Patients can choose from a range of food and fluids of appropriate textures to achieve each nutrient goal.
Menus are designed so patients can meet:
- protein and energy nutrient goals daily
- micronutrient goals when averaged across a seven-day period.
Textures, serve sizes and food sources by age outlines, for each paediatric age group, the:
- appropriate textures for foods
- contribution of breast milk and infant formula to nutritional intake
- recommended age of introduction of solid foods
- appropriate serve sizes.
Nutrient goal development
Aged 7-12 months: Nutrient goals are based on the adequate intake for all genders, unless otherwise specified.
Aged over one year: Nutrient goals are based on recommended daily intake for all genders in the defined age group, unless otherwise specified.1 Where there is a discrepancy between genders, the higher value for that age group has been used. This is usually the recomended daily intake for males, with the exception of iron.
Compliance with Food Standards
Fish options must be bone free to avoid choking risk, and comply to mercury content recommendations outlined in the Food Standards ANZ, Mercury in Fish Advisory Statement.
All foods for infants, including cereal based foods for infants are compliant with the Food Standards Code - Food for infants and other relevant Standards.
Paediatric macronutrient goals
Energy
| 0-12 months | 3500kJ |
|---|---|
| 1-3 years | 4200kJ |
| 4-8 years | 5500kJ |
| 9-13 years | 7400kJ |
| 14-18 years | 9400kJ |
Nutrient actions
From 7 months
- Offer patients three meals and two to three mid-meals.
7-12 months
- 1700kJ will be achieved from (600mL/day) breast milk or infant formula. Remaining 1800kJ to be provided by food.
1-18 years
- Small serves are available, especially for the 1-8 year age group.
- Large serves or extra serves are available especially for the 14-18 year age group.
- Energy-fortified or nutrient-dense options are available for those with smaller appetites.
- Offer a high-energy mid-meal snack, with at least 500kJ per serve at each mid-meal.
- Offer a lower-energy mid-meal snack, with less than 400kJ per serve, at each mid-meal.
Rationale
7-12 months
- Energy goal is based on an infant male aged 12 months.1
1-18 years
- The energy goal is based on the estimated energy requirement for the oldest male child in each age group with a physical activity level of 1.2 (bed rest) and no disease factor.1, 2 This will meet the requirements of most children in each age group.
- Breastfeeding and infant formula may provide a source of energy.3-7
- Insufficient energy intake is a common cause of poor nutritional status. Low energy intake reduces the effectiveness of treatment and further delays recovery.3, 4
- In early childhood (up to five years), it is common for children to have varying appetites and growth rates.
- Small, frequent, energy-dense meals and snacks from the different food groups are important for meeting energy requirements.7
- Older children may have higher appetites and rely on large serves and high-energy snacks to help satisfy appetite and higher energy requirements (e.g. boys 14-18 years).
Protein
| 0-6 months | 10g/day (1.43g/kg) |
|---|---|
| 7-12 months | 14g/day (1.60g/kg) |
| 1-3 years | 14g/day (1.08g/kg) |
| 4-8 years | 20g/day (0.91g/kg) |
| 9-13 years | 40g/day (0.94g/kg) |
| 14-18 years | 65g/day (0.99g/kg) |
Nutrient actions
From 7 months
- High quality protein options are available at each meal. This includes a variety of meat, poultry, fish, legumes, milk, eggs, cheese, yoghurt and custard.
1-18 years
- Offer a protein source, with at least 5g protein per portion, at breakfast.
- Protein-fortified or nutrient-dense options are available for those with smaller appetites or increased needs.
- Small protein serves are available, especially for the 1-8 year old age group.
- Large protein serves or extra serves are available, especially for the 14-18 year old age group.
- Offer a high-protein mid-meal snack, with at least 3g protein per serve, once a day. Make the snack available at other times for those who need additional protein (this could be a combined high-protein and high-energy snack).
Rationale
7-12 months
- Breastfeeding and infant formula provide a source of protein.3-7
9-18 years
- Nutrient goal is based on the recommended daily intake for males.
Fat (saturated and trans)
| 0-3 years | no restrictions |
|---|---|
| 4-18 years | less than 10% of energy should be from saturated and trans fat, with an upper limit of 13% |
Nutrient actions
7 months to 2 years
- Include full fat products on the menu.
- Do not provide low-fat milk to children aged less than two years.
3-18 years
- Include low-fat or reduced-fat products on the menu as an option in addition to full-fat options.
