tag:theconversation.com,2011:/fr/topics/child-nutrition-9417/articlesChild nutrition – The Conversation2024-03-17T19:01:29Ztag:theconversation.com,2011:article/2256682024-03-17T19:01:29Z2024-03-17T19:01:29ZWhy is toddler milk so popular? Follow the money<figure><img src="https://images.theconversation.com/files/582110/original/file-20240315-28-i7q9zu.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/toddler-hands-holding-cup-white-fresh-2057012747">FotoDuets/Shutterstock</a></span></figcaption></figure><p>Toddler milk is popular and becoming more so. Just over a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jhn.12851">third of Australian toddlers</a> drink it. Parents <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01933-X/fulltext">spend</a> hundreds of millions of dollars on it globally. Around the world, toddler milk makes up nearly half of <a href="https://onlinelibrary.wiley.com/doi/10.1111/mcn.13097">total formula milk sales</a>, with a 200% growth since 2005. Growth is expected to continue.</p>
<p>We’re concerned about the growing popularity of toddler milk – about its nutritional content, cost, how it’s marketed, and about the impact on the health and feeding of young children. Some of us voiced our concerns on the <a href="https://www.abc.net.au/news/2024-03-12/toddler-milk-nutrition-benefits-marketing-parents/103517864">ABC’s 7.30 program recently</a>.</p>
<p>But what’s in toddler milk? How does it compare to cow’s milk? How did it become so popular?</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/gOFTZmptaN0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">We shared our concerns about toddler milk and what this means for parents and children.</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/misleading-food-labels-contribute-to-babies-and-toddlers-eating-too-much-sugar-3-things-parents-can-do-194168">Misleading food labels contribute to babies and toddlers eating too much sugar. 3 things parents can do</a>
</strong>
</em>
</p>
<hr>
<h2>What is toddler milk? Is it healthy?</h2>
<p>Toddler milk is marketed as appropriate for children aged one to three years. This <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140693/">ultra-processed food</a> <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/nutrition-and-packaging-characteristics-of-toddler-foods-and-milks-in-australia/1C6BA80843B773FC058BD3087D1A22BA">contains</a>:</p>
<ul>
<li><p>skim milk powder (cow, soy or goat)</p></li>
<li><p>vegetable oil</p></li>
<li><p>sugars (including added sugars)</p></li>
<li><p>emulsifiers (to help bind the ingredients and improve the texture)</p></li>
<li><p>added vitamins and minerals.</p></li>
</ul>
<p>Toddler milk <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/nutrition-and-packaging-characteristics-of-toddler-foods-and-milks-in-australia/1C6BA80843B773FC058BD3087D1A22BA">is usually</a> lower in calcium and protein, and higher in sugar and calories than regular cow’s milk. Depending on the brand, a serve of toddler milk can contain as much sugar as a <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/nutrition-and-packaging-characteristics-of-toddler-foods-and-milks-in-australia/1C6BA80843B773FC058BD3087D1A22BA">soft drink</a>. </p>
<p>Even though toddler milks have <a href="https://link.springer.com/article/10.1007/s00394-019-01950-5">added vitamins and minerals</a>, these are <a href="https://iris.who.int/bitstream/handle/10665/373358/9789240081864-eng.pdf?sequence=1">found in and better absorbed</a> from <a href="https://www.healthline.com/nutrition/synthetic-vs-natural-nutrients">regular foods and breastmilk</a>. Toddlers do not need the level of nutrients found in these products if they are eating a varied diet. </p>
<p>Global health authorities, including the <a href="https://iris.who.int/bitstream/handle/10665/373358/9789240081864-eng.pdf?sequence=1">World Health Organization</a> (WHO), and Australia’s <a href="https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56_infant_feeding_guidelines_150917(1).pdf">National Health and Medical Research Council</a>, do not recommend toddler milk for healthy toddlers.</p>
<p>Some children with specific metabolic or dietary medical problems might need tailored alternatives to cow’s milk. However, these products generally are not toddler milks and would be a specific product prescribed by a health-care provider. </p>
<p><a href="https://www.choice.com.au/babies-and-kids/feeding-your-baby/first-foods/articles/are-toddler-milks-necessary">Toddler milk</a> is also up to <a href="https://nutritionj.biomedcentral.com/articles/10.1186/s12937-022-00765-1">four to five times</a> more expensive than regular cow’s milk. “Premium” toddler milk (the same product, with higher levels of vitamins and minerals) is more expensive. </p>
<p>With the <a href="https://theconversation.com/undernourished-stressed-and-overworked-cost-of-living-pressures-are-taking-a-toll-on-australians-health-223625">cost-of-living crisis</a>, this means families might choose to go without other essentials to afford toddler milk.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman holding blue plastic spoon of formula powder over open tin of formula, milk bottle in background" src="https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582090/original/file-20240315-30-3y4x18.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Toddler milk is more expensive than cow’s milk and contains more sugar.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/powder-milk-blue-spoon-on-light-779728180">Dragana Gordic/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-everyday-foods-you-might-not-realise-are-ultra-processed-and-how-to-spot-them-197993">8 everyday foods you might not realise are ultra processed – and how to spot them</a>
</strong>
</em>
</p>
<hr>
<h2>How toddler milk was invented</h2>
<p>Toddler milk was created so infant formula companies could <a href="https://www.who.int/docs/default-source/nutritionlibrary/breastfeeding/information-note-cross-promotion-infant-formula.pdf?sfvrsn=81a5b79c_1">get around rules</a> preventing them from advertising their infant formula. </p>
<p>When manufacturers <a href="https://www.jandonline.org/article/S2212-2672(21)01197-7/abstract">claim benefits</a> of their toddler milk, many parents assume these claimed benefits apply to infant formula (known as <a href="https://www.who.int/docs/default-source/nutritionlibrary/breastfeeding/information-note-cross-promotion-infant-formula.pdf?sfvrsn=81a5b79c_1">cross-promotion</a>). In other words, marketing toddler milks also boosts interest in their infant formula.</p>
<p>Manufacturers also create brand loyalty and recognition by making the labels of their toddler milk look similar to their infant formula. For parents who used infant formula, toddler milk is positioned as the next stage in feeding.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-youre-feeding-with-formula-heres-what-you-can-do-to-promote-your-babys-healthy-growth-106165">If you're feeding with formula, here's what you can do to promote your baby's healthy growth</a>
</strong>
</em>
</p>
<hr>
<h2>How toddler milk became so popular</h2>
<p>Toddler milk is <a href="https://academic.oup.com/nutritionreviews/article-abstract/82/3/425/7172846?redirectedFrom=fulltext&login=false">heavily marketed</a>. Parents <a href="https://pubmed.ncbi.nlm.nih.gov/37203416/">are told</a> toddler milk is healthy and provides extra nutrition. Marketing <a href="https://uconnruddcenter.org/wp-content/uploads/sites/2909/2020/09/Infant-Formula-and-Toddler-Milk-Brief_9-23-19.pdf">tells parents</a> it will benefit their child’s growth and development, their brain function and their immune system.</p>
<p>Toddler milk is also presented as a <a href="https://uconnruddcenter.org/wp-content/uploads/sites/2909/2020/09/Infant-Formula-and-Toddler-Milk-Brief_9-23-19.pdf">solution</a> to fussy eating, which is common in toddlers.</p>
<p>However, regularly drinking toddler milk could increase the risk of <a href="https://www.researchgate.net/profile/Kathy-Cowbrough-2/publication/44645020_Feeding_the_toddler_12_months_to_3_years--challenges_and_opportunities/links/53e2409e0cf2d79877aa22e5/Feeding-the-toddler-12-months-to-3-years--challenges-and-opportunities.pdf">fussiness</a> as it reduces opportunities for toddlers to try new foods. It’s also sweet, needs no chewing, and essentially displaces energy and nutrients that whole foods provide.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Toddler wearing bib with food smeared on face" src="https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582092/original/file-20240315-20-3y4x18.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Toddler milk is said to help fussy eating, but it may make things worse.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-girl-toddler-picking-her-food-492304303">zlikovec/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-tell-if-your-kids-fussy-eating-phase-is-normal-92118">How to tell if your kid's 'fussy eating' phase is normal</a>
</strong>
</em>
</p>
<hr>
<h2>Growing concern</h2>
<p>The <a href="https://www.who.int/news/item/28-04-2022-who-reveals-shocking-extent-of-exploitative-formula-milk-marketing">WHO</a>, along with public health academics, has been raising concerns about the marketing of toddler milk for years.</p>
<p>In Australia, moves to curb how toddler milk is promoted have gone nowhere. Toddler milk is in a category of foods that are <a href="https://www.legislation.gov.au/F2008B00660/asmade/text">allowed to be fortified</a> (to have vitamins and minerals added), with no marketing restrictions. The Australian Competition & Consumer Commission also <a href="https://www.accc.gov.au/media-release/accc-to-reauthorise-agreement-to-not-advertise-infant-formula-seeks-submissions-on-toddler-milk-advertising">has concerns</a> about the rise of toddler milk marketing. Despite this, there is no change in how it’s regulated.</p>
<p>This is in contrast to <a href="https://www.health.gov.au/topics/pregnancy-birth-and-baby/breastfeeding-infant-nutrition/marketing-infant-formula">voluntary marketing restrictions</a> in Australia for infant formula.</p>
<h2>What needs to happen?</h2>
<p>There is <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01933-X/fulltext">enough evidence</a> to show the marketing of commercial milk formula, including toddler milk, influences parents and undermines child health.</p>
<p>So governments need to act to protect parents from this marketing, and to put <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01933-X/fulltext">child health over profits</a>. </p>
<p>Public health authorities and advocates, including us, are calling for the restriction of marketing (not selling) of all formula products for infants and toddlers from birth through to age three years.</p>
<p>Ideally, this would be mandatory, government-enforced marketing restrictions as opposed to <a href="https://www.health.gov.au/topics/pregnancy-birth-and-baby/breastfeeding-infant-nutrition/marketing-infant-formula">industry self-regulation</a> in place currently for infant formulas.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/essays-on-health-how-food-companies-can-sneak-bias-into-scientific-research-65873">Essays on health: how food companies can sneak bias into scientific research</a>
</strong>
</em>
</p>
<hr>
<h2>We musn’t blame parents</h2>
<p>Toddlers are eating <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13097">more processed foods</a> (including toddler milk) than ever because time-poor parents are seeking a convenient option to ensure their child is getting adequate nutrition.</p>
<p>Formula manufacturers have used this information, and created a demand for an unnecessary product. </p>
<p>Parents want to do the best for their toddlers, but they need to know the marketing behind toddler milks is misleading.</p>
<p>Toddler milk is an unnecessary, unhealthy, expensive product. Toddlers just need whole foods and breastmilk, and/or cow’s milk or a non-dairy, milk alternative.</p>
<p>If parents are worried about their <a href="https://raisingchildren.net.au/toddlers/nutrition-fitness">child’s eating</a>, they should see a health-care professional.</p>
<hr>
<p><em>Anthea Rhodes, a paediatrician from Royal Children’s Hospital Melbourne and a lecturer at the University of Melbourne, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/225668/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer McCann is a researcher with the Institute for Physical Activity and Nutrition (IPAN), a co-chair of the Infant and Toddler Foods Alliance, and a member of the Public Health Association of Australia. </span></em></p><p class="fine-print"><em><span>Karleen Gribble is a member of the Public Health Association of Australia, the World Breastfeeding Trends Initiative, the Australian Breastfeeding Association, the Infant and Toddler Food Research Alliance and the Infant and Young Child Feeding in Emergencies Core Group. </span></em></p><p class="fine-print"><em><span>Naomi Hull is a member of, and volunteers for, the Australian Breastfeeding Association and is a member of the Public Health Association of Australia. She is also an executive on the Infant and Toddler Food Research Alliance. Naomi is the National Coordinator for the World Breastfeeding Trends Initiative Australia.</span></em></p>Toddler milk is high in sugar and can leave toddlers reluctant to try new foods. It’s also heavily marketed to time-poor parents. We’re worried.Jennifer McCann, Lecturer Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin UniversityKarleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityNaomi Hull, PhD candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2023382023-04-26T20:08:27Z2023-04-26T20:08:27ZWhat to eat when you have COVID – and why reaching for the chicken soup is not a bad idea<figure><img src="https://images.theconversation.com/files/519161/original/file-20230404-28-mn04y7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5760%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Got COVID? Again?</p>
<p>Deciding what to eat can be mentally taxing, especially when you are not feeling well. However, our diet plays a role in preventing and managing poor health, including COVID.</p>
<p>Having a healthy diet is associated with a <a href="https://gut.bmj.com/content/70/11/2096">reduced risk of COVID</a>. And, if you do have COVID, a healthy diet is associated with <a href="https://gut.bmj.com/content/70/11/2096">milder symptoms</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-listen-to-gwyneth-paltrow-ivs-are-not-a-shortcut-to-good-health-202621">Don't listen to Gwyneth Paltrow – IVs are not a shortcut to good health</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519163/original/file-20230404-18-nq3k5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Deciding what to eat can be mentally taxing when you’re sick.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What should I eat during COVID infection?</h2>
<p>When we are sick it can be challenging to even think about food. However, the best way to fight the infection is by providing your body with foods that best support you to <a href="https://www.emro.who.int/nutrition/covid-19/nutrition-advice-for-adults-during-the-covid-19-outbreak.html">heal</a>.</p>
<p>Fresh fruit, vegetables, whole grains and various forms of protein are broken down into substances by the body to support your immune system. </p>
<p><a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">The Australian Guide to Healthy Eating</a> suggests we eat a variety of fresh foods every day including:</p>
<ul>
<li><p>two serves of fruit and five serves of vegetables</p></li>
<li><p>whole grains, such as wholemeal pasta, brown rice or wholemeal bread</p></li>
<li><p>healthy fats, such as avocado or olive oil </p></li>
<li><p>meat and meat alternatives (such as lean beef, chicken, tofu or legumes) and dairy (such as cheese or milk). </p></li>
</ul>
<p>Eating these kinds of foods every day helps provide our body with the nutrients required to fight infections and remain healthy. </p>
<p><a href="https://doi.org/10.3390/nu10050587">Avoiding processed and ultra processed foods</a> is also encouraged due to the high levels of salt and sugar and lack of nutrition found in these types of foods.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519165/original/file-20230404-18-fr2hi2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fresh fruit, vegetables, whole grains and proteins help feed your immune system.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What about chicken soup or similar?</h2>
<p>A great way to get all the nutrition your body requires when sick with COVID is through homemade chicken soup, chicken avgolemono, chicken congee or other similar dishes. </p>
<p>Why? Here are four good reasons:</p>
<p><strong>1. It’s easy and cheap to make</strong></p>
<p>The great thing about chicken soup is you can pop it in one pan (or into a slow cooker), throw all the ingredients in together and let it simmer away. </p>
<p>While the ingredients in chicken soup pack a powerful nutritional punch, they don’t cost the Earth.</p>
<p><strong>2. It’s easy to absorb</strong></p>
<p>The boiling process releases the <a href="https://doi.org/10.3390/foods10071456">nutritional elements</a> found in the ingredients and aids in digestion and absorption of these vital nutrients. </p>
<p><strong>3. It’s full of vitamins and minerals</strong></p>
<p><a href="https://scuj.journals.ekb.eg/article_119478.html">Essential vitamins and minerals</a> found in chicken soup include: iron, magnesium, sodium, potassium, calcium, chromium, copper, zinc, vitamin A, vitamin C, vitamin B6 and vitamin B12. </p>
<p><strong>4. It’s flavoursome and powerful</strong></p>
<p>The tasty flavour of chicken soup is enhanced by the <a href="https://doi.org/10.1080/10942912.2017.1291678">seventeen different amino acids</a> found in chicken soup. These amino acids also provide strength for your <a href="https://pubmed.ncbi.nlm.nih.gov/17403271/">immune system</a> </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519166/original/file-20230404-26-mr82o5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The ingredients in chicken soup pack a powerful nutritional punch.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Nutrition can support immune health but it’s not the only answer</h2>
<p>The best way to treat and manage a COVID infection is to avoid it in the first place. So remember to practise good hygiene, like washing your hands regularly, and maintain your recommended <a href="https://www.health.gov.au/our-work/covid-19-vaccines/advice-for-providers/clinical-guidance/clinical-recommendations">vaccine schedule</a>. </p>
<p>Practising a healthy lifestyle will also reduce your risks of not only contracting COVID, but also developing chronic disease. This includes not smoking or vaping, maintaining healthy physical activity habits, getting enough sleep and reducing alcohol consumption. </p>
<p>The current <a href="https://www.health.gov.au/news/australian-alcohol-guidelines-revised#:%7E:text=To%20reduce%20the%20risk%20of,risk%20of%20harm%20from%20alcohol.">recommendation</a> for maximum alcohol intake is ten standard drinks in one week, and no more than four standard drinks in one day. </p>
<h2>Don’t forget to drink plenty of water</h2>
<p>Water is <a href="https://health-study.joinzoe.com/post/how-much-fluid-should-i-drink-if-i-have-covid-19">crucial</a> when you’re sick. </p>
<p>Being dehydrated can enhance symptoms of colds and infections, including COVID. It is also associated with a higher risk of developing <a href="https://ccforum.biomedcentral.com/articles/10.1186/s13054-022-04203-w">long COVID</a>. </p>
<p>Aim to drink at least two litres of water per day, even more if you have a high body weight or have been losing fluids through vomiting or sneezing/runny nose.</p>
<p>If you don’t feel like having plain water, there are many healthy alternatives such as tea, broth or soup. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-like-drinking-plain-water-10-healthy-ideas-for-staying-hydrated-this-summer-191859">Don’t like drinking plain water? 10 healthy ideas for staying hydrated this summer</a>
</strong>
</em>
</p>
<hr>
<h2>Let’s remember to eat healthy anyway</h2>
<p>Eating a healthy and balanced diet is an important part of maintain good health and vitality.</p>
<p>Getting caught up in fads or buying supplements can be expensive and there is <a href="https://theconversation.com/dont-listen-to-gwyneth-paltrow-ivs-are-not-a-shortcut-to-good-health-202621">controversy</a> around their effectiveness. </p>
<p>In the long run, eating healthy will make you feel better and save you money.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-taking-vitamins-and-supplements-help-you-recover-from-covid-182220">Can taking vitamins and supplements help you recover from COVID?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/202338/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p><p class="fine-print"><em><span>Julie Marsh works in her own private dietetic practice as an Accredited Practising Dietitian. She is currently enrolled as a PhD Candidate with the School of Human Movement and Nutrition Sciences at The University of Queensland. Julie is based at the Centre for Community Health and Wellbeing at Springfield Qld. </span></em></p>Deciding what to eat can be mentally taxing, especially when you are not feeling well. But, our diet plays a role in preventing and managing poor health, including COVID.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandJulie Marsh, PhD Candidate, Accredited Practising Dietitian, BNutrDiet (Hons), The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1871752022-07-21T03:16:38Z2022-07-21T03:16:38ZHow to deal with hangry kids and reduce the chances of it happening again – 3 tips from nutrition experts<figure><img src="https://images.theconversation.com/files/474751/original/file-20220719-92275-hvzp5p.jpg?ixlib=rb-1.1.0&rect=11%2C83%2C7916%2C5214&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Like adults, children can get “<a href="https://www.oxfordlearnersdictionaries.com/definition/english/hangry">hangry</a>” – a combination of <a href="https://www.theguardian.com/science/2022/jul/06/being-hangry-is-a-real-thing-psychologists-find-link-between-hunger-and-emotions">angry and hungry</a>. <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269629">Hangriness</a> may be caused by blood glucose levels dropping, leading to irritability, bad mood, anger or tantrums.</p>
<p>Children have smaller stomachs than adults so may become hungry again sooner. Some may not notice they’ve become very hungry until the moment of crisis.</p>
<p>So, what can parents do when hangriness strikes – and reduce the risk of it happening again?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-the-science-of-hangry-or-why-some-people-get-grumpy-when-theyre-hungry-37229">Health Check: the science of 'hangry', or why some people get grumpy when they're hungry</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/474753/original/file-20220719-92480-zmx8jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/474753/original/file-20220719-92480-zmx8jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474753/original/file-20220719-92480-zmx8jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474753/original/file-20220719-92480-zmx8jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474753/original/file-20220719-92480-zmx8jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474753/original/file-20220719-92480-zmx8jk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474753/original/file-20220719-92480-zmx8jk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474753/original/file-20220719-92480-zmx8jk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children may become hungry again sooner than their parents.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What’s really going on?</h2>
<p>First: is your child really hangry, or just angry? Feeding straight away isn’t always the answer. Ask yourself:</p>
<ul>
<li><p>how long has it been since they last slept, and how was last night’s sleep? If they’re actually tired, a storybook, toy or cuddle might do. Consider whether their next meal can be earlier today – before they’re too tired to eat.</p></li>
<li><p>has anything else upset them? If so, act on this, rather than using food to distract or soothe.</p></li>
<li><p>how long has it been since they last ate? Did you miss a meal in the parenting rush? It happens! Maybe it’s time to pause for a <a href="https://raisingchildren.net.au/school-age/nutrition-fitness/daily-food-guides/school-age-food-groups">healthy snack</a>.</p></li>
</ul>
<p>If it’s not long until lunch or dinner, you could:</p>
<ul>
<li><p>just wait</p></li>
<li><p>let them start on the vegetable component of the meal, or</p></li>
<li><p>snack on some easy veggies (of age-appropriate texture) like a carrot, capsicum or cucumber.</p></li>
</ul>
<p>Dinner could be trickier if they’ve filled up on yoghurt or biscuits, so try not to serve things they love (other than veggies) at this time.</p>
<p>If your child complains of hunger but only wants a particular food or refuses veggies, consider whether they really are hungry.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/474755/original/file-20220719-72671-r7okyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/474755/original/file-20220719-72671-r7okyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474755/original/file-20220719-72671-r7okyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474755/original/file-20220719-72671-r7okyg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474755/original/file-20220719-72671-r7okyg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474755/original/file-20220719-72671-r7okyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474755/original/file-20220719-72671-r7okyg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474755/original/file-20220719-72671-r7okyg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Has anything else upset your child? If so, act on that.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Try not to get foods and emotions too entwined</h2>
<p>Many adults struggle with overeating to manage their emotions, a behaviour often <a href="https://www.ncbi.nlm.nih.gov/pubmed/28831105">learned in childhood</a>.</p>
<p>It’s important to find other ways of improving moods so children don’t learn to rely on foods to manage emotions. Explore other activities like listening to music, playing, or having a cuddle. We can also teach children other non food-based ways to manage their emotions, such as <a href="https://growingearlyminds.org.au/tips/mindfulness-for-kids-four-easy-mindfulness-exercises-for-children/">mindfulness</a> and deep breathing. </p>
<p>Using food as a reward or to calm can also lead to <a href="https://doi.org/10.1111/mcn.13341">emotional eating</a>. This may increase children consuming foods irrespective of hunger. </p>
<p>On the other hand, overly restricting food can have unintended effects and lead to emotional eating.</p>
<h2>3 ways to reduce hangriness risk</h2>
<p><strong>1. Maintain a regular eating routine</strong></p>
<p>For most young children, <a href="https://doh.health.tas.gov.au/__data/assets/pdf_file/0004/81769/Web_lady_gowrie_booklet.pdf">three meals and two snacks a day</a> works well. Having these at predictable times helps children learn to eat at meal times and be able to wait until the next meal.</p>
<p>Try to limit grazing. Grazing can set up a cycle where children aren’t hungry at meal times, so eat little, but then become hungry (or hangry) again soon after.</p>
<p>This can frustrate parents who’ve prepared a meal that isn’t eaten, and then feel pressured to prepare extra foods between meals. Grazing, even on nutritious foods, can also contribute to <a href="https://raisingchildren.net.au/babies/health-daily-care/dental-care/tooth-decay">tooth decay</a>.</p>
