Practical Practice

How can we as nutrition professionals foster healthier eating habits in children?

    We can foster healthier eating habits in children by helping parents understand the many influences on young children’s food choices and eating habits. As infants and toddlers develop and the types and amounts of foods offered to them change, they begin to indicate, verbally and behaviorally, likes and dislikes for certain foods (1, 2). Children who reject certain types of foods or groups of food and are unwilling to try unfamiliar foods may be labeled as “picky eaters,” problem feeders or food neophobics (3, 4) Their food dislikes may result in avoidance of particular foods or groups of foods, thus limiting dietary variety (5) and, potentially, major sources of essential nutrients (1, 6). Moreover, consistent avoidance of foods may result in lifelongunhealthy food habits. Young children’s acceptance of unfamiliar foods is influenced by many factors, including parents and siblings in the home, (7, 8) peers, (9) parental feeding styles (6, 10) and the social climate of the eating environment (10). The media and advertising may also affect how children view and select certain foods (11).

Availability, Accessibility and Repeated Exposure

Children choose to eat foods they are served most often and tend to prefer foods that are acceptable and available in the home(12). For example, when fruits and vegetables are typically available, children are more likely to eat them than when they are not usually available (13-15). In addition to availability, foods need to be accessible (15). When foods are easily accessible and ready to eat, children are more likely to eat them. Exposure to foods is key to developing preferences (16-19) andrepeated exposure can often overcome food dislikes. As many as eight to ten separate exposures to a new food may be needed before a young child develops an acceptance for that food (20).

The Family: The Social Context of Meals

For young children, parents or caregivers, for the most part, control when foods are offered to the child, who eats with the child and where meals are eaten … this changes as children become more independent. Children fare better nutritionally with more structured family meals. Children who eat meals with other family members eat more healthy, nutrient-dense foods. Further, children who have companionship at mealtimes tend to eat more servings of foods from the basic food groups (21, 22). Changing social patterns and socioeconomic factors influence whether meals are cooked and served in the home, and how frequently this occurs. Today’s parents are working longer hours, and many children have either single-parent families or two parents working outside the home. Thus, parents increasingly relyon convenience foods or home meal replacements, including those from restaurants. Time spent preparing meals has declined more than 10% from 1994 to 1999 (23). Eating out has increased from 16% of all eating occasions in 1977-1978 to more than 30% now (24-26). Increasing reliance on convenience foods and meals consumed outside the home is associated with higher intake of dietary fat and calories and with lower intake of fruits, vegetables and dairy foods (27). This could result in lower intakes of fiber, calcium, iron and other nutrients that are important for children’s growth and development.

What Parents Think and What Parents Do

Children learn about food within a social context. Parental preferences, beliefs (e.g., which foods are healthy) and attitudes

toward food shape their children’s food-related knowledge, attitudes, beliefs, preferences and consumption (28, 29).

In addition to their own experiences, children learn about eating by watching others (30). Mothers and their children show similar patterns of food acceptance and preferences (31, 32). For example, children’s intake of fruit and vegetables is positively related to parents’ intake of fruit and vegetables, (33, 34) and parents’ modeling of healthful eating behaviors is associated with lower dietary fat intake (35). Children are more likely to sample an unfamiliar food after they have seen an adult eating the food, and they are more likely to eat it if they see their mother eating it rather than a stranger (36).Parents’ feeding styles are also associated with children’s food habits. Feeding styles represent parents’ approaches to maintain ormodify children’s behaviors with respect to choosing and/or eating foods.

Implications

Because diet plays such an influential role in shaping a child’s future health status, it is important that parents understand how food choices develop. The feeding context in early childhood may be critical to establishing lifelong healthy eating habits. For children, the most profound influence is their immediate environment: the family. Family structure and family life influence children’s eating habits. Understanding how the family influences children’s preferences and consumption is key if wewant to promote more healthful eating behaviors in early childhood, at a time when it may make the most difference.

1. Carruth BR, Skinner J, Houck K et al. The phenomenon of “picky eater”: a behavioral marker in eating patterns of toddlers.

2. Skinner JD, Carruth BR, Houck K at al. Mealtime

communication patterns of infants from 2-24 months of age.

