The Health Education Trust

Water, water, everywhere and
It is the shameful truth that the majority of our schools have a lack of facilities for offering access to drinking water for children that is Dickensian.
– Well over half of all pupils must put their mouth around a tap in the toilets or drink from cupped hands how many of their teachers or parents would tolerate such conditions in their workplace?
– Most schools forbid both water bottles in
the classroom and the child to leave a lesson for a drink.
– Almost 10% of schools have no drinking facilities at all
Access to palatable drinking water is a basic human right and the government, LEA’s and schools should move quickly to ensure that schools supply this simple but very vital resource.
Finally you will find on page 9 a timely reminder of the vital role of those at the sharp end of the school meals service. Read on and enjoy!

Since the campaign started in September, The Dairy Council has written to some 3,000 Head Teachers, Directors of Education, Healthy Eating Co-ordinators, MP’s and School Nurses, organised a series of road shows in shopping centres and town centres in the 10 LEA’s and produced a School Milk video for teachers to have a better understanding of how a school milk scheme works.

The following two articles are taken from the conferences.

Further information from:

Michele Stephens
Communications Manager
The Dairy Council
Tel 020 7659 7312
E: M.Stephens@dairycouncil.org.uk

Child health experts who attended the Dairy Council’s Drinks in Schools – Fluid for Thought conferences are calling for more schools to provide drinks at break-time in a bid to reduce dehydration in young children.

The issue of how much children should drink in school topped the agenda at the conferences in Birmingham, Manchester and Cardiff. The one-day conferences, held throughout October, also explored the effects of dehydration on children’s health, from headaches and urinary tract infections to renal disease.

Head Teachers, School Nurses, Catering Managers and School Meal Dieticians from each of the areas packed in to the conference venues to

1.5ml per kcal expended is recommended as a total fluid requirement. This equates to approx. 2600ml for a 7 year old girl and 4000ml for a 15 year old boy.

However, allowances need to be made for the fluid content of foods consumed. It is becoming generally accepted that 6 to 8 cups (appropriate for the size/age of the child) of fluid per day should provide an adequate intake providing allowances are made for extra during hot weather and after vigorous activities. Thirst is a good indicator of fluid needs, provided that there is an opportunity to recognise and respond to it.

Standards and Guidance
There is a legal requirement to supply water that is fit for drinking and the latest School meals guidance and standard documents state that there is an expectation that water will be provided free of charge and milk should be available every day. However, this guidance does not state a quantity, nor does it discuss appropriate venues for serving the drinks.

Dehydration
The effects of poor hydration range in the short term from thirst and headaches, continence problems and constipation to concerns of urinary tract infections, renal stones and renal disease in the longer term.

using the toilets and the habit of sitting or squatting on the toilet seat of both young people who were presenting with renal problems and those with other medical concerns. Although the numbers were small (range 11-38 in each of 4 groups) some of the results showed concerning trends. Older pupils have less (free) access to the toilet areas during the day.
– Older pupils are more likely to not sit properly on the seats (up to 50% of young people presenting with renal linked problems).
– The lack of water fountains shown in the above survey was confirmed.
– There was very little encouragement to drink after games/sports across all age ranges.

Suggested Actions
Some schools need very little encouragement to improve facilities once they are aware of the benefits; especially once both health and education benefits are understood. There are schools that will need more practical advice and support to be encouraged to improve their provision. Practical support in terms of resources, access to grants and ensuring policy makers are aware of the issue are all useful avenues to pursue. The Healthy Schools Standard is an ideal arena for promoting fluids in schools. In Leeds a requirement to address fluid intake is included in the nutrition component. The increasing number of breakfast schemes provided in schools gives another opportunity to offer and encourage fluids.

Reference
1 Clinical Paediatric Dietetics 2nd Edition edited by Vanessa Shaw and Margaret Lawson for the Paediatric group of the British Dietetic Association 2001
2 Kleiner SM. Water: an essential but overlooked nutrient. Journal of the American Dietetic Association 1999; 99:200-206
3 Statutory Instruments 1996 No. 360 The Education (School Premises) Regulations 1996
4 DfEE: Healthy School Lunches. Guidance for school caterers on implementing Nutritional Standards 2000.

For More Information, contact Mary Cooper at Leeds Community & Mental Health Services Trust, St Mary’s Hospital, Greenhill Road,
Leeds LS12 3QE

NDNS information on drinks:
87% of primary school children regularly drink milk, 70% drink sweetened fizzy drinks, 60% drink water, 59% drink sweetened squashes or cordials, 56% drink no added sugar squashes or cordials, 50% drink fruit juice, 36% drink tea and 35% drink ready-to-drink sweetened drinks such as those in cartons, e.g. Five Alive, Ribena, etc.

