Why all children need good nutrition for health.

Encouraging all children to eat a nutritious, balanced diet early on is important for several reasons. Ensuring they get the right nutrition in their diet will help them grow and develop to their full potential. They are also more likely to be energised and motivated, supporting their ability to learn. Educating them on healthy nutrition during childhood will also help them make healthier choices as they become adults.

There is considerable evidence that children with neurodiversity are more likely than those in the general population to have nutritionally related ill health. Issues relating to body weight (both overweight and underweight), swallowing difficulties, gastro-oesophageal reflux disorder, diabetes, bowel disorders and oral health are frequently reported among people with disabilities.

The prevalence of other common age-related disorders which might be linked to poor diet – such as hypertension (high blood pressure), stroke and coronary heart disease – occur among neurodiverse people just as they do in the general population. However, many of these conditions and the related ill health are avoidable with better nutrition and lifestyles. Neurodiverse people are also frequently poorer, live in more challenging circumstances, and may be socially excluded, all factors which may contribute to poorer eating patterns.

It is highly likely that poor nutritional status throughout life contributes to a reduced lifespan, as well as contributing to morbidity (ill health) and poorer quality of life. There is also often insufficient attention paid to the health needs of children and young people with neurodiversity, a lack of basic health promotion, insufficient support to achieve a healthy lifestyle, and under identification of health conditions – so what can help?

Eating well

Children should, wherever possible, be encouraged by family, friends, and support staff to eat a varied diet. They should eat foods from each of the four main food groups every day to ensure they get all the nutrients they need.

The Eatwell Guide divides the foods and drinks we consume into 5 main groups:

• fruit and vegetables
• potatoes, bread, rice, pasta and other starchy carbohydrates
• beans, pulses, fish, eggs, meat and other proteins
• dairy and alternatives
• oils and spreads

You should try to choose a variety of foods from each group to help you get the nutrients you need to stay healthy.

Fruit and vegetables are particularly important for good health. Everyone should be encouraged to eat at least five portions of a variety of different fruits and vegetables every day.

https://www.nhs.uk/live-well/eat-well/

The Eatwell Guide does not apply to children under the age of 2 because they have different nutritional needs.

Between the ages of 2 and 5, children should gradually move to eating the same foods as the rest of the family in the proportions shown in the Eatwell Guide.

Read more about babies, toddlers and young children’s nutritional needs in https://www.nhs.uk/conditions/baby/weaning-and-feeding/babys-first-solid-foods/

Drinks

It is important that children are encouraged to drink a sufficient, but not excessive amount, of fluid each day and it should not be assumed that they will necessarily drink enough fluid without encouragement.

The number of soft drinks given to children should be limited since these offer little nutritional benefit and may suppress appetite and prevent children eating more nutritious foods.

To avoid constipation, it is important that children are as mobile as possible and have sufficient fluid and fibre in their diet.

The eating environment and timing of meals and snacks

All children and young people should be respected as individuals and their food preferences and religious and cultural requirements around food should be accommodated.

Food should be appetising and attractively served, to ensure that children enjoy their food. This is particularly important if the food has its form or texture changed for children with swallowing difficulties.

The timing of meals and snacks throughout the day should be organised to fit around the needs of the child being supported and some children may need frequent small meals and snacks throughout the day.

It is important to ensure that children have enough time to eat and drink and that, where necessary, food is kept warm safely during the meal for those who eat and drink slowly.

Many toddlers go through a fussy stage with their eating. However, it can be difficult when an older child still only eats a handful of foods. Most parents and carers in this situation have tried many strategies to get their child to eat but find that nothing makes any difference. All that happens is everyone gets increasingly stressed, and relationships can start to be affected.

Children may reject a food that looks different on sight without even tasting it and may have a fear around new or different foods. The child may pay attention to the small, specific details of the foods that they eat. They are often brand and packaging loyal and are not motivated to change or see the need to imitate others.

There are a number of Do’s and Don’ts that are good to keep in mind when faced with the challenge of a child with restrictive or other eating difficulties.