- Offer monounsaturated or polyunsaturated spreads at each meal.
- Hot mains are cooked with unsaturated fat, where appropriate.
- Vegetable dishes are cooked with unsaturated fat, where appropriate.
- Potato, rice and pasta dishes have less than 2g saturated fat per standard serve.
- Desserts are prepared with unsaturated fat where appropriate.
- Sandwiches are prepared with monounsaturated or polyunsaturated margarine.
- Offer fish two to three times per week (in main meals, salads, or sandwiches). Oily fish such as tuna, salmon, mullet, or sardines should be preferred.
Rationale
7 months to 2 years
- Restriction of dietary fat is not recommended during the first two years of life. Restriction can compromise the intake of energy and essential fatty acids and adversely affect growth, development and the myelination of the central nervous system.6, 7
3-18 years
- Allow patients to select lower saturated fat options.
- Food preparation must incorporate the use of lower saturated fat ingredients.
Carbohydrate
No goal
Nutrient actions
7 months to 18 years
- All breakfast cereals contain less than 30g sugars per 100g.
- All canned fruit is in natural fruit juice or water, and not syrup.
- All fruit juice is 100% juice with no added sugar.
- Do not offer beverages with added sugar and negligible nutritional value (e.g. cordial and soft drinks).
- 1-8 years: limit juice to once per day.
- 9-18 years: limit juice to twice per day.
Rationale
Added or refined sugars should be avoided for children aged less than 2 years.
Fibre
| 0-12 months | No adequate intake defined.1 |
|---|---|
| 1-3 years | 14g/day |
| 4-8 years | 18g/day |
| 9-13 years | 24g/day |
| 14-18 years | 28g/day |
Nutrient actions
1-18 years
- At least 50% of cold breakfast cereals provide at least 3g fibre per serve.
- Offer wholemeal or multigrain bread at all meals as an alternative to white bread.
- Offer sandwiches made with wholemeal or multigrain bread.
- Offer fruit (fresh or canned) at each main meal and make fruit available as a mid-meal option.
- Offer vegetables at a minimum of two main meals per day.
- Offer a main salad as an alternative to a hot main or sandwich at lunch and dinner.
Rationale
Consuming adequate fibre may prevent and assist with managing constipation. The action of fibre in preventing constipation depends on an adequate fluid intake.
9-18 years
- Nutrient goal is based on the recommended daily intake for males.
Fluid
| 0-6 months | 0.7L/day (from breast milk or infant formula) |
|---|---|
| 7-12 months | 0.8L/day |
| 1-3 years | 1.0L/day |
| 4-8 years | 1.2L/day |
| 9-13 years | 1.6L/day |
| 14-18 years | 1.9L/day |
Nutrient actions
7-12 months
- Water can be given in addition to breast milk or infant formula.
1-18 years
- Water is available at the ward level, or at the bedside of all patients, if appropriate developmentally and clinically.
- Offer a selection of beverages at all meals and mid-meals.
- Cow’s milk, plain or flavoured, is offered at every meal, and mid-meal. Low-fat or reduced-fat dairy products are not offered for children aged less than two years.
- Soy milk, if offered, is fortified with calcium 100mg per 100mL.
- Milk alternatives, such as rice or oat drinks, if offered, are not offered as a substitute for milk as they are not nutritionally comparable.
- 1-8 years: limit juice to once per day.
- 9-18 years: limit juice to twice per day.
- Do not offer tea and coffee.
- Do not offer cordial and soft drinks (including diet or sugar free drinks). They can be available if clinically indicated.
Rationale
7-12 months
- 0.8L per day from all sources (breast milk, infant formula, food, plain water and other beverages). 0.6L should come from fluids.1
1-18 years
- Fluid includes water, milk and other drinks.
Paediatric micronutrient goals
Sodium
| 0-6 months | 120mg/day |
|---|---|
| 7-12 months | 170mg/day |
| 1-3 years | 1000mg/day (upper limit) |
| 4-8 years | 1400mg/day (upper limit) |
| 9-13 years | 2000mg/day (upper limit) |
| 14-18 years | 2300mg/day (upper limit) |
Nutrient actions
From 7 months
- Vegetables are cooked without added salt.
- Single ingredient potato, rice and pasta dishes are cooked without added salt.
- Bread has sodium levels of less than 400mg per 100g.
- Do not offer salt sachets.
7-12 months
- All meat, poultry and fish options are cooked without added salt or other sources of added sodium.
- Small serves are available.
