This is a set of six topics on healthy lifestyles, with information, ideas, resources and activities for families. The programme has been dveloped to provide simple information that can be incorporated into existing activities in early years settings or used to provide guidance for individual parents. The programme information has been developed for use with the general population but, where centre staff are aware of families that have unhealthy lifestyles, they can use the SS4BC programme to target families.

The information will also be relevant to early years staff when parents ask questions about healthy eating or what to do if their child is a fussy eater for example. Staff can refer to the resources to ensure to provide consistent messages when working with families.

Small Steps for Big Change topics list

The information included in SS4BC does not cover areas related to play, parenting skills and emotional wellbeing, such as dealing with temper tantrums. Staff should include relevant information, based on their own expertise, when discussing these issues with parents, emphasising the importance of play, praise and encouragement, understanding and talking about feelings, showing an interest in whet their child is doing, talking to their child and giving their child smiles and hugs.

How to target families who may particularly benefit from the programme and further support

Small Steps for Big Change can be used to support children and families who are at risk of being overweight. In Islington, nearly a quarter of children are overweight or very overweight by the age of five. Overweight and very overweight children tend to remain so or get more overweight as they grow up and become adults

Childhood obesity is linked to a number of poor physical, social and phsychological outcomes:

  • increased severity of asthma and other respiratory disease
  • low self-esteem and bullying
  • lower academic achievement
  • lower quality of life, such as joint pain and difficulty getting about, difficulty breathing when lying down (sleep apnoea)
  • increased risk of long-term health conditions such as diabetes and heart problems

How to identify families whose children may be at risk of becoming overweight or very overweight

  • The parent/carer raises a concern about their child’s diet or weight.
  • Visual identification:
    • unlike in the past, today’s children tend not to grow out of puppy fat because they have fewer opportunities for physical activity and are tempted to eat more than they need.
    • some children have skinny arms and legs and a large tummy therefore may still be overweight.
  • Family displays an unhealthy lifestyle:
    • unhealthy diet – eating unhealthy food; drinking fizzy drinks, energy drinks or soft drinks such as a juice drink or squash, not eating enough fruit and vegetables; drinking lots of milk and/or drinking from a bottle after the age of two. Tooth decay generally indicates a diet high in sugar.
    • sedentary lifestyle – the child spending a lot of time sitting in car seats or pushchairs (children over two should be encouraged to walk as much as possible); spending a lot of time watching TV, playing computer or video games; being on an iPad, mobile or other screens for long periods.
    • lack of routine – no set meal times; constantly eating (grazing); staying up late or irregular sleep pattern; spending a lot of time on screens. Sleep is important for growth and brain development; there is also a link between lack of sleep and obesity: research has shown that three-year-olds who slept for less than 10 hours per day were at greater risk of being obese by the age of seven.
  • Parental weight and lifestyle is the biggest predictor for a child becoming overweight or obese.

Referral to services

For parents who may need more support to make changes to their family's lifestyle, further support is available by referral or signposting to:

1.a Let children have fun with food

  • Children like to see, touch, smell and taste food. Encourage them to use all their senses to learn about food, and praise them when they do.
  • Children enjoy having food served in a fun way, so think about colours, shapes and textures. For example, try making a smiley face on an open sandwich.
  • Children love to help with food at all stages, so involve them in shopping, growing, preparing and cooking food, and laying the table.
  • Children should be encouraged to feed themselves; give them child-size cutlery, and serve finger foods that they can eat with their hands.
  • They may make a mess, but this is how children learn about food and eating. Put a bib on your child and cover the floor with a sheet of plastic so that any spillages are easy to clean up.

Activity: Food preparation - make smiley faces out of snack items

Parent leaflet - Fun with food

EY cards: Talk about where food comes from and Talk about food choices Bengali

EY cards: Talk about where food comes from and Talk about food choices Somali

EY cards: Talk about where food comes from and Talk about food choices Turkish

1.b Healthy teeth are important for healthy eating

  • Children need to be supervised in brushing their teeth twice a day.
  • Parents could use the Small Steps sticker chart to encourage regular brushing.
  • Children need to go to the dentist every six months.
  • Children over one should always drink from a cup or free-flow beaker. Water and milk are the best drinks for young children.
  • Children are more likely to suffer from tooth decay if they regularly eat sugary foods.
  • It is all right to give children foods containing sugar and diluted fruit juice occasionally, but keep them to mealtimes only.
  • Offer your children healthy snacks like vegetable sticks or pitta bread and a hummus dip, natural yoghurt with slices of banana, or crackers and soft cheese.
  • Avoid giving them biscuits, fruit juice, squash, chocolate or sweets as a snack or treat.
  • Children who need to take medicine should be given the sugar free option where possible.