<p><strong>2. Include foods that help children feel fuller for longer</strong></p>
<p>Try to serve nutritious, substantial snacks. Including some protein and carbohydrates can help maintain their energy levels from one meal to the next.</p>
<p>Try natural yoghurt, milk, hummus, nuts/nut butter (of age-appropriate texture), eggs, oat muesli or wholegrain bread, to go with fruit or veggie snacks.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/474756/original/file-20220719-91744-ae4j5h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/474756/original/file-20220719-91744-ae4j5h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474756/original/file-20220719-91744-ae4j5h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474756/original/file-20220719-91744-ae4j5h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474756/original/file-20220719-91744-ae4j5h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474756/original/file-20220719-91744-ae4j5h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474756/original/file-20220719-91744-ae4j5h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474756/original/file-20220719-91744-ae4j5h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hummus can be paired with veggie snacks.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p><strong>3. Encourage children to pay attention to their hunger and fullness cues</strong></p>
<p>It can be tempting to pressure kids to eat more at mealtimes, or offer different foods if they reject what’s served.</p>
<p>But this is unlikely to help in the long run and can create a rod for your own back. It can turn mealtimes into a battle and parents into short-order chefs.</p>
<p>Pressuring children to eat can override their ability to self-regulate; they can get into a habit of overeating instead of listening to their hunger and fullness cues.</p>
<p>“<a href="https://raisingchildren.net.au/preschoolers/nutrition-fitness/healthy-eating-habits/healthy-eating-habits">Parents provide, kids decide</a>” reminds us a parent’s role is to provide nutritious foods at regular intervals; it’s the child’s role to decide <em>how much</em> to eat.</p>
<p>If you include something at each mealtime you know your child will eat, such as a favourite vegetable, then they’ll likely eat something if they are hungry.</p>
<p>If they really don’t want to eat then maybe they aren’t hungry, and that’s OK.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/474760/original/file-20220719-26-ug93mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/474760/original/file-20220719-26-ug93mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474760/original/file-20220719-26-ug93mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474760/original/file-20220719-26-ug93mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474760/original/file-20220719-26-ug93mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474760/original/file-20220719-26-ug93mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474760/original/file-20220719-26-ug93mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474760/original/file-20220719-26-ug93mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents provide, kids decide.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Other <a href="https://www.cookwelleatwell.org.au/products/feeding-kids-tips-1">tips</a> include eating together, eating the same foods, modelling enjoyment of those foods, and turning screens off while eating.</p>
<p>This is general advice for healthy children, but some may have more interest or enjoyment in food, or be more fussy, and may be particularly prone to difficult behaviour when hungry. If your child experiences severe fussiness, restricted eating, or you have concerns about their nutrition or health, speak with your child health nurse, doctor, or accredited practising dietitian.</p>
<p>If you are finding it financially difficult to get enough nutritious food for your family, support is available to <a href="https://askizzy.org.au/">access food</a> and <a href="https://www.cookwelleatwell.org.au/collections/consumer-recipes">low cost recipes</a>.</p>
<p>A well child’s health and nutrition is unlikely to suffer with occasional short bouts of hunger. </p>
<p>Yes, hangriness happens occasionally (it’s normal for children to test the boundaries!). But it’s OK to stay firm and ride it out. With an eating routine there’s another meal not too far away.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-diets-and-screen-time-to-set-up-good-habits-make-healthy-choices-the-default-at-home-114827">Kids' diets and screen time: to set up good habits, make healthy choices the default at home</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/187175/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Spence is a member of Dietitians Australia.</span></em></p><p class="fine-print"><em><span>Alissa Burnett is a member of the Nutrition Society of Australia</span></em></p><p class="fine-print"><em><span>Georgie Russell is a member of the Nutrition Society of Australia and the Australian and New Zealand Obesity Society. </span></em></p>First, check if your child is really hangry, or just angry. Feeding straight away isn’t always the answer.Alison Spence, Senior Lecturer in Nutrition and Population Health, Institute for Physical Activity and Nutrition (IPAN), Deakin UniversityAlissa Burnett, Lecturer in Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin UniversityGeorgie Russell, Senior Lecturer, Institute for Physical Activity and Nutrition (IPAN), Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1674092021-09-16T14:20:11Z2021-09-16T14:20:11ZMaking economic policy in South Africa in hard times: the role of human rights<figure><img src="https://images.theconversation.com/files/419798/original/file-20210907-20-1vtm54n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Residents of Masiphumelele informal settlement in Cape Town gather to collect food parcels provided by One South Africa Movement representative. </span> <span class="attribution"><span class="source">EFE-EPA/Nic Bothma</span></span></figcaption></figure><p>The role that human rights should play in South Africa’s economic policy has been the subject of <a href="https://www.dailymaverick.co.za/article/2020-10-20-threading-the-budget-through-the-eye-of-the-constitutional-needle/">intense controversy and debate</a> over the past year. This, after the finance ministry announced spending cuts in its <a href="http://www.treasury.gov.za/documents/mtbps/2020/mtbps/FullMTBPS.pdf">Medium-Term Budget Policy Statement</a> while the COVID-19 pandemic was ravaging lives and livelihoods.</p>
<p>The statement sets out government’s policy framework for the upcoming budget and its macro-economic plans and goals for the next three years.</p>
<p>The plan is to slash government expenditure over three financial years, from 2021, by R300 billion (about US$21 billion). This will severely affect budgets for education, healthcare, land reform and <a href="https://www.businesslive.co.za/bd/opinion/columnists/2020-10-28-carol-paton-tito-mboweni-budget-lights-fires-of-discontent/">other social services</a>. </p>
<p>The government said the cuts were needed to prevent a “debt spiral” – borrowing money to meet its commitments. Because South Africa has a <a href="http://www.worldgovernmentbonds.com/credit-rating/south-africa/">sub-investment grade rating</a>, it must pay higher interest on new debt. In addition, <a href="http://www.statssa.gov.za/?p=14074">GDP had declined by 7% in 2020</a> due to the impact of COVID-19 on the already struggling economy.</p>
<p>Economists and civil society <a href="https://www.iej.org.za/submission-by-the-budget-justice-coalition-in-response-to-2020-medium-term-budget/">criticised</a> the plan. They argued that it undermined access to socio-economic rights for many disadvantaged groups. Instead, government should explore other options for mobilising resources.</p>
<p><a href="https://www.sahrc.org.za/index.php/sahrc-media/news/item/1262-15-basic-human-rights-you-should-know">Socio-economic rights</a> are set out in the bill of rights. They include access to land and housing, healthcare, food and water, social security and education.</p>
<h2>The doctrine of non-retrogression</h2>
<p>This controversy raises the question of what role human rights should play in economic policy, particularly in challenging economic times. What should guide the weighing of the costs and benefits of different spending priorities? </p>
<p>It is becoming increasingly clear that policymakers can no longer ignore the country’s obligations in terms of <a href="https://www.ohchr.org/en/professionalinterest/pages/internationallaw.aspx">international</a>, <a href="https://www.achpr.org/legalinstruments/detail?id=49">regional</a> and <a href="https://www.gov.za/documents/constitution/chapter-2-bill-rights">national</a> human rights law. </p>
<p>My <a href="https://www.tandfonline.com/doi/full/10.1080/02587203.2021.1972331">new article</a> in the <a href="https://www.wits.ac.za/sajhr/">South African Journal on Human Rights</a> explores the relevance of the doctrine of “<a href="https://academic.oup.com/hrlr/article-abstract/19/3/467/5618868">non-retrogression</a>” to economic policy decisions that imperil socio-economic rights.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-human-rights-should-guide-responses-to-the-global-pandemic-147225">Why human rights should guide responses to the global pandemic</a>
</strong>
</em>
</p>
<hr>
<p>Global human rights bodies developed the doctrine as a tool to evaluate policies which result in a deterioration in the enjoyment of these rights. The doctrine requires states to justify such policies according to certain criteria. </p>
<h2>Austerity measures and human rights</h2>
<p>In my article, I explore the key features of the doctrine of non-retrogression. I look at whether it can be applied to fiscal consolidation and whether it has been applied in any South African court decisions.</p>
<p>The main finding is that the doctrine forms part of the country’s jurisprudence on socio-economic rights. It should thus guide economic policy and budgetary decisions, to ensure they reflect human rights principles and priorities. </p>
<p>That would help government defend its decisions before international human rights bodies or in domestic courts. </p>
<p>In 2018 the <a href="https://www.ohchr.org/en/hrbodies/cescr/pages/cescrindex.aspx">United Nations Committee on Economic Social and Culture Rights</a> criticised the economic policy decisions of the South African government. This committee monitors compliance by states with their obligations under <a href="https://www.ohchr.org/en/professionalinterest/pages/cescr.aspx">the International Covenant on Economic, Social and Cultural Rights</a>. The committee <a href="https://tbinternet.ohchr.org/_layouts/15/treatybodyexternal/Download.aspx?symbolno=E%2fC.12%2fZAF%2fCO%2f1&Lang=en">said</a> the country’s “austerity measures” had cut budgets in health, education and other public services. It expressed concern that the cuts would worsen inequalities and reverse gains made.</p>
<p>The UN body cited its non-retrogression doctrine and recommended that both the executive and legislature take human rights into account when deciding the budget. </p>
<p>It refined key elements of this doctrine in response to the austerity measures adopted during the global financial crisis of <a href="https://link.springer.com/chapter/10.1007/978-3-319-47021-4_39">2008-2009</a>. Since then, states have had to show that certain <a href="https://tbinternet.ohchr.org/_layouts/15/treatybodyexternal/Download.aspx?symbolno=E%2fC.12%2f2016%2f1&Lang=en">criteria</a> have been met. </p>
<p>They must show that:</p>
<ul>
<li><p>retrogressive measures are adopted only as a last resort</p></li>
<li><p>alternatives were comprehensively examined</p></li>
<li><p>those who are disadvantaged and vulnerable will not be adversely affected</p></li>
<li><p>social protection programmes are in place so that people’s essential basic needs are not compromised </p></li>
<li><p>there was genuine public participation in relevant decisions.</p></li>
</ul>
<h2>Courts and the doctrine of non-retrogression</h2>
<p>This retrogressive measures doctrine is receiving increased attention in South African courts. For example, the North Gauteng High Court relied on it in its <a href="http://www.saflii.org/cgi-bin/disp.pl?file=za/cases/ZAGPPHC/2020/306.html&query=Equal%20Education%20v%20Minister%20of%20Basic%20Education">judgment</a> on the suspension of the <a href="https://www.gov.za/faq/education/what-national-school-nutrition-programme-nsnp">National School Nutrition Programme</a> during the lockdown last year. The court said the suspension violated children’s right to basic education and basic nutrition. It ordered the government to develop a plan to ensure that every learner received a daily school meal – regardless of whether they were attending school or studying from home.</p>
<p>The doctrine was also cited in <a href="http://www.saflii.org/za/cases/ZAGPPHC/2020/794.pdf">another judgment</a> in which the court found that the withdrawal of government subsidies for providers of early childhood education was unconstitutional.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/successes-of-african-human-rights-court-undermined-by-resistance-from-states-166454">Successes of African Human Rights Court undermined by resistance from states</a>
</strong>
</em>
</p>
<hr>
<p>The Constitutional Court has <a href="http://www.saflii.org/za/cases/ZACC/2000/19.pdf#page=30">previously ruled</a> that courts must take the availability of resources into account in judging whether government has taken reasonable measures to meet its socio-economic rights duties. <a href="http://www.saflii.org/cgi-bin/disp.pl?file=za/cases/ZACC/2004/20.html&query=Rail%20Commuter%20Action%20Group%20v%20Metrorail">It has also said</a> that the government must show that its resource allocation decisions considered human rights.</p>
<p>For example, <a href="http://www.saflii.org/cgi-bin/disp.pl?file=za/cases/ZACC/2011/40.html&query=City%20of%20Johannesburg%20v%20Blue%20Moonlight%20Properties">the court has said</a> that organs of state cannot rely on the excuse that they have failed to plan and budget appropriately for the fulfilment of their constitutional duties. </p>
<p>Courts should ideally not intervene directly in matters of economic policy and spending priorities. It is primarily the responsibility of the executive and legislature to ensure that budgetary decisions take human rights into account. But, when they fail to do so, courts have a constitutional responsibility to protect these constitutional rights.</p>
<h2>Public participation</h2>
<p>How should the executive and legislature ensure that human rights are taken into account in economic policy decisions?</p>
<p>One way is to conduct human rights impact assessments before undertaking economic reforms, as <a href="https://www.ohchr.org/Documents/Issues/IEDebt/GuidePrinciples_EN.pdf">recommended by the UN</a>. Another is creating a policy framework for thorough public participation in economic policy and budgetary decisions.</p>
<p>Public participation is vital as it can highlight the impact of policies on vulnerable and disadvantaged groups. It can also suggest ways of avoiding or mitigating such impacts.</p>
<p>The <a href="https://www.internationalbudget.org/open-budget-survey/country-results/2019/south-africa">2019 Open Budget survey</a> ranked South Africa highly in terms of the transparency of its budget process, but lowest in terms of public participation. <a href="https://www.dailymaverick.co.za/article/2021-05-25-the-farce-of-public-participation-in-budgetary-processes-and-how-to-fix-it/">Civil society organisations</a> have complained that the budgetary process is inaccessible to poor communities. They say it does not provide meaningful opportunities for engagement.</p>
<p>Without resources, human rights are no more than words on paper. South Africa needs a proper policy and legislative framework for ensuring that human rights principles guide economic decision-making, particularly in hard times.</p><img src="https://counter.theconversation.com/content/167409/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sandra Liebenberg previously received funding from the National Research Foundation and was former member and Vice-Chair of the UN Committee on Economic, Social and Cultural Rights.</span></em></p>It is becoming increasingly clear that South Africa’s policymakers can no longer ignore the country’s obligations in terms of international, regional and national human rights law.Sandra Liebenberg, Distinguished Professor and H F Oppenheimer Chair in Human Rights Law, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1651772021-07-30T07:52:29Z2021-07-30T07:52:29ZCommunity initiative keeps Kenyan women breastfeeding exclusively for longer<figure><img src="https://images.theconversation.com/files/413704/original/file-20210729-17-k25vm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kenyan women march towards a restaurant after a female client was allegedly thrown out for breastfeeding and not covering up. </span> <span class="attribution"><span class="source">Photo credit should read SIMON MAINA/AFP via Getty Images</span></span></figcaption></figure><p>Exclusive breastfeeding in the first six months, as recommended by the <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_1">World Health Organisation</a>, is vital for child growth and survival. Exclusive breastfeeding means that the infant receives only breast milk. This is because breast milk has adequate amounts of nutrients and water required for healthy growth as well as immune factors required for the development of the infants immune system in the first 4-6 months of life.</p>
<p>Other benefits of breastfeeding include protection against common childhood illnesses such as diarrhoea and pneumonia, and infant death. Scaling up exclusive breastfeeding can prevent <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01044-2.pdf">823,000 child deaths every year</a>, and protect against <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01024-7.pdf">overweight and diabetes</a>.</p>
<p>There are benefits for <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01024-7.pdf">mothers too</a>. It’s been shown to reduce risks of breast and ovarian cancer, improve the spacing between births and reduce the risk of diabetes.</p>
<p>Kenya has made great efforts to increase the number of women breastfeeding their babies. Exclusive breastfeeding rates have increased over the years from 32% in 2008 to 61% in <a href="https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf">2014</a>, which is higher than the the current <a href="https://apps.who.int/iris/bitstream/handle/10665/326049/WHO-NMH-NHD-19.22-eng.pdf?sequence=1&isAllowed=y">global average</a> of 43%. </p>
<p>But Kenya’s exclusive breastfeeding rates vary with age. For example, the percentage of children exclusively breastfed decreases sharply from 84% of infants age 0-1 month to 63% of infants age 2-3 months and, further, to 42% of infants <a href="https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf">age 4-5 months</a>. </p>
<p>In a bid to address these patterns, the Kenyan government has put a number of initiatives in place to promote exclusive breastfeeding during the first six months of a baby’s life. </p>
<p>One is the <a href="https://www.who.int/elena/titles/bbc/implementation_bfhi/en/">baby friendly hospital initiative</a>. Launched in 1991, it aims to scale up 10 interventions in maternity facilities to support successful breastfeeding. The initiative has been effective in promoting exclusive breastfeeding during the <a href="https://onlinelibrary.wiley.com/doi/10.1111/mcn.12294">first weeks</a>, but not as effective in sustaining it through to the recommended six months. </p>
<p>This highlighted the need to scale up the promotion of breastfeeding in communities, which led to the baby friendly community initiative. This equips primary healthcare workers and community health volunteers with skills to help mothers breastfeed and feed their infants and young children. It also empowers other family and community members to support breastfeeding mothers.</p>
<p>The intervention is important particularly in regions such as Africa where 60% of women give birth at <a href="https://www.who.int/pmnch/media/publications/aonsectionIII_3.pdf?ua=1#:%7E:text=Yet%20almost%2060%20percent%20of,care%20do%20not%20receive%20it.">home</a>. </p>
<p>We conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33528102/">a study</a> to assess the effectiveness of the baby friendly community initiative in Koibatek, a rural area in the Rift valley region of Kenya where mothers exclusively breastfeed for an average of <a href="https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf">three months</a>. </p>
<h2>What we found</h2>
<p>The study was conducted in 13 community units in Koibatek sub-county. Pregnant women aged 15-49 years were recruited and followed up until their children were at least six months old. Mothers in the intervention group received standard maternal, infant and young child nutrition counselling and support from trained community health volunteers, health professionals, community mother support groups and mother to mother support groups. Those in the control group received standard counselling only, consisting of messages on infant and young child nutrition. No maternal and child nutrition related support was given to the mothers in the control group. Data on breastfeeding practices were collected.</p>
<p>A total of 823 pregnant women were recruited. Compared with mothers in the control group, the 351 mothers in the intervention group were three times more likely to exclusively breastfeed for six months and for a longer time (19 days longer). </p>
<p>The intervention used minimal resources because it was implemented within the existing health system by community health volunteers who were instrumental in providing information on maternal infant and young child nutrition. </p>
<p>They were required to visit mothers in their homes and provide support through community mother support groups and mother to mother support groups. </p>
<p>The mother to mother support groups consisted of 9-15 pregnant, lactating women and in some cases fathers and grandmothers. The group met monthly to discuss issues around pregnancy and young child feeding and nutrition. Community health volunteers and a lead mother, who acted as the leader of the group, facilitated the meetings.</p>
<p>The community mother support group included a nutritionist, community health volunteers, a local administrator, a community leader and a lead mother. The role of the support group was to oversee, plan and execute community meetings on the baby friendly community initiative; mobilise all community members to participate in its activities; support community health extension workers and nutritionists in monitoring and documenting monthly activities at the community level; and to monitor and document the maternal, infant and young child nutrition activities monthly.</p>
<h2>Next steps</h2>
<p>We believe our findings show that supporting mothers in their communities has the potential to increase exclusive breastfeeding for longer. </p>
<p>This is because the help women get in their communities addresses some key reasons that have been identified for the drop off in women breastfeeding exclusively in the first six months. These are:</p>
<ul>
<li><p>Lack of information/knowledge on the importance of breastfeeding</p></li>
<li><p>Advice and cultural beliefs and practices which negatively impact breastfeeding</p></li>
<li><p>Poor breastfeeding positioning and latching</p></li>
<li><p>Inadequate breastfeeding support</p></li>
</ul>
<p>Our findings showed that supporting breastfeeding in communities, and providing information, led to a significant increase in exclusive breastfeeding rates. We concluded from our findings that the baby friendly community initiative has the potential to improve exclusive breastfeeding rates in similar settings. It should be scaled up in Kenya and extended to other African countries.</p><img src="https://counter.theconversation.com/content/165177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Antonina Mutoro works for the African Population and Health Research Center. She is affiliated with the University of Glasgow, United Kingdom</span></em></p><p class="fine-print"><em><span>Elizabeth Kimani-Murage works for the African Population and Health Research Center (APHRC). She receives funding from the Wellcome Trust, USAID, NIH. She is affiliated with Brown University, USA. </span></em></p>Provision of breastfeeding support and information within the community can lead to a significant increase in exclusive breastfeeding rates.Antonina Mutoro, Postdoctoral Research Scientist, African Population and Health Research CenterElizabeth Kimani-Murage, Senior Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1496812020-12-07T15:27:45Z2020-12-07T15:27:45ZThe rise of commercial milk formulas matters for women and children<figure><img src="https://images.theconversation.com/files/369277/original/file-20201113-21-4pdes4.jpg?ixlib=rb-1.1.0&rect=46%2C0%2C5184%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Infant formula sales have doubled between 2005 and 2019.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/preparation-mixture-baby-feeding-on-wooden-554077681">279photo Studio/ Shutterstock</a></span></figcaption></figure><p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00210-5/fulltext">Breastfeeding</a> can play an especially important role in early-life nutrition. It can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486667/">benefit</a> children’s future school performance and economic prospects in later life, as well as the mother’s health. </p>
<p>Health authorities across the world endorse the World Health Organization’s (WHO) <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_2">recommendation</a> that newborns should where possible exclusively breastfeed from the first hour of life until six months of age, and thereafter receive safe and nutritious foods with continued breastfeeding up to two years of age or beyond.</p>
<p>Despite this, our <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13097">recent study</a> shows that global commercial milk formula sales are booming. Between 2005 and 2019, world milk formula sales more than doubled from 3.5kg to 7.4kg per child. Total sales grew from 1 million tonnes to 2.1 million tonnes.</p>
<p>This growth in sales was seen in all types of formula, including “standard” formula for infants (0-6 months), “follow-up” formula (7-12 months), toddler milks (13-36 months), and so-called “specialised” formulas. So more children from a wider range of age groups are consuming formula. </p>
<p>Rapid growth <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13097">has occurred</a> in many highly-populated countries, including the Middle East, north Africa, eastern Europe, central Asia, and parts of Latin America. The most remarkable growth has been in east and south-east Asia. China, in particular, accounted for only 14% of global formula sales in 2005 – but now accounts for 33% of all sales. </p>
<p>In south Asia and west and central Africa, the amount sold to each customer remains low and show no signs of growth. In Europe and North America, although per customer sales volumes remain high, they plateaued or slightly decreased between 2005-2019. </p>
<h2>Behind the sales ‘boom’</h2>