- Multi ingredient potato, rice and pasta dishes are cooked without added salt or other sources of added sodium.
- Default menus are designed to provide not more than the adequate intake for sodium per day for each age group.
1-18 years
- Small serves are available for patients aged 1-8 years.
- 10% or less of hot main menu items offered across the menu cycle have more than 575mg sodium per serve.
- High sodium options included on the menu have an additional high quality nutritional benefit (e.g. also high protein).
- Multi ingredient potato, rice and pasta dishes have sodium levels of less than 300mg per serve.
- Default menus are designed to provide not more than the adequate intake for sodium per day for each age group.
- 10% or less of the mid-meal and snack options have more than 300mg sodium per serve.
Rationale
7-12 months
- No upper limit for sodium is able to be established for this age group.1
1-18 years
- Sodium goal is based on the upper limit for all genders in defined age groups.1
- The menu should not be designed to be low in sodium but should not be high in sodium.
- High-sodium meals or foods (such as cheese and ham) can be included for patients who are unwell or eating poorly, provided they are also nutritionally dense.
- When higher sodium options are on the menu, lower to moderate sodium options within that menu group or as sides should also be on the menu.
- Default menus should be designed to stay below the daily upper limit for sodium.
- Sodium intake reduction is a public health goal.1, 8, 9
Vitamin C
| 0-6 months | 25mg/day |
|---|---|
| 7-12 months | 30mg/day |
| 1-8 years | 35mg/day |
| 9-18 years | 40mg/day |
Nutrient actions
1-18 years
- Uncooked sources of vitamin C, of appropriate texture for the age of the patient, are offered at each main meal and mid-meal. These include fresh fruit, raw vegetables, juices, or salads.
- Juices contain at least 20mg Vitamin C per 100mL.
Rationale
Vitamin C has a significant role in wound healing and infection resistance.10
There are large losses of vitamin C in food service handling, processing and cooking.11, 12 Uncooked sources of vitamin C must be available to reduce the risk of deficiency.
Fruit juice is an easily consumable source of vitamin C for patients who are eating less or unable to consume raw fruits and vegetables.
Folate
| 0-6 months | 65µg/day |
|---|---|
| 7-12 months | 80µg/day |
| 1-3 years | 150µg/day |
| 4-8 years | 200µg/day |
| 9-13 years | 300µg/day |
| 14-18 years | 400µg/day |
Nutrient actions
7-12 months
- Patients can choose a range of appropriately textured solids such as fruit, vegetables and rice cereal to contribute to folate intake.
1-18 years
- Offer folate-fortified breakfast cereals.
- Offer a range of vegetable options to allow for selection of five serves of vegetables per day.
- Offer a range of fruit options to allow patients to choose two serves of fruit per day.
Rationale
1-18 years
- There are large losses of folate in cooking and processing.13
Calcium
| 0-6 months | 210mg/day |
|---|---|
| 7-12 months | 270mg/day |
| 1-3 years | 500mg/day |
| 4-8 years | 700mg/day |
| 9-18 years | 1300mg/day |
Nutrient actions
From 7 months
- Do not offer low -fat or reduced-fat dairy products to children aged less than two years.
7-12 months
- Patients can choose from a range of appropriately textured dairy based desserts such as yoghurt and custard to contribute to dairy intake.
1-18 years
- Offer dairy products at every main meal and mid-meal.
- Soy milk or non-dairy milk alternatives are available and contain at least 100mg calcium per 100mL.
Rationale
1-18 years
- Calcium requirements are largely determined by skeletal needs, which increase during periods of rapid growth (such as childhood and adolescence).
- Children and adolescents need calcium to reach peak bone mass and prevent osteoporosis later in life.4-6
- Dairy products are a good food source of calcium. Alternative (non-dairy) calcium options must be available to meet patient dietary requirements.
Iron
| 0-6 months | 0.2mg/day |
|---|---|
| 7-12 months | 11mg/day |
| 1-3 years | 9mg/day |
| 4-8 years | 10mg/day |
| 9-13 years | 8mg/day |
| 14-18 years | 15mg/day |
Nutrient actions
- Offer iron-fortified breakfast cereals daily.
7-12 months
- Meat and vegetable dishes containing thickener should use an iron-containing thickener (e.g. baby rice cereals).
1-18 years
- Offer red meat in at least one main dish, sandwich or main salad per day.
- Offer wholemeal breads, eggs, legumes and white meats to broaden the variety of iron sources.
- Offer a vitamin C source at the same meal (to promote iron absorption).
