Page last updated at 13:49 GMT, Wednesday, 14 April 2010 14:49 UK

Do toddlers need cake as well as carrots?

By Clare Murphy
Health reporter, BBC News

Baby eats a carrot
Fruit and veg are very important, but portions should not be too big

A new survey shows some nurseries are giving children too much in the way of fruit and vegetables, and not enough starchy carbohydrates to meet their energy needs. Have healthy eating messages left us in a state of confusion about what children should be consuming?

This latest study carried out by the local government regulatory body Lacors focused on children in nursery schools across 29 English councils. While finding that some children were being given portions that were too large and too high in salt, others were simply not being offered enough at all.

The report highlighted the pressure parents, who are themselves constantly warned of the perils of childhood obesity, place on nursery staff to offer low calorie fare. It is a growing problem, according to the National Day Nurseries Association.

"Parents are aware of the importance of ensuring their child eats healthily to avoid obesity and health problems in later life, but this can sometimes lead to parents making requests that their child follows a strict diet, such as skimmed milk and low-fat foods," says its chief executive Purnima Tanuku.

"Children under five have specific needs, and should not have low-fat diets as their growing bodies need fat and carbohydrates."

Indeed the low-calorie, high-fibre diets which many adults have been encouraged to embrace are simply not suitable for the under fives.

No skimming

Growing rapidly, this age-group needs a diet which is - proportional to their size - much higher in calories than that of an adult.

Studies have shown that children burn fat much faster than adults - and so skimmed milk and other low-fat dairy products should remain off the menu until they are much older.

It is important that parents do not apply healthy eating messages designed for the whole population to small children
Helen Crawley
Caroline Walker Trust

"And parents really shouldn't feel too anxious about puddings - sponge and custard is a good dessert to offer, surprising as that may sound," says Jessica Williams, a paediatric dietician. "This is a much better option than a handful of biscuits between meals.

"There have also been problems with the messages about red meat. It's a shame some parents feel so worried about it as it really is the best source of iron, and iron deficiency anaemia among toddlers in particular is common."

Wholegrains and high-fibre dishes are fine in moderation but may fill a child up without providing the calories they need. Seen by some as a nutritional wasteland, easily-digestible white bread is not necessarily a bad option for children, particularly if they have eaten a wholegrain cereal for breakfast.

"And while the five-a-day message must certainly still be there, a child's portion does need to be smaller so they have room for the other, more substantial items on their plates. They simply won't get the calories they need from fruit and vegetables, even in large quantities."

Needing attention

There are in fact concerns that the plight of the underweight child has been forgotten amid the intense focus on childhood obesity.

Studies have shown that being persistently underweight as a child can cause problems over a lifetime, from cognitive impairment to skeletal disorders.

There have been calls for public health policy makers to consider both ends of the body mass spectrum when fixing priorities in child health.

"I think that we are in danger of overlooking these children in the obsession about obesity - and I am not convinced that we have good measures of bodyweight in small children in terms of later risk," says City University's Helen Crawley, director of the Caroline Walker Trust which promotes good diet. "We should be much more careful.

"Poor nutritional status in toddlerhood can be linked to permanent cognitive damage and a child never reaching their full potential, as well as shorter stature in adulthood.

"This does not mean that obesity among pre-school children is not an issue as well, but it is important that parents do not apply healthy eating messages designed for the whole population to small children."

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