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PrimaryHealth & Wellbeing

Regulating Children’s Sugar Intake is Important for Dental Health and Obesity – But that Doesn’t Mean Banning Desserts

Poor oral health leading to tooth extraction is the main reason for hospitalisation in young children, says Lindsay Gilbert

Lindsay Gilbert
by Lindsay Gilbert
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One of the most frequent nutrition questions I get asked by early years practitioners is about sugar – in particular about desserts and whether young children should be allowed them as part of a healthy diet.

With all the media coverage around sugar at the moment highlighting our need to reduce how much we, and in particular our children, eat, many parents are also asking settings to avoid giving desserts to their children, which can put settings in a difficult position and may not be in the child’s best interest.

So, sugar, what’s all the fuss about?

As I’m sure you are aware, childhood obesity is a huge problem in the UK and although the causes of obesity are highly complex, there is clear evidence that what children eat and drink in the early years is an important factor in supporting healthy growth and forming good habits that will keep them healthy into adulthood.

The National Diet and Nutrition Survey (NDNS) highlights that sugar forms a significant proportion of young children’s calorie intake, with many having three times the recommended amount.

The main sources include sweetened drinks such as squash and juices as well as fizzy drinks, but also sweet confectionery, jams, biscuits, cakes and sweetened cereals.

Evidence shows that consuming excess calories from too much sugar is linked to excess weight gain and obesity (SACN 2015), and recently released NCMP data indicates that almost one in four children enter Reception overweight or obese, a figure which increases to one in three children by the time they leave primary school.

Frequently consumed sugar is also a major cause of tooth decay, with one in four five-year-olds having dental caries.

Poor oral health leading to tooth extraction is the main reason for hospitalisation in young children and this contributes to missed days off school, poor dietary intake, pain and discomfort, and can also affect adult teeth coming through.

Free vs natural

A key consideration to understanding the guidelines are the terms ‘free sugar’ and ‘natural sugar’ because natural sugars (fructose and lactose) found naturally in fruit and milk and milk products respectively are not included in the SACN sugar guidelines, and there is no evidence that they contribute to dental caries or obesity.

These foods are an important source of vitamins and minerals like iron and calcium, fibre, protein and fat, which are all important dietary requirements for toddlers and young children.

Conversely, the term ‘free sugars’ refers to those sugars that have been added to a food either by the manufacturer, cook or consumer to specifically sweeten it – think of your table sugar or honey.

These foods are your biscuits, cakes, sweet drinks and sweetened cereals, etc. However, this can also refer to fructose and lactose that has been removed from a fruit or dairy product and added to a different product to sweeten it.

At this point natural sugars have lost their nutritional benefit from the food itself and become one of the bad guys!

Free sugars also refer to juices and purees, as unfortunately, when a fruit is ‘juiced’ or ‘pureed’ the natural sugar is released from the cell structure and becomes a ‘free sugar’ and therefore harmful to teeth.

This is why for babies and young children if they do have it, fruit juices should be diluted with water (1:10 for babies and 50:50 for toddlers).

Serving suggestion

So getting back to the question of desserts. To think about it practically, desserts made from fruit and or dairy products form an acceptable and necessary part of the diet for young children because although they contain natural sugar, they also contain plenty of other nutrients.

They are also an important source of calories vital for normal growth and development.

That said, where possible, reducing the amount of any ‘free’ sugar that also goes into making some desserts by using less in a recipe or choosing an alternative with less sugar is a good way to help meet the SACN guidelines.

Public Health England has recently released example menus for early years settings in England providing examples of good dessert options for both lunch and tea.

The guidance also supports early years settings to meet the Early Years Foundation Stage welfare requirements for food and drink.

Current guidelines

In 2015, SACN reviewed the evidence around sugar and recommended a considerable reduction in the proportion of calories consumed from sugar from 10% to 5% of our total energy intake.

In terms of sugar cubes, this equates to no more than three cubes for two-year-olds, no more than four cubes (15g) for three-year-olds, and more than five cubes (19g) for 4–6-year-olds. With a 30g bowl of Coco Pops containing 10.5g and a 500ml bottle of Ribena containing as much as 50g, it’s easy to see how young children can quickly to exceed the sugar limits and put their health and teeth at risk.


Top tips for reducing sugar

  • Implement the Voluntary Food and Drink guidelines for Early Years settings. This will guide you on suitable breakfast cereals, drinks, desserts and snacks – the key areas for sugar in the diet.
  • Consider how you can manage celebration events (birthdays, etc.) to ensure that children aren’t consuming too much ‘free sugar’.
  • Ensure the portions of any desserts you serve are appropriate for the age of the child.
  • Only provide water and milk as suitable drinks between meals, and dilute fruit juice with water. If fruit juice is given it should be served with a meal and only consumed once a day. The recently revised ‘Eat Better, Start Better’ guidelines actually no longer recommend that fruit juice is given as a drink in early years settings.
  • Avoid biscuits, cakes and pastries as between-meal snacks, and base desserts on fruit or dairy or a combination of the two – e.g. poached pear and natural yoghurt or apple crumble and custard.

Tips for parents

When speaking to parents who are keen to prevent their child from eating desserts, the following tips may be useful:

  • Ensure your food policy includes a section on the nutritional needs of young children and the importance of desserts as part of a balanced diet.
  • Reassure parents that sugar intake is limited across the day/week, particularly if you follow the EBSB guidelines.
  • Gently remind parents that no one is suggesting that we cut out sugar altogether (practically impossible anyway), that all food should be enjoyed, and that sweet foods should form part of that enjoyment.
  • Provide dessert menus including recipes for parents to see and comment on. Why not ask for parents to contribute their favourite recipe?
  • Ask parents to consider the potential negative impact on a child who may not be allowed a dessert when everyone else is.
  • Encourage parents to appreciate that no one food is either ‘good’ or ‘bad’ by itself. We need to take into account the whole diet and the overall quality of the diet. So small amounts of sugar, particularly from natural sources, and the occasional sweet treat are acceptable for all – even those children who do need to cut down on their sugar intake.

Lindsay Gilbert is a paediatric dietitian and joint director of Foodtalk, a social enterprise specialising in the provision of nutrition training and educational resources to early years practitioners. Visit foodtalk.org.uk. Browse resource ideas for Healthy Eating Week.

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