The Health Education Trust

Drinks – worried about fluid intake??

Ensuring children drink enough fluid is sometimes difficult, with children choosing fizzy, sugary drinks instead of the ‘healthier’ alternatives – water and milk. Below outlines some practical tips to encourage healthier fluid consumption.

The best drinks to give children are water and milk, with some fruit juice daily providing a vitamin C boost. Regular soft drinks not only provide ‘empty calories’ (that is they provide calories but few other nutrients), they can also increase the risk of dental caries and dental erosion. Low calorie or diet soft drinks may not provide unwanted calories but to aid the flavour, they are acidic and so can still contribute to dental erosion. Given that over half of 4-18 year olds in the UK have dental decay and 2/3 of schoolchildren have erosion of their permanent teeth (Walker, 2000), we should be concerned about what we can do to reduce this. A study calculated that consuming carbonated drinks increases the chances of a 14-year-old suffering tooth erosion by 220% (Dugmore, 2004).

For information about how the change in children’s drinking habits over recent years may affect their health, click here.

What’s wrong with artificial sweeteners?

It is not sufficient to just replace sugar-laden drinks with low calorie, artificially sweetened soft drinks. Sweeteners in drinks may habituate children’s taste for sweet drinks, offer little or no positive nutrition, take between 60p to £1.00 out of a child’s pocket, and effectively shut out the milsks and pure juices we want children to have access to. Diet soft drinks may still have a detrimental effect on teeth, (the acidity ofsoft drinks is linked to dental erosion) and there is also no conclusive evidence that low calorie drinks have any beneficial influence on obesity levels.

Ask yourselves the question: ‘What will children choose if offered a choice between a wide array of highly flavoured, artificially sweetened soft drinks, or plain water for hydration? Have you ever tasted a diet drink that isn’t more sweet tasting than it’s sugar-containing equivalent? Who decides just how much artificial sweetener is added to children’s drinks? Allowing artificial sweeteners to remain in schools could help to groom a generation of children who view water as a drink for nothing other than cleaning teeth!

Top tips for parents:

• Smoothies – refreshing at any time of the year. Get children to make their own cocktails using various combinations of fruit (fresh, tinned or frozen), ice, fruit juice, milk, yoghurt and water. (Chop the fruit up into small pieces or mash if you do not have a blender). Try these suggestions below:
  • 100ml orange juice, handful of ice, tinned pineapples
  • 150ml milk*, handful of ice, small pot of fruit flavoured yoghurt, chopped banana, fresh strawberries or frozen berries. Add ice in summer to make it more refreshing
  • ½ orange, ½ apple, handful ice, 100ml mixed fruit juice
  • try adding sparkling water to add a fizz to your smoothie
  • use partially defrosted frozen fruit instead of ice cubes for a change in hot weather
• Remember to practice what you preach…… young children look up to adults as a role model, so be enthusiastic about the drinks that you wish your children to consume!

Water

• Routinely placing a jug of chilled water with glasses on the table at mealtimes should encourage children to drink more water. Start this habit from an early age to maximise the benefits. You could even let children use wine glasses for their water to make it a little more exciting for them. Increasing fluid consumption during mealtimes should reduce the volume required between meals.
• Refill large water bottles and keep refrigerated (remembering to wash the bottles thoroughly) – chilled water is much more appealing than straight from the tap
• Keep small water bottles in the fridge to use in lunch boxes, or to put in your bag if you are nipping out to the shops, going to the park or swimming, or for the kids to help themselves too!
• Instead of buying the usual soft drinks when out of the house and thirsty, purchase a bottle of water (ideally chilled), plus a small carton of fruit juice (or even a small fizzy drink) to consume alongside, making sure you finish with the water to reduce the acidity in the mouth
• Freeze water bottles for those hot days, they can also double up as an ice pack in lunchboxes

Milk*
Milk is both a drink and a nutritious food for children. Contributing protein and calcium, it’s a great drink to encourage. Since milk tends to be protective to the teeth, flavoured milk drinks with up to 5% sugar are allowed within the Governments new nutrition standards for schools.

