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Food for Children at the Age of 3–4

Text by Sara Ask, paediatric dietician

Food for children

Does my child eat nutritious food?

Preschool-age children can, in principle, eat anything an adult can eat. But that doesn’t mean they want to. On the contrary, the preschool age can be a time when food is a bit of a tug-of-war. Many parents feel unsure as to whether their child is getting enough nutrition. As far as most nutrients are concerned, the answer is yes, but some may need a little extra thought.

Protein

Proteins are the body’s building blocks and it’s easy to see that protein is important for a small growing person. But there’s usually nothing to worry about, as protein is present in almost all foods, not just in meat, eggs, fish and other obvious sources. For example, protein is present in milk products, bread, pasta, pulses, nuts and there is also a little in most vegetables and fruits.

According to the WHO, preschool-age children should ingest 0.9 grams of protein per kilogram of body weight per day to ensure that their needs are being met. This means around 15 grams of protein a day for an average 3–4 year-old child. It may sound a lot but, as an example, an ordinary pancake contains 5 grams, a meatball contains 1.5 grams, a sausage contains 7 grams, a small glass of milk contains 3.5 grams and a banana contains 1 gram — but you don’t need to keep count. A protein deficiency is usually nothing to worry about as it tends to correct itself. Research shows that children in the Nordic countries get 2–3 times more protein than they actually need.

Fat

Fat provides energy in concentrated form. Most children get enough fat by a comfortable margin, but not always of the most important kind. There are two fatty acids that the body can’t produce by itself and that children need to get from food: the fatty acids Omega-3 and Omega-6. It’s mainly Omega-3 that you may need to give more thought to. One good way is to serve fish two to three times a week and cook with rapeseed oil or fat made from rapeseed oil.

It’s easy to imagine that children need more energy and that they should therefore be given full-fat milk products, but the Swedish National Food Agency recommends that lean milk products be given even to children. The reason is that they contain less saturated fat but, at the same time, the same quantities of nutrients as full-fat products. In other words, most people eat more saturated fat and less unsaturated fat so, in order to get a balance between them, it’s better to serve lean milk products and be generous with fat in the form of fish and rapeseed oil, for example.

Carbohydrates

Carbohydrates are an important source of energy, particularly for growing children. Most carbohydrates are broken down into glucose, which is burned as energy in the cells. By focusing on good sources of carbohydrates, the child not only gets energy, but also other nutrients into the bargain. Example of good sources of carbohydrates include pasta, bulgur wheat, potatoes, bread, pulses, tubers, vegetables, fruit and berries. They provide not only energy, but also vitamins, minerals and antioxidants.

However, sweets, cordials, soft drinks and biscuits provide no nutrition, but only “empty calories”. That’s why it’s a good idea to limit this type of food. That doesn’t mean that you need to avoid sugar altogether. There’s room for a little sugar in a healthy diet. For a 3–4 year-old child, it’s a question of about two tablespoons of sugar a day. That may sound a lot, but there are a lot of hidden sugar traps in the form of items such as flavoured yoghurt, sweetened cereals and other snack products. The most important thing is still not to give children sweets, cordial, soft drinks and biscuits on a daily basis. If you can avoid that, things are normally fine overall.

Fibre

Fibre also belongs to the carbohydrates. Fibre exists in wholegrain products and in vegetables, pulses, nuts, seeds, fruit and berries. Fibre, together with fluid, helps to counteract constipation. Some kinds of fibre also act as food for the good bacteria in the stomach, those that make up a large part of our immune system. When fibre is broken down in the stomach, short-chain fatty acids are formed which act as energy for the intestinal mucous membrane structure. In short: there is a lot to be said for fibre.

So how much fibre is right for a 3–4 year-old? According to nutritional recommendations, the answer is 11–16 grams. That’s quite a lot. As a comparison, an apple contains 2 g of fibre, 1 dl of wholegrain pasta contains 3 g and a disc of crisp bread contains just under 2 g. Most children probably get less than the recommended amount of fibre.

But some children seem to be sensitive to fibre: Some suffer diarrhoea and others suffer constipation if they get too much fibre. We then have to try and find a level that’s just right. For many people this involves switching between wholegrain products and ordinary “white” products.

Vitamins and minerals — where are they found?

