Parental influences on the diets of 2–5-year-old children: systematic review of interventions

During the early years, parents have a major influence on their children's diets, food choices and development of eating habits. However, research concerning the influence of parental feeding practices on young children's diets is limited. This paper presents a systematic review of intervention studies with parents of preschool children. The aim was to investigate the effectiveness of interventions that target parent nutrition knowledge and/or parenting practices with parents of young children aged two to five years in the development of healthy dietary habits. Seventeen studies were identified. Findings highlight the limited number of good quality studies in this age group. Limitations include design inconsistency and a lack of longitudinal data to evaluate sustainability. Research on parental understanding of healthy diets and specific parenting styles and feeding practices is lacking. Further insights into how parents can positively influence children's diets will come from quality longitudinal research examining both parent feeding practices and nutrition knowledge in this age group.     

Reduced Morbidity Motivated Adoption of Infant and Young Child Feeding Practices after Nutrition Education Intervention in Rural Malawi

This study assessed caregivers’ knowledge and practices and factors that influence the adoption of improved infant and young child feeding (IYCF) practices after nutrition education in Kasungu and Mzimba districts among 198 caregivers. Mixed-methods convergent-parallel design, including knowledge tests, focus group discussions, and in-depth interviews in the intervention areas, was used to collect quantitative and qualitative data. Data were analyzed using count regression and content analysis, which showed that knowledge increased among caregivers after nutrition education. The knowledge about diet diversification for young children as well as about hygienic practices when preparing food and during feeding improved in addition. Enhanced health among children motivated caregivers to apply improved IYCF practices. The study was based on the caregivers’ reports. Long-term effects of exposure to nutrition education are unknown. However, the nutrition education that focused on the child’s health benefits motivated mothers to adopt improved IYCF practices.     

Nutrition Knowledge of Caregivers Influences Feeding Practices and Nutritional Status of Children 2 to 5 Years Old in Sekhukhune District,South Africa

BackgroundThe aim of this study was to determine caregivers'' nutrition knowledge and its influence on feeding practices and nutritional status on young children.MethodsA cross-sectional survey was conducted in 120 caregiver-child pairs. A validated questionnaire was used to collect caregivers'' nutrition knowledge and feeding practices. Nutritional status was estimated using anthropometric measurements. Z-scores were computed using WHO Antro software. Chi-square test was used to determine the association between caregivers'' nutrition knowledge and feeding practices. Significance was set at p <0.05.ResultsForty three percent of caregivers reported health professionals as their source of nutrition information. Almost all children (94.2%) were breastfed at one stage in their lives, with 62.5% introduced to solid foods before six months. Maize meal porridge (87.5%) and bread (54.2%) were consumed daily by most of the children, while 48.3% consumed meat and meat products three to four times per week. One in eight children consumed fruits daily and 5.8% vegetables daily. Forty one percent of children were stunted. Family income showed positive correlation with the nutritional status of children (weight-for-age R = 0.207, p < .05; height-for-age R°=°0.203*, p°= .026). An association was observed between the duration of breastfeeding and alternative food, to milk (R = 0.302**, p = .001), amount of fruit consumed daily (R = 0.197*, p = .031) and number of meals consumed daily (R = 0.284**, p = .048). Conclusion: Nutrition knowledge and feeding practices of the caregivers were not satisfactory.     

Young Child Nutrition: Knowledge and Surveillance Gaps across the Spectrum of Feeding

The first 1000 days is a critical window to optimize nutrition. Young children, particularly 12–24 month-olds, are an understudied population. Young children have unique nutrient needs and reach important developmental milestones when those needs are met. Intriguingly, there are differences in the dietary patterns and recommendations for young children in the US vs. globally, notably for breastfeeding practices, nutrient and food guidelines, and young child formulas (YCFs)/toddler drinks. This perspective paper compares these differences in young child nutrition and identifies both knowledge gaps and surveillance gaps to be filled. Parental perceptions, feeding challenges, and nutrition challenges are also discussed. Ultimately, collaboration among academia and clinicians, the private sector, and the government will help close young child nutrition gaps in both the US and globally.     