Activity: Invite Obuko Obiuwevbi, oral health promoter, to run a session for your parents.

Parent leaflet - Healthy teeth

First tooth first visit

1.c Be patient and give children lots of chances to get used to unfamiliar foods

  • Some children may have to taste a new food 15 times before they accept it.
  • Try serving the same food in different ways. For example, you may find that your child likes carrots when they are raw but not when they are cooked.
  • Children may be more willing to try a new food when it is served with a food they like.
  • Avoid offering your child an alternative when they refuse something you have given them.
  • Avoid telling your child off when they refuse food; just take the food away and tell them that mealtime is over.
  • Never force children to eat.
  • Turn off the TV and don’t have distractions like computers, mobile phones or toys on or near the table at mealtimes.
  • Children like to hear positive comments about their eating. Praise children when they try new foods.

Activity: food tasting

Parent leaflet - Try new foods

How to use the Small Steps for Big Change chart

Small Steps for Big Change chart

Veg stickers

Success stickers

1.d Children enjoy eating with others

  • Children will learn to enjoy healthy food and pick up social skills when eating with others who set a good example. Sit down together at mealtimes as often as possible.
  • Children can eat the same healthy food as the rest of the family.
  • Children eat better if mealtimes are calm and enjoyable.
  • Children enjoy it when you talk together at mealtimes. Try talking about the food you are eating, such as where it comes from, why it is good for you and how delicious it is.

Activity: Food tasting activity

Parent leaflet - Mealtimes

Speech and Language leaflet - Table talk

Children should be served child-friendly portions

  • Children need children’s portions. Compare the size of your fist with that of your child. This is equivalent to the difference between an adult’s stomach and a child’s, so they need smaller portions. It’s a good idea to use a smaller plate, too (20cm diameter), so the portions don’t look small.
  • Give your child less to start with – they can always ask for seconds. That way there will be less waste and they won’t eat too much.
  • Take care with prepackaged portions as most of these come in adult sizes. Share a portion between two children or keep some back for another time.
  • Children are very good at knowing when they have eaten enough. They should not be encouraged to eat all the food on their plate as this will stop them being aware of how their tummies feel, and may result in them eating to get praise rather than because they are hungry.
  • Don’t rush a child who is eating – leave time for the brain to register that their tummy is full. Children need to eat small quantities of healthy food regularly (roughly every 1.5 - 3 hours across the day, which means they will have around three meals and two snacks daily).
  • Children need to eat when they are hungry, not for comfort, as a reward, as a treat or out of boredom.
  • Children may eat different amounts from day to day, depending on what else they have eaten, how physically active they have been, or the situation in which they are eating.
  • When children are tired they are likely to overeat, which can lead to them putting on extra weight. It is important for children to develop a good bedtime routine to help them get the sleep they need for healthy development.

Activity: Guess the correct portion

Parent leaflet - Child size portions

FSNT recipe leaflet

3.a Children need a balanced diet to be healthy, to grow, learn and play

  • Food gives children energy (calories) and nutrients (protein, fat, starch, vitamins and minerals) which they need to grow, learn, play and stay healthy.
  • Children grow and develop very fast, so it’s important that they get lots of nutrients from their food.
  • Different foods have different nutrients so children should eat a wide variety of foods in order to get all the different nutrients they need.
  • Children should only eat take-aways and convenience foods occasionally – ideally less than once a week. If a family is used to eating take-aways and convenience foods daily, start by trying to reduce this to 2-3 times a week. This will make it easier to achieve
  • change in the longer term.
  • Children should only have foods and drinks high in fat, sugar or salt, such as biscuits, cakes, chocolate, crisps and sweets, once a day or less.
  • Across the day, children over one should have:
    • at least five portions of different fruit and vegetables: have some vegetables and/or fruits as part of each meal and snack. Dried fruit should not be given as a snack.
    • four portions of starchy foods a day: Each meal should be based on a starchy food, and one snack should contain a starchy food.
    • three portions of milk or dairy products a day, such as milk, yoghurt, cheese, custard or rice pudding.
    • two to three portions of meat, fish, eggs, beans or any other non-dairy sources of protein.