<p>There are <a href="https://www.who.int/nutrition/publications/infantfeeding/WHO_NMH_NHD_09.01/en/">medical reasons</a> for using safe and adequate breastmilk substitutes. And some women find continuing breastfeeding difficult depending on their circumstances, and may use formula as an alternative or complement to breastfeeding. <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13097">Our study</a> also shows decisions and practices around formula use can be strongly shaped by wider societal forces, such as commercial marketing, rather than individual choice.</p>
<p>It’s known that milk formula sales increase as countries become richer and more urbanised, and as more mothers enter into formal employment. Asia’s formula sales boom may be partly explained by millions of women entering the paid workforce, especially in the region’s vast manufacturing zones.</p>
<p>Millions of women worldwide also lack adequate <a href="https://www.who.int/bulletin/volumes/98/6/19-229898/en/">paid maternity leave and social protection</a>. This means the decision to formula feed may only be done out of necessity, to avoid losing employment and income. We also know that many hospitals and healthcare settings aren’t equipped to help women establish breastfeeding, with few maternal and newborn care facilities worldwide meeting <a href="https://www.who.int/nutrition/publications/infantfeeding/bfhi-implementation/en/">standards</a> of care for breastfeeding mothers and newborns.</p>
<p>Commercial factors are also important. Just five companies control 57% of the global formula milk industry, worth US$56.6 billion (£42.5 billion) The industry spends <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13097">an estimated US$5 billion on marketing every year</a>, which <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.12962">powerfully shapes social norms</a> about <a href="https://pubmed.ncbi.nlm.nih.gov/26314734/">feeding babies and children</a>. </p>
<p>Marketing messages can portray formula as modern, scientific and comparable or superior to breastmilk. The growth of social media enables companies to <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00597-w#:%7E:text=Formula%20marketing%2C%20as%20for%20other,a%20brand%20and%20generic%20level.">target mothers</a> with personalised product offerings and ads.</p>
<p>Hospitals are a key marketing channel, too. Companies often engage health professionals to promote formula feeding. In many countries, health professionals are directly compensated to promote formula. But more commonly, companies influence health professionals indirectly by <a href="https://pubmed.ncbi.nlm.nih.gov/31401600/">sponsoring</a> their associations, conferences and education.</p>
<figure class="align-center ">
<img alt="A grocery store aisle full of baby and toddler formula products." src="https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Companies cross-promote products by using the same packaging.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/toronto-canada-november-22-2014-baby-233666974">ValeStock/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Companies also <a href="https://www.who.int/nutrition/publications/infantfeeding/information-note-cross-promotion-infant-formula/en/#:%7E:text=In%20summary%2C%20the%20now%20common,to%20breastfeeding%20and%20infant%20health.&text=As%20a%20result%2C%20young%20infants,cannot%20meet%20their%20nutritional%20needs.">cross-promote</a> their entire product range of follow-up and toddler milks by using packing and labelling that resembles standard infant formula. This allows companies to get around the stricter prohibitions on infant formula marketing.</p>
<p>Marketing regulations are also important. The fact that formula sales are booming in China but have flat-lined at low levels in India partly reflects contrasting regulatory environments – with regulations on marketing being stricter and more comprehensive in India. </p>
<p>Despite <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/international-code-marketing-breastmilk-substitutes-resources/the-code/">an international code</a> to stop <a href="https://www.who.int/nutrition/publications/infantfeeding/breastmilk-substitutes-FAQ2017/en/">aggressive and inappropriate marketing</a> of breast-milk substitutes, most governments haven’t fully incorporated it <a href="https://www.who.int/publications/i/item/9789240006010">into law</a>. And even when laws exist, marketing violations by formula companies often go unpunished. The formula industry has also been able to lobby against any strengthening of regulation, partly by promoting their own – much weaker – corporate policies on marketing.</p>
<h2>Health concerns</h2>
<p>Breastmilk and breastfeeding where it is possible has numerous advantages over formula and bottle feeding – which is why the growth of formula sales is concerning.</p>
<p>Breastfeeding has been shown to reduce the likelihood of children developing infections, and reduces a child’s risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735804/#:%7E:text=Globally%2C%20595%20379%20childhood%20deaths,type%20II%20diabetes%20each%20year">developing chronic disease like obesity and diabetes</a> later in life. Breastfeeding is also associated with lower risk of developing <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext">breast and cervical cancer, or diabetes</a> among mothers.</p>
<p>Rising consumption of formula milk by toddlers and young children is also a worry, as these products are often <a href="https://theconversation.com/the-rise-of-ultra-processed-foods-and-why-theyre-really-bad-for-our-health-140537#:%7E:text=We%20found%20that%20more%20ultra,%2C%20salt%20and%20trans%2Dfats.">ultra-processed</a>, expensive, loaded with sugar and can introduce <a href="https://www.vichealth.vic.gov.au/media-and-resources/media-releases/high-sugar-toddler-milks-overpriced-harmful">poor dietary habits</a>. Their increased use could further contribute to increases of overweight and obese children globally.</p>
<p>Formula isn’t a sterile product and can be dangerous when prepared in unhygienic conditions, or when over-diluted or over-concentrated. It lacks the immune-boosting and other important elements of breastmilk, further increasing the risk of malnutrition and infectious illness. As a result, universal breastfeeding in place of formula use could prevent an estimated <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext">823,000 child deaths every year</a> (mainly in low- and middle-income countries), including 595,000 deaths from diarrhoea and pneumonia, and an estimated 20,000 maternal deaths from breast cancer (mainly in high income countries).</p>
<p>The global surge in formula sales is clearly a problem for global health. Given the power of the corporate milk formula industry to influence behaviour and understanding, more needs to be done to ensure that all mothers and children are protected from inappropriate promotion, and that they are enabled to breastfeed as long as they want to. This means <a href="https://www.who.int/nutrition/netcode/en/">strengthening laws</a> that ban harmful marketing practices, expanding access to paid maternity leave, and ensuring that all <a href="https://www.who.int/nutrition/publications/guidelines/breastfeeding-facilities-maternity-newborn/en/">healthcare facilities</a> meet global standards.</p><img src="https://counter.theconversation.com/content/149681/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David McCoy has recently received funding from the World Health Organization to conduct research on infant and young child feeding. He is also involved in a WHO-sponsored study on the marketing of breastmilk substitutes in the UK. He is a member of Medact, a UK-based charity that works on the upstream determinants of global health; and a Fellow of the UK Faculty of Public Health, the professional association for public health specialists, which supports implementation of the International Code of Marketing of Breastmilk Substitutes. </span></em></p><p class="fine-print"><em><span>Julie P. Smith receives funding from the Australian Research Council and the Australian National University Gender Institute. She has led consultancies on breastfeeding for the World Health Organization and the Australian Department of Health. She is a member of the Australian Breastfeeding Association and the Animal Justice Party. </span></em></p><p class="fine-print"><em><span>Phillip Baker currently receives funding from the World Health Organization to conduct research on infant and young child feeding. He has received funding from the Food and Agricultural Organization, World Bank, UNICEF, Department of Foreign Affairs and Trade, and the Australian Research Council. He is a member of the Independent Expert Group of the Global Nutrition Report. The findings of the research reported in this article, and the views expressed, are his alone and not necessarily those of the above organisations.</span></em></p>Industry marketing can shape beliefs about formula feeding.David McCoy, Professor of Global Public Health, Queen Mary University of LondonJulie P. Smith, Honorary Associate Professor, Australian National UniversityPhillip Baker, Research Fellow, Institute for Physical Activity and Nutrition, Deakin University, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1431432020-07-26T09:53:13Z2020-07-26T09:53:13ZSouth Africa faces mass hunger if efforts to offset impact of COVID-19 are eased<figure><img src="https://images.theconversation.com/files/348871/original/file-20200722-26-zzzd29.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children receive biscuits and other foods from the Groundbreakers community feeding programme in Ocean View, Cape Town.
</span> <span class="attribution"><span class="source">EPA-EFE/Nic Bothma</span></span></figcaption></figure><p>When South Africa entered a hard lockdown on 27 March, the government was globally recognised for taking tough steps to “flatten the curve” and keep COVID-19 infections low. Four months on, our <a href="https://cramsurvey.org/wp-content/uploads/2020/07/Wills-household-resource-flows-and-food-poverty-during-South-Africa%E2%80%99s-lockdown-2.pdf">research</a>, using data from a <a href="https://cramsurvey.org">broader national survey</a>, shows large groups of households are experiencing tremendous hardship as a direct result of the lockdown.</p>
<p>Two out of every five adults interviewed between May and June reported that their household had lost its main source of income since the lockdown started. This has had devastating consequences for household food security and hunger. </p>
<p>Of the adults we interviewed, 47% reported that their home ran out of money to buy food in April. Between May and June, 21% reported that someone in their household went hungry in the last seven days. And 15% reported that a child went hungry in the same period.</p>
<p>The government has used three channels of social protection to safeguard livelihoods: social insurance entailing the COVID-19 Temporary Employer-Employee Relief Scheme, grants, and localised social relief efforts. Community based organisations, faith-based organisations and NGOs also displayed <a href="https://theconversation.com/civil-society-groups-that-mobilised-around-covid-19-face-important-choices-140989">incredible agility</a> in reaching out to their constituencies. </p>
<p>In total, nearly 1 million food parcels were provided by the organisations considered in this study, including government. These may have reached about 5 million people.</p>
<p>But the response was neither wide nor deep enough to overcome the devastating implications of job or income losses on household food insecurity. Furthermore, gaps in government responses emerged. Administrative challenges in expanding social assistance and social insurance delayed the provision of relief to some households.</p>
<p>The suspension of the <a href="https://www.education.gov.za/Programmes/NationalSchoolNutritionProgramme.aspx">national school nutrition programme</a>, which usually reached <a href="https://mg.co.za/education/2020-06-28-advocacy-group-takes-department-to-court-over-school-nutrition-programme/">9.6 million children</a>, stifled the provision of a consistent daily supply of meals.</p>
<p>Our research shows that the country cannot let up on any of the three channels of social protection if it’s going to stave off mass, chronic hunger. Failure to do so could deepen an emerging humanitarian crisis and hamper economic recovery. </p>
<h2>The study</h2>
<p>Our research was undertaken as part of the National Income Dynamics Study – Coronavirus Rapid Mobile Survey (<a href="https://cramsurvey.org">NIDS-CRAM</a>). This is a broadly nationally representative panel survey of 7,000 South Africans done every month. The aim was to provide rapid data on key outcomes such as unemployment, household income, child hunger and access to government grants.</p>
<p>To complement our analysis of this quantitative data, we conducted telephonic interviews with key informants who were able to provide information about the provision of food relief during lockdown.</p>
<p>Others were able to comment on the connection between social relief (including school nutrition) and social protection. The interviewees were drawn from the government, NGOs, community-based organisations, faith-based organisations, humanitarian organisations and philanthropic initiatives.</p>
<p>Some of our findings were that:</p>
<ul>
<li><p>the increases in social grants for <a href="https://www.power987.co.za/news/covid-19-government-allocates-r50-billion-for-social-grants-for-six-months/">six months</a> by the government have played a vital role in providing relief to households and are generally well targeted. But they are insufficient to address food poverty associated with a loss of income during the lockdown. Food poverty in households that receive a child support grant, which benefits <a href="https://theconversation.com/south-africa-can-and-should-top-up-child-support-grants-to-avoid-a-humanitarian-crisis-135222">12.5 million children</a>, is exacerbated through income loss. The situation would have been much worse without the top-up grants, however.</p></li>
<li><p>there have been significant delays in Unemployment Insurance Fund <a href="https://rekordeast.co.za/344696/payments-held-up-as-some-companies-claim-for-the-dead-says-uif/">(UIF) payouts</a>. This needs to be addressed urgently to support households where formal sector jobs have been lost. These payouts are much larger than grant top-ups, and cover gaps in lost household income from earnings more effectively.</p></li>
<li><p>both the survey data and interviews with key informants indicate that well targeted, localised social relief efforts need to be continued and bolstered as a stop-gap measure to reach those not covered by social insurance or social assistance.</p></li>
<li><p>where community efforts at supporting vulnerable households are well targeted, this reinforces the need for effective local information flows to inform social relief efforts, and</p></li>
<li><p>while the country’s social assistance system is <a href="https://theconversation.com/south-africa-has-raised-social-grants-why-this-shouldnt-be-a-stop-gap-measure-138023">expansive in reach</a>, it has not been able to address the needs of large sectors of the population who are unemployed or in informal employment, and who do not qualify for social insurance.</p></li>
</ul>
<h2>Next steps</h2>
<p>As South Africans have experienced significant shocks to their livelihoods, the threat of hunger presents a major concern for health, political and social stability. The nation cannot rebuild and recover economically when large groups of people are hungry. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-south-africa-needs-to-ensure-income-security-beyond-the-pandemic-137551">Why South Africa needs to ensure income security beyond the pandemic</a>
</strong>
</em>
</p>
<hr>
<p>The country must continue to use all three channels of social protection as effectively and efficiently as possible. For this reason, we support current social policy efforts, and make further suggestions to strengthen the three arms.</p>
<p>First, urgent attention needs to be given to rectifying <a href="https://mg.co.za/business/2020-05-21-lockdown-relief-scheme-payouts-to-employees-tops-r14-billion/">technical glitches</a> that exist in the UIF system. </p>
<p>Second, it is critically important that the government continues expanding the reach of the grant system through the COVID-19 <a href="https://www.sassa.gov.za/Pages/Social-Relief-of-Distress-Grant.aspx">social relief of distress grant</a>. </p>
<p>Despite the technical challenges of rolling out this grant, enrolling more South Africans in a formal social protection system would enable the government to respond quickly in getting emergency relief to more households – now and in the future.</p>
<p>We also believe that continuing grant top-ups for three more months until January 2021 is critical. This is particularly true in view of the projected contraction of the economy <a href="https://mg.co.za/business/2020-06-24-sas-economy-expected-to-contract-by-7-2-in-2020/">by 7.2%</a>. It will thus take much longer for the economy to recover enough for people to find jobs.</p>
<p>Additionally, the need to resume the school feeding scheme is a non-negotiable to alleviate child hunger, regardless of school closures. And the government could make better use of NGOs, and other civil society organs, to scale up the provision of food assistance to people who are hard to reach through social insurance, social assistance or the state’s social relief efforts.</p>
<p>The financial sustainability of the social sector and its social relief efforts will require the mobilisation of corporate social investment and philanthropic giving for food security.</p>
<p><em><a href="https://fundawande.org/who-are-we">Bokang Mpeta</a>, a project manager at Funda Wande, was a co-author of the paper this article is based on</em>.</p><img src="https://counter.theconversation.com/content/143143/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabrielle Wills is a researcher with Research on Socio-Economic Policy, Stellenbosch University. </span></em></p><p class="fine-print"><em><span>Leila Patel receives funding from the Department of Science and Technology (DST) and the National Research Foundation (NRF) for her Chair in Welfare and Social Development.</span></em></p><p class="fine-print"><em><span>Servaas van der Berg receives funding from the National Research Foundation.</span></em></p>South Africans have experienced significant shocks to their livelihoods, and the threat of hunger presents a major concern for health, political and social stability.Gabrielle Wills, Researcher at Research on Socio-Economic Policy, Stellenbosch University, Stellenbosch UniversityLeila Patel, Professor of Social Development Studies, University of JohannesburgServaas van der Berg, Professor of Economics and South African Research Chair in the Economics of Social Policy, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1333412020-03-13T12:05:04Z2020-03-13T12:05:04ZAmerica’s poorest children won’t get nutritious meals with school cafeterias closed due to the coronavirus<figure><img src="https://images.theconversation.com/files/320221/original/file-20200312-111227-gask9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An East Brainerd Elementary School lunch, Chattanooga, Tennessee</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/lunch-options-available-to-students-at-the-east-brainerd-news-photo/1178703124">The Washington Post via Getty Images</a></span></figcaption></figure><p>Schools aren’t only places where kids learn. They are also places where kids eat. </p>
<p>Thanks to the <a href="https://www.fns.usda.gov/nslp">National School Lunch Program</a>, 30 million U.S. children – some 60% of all school-aged kids – regularly eat some combination of breakfast, lunch and afternoon snacks at school. Federal subsidies ensure that school meals are affordable for all children to <a href="https://www.encyclopedia.com/social-sciences/applied-and-social-sciences-magazines/statement-president-upon-signing-national-school-lunch-act">stave off hunger and malnutrition</a>. </p>
<p>But what is happening to meals provided by the nation’s largest child nutrition program as public schools shut their doors to contain the spread of the coronavirus pandemic? </p>
<p>Based on <a href="https://scholar.google.com/citations?user=LULSgaYAAAAJ&hl=en&oi=ao">my research</a> on how <a href="https://doi.org/10.3102%2F0013189X18797609">schools provide meals for poor children</a>, I worry that these closures might leave some of the nation’s poorest children without access to nutritious meals.</p>
<p><iframe id="1hrKJ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/1hrKJ/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>School meals address hunger</h2>
<p>Despite persistent concerns about the <a href="https://ssrn.com/abstract=1593844">nutritional quality of school lunches</a> and wasted cafeteria food, serving school meals clearly improves students’ consumption of <a href="https://doi.org/10.1016/j.jada.2008.11.005">calcium, meat and vegetables</a> and a wide array of essential vitamins and minerals.</p>
<p>This nutritional boost is particularly vital for the 18% of U.S. kids whose parents sometimes or frequently <a href="https://www.childtrends.org/indicators/food-insecurity">can’t afford enough nutritious food</a> for the whole family. These children <a href="http://handle.nal.usda.gov/10113/42320">get approximately a quarter of the calories they consume</a> from school meals.</p>
<p>Empty cupboards and missed meals substantially <a href="https://doi.org/10.1377/hlthaff.2015.0645">threaten children’s healthy development</a>. Research <a href="https://doi.org/10.1002/pam.20506">tracking the long-term effects of 1960s-era policy efforts that expanded</a> the National School Lunch Program indicates that when kids regularly eat lunch, they’re more likely to finish high school and perhaps go on to college.</p>
<p>Further, over the last few years <a href="https://www.fns.usda.gov/school-meals/community-eligibility-provision">a new federal program</a> designed to provide free lunches to all students in schools that enroll large proportions of low-income children appears to be working. <a href="https://dx.doi.org/10.2139/ssrn.3333530">Test scores</a> are rising and <a href="https://www.nber.org/papers/w24986">student behavior</a> is improving at the schools taking part in it. </p>
<p>Under federal law, no student pays more than US$2.90 for their lunch. But about <a href="https://nces.ed.gov/programs/digest/d18/tables/dt18_204.10.asp?current=yes">half of public school students pay far less</a>. Families whose household income is less than 185% of the poverty line, currently about $48,000 per year for a family of four, pay up to 40 cents for each meal. Students whose families of the same size get by on less than 130% of that same mark, or below $34,000, pay nothing at all. </p>
<p>More than two-thirds of the <a href="https://www.fns.usda.gov/pd/child-nutrition-tables">children who eat school meals</a> get them for free or at a steep discount.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1238301146500009985"}"></div></p>
<h2>How to feed kids when schools close</h2>
<p>Many low-income families of course can get some additional help through other kinds of federal aid.</p>
<p>That includes the <a href="https://theconversation.com/scaling-back-snap-for-self-reliance-clashes-with-the-original-goals-of-food-stamps-128839">Supplemental Nutrition Assistance Program</a>. But SNAP’s <a href="https://www.fns.usda.gov/snap/recipient/eligibility">complex eligibility requirements</a> <a href="https://doi.org/10.2105/AJPH.2019.305365">exclude many Americans</a> who are are having trouble getting food on their tables.</p>
<p>What’s more, <a href="https://doi.org/10.3102%2F0002831218761337">SNAP benefits are limited</a>. For example, a family of four can get no more than $646 in this aid per month, typically falling short of covering the full cost of all nutritional needs.</p>
<p><iframe id="zgLjQ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/zgLjQ/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Absent fundamental changes to the nation’s <a href="https://theconversation.com/us/topics/safety-net-2185">safety net</a>, I believe school leaders should make sure that schools keep playing an important role in student nutrition – even when schools are closed to protect public health.</p>
<p>And <a href="https://civileats.com/2020/03/06/coronavirus-is-closing-schools-heres-what-it-means-for-millions-of-kids-who-rely-on-school-meals/">schools are indeed looking for ways to provide meals</a> to students whose schools are closed due to the pandemic. The USDA has identified one path. It is letting schools that participate in <a href="https://www.fns.usda.gov/sfsp/summer-food-service-program">a summer meals program for kids from low-income areas</a> to <a href="https://www.fns.usda.gov/cn/child-nutrition-program-waiver-request-guidance-and-protocol-revised">serve meals even if they close due to this pandemic</a>.</p>
<p>While this strikes me as a helpful step, I don’t think that it will be enough.</p>
<p>That’s because the schools eligible to take part in the summertime program serve <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/child-nutrition-programs/summer-food-service-program.aspx">just a tenth of the children who participate in the school lunch program</a>. Unless Congress acts to provide emergency funds to cover the cost of feeding students whose schools have closed – and fast – it will be up to local communities and their food banks to fill the nutritional gap.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/133341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thurston "Thad" Domina receives funding from the National Institute of Child Health and Development.</span></em></p>The millions of US children whose parents can’t always afford enough nutritious food for their families get about a quarter of their calories from what they eat at school.Thurston Domina, Professor, Educational Policy and Organizational Leadership, University of North Carolina at Chapel HillLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1321542020-03-06T13:02:20Z2020-03-06T13:02:20ZHow to stop using food to reward and punish your kids<figure><img src="https://images.theconversation.com/files/318910/original/file-20200305-106573-ruak13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ice cream cones can convey joy and love.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/joyful-mood-emotional-young-man-demonstrating-1462631993">YAKOBCHUK VIACHESLAV/Shutterstock.com</a></span></figcaption></figure><p>At one time or another, just about every parent uses food to reward their kids for good behavior and achievements – or to console them when they’re sad or disappointed.</p>
<p>When children make honor roll, win a big game or persevere through a struggle, a parent might express their pride and joy with candy or ice cream. Likewise, when kids feel down and out, pick-me-ups can take the form of a treat. The reasons for this are simple: Using food as an incentive might get results, and salty, sweet or sugary foods are often within easy reach. </p>
<p>You may figure there’s no harm in doing this kind of thing. But as a <a href="https://scholar.google.com/citations?hl=en&view_op=list_works&gmla=AJsN-F7yojCzIye9lh6-w1usGuBEXYSgTtd89JYKIc6C42ehgVIKaHjTWRBjl_f8ng47vu6UNXtBO9dLTfwZYTHhvNAZwupUt3o0WY6bcKFI1dEO_LD6RyE&user=iMwPMokAAAAJ">dietitian and nutritionist</a> focused on family nutrition, I consider <a href="https://doi.org/10.1016/S1471-0153(03)00024-2">regularly using food as an incentive for kids</a> to be risky.</p>
<p>Rewarding and comforting kids with food <a href="https://doi.org/10.1016/j.appet.2018.06.014">can lead to overeating</a> when they are not hungry. It also increases the chances they will <a href="https://doi.org/10.3945/ajcn.2010.29375">try to deal with their emotions</a> through what they eat.</p>