Infant feeding practices in a poor district of Santo Domingo

We conducted a survey of infant feeding practices by interviewing 103 randomly selected primary care givers of children three years of age and under in poor areas of Los Alcarrizos, Santo Domingo, Dominican Republic. We did the survey to identify community specific deficits in infant feeding practices in order to determine target issues for local health education interventions which are presently based on generalized guidelines. This study identified deficits in milk use, weaning, hygiene, and frequency of food consumption. At least some of these deficits are theoretically amenable to change through nutrition education.     

Understanding the sociocultural roots of childhood obesity: food practices among Latino families of Bushwick, Brooklyn

Despite prevention efforts, childhood obesity has reached epidemic proportions in the United States. This ethnographic study seeks to enhance understandings of the sociocultural dimensions of childhood obesity and inform prevention efforts. Using participant observation, interviews, and life histories, this research probes the sociocultural roots of childhood obesity by exploring the food practices and everyday lives of Latino families in Bushwick, Brooklyn, a low-income neighborhood in New York City. Mired in persistent poverty, Latino families burdened by teetering resources provide for their children using coping strategies in which everyday food practices play an important part. These practices illuminate cultural ideas about good parenting, well-being, and conceptions of the body. We argue that these practices, embedded in the neighborhood food environment, drive food choice and related activities of families, often leading to overweight and obesity in their children. They form the sociocultural roots of childhood obesity, and their implications are critically important for how public health professionals approach the relationship of food, nutrition, and obesity.     

Predictors of Head Start and Child-Care Providers' Healthful and Controlling Feeding Practices with Children Aged 2 to 5 Years

Few child-care providers meet the national recommendations for healthful feeding practices. Effective strategies are needed to address this disparity, but research examining influences on child-care providers' feeding practices is limited. The purpose of this study was to identify determinants of child-care providers' healthful and controlling feeding practices for children aged 2 to 5 years. In this cross-sectional study, child-care providers (n=118) from 24 center-based programs (six Head Start [HS], 11 Child and Adult Care Food Program [CACFP] funded, and seven non-CACFP) completed self-administered surveys during 2011-2012. Multilevel multivariate linear regression models were used to predict seven feeding practices. Working in an HS center predicted teaching children about nutrition and modeling healthy eating; that may be attributed to the HS performance standards that require HS providers to practice healthful feeding. Providers who reported being concerned about children's weight, being responsible for feeding children, and had an authoritarian feeding style were more likely to pressure children to eat, restrict intake, and control food intake to decrease or maintain children's weight. Providers with nonwhite race, who were trying to lose weight, who perceived nutrition as important in their own diet, and who had a greater number of nutrition training opportunities were more likely to use restrictive feeding practices. These findings suggest that individual- and child-care–level factors, particularly provider race, education, training, feeding attitudes and styles, and the child-care context may influence providers' feeding practices with young children. Considering these factors when developing interventions for providers to meet feeding practice recommendations may add to the efficacy of childhood obesity prevention programs.     

Factors Affecting Complementary Feeding of Infants. A Pilot Study Conducted after the Introduction of New Infant Feeding Guidelines in Poland