To properly understand these drinking habits, we need to compare the actual quantities consumed. Parents and the school environment will have some control over drinks offered, but children tend to choose on taste from what is available. In total per week, the average primary school child consumes:

- 15 glasses of low calorie soft drinks
– 15 glasses of sweetened soft drinks about 10 glasses of milk
– 21/2 glasses of fruit juice and
– 2 cups of tea/coffee

(averages about 6-8 drinks per day)

The sweetened soft drinks provide about 30% of the total non-milk extrinsic (NME) sugars in the diet.

The National Diet and Nutrition Surveys (NDNS) are carried out in this country every ten years and provide the government and other agencies with valuable data on which to
base policies. The last NDNS for children aged 4-18 years was published in 2000 and much of the data in this abstract have been taken from this survey.

NDNS information on drinks:
87% of primary school children regularly drink milk, 70% drink sweetened fizzy drinks, 60% drink water, 59% drink sweetened squashes or cordials, 56% drink no added sugar squashes or cordials, 50% drink fruit juice, 36% drink tea and 35% drink ready-to-drink sweetened drinks such as those in cartons, e.g. Five Alive, Ribena, etc.

To properly understand these drinking habits, we need to compare the actual quantities consumed. Parents and the school environment will have some control over drinks offered, but children tend to choose on taste from what is available. In total per week, the average primary school child consumes:

- 15 glasses of low calorie soft drinks
– 15 glasses of sweetened soft drinks about 10 glasses of milk
– 21/2 glasses of fruit juice and
– 2 cups of tea/coffee

(averages about 6-8 drinks per day)
– 1-5% are deficient in magnesium,
– 1-3% are deficient in iron and about 1% are deficient in iodine and B vitamins.

The government has recently begun the Fruit in School scheme. By 2004 it aims to provide every 4-6 year old with a small piece of fruit, every school day, free of charge. Fruit is a rich source of several nutrients, in particular, anti-oxidants, which, in the long term, will help to reduce the risk of developing cancer and heart disease. Milk and a portion of fruit together would complement each other, by providing a valuable addition of key nutrients to the diets of primary school children, particularly those from under privileged backgrounds. It will also help encourage ‘healthier’ choices of food and beverages as the children enter adulthood.

Reference
Gregory J et al (2000) National Diet and Nutrition Survey: young people aged 4 to 18 years Volume 1: Report of the Diet and Nutrition Survey. London: The Stationery Office.

Schools can contact their Healthy Schools Co-ordinator to find out more (see back of book for contact numbers).

Remember we can all benefit from drinking more water.

Encourage students to drink at least 6-8 glasses of pure fresh water per day!

Teachers may also find that drinking more water makes them feel better!

How Can Schools Provide Water?

Water Bottles on Desks

– Perhaps the easiest, cheapest and most effective way for children to get their water is for them to bring in a clear, colourless plastic bottle of tap water from home.

– Ideally, sources of cold drinking water should also be available in school for children to refill their bottles as necessary.

– Bottles should be taken home daily, rinsed with warm soapy water and reused; they should be clear so that children do not bring in squash, juice or fizzy drinks to drink between meals.

- Non-spill sports-style caps are ideal.

- We recommend that students are permitted to drink only water in class in order to protect their teeth.

Water Coolers

– Water coolers use either mains or bottled water.

– They may be used with disposable cups or cones or used to refill bottles.

– Mains water coolers have lower
on-going costs.

Water Fountains
– Water fountains are useful but care should be taken to site them away from toilets, and in easily accessible, suitably supervised areas where students are safe from boisterousness, pushing and bullying.
– The number of fountains should reflect the number of students.

- Can be used to refill bottles in a Water Bottles on Desks scheme.

– Cups should be available disposable cups are ideal or children can bring their own.

– Jugs of drinking water can be chilled in the fridge if space allows.

A Note on Vending Machines
– Schools with vending machines
(or tuck shops) might wish to consider selling bottled water and milk as healthy alternatives to the usual sweet soft drinks and juices (note that some flavoured and/or carbonated waters may contain sugar and/or be acidic).

– Schools with good access to fresh drinking water may even wish to consider removing vending machines!

– Vending machines are not an alternative to free good-quality water facilities.

