Setting children on the path to a healthy life should start with
supporting their well-being and capitalise on their instincts,
imagination and freedom to choose. By Pat Gordon-Smith

It may come as a surprise in this age of advanced medical knowledge and up-to-the-minute advice, but the phrase that springs to mind in relation to children's health is not new. In fact, it is very old: a handful of words attributed in the Bible to St Paul. For while current guidance has settled on three cornerstones for children's healthy living - a balanced diet, an active life, the security of loving relationships - experts also agree, and here is where St Paul comes in, that 'the greatest of these is love'.

'Attachment security is most important of all. Children's emotional well-being far outweighs any physical health issue,' says professor Sarah Stewart-Brown, chair of public health at the University of Warwick's medical school. 'We know from how we feel ourselves that if you're not strong emotionally you're more likely to be physically ill.'

Julie Mountain, director of Play Learning Life, agrees. 'It's about people first and foremost, then fuel and exercise,' she says.

'You can be motivated by good feelings, but bad feelings get in the way,' says early years expert Marion Dowling. 'When memories are preoccupied, the working memory doesn't function properly because minds are filled with negative thoughts.'

This, she explains, can affect a child's actions so that existing knowledge and habits - to wash hands before a meal, to brush teeth correctly - can appear lost: 'It is reflected in the phrase "I can't think straight" that we sometimes use when we're anxious.'

Professor Stewart-Brown makes a similar point about receptiveness. 'If children are emotionally secure they become curious,' she says. But she also acknowledges that it is not enough to make the link between emotional and physical health. 'It's all very well for me to say that attachment is key, but it's not so easy for parents and practitioners to just make it happen. Everyone develops neurological patterns that affect how they deal with the world, and some people need support to find different ways of doing things.'

She hopes that 'mindfulness' - a technique for being present in the moment rather than distracted by other things - can offer a way to manage feelings and so address emotional health.

'It's an extremely calming thing to do and there's lots of research about its success in schools and for adults,' she says. 'If staff started doing it in early years settings it would immediately help their own well-being, and they could do it in small ways with children.'

Early years creativity expert Anni McTavish uses a different approach. She finds that songs, stories and adventures offer rich potential for young children to investigate their feelings and develop healthy routines.

'I might send the children a letter to get things started,' she explains. 'It could say:

"Dear Children. I hope you're well. Just a quick note to say that the Three Billy Goats Gruff are still stuck on the other side of the river. They are scared and hungry and cold. Please can you build bridges and bring something to make them feel better?"

'The idea is to help build social and emotional strength. While we're constructing bridges, we talk about our own needs, about how other people's comforts may differ from our own, and about whom we go to for care and help.'

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CHILDREN'S INSTINCTS

If experts agree that loving, secure attachment is the essential grounding for children's all-round health, they are also clear that trusting children's instincts and a commitment to fostering their self-directed choices are key to a healthy lifestyle.

'It's not just about acquiring skills,' says Lala Manners, early years physical development expert and director of Active Matters (www.activematters.org). 'It's about children making decisions for themselves. They take much more responsibility for their lives than we give them credit for.'

She explains that young children know how much exercise they need. 'They never push themselves too far; they either sleep or just stop.' And they also know best when it comes to choosing activities.

'The UK Physical Activity Guidelines for Early Years recommend 180 minutes of moderate-to-vigorous activity per day for under-fives - nothing heavy; things like jumping on the bed, splashing in the bath and scootering to and from school,' says Ms Manners. 'But they know what works for them. Small children don't shin up a tree unless they are ready for it, and some will prefer to be active by themselves rather than in a group.'

Ms Mountain describes how an outdoor space can be planned to suit varying preferences. 'We create a range of spaces,' she says. 'It won't do to have one space and just break it up into lots of small bits.'

She explains that some children -especially, but not only, boys - need more space than others. 'They are not necessarily being more active, but they move around more. So when we reorganise an outdoor area, we always look to keep a big enough space for moving about as well as small, enclosed harbours for less vigorous movement and chatting with friends.'

Like Ms McTavish, Ms Mountain favours play that engages children's imagination, in this case for fostering their healthy activity. 'We almost always get rid of fixed equipment when redesigning a play area because it doesn't offer the challenge that keeps children moving and which develops their co-ordination.'

She prefers adventure, or 'twin', trails featuring rope balances, ramps and posts set at different heights. Although these, too, are fixed, she says that they can be launch points for imaginative play.

'You might install a wobbly bridge and posts for weaving and balancing at a low level, then add blocks and a den-building kit so that children can adapt a resource that was designed by adults,' she says.

Ms Mountain suggests that a collection of big sticks, log slices, planks and tree trunks can be also added at little or no cost. 'Children can build anything with them, while developing gross motor skills and manual dexterity as they move them around.'

Where young children's choice is for focused activity, there are experts to introduce them to sport. At the Active Learning group of nurseries, children learn the early skills needed for specific sports such as golf, tennis and football.

'The children have been focusing on football skills for the past few months because of the World Cup,' says Active Learning's director Amanda Johnson. 'At first they had no ball skills, but now many can do complex manoeuvres like flipping the ball in the air with their feet and playing it when it lands.'

While each of the Active Learning settings has a significant outdoor area, Ms Johnson says that sporting skills can be developed in smaller areas or in a local park, although 'what is absolutely necessary is fully qualified sport-specific teachers or coaches'.

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HEALTHY EATING HABITS

Choice is also a key ingredient for establishing healthy eating habits. 'While parents or practitioners should choose what goes on the plate, the children should choose what goes in their mouths,' says Professor Stewart-Brown. 'This gives them autonomy over their bodies and helps them to learn how much food they need and when they've had enough.'