Adequate nutrition in the first year of life is the key prerequisite for a child’s healthy growth and development. The success of complementary feeding is influenced by various factors, including the family’s socioeconomic status, maternal age, place of residence and educational level, older children and duration of breastfeeding. Modified infant feeding guidelines were introduced in Poland in 2016. The aim of this study was to identify the factors that exert the greatest influence on infant feeding practices in the Polish population. A thorough understanding of maternal factors that are responsible for undesirable feeding practices is required to improve the mothers’ knowledge and to promote healthy feeding practices. This study was carried out in March–June 2018 and between November 2018 and March 2019 in the Region of Lublin in southeastern Poland. The mothers of children aged 9–14 months, who had introduced complementary foods, were invited to the study. A total of 441 mothers agreed to participate, and 289 of them fully and correctly completed the questionnaires. Logistic regression models were developed to assess the association between maternal factors, such as age, educational level and the nutrition knowledge score, and introduction of solid foods. The infant’s sex and birth weight and the mother’s place of residence had no significant influence on the duration of breastfeeding. The mother’s age and educational level, the number of children in the family and maternal nutrition knowledge scores contributed to significant differences in breastfeeding duration. Older mothers (30–34 years vs. 25–29 years, p = 0.001), better educated mothers (university vs. secondary school education p = 0.002) and mothers with one or two children exclusively breastfed their children for longer (17 weeks vs. 11 weeks, p = 0.002) than younger mothers with secondary school education and more than three children. Exclusive formula feeding was significantly correlated with untimely introduction of solid foods compared to exclusive breastfeeding (13 weeks vs. 19.7 weeks, p = 0.001). Mothers with nutrition knowledge scores in the upper tertile were more likely to adapt food consistency to the skills manifested by the child (88%) (OR = 1.88; Cl: 1.53–2.26, p < 0.05) and were less likely to delay the introduction of new foods that required chewing and biting (84%) (OR = 0.22; Cl: 0.09–0.34, p < 0.05) than mothers with nutrition knowledge scores in the bottom tertile. Maternal age, educational level and nutrition knowledge significantly increased the age at which infants were introduced to solid foods and the correct identification of the signs indicative of the child’s readiness to explore new tastes and foods with a new consistency. The above factors contributed to delayed, but not untimely, introduction of complementary foods (6 months of age or later), including gluten.     

Sociocultural and Environmental Influences on Brazilian Immigrant Mothers’ Beliefs and Practices Related to Child Feeding and Weight Status

Background Length of residence in the United States (US), changes in dietary and physical activity behaviors, and economic and social barriers contribute to high childhood obesity rates among children from immigrant families in the US. Brazilians comprise a fast-growing immigrant population group in the US, yet little research has focused on health issues affecting Brazilian children in immigrant families. Understanding sociocultural and environmental influences on parents’ beliefs and practices related to child feeding and weight status is essential to altering obesity trends in this group. Methods Qualitative study consisting of five focus groups with a convenience sample of 29 Brazilian immigrant mothers. Results Analyses revealed that the sociocultural and environment transitions faced by Brazilian immigrant mothers’ influence their beliefs and practices related to child feeding and weight status. Additionally, acculturation emerged as a factor affecting mothers’ feeding practices and their children’s eating habits, with mothers preferring Brazilian food environments and that their children preferring American food environments. Mothers viewed themselves as being responsible for promoting and maintaining their children’s healthy eating and feeding behaviors, but changes in their social and cultural environments due to immigration and the pressures and demands of raising a family in a new country make this difficult. Conclusions Health promotion interventions to improve healthful eating and feeding practices of Brazilian children in immigrant families must account for social and cultural changes and daily life demands due to immigration as well as potential variation in the levels of acculturation between mothers and their children.     

Sociocultural practices influencing under five nutritional status in an urban community in Osun State, Nigeria

Three hundred and forty four preschool children from Ilare district of Ife Central Local Government Area of Osun State, Nigeria were assessed for nutritional status using selected and sensitive anthropometric techniques. The sociocultural practices of the parents were also examined. Approximately 53.8% and 54.7% of the children were identified to be malnourished and stunted respectively. The socioeconomic situation of the family was identified to have a significant influence on the child's nutritional status. Female children were observed not to be as adequately nourished as their male counterparts. However parity and food taboo had no significant influence on the child's nutritional status. The need for improvement in the socioeconomic status of the family and education of the community on the importance of female nutrition are discussed.     

城市婴幼儿家长营养与喂养现状及需求

【目的】 了解城市婴幼儿家长在喂养动机、喂养环境、营养知识、喂养实践等方面的需求和存在的问题,以有针对性地指导家长合理喂养。 【方法】 通过自填式调查问卷对全国15个城市(区)的0~18个月婴幼儿家长进行调查,内容包括家长的营养与喂养现状及需求。 【结果】 0~6月龄儿童中纯母乳喂养率仅为31%,43%已添加辅食。6月龄时一半儿童已断母乳,12月龄时均已断母乳。儿童添加的第一种辅食以米粉和蛋黄为主。适龄儿童进食蛋类较多,肉类较少。家长常给儿童吃的营养补充剂以鱼肝油和钙制剂为主。家长对儿童的进食较有耐心,且会关注对进食行为的培养和训练。家长喜欢的育儿宣教方式是“面对面咨询指导”、“书报杂志”和“讲座”。除“儿童营养需求”和“常见病防治”外,家长需要的育儿宣教内容随儿童的不同月龄有所不同。 【结论】 城市婴幼儿家长在儿童营养与喂养方面有需要改进的方面,家长对正确科学的营养与喂养知识有所需求,应根据家长的需求进行针对性的指导。     

