Claire Parris and Shilpa Shah
It is no new concept that child health and disease influences lifelong health. To improve the health of future generations and society as a whole, we have to focus on the health of our children. Early childhood is a period during which a child’s life long habits are formed and family lifestyle is open to change and adaptation. There are many factors that influence child health, and as paediatricians we have a responsibility to support families in all aspects of wellbeing.
In this article we give you some top tips to promote healthy living in preschool children – emphasising practical steps parents can take and highlighting some resources that are perfect for sharing.
The NHS recommends pre-schoolers should engage in physical activity for at least 180 minutes a day including active and outdoor play; yet only 9% of 2-4 year olds achieve this, and 84% participate in <1 hour a day. The statistics speak for themselves. This is an area that could be greatly improved and is heavily interlinked with increased sedentary screen time (which will be addressed further down the list…).
Children should be encouraged to play – run, dance, jump, climb, sing nursery rhymes with actions – all of these things contribute to their 3 hours of physical activity a day. Add in playtime outside each day through a trip to the park, kicking a football or simply a run about in the garden and the NHS recommendations can be met.
Here are some great resources for games and activities for preschool children:
- NHS Start4Life: Toddler activities
- Get kids moving: classroom activities
- 49 fun physical activities for kids aged 2 to 4
A healthy, balanced diet is key to ensuring optimal growth and nutrition in children and can contribute to disease prevention. Together with physical activity, eating well to maintain a healthy weight throughout childhood influences longterm health. Currently however, over a fifth of children in the UK are overweight or obese by the time they begin school. Studies suggest obesity at age five predicts obesity in adulthood with increased risk of obesity related diseases including cardiac disease, diabetes and hypercholesterolaemia. The preschool years are therefore crucial in the development of healthy eating habits for life.
So, what does a healthy diet mean for pre-schoolers? It represents a variety of food including the all-important “5 a day” of fruits and vegetables and limiting processed and sugary foods. Appropriate child-sized portions are also key. A healthy diet in children shouldn’t be viewed in isolation, as it is a reflection of the family’s dietary patterns – so promoting healthy meals as a whole family is the best way to improve nutrition in preschool children.
Healthy eating resources, preschool nutritional needs and healthy family meal recipes:
Read a story every day
The simple act of reading to a child has far-reaching health benefits. It improves future literacy achievement, vocabulary, imagination and comprehension.
The American Academy of Pediatrics sees literacy promotion as an essential part of primary care: “Reading regularly with young children stimulates optimal patterns of brain development and strengthens parent-child relationships at a critical time in child development, which, in turn, builds language, literacy, and social-emotional skills that last a lifetime”.
Building storytime into preschool routine can be easy and fun. Here are some helpful resources for parents regarding reading to young children and accessing books:
- Why it is never too early to read with your baby
- Bookstart: free books to every child in England and Wales at two key stages before school
Limit screen time
Screen time, be it watching TV, tablets, computers or smartphone use, is prevalent across all age groups. The use of electronic screens is not inherently ‘bad’.
It offers a means of communication, educational opportunities and entertainment. However, caution is required in preschool children for a whole host of reasons. Excessive screen use has been associated with increased BMI, poor sleep, behavioural issues and decreased mental wellbeing, though causal relationships are unclear.
The RCPCH has not set a recommended screen time limit; rather it encourages parents to ask themselves a series of key questions to examine their screen use. Ultimately it advises parents to build screen time around family activities, not the other way round.
- Is screen time in your household controlled?
- Does screen use interfere with what your family want to do?
- Does screen use interfere with sleep?
- Are you able to control snacking during screen time
The American Society of Paediatrics goes further and recommends limiting screen use to one hour of high quality programmes per day in the 2-5 year age group. Parents ultimately play an important role in helping children navigate media and its moderation is key to ensure healthy development.
Practical ways to introduce screen time boundaries:
Don’t forget immunisations!
Vaccinations are essential to protect children and wider society from communicable diseases.
Also, studies suggest non-specific effects on child health beyond specific disease protection, including reducing mortality more than predicted by the prevention of the target infections. Despite their benefits, vaccination coverage declined in all routine vaccinations across England and Wales over the past year. This is in part due to widespread circulation of misinformation and ‘fake news’ regarding vaccine safety.
In the trust I am currently working, a group of nurses and doctors have embarked on a unique project – ‘The Pro-vac Movement’ – to promote positive conversations around vaccine safety. To hear more about this and how to get involved, listen to “2 Paeds in a Pod”episode 45 where Dr Ian Lewins interviews ST1 trainee Dr Aimee Henry and Paediatric consultant Dr Shilpa Shah.
More information on vaccine safety:
A powerful book highlighting the compelling history of vaccinations written by Professor David Isaacs is worth a read. It is called ‘Defeating the Ministers of Death’.
A multivitamin a day keeps the doctor away
Vitamins have a wide range of important biological functions, and deficiency contributes to a spectrum of diseases. A healthy, balanced diet will of course include the intake of foods containing essential vitamins and minerals. It is difficult, however, to get enough vitamin D from the diet alone. Lack of sunlight, particularly during the winter, can predispose to vitamin D deficiency.
The Department of Health recommends that all children aged 6 months – 5 years should take a daily vitamin supplement containing vitamins A, C and D. It is important to check the label for dosage as a recent study found only 25-36% of commercially available multivitamins contained the recommended 400 IU/day of vitamin D.
Parents in the UK can access free vitamins via the Healthy Start scheme.
Get enough sleep
Sleep is essential for normal growth and development. Studies suggest there is an association between sleep, behaviour and cognition as early as the preschool years.
Sleep problems such as difficulties falling asleep, night-waking, and night terrors are common in young children with a prevalence of 45% in 3-6 years olds and can impact the whole family. Furthermore, poor sleep in children has been associated with obesity, behavioural problems and increased duration of screen time.
What is considered good sleep? The American Academy of Sleep Medicine recommends preschool children require 10-13 hours of sleep per day. Promotion of healthy sleep in young children is centred around a consistent bedtime routine. The characteristics of this ‘routine’ include going to bed at the same time each day, in a relaxed atmosphere with communication from a caregiver such as a bedtime story or singing lullabies.
These are some resources for parents regarding setting a positive bedtime routine:
- Brush, Book, Bed: How to Structure Your Child’s Nighttime Routine
- NHS healthy sleep tips for children
- A collection of leaflets from the Childrens Sleep Charity
As paediatricians, one of our most important roles is to empower parents to take positive steps that can improve the child’s health for the present and beyond.
Promoting healthy living during the preschool years sets positive habits for a lifetime. The lifestyle factors addressed in this article are so entwined with one another – it is important to view lifestyle as a whole rather than its individual parts.