Vitamins and minerals can be found in almost all food, even in ordinary popular children’s dishes such as meatballs, black pudding and pancakes. Children that mainly eat ordinary food rather than food containing empty calories such as soft drinks, snacks and sweets, usually get what they need. But some vitamins and minerals may need a little more thought:

Vitamin D

The main source of vitamin D is the sun, but the sun is only high enough in the sky to provide vitamin D during the spring and summer. When it comes to food, vitamin D is mainly present in oily fish. Enriched milk (low fat, skimmed and semi-skimmed milk), enriched vegetable beverages, enriched edible fats and chanterelles also provide vitamin D.

If you’re not sure whether your child gets enough vitamin D, you can easily carry on with vitamin D drops even if your child is over the age of two. Check with your child’s BVC nurse.

Folate

Folate is required for creating new cells. Folate is therefore particularly important in childhood. Folate is available in most foods, but only in small quantities. The best sources of folate are tubers, dark-green leafy vegetables, brassica of various kinds, beans, chickpeas, lentils, fruit and berries, wholegrain products, soured milk and yoghurt. That’s why it’s good for your child to get some of these foods every day.

Iron

Black pudding, meat and fish are examples of good sources of iron. Eggs and vegetable foods such as dark-green vegetables, pulses, nuts, seeds and dried fruit also provide iron. It’s easier for the body to absorb iron in food of animal origin than from plants, but accompanying vegetarian food with something rich in vitamin C can facilitate the uptake of iron.

Selenium

Selenium is present in almost all foods, but at low levels. Fish, milk, cheese and eggs have the highest selenium content. A good way to ensure that the child gets selenium is to serve fish two to three times a week.

Iodine

Swedish soil is low in iodine, which means that few foods contain iodine. That’s why it’s important to choose iodine-enriched salt. Fish, seafood and eggs are also good sources.

How important are vegetables?

Not all children love vegetables — on the contrary, vegetables are the food group that children hate most often. Some people feel stressed and worry about malnutrition when children don’t eat their vegetables. Then it’s a good thing to know that vegetables are not of primary importance for vitamins and minerals. Fruit, berries and ordinary food, in principle, provide the same nutrition as vegetables. So you can relax and let your child become familiar with vegetables in peace. The important thing is not for the child to dare to taste a pea today, but for the child to see that vegetables have a natural place on the table and for people around the child to eat vegetables and show that they’re good to eat. In the long term, it’s good for your health to eat a lot of vegetables.

Many children like it when the vegetables are served separately, e.g. a bowl of boiled broccoli, a bowl of carrot sticks and one of natural chickpeas. Other children love the taste of the dressing. Children are different, including when it comes to taste. Try and find your way of eating vegetables. But don’t push — it can have the opposite effect.

What could a good food day look like?

There’s no research that indicates the best way of distributing food over the day, but many people are comfortable having three main meals and 2–3 snacks. For example, it might look like this:

Breakfast

Such as yoghurt, cereal, bread, fruit or vegetables.

Snack

Such as fruit, vegetables and/or a sandwich.

Lunch

Such as pasta/potatoes/bulgur wheat + chicken, meat, fish or vegetarian* + vegetables.

Snack

Fruit, vegetables and/or a sandwich.

Dinner

Such as pasta/potatoes/bulgur wheat + chicken, meat, fish or vegetarian* + vegetables.

Possibly an evening meal

Such as a sandwich and milk, yoghurt, fruit or vegetables.

An evening meal isn’t necessary, but it could be a good idea if you know you have a fussy small person at the table — so you’re sure that he or she doesn’t go to bed hungry.

Suitable drinks on a daily basis

Water or milk or enriched vegetable beverages.

* It’s a good idea to serve the child fish two to three times a week. The quantity of cooked red meat shouldn’t exceed 500 g per week. Red meat includes beef, pork, lamb and game.

Is there anything else you shouldn’t give a child?

Pre-school age children can in principle eat anything, at least in theory. But there are some things they should avoid.

A small sceptic at the table — what do you do?

Many children are quite fussy about what they like and what they don’t like. It has to do with the fact that most pre-school age children go through a phase in which they are sceptical about new foods.

