health
Improvement Library on 01698 377600 (opening hours Mon – Fri 9am–5pm).
In addition to the topic sacks, there are a number of nutrition and oral health
materials available in the Health Improvement Library that are suitable for use
with children under five. Telephone or visit for further details.
Health Promotion Resources and Materials
Oral Health
• A variety of dental puppets.
• Jigsaw Toothbrush.
• Jigsaw Perfect Teeth.
• Jigsaw Dentist.
• Model Dental Glove Puppet –
animal puppets with brushable
teeth.
• Enlarged Toothbrush Model –
for use in conjunction with glove
puppets.
• Playmobil Dental Surgery.
• Big Mouth Keeping Teeth Healthy.
• Baby Buds Dental Models.
• Mini Molar Club Stamp and Ink
Pad.
Strategy into Practice in the Early Years
Nutrition
• British Diabetic Association Youth
Pack – under Fives – teaching
pack.
• British Dietetic Association – Give
Me 5 Activity Book.
• NHS Scotland – Adventures in
Foodland: Ideas for Making Food
Fun from an Early Age.
• Teddy’s Healthy Eating Club –
healthy eating for children 1–6 –
teaching pack with guidelines for
playgroup leaders, teachers and
childminders.
• The Eatwell Plate.
• Healthy Lunchbox.
• Healthy Food Bag.
• Artificial Food Box.
• Happy Healthy Mealtimes Topic
Sack.
Resources from Health Promotion 79

• Fruit and Vegetable Topic Sack.
• Happy Healthy Smiles Topic Sack.
• Healthy Food Bag Display.
• A Day’s Worth of Fat.
• Food Choices.
Pregnancy and Parenting
(including breastfeeding)
• Katie Morag and the Tiresome Ted
by Mairi Hedderwick (book).
• The New Baby by Anne Civardi &
Stephen Cartwright (book).
• That’s My Baby by Andrea Wayne
von Königslöw (book).
• The World Is Full Of Babies by Mick
Manning & Brita Granström (book).
• In A Minute by Tony Bradman &
Eileen Browne (book).
• Rosie’s Babies by Martin Waddell
and Penny Dale (book).
• Breastfeeding Jigsaw.
Hand Hygiene
Bug Buster Equipment –
handwashing should be common
practice within the nursery setting.
The Bug Buster Equipment enables
germs to be seen on the hands under
ultra violet light.
Leaflets and Posters
(L = leaflet; P = poster)
Nutrition
• Enjoy Fruit and Vegetables (L).
• Food for the Growing Years (1–5
year olds) (L).
• The Food Hygiene Handbook for
Scotland (L).
• A Guide to Between Meal Snacks
(L).
• The Eatwell Plate (L).
• Food Standard Agency Traffic
Lights (L).
• Guide to Food Labelling (L).
• Sugar Exposed (L).
• Food Allergy: What You Need to
Know (L).
Oral Health
• Teeth for Two (L).
• Contented Maybe for Now (L).
• It’s Never Too Early to Think About
your Baby’s Teeth (P).
Pregnancy and Parenting
(including breastfeeding)
• Getting Off to a Good Start
–Breastfeeding (L).
• Breastfeeding – Helpful Hints (L).
• Breastfeeding Mothers and Work –
A Guide for Employers (L).
• You’re Welcome to Breastfeed Here
(P).
• For a Night Off Breastfeeding Use
the Express (P).
• Who Breastfeeds Nowadays? (P).
• Breastfeeding-Friendly Campaign
(P).
• Breastfeeding: Had Lunch (P).
• Breastfeeding: Sang Happy
Birthday (P).
• Breastfeeding: Went for a Walk (P).
• For a Night Off Breastfeeding Use
the Express (P).
• Lunchtime and Not a Breast in
Sight (P).
DVDs
Nutrition
• Janey Junkfood’s Fresh Adventures.
Oral Health
• How to Protect Your Child’s Teeth.
• Harry at the Zoo – Promoting
Healthy Teeth.
• Harry’s Holiday.
• Molly and the Magic Lunchbox.
• Dental Care for Early Years Age
0–5.
• Dental Care for Children Age 3–12.
80 Resources from Health Promotion Nutrition & Oral Health

