Health and nutrition: to start

An accreditation program in Birmingham is helping early childhood staff encourage children to eat healthy and get more exercise. Meredith Jones Russell reports

With nearly a quarter of Birmingham’s children receiving the year overweight or obese, the Startwell program was established in January 2018 to help promote healthy lifestyles in early childhood settings through physical activity and healthy eating.

Startwell is an award-based program commissioned by Birmingham City Council. It allows PVI settings, nurseries and children’s centers in Birmingham to work towards establishing criteria in order to achieve a Startwell award.

Local childcare providers can also access the program’s training sessions, while the Startwell website provides resources for all professionals. Everything is free.

Startwell team leader Sarah Bates explains: ‘We wanted to come up with a program that really engaged professionals and children and incorporated basic principles of healthy eating and physical activity into their daily routines. There were already programs targeting schools, but we wanted this to be more applicable to the early years.’

Staff often lack confidence when it comes to delivering strong messages about healthy eating and exercise, says Bates.

‘Settings often haven’t explained to children why healthy eating and physical activity are important,’ she adds. “Staff already have a lot to cover, and Ofsted doesn’t ask much about food and drink, so staff aren’t challenged on that. When nutrition messages come through things like the Public Health England guidelines, they are quite complex, not as well publicized and voluntary. You need a good knowledge base to understand exactly what they mean.’


Food training sessions support staff on topics such as weaning, picky eating, and the mealtime environment, while environments must adhere to the Startwell menu guidelines for the early years.

Startwell uses cartoon characters including Two Snacks Max, Fay Five a Day, and Active Azra to deliver health-related messages, based on research linking the use of characters with young children to successful behavior changes, such as increased willingness to eat fruit

“Hopefully, it’s catchy,” says Bates. ‘Although some of the messages are obvious, when practitioners first start the show they may not know exactly why we have a character named 180 Katie, for example. But once it’s explained that the chief medical officer recommends that preschoolers spend at least 180 minutes a day in a variety of physical activities, it’s easier to get it stuck in their heads.’

The award is valid for two years, as long as the settings continue to provide evidence that they meet the required standards.

“We didn’t want it to be a box-ticking exercise,” says Bates. “We wanted it to be something that really clicked. So we are clear from the beginning that it is not a short process. It can take 12 months; it could take more time. We want to make sure environments are comfortable with it and that it can be sustained.”

In some settings, staff turnover can present a challenge in completing the award. “It can be a big problem,” says Bates. ‘Everything can be delayed when a leader leaves and all the work has to be delivered. That’s one of the reasons we want to make sure it’s really integrated; so it’s cascading and not too dependent on one person. We want everyone to be trained.

Environments meet with members of the Startwell team every four to six weeks during the accreditation process, while tracking progress online, attending staff training sessions, and staying in touch by phone or email.

“It’s important that we go and witness what happens in a setting in person,” says Bates. “In part, that’s why it takes time to pass, because we want to be absolutely sure that the activities are really high-intensity, for example.”


Since the revised EYFS introduced a focus on oral health, the program has enrolled many more professionals in its oral health training sessions, with around a quarter of children in Birmingham suffering from caries, missing or filled teeth. , more than the national average.

‘In the training we go through evidence-based practices on things like tooth brushing,’ explains Bates.

“We provide many activities for families to do at home and ideas for professionals to promote Smiley Shen’s oral health messages.”


In Birmingham, 91 nurseries and eight of the city’s ten Children’s Centers have already completed the award. Some of these are also invited to complete the program’s advanced award.

“The advanced award has criteria to further stretch the setup,” says Bates. “We take a closer look at things like a complete menu overhaul, outdoor environment, or physical activity planning.”

A report on the Coventry University program found that staff in Startwell settings had more confidence, better staff training and better access to resources for nutrition and physical activity than in control settings.

Bates says, “We know that everyone interacts differently, so we try to cover as many paths of engagement as possible.”

case study: The Elms Day Nursery at the University of Birmingham

Staff at The Elms Day Nursery at the University of Birmingham already made physical health and nutrition a priority when they applied for the Startwell award.

Assistant Manager Vicki Wall explains: ‘We were so focused on making sure our children were eating well and getting plenty of activity that it seemed like a natural progression to join. I wouldn’t say we needed help, but we felt it would be something that would set us apart.’

In the process, though, Wall says the staff learned a lot. “The initial training definitely gave us new ways of looking at things,” he acknowledges. ‘Some elements were really revealing, especially in relation to oral health, like how many children have cavities. Now, when we are introducing parents to day care, we always ask if your child is registered with a dentist.

“Staff sometimes have a hard time coming up with ideas for physical activities, so it was a great way to get inspired and remind them to join in too. The character of Suzy Startwell is designed to ensure that we are role models in physical activity. We made sure the staff were doing yoga and dancing sessions and just drinking water, so that’s what the kids saw.”

Staff developed a ‘skills for the month’ initiative to help children’s physical development and conducted an audit of the outdoor environment to ensure it was well prepared to support physical activity. “We introduced different areas for the kids outside,” says Wall. ‘Now we have a space for the children to be relaxed and calm, as well as a space where they can express themselves freely. We added growing areas with vegetable boxes and different gradients.’

Using characters also helps kids process healthy eating messages, adds Wall.

After receiving the Startwell award, the environment went on to earn the advanced award, and Startwell’s ongoing training and support has been invaluable, says Wall. “It gives the staff a lot of insight and confidence.”

Eating good

Xanthi Maragdouaki, Registered Nutrition Professional with the Early Years Nutrition Partnership (EYNP), talks about preparing children to enjoy school meals

A key part of the EYNP approach is supporting early childhood educators to engage parents in their children’s nutrition. We often see around this time parents with children who are about to leave the early years and start school who begin to think about school meals or packed lunches. These changes can be a big challenge to established nutritional habits, and parents often turn to their trusted early childhood providers for some advice.

If children receive school meals, there is a risk that every day they will make the same choice, depending on what the school offers, a choice that parents will not necessarily approve of. It is important to encourage children to make good and nutritious choices. Encourage parents to pick up the menu if they can and go over it with their child, discussing how each meal on offer can benefit them. For example, ‘eating protein will help you grow and eating vegetables will make your body stronger’. At the same time, most schools also offer a ‘gift’ day. It’s important for children to be a part of this, so parents and caregivers should avoid demonizing food.

Alternatively, many parents may be considering packed lunches. The goal of including five different fruits and vegetables in your lunch box can be challenging, but you should aim to offer a balanced and nutritious spread of these items throughout the week and alternate protein sources from day to day. For the main part of the meal, there is no need to get too complicated. Some pasta with chicken pieces, hummus with vegetables and bread, or sandwiches with different fillings like cooked fish, egg-free and meat-free options. Chicken nuggets, fish sticks, and bean burgers are also an easy option, in addition to leftovers. If children prefer a hot lunch, these are possible using lunch boxes with a built-in thermostat. Overall though, the message should be to try to keep lunch boxes simple, varied and colourful.

A positive attitude towards food based on a good foundation is a strong predictor of healthy nutrition habits later in life. Most importantly, lunchtime is also an important part of school life, so it’s important for parents and carers to not only focus on what children eat, but also whether it was a fun time and if they had interesting conversations with their friends. Lunch should be nutritious but also enjoyable!

If you would like to discuss any of the topics raised in this column or anything else related to early childhood nutrition, please contact Jonathan Lucas at [email protected] to schedule a conversation with one of the EYNP’s registered nutrition professionals. For more information see

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