<p>I spend a lot of my time at work helping clients break this cycle. I show them how to stop using tactics like <a href="https://doi.org/10.1016/j.appet.2006.06.006">bribery, judgment and shame</a> that involve foods and drinks that can range from a bowl of chocolate pudding to a big glass of soda. I also teach parents <a href="https://doi.org/10.1016/j.eatbeh.2015.07.003">other ways to celebrate</a> and soothe that don’t depend on food.</p>
<p>Plenty of research shows <a href="https://doi.org/10.1016/j.eatbeh.2015.07.003">kids consume more total calories, carbohydrates and fat daily</a> when parents use food to reward behavior. For example, when the mothers of preschool-age children <a href="https://doi.org/10.1038/ijo.2015.30">use food to ease their kids’ emotions</a>, those children eat more sweets when they get upset. And a French study found that moms who used food as rewards for their children stimulated their kids’ tendency to overeat – <a href="https://doi.org/10.1038/ijo.2015.30">even when their children aren’t hungry</a>. Of course, it’s not just moms and dads using food in this way but caregivers of all kinds, from babysitters to grandparents. And while it’s a <a href="https://doi.org/10.1111/josh.12294">big problem at school</a> too, changing patterns at home is key.</p>
<p>To help parents get the hang of kicking this habit, I’ve zeroed in on four steps to purge guilt and let go of food as a reward.</p>
<h2>1. Recognize common scenarios</h2>
<p>Think about how you celebrate after performances or if you often promise a treat when your kids finish a task. Do you prod your kids to clean their room by dangling the possibility of dessert? Do you take them out for pizza to help them cope when they don’t make the team? Recognizing common scenarios is an essential first step toward breaking this pattern.</p>
<p><iframe id="lcLAo" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/lcLAo/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>2. Don’t blame yourself</h2>
<p>You are not alone if food is ingrained in how you interact with kids when you’re not at the table. What matters most is your willingness to explore a new path without stewing in self-judgment. Using food to reward kids <a href="https://doi.org/10.1016/S1471-0153(03)00024-2">undermines healthy habits</a> you’re trying to instill, so any effort toward change may have long-term benefits.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/318915/original/file-20200305-106584-17x0ahm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/318915/original/file-20200305-106584-17x0ahm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318915/original/file-20200305-106584-17x0ahm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318915/original/file-20200305-106584-17x0ahm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318915/original/file-20200305-106584-17x0ahm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318915/original/file-20200305-106584-17x0ahm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318915/original/file-20200305-106584-17x0ahm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318915/original/file-20200305-106584-17x0ahm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Heading out on a family walk can be a real treat.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-feet-legs-jeans-father-mother-218127769">Shutterstock.com/Vitalinka</a></span>
</figcaption>
</figure>
<h2>3. Name the feeling you aim to convey</h2>
<p>Separating your intent from your actions will help you stop using food as a way to soothe or praise. To do this, imagine your child in a situation where you might use food that way. Play the scene out in your mind, stopping before you bring on the food. As you envision your child in the scenario, ask yourself what feeling you would like to convey.</p>
<p>For example, your kid falls down on the sidewalk and skins their knee. You crouch to comfort them and tend their wound as the wailing escalates. You keep consoling after you’ve carefully stuck a Band-Aid on them but they just can’t calm down. If you’re like many of my clients, you’ll be tempted to say, “I’ll help you up and then we can go get ice cream.” </p>
<p>Ask yourself at that point what feeling you want them to perceive. In this case I’ll wager that it’s comfort and relief – rather than a delicious dairy product.</p>
<p>Becoming mindful of your specific feelings enables two things to happen. First, you’ll see how food stands in for various emotions. Second, it will help you separate your feelings from food – making it easier to deliver something else that’s truly needed in the moment.</p>
<p>You can also try saying your feelings out loud. For example, when your child doesn’t get invited to a friend’s party, say, “This feels sad. My wish for you is knowing how much you are loved.” That can help you remember to try something else besides food to console them.</p>
<h2>4. Do something else</h2>
<p>There are plenty of ways to comfort your kid that don’t involve food. You can hug them or give them a bubble bath, for example.</p>
<p>To celebrate, try watching a family video together, taking the time to say what makes you feel most proud of them. If you’re trying to motivate or inspire your child, you can crank up their favorite song, then dance and sing along with the music.</p>
<p>When you want to compel or encourage kids to, say, do their homework, give praising their effort a try. Tell them that you see them working hard and ask: “How can I support you right now?”</p>
<p>With small children, when they’re refusing to leave the playground or get into a bath, try engaging them with a stuffed animal or squishy toy to fidget with. </p>
<p>Try to get your child to help choose some alternatives. They might have good ideas that don’t occur to you.</p>
<p><iframe id="fjfMg" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/fjfMg/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Ways and words</h2>
<p>Using food to reward or console kids is pervasive enough that the <a href="https://doi.org/10.1111/josh.12294">American Academy of Pediatrics</a> and five other professional organizations recommend that parents not use food this way.</p>
<p>But no one, including doctors, is suggesting that you should never make a birthday cake or use food as a reward in any situation. Food is an integral part of cultures everywhere and meant to be fully enjoyed.</p>
<p>Should you find that you regularly rely on food to express emotions with your kids, I believe you ought to try to switch gears.</p>
<p>It’s all about finding ways and words, instead of using food, to show your kids how much you love them.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/132154/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephanie Meyers does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are better ways to convey your emotions.Stephanie Meyers, Registered Dietitian and Nutritionist, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1304702020-03-03T03:22:58Z2020-03-03T03:22:58ZHow much food should my child be eating? And how can I get them to eat more healthily?<figure><img src="https://images.theconversation.com/files/318183/original/file-20200303-18291-1ro5bmw.jpg?ixlib=rb-1.1.0&rect=44%2C67%2C4992%2C3250&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/students-outdoors-eating-lunch-selective-focus-77073568">Shutterstock</a></span></figcaption></figure><p>Children need healthy food in the right amount so they get all the nutrients needed to grow, learn and thrive. </p>
<p>The Australian dietary guidelines outline the number of <a href="https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/recommended-number-serves-children-adolescents-and">daily servings children need each day</a> from each food group, based on their sex and age: </p>
<p><iframe id="XBvmp" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/XBvmp/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p><iframe id="Zo35s" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Zo35s/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>This is just a guide; your child’s needs will depend on their activity levels, but it’s good to get a sense of what you should be aiming for. </p>
<p>Keep in mind <a href="https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/serve-sizes">serving sizes vary</a> for each of the five food groups. For example, here’s what constitutes a serve of grains:</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/318182/original/file-20200302-18308-pvtzct.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318182/original/file-20200302-18308-pvtzct.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=485&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318182/original/file-20200302-18308-pvtzct.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=485&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318182/original/file-20200302-18308-pvtzct.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=485&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318182/original/file-20200302-18308-pvtzct.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=610&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318182/original/file-20200302-18308-pvtzct.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=610&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318182/original/file-20200302-18308-pvtzct.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=610&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A sandwich would equal two serves.</span>
<span class="attribution"><a class="source" href="https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/serve-sizes">NHMRC</a></span>
</figcaption>
</figure>
<p>Choosing from five food groups sounds simple enough. But <a href="https://www.phaa.net.au/documents/item/2336">supermarkets can carry up to 30,000 products</a>. Many foods are <a href="https://www.ncbi.nlm.nih.gov/pubmed/27427474">heavily marketed</a> and it’s rarely the healthy ones. </p>
<p>So children end up eating more junk foods and fewer fruits and vegetables than recommended. A 2011-12 survey of two to 18 year olds found 38% of children’s average total energy intake <a href="https://www.ncbi.nlm.nih.gov/pubmed/17356553">came from junk foods</a>. Cakes, muffins, slices, biscuits, chips, packet snacks, processed meats and sugary drinks were the main contributors.</p>
<p>In 2017-18, just <a href="https://www.abs.gov.au/ausstats/abs@.nsf/PrimaryMainFeatures/4364.0.55.001?OpenDocument">one in 17 children</a> aged two to 17 years ate the recommended daily serves of vegetables.</p>
<p>So how do you get kids to eat less junk and more healthy food?</p>
<h2>Say no to junk foods</h2>
<p>While young children can recognise healthy foods fairly easily, <a href="https://www.ncbi.nlm.nih.gov/pubmed/23973928">they find it hard to know which foods</a> are energy-dense, nutrient-poor “junk” foods. </p>
<p>The foods available in your home act as a powerful signpost to your children about what to eat. When there are <a href="https://www.ncbi.nlm.nih.gov/pubmed/29096640">unhealthy snack foods in the pantry</a> children (and adults) eat more of them. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-a-balanced-diet-anyway-72432">What is a balanced diet anyway?</a>
</strong>
</em>
</p>
<hr>
<p>Unfortunately, it’s hard for parents to avoid some messages their children receive around food, especially from advertising. </p>
<p>But try to ignore <a href="https://www.wcrf.org/int/blog/articles/2019/03/power-pestering">those requests</a>; eventually your child will stop asking. A survey of 7,800 children found that kids who “often” asked for items advertised on TV were <a href="http://www.ideficsstudy.eu/home.html">30% more likely to become overweight</a> during two years of follow-up.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/318199/original/file-20200303-18295-1hx3dv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318199/original/file-20200303-18295-1hx3dv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318199/original/file-20200303-18295-1hx3dv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318199/original/file-20200303-18295-1hx3dv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318199/original/file-20200303-18295-1hx3dv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318199/original/file-20200303-18295-1hx3dv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318199/original/file-20200303-18295-1hx3dv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children have a good sense of what’s healthy but are less clear about unhealthy foods.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-preschooler-boy-has-lunch-home-1474182767">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Avoid portion distortion</h2>
<p>Keep a watch on the size of portions. Serving bigger amounts can lead to unconsciously eating more. </p>
<p>We reviewed <a href="https://www.ncbi.nlm.nih.gov/pubmed/24886094">portion sizes of common foods and drinks</a> that children aged two to 16 years consumed, from 1995 to 2007. </p>
<p>We found typical portion sizes for cooked meat and chicken, mixed chicken dishes, bacon and ham, fish and pizza had increased.</p>
<p>Portion sizes decreased for most dairy products, breakfast cereals, vegetables and some packaged snacks.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-bigger-portion-sizes-make-you-eat-more-23193">Health check: do bigger portion sizes make you eat more?</a>
</strong>
</em>
</p>
<hr>
<h2>Don’t let fussy eating derail healthy eating plans</h2>
<p>It is common for children to go through a period of fussy eating with reports varying from <a href="https://www.ncbi.nlm.nih.gov/pubmed/31900163">one to three out of every five.</a> </p>
<p>Kids’ appetites can vary a lot, particularly among toddlers who are more likely to only eat when they are hungry, regardless of whether it is meal time or not. </p>
<p>Strategies that help children eat healthily <a href="https://link.springer.com/article/10.1007/s13679-018-0297-8">include</a> learning by seeing what others do and having direct contact with foods through touch, taste and smell. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-tell-if-your-kids-fussy-eating-phase-is-normal-92118">How to tell if your kid's 'fussy eating' phase is normal</a>
</strong>
</em>
</p>
<hr>
<p>Try to have set meal and snack times (breakfast, lunch and dinner and two to three snacks) and offer children foods from each of the food groups daily. If a child isn’t hungry at that time, wait until the next scheduled meal or snack and offer food then.</p>
<p>At the dinner table focus on the behaviours you want to see. Do this by praising the child who is trying the meal and tasting new foods. For example, “I love the way you tasted that eggplant”.</p>
<p>Finally, plan inexpensive meals that do not take long to prepare and that children can feed themselves, such as those on the <a href="https://nomoneynotime.com.au/">No Money No Time</a> website.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/318197/original/file-20200303-18303-11p49dm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318197/original/file-20200303-18303-11p49dm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318197/original/file-20200303-18303-11p49dm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318197/original/file-20200303-18303-11p49dm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318197/original/file-20200303-18303-11p49dm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318197/original/file-20200303-18303-11p49dm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318197/original/file-20200303-18303-11p49dm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Encourage children to experiment with different foods.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-saying-grace-before-dinner-283815863">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Want more information on nutrition for kids?</h2>
<p>We have developed two free three-week Massive Open Online Courses (MOOCs). </p>
<ol>
<li><p><a href="https://www.edx.org/course/food-for-kids-a-parents-guide-to-encouraging-healt">Food for Kids: Discovering Healthy Eating</a> is an interactive course designed for primary school aged children. Topics include: what’s in food; how it gets digested in the body; identifying healthy food and drinks; and reducing food waste.</p></li>
<li><p><a href="https://www.edx.org/course/food-for-kids-discovering-healthy-eating">Food for Kids: A Parent’s Guide</a> is designed for parents, teachers and everyone interested in child nutrition. Topics include: how food and drinks influence growth and development; which foods and how much are needed for children to meet nutrition guidelines; and how to develop healthy household eating habits. </p></li>
</ol>
<p><a href="https://www.edx.org/course/food-for-kids-a-parents-guide-to-encouraging-healt">Courses start</a> March 4 but you can enrol any time during the course, once it starts.</p>
<p>If you want to know how your child’s current dietary patterns rate, and are looking for some specific tips to improve their nutrition, you can do the Healthy Eating Quiz <a href="https://healthyeatingquiz.com.au/">here</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-things-parents-can-do-to-improve-their-childrens-eating-patterns-95370">Five things parents can do to improve their children's eating patterns</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/130470/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.</span></em></p><p class="fine-print"><em><span>Tracy Burrows is associated with Priority research Centre of Physical Activity and Nutrition, the University of Newcastle and Affiliate to Hunter Medial research Institute. She receives funding from NHMRC as part of an Investigator grant </span></em></p><p class="fine-print"><em><span>Kerith Duncanson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Just one in 17 Australian children eats the recommended daily serves of vegetables. But it’s tough getting kids to eat healthy foods. These tips might help.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleKerith Duncanson, Senior Research Fellow, School of Medicine and Public Health, University of NewcastleTracy Burrows, Associate Professor Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1127892019-03-21T21:55:24Z2019-03-21T21:55:24ZFederal budget pledges a Canadian school food program but recipe requires funding<figure><img src="https://images.theconversation.com/files/263664/original/file-20190313-123541-1c8afai.jpg?ixlib=rb-1.1.0&rect=7%2C186%2C5114%2C2747&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Canada is ranked 37th of the 41 most wealthy nations in regards to child well-being and access to healthy food, according to UNICEF.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Hectic mornings of rushing around packing school lunches for kids could actually become a thing of the past for Canadian parents.</p>
<p>In the <a href="https://www.budget.gc.ca/2019/docs/plan/chap-04-en.html#Introducing-a-Food-Policy-for-Canada">recent federal budget</a>, Canada has finally declared its intention to work towards a national school food program with the provinces and territories.</p>
<p>The pledge is <a href="https://www.hilltimes.com/2019/03/20/liberals-propose-national-school-meal-program-as-canada-remains-back-of-pack-on-childrens-nutrition/193321">embedded in the new national food policy</a>, although the government has not yet committed any funds for the program.</p>
<p>As researchers focused on student nutrition, wellness and national and provincial food policy, we see <a href="https://theconversation.com/how-to-make-a-national-school-food-program-happen-102018">a national school food program is a no-brainer</a>. </p>
<p>Food at school can improve children’s <a href="http://canadianfoodstudies.uwaterloo.ca/index.php/cfs/article/view/260">health and academic outcomes while creating economic opportunities for local, sustainable agriculture</a>. To ensure this, however, the federal government needs to establish food procurement criteria and regulations to protect against <a href="https://utpjournals.press/doi/10.3138/cbmh.32.2.391">corporate food and beverage from gaining entry into schools</a>. </p>
<p>In many countries, parents’ main focus in the morning is getting their kids out of the door on time because schools handle lunch as part of a larger health, education and economic strategy. </p>
<p>In France, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852781/">school lunches are part of the school day</a>, not a break from it. Children are served a four-course meal while sitting at a group table with a supervisor who teaches them about nutrition, healthy eating and table manners. </p>
<p>In Italy, <a href="https://www.gamberorosso.it/en/news/english-food-news/school-lunches-in-italy-setting-a-healthy-pattern-for-adult-life/">school meals are locally sourced and certified organic</a>, with special meals provided for children with food allergies, intolerances and religious restrictions. School lunch menus are sent home on a weekly basis to help parents avoid overlap at home. </p>
<p>In <a href="https://www.businessinsider.com/japans-amazing-school-lunch-program-2017-3#lunchtime-in-japanese-primary-schools-is-almost-sacred-it-isnt-hurried-or-hasty-kids-get-the-time-just-to-sit-and-eat-1">Japan</a>, where <a href="https://www.cbc.ca/news/health/food-education-the-law-in-japan-1.2894279">food education is mandated by law</a>, lunches are cooked in school. In an effort to reinforce a culture of self-sufficiency students serve one another and when lunch is done everyone helps clean up.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/263644/original/file-20190313-123545-f5s3qz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/263644/original/file-20190313-123545-f5s3qz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/263644/original/file-20190313-123545-f5s3qz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/263644/original/file-20190313-123545-f5s3qz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/263644/original/file-20190313-123545-f5s3qz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/263644/original/file-20190313-123545-f5s3qz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/263644/original/file-20190313-123545-f5s3qz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In Japan, food education is mandated by law. Here, Yoshihiko Noda, former prime minister, joins children for a kindergarten in Yokohama, near Tokyo, in October 2011.</span>
<span class="attribution"><span class="source">(AP Photo/Kyodo News)</span></span>
</figcaption>
</figure>
<p>In <a href="https://www.ncbi.nlm.nih.gov/pubmed/23218237">Brazil, school food is part of a national and comprehensive food strategy</a> that integrates education, agriculture, health and food security while supporting family farming. </p>
<h2>Health crisis spans economic divides</h2>
<p>The last time the federal government seriously discussed implementing a national school food program was during <a href="https://www.tandfonline.com/doi/full/10.1080/09581596.2018.1524849">the Second World War when the government rejected a school lunch program.</a> Instead, Canada decided to provide a <a href="https://www.ubcpress.ca/food-will-win-the-war">family allowance</a> designed to ensure families had enough income to buy food for their children. </p>
<p>Since then, the pervasiveness of diet-related diseases among children may make today’s youth the first generation to have <a href="https://www.ourcommons.ca/DocumentViewer/en/39-1/HESA/report-7">sicker, shorter lives than their parents</a> as found by a House of Commons standing committee on health in 2007.</p>
<p>Children spend a considerable amount of time at school for well over a decade of their lives, so schools are the ideal medium for <a href="https://dcjournal.ca/doi/10.3148/cjdpr-2018-037">fostering and reinforcing a lifetime of healthy eating habits</a>. Preventing chronic diseases through improving nutrition among children and youth should, therefore, be a priority. </p>
<p>A national, <a href="https://globalnews.ca/video/embed/4941523/%22">health-promoting school food program is essential</a> for Canada. With adequate funding and national standards, it can be the powerful health-promotion program needed to reverse our current health crisis that spans socio-economic divides. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/265195/original/file-20190321-93054-1atvmpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/265195/original/file-20190321-93054-1atvmpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/265195/original/file-20190321-93054-1atvmpd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/265195/original/file-20190321-93054-1atvmpd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/265195/original/file-20190321-93054-1atvmpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/265195/original/file-20190321-93054-1atvmpd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/265195/original/file-20190321-93054-1atvmpd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">School food programs are not only about children eating healthier, but also about children developing lifelong skills towards good health.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Universal, sustainable</h2>
<p><a href="https://dcjournal.ca/doi/10.3148/cjdpr-2016-037">Most provinces</a> in Canada have some form of a school food program (breakfast, snack and to a lesser degree lunch), but the type of program and quality of food served varies across the country. Existing programs largely rely on charitable funding because if there is any provincial and municipal support, it often only covers a fraction of the cost. </p>
<p>A national research team that my co-author was part of <a href="http://canadianfoodstudies.uwaterloo.ca/index.php/cfs/article/view/260">recommended six key characteristics to guide a national school food program in Canada</a>. Such a program would be: </p>
<p><strong>1. Universal</strong> and offered to all students at no cost or subsidized cost, and administered in a non-stigmatizing manner. </p>
<p><strong>2. Health Promoting,</strong> thereby focused on providing whole foods, specifically vegetables and fruits.</p>
<p><strong>3. Respectful</strong> of local conditions and needs, serving culturally appropriate foods. </p>
<p><strong>4. Connected</strong> to communities, supporting local food producers when possible.</p>
<p><strong>5. Multi-Component</strong> and integrated with curricula to incorporate nutrition education and hands-on food preparation for the development of food skills.</p>
<p><strong>6. Sustainable</strong> and so receiving ongoing funding, staffing and training along with regular monitoring and evaluation.</p>
<h2>Economic opportunity</h2>
<p>A national school food program isn’t just an expense; it’s an economic opportunity. Internationally, school food programs have an impressive return on investment — <a href="http://documents.wfp.org/stellent/groups/public/documents/resources/wfp281517.pdf">three dollars to $10 for every dollar invested</a> — including the <a href="http://www.farmtocafeteriacanada.ca/wp-content/uploads/2014/06/Upstream-HIA-Oregon-Farm-to-School-policy.pdf">creation of new jobs</a>. </p>
<p>School food could also be a fruitful emerging <a href="https://theconversation.com/farm-to-school-movement-takes-root-in-canada-101635">economic activity in Canada as it is in the United States as my research aims to show</a>. Canada would have the chance to develop a made-in-Canada school food economic growth strategy, akin to what <a href="https://theconversation.com/how-to-make-a-national-school-food-program-happen-102018">Brazil or Italy</a> has pursued. </p>
