This document summarizes a study that surveyed the foods consumed by 4-year-old children from inner-city schools in Jamaica during their break times. The purpose was to record the key nutrients (protein, carbs, fat, calcium, sodium, iron) in the snacks packed in their lunch boxes. Data was collected by observing 103 children during break and analyzing the nutritional content of their snacks. The findings showed the snacks were generally low in important nutrients like protein, calcium and iron, but high in sodium. This provides baseline data on the nutritional intake of these young, inner-city children.

1. School Meals: A Lunch Box Survey of Foods
for Four Year Old Inner-City Basic School
Children at Break Time.
Andrea Searchwell

2. Courage is not the absence of fear… It
is the triumph over it.
Nelson Mandela

3. PURPOSE
 lunch box survey of the foods consumed by four- year- old inner-city
Basic School children at break time
 recording selected energy nutrients in snacks taken to school in the
lunchboxes: (Protein, Carbohydrate, Fat)
 recording important micro-nutrients in snacks: (Calcium, Sodium, Iron)
 reporting the consumption of important Nutrients by inner-city Basic
School children
 providing baseline data emphasizing the implications for the health of
children

4. INTRODUCTION
Nutrition and Child Development
 Proper nutrition during the first five years of a child’s
life is critical for mental, emotional as well as physical
development. Grantham – McGregor et al (2007)
 20% of deaths among young children up to six years
old could have been avoided if appropriate feeding
guidelines for young children were followed.(WHO)

5. Introduction
Nutrition and Child Development
 children will enter into adulthood experiencing health
problems... These include type-two diabetes, coronary
heart disease and a reduction in life expectancy.
Fox et al (2009)

6. LITERATURE REVIEW
 Reviews on child development in developing countries
describe nutrient deficiencies as biological risk factors
that contribute to loss of developmental potential in
children younger than 5 years.
 200 million children aged less than 5 years living in
developing countries fail to reach their potential in
cognitive and socio-emotional development because
of stunting which is an indicator of chronic under
nutrition.
Grantham McGregor et al(2007) Lancet

7. Early Childhood Commission (2005)
Highlighted that there were persistent levels of
malnutrition characterized by underweight and obesity
in Jamaican children
Reported the findings of the Survey of Living Conditions
in Jamaica 2004 to Cabinet in parliament
Five percent of Jamaican children were malnourished

8. Malnutrition
 The World Health Organization (WHO) reports that
178 million children worldwide are stunted resulting
from inadequate food, vitamin and mineral
deficiencies as well as poor diet and disease.

9. Malnutrition
Stunting is described as (length-for-age less than -2
standard deviation) according to the United States
National Center for Health Statistics Growth References
Stunting:
 Inadequate height for age
 Failure to thrive
 Jamaican context ( the pickney down grow)

10. Malnutrition
 Stunting leads to poor growth which in turn slows
down brain development and leads to poor mental
development.
 Poverty is linked to inadequate food, and when
compounded by poor sanitation and hygiene, it also
leads to infection and stunting.

11. Research
 Several cross-sectional studies have shown an
association between stunting and poor school
performance and reduced cognitive ability.
 In Egypt and Kenya the dietary intakes of children
have been associated with cognition and behavior.
Grantham – McGregor et al(2007) Lancet

12. Research
 A few longitudinal studies (long term) have been
done on the topic of nutrition and child development.
They give better quality evidence to confirm the
relationship between nutrition and development
 Studies in Guatemala and Jamaica have confirmed that
undernourished children showed later deficits in
literacy and numeracy as well as memory, vocabulary
and reasoning.
Baker – Henningham et al (2005)

13. OVERNUTRITION or OBESITY
 Research has shown that children sometimes snack on
calorie dense chips and sugar beverages which increase
their risk of developing obesity

14. Malnutrition
Obesity
 The eating habits of children are formed early
 International Obesity Task Force reported in 2003
that the prevalence of obesity in children 5-17 years
was 32% in the Americas and 10% worldwide.

15. Food Choices
In light of the increased number of persons suffering
under nutrition and obesity worldwide including in very
young children, the development of good eating
behaviors during childhood is needed to improve the
dietary patterns and health status of children
Fox et al (2009)

16. School Meals
 In Jamaican early childhood institutions or basic
schools children spend approximately seven hours a
day.
 School is often a place where children are socialized
and where they engage in eating because their peers
are doing the same.