25: USEFUL CONTACTS & FURTHER READING
Local Contacts
Health Improvement Library
Law House
Airdrie Road
Carluke
ML8 5ER
Tel: 01698 377600
North Lanarkshire Education
Resource Service
Clyde Valley High School
Castlehill Road
Wishaw
ML2 0LS
Tel: 01698 403510
Childcare Information Service (NLC)
Kildonan Street
Coatbridge
ML5 3BT
Tel: 01236 812281
www.scottishchildcare.gov.uk
Childcare Information Service (SLC)
Chatelherault Primary School
Silvertonhill Avenue
Hamilton
ML3 7NT
Tel: 01698 476745
www.scottishchildcare.gov.uk
Environmental Services Department
(NLC)
Food Safety Section
Fleming House
2 Tryst Road
Cumbernauld
G67 1JW
Tel: 01236 616469
www.northlanarkshire.gov.uk
Environmental Services Department
(SLC)
Atholl House
Churchill Avenue
East Kilbride
G74 1LU
Tel: 0845 740 6080
www.southlanarkshire.gov.uk
Head of Oral Health Education
Salaried Primary Care Dental Services
Blantyre Health Centre
64 Victoria Street
Blantyre
G72 0BS
Tel 01698 727861
Lanarkshire Community Food and
Health Partnership
Unit 7, Strathclyde Business Park
391 Langmuir Road
Bargeddie
G69 7TU
Tel: 0141 771 9043
Toy & Equipment Lending Library
Lismore Drive
Coatbridge
ML5 5JN
Tel: 01236 757647
Strategy into Practice in the Early Years
Useful Contacts & Further Reading 81

National Contacts
Food Standards Agency Scotland
6th Floor, St Magnus House
25 Guild Street
Aberdeen
AB11 6NJ
Tel: 01224 285100
Email:
scotland@foodstandards.gsi.gov.uk
www.food.gov.uk/scotland
NHS Health Scotland
Woodburn House
Canaan Lane
Edinburgh
EH10 4SG
Tel: 0131 536 5500
Email:
general_enquiries@health.scot.nhs.uk
www.healthscotland.com
Scottish Food and Drink Federation
4a Torphichen Street
Edinburgh
EH3 8JQ
Tel: 0131 229 9415
Email: generalenquiries@fdf.org.uk
www.sfdf.org.uk
British Heart Foundation Scotland
Ocean Point One
94 Ocean Drive
Edinburgh
EH6 6JH
Tel: 0131 555 5891
Email: commfund@bhf.org.uk
www.bhf.org.uk
Diabetes UK Scotland
The Venlaw
349 Bath Street
Glasgow
G2 4AA
Tel: 0141 245 6380
Email: scotland@diabetes.org.uk
www.diabetes.org.uk
Coeliac UK
1 Saint Colme Street
Edinburgh
EH3 6AA
Tel: 0131 220 8342
Email: helpline@coeliac.org.uk
www.coeliac.org.uk
British Dietetic Association
5th Floor, Charles House
148/9 Great Charles Street
Queensway
Birmingham
B3 3HT
Tel: 0121 200 8080
Email: info@bda.uk.com
www.bda.uk.com
Caroline Walker Trust
22 Kindersley Way
Abotts Langley
Herts
WD5 0DQ
Tel: 01923 445374
Email: info@cwt.org.uk
www.cwt.org.uk
The Dairy Council
93 Baker Street
London
W1U 6QQ
Tel: 020 7467 2629
Email: info@dairycouncil.org.uk
www.milk.co.uk
British Nutrition Foundation
High Holborn House
52–54 High Holborn
London
WC1V 6RQ
Tel: 020 7404 6504
Email: postbox@nutrition.org.uk
www.nutrition.org.uk
82 Useful Contacts & Further Reading Nutrition & Oral Health