• Give children a glass of milk* with their after school/afternoon snack, this is filling and very nutrient dense
• Dilute regular milkshakes/flavoured milks with extra milk* to reduce the total sugar content
• Add ice cubes to milk, flavoured milk and milkshakes to make a chilling drink. Crushed ice cubes are ideal
• Make ‘iced milk’ using ice cubes made from milk, which could then be used in fresh milk or milkshakes
• Make hot chocolate in winter, using cocoa powder rather than sweeter drinking chocolate. You can also blend in a banana for a banana hot chocolate.

Fruit juice
More isn’t always better: we assume that fruit juice is a healthier option than soft drinks, but even this is acidic so can be just as harmful to the teeth and is also high in sugar. 150ml of fruit juice or fruit smoothie contributes to one daily portion of fruit and vegetable. During the processing of fruit into fruit juice, the natural sugars within the cells of the fruit are released, which increases the total sugar, and reduces the fibre and vitamin C content of the final product. This is why fruit juice (and fruit smoothies) can only count as one portion of fruit a day, irrespective of the quantity consumed. So a small 150ml glass a day to contribute to achieving your 5-a-day fruit and vegetables can be seen as sensible, but drinking fruit juice to quench thirst in larger quantities can be costly to your pocket and your teeth!

• Lunchboxes: A small carton of pure fruit juice to drink in one go with lunch , plus a sports bottle of water for sipping through the day is a good solution
• Freeze fruit juice into ice cubes to be used in water to produce a colourful refreshing drink. You could even try adding frozen fruit as well e.g. raspberries
• Combine fruit juice with water. Try adding carbonated water for an extra fizz
• Fruit juice cocktails: mix a variety of fruit juices with ice cubes to reduce the sugar concentration, and you could even use fresh fruit to add texture
• Fruit punches are great for parties – try mixing orange juice, pineapple juice, fizzy water, ginger beer and ice cubes with sliced oranges, apples, lemons and any other fruit you fancy. Use a big bowl with a ladle, and let children help themselves
• Fruit swirls: carefully combine fruit juices to add swirls of colour – try adding orange juice to a glass of tomato juice
• Sports bottles encourage sipping, so should be avoided when consuming sugary or acidic drinks. Sipping a drink means that the fluid will be in contact with the teeth for prolonged periods of time. Try a straw instead, which pushes the drink to the back of the mouth reducing contact with the teeth. Use sports bottles for water only. This also makes them easier to keep clean!
• Only drink fruit juice during mealtimes to reduce the effects of its acidity, and this will also aid iron absorption from the meal through the vitamin C content of the juice!
• Freeze fruit juice for those hot days, they can also double up as an ice pack in lunchboxes
• Be aware of juice drinks: many of these are soft drinks with a small amount of fruit juice included. Read the label carefully, choose products that only contain fruit juice, pureed fruit and water. Watch out for added sugar (in the form of sucrose, fructose, glucose and others) and sweeteners!

* Milk: Advice from the Food Standards Agency states that children under 2 years should only consume full fat milk to ensure that they receive enough calories required for linear growth. From the age of 2, semi-skimmed milk can be introduced (alongside a balanced diet), but skimmed milk should not be introduced before the age of 5 as it’s too low in calories to meet growing children’s needs.
www.eatwell.gov.uk/asksam/agesandstages/childrenandbabies/#A219842

References:
Dugmore CR, Rock WP (2004) A multi-factorial analysis of factors associated with dental erosion. British Dental Journal. 196; 283-286.

Walker et al (2000) National Diet and Nutrition Survey: Young people aged 4 to 18 years. Volume 2: Report of the oral health survey. London: The Stationary Office.

• Small dessert bowl of salad.
• 2 tbsp of raw, cooked, frozen or canned vegetables.
• 1 medium carrot or tomato.
• 150ml fruit juice – only counts as one portion a day irrespective of quantities consumed due to the high sugar content.
• Medium piece of fruit – e.g. apple, orange, pear.
• 6 strawberries.
• 2-3 tbsp of fresh fruit salad, or stewed or canned fruits in natural juices.
• ½ grapefruit or avocado.
• 2 plums or other small fruits.
• 1 cupful of grapes, cherries and berries.
• ½-1 tbsp dried fruit.
• 2-3 tbsp peas, beans or lentils.