Activity: label reading

Parent leaflet - Healthy eating

Label reading cards

3. b Children need three nutritious meals and two snacks spread across the day

  • Children should eat regularly. The time between a snack and a meal should be no less than 1½ hours and no longer than 3 hours.
  • Get children used to sitting down and having breakfast. A healthy and nutritious breakfast gives children the energy to learn and be active. A healthy breakfast can be: porridge; low sugar cereal (such as wheat biscuits or malt wheat); or toast with a topping such as a fat spread, jam, peanut butter, cheese, banana or baked beans; dried, tinned (in juice) or fresh fruit; and a drink, such as milk, diluted fruit juice or water.
  • Plan snacks so they are healthy rather than just grabbing something on the go.
  • One of the snacks should contain a starchy food, such as crackers, breadstick, bread, or toast; the other should include a vegetable or some fruit (but not dried fruit).
  • For example, snacks could include: vegetable sticks or pitta bread and a hummus dip; natural yoghurt with slices of banana; or crackers and soft cheese.

Activity: Uncover the sugar

Uncover the sugar activity sheet

Parent leaflet - Nutritious meals

Parent leaflet - Snack suggestions

3.c Children should be encouraged to have water as their main drink

  • Sugary drinks have no place in a child’s diet.
  • Water is the perfect drink to have when thirsty. It is free, contains no calories, and replaces the fluids that the body loses during the day.
  • Children under five should drink about a litre a day, some of which is milk.

Milk
From 12 months:

  • Whole cow’s milk should replace infant formula. Skimmed milk should not be given to children under the age of five.

Children aged 12 months - two years:

  • should have 300 - 400ml (2 cups) of whole milk as a drink or as part of their food daily. This counts as two of their three daily portions of dairy foods.
  • If breastfeeding, continue to do so, and use whole milk in food or as a drink.

Children over two:

  • can reduce their milk intake to 150 - 200ml (1 cup) if they are eating other dairy foods (such as cheese and yoghurt). This counts as one of their three daily portions of dairy foods. If children drink lots of milk, they won’t eat as well, and will miss out on nutrients such as iron (which is low in milk).
  • can have semi-skimmed milk if they are eating and growing well.

Parent leaflet - suitable drinks

4.a Plan a menu for the week and buy food accordingly

  • Cooking from scratch is cheaper and healthier than buying readymade meals, which are often high in fat, sugar, salt and additives.
  • Fruit and vegetables are often cheaper at the market than in a supermarket.
  • Avoid pre-cut, pre-peeled and packaged vegetables and fruit. They are more expensive and lower in nutrients than loose fruits and vegetables.
  • Buy own brand cereals, which are cheaper but generally no different from branded versions. The saver versions of many foods can also be a good choice, but avoid saver versions of meat products like sausages or burgers, as these are likely to be low in meat content and high in fat and salt.
  • Frozen fruit and vegetables are as nutritious as fresh, and tend to be cheaper. They can be stored and used when needed, which cuts down on wastage.
  • Tinned tomatoes, beans, pulses and fish are cheap and healthy. They often have long use-by-dates which reduces waste. Tinned fruit in fruit juice and unsalted vegetables can count towards your five-a-day.
  • Cut down on meat. Use less meat in dishes by adding peas, beans (such as chickpeas, red kidney beans) or lentils.
  • Children in Islington primary schools are eligible for free school meals. Packed lunches are time consuming to make, more expensive than a free school meal and generally not as healthy.
  • If eligible, use Healthy Start vouchers to buy fruit and vegetables.

Further information on the national Healthy Start scheme

Activities: Price comparison, menu planning, shopping list. Promote Family Kitchen or other healthy cook and eat sessions run in your Bright Start area (www.islington.gov.uk/brightstart)

Ready vs Homemade quiz

Ready vs Homemade quiz answers

Family meal planner

Menu shopping list

Parent leaflet - Eating on a budget

EY cards Health with cooking and Plant a seed Bengali

EY cards Health with cooking and Plant a seed Somali

EY cards Health with cooking and Plant a seed Turkish

4.b Children under five should take a vitamin supplement daily: Healthy Start supplements are free in Islington

  • All women who are trying to get pregnant, as well as pregnant women, mothers with children under a year old, and children up to the age of four who live in Islington are eligible to get free Healthy Start vitamins. These should be taken daily. Breastfeeding mothers and those who are recipients of Healthy Start are eligible for Healthy Start vitamins until their child is one.
  • Healthy Start vitamin tablets are made specifically for pregnant and breastfeeding mums. They contain folic acid and vitamins C and D.
  • Healthy Start vitamin drops for children contain vitamins A, C and D.
  • Healthy Start vitamins should not replace a healthy diet but should supplement a good, balanced diet for mothers and children.
  • Healthy Start vitamins are available from some health centres and children’s centres around Islington.