Useful websites
British Dental Association – Patient Website
www.bdasmile.org
British Dental Health Foundation
www.dentalhealth.org.uk
British Nutrition Foundation
www.nutrition.org.uk
Childsmile
www.child-smile.org
Colgate
www.colgate.co.uk
Curriculum for Excellence
www.ltscotland.org.uk/curriculumforexcellence/
Department of Health
www.dh.gov.uk
Early Years Matters Newsletters
www.ltscotland.org.uk/earlyyears
Eco Schools and Nurseries
www.ecofriendlykids.co.uk
Food Standards Agency – Eat Well
www.eatwell.gov.uk
Food Standards Agency Scotland
www.food.gov.uk/scotland
Grab 5
www.sustainweb.org/grab5/
Grounds for Learning
www.gflscotland.org.uk
Health Information Plus
www.healthinfoplus.co.uk
Health Promoting Schools
www.ltscotland.org.uk/healthpromotingschools/
Hemming Visual Aids
www.hemmingva.com
Strategy into Practice in the Early Years
Useful Contacts & Further Reading 83

Lanarkshire Breastfeeding Initiative
www.lanarkshirebreastfeeding.org.uk
Learning and Teaching Scotland
www.ltscotland.org.uk
Learning and Teaching Scotland – Parentzone
www.ltscotland.org.uk/parentzone/
NHS Choices – 5 A DAY
www.5aday.nhs.uk
NHS Direct
www.nhsdirect.nhs.uk
NHS Lanarkshire
www.nhslanarkshire.org.uk
NHS Health Scotland
www.healthscotland.com
Nutritional Guidance for Early Years
www.scotland.gov.uk/Publications/2006/01/18153659/0
Oral B
www.oralb.co.uk
Scotland’s Health on the Web
www.show.scot.nhs.uk
Scottish Government
www.scotland.gov.uk
Take Life On campaign
www.takelifeon.co.uk
Unicef UK Baby Friendly Initiative
www.babyfriendly.org.uk
The Vegetarian Society
www.vegsoc.org
Recipe Ideas
www.eatwell.gov.uk/agesandstages/children/
www.eatwell.gov.uk/healthydiet/seasonsandcelebrations/
www.healthylivingaward.co.uk/docs/hla%20recipe%20book.pdf
84 Useful Contacts & Further Reading Nutrition & Oral Health

26: REFERENCES
Crawley, H. (2006) Eating well for under-5s in child care. 2nd ed. St Austell: The
Caroline Walker Trust.
Fife Council Education Service and NHS Fife (1999) Play@home. Fife: Fife
Council.
Food Standards Agency Scotland and Scottish Executive (2006) Catering for
Health: A guide for teaching healthier catering practices. Aberdeen: Food
Standards Agency Scotland.
Health Education Board for Scotland and Edinburgh Community Food Initiative
(1999) Just for Starters. Edinburgh: HEBS.
Karmel, A. (2001) Superfoods for Babies and Children. London: Ebury Press.
Learning and Teaching Scotland (2009) A Curriculum for Excellence. Glasgow:
Learning and Teaching Scotland.
Making the case for UK Physical Activity Guidelines for Early Years:
Recommendations and draft summary statements based on the current evidence
(2009)
NHS Health Scotland (2006) Hassle Free Food. Edinburgh: NHS Health Scotland.
NHS Health Scotland (2008) Fun First Foods: An easy guide to introducing solid
foods. Edinburgh: NHS Health Scotland.
Scottish Executive (2003) Let’s Make Scotland More Active: A strategy for physical
activity. Edinburgh: Scottish Executive.
Scottish Executive (2005) An Action Plan for Improving Oral Health and
Modernising NHS Dental Services in Scotland. Edinburgh: Scottish Executive.
Scottish Executive (2006) Nutritional Guidance for Early Years: food choices for
children aged 1-5 years in early education and childcare settings. Edinburgh:
Scottish Executive.
Scottish Government (2001) Regulation of Care (Scotland) Act 2001. Edinburgh:
TSO.
Scottish Government (2005) National Care Standards: Early education and
childcare up to the age of 16. Edinburgh: Scottish Government.
Scottish Government (2007) Schools (Health Promotion and Nutrition) (Scotland)
Act 2007. Edinburgh: TSO.
Scottish Government (2008) The Early Years Framework. Edinburgh: Scottish
Government.
Scottish Government (2009) Scottish Health Survey 2008. Edinburgh: Scottish
Government.
Scottish Office (1996) Eating for Health: A Diet Action Plan for Scotland.
Edinburgh: TSO.
Scottish Office (1999) Towards a Healthier Scotland. Edinburgh: TSO.
Timperley, C. (1997) Baby and Child Vegetarian Recipes. London: Ebury Press.
Strategy into Practice in the Early Years
References 85

