The results of the diet and nutrition survey of infants and young children (DNSIYC) 2011 were published on the 13th March 2013, and are available on the Department of Health website here. DNSIYC is a one-off survey, commissioned by the Department of Health and the Food Standards Agency. The survey, which includes 2683 children, provides the only source of high quality nationally representative data on the types and quantities of foods consumed by the 4 to 18 month age group, from which estimates of nutrient intakes are derived. This information will compliment data from the National Diet and Nutrition Survey (NDNS), which covers children and adults aged from 18 months upwards, to provide a fuller picture of the diet, health and food safety of the nation, and to support public health policy and food safety assessments. 

DNSIYC involved an interview, a 4-day diet diary, maternal and child anthropometric measurements, blood samples and estimates of breast milk intake, fluid intake and body composition. The survey was carried out in all 4 countries of the UK between January and August 2011. Additional recruitment was undertaken in Scotland and among those in receipt of Healthy Start vouchers in order to provide more detailed analysis of these populations. These additional samples are referred to as ‘boosts’. Results for the boosted Scottish sample form a separate report published on the Scottish Government website and results for the boosted Healthy Start1 sample are presented in Annexe A of the DNSIYC report. Food consumption patterns were broadly similar in the DNSIYC Healthy Start sample as for the DNSIYC UK sample.

Overall, infants and young children aged 4 to 18 months in DNSIYC were reported to consume a varied diet and dietary recommendations were generally met by the majority of the population.  The analyses presented in the report do not identify any new nutritional problems in this age group.

The findings, in relation to recommendations, include:

The Department of Health recommends that mothers exclusively breastfeed for around the first six months of the child’s life.
  • Twenty two per cent had never been breastfed, of those who were breastfed, 57% were not breastfed beyond three months of age. 

For those who choose to use breast milk substitutes, follow-on formula and ‘goodnight’ milks should not be introduced before the child is six months of age.
  • Thirty two per cent of infants aged 4 to 6 months consumed follow-on formula, which is not recommended before six months. 

At around six months of age a variety of complementary foods should be introduced alongside continued breastfeeding (and/or breast milk substitutes, if used).
  • Complementary foods were introduced before the age of three months for 10% of children, and before five months for 75% of children. For 22% of children, foods were not introduced until six months, and for 3%, foods were introduced at seven months or more. 

Cow’s milk should not be introduced as a main drink until after 12 months. If provided, this should be whole (not semi-skimmed) milk until at least two years of age.
  • Children aged below one year generally consumed no more than a quarter of a pint (146g) of whole milk per day, in keeping with the recommendation. For example, 15% of those aged 4 to 6 months consumed whole cow’s milk over the survey period with a mean consumption of 53g per day among consumers. This increased to 79% of those aged 12 to 18 months with a mean consumption of 329g per day. 
  • A small proportion of children consumed, as a drink, semi-skimmed milk; 5% of infants aged 4 to 6 months with mean intakes of 40g per day among consumers increasing to 13% of children aged 12 to 18 months with mean intakes of 169g per day among consumers. Small proportions of children consumed other milk including 1% milk, skimmed milk and cream, increasing from 1% of those aged 4 to 6 months to 10% of those aged 12 to 18 months. 

Salt should not be added to children’s food.
  • For those children who had food other than milk, most parents (83%) reported ‘never’ adding salt to the child’s food.

Vitamin A, C and D supplements should be given from six months unless the child is formula fed and receiving more than 500ml of formula per day. Breastfed infants born to mothers with a low vitamin status may require supplements earlier, from the age of one month.
  • Over the four-day food diary period, the proportion of children given a micronutrient supplement ranged from 5% for those aged 4 to 6 months to 10% for those aged 12 to 18 months, most often a multi-vitamin supplement. Children aged 4 to 18 months of South Asian and ‘other’ ethnicities were more likely to be given at least one supplement during the four-day food diary period than white children. 

Breastfeeding mothers should take vitamin D supplements of 10μg per day.
  • Nearly half (46%) of breastfeeding mothers took supplements, most often a multi-vitamin and mineral supplement, which were taken by 27% of all breastfeeding mothers. The proportion taking supplements containing 10μg vitamin D was not assessed. 

If formula feeding, guidance regarding the safe preparation, storage and handling of infant formula should be followed, for example: Powdered formula should be made up as needed, with boiled water that has been allowed to cool for no more than 30 minutes.
  • The majority of parents feeding their child infant formula in the home followed recommendations for preparation. For example, 79% reported making up the formula as needed and 68% used water that had been left to cool for no longer than 30 minutes. 

For optimum dental health mothers should start to introduce infants to drinking from cups and beakers from about six months and tooth brushing twice a day should begin as soon as teeth begin to appear.
  • The proportion of children who had ever drunk from a cup or beaker with a spout increased with age, from 47% of those aged 4 to 6 months, rising steadily to 95% of those aged 12 to 18 months. 
  • A toothbrush was reported to be used at least once every day for 66% of children with at least one tooth.

Other key findings include:
  • Seventy five per cent of boys and 76% of girls exceeded their Estimated Average Requirement (EAR) for energy. 
  • Mean protein intakes were well above the Reference Nutrient Intake (RNI) in all age groups.
  • Mean daily intakes of key vitamins and minerals from all sources (including supplements) were above or close to the RNI for all age groups with the exception of vitamin D for non-breastfed children aged 12 to 18 months and for breastfed children (by any degree of breastfeeding), across all age groups, although these are underestimates as they do not include the contribution of breast milk to vitamin D intake. 
  • The proportion of children with daily intakes of vitamins and minerals from all sources below the Lower Reference Nutrient Intake (LRNI) was low (8% or less) except for iron for all age groups (10% to 14%) and magnesium for infants aged 4 to 6 months (10%). 
  • For those aged 12 to 18 months, the proportion with intakes of iron below the LRNI was significantly greater for South Asian (28%) and ‘other’ (19%) children compared to white children (11%), as well as for children in the routine and manual category (17%) compared to the managerial and professional category (8%). 
  • Mean daily intakes of sodium were only 85% of the RNI for children aged 4 to 6 months, but increased to 181% for children aged 12 to 18 months. This equates to an intake of 2.3g salt per day for children aged 12 to 18 months, exceeding the population recommendation for this age group of no more than 2g salt per day. 
  • The majority of children had adequate haemoglobin and serum ferritin concentrations, with only about 3% below the thresholds at which anaemia is indicated. 
  • Ninety four per cent of children aged 5 to 11 months and 98% of children 12 months or over had 25-hydroxyvitamin D concentrations above the lower threshold for vitamin D adequacy.

1Healthy Start is a Government scheme set up to offer a nutritional safety net for pregnant women, new mothers and children under 4 years of age in very low income families, and encourage them to eat a healthier diet. The scheme provides vouchers to put towards the cost of milk, fruit and vegetables or infant formula, and coupons for free Healthy Start vitamin supplements (see: http://www.healthystart.nhs.uk/). 
 
Reference Nutrient Intake (RNI): The RNI is the amount of a nutrient that is enough to ensure that the needs of nearly all the group (97.5%) are being met. By definition, many within the group will need less.
 
Lower Reference Nutrient Intake (LRNI): The amount of a nutrient that is enough for only the small number of people who have low requirements (2.5%). The majority need more.

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