Background Children's dietary habits are often well established by 5 years of age. However, statutory guidelines to promote healthy food currently only apply to schools, not pre-school nurseries. Furthermore, good practice evidence has been well summarised in the Caroline Walker Trust (CWT) Guidelines to Encourage Healthy Eating in Children Under Five. (2006).

Objectives To evaluate the extent to which national and local UK guidelines for the early years sector address key recommendations based on the Caroline Walker Trust healthy eating guidelines for under-fives.

Methods A. Mixed method systematic review to identify new evidence to augment CWT “Eating Well for under fives in childcare” guidelines; B. Evaluation of local to national level government early years sector health eating guidelines using updated CWT guidelines as the “gold standard”

Main Outcome Measures Identification of new evidence to augment CWT 2006 guidelines. Identification of gaps in early years sector health eating guidelines at local to national levels.

Results Seven studies were deemed appropriate for analysis alongside the CWT eat well guidelines. Ten key recommendations and sub-recommendations were identified in relation to promoting healthy eating in the early years setting: role of government; nursery policy/guidelines; training; information and communication; menu planning; parents; atmosphere and encouragement; learning through food; sustainability; and equal opportunities. The evaluation of the seven government guidelines revealed that they had all included the ten key recommendations but there was sporadic cover of sub-key recommendations and in several cases detail was limited.

Conclusions The CWT guidelines for healthy eating in children under five remain highly appropriate. However, further work needs to be done to understand the optimal content and detail of such guidelines to maximise their effectiveness. Guidelines are only one element of what should be an integrated approach to implementing healthy eating across the early years sector. All key and sub-key CWT recommendations should be included in government guidelines. Guidance on the presentation of food and practical tips to encourage children to eat their food needs to be included, especially at local level. The wider role that food and meal times can play in children achieving Early Years Foundation Stage competencies should be explored. And crucially, the possible ways that nurseries can support parents to achieve healthy eating within the home.