Jubilee Day Nursery in Reading offers lots of freedom with eating, especially at breakfast where all the children from 18 months old serve themselves. 'Everything is put out at the children's level in containers that they can reach,' says nursery manager Lesley Thompson. 'We talk about portion size and the children quickly learn how much they can manage. It also helps them to learn about waste.'

Penny Tassoni, early years consultant and president of the Professional Association for Childcare and Early Years, says that knowing how much to put on a plate is a skill that parents and practitioners need to learn just as much as the children.

'Through history, parents have been hard-wired to feed children up, because in time of famine or shortage heavy babies were more likely to survive. Now we have to do the opposite, which is to learn that you don't have to eat food just because it is there,' she says.

Adults and children also need to weigh up all the messages about diet in order to strike a healthy balance, says Jessica Williams, paediatric dietician and advisor on the Voluntary Food and Drink Guidelines for Early Years Settings in England, published by the Children's Food Trust.

'The statutory framework for the Early Years Foundation Stage says that food offered to children must be "healthy, balanced and nutritious", but it's hard to know what that means,' she says. 'It doesn't mean that children should never have sweet foods.'

Ms Tassoni agrees. 'By and large, messages are too simplistic. Take orange juice, for instance. Is it good or bad for you? Well, the simple answer is that it's bad.' As Professor Stewart-Brown explains, 'The sugar in juice is more readily available to the body than if you eat the fruit and this has fuelled the obesity epidemic'.

'But,' Ms Tassoni continues, 'juice is also very nice, and a little of it makes us feel good. At other times, ice frozen into funny shapes can help children enjoy plain water.'

Ms McTavish, who sometimes scandalises practitioners by suggesting that the children take an imaginary piece of chocolate cake on a creative journey, agrees. 'You have to give children a bit of what is forbidden so they can regulate what they have for themselves,' she says. 'It's usually the children who have had too many restrictions who don't have self-control.'

'Children need more calories relative to their size than we do,' explains Dr Williams. 'So sometimes they should have cake for dessert, rather than just fruit or yoghurt. The problem comes when they have cake or biscuits as a snack rather than as part of a meal. Instead, they need regular meals and regular snacks with a range of foods.'

At Jubilee Day Nursery, the children often snack on fruit and vegetables they have grown. 'The children plant and harvest food, and they can eat it there and then if they want,' says manager Ms Thompson. 'They've been picking raspberries today and just popping them in their mouths. At other times of year, we keep a bucket of water near the vegetable patch so that the children can wash carrots they have pulled from the ground and eat them straight away.'

Jubilee has a 50-acre outdoor area but, as Ms Thompson says, produce such as tomatoes, peas and strawberries grow well in bags that take up little space. 'And you can grow potatoes in a tyre stack. We did that once. You stack up the tyres then add soil and seed potatoes into the hole. When the potatoes are ready, take the tyres away and the potatoes just fall out.'

It is a simple solution to a problem, just as a few clear principles - about balance, imagination, trusting children, using what you have and respect for difference - can lay a simple path through the many misleading messages about health. Those same principles are also the guide for understanding and appreciating the many different styles and traditions of a loving relationship in which children flourish, and which provide the essential foundation for their all-round health.

As Ms Manners puts it, healthy children have 'time, space and enough supervision to be able to interact with the environment and each other, and to develop in a way that fits with the culture in which they are growing up'. All the rest is detail.

SONGS FOR HEALTHY ROUTINES

By independent early years consultant Anni McTavish

Wash your hands

To the tune of Row Row Row Your Boat:

Wash, wash, wash your hands,

Make them nice and clean.

On the top, on the bottom,

Fingers in between.


Sing a song of toothpaste

To the tune of Sing a Song of Sixpence:

Sing a song of toothpaste, squeeze it on our brush,

Clean them in the morning, there's no need to rush,

Clean them in the evening, make them shining bright,

Round and round, up and down, what a smiling sight!


The Train Chant

Cheese and crackers, cheese and crackers.

Eggs on toast! Eggs on toast!

Spaghetti, spaghetti.

PEAS! PEAS! PEAS!


ROUTES TO HEALTHY LIVING

Mindfulness

- For background information, and a review of research, see 'Developing mindfulness with children and young people: a review of the evidence and policy context' by Katherine Weare (2013) in Journal of Children's Services, 8 (2), 141-53.

- Access to mindfulness teacher-training courses, http://mindfulnessteachersuk.org.uk

- Still Quiet Place is a CD/MP3 download with a gentle mindfulness journey for young children to learn how to control breathing and find balance in their bodies and lives. The American narration is thoughtful, but it is annoyingly languid and practitioners may prefer to use the text for their own sessions, www.stillquietplace.com

Songs and stories

  • Sing a Song, Tell a Tale, published by Early Education, is Anni McTavish's joyful practical guide on how to work creatively with songs and stories.

  • Puppets by Post has a range of characters, www.puppetsbypost.com

  • There are a handful of storybooks for emotional health and good eating: Frog is Frightened, Frog in Love and many other 'Frog' titles by Max Velthuijs; The Blanket by John Burningham; Super Daisy and the Peril of Planet Pea by Kes Gray and Nick Sharratt, and Isabel's Noisy Tummy by David McKee.

Active children

Healthy eating

The Voluntary Food and Drink Guidelines for Early Years Settings in England offer guidance on all aspects of young children's diet, including pictorial representations of portion sizes on the plate, www.childrensfoodtrust.org.uk/pre-school/resources/guidelines

More pictorial representations of portion sizes, from the Caroline Walker Trust - child portions, www.cwt.org.uk/chew.html; adult portions, www.cwt.org.uk/publications.html

Growing Schools offers advice for growing food in settings, www.growingschools.org.uk/resources/early-years.

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