• 1 egg sized potato.
• 1 small pitta or chapatti.
• 1 bagel.
• 3 tbsp of cereal flakes.
• 1 whole wheat cereal biscuit.
• 2 tbsp cooked rice, pasta or noodles.
• 2 tbsp cous cous or elby.
• 2 tbsp muesli or uncooked oats.
• 3 crackers or crispbreads.

• 2-4oz (50-100g) lean meat/poultry or oily fish.
• 4-6oz (100-150g) white fish.
• 1-2 eggs.
• 3 tbsp peas, beans or lentils (cooked).
• 2 tbsp peanut butter or nuts.

Milk and dairy (15% of plate) consume 3 times a day – required to provide calcium to strengthen bones.

• 1/3 pt (200ml) semi-skimmed milk.
• Small pot (6oz/150g) yogurt or fromage frais.
• 1oz (25g) matchbox size hard cheese.
• Small pot (4oz/100g) of cottage cheese.

• Eat in moderation – observe this list as there are many products that you may not associate with being fatty or sugary.
• Crisps – although crisps are potatoes they are not included as a potato as they are very high in fat.
• Ice-cream – although it is a dairy product, is also high in sugar and fat.
• Butter, margarine, spreads, oil, cream, mayonnaise, salad dressings, salad cream.
• Sugar, jam and honey.
• Biscuits, sweets and chocolate.
• Pastries and donuts.
• Sausage rolls and pork pies.
• Fizzy drinks.
• Gravy

Fluids – necessary to keep re-hydrated, which helps concentration.

• 6-8 glasses or cups a day.
• Consume less highly sugared drinks and try to consume more water.
• Consume more on a hot day.
• Keep a large bottle of water in the fridge as cold water is much more appealing than warm water!

• Salt – try not to add to dishes, use alternative ingredients to enhance flavour. See salt article.
• Alcohol – drink in moderation, 1-2 units a day is better than binge drinking at the weekends. 1 unit is equivalent to half a pint of medium strength larger or bitter, one shot of spirits or a small glass of wine.

For further information about the BOGH visit the following web pages;
The Balance of Good Health has now been replaced with The Eatwell Plate. The principles however are the same. Click here for more information.

http://www.meatandhealth.co.uk/consumer/docs/variety.htm Browse this site for information on food groups in the BOGH, how to achieve the requirements and describes vital nutrients.

Refer to the HET resource page for useful leaflets outlining the BOGH http://www.healthedtrust.com/pages/edresource.htm

Visit the Vegetarian Society for idea on how to incorporate the BOGH into a vegetarian diet http://www.vegsoc.org/newveg/fft/balance.html

Practical guidelines, ideas and solutions to help families and children enjoy a healthy balanced diet.

Breakfasts

• Eat breakfast! It is the most important meal of the day, and if you make the correct choices you will feel less hungry mid morning and your concentration should improve. This will also help prevent snacking on high salt, fat and sugar products midmorning.
• Consuming breakfast in front of children will encourage them to eat with you and reinforce its importance.
• Chose brown bread with extra grains.
• Try mixing yoghurt with muesli.
• Breakfast cereals aimed specifically at children are currently not only high in salt but high in total, trans and saturated fat, and high in sugar. It is not necessary to buy cereals specifically aimed at children! For further information from Which? cereals click here

• Choose lower salt/sodium cereals: A cereal breakfast is an excellent start to the day, giving a good nutritious boost to your diet. Encourage all the family to choose wholegrain, lower sugar cereals that aren’t high in salt, such as: Weetabix, Ready Brek, Shredded Wheat, porridge oats, Quaker Oatso Simple (original), puffed wheat, puffed rice, no added sugar muesli, Shreddies, Raisin Wheats, Shredded Wheat Fruitful, Just Right.
• Try mixing the above cereals with so called ‘children’s’ cereals to gradually wean children off the high salt, high sugar, low fibre cereals, e.g. one Weetabix with a handful of Kellogg’s Coco Pops or Shredded wheat with Sugar Puffs, or a tbsp porridge oats mixed with your child’s favourite cereal.
• Add fruit (fresh, tinned without juices and dried) to cereals.