That can also apply to food they gladly shovelled down when they were infants. It can be very frustrating for parents, but the causes are completely natural: it’s the child’s way of gradually learning what food is safe and what isn’t. Here are a few suggestions that could make mealtimes happier during this period:

Eat yourself — you are the best role model

Children don’t do as we say; they do as we do. If you eat and show that you think it’s nice and cosy, then there’s a greater chance that your child will follow suit. Of course you can have adult dinner later if you want, but if you do that often, you’ll miss out on a lot of opportunities to set an example.

Try the taco model

Many children at this age appreciate being allowed to pick the ingredients individually, as you do when you eat tacos. That enables them to choose what they want, and leave anything that seems unpleasant. There will also be less complaining. “I want nuts and maize” is more fun to listen to than “Take the tomato off my plate!”

Understand the fear of stew

Many pre-school age children dislike stews and other blended food, perhaps because it’s difficult to see exactly what’s in them. If the rest of you are eating stew, make sure there’s something on the table that the child can eat his or her food on. Perhaps your child will accept a small spoonful of stew on a plate, if not something else as food to look at? One fine day, the food to look at will slip down.

Ignore — strengthen

However impossible it feels — try and ignore it if your child plays with his or her food. Try not to sigh, nag or force. Children are so fond of attention that they prefer negative attention to no attention at all, and you can take advantage of that in this situation. If, on the other hand, the child does something you want to see more of, for example sitting still for a while, perhaps even eating something at the table, give attention by looking at the child, listening with greater attention and/or talking about something the child is interested in.

Dare to add spices

Some children like garlic, curry, oregano, chilli and, well, all kinds of spices. Some children actually seem to think it’s not worth eating food if it doesn’t taste of anything.

Start with a very small portion

Let the child take his or her own food, or give him or her quite a good-sized portion, though not a giant portion which could be overwhelming for a child. If you have a small thief who prefers to take food from your plate, that’s quite OK. There’ll be plenty of time to polish table manners.

Don’t fall into the trap

Avoid the trap of “Eat up the food now and then you’ll get ice cream!” That sentence automatically says “Food is so boring you have to be rewarded with something sweet when you’ve got through it”. And that’s not a successful message…

Have a moderate level of ambition

Perhaps the child hasn’t had time to get hungry again after the previous meal? Are you being over-ambitious about how much the child must eat in order for it to count as a meal? If it’s just a little tiny pasta screw, let it go! It’s usually not long to the next meal.

Don’t allow the child to eat between meals

Appetite is the best spice. Make sure not to give the child raisins, sweet drinks, biscuits, fruit or other snacks between meals which mean that the child will have no appetite when it’s time to eat.

Don’t compare one child with another

Children are different, including when it comes to food and taste. Some children eat everything that’s put in front of them, whereas others function on ten foods, and there needn’t be anything unusual about that. Some children (and adults) are so-called “supertasters”. That means that they can detect tastes, for example bitter, more strongly than other people. For those people, it can take longer to learn how to eat something like broccoli and other vegetables that contain this bitter taste. It’s therefore necessary to be extra patient with those children.

Think about what you were like as a child

There’s a clear hereditary aspect when it comes to making a fuss about food. That correlation is particularly strong when it comes to protein-rich food such as meat and fish. Maybe you were also a fussy eater as a child? Don’t blame yourself in that case, but think instead that you managed to grow up despite that!

Sit for a maximum of 20 minutes

If the meal is hard work, don’t sit there for hours. That’s boring for everyone. 20 minutes might be just right. It’s rarely very long before you get another chance. Your task is to make sure that there’s good food on the child’s plate. The child decides how much he or she wants to eat.

Talk to the BVC if you’re worried.

It’s common for parents to find that children make a fuss about food. Often the fuss is actually a sign that everything is as it should be. It’s a sign that the child is going through different phases, which sometimes becomes clear at the dinner table. However, for some children, problems with food are of a more difficult kind. Some children may be suffering from an illness, a food allergy or an anatomical abnormality, for example, that makes it difficult for them to eat. If you suspect that your child feels discomfort or if the fuss about food doesn’t stop, it’s important to seek help. The BVC can provide you with tips on where to go.