27: APPENDICES
Appendix 1: NHS Lanarkshire ‘You’re Welcome To Breastfeed
Here’ poster
Appendix 2: Preparing a bottle feed
Appendix 3: Sterilising baby feeding equipment
Appendix 4: Table 1 – Function and sources of key vitamins
Appendix 5: Table 2 – Children’s fruit and vegetable portion sizes
Appendix 6: Food labelling
Appendix 7: Healthy Start
Appendix 8: Childsmile programme
Appendix 9: Advice on consumption of peanuts during
pregnancy, breastfeeding and early infant life
86 Appendices Nutrition & Oral Health

Appendix 1
If you would like somewhere
private to breastfeed,
please ask a member of staff
Strategy into Practice in the Early Years
Appendices 87

Appendix 2
Preparing a bottle feed using baby milk powder
1 2 3
Boil some fresh tap water and
let it cool for a few minutes. (It
should still be more than 70ºC so
don’t leave it for more than half an
hour). Do not use bottled or
artificially softened water.
Read the tin or packet to find
out how much water and
powder you need. You should
make up a fresh bottle for each
feed.
Wipe clean an area on
which to prepare the feed.
Wash your hands very well with
soap and water.
4 5 6
If using a steriliser, remove
the lid and turn it upside
down. Remove the teat and cap
and place them on the upturned
lid. If you wish to rinse them, use
cooled boiled water, not tap water.
Remove the bottle, rinse if
wished (with the boiled
water) and stand it on a clean flat
surface. Pour the boiled water
into the bottle up to the required
mark.
Measure the exact amount
of powder using the scoop
provided with the milk. Level the
powder in the scoop using the
plastic knife or the spatula supplied
with the milk powder or steriliser.
7 8 9
Add the powder to the
water in the bottle. All baby
milks in Britain now use one scoop
to 1oz (30mls) water. Never use
more than this or you will make
your baby ill. Do not add anything
else to the feed.
10
Check the temperature of
the feed by dripping a little
onto the inside of your wrist
before giving it to your baby.
After the feed, throw any
11 unused milk away and
clean the bottle. Don’t
make up more than one feed at a
time. Storing made-up milk
increases the risk that your baby
will fall ill.
Place the disc supplied on
the top of the bottle, followed
by the teat and cap.
Additional tips:
Screw the cap on tightly and
shake well until all the
powder has dissolved.
The amount of milk per feed suggested on the tin or packet is only a
guide. Your baby may want more or less according to appetite.
Use the scoop provided with the brand of milk powder you are making up
- the scoop provided with another brand may be a different size.
If your powder does not come with a spatula, you should sterilise a
plastic knife and dry it on clean tissue paper. You can then keep it in the
powder with the scoop.
Powdered baby milk is not sterile. Feeds should therefore not be made
up in advance. If you are going to need to feed your baby while you are
out it is safest to take freshly boiled water in a sealed flask and make up
the feed when you need it.
Almost all baby milk powders are made from cows' milk which has
been processed to make it suitable for babies. Whey based (first) milks
are more easily digested by a young baby. Casein based (second) milks
take longer to digest and are not recommended for young babies.
Ordinary cows' milk should not be given until your baby is at least a year
old.
Do not use soya or goat milk formulas without medical advice.
Breastfeeding is the healthiest way to feed your baby and it doesn't cost anything. If you use baby milk, it is very important for your baby's health that you follow all instructions carefully.
It is possible, but difficult, to reverse a decision not to breastfeed or to re-start breastfeeding once you have stopped. Introducing partial bottle feeding will reduce a mother's breastmilk
supply. Breastfeeding mothers don’t need to eat any special foods but, just like everyone else, they are advised to eat a healthy diet. (Infant formula & follow-on formula regulations 1995)
Reproduced by the UNICEF UK Baby Friendly Initiative, with thanks to the Women’s Centre, Oxford Radcliffe Hospital NHS Trust. December 2005
88 Appendices Nutrition & Oral Health

