11 minute read
Early years nutrition
dr emma haycraft
the Child feediNg gUide:
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a helpful resource for families who are worried about children’s fussy eating
Fussy eating is prevalent in young children with at least 40 to 50 percent of parents reporting that their child is fussy or eats a limited diet (1). although commonplace, particularly in children aged 19 to 24 months (2), fussy or difficult eating behaviours are significant as they often persist over time (3).
dr Gemma witcomb
dr claire Farrow
emma is a Senior lecturer in Psychology at loughborough University. her research focuses on parent-child interactions around feeding/eating. She is a co-developer of The Child Feeding Guide.
gemma is a research and teaching fellow at loughborough University. She is a co-developer of The Child Feeding Guide. her focus is on translating research into tangible resources to aid breastfeeding, fussy eating, and clinical eating problems.
Claire is a Senior lecturer at Aston University. Claire is interested in the factors that influence child eating behaviour and is a co-developer of The Child Feeding Guide. How this fussiness is managed can affect whether children outgrow it, or if it will continue as they get older, which is why parents and caregivers have such a vital role in helping children to develop healthy eating habits. Furthermore, a poor diet in childhood can predict a poor diet in adulthood and is associated with obesity and a range of preventable diseases, such as diabetes and cancer (4).
While the medical profession makes recommendations regarding the benefits of breastfeeding and the introduction of solid foods, a review of national and international feeding guidelines has suggested that many issues known to be important in establishing healthy feeding practices and diet in young children are not communicated to parents or caregivers at all, or only in very minimal detail. There is also an absence of any tangible practical advice about child feeding, particularly once weaning has occurred (5). Our own research has confirmed that many parents feel that the available resources about feeding young children and promoting a healthy diet are ‘too basic’, with parents often searching for information independently (6).
To address the reported lack of information and support available for parents surrounding fussy eating, we developed The Child Feeding Guide which is available as a website and free mobile app for iPhones/iPads and Android phones. Based on 25 years of collective research, The Child Feeding Guide provides evidence-based information and practical support for anyone who is concerned about children’s eating behaviours. Although it is directed at parents and caregivers (henceforth referred to as ‘parents’), it is also a useful resource for health professionals to use and disseminate to the families that they work with. The guide explains the science behind children’s eating behaviours, allowing parents to assess and monitor their own and their child’s responses around mealtimes and food. It also provides strategies to address fussiness in a positive way.
The Child Feeding Guide describes the five most common feeding pitfalls that families encounter. It explains what they are, why they occur and what parents can do to avoid them. Three of these pitfalls are summarised below. Details about the other two pitfalls (parental use of restriction and children’s unhealthy food preferences) can be found by visiting the website: www.childfeedingguide.co.uk.
1. Food refusal A common child eating behaviour which parents can find worrying, is food refusal. At around 18 to 24 months, many children go through a phase known as ‘food neophobia’, where they become wary of new foods or of foods that they previously liked (7). This phase often manifests as children being fussy and many parents are unsure how to respond to this. Research has indicated
that children may require a food to be offered up to 15 times before they trust it and are willing to taste it (8). Once a food is deemed ‘safe’, it can take a further 15 offerings, or ‘exposures’, for the child to develop a liking for it (9). It is therefore important that parents continue to offer foods that their child dislikes, as only by increasing children’s familiarity with a food will it become likely to be eaten (10). These food exposures can be offered as part of a meal or snack, but they can also be in non-mealtime contexts, such as playing with the food (e.g. messy play with cooked spaghetti or mashed potato), reading stories about foods, or allowing the child to pick out and touch different foods when shopping.
Research suggests that parents tend not to offer pre-schoolers a disliked and refused food more than five times (2, 11). Given that it can take many more than five exposures before a food is trusted and liked by young children, The Child Feeding Guide includes an Exposure Monitor; an interactive tool which allows parents to keep track of how many times a food is offered to their child. After setting up a profile, parents can quickly and easily log each food that is being offered and whether it was eaten or rejected by their child. This information is stored and enables parents to objectively monitor and review their child’s exposure to different foods.
2. pressure to eat Another common feeding pitfall that The Child Feeding Guide addresses is parental use of pressure to eat. Many parents find it concerning when they are faced with a child who won’t eat fruit or vegetables, but who will happily eat biscuits, pizza and other ‘junk’ foods. These parents may feel the need to pressurise or force their child to eat healthy foods, believing that this is in the child’s best interests. However, there is now a wealth of evidence which indicates that pressuring a child to eat a food, or to eat more than they wish, can have unintended negative consequences.
Research has shown that foods people are pressured or forced to eat become less desirable (12). This means that a child who is repeatedly forced to finish her vegetables is actually likely to eat even fewer of them. There is also evidence to show that if children are repeatedly asked to eat more than they want to at mealtimes, it can ‘teach’ them to ignore their internal signals about fullness and hunger, which, in the long-term, may lead to overeating and contribute to children becoming overweight or obese (13).
Rather than pressuring or forcing a child to eat, The Child Feeding Guide recommends alternative practical steps for parents to follow to help encourage children to have a healthy diet. These include: ‘examining the evidence’ (e.g. thinking about how long it is since the child last had a snack or filling drink, such as milk, which may be reducing their hunger); and ‘checking portion sizes’ to check that parents are not expecting children to eat too much (e.g. as a guide, a single portion is roughly what would fit in the palm of the child’s hand - providing too much food could be why children refuse to eat it). Following these simple steps can make parents more mindful of factors that might explain why their children are full and help parents to make changes, such as providing smaller portions, to promote healthier child eating behaviours.