The Role of Women in Food Provision and Food Choice Decision-Making in Singapore: A Case Study

As countries develop economically and increasing numbers of women enter the workforce, children are partly being cared for by someone other than their mother. Little is known about the impact of this shift in child-care provider on children’s nutrition. This study presents findings from a case study of Singapore, a small country that has experienced phenomenal economic growth. Focus groups were conducted with 130 women of varying educational levels and ethnicities to learn about food decisions in their families. The findings showed that Singaporean working women cook infrequently, families eat out frequently, and children exert considerable influence on food choices. Implications for work–family policies and child health are discussed.     

甘肃省农村地区6~24月龄婴幼儿营养状况及其影响因素分析

目的 了解甘肃省农村地区不同民族婴幼儿的营养状况,分析影响因素。方法 采用多阶段分层随机整群抽样方法,在甘肃省抽取12个项目县,于2014年12月-2015年1月进行现场调查,收集样本量为3 663名。调查内容包括婴幼儿看护人问卷调查和婴幼儿的体格测量。结果 甘肃省6~24月龄婴幼儿营养不良发生率为21.3%,其中超重、消瘦、低体重和发育迟缓率分别为7.0%、4.0%、3.2%和7.1%。单因素分析结果显示,影响6~24月龄婴幼儿营养不良的因素有民族、性别、贫血状况、是否早产、出生身长和体重、看护人学历和职业、6个月内喂养方式、辅食添加时间、辅食添加种类以及营养素补充等。多因素Logistic回归分析显示性别、月龄、是否早产、看护人职业、科学喂养知识水平、辅食添加时间和种类的对营养水平的影响有统计学意义。结论 甘肃省6~24月龄婴幼儿营养状况总体有所改善,发育迟缓仍然是主要营养问题,超重率上升是需要特别关注的重要问题。建议采取综合措施改善儿童营养水平。     

Heavy agricultural workloads and low crop diversity are strong barriers to improving child feeding practices in the Bolivian Andes

Most nutrition initiatives to date aimed at improving infant and young child feeding (IYCF) have emphasized addressing knowledge gaps through behavior change messaging with less focus on addressing the underlying environmental barriers that may shape these behaviors. This research integrates an analysis of longitudinal dietary data with qualitative data on barriers to improved child feeding to identify the nature and extent of the barriers caregivers face to improving IYCF practices in a farming region of the Bolivian Andes, and to determine the relative influence of these barriers on caregivers' abilities to improve IYCF practices. Sixty-nine caregivers were selected from a sample of 331 households that participated in a longitudinal survey assessing changes in IYCF practices among caregivers with children aged 0-36 months from March 2009 to March 2010. Forty-nine barriers within 12 categories of barriers were identified through semi-structured interviews with the 69 caregivers. The most frequently reported barriers were those related to women's time dedicated to agricultural labor, the limited diversity of household agricultural production, and lack of support for child feeding from spouses and mothers-in-law. In multivariate analyses controlling for several variables that could potentially influence IYCF practices, these barriers were negatively associated with changes to the diversity of child diets, child dietary energy intake, and child meal frequency. While knowledge gaps and individual-level influences affected IYCF practices, physical and social caregiving environments in this region of Bolivia were even more important. Behavior change communication alone will likely not address the social and environmental barriers to improved child feeding that often prevent translation of improved knowledge into action. Particularly in rural regions, agriculture may strongly influence child feeding, not only indirectly through household food security, but also directly by affecting women's caregiving capacity.     

