Nursery Food: Quality - Progress report

Nursery nutrition was a little-visited topic until 2008, when a report by the Soil Association provided the first detailed investigation into the state of food given to nursery-age children in England and Wales. The Georgie Porgy Pudding and Pie study found that 30 per cent of private, voluntary and independents (PVIs) regularly served biscuits, while 5 per cent regularly served ready meals and fizzy drinks.

Since then, the need for one set of universally accepted guidelines to raise quality and standardise good practice has been a clarion call for the sector. The Department for Education commissioned the Children's Food Trust to produce the Voluntary food and drink guidelines for early years settings in England, published in January 2013. They were based on the EYFS recommendation that any food given to children should be 'healthy, balanced and nutritious'.

The latest research on nutritional standards in the sector comes from the Centre for Diet and Activity Research (CEDAR) at the University of Cambridge. Its study, which analysed detailed results from 851 UK nurseries, was to describe foods and beverages served in nurseries, assess carer behaviours related to feeding, and compare these practices to the guidelines. Full results are to be published later this year.

The data showed that while just 0.7 per cent of nurseries now serve fizzy drinks, the vast majority (83 per cent) are still serving sugary drinks such as squash. Also, 30 per cent of nurseries are still not serving vegetables once per day, though most nurseries serve fruit daily (92 per cent). Less than a third (28 per cent) met the guideline to serve oily fish often while a similar number of nurseries reported that they served pulses, legumes and lentils often (31 per cent).

THE IMPACT OF DEPRIVATION

The study covered nurseries in a mix of areas ranging from high levels of deprivation to low, according to the Government's Index of Multiple Deprivation. It found that the 'nutritional quality of some foods and beverages served to children was affected by the deprivation level of the area'.

Nurseries in more deprived areas were 'in many instances' better than those in the least deprived areas at meeting most of the guidelines, including not serving sugary drinks, and serving more legumes, pulses and lentils. Large improvements were seen in serving more wholegrains (76 per cent versus 60 per cent), and serving oily fish (32 per cent versus 22 per cent).

The behaviour of staff in the nurseries in more deprived areas was also often better at promoting good nutrition. More than twice as many nurseries diluted juice with water (35 per cent compared with 16 per cent in the least deprived areas) while 80 per cent seated fussy eaters with good eaters, compared with 70 per cent of their counterparts in the least deprived areas.

The impact of the trust guidelines was also charted. According to the survey, 56 per cent of managers say they get information about nutritional standards from 'national reports', with only 12 per cent of these naming the trust's guidelines as their 'primary resource for nutrition information'. This indicates that less than one in eight nursery managers use the new Government-endorsed guidelines at present.

Lead author of the study is Sara Benjamin Neelon, an honorary senior visiting fellow at CEDAR and associate professor, Duke University Medical Center and Global Health Institute, North Carolina.

She says, 'As a child nutritionist, I think that the results of this study are very promising. Most of the nurseries in the study reported that they served healthy foods, although there was still some room for improvement.

'In many instances, nurseries in the more deprived areas reported serving more healthy foods than nurseries in higher resource areas. This shows a strong commitment by nurseries in more deprived areas to promote the health of the children in their care.'

On deprivation, the study noted, however, that 'while nurseries in the most deprived areas reported serving more healthy foods (than those in least deprived areas), a large percentage of these nurseries were still not meeting national guidelines. Policy and intervention efforts may increase consistency with national guidelines in nurseries in more deprived areas, and across England'.

Some early years practitioners have said the fact that the guidelines aren't mandatory explains why less than 12 per cent of nurseries are using them.

Annie Seeley, early years nutritionist, says, 'The early years guidelines are easy for early years settings to adopt and are comprehensive. The issue is that they are voluntary (unlike the school food standards, which work very well). This means that only nurseries that are engaged will follow them.

'We see the good nurseries. Yet I have heard anecdotally of nurseries that only use a microwave and a tin-opener - these are the nurseries that fall under the radar, because there is no monitoring of provision.'

CHILDREN'S FOOD TRUST TRAINING

As well as producing the guidelines, the Children's Food Trust has put together a support programme of nutrition guidelines training for local authorities, and public health and early years staff. One course is about how to apply the food and drink guidelines in practice at a setting. Councils are trained to conduct 'baseline' and 'follow-up' audits at settings before and after the training, to track improvement.

An additional course is run by the trust for councils to deliver free coaching to children's centres and PVIs on how to run healthy cooking sessions with families.

The support programme, which initially targeted 25 local authorities with higher than average levels of deprivation and health inequalities, has now been commissioned by a further 12 councils, while the guidelines have been downloaded 20,000 times since being published.

The trust's head of nutrition Patricia Mucavele adds, 'This is equivalent to one in four local authorities; for a relatively small national charity we are pleased with this coverage.' The programme is 'active' in 50 early years settings in Southwark alone (according to a report from the London Health Inequalities Network).

The latest review of this programme found that the number of settings able to describe how food supports learning increased from 43 per cent to 69 per cent between baseline and follow-up audits.

There is also 'increased use of food policies within settings' (from 84 per cent to 92 per cent of settings having policies in place between audits), 'and engagement with parents and children around food activities' after settings have been trained. The proportion of settings including all relevant detail in their policy increased from 48 per cent to 73 per cent.

The review, Eat Better, Start Better programme Phase 2 (2012-13), which was published this January, looked at 292 settings that had been trained by local authority staff who had received the trust's programme of nutrition training.

Also significant was that nearly half (43 per cent) of settings provided children with a portion of fruit or vegetables as part of breakfast at baseline, but this increased to three quarters (75 per cent). The remaining 25 per cent who do not remains 'an area of focus' for the sector.

Because many of the guidelines used in the CEDAR survey are paraphrases, adapted for the purposes of the study, it is not often possible to make direct comparisons. The trust data also looks only at nurseries that have been trained in how to use the guidelines, and so is likely to paint a more optimistic picture than the national reality.

MORE INFORMATION

- CEDAR study, www.cedar.iph.cam.ac.uk/research/directory/nursery-nutrition-practices-survey

- Georgie Porgie Pudding and Pie: exposing the truth about nursery food, www.soilassociation.org/LinkClick.aspx?fileticket=P7%2F0qfiUPe4%3D&tabid =659

- Voluntary food and drink guidelines for early years settings in England, www.childrensfoodtrust.org.uk/pre-school/resources/guidelines

- Eat Better, Start Better evaluation, www.childrensfoodtrust.org.uk/assets/research-reports/EatBetterStart BetterEvaluationJan2014.pdf.