3. Food as a reward Another common feeding pitfall is using food as a reward. Food can be very effective when used as a tool or a reward. For example, it can be tempting to offer children appealing foods, such as sweets, in exchange for good behaviour. Pudding is often used to reward children for eating vegetables. However, research shows that using food as a reward, or a bribe, can have adverse consequences (14). These include children having an increased liking for the reward food (pudding) and a decreased liking for the non-reward food (vegetables). This practice can also contribute to a child’s poor diet, as the foods that are most often used as rewards are often unhealthy, sugary treats and snacks, which can contribute to weight gain. The Child Feeding Guide explains all this and suggests alternative rewards, such as offering children real, tangible objects or experiences as rewards - a sticker or a trip to the park - rather than food. Evidence suggests that offering non-food rewards like stickers can be an effective way of getting children to taste disliked foods (15).
As well as addressing common feeding pitfalls, The Child Feeding Guide provides tips for ways that parents can promote healthy eating. In the UK, consumption of five portions of fruit and vegetables per day is recommended. However, only around 20 percent of children achieve this (16). The guide has a section which outlines ways for parents to increase children’s fruit and vegetable intake. For example, this could be using real fruits and vegetables in messy play, ‘growing your own’ and getting children involved in food preparation and cooking. All of these activities help to increase children’s exposure to foods which serves to increase their familiarity with them. If a food is more familiar, it is much more likely to be eaten (10).
Initial evaluation of The Child Feeding Guide by parents and caregivers, health professionals and childcare workers has been incredibly positive. Users have reported that it is informative, contains novel information and has helped them to understand children’s eating behaviour better. They also felt that it was empowering to have this information available in this format. Health professionals commented favourably about the guide’s clarity, accessibility and ease of use, that it was engaging and interactive and that it offers impartial, credible advice to families. In addition, childcare workers reported that the guide contained information about unfavourable feeding practices that they were not aware of and that, having engaged with the guide, their strategies for feeding children in their care will change. For dietitians working with families with a fussy eater, The Child Feeding Guide is a useful, freely-available and evidence-based resource which can help parents and caregivers to effectively manage their child’s difficult eating and hopefully support them in developing healthy eating habits that will last a lifetime. For more information, visit our Child Feeding Guide website (www.childfeedingguide. co.uk) or download our free mobile app from the Google Play and Apple app stores. Follow us on Twitter @FeedingKidsUK or Facebook www. facebook.com/FeedingKidsUK
references 1 reau Nr, Senturia YD, Lebailly Sa and Christoffel KK (1996). Infant and toddler feeding patterns and problems: normative data and a new direction. Pediatric research Group. Journal of Developmental and behavioural Pediatrics, 17, 149-153 2 Carruth br, Ziegler PJ, Gordon a and barr SI (2004). Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. Journal of the american Dietetic association, 104, 57-64 3 Farrow C and blissett J (2012). Stability and continuity of parentally reported child eating behaviours and feeding practices from 2 to 5 years of age. appetite, 58(1), 151-156 4 Nicklas ta and Hayes D (2008). Position of the american Dietetic association: Nutrition guidance for healthy children ages 2 to 11 years. Journal of the american Dietetic association, 108(6), 1038-1044 5 Schwartz C, Scholtens PaMJ, Lalanne a, weenen H and Nicklaus S (2011). Development of healthy eating habits early in life. review of recent evidence and selected guidelines. appetite, 57, 796-807 6 Mitchell G, Farrow C, Haycraft E and Meyer C (2013). Parental influences on children’s eating behaviour and characteristics of successful parent-focused interventions. appetite, 60, 85-94 7 birch LL and Fisher JO (1998). Development of eating behaviours among children and adolescents. Pediatrics, 101, 539-549 8 wardle J, Carnell S and Cooke L (2005). Parental control over feeding and children’s fruit and vegetable intake: How are they related? Journal of the american
Dietetic association, 105, 227-232 9 wardle J, Cooke LJ, Gibson EL, Sapochnik M, Sheiham a and Lawson M (2003). Increasing children’s acceptance of vegetables: a randomised trial of parent-led exposure. appetite, 40, 155-162 10 aldridge VK, Dovey tM and Halford JCG (2009). the role of familiarity in dietary development. Developmental review, 29(1), 32-44 11 Carruth br and Skinner JD (2000). revisiting the picky eater phenomenon: Neophobic behaviours of young children. Journal of the american College of
Nutrition, 19(6), 771-780. 12 Galloway at, Fiorito LM, Francis La and birch LL (2006). ‘Finish your soup’. Counterproductive effects of pressuring children to eat on intake and affect. appetite, 46, 318-323 13 Carper JL, Fisher JO and birch LL (2000). Young girls’ emerging dietary restraint and disinhibition are related to parental control in child feeding. appetite, 35(2), 121-129 14 Puhl rM, Schwartz Mb (2003). If you are good you can have a cookie: How memories of childhood food rules link to adult eating behaviours. Eating behaviours, 4(3), 283-93 15 Holley CE, Haycraft E and Farrow C (in press, 2015). ‘why don’t you try it again?’ a comparison of parent-led home based interventions aimed at increasing children’s consumption of a disliked vegetable. appetite. http://dx.doi.org/doi: 10.1016/j.appet.2014.12.216 16 Health and Social Care Information Centre (2014). Statistics on Obesity, Physical activity and Diet: England 2014. www.hscic.gov.uk/catalogue/PUb13648/
Obes-phys-acti-diet-eng-2014-rep.pdf
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