Eating at least five portions of fruit and vegetables a day to support children's growing brains and bodies is widely recognised, but the importance of consuming omega-3 is often overlooked.
Our bodies are unable to produce the amount of omega-3 we need to function properly, meaning we need to get it from the food we eat.
Omega-3 fatty acids are a group of polyunsaturated fats:
- Alpha-linolenic acid (ALA) – found in plant foods such as flax seeds, chia seeds, walnuts and soybeans; also some green leafy vegetables, including kale, spinach and Brussels sprouts.
- Eicosapentaenoic acid (EPA) – mostly found in oily fish and fish oil, including salmon, mackerel, sardines and trout.
- Docosahexaenoic acid (DHA) – also mostly found in oily fish and fish oil.
While all three have health benefits, specialist paediatric dietitian Lucy Upton says DHA is the most important omega-3 fatty acid in our bodies. ‘DHA is a powerhouse nutrient for the brain,’ she explains. ‘It makes up about 15 to 20 per cent of the brain's fat content and is essential for maintaining normal brain function.
‘It's like a building block for the brain and is very important for sending messages and building new connections, building new nerves and nerve pathways, so it has a big job.’
DHA helps brain development by:
- supporting brain cell membrane health and allowing brain cells to communicate with each other
- helping with the creation of new neurons
- contributing to the release of neurotransmitters.
Along with the brain, Upton adds that consuming omega-3 supports eye development, including healthy vision, and safeguards the brain and body against various stresses and inflammation. ‘So it's a really key nutrient, particularly for children,’ she says. ‘Lots of brain building is happening in the first three years of life – in that first 1,000 days – so a good intake of omega-3 is widely linked to cognitive ability, better attention and memory and even areas such as emotional regulation.’
There are no specific government recommendations for children's daily intake of omega-3 in the UK. However, the European Food Safety Authority (EFSA) suggests an adequate intake of combined EPA and DHA of 250mg per day for children aged over two years old and adults. Younger children, from seven to 24 months old, are recommended by the EFSA to have a daily DHA intake of 100mg. Consuming DHA is now recognised as so important that it is mandatory in the UK and EU to include it in formula milk.
BARRIERS
Unfortunately, recent studies suggest that many children in the UK are not getting enough omega-3 fats in their diets.
‘Research from the University of Bristol found that seven-year-olds were consuming just 85mg of long-chain omega-3s per day, less than half the recommended amount,’ says Bahee Van de Bor, registered paediatric dietitian and chair of the British Dietetic Association's Paediatric Specialist Group. ‘Similarly, a study from the University of Oxford suggests that many, if not most, UK children probably aren't getting enough of the long-chain omega-3 we all need for a healthy brain, heart and immune system.’
She believes that several factors are contributing to this trend, including children not regularly eating oily fish, which is the richest source of omega-3.
‘Growing concerns about microplastic contamination in seafood have also made some parents hesitant to include fish in their family's diet,’ says Van de Bor. ‘Additionally, the higher cost of fresh, high-quality fish can be a barrier for many families.’
Upton recommends using cheaper cuts of oily fish or tinned and frozen oily fish as a cheaper alternative – ‘mackerel tends to be much cheaper, or tinned sardines are great, and you also get the benefit of the calcium from the little bones’.
She adds that knowing how to cook fish and what meals to include it in is not often shared, so parents can struggle. Early years settings can support families by sharing popular oily fish recipes with them – such as fish cakes, cheesy salmon pasta or kedgeree.
‘Even if families serve fish, some children don't want to eat it because it's strong-tasting. It is one of the most common foods that toddlers drop when they hit the neophobic food refusal stage because it's got a strong smell and a very distinct texture,’ Upton says.
While our bodies can convert ALA from plant-based foods into DHA, this happens very slowly and is not efficient.
‘For children who either don't eat fish because they don't like it or can't eat it because they are allergic, vegetarian or vegan, I recommend giving them a DHA supplement when they have stopped having breast or formula milk,’ Upton advises. ‘There are DHL supplements that are fish oil – not cod liver oil – but vegetarian and vegan ones are from algae. There is no specific guidance around dosage, but for two-to four-year-olds, around 100 to 150mg a day is good.’
GETTING USED TO IT
It can take a while for children to like a new food, sometimes as many as eight to 15 times, so it is recommended that children are regularly served oily fish at nursery and home in order for them to try a small amount and, hopefully, get used to it.
Upton says it is good practice to include oily fish on the nursery menu at least once a week. ‘If parents are also offering it once at home then you've got two portions of oily fish, which is a good balance,’ she explains. However, she cautions against consuming large quantities because of the risk of possible pollutants in the fish.
Omega-3 is also sometimes added to other foods, such as enriched eggs, milk, bread and some spreads. Certain fish fingers that are made from non-oily fish also have DHA added. For a non-fish alternative, include seaweed (nori) in the weekly diet.
‘Incorporating omega-3-rich foods into the weekly menu and varying the presentation can make it easier for children to get the DHA and EPA they need,’ adds Van de Bor. ‘To encourage children to eat fish, try incorporating it creatively into meals. For example, make fish pie, add fish to pizzas or mix salmon with yoghurt to create a tasty spread for toast. Repeated exposure to these flavours in different ways helps children become more accepting of foods they might initially be hesitant to try.’
the role of omega-3 in ADHD and autism
Some studies have shown that omega-3 can be used to support children who have ADHD and autism (see Further information, above).
However, both Upton and Van de Bor say these findings should be viewed with some caution.
‘There is some early evidence suggesting that omega-3 supplementation might provide modest benefits for children with ADHD, especially those with low omega-3 levels,’ says Van de Bor.
‘For example, a study of 92 children with ADHD found that those with lower EPA levels showed improved attention after supplementation. However, other research shows omega-3 supplements to be less effective overall.
‘In children with autism, some studies have noted improvements in hyperactivity and social skills, while others found no significant effects.’
FURTHER INFORMATION
- The Association of UK Dietitians on omega-3 and links to ADHD and autism: https://tinyurl.com/3p9up6tn
- The Marine Stewardship Council's guide to purchasing seafood from sustainable sources: https://tinyurl.com/499enpfu
- Lucy Upton: https://tinyurl.com/55r32zw8
- Bahee Van de Bor: https://tinyurl.com/pr4stb5t