Appendix 3
Sterilising baby feeding equipment
It is very important to keep any equipment used for feeding your baby either formula or breastmilk (such as bottles, teats
and breast pumps) completely clean. This will help to protect your baby against infection, particularly tummy bugs
(diarrhoea and vomiting).
To do this you need to sterilise your equipment after you have washed it thoroughly. You will need to continue to do this
until your baby is a year old. Any equipment not used straight away should be re-sterilised before use.
There are several ways of sterilising equipment. You could use:
a saucepan
a chemical steriliser
(not suitable for metal items)
a steam steriliser
You could also use a special microwave bottle steriliser in a microwave oven, but this is not suitable for metal items
or certain types of plastic.
1 2 3
Wash all bottles and other
equipment thoroughly in hot
soapy water using a bottle brush.
Scrub the inside and outside of the
bottle to remove fatty deposits.
Pay particular attention to the rim.
Use a small teat brush to
clean the inside of the teat; or
turn it inside out and wash in hot
soapy water.
Rinse all your washed
equipment thoroughly before
sterilising.
To sterilise by boiling:
4
Put the equipment into a large pan
To sterilise with chemicals:
5
Make up the solution, using
6
filled with water. Make sure there tablets or liquid, following
is no air trapped in the bottles or
teats. Cover the pan with a lid and
bring to the boil. Boil for at least
10 minutes. Make sure that the
pan does not boil dry.
the manufacturers’ instructions.
Keep the pan covered until the
equipment is needed.
Check teats and bottles regularly
for signs of deterioration. Bottles
may become cloudy or cracked
over time and teats get cracked or
spongy. If you are unsure about a
bottle or teat, it’s safer to throw it
away.
Submerge the equipment in the
solution, making sure there is no air
trapped in the bottles or teats. Your
sterilising tank should have a
plunger to keep all equipment
under the water - or you can use a
plate. Leave in solution for at
least 30 minutes.
Make up a fresh solution every 24
hours.
To use steam or microwave
sterilisers, just follow the
manufacturer's instructions.
Make sure the openings of the
bottles and teats/equipment are
face down in the steam steriliser.
Always wash your hands before
removing equipment from your
steriliser.
If you have used a chemical
steriliser and wish to rinse your
equipment prior to use, use water
that has been boiled and allowed to
cool.
Reproduced by the UNICEF UK Baby Friendly
Initiative, with thanks to the Women’s Centre,
Oxford Radcliffe Hospital NHS Trust.
Breastfeeding is the healthiest way to feed your baby and it doesn't cost anything. If you use baby milk powder, it is
very important for your baby's health that you follow all instructions carefully. It is possible, but difficult, to reverse a
decision not to breastfeed or to re-start breastfeeding once you have stopped. Introducing partial bottle feeding will
reduce a mother's breastmilk supply. Breastfeeding mothers do not need to eat any special foods but, just like
everyone else, they are advised to follow a healthy diet. (Infant formula & follow-on formula regulations 1995)
Strategy into Practice in the Early Years
Appendices 89