17.  School age children [in Jamaica] engage in a high
consumption of snacks and sweets both for break and
lunch and although these are high in energy they are
low in protein and micronutrients especially iron.
Walker et al (2007)

18. Methodology
STUDY SITE
 The sample was selected from a larger study looking at
violence prevention intervention in inner city basic schools
in Kingston Jamaica. TMRI, UWI
 The parent study was a cluster randomized controlled trial
in 24 inner city basic schools. There are approximately 20
students in each class.
 This study utilized a convenience sample of the 4 year old
classes in 10 of the basic schools in the parent study.

19. Sample
 A convenience sample of 103 lunch boxes was selected
from the 4 year old classes in the 10 basic schools.

20. Data Collection
 The researcher acted as a non participant
observer
 The observation instrument was compiled using a
validated observation sheet adapted from the Early
Childhood Nutrition Pilot Study
 The instrument was adjusted after piloting by
including more space under the lunchbox
identification to accommodate a detailed description
of the lunch box

21. Ethical Approval
 An application was submitted to the University of the West
Indies Ethical Committee and an exemption for ethical
approval was granted.
 The researcher was advised to obtain written consent from
the Ministry of Education as well as the Principal in each of
the study schools and this was obtained.

22. Procedures
 1. Obtain written permission from the Ministry of
Education and principals of the ten basic schools
selected for the lunch box survey.
 2. Visit each school and schedule the date and time
for data collection with principal and the teacher for
class four.
 3. Check the class time table for the times allotted for
break and lunch.

23. Procedures
 4. On the day of data collection arrive at the school at
least one and a half hours before break time.
 5. Report to the principal and the class teacher on
plans for the lunch box survey.
 6. Proceed to the class room and identify the area
where the lunch boxes/bags are kept.

24. Procedures
7. Identify and sort lunch bags and separate them from
the school bags.
8. Find out which school bags are used for snacks as well
as those snacks that are kept in the kitchen.
9. Use a small numbered sticker to tag the lunch bag. It
should be place inconspicuously so that children may
not remove it. (e.g. In a pocket or under a flap).

25. Procedures
 10. Write a detailed description of the lunch bag
indicating the brand name, colour or any identifying
feature which may distinguish it from others.
 11. The observation sheet was then used to record the
pre-break contents as well as post- break contents of
the lunch bag.

26. INSTRUMENT
 Validated observation sheet adapted from the Early
Childhood Nutrition Pilot Study.
 Piloted and pre-tested in two schools

27. Lunch Box Number and ID Food Choices Portions Eaten
#1
Green and black Yak Pack
medium size bag. Front
pocket black.
1 bag St. Mary’s banana
chip . (2oz.)
1 chubby soda grape. (4oz)
All
1/2
#2
LUNCH BOX SUVEY
FOOD CHOICES AND PORTIONS EATEN AT BREAK
SCHOOL ID: _________________________
DATE:___________________ TIME:___________________

28. Data Collection
 Additional note paper was used to record the
nutritional contents of the local foods that would not
be found in Nutribase a nutrition data analysis
programme.
 Empty snack bags, paper, drink boxes and bottles were
collected and the nutrient contents of these foods
recorded from food labels at a later time.

29. Procedures
 Children were observed during break time to
determine if portions were spilled or discarded in the
garbage bins.
 An estimate of the children’s consumption was done
and recorded in fractions so that children were
recorded as eating whole, half, or a quarter of the
snack or lunch items
 The researcher did the observation on one school day
in each of the 10 four year old class rooms.

30. Data Analysis using NUTRIBASE
Food Item Protein
grams
Carbs
grams
Fat
grams
Fruit -
Flavored
Drinks
3.36 3.90 0
Fruits, Canned 3.36 3.60 -
3.78
0
Fruits, Raw 3.36 2.48 -
3.60
0
0

31. Data Collection
 The food items which represented the snacks selected
by the inner city basic school children were entered
into the Nutribase Data base.
 The Nutribase database is a nutrition analysis
programme used to analyse the nutrient content of
food items. The majority of the food items were not
found in the Nutribase database.

32. Data Collection
 The nutrient content of food items not found were
entered manually into the database as a Personal Food
Item (PFI).
 Where no nutrient information for the food items was
available the Food Composition Tables compiled by
the Caribbean Food and Nutrition Institute was used
and the food items entered manually into the
Nutribase Database.

33. Data Collection
 The results were entered into SPSS.
 Descriptive statistics was used to present the findings. The
data was skewed eg. some snacks were high in sodium and
some were low
 The Median and Range statistics were utilized instead of
the Mean (average)
 Median gives a better (true) report of the average because it
is not affected by high or low numbers

34. Presentation of Findings
 Table 1 shows the most popular snacks brought to
school in the lunch box of the 4-year-old inner city
basic school children in the study. The snacks were
mainly low in protein, calcium and iron and high in
sodium.

35. Table 1- Popular Snacks Brought to Schools in the Lunch Box of 4-year-old
Inner City Basic School Children in Ten Schools
FOOD ITEM PRO
gm
CHO
gm
FAT
gm
CALCIUM
mg
SODIUM
mg
IRON
mg
KCAL
cheese krunches 3 25 7 0 390 0 175
chee zees corn snacks 3 22 16 0 300 0 244
big foot corn snack 1 11 6 0 205 0 102
sandwich cookies 2 24 7 0 80 0 171.5
soda
0 36 0 0 0 0 144
pine apple juice drink 0 27 0 0 0 0 108
fruit punch
0 23 0 0 0 0 92
cherry fruit drink 0 36 0 0 0 0 144

36. Table 2 : Percentage Contribution of Food
Items in the Lunch Boxes of 4-year-old Inner
City Basic School Children in Ten Schools
FOOD ITEM NUMBER OF
CHILDREN OBSERVED
(103)
PERCENT
FRUIT 6 6
CHIPS 40 39
BAKED PRODUCTS 40 39
CHEESE TRIX TYPE 44 43
DRINK
SODA 20 19
FRUIT JUICE/DRINK 87 85

37. Table 3: Macro Nutrient and Kilocalories in Snacks Consumed by 4-year-old
Basic School Children in Ten Inner City Schools at Break Time
SCHOOL
(Number of
children)
CONSUMED
PROTEIN (G)
Median
(Range)
CONSUMED
CARBOHYDRATE(G)
Median
(Range)
CONSUMED
FAT(G)
Median
(Range)
CONSUMED
KILOCALORIES
1
(N=10)
2
(1-11.5)
45
(20-96)
6
(4-16)
265
(167-496.5)
2
(N=8)
0.5
(0-6)
34.5
(0-73)
5
(0-12)
189
(63-428.5)

38. Table 4: Micro Nutrient in Snacks Consumed by 4-year-old
Inner City Basic School Children in ten schools at Break time
SCHOOL
(Number of
children)
CONSUMED
CALCIUM
Milligrams
(Median Range)
CONSUMED
SODIUM
Milligrams
(Median Range)
CONSUMED
IRON
Milligrams
(Median Range)
1
(N=10)
0
(0- 280)
183
(0-273)
0
0
2
(N=8)
0
(0-14)
147.5
(0-273)
0
0
3
(N=9)
0
0
100
(0-205)
0
0
4
(N=9)
0
0
150
(0-390)
0
0

39. Table 5: Macro Nutrient and Kilocalorie Content of Snacks Brought to
School and Consumed by 4-year-old Inner City Basic School Children in
ten schools at Break Time
BROUGHT TO SCHOOL
TOTAL
PROTEIN
grams
Median
Range
TOTAL
CARBOHYDRATE
grams
Median
Range
TOTAL FAT
grams
Median
(Range)
TOTAL KILOCALORIES
IN LUNCHBOX
grams
Median
(Range)
3 55 10 329
(0-19) (15-144) (10-75) (140-1006)
CONSUMED
CONSUMED
PROTEIN
grams
Median
(Range)
CONSUMED
CARBOHYDRATE
grams
Median
(Range)
CONSUMED FAT
grams
Median
(Range)
CONSUMED TOTAL
KILOCALORIES
Median
(Range)
1.5 42 6 220
(0-11.5) (0-113) (0-45.5) (0-697)

40. Table 6- The Percentage of the R.D.A's of Protein, Micro Nutrients and
Kilocalories Consumed in the Snacks taken to school in the Lunch Box
of the 4-year-old of Inner City Basic School Children in Ten Schools
REQIIRED
PROTEIN
mg
REQUIRED
CALCIUM
mg
REQUIRED SODIUM
mg
REQUIRED
IRON
mg
REQUIRED
KILOCALORIE
21.5 500 300* 10 1712.5
%R.D.A
PROTIEN
CONSUMED
(milligrams)
Median
(Range)
%R.D.A.
CALCIUM
CONSUMED
(milligrams)
Median
(Range)
%R.D.A. SODIUM
CONSUMED
(milligrams)
Median
(Range)
% R.D.A.
IRON CONSUMED
(milligrams)
Median
(Range)
% R.D.A.
KILOCALORIE
CONSUMED
(milligrams)
Median
(Range)
6.7 0 55 0 13
(0-53.5) (0-56) (0-143) (0-11) (0-410)

41. Findings
 The most popular food items were commercially
prepared fruit drinks, chips and baked products such
as biscuits or crackers.
 Very few fruits and no vegetables were consumed by
the children
 Salty snack items such as chips or cheese trix were
popular.

42. EMPTY CALORIES

43. Findings
 preschool children snack on foods high in calories but
low in protein and micronutrients
 the pattern of consumption is not consistent with
dietary guidelines e.g Recommended Dietary
Allowances and has implications for children’s health
and well being

44. These food consumption patterns may lead to
under nutrition (characterized by stunting)
 Failure to thrive
 Impaired mental development
 Emotional issues
 Behavioral problems
 Poor performance in school
 Inter - generational poverty
.

45. Findings
Empty calorie foods (high in calories and low in
vitamins and minerals) were popular in lunch boxes
Implications:
 Obesity increasing the burden of disease
 High rates of non communicable diseases
 Diabetes, hypertension, cancer, heart disease
 Disability and death

46. Recommendations
 Dietary guidelines given to parents and care givers
should stress the importance of meeting the special
nutritional needs of preschool children

47. Recommendations
 Increase the awareness of parents, teachers and care
givers about the impact of early food choices on the
eating habits of children over time.
 Policy guidelines which indicate the nutrient content
of school meals should be formulated to improve the
diet of school children since they spend several hours a
day in school.

48. Prepare and promote

49. References
1. Retrieved March 19, (2010) World Health Organisation (WHO) 10 facts on
nutrition.http:// www. who.int/ features/act/files/nutrition/facts/en/index.html.
2. Fox M. K, Dodd A.H., Wilson A., Gleason P.M, (2009) Association between
School Food Environment and Practices and Body Mass Index of U.S. Public School Children: Journal of American Dietetic
Association, Supplement 1, Vol. 109.#2, S108-S117.2.
3. Grantham – McGregor S., Cheng Y.B.(2007) Child Development in
Developing Countries: Developmental Potential in the first 5 years for children in developing countries. The Lancet
Vol.369#9555:60-70.
4. Engle P.L.,Black M., Behrman J.r., Cabral de Mello M.,Gertler P.J.,Kapririri
L., Martorell R., Young M.E.,and the International Child Development Steering Committee:(2007) Child Development in
Developing Countries 3:Strategies to avoid loss of developmental potential more than 200 million children in the developing
world. The Lancet .vol.369 num.9557.229-242.
5. U S National Centre for Statistics and Growth References

50. References
6. World Health Organization official website
7. Grantham – McGregor S., Cheng Y.B.(2007) Child Development in
Developing Countries: Developmental Potential in the first 5 years for children in developing countries. The Lancet Vol.369#9555:60-70.
8. Devaney B., Ziegler P., Pac S., Karwe V., Barr S. (2004) Feeding Infants and
Toddlers Study: Meals, Snack and Beverage Patterns of Infants and Toddlers. Journal of American Dietetics Association.Vol.104/Num.1
Suppl.1
9. Early Childhood Commission (2006): The Development and Implementation of
a Nutrition Programme for Early Childhood Institutions in St. Mary, Jamaica
10. Planning Institute of Jamaica (2002) Survey of Living Conditions.
11. Planning Institute of Jamaica (2002) Survey of Living Conditions