Home cooked food isn`t what it used to be

However, families have changed beyond all recognition since then. Families may often only contain one adult, Mum is more likely to be wearing a business suit than a pinny and eating round the television rather than the table has become the norm. As Healthcare Professionals we have often assumed that a home cooked meal is going to provide good nutrition for the children and families in our care. However, as our society continues to change so much, does that still apply?

How things were¹
In the 1950s family diets contained more bread, vegetables and milk than children eat today; but were also higher in fat. Food was a major part of most families’ spending, taking up about a third of the average income, with people eating food that was in season. During the 1960s, people started taking package holidays, leading to demand for dishes such as Spaghetti Bolognese. Also, the gradual growth of Indian and Chinese takeaways and restaurants helped to develop the taste for more exotic food. Tinned foods continued to be the most common convenience foods; however frozen foods began to be popular. From the 1970s vegetable consumption started to fall, despite the availability of frozen vegetables increasing. Red meat was still popular, with the average person consuming almost twice the amounts today. Spending on food was down to about a quarter of the average family’s income. The 1980s saw a significant growth in the number of women who worked outside the home, leading to a demand for meals that were easy and quick to prepare, helped by the development of microwaves and cook-chill technology. People became more health conscious and foods such as pasta became popular. Produce became extremely varied in the 1990s, with supermarkets stocking a much wider range of exotic fruits and vegetables, but also more processed foods and snacks. More food was eaten as snacks on the move, leading to increasing numbers of fast food outlets. The market for prepared foods grew, with chilled ready-prepared meals overtaking frozen varieties. Conversely, sales of raw ingredients for cooking fell. By 2000, food and drink had fallen to less than a fifth of average household spending². Ironically, as people became less inclined to spend time preparing food, the phenomenon of the celebrity chef arrived, spawning television programmes and best selling cookbooks. For more information on historical trends in eating see: www.eatwell.gov.uk/healthydiet/ seasonsandcelebrations/howweusedtoeat

Where are we now?
Two government surveys^3,4 provide an insight into current trends. More than half of people prepare at least one meal from scratch every day and almost three quarters eat a meal together at least once a day, both upward trends. However, another survey⁵ found that of those who prepare a meal, only a third would cook from scratch, just over half would use a cooking sauce or paste and the rest would prepare a light meal such as beans on toast instead. This suggests that families increasingly tend to ‘assemble’ rather than prepare a meal. More than 50% of people eat ready meals regularly or occasionally, while over two thirds eat other convenience foods. Almost half of respondents claim to be eating more fruit and vegetables; although this isn’t borne out by consumption figures⁴. The number of people looking for the level of salt in products is increasing³ and there is a downward trend in consumption⁴; although it is unclear whether this is due to a change in eating behaviour, changes in manufacturing processes or both. Interest in food labelling is increasing, with more people now looking specifically at nutrition information³. This suggests that there is a general desire to know more about food.

Relatively little research has been conducted into the diets of infants and toddlers. The Infant Feeding Surveys provide the most comprehensive information on weaning diets. The results of the 2005 survey have been published, but this does not include weaning information. The previous survey⁶ found that babies under six months were more likely to have manufactured baby foods than home made foods. By nine months, about half receive commercial baby food. Babies under six months are most commonly given home made fruit and vegetable purées, with only one in twenty families offering meat. This is of concern because, although important in the diet, fruit and vegetables are low in calories, protein and iron, all important components of the weaning diet⁷. By nine months, a much higher proportion of babies received home made food. Unfortunately – particularly given the high intakes in younger babies - only about half of the babies were given vegetables and fruit every day. However, the majority of mothers gave their children starchy foods and around three quarters dairy foods every day, but only a third gave their baby meat every day. High iron foods should be given to babies and toddlers every day, to protect against the problems with growth and development that can result from iron deficiency anaemia. As meat is the best source of iron, this should form a daily part of the diet; other important sources are iron fortified cereals and infant or follow-on formulas. For vegetarians, beans and pulses – with a source of Vitamin C such as fruit and vegetables, to aid iron absorption - are good alternatives. Currently, at least 1 in 8 toddlers are anaemic by the time they reach their second year and this rises to 40 percent in some deprived communities⁸. Iron deficiency anaemia is particularly common in Asian communities, where weaning is often delayed, cows’ milk is more often started early and there can be overdependence on baby puddings; particularly as savoury jars may not be suitable for religious reasons. Also in Asian – as well as Afro Caribbean and Middle Eastern communities – rickets is still a problem⁹. This is linked to prolonged breastfeeding and inadequate weaning¹⁰. It is particularly important that parents from these groups are given appropriate advice on weaning diet and vitamin supplementation. Department of Health guidelines recommend that any infant not receiving 500mls of infant formula should have a vitamin supplement containing Vitamin D from six months. At-risk breastfed infants are recommended to receive supplements from one month. Pregnant and breastfeeding mothers from at-risk groups should also receive supplementation.