Hughes (Bredbury)
0161 430 5856
Spa
01422 883 916
Hydropure
0800 11 77 44

This is not a definitive list, there are many more in the Yellow Pages

Bottled water coolers (large inverted bottle) style usually used with purchased water although some designs can be refilled with tap water.
We would suggest that the mains plumbed water fountains could be the best option for schools as they do not have the expense of litter associated with cups. These point-of-use (POU) machines have a ‘bubbler’ (jet for drinking water) and a ’swan neck’ (to allow a cup or bottle to be filled).
The traditional water cooler (large bottle on top of cooler, not plumbed in) is the cheapest (to purchase approx. 300).

Some companies offer these machines on a free rental scheme but you have to purchase the water bottles

If you have a good relationship with the school ancillary staff, you could consider this option. But remember these machines need the drip tray washing daily, and sanitising 4-6 weekly, plus the cost of cups if personal bottles are not used (the plastic cups can be recycled, many of them are made from recycled plastic).

Water fountains (plumbed in and requiring a drain for waste) start from 500. The only additional costs are for filters (30 x six monthly) and sanitising. They could initially cost more to install if the mains water needs re-siting but are the cheapest to run, and the most robust machines. Water fountains can be rented and all the costs are included in the rental. AquaAid and Aqua Cool are currently charging 25 per month per machine
(July 2001).

There is probably not one definitive answer to your water needs. Much will depend on the current plumbing, siting of the machines and size of the school. It may be possible to have the less expensive water

coolers in dining rooms, sixth form blocks and staff rooms, as they may be treated with more care in these areas. The heavy duty fountains could be sited in areas where they will not be as carefully managed.

Further advice may also be available from local Schools Buildings Inspectors. There are many water delivery systems available so most school needs can be catered for.

A Note about Funding
In addition to the usual sources of funding, school water schemes can be paid for in a variety of other ways:
– Supermarkets and bottled water manufacturers may donate bottles for Water on Desks Schemes.
– Food Co-Ops may be able to supply low-cost bottled water for tuck shops.
– Many suppliers of fountains and coolers offer discounts for schools and additional discounts for larger orders.
– The Drinking Fountain Association is a charity which donates water fountains to schools in return for a 25 membership fee (which is used to fund more fountains). Schools then only need to arrange fitting (typical cost approximately 70).

Who could deny that those who prepare and serve food in schools are vital to its quality and success?

Their skills and commitment to the services are as important as the ingredients that they use. But too often school meals workers feel that their service is a low priority. They are frustrated by the ignorance of its central role in child development and the health of the nation. The earliest organisers of the education system knew that to feed the mind, you must feed the body. Food at school during terms and holidays served health, education and welfare strategies. After the barren years of Baroness Thatcher, school meals were relegated to a non-essential unregulated service. The reintroduction of national nutritional standards and an element of compulsory provision must be good news. The joint DfEE/DOH Food in Schools programme is a positive initiative which restores, in some measure, the status of school meals and other nutritional issues. But there are fundamental barriers to progress which have been created over the last twenty or so years. Funding levels have failed to meet need throughout the public sector. There have been pressures to achieve educational standards and to equip children for a new technological age. The combination of the two factors has worked against the delivery of a high quality catering service. And while those at the chalk-face have undoubtedly felt the pinch, those at the food-face have had to perform loaves and fishes miracles.

A kitchen team may have as little as 40p or less a head to provide a tempting and tasty midday meal. While Government investigates how to improve take-up of school meals, those who run the service may doubt that they have the capacity to meet increased demand. Kitchen and dining room premises have also deteriorated.

Pay and condition remain pitifully low. As term-time only workers , many school ancillary staff have received retainer pay during the holidays. These schemes have been under attack in local authorities. Private companies, which hold about 20 per cent of school meal contracts, are unlikely to fund them. And now access to job-seeker’s allowance during unpaid holidays is disallowed following the failure of a UNISON-backed petition to the House of Lords on interpretation of the regulations.

The judgement did refer to the low levels of pay and poverty trap into which school support can fall.

If you can’t make omelettes without cracking eggs, you certainly can’t pursue the Food in Schools programme without consideration of the egg-crackers. The staff have hands-on experience and indispensable skills and should be an essential part of any discussion on the shape and direction of the services. Despite the poor terms and conditions, most school meals workers enjoy their role and would dearly love to have the resources to do more. If the government and employers are sincere about effecting positive change in children’s diet and their relationship with food, they will need to invest in the service and its workers.

This exciting publication is a comprehensive update by Joe Harvey of the original Snag Guide. It covers new government initiative and regulations and offers a step by step approach to establish a school food policy via a whole school approach. Essential reading for health and education professionals, caterers and anyone else with an interest in improving food services and young peoples nutrition in schools.

To order a copy Click Here