A child's socioeconomic status has an effect on their health from "womb to tomb", explains Dr Cathal McCrory, psychologist and research assistant professor at Trinity College Dublin. A timely reminder perhaps, if ever we needed it, that all children are not born equal.
“Data from the Central Statistics Office [CSO] indicates that children from lower socioeconomic status households have lower life-expectancy at time of birth compared with their more advantaged counterparts. On average, children from lower socioeconomic households are born lighter compared with their more advantaged counterparts,” he says.
“Interestingly, they gain weight at a faster rate thereafter but this is not matched by gains in length/height so that, by three years of age, they are twice as likely to be obese. Our research suggests that smoking during pregnancy, lower breastfeeding rates and earlier transition to solid foods are major contributory factors to this pattern,” McCrory adds.
When it comes to activity levels, there’s a difference too. “The ability to pay for recreational pursuits” has proven to be a feature of the social differences, McCrory says, “but it is important to acknowledge that there are structural features of the neighbourhood environs which may make it difficult for children from lower socioeconomic backgrounds to play safely [for example] lack of green spaces, traffic density in urban areas, etc”, he points out.
So what can we do to optimise our children’s overall health and wellbeing?
And how do these requirements change over the course of childhood?
In the first of a four-part series looking at nutrition, activity levels and taking care of the mental wellbeing of our children, we start with those aged zero to eight.
1: Eating well
The rumours are true – breast-fed babies are exposed to a variety of tastes through their mother's breastmilk. It's one reason "mothers should be encouraged to eat a wide variety of foods while breastfeeding", dietician Sonja Lynch (what2eat.ie) says.
“Breastmilk is tailormade and is constantly adapting to the changing needs of your baby. Breastmilk contains antibodies, live cells and other protective factors. These are produced by your body in response to your environment and are passed on to your baby in your breastmilk. These give your baby unique protection from their surroundings,” making it “the ideal first food”.
Ensure that there is at least one thing on the table that they will eat, even if that's just some fruit, cheese or bread
Trying to get a toddler to eat a balanced diet can be a challenge sometimes, Lynch says. “Fussy eating is common in toddlers. Most toddlers go through phases of refusing to eat certain foods or, at times, refusing to eat anything at all. Fussy eating and food refusal are normal developmental stages. Leading by example and eating together as a family is one of the best ways to avoid fussy eating taking hold long-term.
“Repeated exposure and patience are the key. Don’t offer an alternative dinner. Do, however, ensure that there is at least one thing on the table that they will eat, even if that’s just some fruit, cheese or bread. It can be helpful to involve children in meal preparation [for example] letting a toddler choose which frozen vegetables or which pasta shapes you will cook. Make food fun outside of the kitchen by encouraging them to play with a tea set, growing vegetables or reading books about food,” she adds.
“Ensuring that children have a balanced diet in early childhood is vital for the development of their growing brains and bodies,” Lynch says. “Pound for pound children need much more nutrients such as iron and calcium compared to adults. Iron is important for their brain development, while calcium helps growing bones. To develop their immune system, children require a balance of all food groups and nutrients.”
One obstacle to maintaining that balanced diet is hidden sugars. "Three-year-olds in Ireland are consuming on average 10 level-teaspoons of 'free sugar' a day. Consuming too much sugar is one of the main contributors to the risk of dental caries and obesity. Many foods aimed at children have added sugars, such as sugary breakfast cereals, bars and sugary fruit drinks," Lynch says, recommending that parents "try to choose foods that contain less than 5g of sugar per 100g".
“Eating a balanced diet doesn’t have to be complicated or expensive,” Lynch notes, suggesting parents “try offering a piece of fruit or vegetables at each meal or snack. Frozen vegetables or tinned fruit – in its own juice – can be inexpensive and just as nutritious. Offering sugary foods or fun foods is fine occasionally but try not to use food as a reward. Try to reward children with your time – playing a game together or going to the park”.
2: Getting active
Establishing good physical activity habits should start in babyhood, according to Laurann O'Reilly (nutritionbylaurann.ie), who has a master's in public health and is involved in the rolling out of a national health programme for preschool-aged children.
As babies “become more alert and spend more time awake, parents can continually increase movement and activity during their waking hours”, she says. “The HSE guidelines recommend that babies should be active several times a day. They also recommend limiting a baby’s inactivity, for example, being in a child car-seat for no more than an hour a day except when they’re asleep.”
Children over three should have three hours of physical activity over the course of the day, which should include 60 minutes of “structured active play” that is “energetic”, such as chasing or kicking a ball, O’Reilly says.