For toddlers, the last government survey was undertaken in 1995¹¹. Although consumption may have altered to some extent during this time, it still provides useful information. Cereals and cereal products made up approximately a quarter of daily calories, with a further twenty percent being provided by milk and milk products. Almost three quarters of the children ate white bread, biscuits, whole milk, soft drinks, crisps, chocolate and chips in the study period. In contrast, peas and carrots were the only vegetables and apples and pears were the only fruit eaten by more than half of children; less than a quarter ate raw vegetables, salad or citrus fruit. Children’s diets contained fifty percent more saturated fat and twice as much sugar compared with recommendations. Although toddlers’ diets are not supposed to be low fat, giving some unsaturated fat as well as the saturated fat found in important foods such as meat and milk provides a good balance. Sugar provides little in the way of nutrition and can be detrimental to dental health. High intakes of juice drinks can lead to what has been described as ‘squash drinking syndrome’¹² which can include lethargy, irritability and faltering growth. Also of concern is that children were eating almost twice the recommended amount of salt each day.

Table 1 – Food Groups

A more recent survey¹³ of toddlers found that although over half of parents responded that they would always ensure that their child ate a nutritionally balanced diet, only 16% cooked food from fresh ingredients most of the time; this was even lower for mothers on low incomes. Over eighty percent of parents claimed that their children ate fresh fruit every day, although this fell with age. More worryingly, children were given processed meat and fish products (such as chicken nuggets, fish fingers, etc) almost as often as fresh foods and younger mothers gave more processed than fresh versions. This is of concern, as processed foods have a fixed, often high content of ingredients such as fat and salt, taking away any parental control of the amounts they are eating. Despite this, parents reported that nutritional value was their top priority in choosing foods. However, by three years of age, what the child liked was as important to parents as nutrition. In most cases, parents said that the toddler ate their main meal with the rest of the family and this increased with age.

Anecdotally, there does seem to be a tendency for parents to make assumptions about what their children will eat. There seem to be many families who feed their babies manufactured baby food and move straight on to ‘children’s food’; all breaded products and the notorious ‘smiley faces’. This is of course, magnified if families don’t eat together – there is a temptation for parents to opt for a simple, well accepted frozen option for the children if they are going to be preparing food again later for themselves. Children learn by example and seeing others eat foods means they are more likely to attempt them. During the first year of life, babies are more open to trying new flavours and this should be exploited to the full as during the second year they become ‘neophobic’; unwilling to try new flavours (see previous article `Fussy eaters; both born and made`). The more variety is in the diet, the more likely it is to be nutritionally adequate; the wider the initial food choices, the more foods are likely to remain during the fussy toddler stage.

So what can we do?
The trends described above are a worry, but conversely not a surprise given the sharp increases in childhood obesity^14,15. If the trends are to be reversed, families need to understand that the food they feed their children can have health and emotional consequences for their children. Even during childhood, obesity is linked with problems such as Type II diabetes, high blood pressure, high cholesterol, orthopaedic problems and exacerbation of asthma^16,17. Additionally, overweight children tend to suffer from higher rates of low self esteem and bullying. Good eating habits should start from weaning and be adopted throughout the family if they are going to become established.