Food and eating as social practice – understanding eating patterns as social phenomena and implications for public health

Globally, public health agencies recognise obesity trends among populations as a priority. Explanations for population obesity patterns are linked to obesogenic environments and societal trends which encourage patterns of overeating and little physical activity. However, obesity prevention and nutrition intervention focus predominantly on changing individual level eating behaviours. Disappointingly, behaviour‐based nutrition education approaches to changing population eating patterns have met with limited success. Sociological perspectives propose that underlying social relations can help explain collective food and eating patterns, and suggest an analysis of the sociocultural context for understanding population eating patterns. We propose a theoretical framework for the examination of eating patterns as social phenomena. Giddens’ structuration theory, in particular his concept of social practices understood as an interplay of ‘agency’ and ‘social structure’ (rules and resources), is used to study food choice patterns. We discuss the application of these concepts for understanding routine food choice practices of families, elaborating how rules and resources configure the enabling or constraining conditions under which actors make food choices. The framework assists in characterising how social structural properties are integral to food choice practices, and could direct attention to these when considering nutrition interventions aimed at changing population eating patterns.     

贫困地区5岁以下儿童家长营养教育效果研究

目的分析营养教育对家长喂养儿童的知识、态度、行为的作用及影响因素，探索在贫困农村现有经济条件下有效开展营养干预的途径和方法。方法对随机抽取的3个国家级贫困县的6个乡内5岁以下儿童母亲进行为期一年的营养知识教育，观察教育前后喂养知识、态度和行为的改变。结果儿童母亲的营养知识和喂养知识评分有了显著性提高（P〈0．05），喂养态度有了明显转变，肉类、蔬菜、水果以及蛋类等食物的摄人频率有不同程度增加。地区、民族、文化程度、家庭经济水平是营养教育效果的主要影响因素。结论营养教育能显著提高儿童母亲营养知识水平，改善喂养儿童的行为，但应考虑不同地区人群的具体情况才能取得良好效果。     

Comparison of College Students’ Current Eating Habits and Recollections of Their Childhood Food Practices

In order to investigate the stability of food habits from childhood into late adolescence, we compared the current eating habits of college students and their recollections of their childhood caregivers’ feeding practices.The 546 subjects responded to a questionnaire sent to 1000 18- to 23-year-old college students. Subjects’ current eating habits were related to their recollections of their caregivers’ feeding practices and their own food habits when the subjects were children. For example, current habits such as eating all food on the plate, using food as an incentive, eating dessert, and eating regularly scheduled meals were dependent on those feeding practices being used by caregivers during the respondent's childhood. In addition, current consideration of nutrition when selecting food was dependent on caregivers talking about nutrition. This study contributes to existing literature that links parent-child feeding relationships to the development of an individual's relationship with food.     

北京市朝阳区5岁以下流动儿童营养与健康状况调查

【目的】 了解5岁以下流动儿童营养与健康状况,为制定相关政策提供科学依据。 【方法】 采用问卷调查和体格检查的方法对通过整群抽样方法获得的朝阳区490名5岁以下流动儿童进行营养与健康状况调查。 【结果】 低出生体重儿和巨大儿占2.45%和10.61%,均高于北京市城区平均水平。4个月和6个月内纯母乳喂养率分别为67.11%和49.78%,前者高于北京市4月龄儿童纯母乳喂养率。2岁以下儿童的辅食添加率为85.12%。 【结论】 流动儿童喂养存在不合适之处,同时流动儿童存在营养不均衡问题。     

Effect of nutrition education and psychosocial factors on child feeding practices: findings of a field experiment with biofortified foods and different women categories

Despite the efforts to promote good practices in infant and young child feeding (IYCF), the adoption of such practices has been low. Using data from a sample of 665 women, and the theory of planned behavior, we examine the effect of different types of nutrition education and psychosocial factors on the use of recommended IYCF practices. Regression results show that nutrition education and psychosocial factors have strong positive effect on the extent to which IYCF practices are used, with the latter having conflicting individual but overall positive effect. Moreover, coefficients of latter were mostly less than those of the former indicating that pschosocial factors were less important in explaining variability in usage of IYCF than the nutrition education variables. It further finds that different sets of nutrition education and psychosocial factors affect different categories of women, with interactive nutrition education approaches having a greater effect. The findings also suggest need for targeting of beneficiaries with multiple nutrition education approaches.