3. Pelchat ML, Pliner P. Antecedants and correlates of feeding

4. Pelchat ML, Pliner P. “Try it. You’ll like it”: effects of

24:153-66.

5. Falciglia GA, Couch SC, Gribble LS et al. Food neophobia in

100:1474-81.

6. Birch LL, Johnston SL, Fisher JA. Children’s eating: the

1995; 50:71-8.

7. Koivisto UK, Sjoden PO. Food and general neophobia in

Swedish families: parent-child comparisons and relationships

8. Pliner P, Pelchat ML. Similarities in food preferences between

7:333-42.

9. Birch LL. Effects of peer models’ food choices and eating

51:489-96.

10. Sanders MR, Patel RK, Grice BL, Shepherd RW. Children

with persistent feeding difficulties: an observational analysis of

the feeding interactions of problem and non-problem eaters.

11. Matheson DM, Killen JD, Wang Y et al. Children's food

79:1088-94.

12. Birch LL, Marlin DW. I don't like it; I never tried it: effects of

1982; 3:353-60.

13. Hearn M, Baranowski T, Baranowski J et al. Environmental

influences on dietary behavior among children: availability and

14. Cullen KW, Baranowski T, Rittenberry L, Olvera N. Socialenvironmental

influences on children's diets: results from focus

groups with African-, Euro- and Mexican-American children

29. Skinner JD, Carruth BR, Bounds W et al. Do food-related

experiences in the first 2 years of life predict dietary variety in

30. Hayman LL. The Dietary Intervention Study in Children

31. Malone TE, Johnson KW and the Secretary’s Task Force on

Black and Minority Health: USDHHS, National Cancer

Institute. 1986.

32. Chen VW, Fontham E, Groves FD et al. Cancer incidence in

33. Fisher JO, Mitchell DC, Smiciklas-Wright H, Birch LL.

Parental influences on young girls’ fruit and vegetable,

102:58-64.

34. Gibson EL, Wardle J, Watts CJ. Fruit and vegetable

consumption, nutritional knowledge and beliefs in mothers and

35. Tibbs T, Haire-Joshu D, Schechtman KB et al. The

relationship between parental modeling, eating patterns, and

36. Harper LV, Sanders KM. The effect of adults’ eating on young

37. Cullen KW, Baranowski T, Rittenberry L et al. Socioenvironmental

influences on children’s fruit, juice, and

vegetable consumption as reported by parents: reliability and

38. Birch LL, Fisher JO. Development of eating behaviors among

39. Reed DB. Focus groups identify desirable features of nutrition

40. Gable S, Lutz S. Household, parent and child contributions to

15. Baranowski T, Cullen KW, Baranowski J. Psychosocial

1992; 50:249-55.

17. Birch LL, McPhee L, Shoba BC et al. What kind of exposure

18. Stark LJ, Collins FL, Osnes PG, Stokes TF. Using reinforcement

and cueing to increase healthy snack food choices in

19. Pliner P. The effects of mere exposure on liking for edible

20. Wardle J, Herra ML, Cooke L, Gibson EL. Modifying

children’s food preferences: the effects of exposure and reward

2003; 57:341-8.

21. Stanek K, Abbott D, Cramer S. Diet quality and the eating

90:1582-4.

22. Neumark-Sztainer D, Hannan PJ, Story M et al. Family meal

patterns: associations with sociodemographic characteristics and

2003; 103:317-22.

23. NPD Group, Inc. Timelines: How Americans Spent Their

Time During the ’90s. 2000.

24. Lin B, Guthrie J, Frazao E. Popularity of dining out presents

25. Lin B, Frazao E, Guthrie J. Contribution of away-from-home

1999; 12:85-9.

of Illinois Extension Service. June 2005. Available at:

http://www.urbanext.uiuc.edu/yourhealth/default.cfm?IssueId=24.

Accessed January 31, 2006.

27. French SA, Story M, Neumark-Sztainer D et al. Fast food

restaurant use among adolescents: associations with nutrient

intake, food choices and behavioral and psychosocial variables.

28. Dennison BA, Erb TA, Jenkins PL. Predictors of dietary milk

33:536-42.