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CHAPTER 4 FOOD AND EATING

4.1 Introduction

This chapter reports on findings from the birth cohort only and focuses on their food and eating. This suite of questions was introduced at the second sweep for this cohort and provides a good opportunity to explore issues relating to key health related behaviours - the provision and consumption of food. However, food and eating also form part of day-to-day family life and touch on issues of children's preferences and parental control as well as family practices relating to meal times and snacking. All of the following analysis, therefore, relates to children aged approximately 22 months at the time of interview. Since food and eating was a new topic at sweep 2, there are no comparative data from the first sweep.

The chapter focuses on parental views and challenges in relation to their children's eating. This is an important area as there is growing concern about levels of obesity, even in young children, and the imbalance between calorie intake and expenditure. Understanding the factors that influence what food parents provide for their children and what their children eat is essential if interventions to support healthy eating are to be effective. There is also concern about the erosion of family life, family meals and family time and this chapter provides relevant empirical evidence about who young children eat with in their homes. This chapter is able to explore both what these young children are reported to eat and also something about their eating habits, both at meal times and through snacking. It is also able to consider how respondents feel about their control over what their children eat and what factors they think influence food and eating.

The tables in this chapter present the following main type of analysis:

• Analysis of the answers of main respondents in the birth cohort at sweep 2 by factors that might help explain these answers (for example, the age or educational background of the respondent).

4.2 Eating habits and special diets

The majority of respondents were finding it very easy or fairly easy to feed their child (80%). However, more than 9% of respondents found it fairly difficult to feed their child, with a further 3% finding it very difficult.

Respondent's finding it very difficult to feed their child were far more likely to report that their child was a fussy eater (88%) than those parents who found it very or fairly easy to feed their child (1%). In contrast 89% of parents who found their child very easy to feed, also reported their child as eating 'most things': only 2% of the respondents who found it very difficult to feed their child reported this.

Figure 4-A Ease of feeding child by variety of foods eaten

Relatively few children (6% in the birth cohort) followed a special diet of any kind. Of those children who did follow a special diet, 38% did so due to food allergies or intolerances, 19% due to religious reasons, 16% were vegetarian, vegan or pescetarian ⁹ and the remainder for a range of 'other' reasons. Interestingly, respondents whose children had special diets were actually less likely to be experiencing difficulties in feeding their child than those who did not mention the child having a special diet with only 11% saying that feeding their child was very or fairly difficult, compared with 19% of parents of children without a special diet.

4.3 Main and evening meals

There has been considerable debate in recent years about the importance, and perceived erosion, of family mealtimes. What can the survey tell us about how structured children's eating patterns actually are? Most children normally ate (presumably at a table) in either the kitchen or dining room (61%). Most of the remainder ate in the living room (34%). The majority of children ate with at least one parent (84%), leaving 16% eating with just their siblings or alone. More specifically, 83% ate with their mother, 53% with their father, 50% with siblings and 6% of children ate alone. ¹⁰ Children in larger households (with four or more children) were more likely to eat without an adult, one in five eating on their own or with siblings only, compared with one in ten only children. Perhaps surprisingly, children who did not eat with their parents were more likely to be in households classed as managerial or professional, those with a higher income, and an older mother. There does not however, appear to be a link between education level and whether parents ate with their children.

4.4 Types of food eaten

4.4.1 Fruit

Although much more limited in scope than dedicated diet and nutrition studies, GUS is nevertheless able to provide some useful information on the range of food types - both healthy and unhealthy - eaten by children on a typical day. Looking firstly at healthy foods, it was encouraging to see that almost all toddlers ate at least one type of fruit a day, with 59% having two or three types a day and a further 25% having four or more (Figure 4-B).

Figure 4-B Number of different types of fruit eaten on a typical day

It was clear that children from certain types of households ate more fruit than others. Factors which appeared to be particularly influential were:

• Family structure; 27% of those in a couple family ate four or more different types of fruit on a typical day, compared with 21% of those in a lone parent family. Given that lone parents were more likely to be on lower incomes, this may be more related to differences in income than family type (see bullet below);
• Mothers' education; 29% of children whose mother had Higher grades or above ate four or more varieties of fruit per day in contrast to only 16% of those whose mother's had no qualifications;
• Maternal age; 29% of children whose mother was aged over 40 at the child's birth ate four or more types of fruit a day, in contrast to only 11% of children born to a teenage mother;
• Family income; 34% of children in households in the highest income group ate four or more types of fruit a day in contrast to 18% of children who lived in households in the lowest income group. It is worth noting that despite this pattern, respondents who said that the cost of food had a lot of effect on what they gave their children to eat were just as likely to report giving their child the same variety of fruit on a typical day as those who said the cost of food had no effect at all;
• Knowledge of healthy eating; those who knew 'a great deal' about healthy eating were far more likely to say that their child ate four or more types of fruit a day (33%), compared with respondents who knew 'nothing at all' about healthy eating (9%).

4.4.2 Vegetables

Most toddlers ate some vegetables (not including potatoes) on a typical day. However, 24% were only having one type of vegetable and 6% had none (Figure 4-C).

Figure 4-C Number of different types of vegetables eaten on a typical day

As might be expected, patterns of vegetable consumption across sub-groups mirrored those for fruit. In other words, the variety of vegetables consumed was lower among children from lone parent households and low income households, and among those whose mothers were younger, had poorer educational qualifications and knew less about healthy eating.

4.4.3 'Unhealthy' foods

So far we have focused on healthy eating. What does the survey tell us about the consumption of less healthy foods and drinks? What is immediately apparent is that there is a significant proportion of children for whom such foods are, at the age of 22 months, already an established part of their daily intake. 90% of children ate sweets or chocolates once a week or more often, including 43% who ate sweets or chocolates once a day or more. Again, nine out of ten children had crisps or savoury snacks once a week or more, with almost half having these once a day or more. It is worth noting that 69% of children who were having sweets or chocolates once a day or more were also having crisps or savoury snacks once a day or more.

Although eight out of ten of respondents reported that their child had a soft drink which was not lo-calorie or diet less often than once a month or never, more than one in ten had such a soft drink at least once a day. Four-fifths of those who drank these soft drinks once a day or more also had sweets or chocolate and crisps or savoury snacks once a day or more.

Table 4.1 Frequency of consumption of selected food types

The patterns here by sub-group are essentially the inverse of those for consumption of fruit and vegetables. Lone parents reported giving the cohort child sweets and chocolates, and crisps and savoury snacks more often than respondents in couple families. Furthermore, lone parents were twice as likely as those in couple families to report giving their child soft drinks which were not diet or lo-calorie once a day or more often. Two-thirds (66%) of children whose mothers had no qualifications ate sweets and chocolates once a day or more often, in contrast to just over a third (37%) of children whose mothers had Higher grades or above. Similar trends are evident in daily consumption of crisps and savoury snacks, and in sugary soft drinks (Figure 4-D). Thus, whilst consumption of sweets and chocolate, and crisps or savoury snacks is fairly common across the whole sample (sugary drinks being less common generally), frequent consumption of these foods is more prevalent amongst the more socially disadvantaged groups.

Figure 4-D Daily consumption of selected foods and drinks by family type and mother's qualifications

Figure 4-E illustrates the dramatic differences in consumption of these items by household socio-economic classification and income. Around double the number of children in households in semi-routine and routine occupations, and in the lowest income group respectively, had sweets or chocolates once a day or more, compared with households in managerial and professional households and those in the highest income group. Similar patterns can be seen in daily consumption of crisps or savoury snacks and sugary drinks, indeed, almost a fifth of children in the lowest income group and a similar proportion in semi-routine and routine households, had a soft drink which was not diet or lo-calorie at least once a day.

Figure 4-E Daily consumption of selected food types by NS-SEC and income

Table 4.2 Frequency of consumption of soft drinks (not diet or lo-calorie) by maternal education

Perhaps unsurprisingly, the educational attainment of respondents was also a key predictor of the frequency of consumption of soft drinks (not lo-calorie or diet). Just 9% of respondents with higher grade qualifications or above reported their child having such a drink at least once a day, in contrast to 25% of respondents with no qualifications. This raises questions about just how well 'healthy eating' messages are getting through to particular groups and whether more focused campaigns on sugary drinks need to be utilised.

4.4.4 Difficulty in controlling the amount of sugary snacks/drinks children have

To what extent do parents feel able to control their child's intake of less healthy foods and drinks? With their children aged just 22 months, it is perhaps not surprising that most said that they still found it very or fairly easy to control the amount of sweets or sugary snacks or drinks that their child had. However, more than one in ten found it very or fairly difficult. There was a higher instance of reported difficulty among younger mothers; 16% of mothers who were in their teens at the birth of the cohort child reported finding this difficult, in contrast to 5% in their forties.

Figure 4-F Parents' reasons for difficulties in controlling the amount of sweets and sugary snacks that children have

Grandparents appear to have a particularly important role here (almost two-fifths of parents who mentioned difficulties gave this reason) no doubt as the result of the high levels of involvement they tend to have, though perhaps also because of generational differences in attitudes to healthy eating. Grandparents were not the only other parties involved, 17% of respondents said that other non-relatives gave the child sweets, while 13% cited other relatives (other than grandparents) giving the child sweets. The findings suggest that grandparents may offer a useful focus for social education interventions in this area.

4.4.5 Effects on what children have to eat

Respondents were given a list of possible influences on what they give their child to eat and asked to say how much of an effect, if any, each one had.

Respondents' knowledge of cooking had a notable impact, with 11% of respondents reporting this affected what they gave their child 'a lot' whilst the things the child will and won't eat had a lot of effect for 8% of parents (Figure 4-F). Other effects included the things others in the household will and won't eat, and the time taken to prepare meals. Although the cost of food only had 'a lot' of effect for 2% of respondents (4% in the lowest income group), the cost of food had some effect for 35% in the lowest income group in comparison to 14% in the highest income group.

Figure 4-G Factors and level of influence on what children eat: birth cohort

4.5 Snacks

Respondents were asked to describe the extent to which their child snacked during the day. Most reported that their child 'snacks during the day but also has meals' (76%), with 22% saying that their child 'doesn't snack much, just has meals'. Only 2% of parents said that their child 'snacks all day and doesn't have meals'.

Parents were asked about the type of snacks their child would be likely to have. A large number of different types of snacks were reported and parents could report more than one type of snack. Fruit was the most popular snack, reported by over three-quarters of parents. Forty percent of parents said their child had savoury snacks and 40% would have bread, toast or something similar. Thirty-six percent of children had crisps. Again, variations could be seen in the types of snacks given by different sub-groups.

Figure 4-H Selected foodstuffs given as snacks by household income: birth cohort

As Figure 4-H illustrates, children in households with a higher income were far more likely to have reported giving their child fruit as a snack than children in households with lower incomes (84% in households earning over £44,000 compared with 61% in households earning under £14,999). Lower income households on the other hand, were far more likely to report their child having crisps (47% in the lowest income group compared with 24% in the highest income groups) or sweets/chocolates (29% compared with 18%) as a snack.

The cost of fruit did appear to have an impact on the extent to which it was used as a snack for the child, 61% of parents who said that the cost of food affected what they gave their child to eat a lot, gave their child fruit as a snack compared with 75% of parents who said the cost of food had no effect gave their child fruit. This is particularly interesting as earlier, we found that the cost of food had no effect on the variety of fruit eaten on an average day, suggesting that although parents in lower income families are equally likely to give their child the same range of fruit over the day as higher income families, this is more likely to be given at meal-times rather than as a snack. However, it is worth bearing in mind that the cost of food question referred to food generally and not specific food types such as fruit.

A similar pattern can be seen across NS-SEC groups, with far more managerial and professional households reporting their child having fruit as a snack than semi-routine or routine households. In addition, children in couple households, those with parents with higher grade qualifications or above, and those with an older mother were more likely to have fruit as a snack compared with children in lone parent families, those whose parents had qualifications lower than Higher grade and those with younger mothers respectively.

Parents who claimed a great deal of knowledge about healthy eating and children's diet were more likely to give their child fruit, and less likely to give their child crisps or sweets/chocolate as a snack than those who knew nothing or not very much about healthy eating. For example, 80% of parents in the former group gave their child fruit as a snack compared with 50% in the latter group.

Table 4.3 Types of snacks eaten by parental knowledge of healthy eating

4.6 Sources of help/advice on children's diets, eating habits or healthy eating

Respondents were asked which sources they had used for help or advice on children's diets, eating habits and healthy eating. Overall, seeking this sort of information was quite common with 85% of parents reporting use of at least one source for help or advice. However, accessing help or advice varied by family type (Figure 4-I). Twenty-one percent of lone parents said they had not accessed any information or advice on healthy eating, compared with 13% of parents in couple families. Considering lone parents' increased likelihood of giving their child fewer healthy foods and more unhealthy foods, as we have just seen, this is a further point of possible intervention. Likelihood of seeking information also differed by maternal education - mothers educated to Higher grade or above were both more likely to have sought information of this nature, and to have used more sources were those with Standard grades or no qualifications.

Figure 4-I Number of sources consulted on healthy eating by family type

The most popular source of information about healthy eating was paper literature such as books, magazines or newspapers (66%), with family and friends coming a close second (62%). A little over half (55%) of respondents had consulted health professionals, while two-fifths had spoken to other mothers. Lone parents and mothers with no qualifications were considerably less likely than those in couple families and with any qualifications to have consulted paper literature for information or advice (Figure 4-J). In contrast, lone parents and mothers with no qualifications were most likely to have spoken to a health professional about healthy eating (64% of lone parents compared with 53% of parents in couple families, and 63% of respondents with no qualifications compared with 53% of respondents with Highers or above). Younger mothers were more likely to report getting information from family and friends, 67% of teenage mothers at the birth of the cohort child used this source of help in contrast to 47% of mothers aged 40 or older at the birth of the cohort child.

Figure 4-J Sources consulted about children's diets and healthy eating

4.7 Key points

• Six percent of children followed a special diet, mainly due to food allergies/intolerances or for religious reasons.
• Virtually all children normally had a main evening meal each day, nearly all had this always or usually at regular times.
• Eighty-five percent of children had at least two types of fruit a day, including a quarter who had four or more.
• The majority of children had at least one type of vegetable on a typical day, although only two-fifths had two types of vegetables or more.
• Unhealthy foods were part of many children's daily intake: 43% of children had sweets or chocolates every day and 46% had crisps every day. In addition more than 12% had a soft drink (not diet or lo-calorie) every day, although this rose to 25% of those children whose mothers had no educational qualifications.
• Grandparents offering children sweets or sugary snacks were often a problem for those parents who had difficulty with trying to limit their child's sugar intake.
• The majority of respondents reported having received information or advice on children's diets and healthy eating from at least one source, the most popular of these being books, magazines or newspapers, family and friends, and health professionals.

4.8 Conclusion

This chapter provides much that is positive about the food that the birth cohort, now aged 22 months, eat. It would seem that the health promotion messages about fruit, and to a lesser extent vegetables, are being taken seriously by the majority of parents as manifest in their reports about the provision of fruit and vegetables to their young children and their children's consumption of these foods. There are also positive messages about how children eat - it seems most sit at a table and eat with others, usually a parent and/or sibling. These findings challenge the myth about the erosion of family meal times.

However, there are also causes for concern, especially in relation to children's exposure to sugary snacks and drinks and savoury snacks/crisps. Almost all parents said that their child had meals every day but most also had snacks. Although fruit was reported as being the most popular snack, almost half reported that their child had sweets/chocolates and a savoury snack/crisps at least once a day. A worrying 12% reported that their child had a sugary soft drink every day.

Most parents said that they did not have difficulty controlling the amount of sugary snacks/drinks that their child had, although one in ten did report that it was very or fairly difficult. We might expect this proportion to rise as the child gets older with more external influences, although it is interesting to note that even with this young age group, some respondents were beginning to find it difficult to control what their child ate. The most frequently cited reason for having such difficulties was that grandparents gave their child sugary snacks. Further qualitative work would be required to investigate the social dynamics of these relationships and their overall influence on what young children are given to eat.

The findings also show how material circumstances and other indicators of advantage and disadvantage are associated with healthy or less healthy eating. Socio-economic position, maternal age, family type and level of education are all important and of course interrelated. Unsurprisingly, then, lone parents, mothers with less educational qualifications, younger mothers, and those on lower household incomes were least likely to report that their child ate two or more fruits a day and most likely to report that they ate sugary and savoury snacks and sugary soft drinks. Disadvantage can be seen to have an early effect on the lives of young children through their developing eating habits and the type of food available to them.

However, when mothers were asked what influenced what they gave their child, issues of cost did not seem to be the most important, suggesting that the relationship between disadvantage and food and eating behaviour is complex. One in ten reported knowledge of cooking as being an important influence. The data also suggest that knowledge of healthy eating was directly related to the eating of healthy foods by the child, suggesting that a direct approach in terms of health education aimed at improving knowledge would improve eating behaviour. However, the relationship between knowledge and behaviour is notoriously complex and many mediating factors influence outcomes.

It is clear that the wider socio-economic circumstances in which the family live also impacts both directly and indirectly on the child's eating behaviour - directly in terms of the affordability of healthy food and indirectly through the associated poorer educational attainment of the mother. Although this chapter is able to report many positive findings about healthy eating amongst young children, there are also emergent concerns particularly amongst the most disadvantaged whose young children are more likely to eat sugary snacks and drinks and less likely to eat fruit and vegetables. The broader context of the lives of these families needs to be taken into account when considering how best to promote healthy eating.

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