Try to

✓ Allow the child to eat the foods that they like.
✓ Model eating new foods in front of the child, without the expectation that they will have to try it.
✓ Play games involving food that are fun, involve touching, seeing, and smelling new foods.
✓ Involve them in preparing meals so they can touch, smell, and see the food.
✓ Place small bowls of food with new items on the table so the child can choose to interact with it or not.
✓ Look calm and be positive if they try a new food.
✓ Encourage eating together with family and friends.

Try not to

✗ Prompt – this can make a child less likely to try a new food.
✗ Pressurise – this can make a child feel anxious.
✗ Bribe – if a child is fearful about eating something, a bribe will not help.
✗ Reward with food. Use non-food rewards instead e.g., stickers, activities, and quality time together.
✗Hide a new food in a preferred meal as this may mean they will not eat that food again.
✗Look anxious when your child is trying a new food, as they will be super tuned into you and if you appear anxious so will they be.

Eating a varied diet is good for your health, but many children find this difficult. Some have a restricted diet, eating only a limited range of food. Others may over-eat. This section explores common issues and ways you can help.

Research indicates that children who are anxious and sensory-sensitive are more likely to have issues with eating. It is not surprising then that eating problems are common and varied in neurodivergent children such as:

• only eating a very few foods
• not being able to eat at school
• only eating when they are on their own.
• going for long periods of time without eating
• overeating
• Pica (eating non-foods)

This can be difficult to understand and manage. Parents and carers can feel high levels of anxiety, frustration and blame if their child has difficulty with eating a healthy varied diet.

Supporting children with eating and drinking

A real partnership between families, friends and support staff is essential so that everyone works together to ensure that each child eats and drinks in a way that they prefer, and which is enjoyable, appropriate, safe, and nutritious.

To make mealtimes a time of pleasant social sharing, and as good practice, families and supporting staff could sit with the children during meals and snacks, where appropriate sharing the same foods and drinks to model eating skills and to encourage social interaction and conversation.

https://www.ellynsatterinstitute.org/wp-content/uploads/2015/08/ELLYN-SATTER%E2%80%99S-DIVISION-OF-RESPONSIBILITY-IN-FEEDING.pdf

https://www.ellynsatterinstitute.org/resources-and-links-for-the-public/

Family Mealtimes

Try to:

• Eat together as a family at the same time every day.
• Have a good family meal and snack routine to prevent grazing through the day.
• Ensure that mealtimes are no longer than 30 mins.
• Give child a verbal warning, ”we will be eating in 5 minutes” and a visual timer.
• Use communication aids to prepare your child e.g., visual timetables, now and next boards.
• Sit at the table, ensure your child has a chair which is comfortable for them.
• Ensure child’s feet are supported and legs/hips are at 90 degrees flexion.
• Avoid screens at mealtimes where possible (e.g., TV / computer tablet / phones)
• Avoid food battles at the family meal, focus on the social element.
• Allow and encourage children to be involved or present during food preparation enables children to see what they are eating and where it comes from
• Model (show) the behaviour you want to encourage, for example by you trying new foods / using cutlery / eating a variety of foods on your plate / stopping when you are full.
• Talk about the food, colour, smell, shape and how it feels.
• Place food on the table for family members to serve themselves.
• Encourage your child to participate in dishing up their own and other family members meals, even if this is a food that they do not eat.
• Give your child a second plate which sits next to their own meal on the table for the duration of the mealtime. They can dish up food that the rest of the family are eating but use this as a ‘learning plate’ and there is no pressure on the child to try anything off this plate but talk about the sensory aspects of the food on the plate.
• Keep expectations low and typically progress in this area is a slow process with a long-term focus. Acknowledge that all family members eat at different speeds and have their own preferences (it can be helpful to discuss this)
• Have a ‘clean-up’ routine when eating and drinking has finished. The clean-up routine helps children know what to expect, and clearly defines that there is ”an end” and when it will be.