Appendix 4
TABLE 1: Function and Sources of Key Vitamins
(Adapted From ‘Catering for Health: A guide for teaching healthier catering practices’
Food Standards Agency Scotland & Scottish Executive)
VITAMIN FUNCTION SOURCES
FAT-SOLUBLE:
A
D
Maintains and repairs tissues,
needed for growth &
development. Essential for
immune system & vision
Essential for bones & teeth,
promotes absorption of calcium
from food
As retinol (pre-formed vitamin A) milk,
fortified margarines, cheese, egg, liver,
oily fish (pilchards, sardines, herrings,
tuna)
As carotene (converted to vitamin A by
the body) carrots, tomatoes, green leafy
vegetables, peppers, mango, apricots,
melon
Fortified margarines & spreads, oily fish,
fortified breakfast cereals
E
Antioxidant vitamin which helps
prevent damage to cells
Green leafy vegetables, margarine,
whole grain cereals, eggs
K Essential for blood clotting Dark green vegetables especially
cabbage, Brussels sprouts & spinach
WATER-SOLUBLE:
B1 (thiamin)
Involved in release of energy from
carbohydrates & fat, needed for
brain & nerve function
Potatoes, bread, fortified breakfast
cereals, milk, diary products, meat &
poultry
B2 (riboflavin)
Involved in release of energy from
carbohydrate, fat & protein,
needed for growth
Milk & dairy products, liver, fortified
breakfast cereals, meat & poultry
B3 (niacin) Same as B2 Meat & poultry, fortified breakfast
cereals, fish, potatoes
B6 (pyridoxine)
Protein metabolism, formation of
healthy blood & nervous system
Meat, milk, potatoes, fortified breakfast
cereals
B12
(cyanocobalamin)
Production of red blood cells,
involved in nervous system
Meat, milk, dairy products, fish, eggs,
fortified breakfast cereals, yeast extract
FOLATE
Production of red blood cells,
reduces risk of neural tube
defects e.g. spina bifida in early
pregnancy
Green leafy vegetables especially
Brussels sprouts, spinach, green beans,
potatoes, oranges, melon
C
Helps wound healing & iron
absorption, needed for formation
of bones, muscle & blood vessels,
antioxidant vitamin
Fruits especially citrus fruit – oranges,
blackcurrants, strawberries, green
vegetables, potatoes
90 Appendices Nutrition & Oral Health

Appendix 5
TABLE 2: Children’s fruit and vegetable portion sizes
Fruit/Vegetable
Vegetables (fresh, frozen, canned)
Salad
Pulses
Vegetables in composite dishes
e.g. vegetable chilli
Banana
Large fruit e.g. melon or pineapple
Medium fruit e.g. apple or pear
Small fruit e.g. kiwi or plum
Very small fruit e.g. strawberries or grapes
Dried fruit e.g. raisins or apricots
Fruit in composite dishes
e.g. stewed fruit in apple pie
Frozen or canned fruit (in own juice not
syrup)
Fruit juice
Portion Size
1–2 heaped tablespoons (25–50g)
¼ to ½ cereal bowlful
1–2 heaped tablespoons (25–50g)
1–2 heaped tablespoons per portion of the
recipe (25–50g)
½ to 1 small (30–60g)
½ to 1 small slice
¼ – ½ fruit (25–50g)
½ – 1 fruit (25–50g)
½ – 1 average handful
½ tablespoon
1–2 heaped tablespoons per portion of the
recipe (30–60g)
1–2 heaped tablespoons (30–60g)
½ – 1 small glass (100–150 ml)
The above table of children’s portion sizes has been adapted from Nutritional Guidance for
Early Years: food choices for children aged 1–5 years in early education and childcare settings
(Scottish Executive, 2006).
Strategy into Practice in the Early Years
Appendices 91

