The theme of this week's National Food Awareness Week is Give me 5. We are being reminded that children, and indeed all of us, should eat five portions of fruit and vegetables every day. Making this point can easily sound like preaching, but its importance to your child's health cannot be overestimated. A colleague was telling me that her six-year-old, Conor, hates vegetables and refuses to eat anything vaguely green or leafy. The only fruit he will eat is an apple, provided it is cut up and peeled.
He enjoyed pureed fruit and vegetables as a baby but from the moment he could hold his own spoon, things changed, his mother says. It got worse when he started school. He refused to eat anything that he could recognise as a vegetable and became fussy about fruit. His friends at school are the same and I think they must influence him.
She resorts to sneaking pureed onions, carrots and mushrooms into bolognaise sauce and offers incentives if her son does eat a fruit or vegetable snack.
Conor is not alone. A National Diet and Nutrition Survey published this year showed that on average British schoolchildren aged between four and 18 eat less than half the recommended five portions of fruit and vegetables per day. One in five children ate no fruit at all during the survey week.
Another survey published in 1998 showed that the consumption of vegetables in the UK was 16 per cent lower than that of ten years earlier. In Britain we eat fewer fruit and vegetables than people in almost any other European country. We also have one of the highest rates of some cancers and heart disease. These two facts are almost certainly connected. Eating more fruit and vegetables promotes good health and protects against many serious diseases. It is easier said than done sometimes, but developing good dietary habits in childhood will stand your child in good stead for life.
The vitamins, fibre and minerals found in fruit and vegetables are vital to health. Vitamins are needed in tiny quantities and too little of even one vitamin can cause health problems. Vitamin A protects against cell damage, keeps skin healthy, is good for growth and strong bones, hair and teeth and helps you to see in the dark. Good sources are apricots, melons, carrots, leafy greens, red peppers and tomatoes. The B vitamins are vital for energy production, keeping the brain, nerves, blood and muscles functioning and skin, nails and hair healthy. Some of the B vitamins are found in bananas, peas, beans, lentils and leafy greens as well as cereals, milk and meat.
Vitamin C helps the body to absorb iron and to heal wounds and keeps skin and gums healthy. It is easily destroyed by heat so food is best eaten raw or only lightly cooked. Sources include citrus fruits, kiwi fruit, leafy greens, broccoli and red and green peppers. Vitamin E protects cell membranes from damage and is important in the formation of red blood cells. It is found in leafy greens, avocados and vegetable oils.
Fibre keeps the intestines working and seems to reduce levels of fats in the blood. In the long term a fibre-rich diet may help to prevent heart disease and some cancers. The best sources are dried fruit and pulses (including baked beans).
Minerals have many properties, too. Calcium strengthens teeth and bones, which prevents fractures, aids blood clotting and keeps the heart beating regularly. It is found mainly in milk and milk products but also in oranges, dried fruit and leafy greens. Iron is needed to make red blood cells, which carry oxygen around the body. It helps muscles to work and increases resistance to disease and stress. The body does not readily absorb iron but eating it with a source of Vitamin C makes this easier.
In addition, Vitamins A, C and E are known as antioxidants. They mop up chemicals called free radicals, which are naturally produced in the body in the reactions that produce energy. Free radicals have been implicated in cancers, asthma, coronary heart disease, diabetes, and many other disorders as well as ageing. Some antioxidants are produced in the body but others need to be acquired through diet. Research to date suggests that the best way to get antioxidants in the correct quantities is through diet and not by taking vitamin supplements.
So what should your child be eating? There are no published portion sizes of fruit and vegetables for children. But you won't go far wrong if you encourage your child to eat a wide variety of fruit and vegetables at least five times a day. For example a four-year-old might have a satsuma, half an apple, a plum, a tablespoon of peas and a tomato during the day.
Consider frozen vegetables too. I was surprised to learn that they may be better than fresh. They are frozen very quickly after being picked and retain their nutritional quality. Canned vegetables, fresh fruit juice and dried fruit can be included in the five portions too. Make sure that you give 100 per cent fruit juice and not fruit drinks, which contain a lot of sugar and very little actual fruit juice. Dried fruit and fruit juices can cause tooth decay and should be given as part of a meal, not as a snack.
You may be surprised to hear that potatoes should not be counted as a vegetable portion. Nutritionally they are classed as a starchy food alongside bread and cereals. Your child should be eating five portions of fruit and vegetables a day on top of potatoes.
As Conor's mother knows, it can be a battle to get your child to eat fruit and vegetables. Including them regularly in his diet from an early age will encourage good habits. My children have always loved fruit and vegetables. I can't claim to take credit for this myself. When they were small their nanny succeeded in getting them to eat broccoli, carrots and even Brussels sprouts. When I asked her recently what her trick was she said it was just persistence. It is extremely important to set a good example yourself by eating plenty of fruit and vegetables and ensuring that they are always included as a normal part of the whole family's diet. Get into the habit of adding fruit to breakfast cereal, offering chopped fruit or vegetable sticks as snacks and adding chopped fruit to yoghurt or ice-cream as a dessert. Grate or chop vegetables into shepherd's pie, lasagne, bolognaise sauce or casseroles, and add extra vegetables such as mushrooms, peppers and even pineapple to pizza.
Introducing an element of novelty may help. Your children might enjoy colourful fruit and vegetable kebabs, or pancakes filled with soft or cooked fruit served with ice-cream. Most enjoy milkshakes. Try liquidising bananas, strawberries, raspberries or mango or a mixture of these with milk and a scoop of ice-cream. Banana bread is easy to make and is another way of encouraging a child to take fruit.
With an older child you are in a position to negotiate and ensure that they know about the benefits of fruit and vegetables.
The Give me 5 message, promoted by the British Dietetic Association, is being taken seriously by the Government, which may be realising that prevention of many adult diseases starts in childhood. In July this year the Department of Health pledged £2 million to promote fruit and vegetable consumption in children. Nutritional standards are being introduced for school lunches after an absence of 20 years, with new regulations specifying the availability of different types of fruit and vegetables. And as part of the NHS Plan, by 2004 every primary school child will receive a free daily piece of fruit at school.
If you suspect that your child may be eating an inadequate diet and are concerned that his health may be suffering, consult your GP, who may refer you to a state-registered dietitian.
Information on Give me 5 week is available at: www.bda.uk.com.
Jane Collins is the medical director of Great Ormond Street Hospital for Children. She is unable to enter into correspondence.