<p>The economic burden and preventable cost of nutrition-related disease in Canada is estimated at <a href="https://doi.org/10.1371/journal.pone.0196333">$13.8 billion annually</a>. Treating chronic disease already consumes an alarming <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907549/">67 per cent of all direct health care spending</a>. Such expenditure levels could cripple Canada’s universal health care system. Yet, over <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907549/">30,000 deaths could be averted or delayed</a> annually if our diets complied with dietary recommendations, particularly for eating more fruit and vegetables. </p>
<p>Right now, more than <a href="https://petitions.ourcommons.ca/en/Petition/Details?Petition=e-1957">3,200 signatures have been put to a petition to the Minister of Health</a> for the implementation of a universal healthy school food program whose cost is shared with the federal government. </p>
<p>This is an official <a href="https://petitions.ourcommons.ca/en/home/about">e-petition</a> to the House of Commons — that means it was made available online on the House of Commons website after it was introduced to Parliament by <a href="http://www.ourcommons.ca/Parliamentarians/en/members/Julie-Dabrusin(88994)">MP Julie Dabrusin</a> on behalf of Debbie Field, co-ordinator of the <a href="https://www.healthyschoolfood.ca/who-we-are">Coalition for Healthy School Food</a>. </p>
<p>The promise of a national school food program is an important step forward for Canada. The provision of adequate funding will ensure that it benefits all Canadian children.</p>
<p>An investment in a national school food program is <a href="https://obrieniph.ucalgary.ca/files/iph/raising-canada-eco-report.pdf">an investment in children today</a> and the leaders of tomorrow.</p><img src="https://counter.theconversation.com/content/112789/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amberley T. Ruetz receives funding from the Ontario Ministry of Agriculture, Food and Rural Affairs for her current research on the economic impact of the farm-to-school program. She is a supporter of the Coalition for Healthy School Food, which is advocating for a national school food program. She also consults with the Ontario Student Nutrition Program, Southwest Region.</span></em></p><p class="fine-print"><em><span>Sara FL Kirk receives funding from the Canadian Institutes for Health Research, Heart and Stroke, the Lawson Foundation, the Max Bell Foundation, the Public Health Agency of Canada and the Nova Scotia Health Research Foundation. She is a supporter of the Coalition for Healthy School Food, which is advocating for a national school food program. She is also a board member of Canada Bikes, a not-for-profit that promotes everyday cycling in Canada.</span></em></p>A well-planned national school food progam in Canada could be a huge boost to children’s health outcomes, long-term healthcare spending and local agriculture and economies.Amberley T. Ruetz, PhD Candidate in Geography and Arrell Food Scholar, University of GuelphSara F.L. Kirk, Professor of Health Promotion; Scientific Director of the Healthy Populations Institute, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/989382018-10-17T00:05:40Z2018-10-17T00:05:40ZCurious Kids: Why do we need food?<figure><img src="https://images.theconversation.com/files/224818/original/file-20180626-19375-1o9ueyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Food helps recharge your batteries.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>This is an article from <a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a>, a series for children. The Conversation is asking kids to send in questions they’d like an expert to answer. All questions are welcome – serious, weird or wacky! You might also like the podcast <a href="http://www.abc.net.au/kidslisten/imagine-this/">Imagine This</a>, a co-production between ABC KIDS listen and The Conversation, based on Curious Kids.</em> </p>
<hr>
<blockquote>
<p><strong>Why do we need food? – Milo, age 5, Cowes, Victoria.</strong></p>
</blockquote>
<hr>
<p>Just like a mobile phone needs to be recharged every day, so does your body. You need to eat food and drink water every day to keep your body going. Food gives you energy to grow, play games, be healthy and learn. Every day, you need to eat different foods from the five food groups.</p>
<p>The five food groups are:</p>
<ol>
<li><p>grains</p></li>
<li><p>fruit</p></li>
<li><p>vegetables</p></li>
<li><p>milk or vegetarian choices</p></li>
<li><p>meat or vegetarian choices</p></li>
</ol>
<p>Your body also needs nuts, healthy oils and spreads in small amounts too.</p>
<p>Fresh food is best. Foods that are processed and contain unhealthy fats and sugar, which is why cake, lollies and soft drinks are not recommended. If you eat lots of these your body can get sick.</p>
<h2>The food journey</h2>
<p>The food you eat starts a journey in your mouth where your teeth and tongue chew it into smaller parts. When you swallow, the chewed food passes into a long tube called your digestive system. Here, the food is broken down into tiny pieces that can be used by your body. This is called digestion.</p>
<p>Foods like wholegrain bread, vegetables and fruit contain carbohydrates and fibre, whereas nuts, oils and spreads contain healthy fats. Your body uses the carbohydrates and fats as energy so you can run and play games. Fibre helps the food pass through the long tube easily so you can poo in the toilet.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/238017/original/file-20180926-149976-kli4ig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/238017/original/file-20180926-149976-kli4ig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/238017/original/file-20180926-149976-kli4ig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/238017/original/file-20180926-149976-kli4ig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/238017/original/file-20180926-149976-kli4ig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/238017/original/file-20180926-149976-kli4ig.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/238017/original/file-20180926-149976-kli4ig.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/238017/original/file-20180926-149976-kli4ig.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vegetables and fruit contain carbohydrates and fibre.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/sonnysideup/2577052946/in/photolist-4VJ54m-UqaWAk-o6rN7e-buRpwD-6FfWnM-gYKxjX-8zjRbQ-RzmmD6-cKG5aq-JPT7H-eW99jx-eaEfLz-P6RWJJ-85PsMA-6RTGVP-JoThHi-bcudxn-pdishq-otTEjB-c4Dh7Q-czvFK7-2UiPZf-DAgHjn-cn4fmf-ieBtCe-9g71vb-Xq6EHN-TgyYEB-fCGfjT-6FRU2g-qEoEH-fwgw6-8dp3hM-euS1P1-2aaEPAu-5z28xq-e2cUDB-8NjYfB-nZ7Ate-2bc4WUL-ayDwZT-25Svy5G-baNkFa-22e8XPb-5tzw5G-2bad59b-27SDuMt-aBhbhM-24gdTSu-Zx4mK5">Flickr/Sonny Side Up!</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Milk, meat, eggs and legumes are high in protein. Your body uses protein to grow hair, fingernails and skin and fix any cuts. </p>
<p>Vitamins and minerals are in your food in small amounts. They help your body stay healthy.</p>
<p>Vitamin A is found in meat and orange vegetables like carrots, and helps your eyes see in the dark. Vitamin C is found in oranges, and helps your body fight off nasty bugs that can make you sick. </p>
<p>Minerals like calcium, which is found in dairy foods, helps your bones grow strong. Iron, found in meats and some breakfast cereals, helps your blood carry oxygen throughout your body.</p>
<h2>Tummy rumbles</h2>
<p>Do you ever hear any noises like grumbling or growling in your tummy? When your tummy rumbles, it means you are hungry and need to eat food. When your tummy feels full you can stop eating - you don’t want to feel too full. </p>
<p>Water is the best drink for you every day, and helps your body and brain to work properly. If you have been playing sport that makes you hot and sweaty, you’ll need to drink some water.</p>
<p>Without food and water every day, you will feel tired and you won’t be able to play and learn well.</p>
<p>As long as you eat a variety of foods each day and drink water regularly during the day, you’ll be okay.</p>
<p><em>Note to teachers and carers: <a href="http://www.refreshedschools.health.wa.gov.au">Refresh.ED</a> is an online portal that prepares school teachers for nutrition education with curriculum support materials (teaching materials, classroom activities).</em></p>
<hr>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to us. They can:</em></p>
<p><em>* Email your question to curiouskids@theconversation.edu.au
<br>
* Tell us on <a href="https://twitter.com/ConversationEDU">Twitter</a></em></p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p><em>Please tell us your name, age and which city you live in. You can send an audio recording of your question too, if you want. Send as many questions as you like! We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/98938/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Devine receives funding from Healthway, Western Australian Department of Health and Western Australian Department of Education and other funding bodies for scientific research. Dr Devine owns shares in Wide Open Agriculture and Keytone Dairy and is a co-director of Australasian Health Development Network. She is affiliated with the Nutrition Society of Australia and a friend of Dietitians Association of Australia.</span></em></p>Just like a mobile phone, your body needs to be recharged every day. You need to eat food and drink water every day to keep your body going. Some foods are better than others at helping you stay well.Amanda Devine, Professor of Public Health Nutrition, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1012692018-08-17T10:01:57Z2018-08-17T10:01:57ZExaggerated portions alongside real nutrition claims on cereal boxes may mislead consumers – new study<figure><img src="https://images.theconversation.com/files/232251/original/file-20180816-2900-1slym8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cereal portions this big are not good for children.</span> <span class="attribution"><span class="source">Daisy Daisy/Shutterstock</span></span></figcaption></figure><p>Eating healthy cereals in moderation can contribute to a balanced diet. However, many breakfast cereals on offer in the UK contain very high levels of sugar. In fact, based on total product weight, some are made up of <a href="https://theconversation.com/how-much-sugar-is-lurking-in-your-cereal-36797">more than a third</a> of the sweet stuff. </p>
<p>For children, breakfast cereals can be more than just a morning meal. Because they are quick and easy to prepare, kids tend to snack on them throughout the day too. This popularity means that cereal products are the second main contributor of free sugars (sugars added to food and drink, as well as sugars found naturally in things such as honey or unsweetened fruit juices) to children’s diets. They <a href="https://www.gov.uk/government/statistics/national-diet-and-nutrition-survey-results-from-years-1-to-4-combined-of-the-rolling-programme-for-2008-and-2009-to-2011-and-2012">account for</a> 8% of the free sugars intake in children (four to 10 years old) and 7% in teenagers (11–18 years).</p>
<p>When it comes to sugar discussions, we are frequently told that consuming excess free sugar in food and drink is detrimental to health and increases the risk of obesity, which is associated with greater risks of developing type 2 diabetes, hypertension, coronary artery disease and cancer. However, what is sometimes less discussed in the media is that excess sugar is also a well-established risk factor for tooth decay – which itself <a href="https://www.nhs.uk/conditions/tooth-decay/">can lead to</a> cavities, gum disease and painful abscesses.</p>
<p>For <a href="https://www.nature.com/articles/sj.bdj.2018.531">our recently published study</a>, we wanted to look at how breakfast cereals which are high in sugar are marketed to children, and how this impacts on oral health. We were particularly keen to look at how portion sizes are presented on the front of packets, and what this meant for sugar intake.</p>
<h2>Oversized portions</h2>
<p>Recent UK nutritional recommendations have indicated that free sugars should not exceed <a href="https://www.nhs.uk/common-health-questions/food-and-diet/how-much-sugar-is-good-for-me/">5% of total dietary energy</a> for children aged two and up. <a href="https://www.nhs.uk/live-well/eat-well/how-does-sugar-in-our-diet-affect-our-health/">According to the NHS</a> this is no more than 19g a day (approximately five teaspoons) for children aged four to six years old, and no more than 24g (six teaspoons) for children aged seven to 10.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/232252/original/file-20180816-2900-16tpy0d.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/232252/original/file-20180816-2900-16tpy0d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/232252/original/file-20180816-2900-16tpy0d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/232252/original/file-20180816-2900-16tpy0d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/232252/original/file-20180816-2900-16tpy0d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=567&fit=crop&dpr=1 754w, https://images.theconversation.com/files/232252/original/file-20180816-2900-16tpy0d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=567&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/232252/original/file-20180816-2900-16tpy0d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=567&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nine of the 13 cereal boxes examined in the study.</span>
<span class="attribution"><span class="source">Maria Morgan</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Using these guidelines, we looked at the packaging of the nine most popular types of breakfast cereals marketed to children in the UK. As it is the most popular of the top nine (according to Mintel marketing reports), we decided to look at Coco Pops in more detail and included all branded and UK supermarket versions of the chocolate flavour cereal. This meant that in total we included 13 breakfast cereals in our study: Cheerios, Coco Pops (and Asda, Sainsbury’s, Morrisons and Tesco supermarket branded versions), Cornflakes, Crunchy Nut Cornflakes, Frosties, Rice Krispies, Shreddies, Sugar Puffs and Weetabix. </p>
<p>What we found was that, at the manufacturer’s suggested portion size, eight of the 13 cereals provided more than half of the recommended daily sugar intake for a child aged four to six years old. But we also found that the images of the portion sizes on the front of the packaging could be misleading for consumers. While manufacturers suggested portion sizes on the packaging, the images appeared to show portions that were at least two-thirds more than the recommendations. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/231883/original/file-20180814-2912-ed7sei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/231883/original/file-20180814-2912-ed7sei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/231883/original/file-20180814-2912-ed7sei.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/231883/original/file-20180814-2912-ed7sei.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/231883/original/file-20180814-2912-ed7sei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/231883/original/file-20180814-2912-ed7sei.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/231883/original/file-20180814-2912-ed7sei.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sugar content of the leading UK children’s breakfast cereals (g/100g).</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Alongside these deceptive portion pictures were cartoon characters, royal endorsements and QR codes promoting the breakfast cereals, many of which appeared to be targeted at child consumers. </p>
<p>We did find that nutritional claims focused on vitamins (especially folic acid) and minerals (notably iron), whole grains and no artificial colours or flavours, were legitimate on all the cereals. In addition, only two of the 13 cereals we looked at – Weetabix and Sugar Puffs – did not have a voluntary <a href="https://www.nhs.uk/live-well/eat-well/how-to-read-food-labels/">front-of-pack nutrition label</a> (often colour coded into traffic lights). But the problem here is that while legitimate claims about other nutritional constituents in the cereals appear alongside images which don’t depict the manufacturers’ actual recommendation, consumers may think that the products are healthier than they are. </p>
<p>This may not necessarily be a deliberate attempt to mislead consumers, but dentists and other health professionals need to be aware of the high sugar content of these cereals, and the effects of marketing techniques, when giving nutritional advice to children and parents. At the same time, consumers need to be a bit more savvy about their breakfast choices too. </p>
<p>A good breakfast is an important part of the day – and it need not be “boring”. Simply choosing breakfast cereals with less sugar, such as porridge, plain shredded wholewheat and plain wholewheat biscuit cereals, adding some fresh fruit (bananas or raspberries are good) and serving with semi-skimmed milk or natural yoghurt, can make all the difference. For more ideas and information, Change4life has some top tips for <a href="https://www.nhs.uk/change4life/cutting-back-sugar">cutting sugar at breakfast</a>, as well as some <a href="https://www.nhs.uk/change4life/recipes">quick and easy recipes</a>.</p><img src="https://counter.theconversation.com/content/101269/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was conducted by Rosie Khehra as part of her BDS; it was led by Maria Morgan who acted as research supervisor and Dr Ruth Fairchild from Cardiff Metropolitan University was a co-author.</span></em></p>The marketing of breakfast cereals may be confusing consumers with a mix of true and inflated claims.Maria Morgan, Senior Lecturer in Dental Public Health, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/967402018-05-16T12:47:05Z2018-05-16T12:47:05ZDoes breastfeeding really belong on the school curriculum?<figure><img src="https://images.theconversation.com/files/219192/original/file-20180516-155607-mubkge.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Learning at home.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-portrait-white-caucasian-family-three-604772027?src=Qq6zvU7E1j6_bECk1p98bQ-1-0">Anna Kraynova/Shutterstock</a></span></figcaption></figure><p>The idea of introducing breastfeeding to the UK school curriculum has once again <a href="https://twitter.com/5WrightStuff/status/996423964078440448">hit the news</a> and is, of course, receiving a varied reception. But should the idea be taken seriously? The answer is, of course, yes. Just like children learn about any other aspect of biology, child development and social science, they should be taught how babies are fed and the impact this can have. </p>
<p>In a tightly packed curriculum, it can be hard to justify any addition, but the fact is that we urgently need to change public attitudes to and understanding of breastfeeding and human milk. They contribute to the UK having some of the <a href="https://www.theguardian.com/lifeandstyle/2017/aug/01/uk-attitudes-to-breastfeeding-must-change-say-experts">lowest breastfeeding rates</a> in the world, and changing the next generation’s knowledge and attitudes is critical to improving this. </p>
<p>The UK – <a href="https://today.yougov.com/topics/lifestyle/articles-reports/2013/09/11/french-women-least-tolerant-public-breastfeeding">and many other Western countries</a> – is not generally supportive of breastfeeding. Although most people might agree with statements that “breast is best”, they’ll follow them with several “buts”. At least a third of people in the UK think women <a href="https://www.theguardian.com/lifeandstyle/2018/mar/05/why-britains-attitude-to-breastfeeding-is-still-a-disgrace">shouldn’t breastfeed in public</a>, or that a toilet is an acceptable place to feed a baby. Other stats show that although we may state breastfeeding is optimal, we think it <a href="http://journals.sagepub.com/doi/10.1177/0890334405278490">makes little difference</a> if babies aren’t breastfed. Our attitudes and logic are skewed towards formula being normal, which can <a href="http://www.pinterandmartin.com/breastfeeding-uncovered-who-really-decides-how-we-feed-our-babies.html">significantly reduce the likelihood</a> that women get the right support to breastfeed, risking the health of mothers and babies. </p>
<p>Of major concern is that these attitudes get embedded from a young age. Older generations are actually the most supportive of breastfeeding while up to 80% of students <a href="http://journals.sagepub.com/doi/abs/10.1177/0890334412446798">believe breastfeeding in public is not acceptable</a>, with female students typically more critical towards breastfeeding than their male peers. This is likely compounded by the fact that <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-277X.2010.01048.x">less than half</a> of teenagers have ever seen a woman breastfeed. </p>
<p>There is no simple way to change public attitudes to breastfeeding, but certainly educating the next generation is an important part. Children and teens learn about how babies are made, grow, and are born – why not how they are fed? Breastfeeding is part of the reproductive cycle but also fits with other areas of the curriculum, too. Students are taught about lifestyle factors that affect cancer risk, but rarely about the protection breastfeeding offers against <a href="https://www.theguardian.com/science/2013/aug/15/breastfeeding-six-months-breast-cancer">female reproductive cancers</a>. They are taught about family life, budgeting and caring for infants, but rarely about the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.12366">money breastfeeding can save</a>. They learn about history, politics and global health so why not the <a href="https://www.theguardian.com/lifeandstyle/2018/feb/27/formula-milk-companies-target-poor-mothers-breastfeeding">devastating impact formula promotion</a> has caused in developing countries? </p>
<p>Some might roll their eyes and think no school pupil wants or needs to know about breastfeeding. And at first glance, maybe it’s not exactly Snapchat-worthy. But the <a href="http://www.human-milk.com/science.html">science of human milk and how it works</a> is fascinating. Emerging research suggests Hamlet, a component of human milk, may target and kill tumour cells. Another component, <a href="https://www.ncbi.nlm.nih.gov/pubmed/16936809">Lactoferrin, can kill e-coli</a>. If human milk was a pharmacological product it would be all over the curriculum. </p>
<p>From a schools perspective, it appears that breastfeeding education would be well accepted. <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-017-0106-0">In one study</a>, 76% of secondary school students agreed breastfeeding information should be part of the main curriculum. 88% thought it should be part of the child development module, 78% part of sex education, and 62% part of home economics. Teachers were also supportive of the idea, although as always were concerned about who would deliver the lessons – and it is essential that any content is created by someone with expertise in breastfeeding, and critically free from industry association. </p>
<p>But we know that education works. Teaching topics like this in schools <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjhp.12024">improves knowledge and attitudes</a> towards breastfeeding, and teens who hold <a href="http://journals.sagepub.com/doi/abs/10.1177/0890334402239735">positive attitudes to breastfeeding</a> are more likely to want their own future babies to be breastfed. </p>
<p>Breastfeeding lessons should be woven into primary school curriculums too – at least to the extent that formula feeding already is. Young children feed dolls with bottles in the nursery. They are read books in which babies are bottle fed. They colour in pretty pictures where “b is for bottle”. Some might react in horror at the concept of breastfeeding being discussed with five-year-olds, but only because they have <a href="https://www.bellybelly.com.au/breastfeeding/the-sexualisation-of-breasts/">oversexualised</a> it in their own minds. </p>
<p>We teach children all sorts about how their bodies work, and no one needs to sit down and formally teach them about the breast. Having books available <a href="https://theconversation.com/breastfeeding-is-rarely-seen-in-childrens-books-its-time-to-rewrite-attitudes-65995">where babies are breastfed</a>, for example, can make all the difference in readdressing the balance. The Katie Morag books by Mairi Hedderwick, for example, have illustrations where babies are casually breastfed in the background. Not sensationalising. Normalising. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"566252317952184320"}"></div></p>
<p>Of course, teaching children about breastfeeding and human milk is only one part of solving the major social challenge of changing infant feeding patterns. Public health <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jhn.12496">must step up and invest</a> in numerous areas, not least increasing professional expertise and support for mothers. But changing the next generation’s attitudes certainly plays a role in this. </p>
<p>As <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2015.0175">one participant in my research</a> stressed: “Go into schools. Talk to the children before someone else gives them the idea that breastfeeding is something to be ashamed about and formula milk is normal.”</p><img src="https://counter.theconversation.com/content/96740/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has received funding from the ESRC, NIHR and Public Health Wales. She is author of two books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies' and Why starting solids matters. </span></em></p>It’s time to normalise it.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/955692018-04-25T13:42:49Z2018-04-25T13:42:49ZBefore banning fast food shops near schools, give pupils a reason to dine in<figure><img src="https://images.theconversation.com/files/216309/original/file-20180425-175069-p3a2fb.jpg?ixlib=rb-1.1.0&rect=53%2C30%2C4999%2C3323&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/primary-school-kids-eat-lunch-cafeteria-432895708">Shutterstock.</a></span></figcaption></figure><p><a href="https://www.theguardian.com/society/2018/apr/23/ministers-urged-to-ban-fast-food-outlets-from-opening-near-schools">A ban</a> on fast food shops operating within 400 metres of schools has been called for by the Royal College of Paediatrics and Child Health. At a time when nearly one third of children aged two to 15 <a href="https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action/childhood-obesity-a-plan-for-action">are overweight or obese</a>, this measure sends a strong message to young people and their families, about the importance of cutting down on fast food. Even so, I doubt it would work.</p>
<p>Young people from poorer backgrounds <a href="https://www.theguardian.com/inequality/2017/dec/01/schoolchildren-poor-areas-exposed-fast-food-takeaways">are more likely</a> to go past food shops on their way to or from school, compared with pupils from wealthier backgrounds. Having the opportunity to buy food or drink makes people more likely to do so, so it’s important to consider access to food shops, when searching for ways to encourage young people to eat better. </p>
<p>But many young people go out to buy food before, during or after school at shops further than 400 metres away. Some will run to the shops during their lunch break, to get the food they want. Independent shops, in particular, understand their school-aged customers’ preferences, which are typically to buy something that fills them up quickly, at a price they can afford. </p>