Appendix 6
FOOD LABELLING
Food labels now contain a vast amount of information relating to food safety
and nutrition, which can be confusing. The information below aims to
make reading food labels easier for nursery staff, childcare providers, parents
and carers.
Use by
‘Use by’ dates are usually found on perishable foods, which tend to go off
quickly, such as milk, soft cheese, yoghurt, ready-prepared salads and meat
and poultry. Generally, food with a ‘use by’ date should be kept in the fridge.
Do not use any food or drink after the end of the ‘use by’ date shown on
the label. Even if it looks and smells fine, it may be harmful and cause
food poisoning.
Best before
Foods with a ‘best before’ date tend to last for longer, for example, tinned,
frozen or dried foods. It should be safe to eat food after the ‘best before’ date
has passed; however, the food will no longer be at its best and may have lost
some of its flavour or texture.
Eggs should not be used after the ‘best before’ date because they can contain
salmonella bacteria which may start to multiply after the ‘best before’ date.
Storage instructions
It is important to follow the storage instructions shown on the label, as this will
ensure that the food lasts until the ‘use by’ date. This may include terms such
as ‘keep refrigerated’.
Preparation and cooking instructions
To enjoy food and avoid food poisoning, it is important to follow the
preparation and cooking instructions which are shown on the label. This will
ensure food is cooked thoroughly and any harmful bacteria are killed.
This may include instructions such as defrosting times.
Ingredients list
All of the ingredients present in a food or drink will be listed on the label in
descending order e.g. the biggest ingredient is listed first.
Nutrition information panel
The nutrition information panel will display information about the nutritional
value of the product. Some labels provide information on four key areas –
energy, protein, carbohydrate and fat. Other labels provide more information
and include energy, protein, carbohydrate (of which sugar), fat (of which
saturated fat), fibre and sodium (salt). Nutrients will be given per 100g and
often per pack size too. If you want to compare two similar products, compare
the nutrient values per 100g.
92 Appendices Nutrition & Oral Health

Remember:
High (per 100g) Low (per 100g)
20g of fat or more
3g of fat or less
5g of saturated fat or more
1.5g of saturated fat or less
15g of sugar or more
5g of sugar or less
0.6g of sodium or more (1.5g salt) 0.1g of sodium or less (0.3g salt)
If quantities fall between these figures, then this would be a moderate amount.
Strategy into Practice in the Early Years
Appendices 93

Appendix 7
HEALTHY START
Healthy Start was introduced across the
UK in November 2006 and replaces the
Welfare Food Scheme. It is open to
pregnant women and families with
children under the age of four who are on
income support, income-based job seeker’s
allowance, or child tax credit with an income
of £16,040 a year or less (2009/10). All pregnant women under the age of
eighteen are eligible for Healthy Start regardless of entitlement to benefits.
An application for Healthy Start is distributed to families by a Midwife or Public
Health Nurse. Pregnant women will receive vouchers from the tenth week of
pregnancy and thereafter via post every four weeks. Pregnant women and
each child aged between 1–4 years is entitled to a weekly voucher of £3.10.
Babies under one year get two vouchers per week. Vouchers can be exchanged
for milk, (first stage) infant formula and fresh fruit and vegetables. A number
of retailers are involved in the Healthy Start scheme, including, supermarkets,
community food initiatives and independent corner shops.
Healthy Start also entitles some mothers to free vitamins, including, tablets for
mothers (folic acid, vitamins C and D) and children’s drops (vitamins A, C and
D). Entitlement to vitamins is detailed on the letter attached to the vouchers.
Mothers should bring the letter with them to claim their vitamins from their
local health centre.
Healthy Start provides additional support to those who wish to breastfeed by
offering a greater choice of nutritious foods to mothers, including fresh fruit
and vegetables, as well as milk. Advice from a health professional about
healthy eating, breastfeeding, infant feeding and using the vouchers, is a
key component of the registration process, therefore benefiting families most
in need.
For more information log on to www.healthystart.nhs.uk
94 Appendices Nutrition & Oral Health