• From around six months, babies need food from all the food groups every day split over three meals, with savoury courses and puddings in the middle of the day and in the evening (see Table 1). This can be from bought foods or home made foods, but it is advisable that parents give some home made foods from the start.
• Parents need to understand the nutritional superiority of unprocessed foods (in terms of fat and salt content) eg chicken breast vs chicken nugget, pork chop vs pork sausage etc for their babies and toddlers and as far as possible choose manufactured foods from proprietary ranges of baby and infant foods which have been made to strict guidelines.
• Encourage families from other cultures to give babies family foods. Mild spices such as cumin, coriander and cardamom are entirely suitable in the weaning diet and to be encouraged. It is all too common to see toddlers from families where curry and chapatti or rice is the norm only eating foods such as fish fingers and chips.
• Give particular attention to breastfeeding mothers and their infants from ethnic minorities, ensuring they receive appropriate advice on Vitamin D supplementation and on timely, nutritionally adequate weaning.
• By a year babies should be having three meals and two to three snacks a day (see Table 2).
• Ensure that families give breastfeeds or infant formula (or follow-on formula) until at least the age of one, longer if food intake is sub-optimal. If infant formula is used after 12 months a growing up formula is recommended.
• Suggest healthy alternatives to snacks such as crisps, biscuits and confectionery (see Table 2).
• Find out from families about their own cooking skills as well as the equipment and environment they have available for food preparation (see Table 3). Advise on locally available cooking equipment and on meals that can be prepared using minimum facilities.
• Give parents ideas for simple home made meals – and consider running cook and eat sessions so that parents can feel confident not only that they can prepare the meal, but that their children will eat it! For families on a low income this is extremely important as they cannot afford to waste food.
• Team up with other community professionals eg community Dietitians, health promotion, Sure Start, Community Food Co-ops etc to provide healthy food initiatives to improve access to, and uptake of, healthy food.
• Give priority to food and eating in consultations – with the myriad of other subjects that need to be covered it is easy for nutrition to be overlooked; parents are more likely to see it is important if it is given a high profile by professionals.
• Parents from across the social spectrum need guidance and support on appropriate foods to feed their infants and toddlers, given that it is becoming so much less common across society to cook meals from basic ingredients.

Finally – and most importantly – encourage families to cook, eat and enjoy food together. ‘Foodies’ and ‘fuelies’ have been described¹⁸; the former taking time to prepare and enjoy food, the latter eating convenience food on the run. Most of us are probably both some of the time; but being ‘foodies’ more of the time would help to enhance our frenetically paced twenty first century lives; there is certainly evidence that family meals have nutritional benefits¹⁹. It has to be hoped that trends will come full circle so that families once again see the value of prioritising time to share a home cooked meal whenever possible.

Click here for information on Cow & Gate Growing Up Milk for toddlers from 1 - 2 years.

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References

1. www.eatwell.gov.uk/healthydiet/seasonsandcelebrations/howweusedtoeat
2. National Statistics (2002): Family Spending: A report on the 2000 - 2001
3. Family Expenditure Survey. TSO: London
4. Food Standards Agency (2006): Consumer Attitudes to Food Standards 2005. www.food.gov.uk
5. Defra (2006): Family Food in 2004-5. www.defra.gov.uk
6. Institute of Grocery Districution (2006): Shopping Trends in 2006
7. Hamlyn B et al., (2000): Infant feeding survey. TSO: London
8. Stordy BJ, Redfern AM, Morgan JB (1995): Healthy eating for infants – mothers’ actions. Acta Paediatr 84, 733-741
9. Booth IW, Auckett MA (1997): Iron deficiency anaemia in infancy and early childhood. Arch Dis Child 76, 549-54
10. Ladhani et al., (2004): Presentation of Vitamin D deficiency. Arch Dis Child 89, 781-4
11. Weisberg, P et al., (2004): Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003. Am J Clin Nutr 80(6 suppl) 1697S-705S
12. Gregory JR et al., (1995): National Diet and Nutrition Survey: children aged 1 1/2 to 4 1/2 years, HMSO, London
13. Hourihane J O, Rolles CJ (1995): Morbidity from excessive intake of high energy fluids: the ‘squash drinking syndrome’. Arch Dis Child 72, 141-3
14. Nutricia (2005): The Forgotten Years, consumer survey
15. Jotangia D et al., (2005): Obesity among children under 11. Department of Health
16. Zaninotto P et al., (2006): Forecasting obesity until 2010. Department of Health
17. RCPCH et al., (2004): Storing up problems: the medical case for a slimmer nation.
18. SIGN (2003): SIGN guideline No.69: Management of obesity in children and young people: a clinical guideline. www.sign.ac.uk Institute of Grocery Distribution (2006): Shopper trends in 2006 www.igd.com
19. Gillman MW et al., (2000): Family dinner and diet quality among older children and adolescents. Arch Family Med 9, 235-40