|Food and Nutrition Bulletin Volume 17, Number 3, 1996 (UNU Food and Nutrition Bulletin, 1996, 104 pages)|
|Nutrition and behaviour|
|Effects of breakfast on classroom behaviour in rural Jamaican schoolchildren|
The academic achievement levels of schoolchildren in developing countries are far lower than those of children in industrialized countries . There is increasing concern that children's poor health and nutrition may detrimentally affect their ability to learn in school and subsequently lead to low achievement levels [2, 3]. In particular, undernutrition and poor dietary intakes have been found to be associated with poor attainment levels in several studies . Many countries have implemented school feeding programmes in the expectation that the children's school performance will benefit . However, few programmes have been evaluated. Early studies often lacked scientific rigour, but more recent studies indicate that benefits to school achievement and increased school attendance may occur .
There are various mechanisms by which school meals may affect children's school learning and behaviour. It has been theorized that the consumption of meals may meet the specific nutrient needs of the child. For example, if the meals provide iron, the achievement of iron-deficient children may improve [9,10]. Meals may also improve the children's nutritional status, especially in those who were previously malnourished. Numerous studies have shown that school-aged children who had protein-energy malnutrition in early childhood have poor IQ levels and school achievement and greater behavioural problems than children who were not malnourished . There is also increasing evidence that missing breakfast or fasting has negative effects on children's cognition [12,13]. The results of these studies imply that by providing meals to these children the effects of short-term hunger would be reduced. Further, in a small school trial we have shown benefits of breakfast to children's arithmetic scores even though their nutritional status did not improve . This suggests that the benefits may have been due to the relief of hunger.
The outcome variables of most school feeding evaluations have been school achievement, school attendance, dietary intake, and nutritional status measured by anthropometry. Spending sufficient time on task is an essential part of successful learning . It is possible that paying more attention to task and other improvements in classroom behaviour may mediate the benefits of school meals on achievement. Associations have been found between teachers' ratings of children's attention-restlessness and interest-participation in the first year of school and their school grades and test performance in later years . There is, however, little information concerning the extent to which classroom behaviour is affected by providing school meals.
In two early studies, Laird and colleagues  and Keister  found that mid-morning snacks reduced children's negative behaviour in the classroom. Unfortunately the behaviours were poorly defined. Benton and colleagues  found that children who were given a glucose drink were more attentive and showed fewer signs of frustration in an experimental task. However, the results may not be the same in the classroom situation. All three studies were conducted in developed countries, and the findings may be different in children in developing countries, who are more likely to be undernourished.
There is some evidence that the classroom behaviour of undernourished children differs from that of adequately nourished children. In two studies [19, 20] teachers reported that children who had been severely malnourished in early childhood had shorter attention spans and were more distracted and restless than matched controls.
Teachers' assessments may be biased by the children's appearance, socio-economic status, and school grades. A more valid picture of the children's behaviour is obtained by direct observation. Sigman and colleagues [21 ] in Kenya observed that girls with better dietary intake were more attentive in class than girls with poorer intakes. In contrast, in Egypt boys with higher iron intake were observed to be more off task in the classroom . Associations between behaviour and nutritional status may, however, be confounded by poverty. For example, children from impoverished homes may behave differently in school because of their poor environment rather than their poor nutritional status. It is easier to infer causal relationships from nutritional interventions. In a recent report, McDonald and colleagues  found that Kenyan children became more off task during a famine. However, other stressors may have played a role. We are unaware of any studies of the effects of school meals on children's classroom behaviour in developing countries.
In the present study we compared the short-term effects of providing school breakfast on the cognitive function and classroom behaviour of undernourished and adequately nourished children. We previously reported that the verbal fluency performance of the undernourished children improved when they received breakfast, but that the performance of the adequately nourished children was not affected . In this paper we report observations of classroom behaviour in a subsample of the children. We hypothesized that the children's behaviour would improve when they had breakfast: specifically, that they would spend more time on task, talk less to their classmates, participate more in teaching activities, and move less around the classroom.