Chubby children — practical advice

The pre-school age is usually a time when children are growing much more slowly than in the infant year. The chubby thighs disappear and the ribs can become visible, but there’s nothing unusual about that. However, not all children slim down. Some carry on being chubby during the pre-school years. Research shows that it’s easier to avoid being overweight later in life if it’s detected at pre-school age and the BVC therefore monitors children who quickly put on weight. As a parent, you can feel both attacked and questioned, but the discussion is well-intentioned. It’s hard for you yourself to see that your children are overweight. Research from both Sweden and other countries shows that many parents underestimate their children’s weight, and overestimate how much a child needs to eat. By obtaining guidance and finding out why the child is putting on more weight than normal, your child can be helped to grow into his or her weight. Therefore it’s not about the child having to lose weight; it’s about finding the right balance for the child.

Genes and environment interact

There are a lot of prejudices about being overweight and the reasons why children become overweight. However, there are many possible causes and they differ from one individual to another. Both environmental factors and genetic factors come into play. For example, the ability to feel hunger and satiety varies from one individual to another, as does the child’s access to food and other edible items. Another example is the fact that some people are more efficient at storing a surplus of energy (= calories) as fat, which was useful during periods when the supply of food was limited. But when there is an abundance of food, that characteristic can lead to excess weight.

A few examples of the causes for which children take in more energy than they have time to burn off are set out below, along with tips on what to do if you recognise any of them:

Is the child a small person who likes his or her food?

That’s a good characteristic! Take advantage of it by trying to get your child interested in all forms of vegetables. One portion of food is enough for most and if your child wants to eat more, it’s great if there are vegetables to take and fruit for dessert so that each meal doesn’t provide too much energy. Train the child to pay attention when he or she is eating — to feel what the food tastes like and to eat with all his or her senses. That will increase the chance of feeling satiety. In purely practical terms, it’s a question of eating without being distracted by TV or other screens, for example, and not eating quickly, but putting down the cutlery sometimes and talking a little between mouthfuls.

Is your child permanently peckish — either for food or sweets or “anything”?

Try and help the child distinguish between hunger and being peckish by asking him or her to recognise — is your stomach really rumbling? Is it hunger he or she feels, or is it peckishness that really represents something else, perhaps the fact that the child is bored? Can the peckishness be distracted, for example, by a game or crafts while waiting until it’s time to eat?

All children are healthy in a healthy food environment, in other words where there is mainly food, vegetables and fruit at home and less sweets, snacks and sugary drinks. That’s particularly important for children who are permanently peckish.

Do you, the parent (or other important adults around the child), find it is difficult to set limits?

It’s not always easy to set limits for the little person you love so much. But setting limits is actually one way of showing love. That applies particularly when it comes to food and other edible items.

Most children are very fond of sweets, ice cream, snacks and fast food such as chips and soft drinks. The sort of thing that provides a lot of energy but no nutrition. Children therefore need help from adults to set limits, e.g. by introducing Saturday sweets. However, a total ban doesn’t appear to be the solution: research shows that it can make the child even more fixated on sweets.

Do you think your child needs more food than he or she actually does need?

As stated previously, it’s common for parents to think that their child needs greater quantities of food than he or she actually does need. This can lead to parents trying tricks to get their child to eat more and the child doesn’t get to practice listening to his or her hunger and satiety signals. A good rule of thumb is for you, the parent, to decide when and what is served and for the child to decide what and how much he or she wants. It doesn’t matter if it doesn’t make up a full meal — the important thing is what the child eats for a longer period of weeks and months. Always cooking meals that you know the child likes a lot can be risky. It can make the child eat more than he or she really needs because it’s always so delicious.

Does the child get a lot of energy via sweet drinks?

Sweet drinks increase the risk of being overweight, partly because sweet things in liquid form appear to be difficult for the body to register, which can in turn mean that the energy intake is too high. It’s easy to believe that juice is a better option because it contains natural sugars, but the best thing is to provide fruit whole. Then the child also gets satisfying fibre and other good things.

Important for everyone: Advice to promote a positive body image

Research shows that even children as young as 4–5 can express dissatisfaction with how their bodies look. Some of them may even know what dieting is. The book Projekt Perfekt — om utseendekultur och kroppsuppfattning (Natur & Kultur) gives the following advice, set out in an abbreviated version here, to parents and other adults to promote a positive body image among children:

Last but not least

Good eating habits and exercise in everyday life are important for everyone, regardless of body weight. Habits established early are easier to maintain later in life. In the constant flow of information about food, it can be difficult to sift through the information and it’s easy to get the impression that good food is difficult. But, in reality, you can go a long way by sticking to a few simple points: