Australian Institute of Health and Welfare. Nutrition Across the Life Stages. 2018. (accessed 20/08/2019)

Australian Bureau of Statistics. National Health Survey: First Results, 2017-18. 2018. (accessed 20/02/2020)

Bere E, Veierod MB, Klepp KI. The Norwegian School Fruit Programme: evaluating paid vs. no-cost subscriptions. Prev Med.. 2005; 41:(2)463-470

Cockburn J. Adoption of Evidence into Practice: Can Change be Sustainable?. Medical Jounal of Australia. 2004; 180:(6)66-67

De Villiers A, Steyn N, Draper CE, Hill J, Gwebushe N, Lambert EV, Lombard C. Primary School Children's Nutrition Knowledge, Self-Efficacy, and Behavior, after a Three-Year Healthy Lifestyle Intervention (HealthKick). Ethnicity & Disease. 2016; 26:(2)

De Vlieger N, Van Rossum J, Riley N, Miller A, Collins C, Bucher T. Nutrition Education in the Australian New South Wales Primary School Curriculum: Knowledge and Attitudes of Students and Parents. Children. 2020; 7:(4)

Donaldson-Pressman S, Jackson R, Pressman R The Learning Habit: A Groundbreaking Approach to Homework and Parenting that Helps Our Children Succeed in School and Life, 1st ed. New York, USA: Penguin Group; 2014

Dresler-Hawke E, Whitehead D, Coad J. What are New Zealand children eating at school? A content analysis of `consumed versus unconsumed’ food groups in a lunch-box survey. Health Education Journal. 2009; 68:(1)3-13

Effective Public Health Practice Project. Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies Hamilton. 1998. (accessed 21/03/2020)

Evans CE, Greenwood DC, Thomas JD, Cade JE. A cross-sectional survey of children's packed lunches in the UK: food- and nutrient-based results. J Epidemiol Community Health. 2010; 64:(11)977-983

Evans CEL, Cade JE. A cross-sectional assessment of food- and nutrient-based standards applied to British schoolchildren's packed lunches (Article). Public Health Nutrition. 2017; 20:(3)565-570

Evans CEL, Greenwood DC, Thomas JD, Cleghorn CL, Kitchen MS, Cade JE. SMART lunch box intervention to improve the food and nutrient content of children's packed lunches: UK wide cluster randomised controlled trial (Article). Journal of Epidemiology and Community Health. 2010; 64:(11)970-976

Evans CEL, Mandl V, Christian MS, Cade JE. Impact of school lunch type on nutritional quality of English children's diets (Article). Public Health Nutrition. 2016; 19:(1)36-45

Evans CEL, Melia KE, Rippin HL, Hancock N, Cade J. A repeated cross-sectional survey assessing changes in diet and nutrient quality of English primary school children's packed lunches between 2006 and 2016 (Article). BMJ Open.. 2020; 10:(1)

Falkenbach D, D'Avila H, Mello E. Knowledge, Attitudes and Practices of Primary School Teachers on Nutrition and Food. International Journal of Nutrology. 2018; 11:(01)021-029

Florence MD, Asbridge M, Veugelers PJ. Diet Quality and Academic Performance. Journal of School Health. 2008; 78:(4)209-215

Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V. School-Based Interventions on Childhood Obesity. American Journal of Preventive Medicine. 2009; 37:(5)418-427

Huang Z, Gao R, Bawuerjiang N, Zhang Y, Huang X, Cai M. Food and nutrients intake in the school lunch program among school children in Shanghai, China (Article). Nutrients. 2017; 9:(6)

Healthy Kids Association. nd-a. Canteen Guidelines. (accessed 05/05/2020)

Healthy Kids Association. nd-b. Crunch & Sip. (accessed 05/05/2020)

Healthy Kids Association. nd-c. Promoting and Influencing Healthy Food Choices for Children. (accessed 05/05/2020)

Ibeanu VN, Okechukwu FO, Eme-Okafor EP. Nutritional adequacy of home-packed school lunch in Nsukka, South East Nigeria (Article). Pak J Nutr.. 2017; 16:(3)125-130

Kleinman RE, Hall S, Green H, Korzec-Ramirez D, Patton K, Pagano ME, Murphy JM. Diet, breakfast, and academic performance in children. Ann Nutr Metab.. 2002; 46:24-30

Breakfast and cognition: an integrative summary. American Society for Clinical Nutrition. 1998; 67:804-813

Matuk TT, Stancari PCS, Bueno MB, Zaccarelli EM. Composição de lancheiras de alunos de escolas particulares de São Paulo. Revista Paulista de Pediatria. 2011; 29:(2)157-163

Mills SD, Tanner LM, Adams J. Systematic literature review of the effects of food and drink advertising on food and drink-related behaviour, attitudes and beliefs in adult populations. Obes Rev.. 2013; 14:(4)303-314

Moffat T, Galloway T. Food consumption patterns in elementary school children (Article). Canadian Journal of Dietetic Practice and Research. 2008; 69:(3)152-154

National Health and Medical Research Council. Australian Dietary Guidelines. 2015. (accessed 03/03/2020)

National Health Service. The National School Fruit Scheme. 2002. (accessed 05/05/2020)

Naylor PJ, McKay HA. Prevention in the first place: schools a setting for action on physical inactivity. Br J Sports Med.. 2009; 43:(1)10-13

Niaki SF, Moore CE, Chen TA, Weber Cullen K. Younger Elementary School Students Waste More School Lunch Foods than Older Elementary School Students. J Acad Nutr Diet.. 2017; 117:(1)95-101

Nicklas T, Johnson R Position of the American Dietetic Association: Dietary guidance for healthy children ages 2 to 11 years. J Am Diet Assoc.. 2004; 104:(4)660-677

Numbeo. Cost of Living in Nigeria. 2009 - 2020. (accessed 23/01/2020)

NSW Government. NSW Education Standards Authority PDHPE Syllabus K-10. 2019. (accessed 15/05/2020)

Oostenbach LH, Slits E, Robinson E, Sacks G. Systematic review of the impact of nutrition claims related to fat, sugar and energy content on food choices and energy intake. BMC Public Health. 2019; 19:(1)

World Health Organization. Global Strategy on Diet, Physical Activity and Health. 2020. (accessed 10/01/2020)

Rees GA, Richards CJ, Gregory J. Food and nutrient intakes of primary school children: A comparison of school meals and packed lunches (Article). Journal of Human Nutrition and Dietetics. 2008; 21:(5)420-427

Rogers IS, Ness AR, Hebditch K, Jones LR, Emmett PM. Quality of food eaten in English primary schools: school dinners vs packed lunches. European Journal of Clinical Nutrition. 2007; 61:(7)856-864

Rohrbach LA, Grana R, Sussman S, Valente TW. Type II translation: transporting prevention interventions from research to real-world settings. Eval Health Prof.. 2006; 29:(3)302-333

Sally Boyd RD, Campbell Renee, Corter JKaA. Taking a bite of the apple: The implementation of Fruit in Schools (Healthy Futures evaluation report to the Ministry of Health).Wellington New Zealand: New Zealand Council for Education Research; 2007

Sanigorski AM, Bell AC, Kremer PJ, Swinburn BA. Lunchbox contents of Australian school children: room for improvement. European Journal of Clinical Nutrition. 2005; 59:(11)1310-1316

Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do Obese Children Become Obese Adults? A Review of the Literature. Preventive Medicine. 1993; 22:(2)167-177

Stevens L, Nelson M. The contribution of school meals and packed lunch to food consumption and nutrient intakes in UK primary school children from a low income population (Article). Journal of Human Nutrition and Dietetics. 2011; 24:(3)223-232

Taras H. Nutrition and Student Performance at School. Journal of School Health. 2005; 75:(6)199-213

Tilley F, Weaver RG, Beets MW, Turner-Mcgrievy G. Healthy Eating in Summer Day Camps: The Healthy Lunchbox Challenge. Journal of Nutrition Education and Behavior. 2014; 46:(2)134-141

UK School Food Trust. Revised guide to standards for school lunches. 2007. (accessed 03/04/2020)

United Fresh Start Foundation. Fresh Fruit and Vegetable Snack Program. 2020. (accessed 05/05/2020)

Ward SA, Belanger MF, Donovan D, Carrier N. Relationship between eating behaviors and physical activity of preschoolers and their peers: a systematic review. Int J Behav Nutr Phys Act.. 2016; 13

Nutritional content and quality of food consumed at recess and lunchtime by 5–8-year-olds

02 October 2020
18 min read
Volume 1 · Issue 5



One in 4 children are overweight or obese and many do not meet the required fruit and vegetable intake of the Australian Dietary Guidelines.


To systematically examine the international literature on the nutritional content and quality of meals consumed at recess and lunchtime of primary school children between the age of 5 and 8 years.


A systematic literature review of peer-reviewed articles published in English with no date restriction placed on publication.


Nine studies met the search criteria. Eight studies reported on packed lunches, 4 studies on school prepared lunches and 3 studies on a combination of packed and school prepared food. The majority of food consumed was in excess or short of the countries' recommended guidelines of food groups and nutrients.


Further study is required to develop a means of improving the problem of not meeting the guidelines of food groups and nutrient consumption.

One in four (29.4%) Australian children between the ages of 5 and 17 years are overweight or obese and more than seven in ten (73.0%) are not meeting the guidelines of fruit and vegetable intake (Australian Bureau of Statistics, 2018). Twenty percent of 4–8-year-old males and 25% of 4-8 year old females are overweight or obese (Australian Institute of Health and Welfare, 2018). It has been shown that obese children are more likely to suffer from bullying, reduced exercise ability, gastrointestinal problems, orthopaedic complications and sleep apnoea. These children are also more likely to become obese adults and develop non-communicable diseases (Serdula et al, 1993; World Health Organization, 2020).

Diet plays an important part in children's academic performance (Florence et al, 2008). Studies show that undernourished children have decreased attention spans and poorer academic performance (Taras, 2005). Recent studies show that eating breakfast has a positive effect on school-aged children's cognition as well as academic performance and behaviour (Mathews, 1998; Kleinman et al, 2002; Taras, 2005). A survey on dietary intake, height, weight and sociodemographic status conducted with grade 5 children in Nova Scotia, Canada, demonstrated that diet variety and adequacy were important in the academic performance of these children (Florence et al, 2008). Particularly important was an adequate dietary intake of fruits, vegetables and fat (Nicklas et al, 2004).

Register now to continue reading

Thank you for visiting Journal of Child Health and reading some of our peer-reviewed resources for children’s health professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month