But reaching these targets proves challenging for some. “Time can be a huge issue for many parents with busy working lives,” she says, but “knowledge can be another factor, in that many parents genuinely do not know the activity requirements of their children”.
Many families may not have had access to outdoor areas or a park within their 5km radius
Screen-time is also proving an obstacle when it comes to meeting recommended guidelines. “Understandably, screens including video games, TV and the phone can be of great assistance to busy parents, however, the HSE do not recommend screens for children under the age of two years and a maximum of one hour screen-time per day for children over the age of two years,” she adds.
The pandemic has also played its part in reducing activity levels.
“Covid would have had an impact on children’s activity levels as many families may not have had access to outdoor areas or a park within their 5km radius. Schools provide a huge opportunity and supportive environment for children to be active and to meet many of the activity guidelines. While the schools were off and with many parents also working from home or as essential workers, understandably meeting these activity requirements would have been challenging.
“Physical activity or active play has numerous benefits in helping children to meet their developmental milestones, developing their senses, improving their posture, enhancing their understanding of spatial reasoning, promoting bone and joint health, maintaining a healthy weight and building strength – as well as the social and emotional aspect of interacting,” O’Reilly says.
“Children gain more skills in their first six years than at any other point in their lives. These are their basic fundamental moving skills and building blocks.
“Physical activity plays a vital role in preventing chronic illnesses such as heart disease, cancer, typetwo diabetes as well as other conditions in later life,” she adds, pointing out the continuing challenge Ireland faces with childhood obesity.
“One in five children are overweight or obese,” she says. “A combination of the correct nutritional and physical activity strategies can help to combat this and setting down the foundations of these at a young age is essential.”
Unsurprisingly a “monkey see, monkey do” approach appears one of the best strategies in encouraging young children to be active. “Evidence has found that children whose parents or guardians are active are more than five times as likely to stay active.” What is also important, O’Reilly says, is choosing the right activities for your child’s age. “If you don’t, your child might become bored or frustrated.”
3: Mental wellbeing
Lecturer in psychology and early childhood studies with the Open University Dr Mary O'Kane says: "We should be aware of positive mental-health from birth. We know that babies come into the world ready to make connections with others and this interaction is important for their wellbeing. Research, where mothers are asked to stop communicating with their babies during interactions, show us how babies respond with distress to a lack of response from the mother. Warm loving relationships provide comfort and are the way in which babies develop a sense of their own worth".
In that context, O’Kane is completely against the idea of self-soothing in terms of sleep strategies. “If children are struggling to go asleep by themselves, to me they are crying out for connection. Letting them ‘cry it out’ means leaving them without that connection. I wouldn’t recommend ignoring the cries of a child at any age.”
She does see value in terms of equipping children “with skills they can use to help them calm when feeling stressed or anxious”.
Causes of mental-health struggles for children in this age group can vary, O’Kane says. “There can be genetic tendencies but also environmental. We used to talk about nature or nurture but now we know the interaction of the two is important. What we do know is that mental-health difficulties are becoming more common. Research published in 2013 found that by the age of 13, one in three children in Ireland will have experienced some form of mental-health difficulty. So, for a family with three children, it is likely that one may struggle with some mental-health difficulty by the time they are a teenager.
There is absolutely no evidence to show that homework benefits children below 11 years
“Issues in school can be huge. Bullying, relational aggression, struggles with friendships – and they can lead to mental-health issues, again particularly anxiety. School refusal is becoming more and more common. I absolutely hate that term as it implies the child is in control and has made a decision not to attend, when for many children, the struggle is with anxiety.”
O’Kane has strong feelings on homework. “There is absolutely no evidence to show that homework benefits children below 11 years,” she says. “In fact, there is also little evidence to show it helps older students either. Yet, the time our children spend on homework is increasing and increasing. So many parents complain that homework causes stress and arguments every day. The learning environment for children in the home is very important and academic homework seems to set this up to be a negative experience. Instead, ‘homework’ like reading a book they enjoy, getting outside to play – this is how our young children learn best – playing a sport, or spending time with family, are a much better use of their time.”
The biggest influence on a child’s mental health “is their relationship and connection with you”, O’Kane says. “Encourage them to talk about their feelings and emotions. Be that ‘one good adult’ your child needs by being a calm, consistent presence in their lives.
“Try not to remove all stressors for them. Instead, encourage them to push boundaries. When faced with difficulties, support them to problem-solve themselves rather than fix everything for them. And practice, practice, practice their controlled breathing when they are calm.
“While it’s normal for all children to struggle at times,” O’Kane cautions to “always see your GP if you feel your child’s mental health is an issue that is significantly affecting their daily life”.