<p>And it’s not just fast food shops which sell goods that are high in fat, salt or sugar; supermarkets also attract pupils with meal deals and other marketing promotions, which means that a group of friends can chip in to buy a multi-pack of donuts, for example, at a price that appeals to them.</p>
<h2>Reality bites</h2>
<p>If government is serious about enacting this kind of regulation, it would need to extend the ban to all food outlets within an 800-1,000 metre radius of schools. Otherwise, the policy will do little to change where young people buy their food and drink. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/216311/original/file-20180425-175058-31hy2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216311/original/file-20180425-175058-31hy2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=371&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216311/original/file-20180425-175058-31hy2l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=371&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216311/original/file-20180425-175058-31hy2l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=371&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216311/original/file-20180425-175058-31hy2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=467&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216311/original/file-20180425-175058-31hy2l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=467&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216311/original/file-20180425-175058-31hy2l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=467&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Worth crossing the road for, apparently.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/doctorow/1808768706/sizes/l">gruntzooki/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Students from lower income families want their money to stretch as far as possible, so they are canny consumers when it comes to finding the best value chips, crisps or soft drinks. </p>
<p>Of course, this is not the food and drink that public health professionals such as myself would like young people to consume. But the reality is that most teenagers prioritise spending time with their friends over setting out to find healthier food or drink options.</p>
<h2>Consulting with caterers</h2>
<p>But there’s still a lot schools can do to help. Basic things, such as ensuring tables and chairs in the cafeteria are not broken; providing cool, fresh jugs of water; not pushing young people outside once they have eaten and taking the time to find out what students actually want to eat and drink. </p>
<p>These simple solutions come up time and again <a href="https://www.tandfonline.com/doi/full/10.1080/0305764X.2015.1110114">in research</a>, and still many schools find it difficult to consult with young people about improving the food and dining environment, in a way that will appeal to them. </p>
<p>Yet the big companies with contracts to provide food and drink in schools, such as <a href="http://cn.education.sodexo.com/6.3.1.php">Sodexo</a>, are increasingly willing to spend time producing strategies together with young people. School governors, head teachers and in-house catering staff need to prioritise working with contract caterers to come up with <a href="https://twitter.com/hashtag/cityfoodsym?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Ehashtag">new, inclusive ways</a> of persuading young people that school is the cool place to eat.</p><img src="https://counter.theconversation.com/content/95569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wendy Wills receives funding from Food Standards Scotland, the Food Standards Agency and the ESRC. </span></em></p>With obesity affecting so many students, it’s better to give them cheap, appealing food and drink choices at school.Wendy Wills, Professor of Food and Public Health, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/898762018-01-11T10:14:45Z2018-01-11T10:14:45ZSugar: six easy ways to encourage children to eat less<figure><img src="https://images.theconversation.com/files/201420/original/file-20180109-36019-9uxc8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tempted...</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/diet-kids-sad-unhappy-child-reaches-768409303?src=BpJU09cVlGpRKTyemTSiPw-1-0">Sharomka/Shutterstock</a></span></figcaption></figure><p>A new campaign from Public Health England is urging parents to <a href="http://www.bbc.co.uk/news/health-42411474">limit snacks for children</a> to two a day, and 100 calories a piece. The aim is to reduce kids’ sugar consumption – according to <a href="https://www.nhs.uk/change4life/food-facts/sugar#y923EBPuvyUuzyF8.97">PHE data</a>, children eat on average 10kg of sugar every year, with about half of this coming from sugary drinks and snacks.</p>
<p>This is definitely an important initiative, but any parent will tell you that getting little ones to swap cereal bars for celery is no easy task. You could explain again and again how eating too much sugar can lead to health problems like obesity and tooth decay, but that doesn’t mean children will fully understand why snacking on sweet treats can be a problem.</p>
<p>Though encouraging children to eat healthy snacks isn’t as easy as clearing out the cupboards, that doesn’t mean it’s an impossible feat. Here’s how to make it less of a labour.</p>
<h2>1. Be creative</h2>
<p>There are only so much vegetable sticks and hummus that anyone can eat before it gets boring, so you will need to get a bit creative with the snacks on offer. But this is not about going over the top with Pinterest-worthy creations either. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2011.02409.x/full">Bright colours</a> and interesting textures will do the trick, as well as pairing already <a href="http://jn.nutrition.org/content/143/7/1194.short">well-liked flavours with new tastes</a>.</p>
<h2>2. Stock up with different choices</h2>
<p>Variety can help as well. Rather than just having single snacks to hand, get a couple of alternatives ready. Again, these don’t need to be presented on a platter, the idea is to give them <a href="https://www.ncbi.nlm.nih.gov/pubmed/27062194">the autonomy to choose</a>. </p>
<p>Have pots of plain yogurt or fromage frais in the fridge, nuts and raisins ready to be scooped out in handfuls, or some oven roasted vegetable crisps with a small amount of dip waiting in the cupboard. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/201486/original/file-20180110-46715-ljfn4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/201486/original/file-20180110-46715-ljfn4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/201486/original/file-20180110-46715-ljfn4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/201486/original/file-20180110-46715-ljfn4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/201486/original/file-20180110-46715-ljfn4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/201486/original/file-20180110-46715-ljfn4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/201486/original/file-20180110-46715-ljfn4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/201486/original/file-20180110-46715-ljfn4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Snack suggestions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/school-lunch-box-snacks-kids-over-698716126?src=gEcP4tIxDZ9dgVeVd-l3Jw-1-65">Dado Photo/Shutterstock</a></span>
</figcaption>
</figure>
<h2>3. Avoid sugary drinks</h2>
<p>Parents hear over and over that even seemingly healthy drinks can often hide numerous teaspoons of sugar in them. While fizzy drinks are generally regarded as the most unhealthy options, fruit juice and smoothies aren’t <a href="https://www.theguardian.com/society/2016/mar/23/fruit-juices-smoothies-contain-unacceptably-high-levels-sugar">as healthy as they seem either</a>. </p>
<p>Flavoured water and squash <a href="http://www.telegraph.co.uk/foodanddrink/healthyeating/11504822/How-your-healthy-flavoured-water-contains-more-sugar-than-cola.html">can also contain sugar</a> so that leaves plain water as <a href="https://theconversation.com/under-threes-need-water-and-milk-not-sugar-loaded-drinks-32347">the best option</a> for children to drink. Though many kids will say they don’t like the taste, adding a squeeze lemon or orange, or infusing a large jug with mint and strawberries will help change their minds. </p>
<h2>4. Don’t forbid but do control</h2>
<p>As research has repeatedly shown, forbidding foods makes them <a href="http://www.sciencedirect.com/science/article/pii/S0195666307002668">even more attractive</a> for children. In fact, the power of forbidden foods is so strong, it has even been suggested that it <a href="http://www.sciencedirect.com/science/article/pii/S0195666308001499">works on healthy foods</a>, like fruit. </p>
<p>The occasional biscuit or chocolate bar will not jeopardise a child’s eating health habits, so long as it is just one or two every once in a while. As a rule of thumb, try not to keep sugary snacks in the home, avoid offering them if the kids don’t ask for them, and limit the quantity offered if they do. Explain to them why it is important to limit those foods, too, as teaching them about their own health will work better in the long run than just saying no without explanation. </p>
<p>Keep in mind that the 100 calorie recommendation is a rough guide to help parents quantify sugar. Nuts, for example, are a healthy snack choice but a portion size is often more than 100 calories.</p>
<h2>5. Start thinking about meals, too</h2>
<p>While snacks are easier to target through public health campaigns, remember that reducing sugar consumption should be done holistically. If half of childrens’ total sugar consumption comes from sugary drinks and snacks then it is obvious that meals account for the other half. Start thinking about moderating desserts after meals and sugary breakfasts as well.</p>
<h2>6. Eat healthy as a family</h2>
<p>Children learn from what they <a href="https://www.ncbi.nlm.nih.gov/pubmed/15003137">see adults doing</a>, so it is important that parents also make healthy choices. Research shows that children who participate in frequent family meals are <a href="http://www.sciencedirect.com/science/article/pii/S0002822310018316">more likely to eat fruit and vegetables</a>, and they have more healthy eating habits overall that <a href="https://www.ncbi.nlm.nih.gov/pubmed/25485670">can continue in adult life</a>. Apply the same rules to everyone in the family, and the children won’t be the only ones learning a valuable lesson.</p>
<p>Kicking the sugar habit may be tricky to begin with, but following this simple advice will help make food a positive experience for you and your little ones.</p><img src="https://counter.theconversation.com/content/89876/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophia Komninou does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A child nutritionist gives her advice.Sophia Komninou, Lecturer in Infant and Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/858822017-11-02T09:47:32Z2017-11-02T09:47:32ZThe real reasons why parents struggle with children’s portion sizes<figure><img src="https://images.theconversation.com/files/192819/original/file-20171101-19853-ynuv45.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A tasty treat but is it too much?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-boy-eats-big-hamburger-725109037?src=j_7SLnEX_6MjDzAPDTnFdA-1-15">Shutterstock/Daniel M. Nagy</a></span></figcaption></figure><p>Parents are repeatedly told to watch what they are feeding their children, but they must also keep a keen eye on how much of it they are serving.</p>
<p>As the place where they consume <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626144/">around two thirds of their daily food intake</a>, being obese or overweight begins at home for children. Child portion control has become so much of a problem that the World Health Organisation (WHO) has declared families’ healthy food portions <a href="http://www.who.int/dietphysicalactivity/childhood/en/">critical to childhood weight management</a>. </p>
<p>But very little is known about what exactly influences parents’ portion size choices for their children. <a href="http://journals.sagepub.com/doi/abs/10.1177/0009922814555977">Previous research</a> into child weight management has identified gaps in parents’ knowledge, denial of their children’s weight status, and cultural practices as barriers towards healthy eating. Few studies have been done into parents’ portion behaviours, however. </p>
<p>To find out the situation in the UK, we conducted a series of group discussions with 22 parents from across the country – mainly mothers with overweight children above the age of five – along with four family weight management caseworkers. Unlike <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2009.00648.x/full">previous qualitative research</a>, we wanted to get answers directly from adults.</p>
<h2>Knowledge and emotion</h2>
<p>So far, efforts to explain the consumption of large portion sizes have focused mainly on how the shape and size of dinnerware <a href="http://www.ajpmonline.org/article/S0749-3797(06)00179-6/fulltext">provides visual prompts that influence consumption</a> beyond our consciousness, as well as the availability of <a href="https://www.ncbi.nlm.nih.gov/pubmed/12589331">low cost, large quantities</a> of high energy dense foods. </p>
<p>But <a href="https://link.springer.com/epdf/10.1186/s12889-017-4711-z?author_access_token=jzCbOzITEOeyT3VrrfEERm_BpE1tBhCbnbw3BuzI2RNOcYWMrpkai3FhTUNmpM3WkTkSZ_3yDRbW_npTkSFZwgwB_A_9D4dSupOGqwmYfp6JWWmV_7F9sMgsneOC2XckYg2NoVbh0JuZf7lI-JddJw%3D%3D">our findings suggest</a> that both parents’ emotional and habitual responses, and beliefs are also potentially important influences on their portion control behaviours.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/192820/original/file-20171101-19861-kyak53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/192820/original/file-20171101-19861-kyak53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/192820/original/file-20171101-19861-kyak53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/192820/original/file-20171101-19861-kyak53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/192820/original/file-20171101-19861-kyak53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/192820/original/file-20171101-19861-kyak53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/192820/original/file-20171101-19861-kyak53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pasta portions – but which is the right one?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/colorful-raw-pasta-color-measure-cups-606602912?src=YdZWEA-mfzjD7Sy0jsSInA-1-1">Shutterstock/Renvema</a></span>
</figcaption>
</figure>
<p>The parents who took part in our research had limited knowledge about what healthy portion sizes were for themselves and their family members as supported in <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-277X.2009.00969.x/full">previous research</a>. However, this is not too surprising as there is very little <a href="https://www.nhs.uk/Livewell/childhealth6-15/Pages/child-health-measurement-programme-healthy-weight-advice.aspx">official public health guidance</a> on age appropriate portion sizes.</p>
<p>They, and the caseworkers, also said that they found it difficult to talk to the children about the need for smaller portion sizes to manage weight. This builds on previous research showing that greater child weight is associated with <a href="http://www.tandfonline.com/doi/abs/10.1080/03004430.2010.548606">poor parent-child communication</a>.</p>
<p>Both parents and caseworkers agreed that part of the difficulty in communicating with children arose from parents’ fear of <a href="http://online.liebertpub.com/doi/abs/10.1089/chi.2011.0025?journalCode=chi&">lowering their children’s confidence</a>
and causing anxiety, particularly among older children. In addition, the parents revealed that along with the <a href="http://pediatrics.aappublications.org/content/122/3/e682.short">fear of causing eating disorders</a> and <a href="http://www.sciencedirect.com/science/article/pii/S1871403X11000081?via%3Dihub">guilt of restricting food</a>, they worried about the possibility of being disliked by their children.</p>
<p>On the other hand, some parents believed that measuring portion sizes required too much mental effort and time. Cultural food practices were also highlighted in conversations with parents, in relation to their concerns towards food wastage where they admitted that if they cooked too much food, they would overfeed, rather than not serve it. These findings reflect previous research suggesting that parents’ core values in relation to food waste is instilled during their own childhood, where it was often expected that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734152/">all food on the plate should be eaten</a>. </p>
<p>The parents in the study also had low confidence in their ability to manage their children’s weight through portion control due to their own unsuccessful attempts at losing weight.</p>
<h2>Habits</h2>
<p>The parents we spoke to said they had a habit of using plates for portion guidance and that they found it difficult to provide healthy portion sizes when the little ones moved to adult sized plates. As we know, dinnerware has <a href="http://www.bmj.com/content/351/bmj.h5863.full">increased in size</a> over the years, leading to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579823/">serving and consuming larger portions</a>. Most parents also had no weighing scales and agreed that they had no time or motivation for using them compared to dinnerware for portion control, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-277X.2009.00969.x/full">as reported elsewhere</a>.</p>
<p>The parents and caseworkers also said that grandparents were obstacles to the regulation of children’s food. The grandparents were seen as often providing extra food, undoing parents’ good work. Mothers also expressed frustrations with partners giving children greater portion sizes than needed.</p>
<p>From what we have found, it appears that family weight management programmes which target portion control or focus purely on one aspect of the problem – such as <a href="http://www.sciencedirect.com/science/article/pii/S0195666314005546">environmental strategies</a>, which target things like utensil and dish size – may not be as effective as those that account for parents’ own knowledge, skills and motivations. </p>
<p>Further research is needed, but from what we’ve found in this study, there are some solutions that could be easily implemented. Family weight programmes should provide parents with ideas for quick and simple ways for measuring healthy sized portions, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526951/">using hands as a guide</a>, whereby children’s hands are used for measuring children’s portions and adult’s hands are used for adult portions. Parents could also be helped to improve their communication skills and problem solving techniques in order to address their own emotional issues with food.</p><img src="https://counter.theconversation.com/content/85882/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristina Curtis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s not laziness that is causing some parents to overfeed their children.Kristina Curtis, Research Fellow in eHealth and behaviour change, Coventry UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/822182017-08-10T12:42:00Z2017-08-10T12:42:00ZHow ‘clean eating’ can damage children’s health<figure><img src="https://images.theconversation.com/files/181646/original/file-20170810-27635-hgt3di.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An unbalanced meal.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-kitchen-cleans-mandarinstanding-next-juice-619785605?src=8Wn0qAVqBywMjT6gNZkkOA-4-51">kovokvm/Shutterstock</a></span></figcaption></figure><p>Clean eating seems ideal for parents who want to establish their children’s healthy habits early on. It’s no surprise really: “<a href="https://theconversation.com/a-dietitian-puts-extreme-clean-eating-claims-to-the-test-and-the-results-arent-pretty-63675">clean eating</a>” is the perfect buzz term for parents who are faced with supermarket shelves full of baby and toddler food which is <a href="https://www.theguardian.com/science/2013/sep/10/baby-food-nutrition-weaning-breastmilk">high in sugar content and low in nutritional value</a>.</p>
<p>But while some clean eating plans are focused on a balanced diet – with <a href="https://theconversation.com/forget-about-fats-its-processed-food-we-should-be-worried-about-59850">less processed</a> and more whole foods – others are extreme. Some advise cutting out things such as gluten, or whole food groups, such as grains and dairy – all the while advising us to consume so-called “super-foods” to maximise health and well-being. </p>
<p>There’s a reason why it’s called a “balanced” diet, and subscribing to any extreme nutritional plan can adversely affect child health on multiple levels. Excluding major food groups from our diet at any age can lead not only to inadequate calorie intake, but potentially malnutrition, and deficiencies in minerals and vitamins. </p>
<h2>Food groups</h2>
<p>Gluten – a protein found in cereals like wheat, rye and barely – appears to be one of the main targets for clean eating plans. Although some people will have the clinical condition coeliac disease, which means their body has an inflammatory reaction to gluten, most people have no problems processing it. </p>
<p>Cereal products are recommended as one of the fundamental bases of a healthy diet by world leading health and nutrition organisations such as <a href="http://www.nhs.uk/Livewell/Goodfood/Documents/The-Eatwell-Guide-2016.pdf">Public Health England</a>, <a href="http://www.eatright.org/resource/food/nutrition/dietary-guidelines-and-myplate/make-your-kids-meal-a-myplate-superstar">the Academy of Nutrition and Dietetics</a>, and <a href="https://www.cnpp.usda.gov/sites/default/files/archived_projects/FGPPamphlet.pdf">the US Department of Agriculture (USDA)</a>, and are a staple food in the <a href="http://mediterradiet.org/nutrition/mediterranean_diet_pyramid">Mediterranean diet</a>. They contain the carbohydrates the human body <a href="http://www.nhs.uk/Livewell/loseweight/Pages/the-truth-about-carbs.aspx">needs to function</a>, and so depriving constantly moving babies, toddlers and children from the main fuel for their muscles and brain can only delay their development.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/181650/original/file-20170810-27661-1gdjktc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/181650/original/file-20170810-27661-1gdjktc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181650/original/file-20170810-27661-1gdjktc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181650/original/file-20170810-27661-1gdjktc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181650/original/file-20170810-27661-1gdjktc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181650/original/file-20170810-27661-1gdjktc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181650/original/file-20170810-27661-1gdjktc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Super’ food?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/spinach-green-fruits-smoothie-ingredientssuper-foods-519070624?src=yVZjTQOe0R4w70dHiZWOYA-1-52">Losangela/Shutterstock</a></span>
</figcaption>
</figure>
<p>In addition to advocating that gluten should be cut, the extreme “clean eating” philosophy is that not all carbohydrates are created equal – even if it’s exactly the <a href="https://theconversation.com/could-some-types-of-sugar-actually-be-good-for-you-55330">same molecules at the base of them</a>. People are led to believe that refined sugar is the ultimate evil, a poison that will sabotage their health. Yet, they are happy to consume a “green” or “protein” smoothie that contains <a href="https://www.theguardian.com/society/2016/mar/23/fruit-juices-smoothies-contain-unacceptably-high-levels-sugar">as much sugar as a can of fizzy drink</a> without a whiff of guilt. </p>
<p>On the contrary, they feel they are doing something good for themselves and their kids, giving their bodies a boost of nutrients and even getting some veggie goodness into them. Similarly, a cake recipe that features agave syrup, honey or coconut sugar instead of refined sugar is marketed as a “healthy alternative” or a “guilt free” treat.</p>
<p>Some clean eating plans also advocate eliminating dairy products from the diet despite them actually being the most <a href="https://www.nutrition.org.uk/attachments/article/874/Calcium%20Counts.pdf">efficient natural source</a> of calcium. A cup of milk or yogurt, or a slice of cheese, can contain anything from 300-400mg of calcium, while a typical serving of non-dairy sources – except for small fish eaten with their bones – does not tend to contain even 100mg, and usually falls well under that. </p>
<p>The average adult needs about 1,000mg of calcium per day. Children go through several growth spurts until adulthood and their needs are even higher – <a href="https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/">teenagers require 1,300mg</a>, for example. If not carefully designed, a non-dairy diet can delay children’s growth and impact on future bone strength. </p>
<p>At the same time, many of the promoted superfoods, such as kale, beetroot and chia seeds, for example, can be potentially unsuitable for younger kids. <a href="http://wholesomebabyfood.momtastic.com/kale-for-baby.htm">Kale</a> and <a href="http://pediatrics.aappublications.org/content/116/3/784.full">beetroot</a> are naturally high in nitrates that can be toxic for younger babies, while <a href="http://www.littlelondonmagazine.co.uk/food-should-we-be-imposing-clean-eating-on-our-children/">chia seeds</a> swell up in the stomach filling the space for nutrient dense foods, and potentially causing upset tummies. </p>
<h2>Healthy attitudes</h2>
<p>In addition to physical effects, imposing a clean eating diet may change a child’s attitudes to food, too. It is well established that the most effective way to create or increase desire is <a href="https://www.ncbi.nlm.nih.gov/pubmed/18501474">to restrict access</a>. Younger toddlers, who are unaware of the existence of the “forbidden fruit” will not ask for it. But when the restriction is lifted and children taste the “new” palatable foods, they are unequipped to manage their natural desire for it.</p>
<p>Healthy eating should not only be about promoting foods that sustain physical health, but also behaviours that sustain a healthier relationship with food. What this whole trend of clean eating is missing is that food is more than a fuel for our body. It’s also centuries of culture, and ignores how people connect over a meal and enjoy it. </p>
<p>Ultimately, helping a child to be happy and healthy isn’t about being “clean” or “dirty”, it is about teaching them to enjoy nutritional foods, and to be aware of what makes up a balanced diet.</p><img src="https://counter.theconversation.com/content/82218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophia Komninou does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A healthy diet is a good idea, but cutting out entire food groups is not.Sophia Komninou, Lecturer in Infant and Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/779822017-07-07T12:11:39Z2017-07-07T12:11:39ZMothers are subject to a postcode lottery for breastfeeding support<figure><img src="https://images.theconversation.com/files/177298/original/file-20170707-3005-131g4vj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-breastfeeding-hugging-baby-young-mom-528384532?src=1JMEE0R1scNoohB-hLItqw-1-50">Uvarov Stanislav/Shutterstock</a></span></figcaption></figure><p>Though some mums choose not to breastfeed their children, it is still considered by most to be “an <a href="http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/">unequalled way</a> of providing ideal food for the healthy growth and development of infants”. </p>