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Adopting a ‘balanced meal’ approach to mealtimes may help to encourage children to eat a greater variety and quantity of health-giving fruits and vegetables, by using kid’s favourites, such as chips, sausages and bacon as the ‘carrot’ so to speak! Thinking about the balance on the plate can also help to keep the salt content of the meal within sensible limits. Here are some suggestions to get you started:

Bacon and orange salad: Chop bacon and rings of orange on top of a big bowl of salad. Include a variety of colours to make more appealing to kids.
BBQ sausage and vegetable kebabs: Let your children help make these so that they know what they will be eating. Cooking is good fun once the kids get stuck in and may encourage them to try new vegetables. Alternate small chunks of sausage with different vegetables. Use vegetables that are familiar and gradually incorporate new ones, e.g. chunks of corn on the cob, squash and big pieces of pepper. NB: be cautious about cooking times to make sure the meat is cooked thoroughly – try precooking and assembling cold as salad or fruit kebabs!
Oven chips or jacket potato wedges are a good alternative to fried chips.
Chip ‘n’ salad buttie: 1/3 standard chip portion served in a bap with plenty of salad, lettuce, tomato and cucumber, and a slither of mayonnaise or salad cream (instead of butter on the bread). Less fat than a standard portion of chips and also provides fibre and vitamins!
Pizza extraordinaire: Add extra vegetable toppings such as sliced tomatoes, (there’s never enough!), sliced peppers & onions, frozen sweetcorn, baby spinach, tinned pineapple – choose any sort of vegetables to give the pizza more colour and texture!

Chicken nugget ideas: Visit http://www.healthedtrust.com/sum03/sum3.htm for exciting ideas on how to introduce vegetables into your child’s favourite food!
Fruit and ice cream: Top tinned fruit or chopped fresh fruit with your child’s favourite ice cream, or a sliced frozen chocolate bar ice cream.
Ready made meals: Cook vegetables to accompany your dish, frozen vegetables are ideal and take about the same time to cook!
Takeaways: Prepare a salad to accompany your pizza or curry, or peas and beans to sit alongside your fish and chips!
Crisp sandwiches: Makes a great filling snack. Place crisps between two slices of wholemeal or granary bread, without butter, and pile in salad, (grated carrots, lettuce, tomato, cucumber etc.) or fruit (thinly sliced apples, oranges and grapes).
Chocolate surprise: Combine chocolate and fruit pieces – apples, oranges and grapes, with small cubes of chocolate, the great compromise!
Simple Sausage casserole: With plenty of vegetables. Tinned tomatoes, onions, carrots, parsnips and any tinned or frozen vegetables, lots of herbs, fresh or dried and pepper. If your child will only consume one type of vegetable, i.e. peas, make sure you include them. Place it all in a casserole dish and place in the oven. Combine this with rice, pasta or potatoes.
Look carefully at the packaging of sausages and choose the lower salt varieties and those with the highest meat content.

Roll your own: Sausages rolled in brown or granary bread with tomato sauce, challenge your children to see how much sliced cucumber and tomato they can fit in.

Sausage a la pasta: To feed four people:
Grill 8 sausages. Cook 250g of pasta via instructions on the packaging. Fry one large finely chopped onion and one large chopped pepper in a little olive oil for several minutes until brown, add a crushed garlic clove (or a squirt of garlic paste), tomato puree, ground black pepper, dried basil or a handful of fresh, ripped basil, and a teaspoon of mild curry, chilli powder or Cajun spices (to add a kick, if desired).
Add 400g of tinned tomatoes and 200ml of water. Add 4 medium carrots cut into chunks, 100g of fresh or frozen vegetables, i.e. peas, broccoli, runner beans, mangetout, sweetcorn. Put a lid on and simmer until the pasta and sausages are cooked. Once the sausages are ready cut them into mouth sized portions and add to the tomatoes mixture. Stir pasta into this mixture. Voila.