Rationale
7-12 months
- Solids are the main source of iron in the diet for this age group.
1-18 year
- Iron requirements for adolescent boys increase during growth spurts as new muscle is laid down.
- Adolescent girls may develop an iron deficiency due to growth, menstrual iron losses, and a low intake of dietary iron.14
13-18 years
- Nutrient goal is based on the recommended daily intake for females.
Zinc
| 0-6 months | 2mg/day |
|---|---|
| 7-12 months | 3mg/day |
| 1-3 years | 3mg/day |
| 4-8 years | 4mg/day |
| 9-13 years | 6mg/day |
| 14-18 years | 13mg/day |
Nutrient actions
7 months to 18 years
- Offer meats, fish and poultry daily on the menu.
- Offer cereals and dairy foods daily on the menu.
Rationale
Ensuring adequate intakes of energy, protein and iron will provide opportunities for meeting the zinc requirement.
Zinc is especially important during adolescence because of its role in growth and sexual maturation.15
13-18 years
- Nutrient goal is based on the recommended daily intake for males.
Vitamin B12
| 0-6 months | 0.4µg/day |
|---|---|
| 7-12 months | 0.5µg/day |
| 1-3 years | 0.9µg/day |
| 4-8 years | 1.2µg/day |
| 9-13 years | 1.8µg/day |
| 14-18 years | 2.4µg/day |
Nutrient actions
7 months to 18 years
- Offer dairy products at every main meal and mid-meal.
- Offer meats, fish and poultry daily.
Rationale
7 months to 18 years
- There are limitations in the ability to analyse patients’ actual intake of vitamin B12.
- Reporting of vitamin B12 intake is therefore not required when assessing against the standards.
- Ensuring adequate intakes of energy, protein and calcium will provide opportunities for meeting the vitamin B12 requirement.1
References
- National Health and Medical Research Council. Australian Government Department of Health and Ageing. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. Canberra: NHMRC; 2006 [cited 22 Mar 2022; updated Sep 2017].
- National Health and Medical Research Council. Australian Government Department of Health and Ageing. Nutrient Reference Value for Australia and New Zealand: Energy. Canberra: NHMRC; 2006 [cited 22 Mar 2022].
- National Health and Medical Research Council. Eat for Health Infant Feeding Guidelines Information for Health Workers. Canberra: NHMRC; 2012.
- Australian Department of Health and Aged Care. Australian National Breastfeeding Strategy collection. Canberra: Australian Department of Health and Aged Care; 2022 [cited 15 Aug 2022].
- NSW Ministry of Health. Breastfeeding your baby. Sydney; NSW Ministry of Health; 2016
- NSW Ministry of Health. Breastfeeding in NSW - Promotion, Protection and Support (PD2018_034). Sydney: NSW Ministry of Health; 2018.
- World Health Organization. Infant and young child feeding. WHO; 2021 [cited 15 Aug 2022].
- National Health and Medical Research Council. Australian Government Department of Health and Ageing. Nutrient Reference Values for Australia and New Zealand: Sodium. Canberra: NHMRC; 2017 [cited 22 Mar 2022].
- National Health and Medical Research Council. Australian Dietary Guidelines. Canberra: NHMRC; 2013 [cited 22 Mar 2022].
- Academy of Nutrition and Dietetics. Nutrition Care Manual. Academy of Nutrition and Dietetics; 2022 [cited 15 Aug 2022].
- National Health and Medical Research Council. Australian Government Department of Health and Ageing. Nutrient Reference Values for Australia and New Zealand: Vitamin C. Canberra; NHMRC; 2006 [cited 22 Mar 2022].
- National Institutes of Health Office of Dietary Supplements. Vitamin C Fact Sheet for Health Professionals. US: NIH; 2022 [cited 22 Aug 2022].
- McKillop D, Pentieva K, Daly D, et al. The effect of different cooking methods on folate retention in various foods that are amongst the major contributors to folate intake in the UK diet. Br J Nutr. 2002;88(6):681-688. DOI: 10.1079/BJN2002733
- National Health and Medical Research Council. Australian Government Department of Health and Ageing. Nutrient Reference Values for Australia and New Zealand: Iron. Canberra: NHMRC; 2006 [cited 22 Mar 2022].
- National Health and Medical Research Council, Australian Government Department of Health and Ageing. Nutrient Reference Values for Australia and New Zealand: Zinc. Canberra: NHMRC; 2006 [cited 22 Mar 2022].