<p>It is for that very reason that both the <a href="http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/">World Health Organization</a>and <a href="https://www.nhs.uk/start4life/breastfeeding">the NHS</a> specifically recommend breast milk as the only food for babies up to six months old, with infants benefiting from continued breast milk up until at least two years old. </p>
<p>But for both new and experienced mothers, starting to breastfeed a new baby can be difficult. For both parent and child to remain happy and healthy, <a href="http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/">they need support</a>. In the UK, <a href="https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwj7uN-KiPXUAhXLb1AKHW-FBnoQFggtMAE&url=http%3A%2F%2Fcontent.digital.nhs.uk%2Fcatalogue%2FPUB08694%2Fifs-uk-2010-sum.pdf&usg=AFQjCNGCK637nNzh1KfyiCHzNdF-jqBsWg">more than 80% of mothers</a> breastfeed their baby at least once, but rates drop off quickly. </p>
<p><a href="https://www.nice.org.uk/guidance/ph11/chapter/4-recommendations#breastfeeding-3">According to NICE</a> – the body which suggests the treatments patients should receive as part of NHS England care – the health service should have “a multifaceted approach or a coordinated programme of interventions across different settings to increase breastfeeding rates”. In other words, all mothers should be getting help to breastfeed their babies – but we’ve found that this is not the case. </p>
<p>One specific <a href="https://www.nice.org.uk/guidance/ph11">NICE recommendation</a> is that mothers should be guided and encouraged through breastfeeding peer support programmes. The peer supporters are women who have received training in breastfeeding and have personal experience. However, NICE does not provide guidance about what this peer support should be like. In the US, there is a standardised training programme for peer supporters, trainers and service managers, which has helped to <a href="https://www.fns.usda.gov/sites/default/files/ops/WICPeerCounseling-PhaseII-Summary.pdf">work towards a standard</a> service across the country. But in the UK, each NHS trust or health board has its own strategy for the care of breastfeeding mothers, and these training programmes vary greatly.</p>
<h2>Service success</h2>
<p>To date, breastfeeding peer support services have <a href="http://www.bmj.com/content/344/bmj.d8287">not been successful</a> in the UK. For this reason, the National Institute for Health Research commissioned us to undertake <a href="http://www.cardiff.ac.uk/centre-for-trials-research/research/studies-and-trials/view/mamkind">a programme of research</a> to find out how mothers were being supported to breastfeed across the country, outside of midwifery and health visiting services.</p>
<p>We asked NHS and local authority staff who had responsibility for infant feeding if breastfeeding peer supporters were available in their area – defined as either a NHS health board, NHS trust or local authority (in England). Where we did not get a reply from the member of staff, we searched NHS/local authority websites.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1067&fit=crop&dpr=1 754w, https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1067&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1067&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Breastfeeding support availability in the UK.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><a href="http://orca.cf.ac.uk/100555/">What we found</a> was that breastfeeding peer support is not available uniformly across the country – despite NICE’s recommendation. In fact, peer support is only available in 56% of NHS trust areas. This postcode lottery means that some mothers are not able to access peer supporters, which might make it harder for them to breastfeed their children. </p>
<p>Alongside this, participants also told us that services were not even available uniformly under the NHS trusts and health boards they worked with or for – while some towns had access to peer support services, others did not. They attributed this lack of service to the money available, rather than the support needs of new mothers. Indeed, some services reported there had been budget cuts which meant services such as training new peer supporters could not be provided. </p>
<p>Among the areas which had peer supporters, the roles that they did – such as providing support in hospital wards or visiting new mums at home – varied. Participants in our study advised that peer support services were most complimentary to NHS midwifery care when the peer supporters had clear roles and responsibilities. It was also important that peer supporters were visible to midwives and health visitors, for example by working on postnatal wards.</p>
<p>The health professionals also told us that it was difficult to attract mothers from poorer backgrounds to seek support from breastfeeding peer support programmes.</p>
<p>We also looked into the availability of support groups for breastfeeding mothers across the country. These are groups based in the community which aim to help mothers breastfeed. Though they are sometimes run or attended by peer supporters, they are also run by midwives, health visitors and voluntary groups, such as the <a href="https://www.nct.org.uk/">National Childbirth Trust</a>. Most areas in the study (89%) had at least one breastfeeding support group, but the number of groups was not related to the number of births or the perceived level of need. </p>
<h2>Proving benefit</h2>
<p>One reason for the low prevalence and lack of funding for breastfeeding support may be the <a href="http://www.bmj.com/content/344/bmj.d8287">insufficient amount of evidence</a> of its clinical benefit in the UK. Globally, it has been proven that these support services <a href="http://www.bmj.com/content/344/bmj.d8287">increase breastfeeding rates</a>, but without specific evidence from UK mothers, trusts would be reluctant to fund it.</p>
<p>For so many mothers, peer support feels absolutely vital to continuing their breastfeeding. At what can be a <a href="https://theconversation.com/traumatic-breastfeeding-experiences-are-the-reason-we-must-continue-to-promote-it-63550">lonely, frustrating and upsetting time</a>, it is absolutely vital that mothers have someone to turn to.</p>
<p>Our team is now working to test a new model of breastfeeding peer support, <a href="http://www.cardiff.ac.uk/centre-for-trials-research/research/studies-and-trials/view/mamkind">Mam-Kind</a>, which aims to <a href="https://www.facebook.com/mibfps.study">provide mothers with regular support</a> to help them identify and meet their own breastfeeding goals.</p><img src="https://counter.theconversation.com/content/77982/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aimee Grant receives funding from the National Institute for Health Research, the Wellcome Trust ISSF Public Health Scheme and the Welsh Crucible Small Grant Scheme. She has also undertaken paid consultancy for Public Health Wales NHS Trust, where she previously held the role of Senior Health Promotion Practitioner. She is affiliated with the Action on Smoking and Health (ASH) Wales Cymru research committee, where she previously held the role of Research and Policy Officer.</span></em></p>The UK isn’t doing enough to help mums breastfeed successfullyAimee Grant, Research Associate, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/779902017-05-25T13:51:36Z2017-05-25T13:51:36ZThe health cost of cutting free school lunches will be far greater than the price of them<figure><img src="https://images.theconversation.com/files/170978/original/file-20170525-23251-1w0e5sb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Food for thought.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-pupils-sitting-table-school-cafeteria-268226171?src=IzjzKr3Lw5Hl-8FsniGC9Q-5-34">SpeedKingz/Shutterstock</a></span></figcaption></figure><p>The <a href="https://www.conservatives.com/manifesto">Conservative Party’s manifesto</a> pledge to replace free school lunches – for children in the first three years of primary school in England – with free breakfasts is curious to say the least.</p>
<p>Since it was announced, researchers have found that the cost of the project is hugely undervalued. In an <a href="http://schoolsweek.co.uk/conservatives-back-track-on-60m-for-primary-school-breakfasts/">official statement</a> launched before the manifesto, the party said that breakfast clubs “will cost £60m a year”. It has since been found that this would be the equivalent of <a href="http://schoolsweek.co.uk/conservatives-free-breakfast-pledge-costed-at-just-7p-per-meal/">less than 7p per pupil</a>.</p>
<p>Further analysis by think tank Education Datalab has found that if only half of pupils take up the free breakfast at a more realistic cost of 25p – though even this would <a href="http://schoolsweek.co.uk/conservatives-free-breakfast-pledge-costed-at-just-7p-per-meal/">only amount to porridge with milk</a> – it could cost <a href="https://educationdatalab.org.uk/2017/05/can-free-breakfasts-for-all-primary-pupils-really-be-delivered-for-60m/">more than £400m</a> when extra staffing costs are added in. </p>
<p>Before the financial disparity was highlighted, questions quickly arose over whether a free school breakfast for all children could be better than a free school lunch for some.</p>
<p>Reports warned that almost a million children from poor backgrounds could lose out under the new policy. And it could potentially cost families <a href="http://www.independent.co.uk/news/uk/home-news/theresa-may-conservatives-free-school-lunches-cuts-poverty-a7747066.html">£440 for each child affected</a> every year.</p>
<p>Not all children can, or want to, attend the breakfast clubs, however. Former deputy prime minister Nick Clegg, who was a <a href="https://www.gov.uk/government/news/free-school-lunch-for-every-child-in-infant-school">champion of the policy</a> when it was rolled out in 2014, <a href="http://www.independent.co.uk/news/uk/home-news/theresa-may-conservatives-free-school-lunches-cuts-poverty-a7747066.html">has warned that</a> “the offer of free breakfasts won’t reach the children who don’t come to breakfast clubs”.</p>
<h2>Questionable research</h2>
<p>Though the Conservatives have issued statements saying that breakfasts are “<a href="https://www.youtube.com/watch?v=nv8sQplhvX0">at least as effective as lunch</a>”, the data that they are relying on is simply not enough.</p>
<p>The manifesto pledge is backed by the findings of a pilot study: the <a href="https://educationendowmentfoundation.org.uk/our-work/projects/magic-breakfast">Magic Breakfast Project</a>. Year two and year six students in 106 English schools were allocated to receive free breakfast every day during the 2014-2015 academic year in the context of a breakfast club. There was also a control group, for whom breakfast was not provided. </p>
<p>The childrens’ academic achievement was measured by assessing Key Stages one and two assessments in maths and English, along with teachers’ feedback on class behaviour and concentration. The breakfasts were found to be successful in increasing the academic achievement of year two students and helping them to get two months ahead of their peers. Teachers also reported improved behaviour and concentration. </p>
<p>But there are a few problems here. While the Key Stage assessments might provide some unbiased information, behaviour and concentration was only assessed by teachers, who were likely to know whether the student attended the breakfast club. With most other literature reporting the positive effects of breakfast on students, this observation could well have been biased.</p>
<h2>Educational benefit</h2>
<p>In a very recent review of the academic research on the impact of <a href="http://onlinelibrary.wiley.com/doi/10.1111/jhn.12407/full">dietary intake on school performance</a>, it was found that most studies have looked at the effects of breakfast consumption on academic performance. </p>
<p>That doesn’t mean that breakfast aids academic achievement in school-aged children better than lunch. It means that there is more evidence from (mainly cross-sectional) breakfast studies.</p>
<p>Ideally, to compare the two, there would need to be randomised control trials with direct comparisons between different types of meal and educational outcomes – at present there are none. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/nv8sQplhvX0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Academic achievement is an important criterion, but it shouldn’t be the only one on which we measure the success of a school provision. For many children, their free school lunch may be the <a href="https://www.theguardian.com/society/2017/apr/24/school-holidays-leave-3-million-children-at-risk-of-hunger-report-says">only hot meal they have in a day</a>. It may also be the only opportunity they have to eat a nutritious meal, including vegetables to support the development of healthy eating habits, and protein to support physical development. </p>
<p>In short, lunchtime is one more lesson on healthy eating and on what a healthy meal should look like. </p>
<p>Although Theresa May pledged to keep free school lunches for the poorer students, the criteria that will be set are unclear and, considering a lot of poor students were <a href="https://www.childrenssociety.org.uk/sites/default/files/tcs/fair_and_square_policy_report_final.pdf">left out before the provision</a>, this is concerning. </p>
<p>But regardless of financial background, healthy eating is something every student should learn. This is about educating children to hopefully make healthier choices throughout their lives.</p>
<h2>Social skills</h2>
<p>The Magic Breakfast Project makes another very important point that was overlooked in the manifesto: it is not just eating breakfast that delivers improvements, but attending a breakfast club. </p>
<p>It might be the experience of communal eating itself, a time spent with their peers interacting in a non-academic environment, that explains the findings. Considering the Conservative Party is quoting <a href="https://www.theguardian.com/education/2017/may/24/theresa-may-free-school-breakfasts-undercosted-tory-manifesto">only 25% of children attend</a> breakfast clubs at present, a large proportion of students might miss the opportunity of the free meal and this experience of communal eating. On the contrary, school lunches are attended by all students, providing an equal opportunity to all.</p>
<p>There is not, at present, enough convincing evidence to switch from free school lunches for some children to free breakfasts for all. The financial costs alone are a cause for concern, but the ramifications it could have on teaching children to lead healthy lives are too great to ignore.</p><img src="https://counter.theconversation.com/content/77990/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophia Komninou does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lunchtime is one more lesson on what a healthy meal should look like.Sophia Komninou, Lecturer in Infant and Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/751402017-03-30T14:29:26Z2017-03-30T14:29:26ZSchool feeding schemes can fill children’s tummies and farmers’ pockets<figure><img src="https://images.theconversation.com/files/163267/original/image-20170330-15603-ops1k3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">School feeding schemes play a major role across Africa.</span> <span class="attribution"><span class="source">Reuters/Thomson Reuters Foundation</span></span></figcaption></figure><p>Every day, about <a href="http://reliefweb.int/report/world/school-meals-vital-ingredient-ending-hunger-and-promoting-healthy-diets">370 million children</a> worldwide benefit from national school feeding programmes. Sometimes it’s breakfast; sometimes it’s lunch and sometimes it’s both. But whatever the meal, school feeding schemes are a nutritional lifeline for these children.</p>
<p>It’s been proved <a href="https://www.ncbi.nlm.nih.gov/pubmed/21294742">repeatedly</a> that being fed at school improves children’s attendance and their academic performance. In Kenya, a breakfast programme increased school participation by 8.5% in a <a href="http://hgsf-global.org/en/bank/downloads/doc_details/334-hgsf-working-paper-4-food-provision-in-schools-in-low-and-middl">randomised control trial</a> of 25 pre-schools. School feeding schemes are also helping to greatly improve girls’ access to <a href="http://www.un.org/en/ecosoc/innovfair2011/docs/wfp.pdf">primary education</a>. During a recent research trip to Banu, a rural farming community in Ghana’s Sissala East District, I saw first hand how that country’s school feeding scheme is helping children.</p>
<p>The <a href="https://www.au.int/en/commission">African Union Commission</a> has recognised how important school meals are. In recent years, it’s added another leg to this: pushing the idea that the schemes should be “home grown”. This means that the food for these meals should be sourced from local farmers. </p>
<p>Celebrating the <a href="https://www.wfp.org/news/news-release/second-africa-day-school-feeding-celebrated-brazzaville-republic-congo">second Africa School Meals Day</a> in Congo Brazzaville on March 1 2017, the commission called on African governments to embrace homegrown school feeding. This involves local governments and education authorities buying food from farmers within beneficiary schools’ catchment areas. Getting local farmers involved in school feeding schemes has the potential to boost individuals’ livelihoods and revitalise rural economies in Africa.</p>
<p>A number of African countries – among them Kenya, Ghana and Nigeria – have already made a head start. But there are huge obstacles in the way of looping farmers in as part of the food chain. </p>
<h2>Small-scale farmers’ struggles</h2>
<p>Small-scale farmers – those who cultivate five or fewer acres of land – in Africa struggle to make ends meet. On their small plots they produce about<a href="https://mg.co.za/article/2014-06-19-smallholder-farming-the-surest-route-to-african-growth"> 80%</a> of the food that’s consumed in Africa. Yet, most live in <a href="http://www.africaprogresspanel.org/food-and-the-transformation-of-africa-getting-smallholders-connected-kofi-annan-and-sam-dryden-write-in-foreign-affairs/">poverty</a>. </p>
<p>One of the biggest problems they face is getting their produce to <a href="https://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/8376.pdf">market</a>. They are largely constrained by geography. Main market centres tend to be far away from rural areas and transport is not even, given the poor state of infrastructure.</p>
<p>As such, small-scale farmers have no choice but to rely on middlemen who tend to buy from them at lower prices than they’d earn at the markets themselves.</p>
<p>It’s this reality – the struggle of small-scale farmers to lift themselves and their families out of poverty – that’s prompted the AU and others to call for governments to stock their school feeding programmes with locally grown produce.</p>
<p>Such initiatives make sense on a number of levels. Governments save money since the food doesn’t have to be transported for long distances. School children benefit from familiar, locally grown nutritious food. And the farmers themselves can use their earnings to support their families or even reinvest into their farming businesses.</p>
<p>Brazil’s experience over the past few years suggests that homegrown school feeding programmes work. The South American nation has created strong linkages between school feeding schemes and small-scale farmers thanks to two initiatives: the <a href="http://documents.wfp.org/stellent/groups/public/documents/newsroom/wfp207419.pdf?_ga=1.248060999.1955371633.1486168309">National School Feeding Programme</a> and the <a href="http://www.ipc-undp.org/pub/IPCTechnicalPaper7.pdf">Food Acquisition Programme</a>. As of 2012 – the most recently collated data – some 67% of it <a href="http://www.ipc-undp.org/pub/IPCTechnicalPaper7.pdf">states and municipalities</a> were buying food produce from smallholder farmers for school feeding. </p>
<p>Inspired by the Brazilian experience, several African governments are integrating this pro-smallholder procurement model into their school feeding schemes. For instance, the <a href="http://www.fao.org/3/a-i4291e.pdf">Purchase from Africans for Africa</a> initiative is being piloted in five countries: Ethiopia, Malawi, Mozambique, Niger and Senegal. Results from the first phase of implementation revealed that about 37% of participating farmers’ <a href="http://paa-africa.org/2015/01/paa-africa-launches-report-on-the-first-phase-of-implementation/">produce</a> was bought to support school meals. </p>
<p>And in 2016 the Nigerian government launched a similar <a href="http://www.schoolsandhealth.org/News/Pages/Nigerian-Vice-President-launches-National-School-Feeding-Programme.aspx">campaign</a>.</p>
<p>But the continent has a long way to go to entrench a culture of homegrown school feeding schemes.</p>
<h2>Policy and governance</h2>
<p>So far, small-scale farmers’ participation in such schemes has been <a href="https://agriknowledge.org/downloads/5x21tf46t">low</a>. This is because the people running school feeding schemes are only being “encouraged” to buy from local farmers. There’s no contractual arrangement that outlines how much of a caterer’s food procurement budget ought to be spent on local purchases.</p>
<p>Another setback is the irregular disbursement of funds to caterers or schools for meal preparation. For example, in Ghana, caterers contracted to prepare school meals go for months without receiving payments for their <a href="https://www.ghanabusinessnews.com/2015/12/16/government-urged-to-address-delays-in-paying-school-feeding-caterers/">services</a>. This affects the quality of meals available to pupils. It can also be a disincentive for caterers to buy from small-scale farmers, who usually demand cash up front – which the caterers simply don’t have.</p>
<p>These concerns can be traced to the fact that most school feeding programmes don’t operate within set policy frameworks and aren’t governed by clear legislation. </p>
<p>The first step would be for national governments to formalise linkages between small-scale farmers and school feeding schemes. This would require governments to develop clear policy guidelines. </p>
<p>The recent launch of the <a href="http://reliefweb.int/report/world/home-grown-school-feeding-resource-framework-synopsis-march-2017">Home Grown School Feeding Resource Framework</a> by the UN World Food Programme and collaborating agencies is encouraging. Beyond this, platforms for facilitating country peer-learning and sharing best practice both regionally and globally are crucial. Research also has a role to play so that governments can learn from what works and what doesn’t. </p>
<p>All of this work can inform national governments and development partners to work towards more effective, homegrown school feeding schemes.</p><img src="https://counter.theconversation.com/content/75140/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clement Mensah does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Getting local farmers involved in school feeding schemes has the potential to boost livelihoods and revitalise rural economies in Africa.Clement Mensah, PhD Candidate in Development Studies, Institute for Social Development, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/747942017-03-22T14:02:23Z2017-03-22T14:02:23Z26 years ago the UK signed up to formula milk advertising rules – so why isn’t it law yet?<figure><img src="https://images.theconversation.com/files/162007/original/image-20170322-31219-f4re2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protecting children's health starts with curbing formula adverts.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-bottle-boxes-infant-milk-381680932?src=Uvjq01ckbdCdF9iK97Gd8A-1-3">Kacenki/Shutterstock</a></span></figcaption></figure><p>Like the <a href="https://theconversation.com/mothers-are-made-to-feel-guilty-whether-they-breastfeed-or-formula-feed-their-baby-66101">topic of infant feeding</a> itself, public health bills can be a minefield. For each issue, there can be numerous pros, cons and opinions. And much like the debates that follow them, it is quite often that some go undiscussed by the mainstream media.</p>
<p>Ask any mum or dad and they will tell you that parenting media in the UK is <a href="http://www.telegraph.co.uk/women/mother-tongue/11697178/Breastfeeding-Formula-industry-has-hijacked-breastfeeding-for-profit.html">flooded with</a> potentially <a href="http://www.dailymail.co.uk/health/article-1201307/Formula-milk-ad-banned-misleading-parents-immunity-boosting-claims.html">misleading</a> advertising for <a href="https://hansard.parliament.uk/commons/2016-11-16/debates/552A05C8-5D1C-4BDB-BB2A-03C37A034DD4/FeedingProductsForBabiesAndChildren(AdvertisingAndPromotion)">certain formula products</a>. </p>
<p>Many global health organisations state that babies should be breastfed <a href="http://www.who.int/nutrition/topics/global_strategy_iycf/en/">exclusively for the first six months</a> of their lives. But for some mums that is not possible, either for their own health or other personal reasons. These mothers instead turn to “first infant formula” – for babies up to six months old – to feed their children.</p>
<p>The problem is that though the NHS tells mothers that babies who are fed first infant formula need <a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/types-of-infant-formula.aspx">nothing more than that</a>, there is still a wide range of “follow on” formulas available for babies over six months old. The health service has a clear stance that this <a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/types-of-infant-formula.aspx">variety is unnecessary</a>, saying outright that there is “<a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/types-of-infant-formula.aspx">no evidence</a>” that formulas marketed for “hungrier babies” make them sleep longer, for example.</p>
<p>So why do manufacturers make these products, and advertise their “health benefits” if children don’t need them? The current UK rules are that though follow-on formula milk can be promoted, manufacturers and sellers are <a href="http://www.legislation.gov.uk/uksi/2007/3521/contents/made">banned from advertising</a> “first infant formula”. <a href="http://www.babymilkaction.org/">Baby Milk Action</a>, the UK member of the <a href="http://www.ibfan.org/">Intentional Baby Food Action Network (IBFAN)</a>, has <a href="http://www.babymilkaction.org/ukrules-pt2a">highlighted</a> that these adverts encourage brand recognition and cross-promote products, including infant formula intended for use by newborns.</p>
<p>The UK government does not proactively monitor formula advertising for breaches, so infant formula companies, who profit when women do not breastfeed, regularly undermine breastfeeding by <a href="http://www.babymilkaction.org/monitoringuk17">breaching the code</a>. Price promotions and prominent displays have been placed at the point of sale, and advertisements and promotions suggest that infant formula <a href="http://www.which.co.uk/reviews/formula-milk/article/choosing-the-right-formula-milk/breastfeeding-vs-formula-milk">is comparable to breast milk</a> in terms of health and development. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Supermarket aisles are stocked with formula options.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/toronto-canada-november-22-2014-baby-233666974?src=hu8qAJf1-RvRrOM0ZROsXw-1-6">ValeStock/Shutterstock</a></span>
</figcaption>
</figure>