Further information and places to collect Healthy Start vitamins

Islington Healthy Start fold out card

Islington Vitamin D leaflet

5.a Children under five need to be active for three hours a day to help them develop and stay healthy

  • Children under five need to be active for at least three hours every day to develop their muscles and motor skills and have a healthy heart.
  • Being active also helps to improve children’s sleep, concentration and behaviour and emotional health and wellbeing.
  • Being active helps children to be a healthy weight.
  • Encourage children to be more physically active in lots of different ways. Physical activity for children under five should include both light intensity activities, such as walking, and more energetic activities, such as running, jumping and climbing.
  • Light intensity activity can include walking, standing up, washing, dressing, craft activities and playing board games.
  • Energetic physical activity can include running, climbing, jumping, cycling, scooting, swimming, skipping and dancing to music.
  • Parents should reduce the time children spend sitting without being active (for instance, strapped in a car seat or pushchair) unless they are doing a learning activity such as reading.

Activity: Throw and catch game with bean bag

5.b Children can be active inside and outside in lost of different ways

  • Children can take part in organised activities for children or the whole family, for example a game of football at the park or meeting up to play with their friends in the park.
  • Children can spontaneously do unstructured individual activities, for example by providing them with dance scarves to dance or playing with balloons.
  • Encourage children to walk, scoot or cycle rather than sit in a pushchair.
  • When children are aged two to three, they should be able to jump, climb on a climbing frame, kick a ball and hit a ball with a bat.
  • When children are aged three to four they should be able to catch a ball, ride a scooter and a two-wheeled bike with stabilisers.
  • Children who have a disability or any other learning delay may not have the same level of ability or may develop their physical activity skills at a different rate.

Activities: Using dance scarves and playing Keepy Uppy with a balloon

British Heart Foundation leaflet - Help your child move and play every day

Let's play leaflet

EY cards Play ball games with your child and Play singing and dancing games Bengali

EY cards Play ball games with your child and Play singing and dancing games Somali

EY cards Play ball games with your child and Play singing and dancing games Turkish

6.a Decide what your child is going to watch or do in front of a screen and limit the time

  • Encourage children to watch television programmes they can actively participate in by, for example, singing along and copying actions.
  • Follow up programmes by encouraging play and conversation about what children have watched.
  • Good screen time is when children’s eyes are moving about and following things on the screen, rather than staring straight ahead as they watch.
  • Ask children to repeat new words and talk about what they have seen on TV or done on the computer.
  • Watch television with your child and talk about what is happening.
  • Switch the television off and put away computers and mobiles at mealtimes.
  • Avoid using the television as background noise. If no one is watching it, switch the television off.
  • Try to limit the amount of time children spend in front of a screen. Children under two should spend no more than 30 minutes per day looking at a screen, and for children aged between two and five, this should be no more than two hours a day. The less the better.
  • Children who spend too much time in front of a screen have less time to talk, be physically active and explore the world around them. They may be deprived of the opportunity to play, explore and interact with other children and adults.
  • Children are less likely to be physically active if they spend a lot of time playing computer games (such as Wii, Playstation and Xbox), watching TV or in front of any other screens. This may delay the development of their motor skills (intentional movements that must be learned and practised). Children need plenty of opportunities to physically explore their surroundings in order to develop motor skills successfully.
  • Children who spend a lot of time looking at screens have fewer opportunities to develop their social and language skills.

Parent leaflet - Best use of screentime

 Speech and Language leaflet - Watch less talk more

EY activity card Collect large boxes to use in imaginative play and Making marks, patterns and drawings Bengali

EY activity card Collect large boxes to use in imaginative play and Making marks, patterns and drawings Somali

EY activity card Collect large boxes to use in imaginative play and Making marks, patterns and drawings Turkish

6.b Build in time without screens as part of your child's daily routine

  • Plan some activities that you can suggest when your child is bored. For example, make a den with blankets and sheets or play dressing up.
  • Try to have some time playing or reading a book with your child as part of their daily routine.
  • Encourage your child to choose a game and let them lead on it. Praise them when they are playing and talking
  • Change the toys that you get out for your child to play with, so he or she doesn’t get bored. Borrow new toys from the toy library at your local children’s centre.
  • Imaginative, unstructured play helps children explore and understand the world around them.
  • Messy play helps children get used to different touch sensations, and may benefit children who are fussy eaters.

Parent leaflet - Limit screen time

Speech and language leaflet - Language through play

Speech and language leaflet - Talking with playdough

Small Steps for Big Change resource pack

Parent only programme presentations (developed by Hugh Myddelton)

Record of Delivery (complete and return to Marjon for a new pack of resources)

Regular training is provided to support EY professionals to ensure consistent healthy lifestyle messages are provided to families. Book your place through the training channel:

Finding a course

For further support and advice or staff training at your setting, please contact Marjon Willers:

Email Marjon Willers.