Appendix 8
CHILDSMILE PROGRAMME
Childsmile is a national programme,
funded by the Scottish Government,
designed to improve the dental health of
children in Scotland and reduce
inequalities both in dental health and
access to dental services. The main
components of Childsmile are outlined in
the table below. Further information is
available on www.child-smile.org.
Childsmile will operate in all NHS Boards
across Scotland once it is fully rolled out. The integrated programme combines
a population approach, where every child will have access to Childsmile dental
services, with additional support targeted towards children most at risk of
dental disease.
CHILDSMILE
COMPONENT
AGE
CONTENT OVERVIEW
Childsmile Practice From birth • Promoting oral health from birth with advice,
support and clinical prevention. Fluoride varnish
(from age two years) & fissure sealants (from
age six years) tailored to the needs of the
individual child via primary care dental services.
• Additional home and community support
facilitation into dental services via community
based Dental Health Support Workers.
Childsmile Core
Toothbrushing
Childsmile Nursery
(targeted within the
most deprived SIMD
quintile locally)
Childsmile School
(targeted within the
most deprived SIMD
quintile locally)
From birth
to five
years
of age
At an
appropriate
age
From five
years of
age
• Oral health packs given to every child age one
year, three years (two packs), four years (two
packs) and five years.
• Every child in daily supervised nursery
toothbrushing.
• 20% P1 and P2 children in priority areas to be
in daily supervised toothbrushing programmes.
• Fluoride varnish applied 6 monthly via
Childsmile Dental Teams.
• Fluoride varnish applied 6 monthly via
Childsmile Dental Teams consisting of
Extended Duty Dental Nurses and a Dental
Health Support Worker.
• Fissure sealants applied at age 6/7.
Strategy into Practice in the Early Years
Appendices 95

Appendix 9
ADVICE ON CONSUMPTION OF PEANUTS DURING PREGNANCY,
BREASTFEEDING AND EARLY INFANT LIFE
Following a review of the scientific evidence, the Scottish Government has
revised its advice about eating peanuts (also known as monkey nuts or ground
nuts) during pregnancy, breastfeeding and early infant life.
Pregnant, planning a baby or breastfeeding
If a woman would like to eat peanuts or foods containing peanuts (such as
peanut butter) before or during pregnancy, or while breastfeeding, they can
choose to do so as part of a healthy balanced diet, unless they are allergic to
them or a health professional advises them not to.
You may have heard that some women, in the past, have chosen not to eat
peanuts before or during pregnancy, or while breasfeeding. This is because
they were previously advised that they may wish to avoid eating peanuts if
there was a history of allergy in their immediate family (such as asthma,
eczema, hayfever, food allergy or other types of allergy). This advice has now
been changed because the latest research has shown that there is no clear
evidence to say that eating or not eating peanuts before or during pregnancy,
or while breastfeeding, affects the chances of the baby developing a peanut
allergy.
Introducing children to solid foods
Babies should be exclusively breastfed until around six months of age.
If a mother chooses to start giving their baby solid foods before six months
(after talking to their Health Visitor/Public Health Nurse or GP), they should
not give them any peanuts, other nuts (such as hazelnuts, almonds, walnuts,
etc.), seeds, milk, eggs, wheat, fish, shellfish, or foods containing these until
after six months of age. This is because these foods can sometimes trigger
development of a food allergy.
When these foods are given to a baby for the first time, it’s a good idea to
start with one at a time so that any allergic reaction can be identified.
Previous advice stated that parents should avoid giving a child foods
containing peanuts before three years of age, if there was a history of allergy
in the child’s immediate family (such as eczema, hayfever, food allergy or
other types of allergy). Latest research now shows that there is no clear
evidence to say that this will help to reduce the risk of the child developing a
peanut allergy.
If a child already has a known allergy, such as a diagnosed food allergy or
diagnosed ezcema, or if there is a history of allergy in the child’s immediate
family (if the child’s parents, brothers or sisters have an allergy such as
asthma, eczema, hayfever, or other types of allergy) then the child has a
96 Appendices Nutrition & Oral Health

higher risk of developing peanut allergy. In these cases parents and/or carers
should talk to their GP, Health Visitor/Public Health Nurse or medical allergy
specialist before giving peanuts or foods containing peanuts to their child for
the first time.
Whole peanuts or whole nuts should never be given to children under five
because of the risk of choking. For further information, see the Food Standards
Agency’s website: www.eatwell.gov.uk
Strategy into Practice in the Early Years
Appendices 97