<p>There are now moves to change this, however. The <a href="http://services.parliament.uk/bills/2016-17/feedingproductsforbabiesandchildrenadvertisingandpromotion.html">Feeding Products for Babies and Children (Advertising and Promotion) Bill</a> passed through parliament <a href="http://www.bbc.co.uk/news/uk-scotland-scotland-politics-38000569">on its first reading</a> with unanimous support in November 2016 – though as yet it has not attracted the public attention that it should have. </p>
<p>If enacted, the bill would provide important provisions to protect the health of babies and children from corporate advertising, which the World Health Organisation <a href="http://www.who.int/nutrition/topics/global_strategy_iycf/en/">identifies as a priority</a> for improving child health. It would bring into UK law <a href="http://www.who.int/nutrition/publications/code_english.pdf">WHO provisions</a> on the marketing of infant formula which have been in place since 1981. Though the country is signed up to the code, until this bill arrived the government had not <a href="http://apps.who.int/iris/bitstream/10665/206008/1/9789241565325_eng.pdf">fully legislated to implement it</a>.</p>
<p>The WHO code includes a ban on the promotion of formula, including through advertising, gifts directed towards mothers and health professionals, and at the point of sale. It also provides detailed guidance on appropriate packaging, for example restricting nutritional and health claims and images which idealise formula use. </p>
<h2>The follow-on fallacy</h2>
<p>The Formula Marketing Bill has long been needed, and is of vital importance to ensuring the health of both babies and mothers. However, 26 years after the WHO code was signed by the UK, it has taken a <a href="https://hansard.parliament.uk/commons/2016-11-16/debates/552A05C8-5D1C-4BDB-BB2A-03C37A034DD4/FeedingProductsForBabiesAndChildren(AdvertisingAndPromotion)">private members’ bill</a> to put this issue on parliament’s agenda – and even then its second reading has been delayed by a month already.</p>
<p>The provisions of the bill seek to establish a new infant and young child nutrition agency which would ensure that infant formula and packaging was regulated to optimise child health. This includes licensing feeding products suitable for children aged under 36 months, to prevent unnecessary ingredients being added, and to ensure that packaging does not undermine breastfeeding. Those who breach the law by selling unlicensed products could be fined or imprisoned for up to six months.</p>
<p>Other important clauses include one that would allow plain packaging of infant formula, and ban terms that <a href="http://www.babymilkaction.org/monitoringuk17">can confuse parents</a>, such as “follow-on milk”. These steps will help parents understand that the legally required recipe for infant formula results in minimal variation between brands, saving them money, and protecting them from unverifiable claims. Alongside this, the bill also seeks to comprehensively restrict other types of advertising and promotion of feeding products for babies and infants – for example, by restricting formula industry social media, parenting clubs and classes, and helplines.</p>
<p>We need to stop wasting time and make this bill law.</p><img src="https://counter.theconversation.com/content/74794/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aimee Grant receives funding from the National Institute for Health Research, the Wellcome Trust ISSF Public Health Scheme and the Welsh Crucible Small Grant Scheme. She has also undertaken paid consultancy for Public Health Wales NHS Trust, where she previously held the role of Senior Health Promotion Practitioner. She is affiliated with the Action on Smoking and Health (ASH) Wales Cymru research committee, where she previously held the role of Research and Policy Officer.</span></em></p>Parents need to know the truth about formula milk.Aimee Grant, Research Associate - infant feeding, smoking, stigma, class, identity, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/713712017-01-20T11:35:35Z2017-01-20T11:35:35ZBribing kids to eat vegetables is not sustainable – here’s what to do instead<figure><img src="https://images.theconversation.com/files/153579/original/image-20170120-5221-mabdha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cash for veg.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-on-money-piggy-bank-purchases-249406468?src=aCAC0rFZrwWho9KMNYipkg-1-36">www.shutterstock.com/Alliance</a></span></figcaption></figure><p>How can you get a fussy child to eat vegetables? It’s a question that plagues many frustrated parents at countless mealtimes. Some take to hiding morsels in more delicious parts of meals, while others adopt a stricter approach, refusing to let little ones leave the table until plates are clear.</p>
<p>One “alternative” idea touted recently is for parents to essentially bribe their children, depositing <a href="http://www.dailymail.co.uk/health/article-4123130/Bribery-works-paying-children-money-eat-greens-halt-obesity-crisis.html#ixzz4VuRSkR7t">money into a child’s bank account as a reward</a> when they eat vegetables – an idea actually backed up by research. </p>
<p>A US study in 2016 showed that the technique continued to encourage primary school age children to eat their greens for up to <a href="http://www.sciencedirect.com/science/article/pii/S0167629615001368">two months after these incentives were stopped</a>. Children who were incentivised for a longer period of time were more likely to continue eating vegetables after the deposits ended too. </p>
<p>The core idea here is that, providing children have the cognitive ability to understand the exchange, they will learn to eat healthily as well as learn the value of money. After a while, they will continue eating the food, not because of the reward, but because they will get into the habit of eating healthy. </p>
<p>But one study is really not enough to draw conclusions and suggest action – especially as there was not a control group to compare money with other types of incentives, or no incentive at all. </p>
<p>And monetary incentives can actually <a href="http://psycnet.apa.org/psycinfo/1971-22190-001">decrease our motivation</a> to perform the activity we are paid for, and eventually we lose interest. So, even if bribing kids with cash to eat their greens works at first, it is not sustainable in the long term. </p>
<p>Non-monetary rewards aren’t much better either. The phrase: “You can have dessert as long as you eat your sprouts”, will ring a bell for most people. This, though said with the best intentions, may increase the intake of the target food in the short term, but can convey the wrong message to its receipents: “This food must be really bad if I am getting something for eating it!”. It not only places dessert as a food of high value – a trophy that is earned – but also teaches kids to dislike the target food.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/153584/original/image-20170120-5214-3hid9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/153584/original/image-20170120-5214-3hid9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/153584/original/image-20170120-5214-3hid9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/153584/original/image-20170120-5214-3hid9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/153584/original/image-20170120-5214-3hid9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/153584/original/image-20170120-5214-3hid9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/153584/original/image-20170120-5214-3hid9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A familiar sight for many parents.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-girl-expression-disgust-against-vegetables-253719919">www.shutterstock.com/Oksana Kuzmina</a></span>
</figcaption>
</figure>
<h2>Better methods</h2>
<p>So what can you do instead? First and foremost, start early. Formation of food preferences <a href="https://www.theguardian.com/lifeandstyle/wordofmouth/2014/apr/08/child-food-preferences-womb-pregnancy-foetus-taste-flavours">start in the womb</a>, and the first months of life are crucial in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678872/">developing eating habits</a>. The older children get, the more exposures they need to a novel vegetable <a href="http://psycnet.apa.org/psycinfo/1990-27964-001">in order to consume it</a>. Which brings us neatly to the next point.</p>
<p>Vegetables must be offered frequently, without pressure – and you mustn’t get discouraged by the inevitable “no”. Even if you have missed the first window of opportunity, all is not lost. Parents can lose hope after offering the same vegetables between three and five times, but, in reality, toddlers in particular <a href="https://www.ncbi.nlm.nih.gov/pubmed/14702019">might need up to 15 exposures</a>. </p>
<p>You also need to let your children experience the food with all of their senses – so don’t “hide” vegetables. Yes, sneaking a nutritious veggie into a fussy eater’s food might be one way to get them to eat it, but if the child doesn’t know a cake has courgettes in it, they will never eat courgettes on their own. It can also backfire if children can lose their trust in food when they realise they have been deceived. </p>
<p>Likewise, don’t draw unnecessary attention to specific foods that you might think your child is not going to like. Sometimes our own dislikes get in the way, and create the expectation that our child is not going to like it either. Our food preferences are <a href="https://thepsychologist.bps.org.uk/volume-22/edition-7/factors-food-choice">formed through previous experiences</a>, which children don’t have. <a href="http://www.sarahremmer.com/praising-at-meals-why-it-may-hinder-rather-than-help/">Praising and bribing are commonly used</a>, especially when we don’t expect children to like the food offered, but it can be counterproductive. Instead, serve food in a positive environment but keep your reactions neutral. </p>
<p>This isn’t just about what is on the plate, it’s about a relationship with food. So if your children are old enough, let them help in the kitchen. It can be very messy and time consuming, but it is an excellent way to create a positive atmosphere around food. </p>
<p>It is also important to have frequent family meals and consume vegetables yourself. It’s been shown that children who eat with family do <a href="https://www.ncbi.nlm.nih.gov/pubmed/21272701">eat more vegetables</a>. Kids often copy adult behaviours, so set a good example by routinely serving and consuming vegetables.</p>
<p>There is sadly no single answer as to what will work for your children, and it might be a case of trial and error. But these actions can create positive associations with all kinds of foods, and you can help your kids lead healthier lives – saving yourself a bit of cash while you’re at it.</p><img src="https://counter.theconversation.com/content/71371/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophia Komninou does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Here are some tips to get your picky eater into lifelong healthy habits.Sophia Komninou, Lecturer in Infant and Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/641782016-08-19T15:12:46Z2016-08-19T15:12:46ZChildhood obesity plan forgets about babies and toddlers<figure><img src="https://images.theconversation.com/files/134797/original/image-20160819-30400-15id86i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Childhood obesity can be tackled from birth – so why aren't we doing anything about it?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-311142566/stock-photo-adorable-baby-boy-with-a-measuring-tape.html?src=iYkSkHv8UN0TDcR27albvw-1-45">Shutterstock/DementivaJulia</a></span></figcaption></figure><p>The British government’s long-awaited <a href="https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action">childhood obesity plan</a> has finally been published. Touted as a proposal to “significantly reduce childhood obesity by supporting healthier choices”, it includes measures such as a soft drinks tax, a new healthy rating scale for schools, and daily hour-long activity in the curriculum to curb obesity over the next ten years. </p>
<p>The plan was immediately met with criticism and horror from several corners. The Guardian deemed it <a href="http://www.theguardian.com/politics/2016/aug/18/former-ministers-attack-massive-damp-squib-childhood-obesity-plan">a “massive damp squib”</a>, the BBC criticised it as being <a href="http://www.bbc.co.uk/news/health-37108767">“weak and watered down”</a>, while sugar tax warrior Jamie Oliver said the plans were <a href="http://www.huffingtonpost.co.uk/entry/jamie-oliver-child-obesity_uk_57b555f7e4b0c5667a06f585">“underwhelming and disappointing”</a>.</p>
<p>Overall the strategy did not go far enough with measures: it only placed a sugar tax on soft drinks, for example, rather than all sugar-laden foods. The government also failed to restrict junk food advertising – apparently because Prime Minister Teresa May believes the economy is <a href="http://www.thetimes.co.uk/article/may-rips-up-plans-for-junk-food-crackdown-35skq6fxw">more important than our health right now</a>. In addition, there is an over-reliance on voluntary action rather than legislation.</p>
<p>While these omissions are serious, what is particularly concerning is that the government appear to have completely ignored an entire critical period when children’s weight gain patterns, eating habits and even taste preferences are developed: pregnancy and the first years of life.</p>
<h2>Early eating</h2>
<p>The government plan focuses predominantly on school-aged children, but a quarter of children aged two to five-years-old are overweight or obese <a href="http://adc.bmj.com/content/early/2015/01/07/archdischild-2014-307151.short?g=w_adc_ahead_tab">before they even start education</a>. Their weight is not simply due to genetics either: the number of overweight children has doubled in the last 20 years at a rate far exceeding genetic mutation. </p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1552-6909.2007.00181.x/full">Copious research</a> has shown that the early years of life are a critical period for the development of healthy eating habits and weight. Maternal obesity and excessive weight gain during pregnancy have been linked to increasing <a href="https://www.noo.org.uk/NOO_about_obesity/maternal_obesity_2015/child_outcomes">the risk of childhood obesity by two to three times</a>. </p>
<p>In fact, food preferences <a href="https://www.theguardian.com/lifeandstyle/wordofmouth/2014/apr/08/child-food-preferences-womb-pregnancy-foetus-taste-flavours">begin in the womb</a>: babies are exposed to their mother’s food as the aminotic fluid gets flavoured with the taste of it. Preferences for vegetables can be developed in the womb, but a pregnancy diet high in junk food may <a href="http://www.fasebj.org/content/27/3/1275.long">prime the brain</a> to want more of these foods. </p>
<p>Breastfeeding is also critical to healthy weight development, and the longer and more exclusive the better. Meta analyses suggest that for each month a baby is breastfed the <a href="http://www.ncbi.nlm.nih.gov/pubmed/16076830">risk of obesity falls by 4%</a>. The reasons for this are <a href="http://abm.me.uk/wp-content/uploads/2011/07/summer-2011-feature-article.pdf">multifaceted</a>: formula-fed babies consume a greater volume of milk; formula milk is too high in protein; and bottle-fed babies have less control over the amount they consume, as parents worry about them finishing all the milk in their bottle. </p>
<p>Introduction to solid foods is also important. Doing it too early can <a href="http://pediatrics.aappublications.org/content/127/3/e544.short">increase the risk of obesity</a>, as babies may consume more calories and protein overall. What foods babies eat also matters. Many parents rely on ready made baby foods but these are often <a href="http://onlinelibrary.wiley.com/store/10.1111/mcn.12208/asset/mcn12208.pdf?v=1&t=is1my5da&s=df47d040240f30924177f60ebb20611da63129ce">predominantly based on sweet tastes</a>, emphasising sugar intake, and are often <a href="http://adc.bmj.com/content/98/10/793.short">lower in nutrients</a>) than many home-cooked meals. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/134798/original/image-20160819-30393-gtr25y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134798/original/image-20160819-30393-gtr25y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134798/original/image-20160819-30393-gtr25y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134798/original/image-20160819-30393-gtr25y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134798/original/image-20160819-30393-gtr25y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134798/original/image-20160819-30393-gtr25y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134798/original/image-20160819-30393-gtr25y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parents can play a proactive role in preventing obesity from a very young age.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-14501131/stock-photo-mother-feeding-baby-food-to-baby.html?src=_7B-N32oCAbKPGLz0qei8Q-2-0">Shutterstock/Monkey Business Images</a></span>
</figcaption>
</figure>
<p>Whatever milk or food a baby receives, the feeding environment is also critical to developing positive relationships with food. So critical in fact that the World Health Organisation <a href="http://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf">flags responsive feeding</a> – where babies are allowed to set the pace of their meal and enjoy and explore food under their own control – as central to developing good eating habits for life. Indeed, babies who are fed responsively during weaning have better appetite control and <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.2047-6310.2013.00207.x/full">eat a wider range of foods as toddlers</a>. </p>
<p>So why are these early influences so starkly missing from the government’s plan? It’s not as if the UK already has excellent early feeding outcomes. Half of women are <a href="http://www.telegraph.co.uk/news/12181610/Half-of-pregnant-women-attending-their-first-maternity-appointment-are-overweight-or-obese.html">overweight during pregnancy</a>, we have the <a href="http://www.bbc.co.uk/news/health-35438049">lowest breastfeeding rates in the world</a> and three-quarters of babies are <a href="http://digital.nhs.uk/catalogue/PUB08694/ifs-uk-2010-sum.pdf">introduced to solids before they are five months old</a>. Clearly, education, support and investment are desperately needed in these areas </p>
<p>Was it an omission? A political play? Or another example of preference to the economy over health? The government’s already established Change4life campaign aimed at promoting healthy behaviours is heavily <a href="http://info.babymilkaction.org/change4life">funded by formula and baby food companies</a>, despite the known link between formula, early solids and obesity.</p>
<p>If the government had simply looked westwards from Westminster, it would have seen that the Welsh government has already <a href="http://www.wales.nhs.uk/sitesplus/888/news/40753">developed a programme</a> that is far more on target than this narrow national plan. Six of the <a href="http://www.wales.nhs.uk/sitesplus/888/news/40753">“ten steps to a healthy weight”</a> cover preconception, pregnancy and the baby and toddler years, aimed at helping children grow up healthily from day one. </p>
<p>Sadly, the UK-wide plan starts far too late in life, and fails to invest in early prevention. Sticking a plaster over the problem won’t suffice, we need a plan, and investment behind it, which addresses childhood obesity before it becomes an even more life-threatening problem.</p><img src="https://counter.theconversation.com/content/64178/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the Economic and Social Research Council</span></em></p>To combat childhood obesity, we need to start from day one.Amy Brown, Associate Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/608752016-06-22T14:25:28Z2016-06-22T14:25:28ZGhana’s school feeding scheme is slowly changing children’s lives<figure><img src="https://images.theconversation.com/files/126731/original/image-20160615-14057-15cyyi1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children struggle to learn when they're hungry.</span> <span class="attribution"><span class="source">Reuters/Bruno Domingos </span></span></figcaption></figure><p>Millions of Ghanaian children <a href="http://uni.cf/1UOReAB">live in poverty</a>. About one in ten – roughly 1.27 million – come from households that are so poor they <a href="http://uni.cf/1UOReAB">can’t afford</a> the amount and type of food that’s needed to stave off malnutrition. </p>
<p>Without proper food, children are prone to stunted growth or are underweight for their age. And their schooling suffers, too: <a href="http://unesdoc.unesco.org/images/0014/001429/142929eo.pdf">research</a> has <a href="http://unesdoc.unesco.org/images/0017/001780/178022e.pdf">repeatedly shown</a> that children struggle to learn when they are not properly fed and nourished. </p>
<p>A school feeding programme introduced by the Ghanaian government more than a decade ago has gone some way to tackling the problem of hunger. The programme has reached millions of children – and it’s been proved to keep them in school far longer than their hungry peers. Now some more work is needed to make the project sustainable and to ensure it doesn’t constantly have to rely on donor funds.</p>
<h2>Millions of children reached</h2>
<p>The <a href="http://www.schoolfeeding.gov.gh/">Ghana School Feeding Programme</a> was initiated in 2005 by the country’s government in collaboration with the Dutch government. Its primary objectives are to increase school enrolment, attendance and retention among children in kindergartens and primary schools. It also, of course, aims to reduce hunger and malnutrition. </p>
<p>The programme started as a pilot project with ten schools, one from each of Ghana’s ten regions. This was later increased to 298 schools, reaching about 234,000 children in 138 schooling districts. In March 2016, it was reaching more than 1.7 million children every day – about 30% of all Ghanaian primary and kindergarten pupils.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/126476/original/image-20160614-29216-1wo1pma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/126476/original/image-20160614-29216-1wo1pma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/126476/original/image-20160614-29216-1wo1pma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126476/original/image-20160614-29216-1wo1pma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126476/original/image-20160614-29216-1wo1pma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126476/original/image-20160614-29216-1wo1pma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126476/original/image-20160614-29216-1wo1pma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126476/original/image-20160614-29216-1wo1pma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children line up for a meal at their school in Ghana.</span>
<span class="attribution"><span class="source">Supplied</span></span>
</figcaption>
</figure>
<p>Each day, children receive a hot, nutritious meal. This is made up of locally produced foods like rice, dried African locust bean seeds, African carp and sesame leaves, and of fortified food rations supplied by the World Food Programme. The rations include 150g of fortified corn-soy blend, 3g of iodised salt and 10g of palm oil per child per day.</p>
<p>There is also a second feeding category: girls in selected schools in Ghana’s three northern regions are <a href="https://www.wfp.org/stories/ghana-girls-reach-their-full-potential-take-home-rations">given</a> food to take home each time they attend school for 85% of the month. This food <a href="https://www.wfp.org/stories/ghana-girls-reach-their-full-potential-take-home-rations">includes</a> rice, maize, vegetable oil and iodised salt.</p>
<p>The ration programme for girls started in 1999 and has been gradually absorbed into the bigger school feeding programme. It has yielded remarkable results: girls’ enrolment in these selected schools has <a href="https://www.ghanabusinessnews.com/2016/03/04/world-food-programme-to-support-school-feeding-programme/">grown</a> from 9,000 to 42,000 between 1999 and 2016. Retention rates have doubled to 99%. This scheme is essential in tackling gender disparity in education, particularly in northern Ghana’s food-insecure and deprived communities where girls’ education is <a href="https://www.modernghana.com/news/399838/50-northern-region-girls-receive-wfpges-scholarships.html">not often prioritised</a> by families. </p>
<p>Sadly the ration programme for girls is being slowly <a href="http://documents.wfp.org/stellent/groups/public/documents/newsroom/wfp207421.pdf">phased out</a> – its managers believe their work is done given the huge spike in retention rates. Now the focus will be entirely on the bigger school feeding scheme, which has also been very successful. It has, according to my <a href="http://www.equityforchildren.org/wp-content/uploads/2016/05/Abuja-PaperCompendium.pdf">own research</a>:</p>
<ul>
<li>increased school enrolment by 20%;</li>
<li>reduced truancy and absenteeism;</li>
<li>lowered school drop-out rates; and</li>
<li>improved individual academic performance and the participating schools’ overall performance too.</li>
</ul>
<p>These are all excellent, positive results. But there’s still work to be done. </p>
<h2>Plotting the next steps</h2>
<p>One of the biggest problems facing the programme is a lack of funding. It cannot be rolled out more widely because there just isn’t enough money.</p>
<p>Schools that aren’t currently part of the programme are struggling. A survey conducted in Ghana’s Sekyere Kumawu district found that non-beneficiary schools were actually losing pupils. The same study <a href="http://jcss.our.dmu.ac.uk/files/2013/03/JCSS-Ghana-School-Feeding-Winter-2015.pdf">revealed</a> that pupils were switching to the schools that offer the scheme in order to receive the benefits. </p>
<p>The government and stakeholders need to put mechanisms in place that will strengthen the existing programme, allow it to expand into other schools and make it sustainable. The government must wean the programme of its reliance on donor funds. It can learn here from the experiences of South Africa’s national school feeding programme, which is funded by the country’s National Treasury. This approach ensures that the government takes ownership of the programme and plans for its sustainability.</p>
<p>Policy will be important: the programme falls under Ghana’s National Social Protection Strategy, but should be bolstered with a strong legal and policy framework that clearly maps the way forward. This legislation should delineate the guidelines for implementation and institutional mechanisms to make sure the programme delivers what is necessary.</p>
<p>Finally, a robust monitoring and evaluation framework will be needed to ensure that the programme’s organisers learn from their failures and successes. This way adjustments can be made along the way so that Ghana’s children can keep getting the meals they need at school.</p><img src="https://counter.theconversation.com/content/60875/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Addaney does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ghana’s school feeding programme has reached millions of children in the past 11 years. It does important work, but needs more support to grow and become sustainable.Michael Addaney, Assistant Researcher at the Quality Assurance and Planning Unit, University of Energy and Natural ResourcesLicensed as Creative Commons – attribution, no derivatives.