Parental Influences on Child Eating Behaviors

Parental Influences on Child Eating Behaviors
Stefanie Djuric, Dietetic Intern OSF Saint Francis Medical Center Nutrition Luncheon Series March 16, 2012

Objectives Describe the foundation of human eating behaviors
Understand parent influences on child eating behaviors in both short- and long-term Discuss potential consequences of parent influences Understand why its important that these influences are recognized Provide recommendations to help providers empower parents to enhance lifelong eating behaviors for their children

What has Influenced our Eating Behaviors?
Innate predispositions Genetic components Infant feeding practices Family environment Maternal influences Environmental factors *Genetic components: parents pass their own food preferences and taste perceptions on to their children through genetic transmission. For example, it has been shown that sensitivity to the bitter taste has been shown to be highly heritable and food neophobia Lucy Cooke, shim, stang, Kral 5, 17, 26, 27

Why is this Significant?
Understanding child eating attitudes and behaviors is important for overall child health Research has shown that dietary habits acquired during childhood persist through to adulthood Understanding food consumption patterns of children can assist dietitians when working with parents to provide targeted guidance to encourage the development of healthy eating habits And also, as we all know, total nutrient needs during adolescence are higher than at any other time in the lifecycle, and failure to consume an adequate diet could potentially affect growth. Scaglioni, Fox, Pearson 12, 21, 25, 28

The Foundation of Eating Behaviors
Where it Begins: The Foundation of Eating Behaviors

Food preference strongly influences intake Few food preferences are innate Sweet and salty flavors vs. bitter and sour tastes Individual differences in taste preferences arise from genetic variation and early experience Humans are genetically predisposed to prefer sweet taste Food preference strongly influences intake, therefore it is important to understand how these preferences arise Although few food preferences are innate, a liking for sweet tastes and an aversion to sour or bitter tastes appears to be universal. This can be clearly seen in the facial expressions of newborn’s who will react enthusiastically to a sugar solution and grimace at the taste of citric acid. For example, a liking for salty tastes is not present at birth, but will emerge around 4 months with sufficient exposure. Because sweet foods are naturally good and safe sources of energy and nutrients, adaptive evolutionary development has resulted in a preference for them. However, this evolution happened long ago when food was scarce. Today, with a great variety of sweet foods readily available in the Western countries, the preference for these foods may also have disadvantages. Lucy Cooke, keskitalo, kral 5, 16, 17

Other property of foods related to children’s preferences- energy density Gibson and Wardle (2003) found that children prefer foods delivering more calories per gram Banana preferred to melon Potato preferred to zucchini A recent study showed that even within the food groups of fruit and vegetables, which are relatively low in energy overall, children prefer those delivering more calories per gram. Taken together, these findings go some way to explaining the typical modern child’s diet which reflects their innate predispositions to prefer sweet, salt, and energy dense foods. Cooke, scaglinoni *These findings explain the typical modern child’s diet- sweet, salty, and energy dense foods 6, 25

Genetics and Food Preferences
Highly heritable food preferences: Sensitivity to bitter taste Influences liking ratings and food selection Food neophobia Lowers diet quality and variety Kral 17

Early Feeding Practices
Parent early feeding practices: Determine infant exposure to food Include responses to infant feeding behavior These feeding practices influence children’s eating patterns Firmly established by five years of age and lay the foundation of adult eating habits The genetic predispositions for food preferences are modified by things throughout childhood. And to start, they are changed through early feeding practices from parents. Determine the infant exposure—the type, amount and frequency of the food, and include responses such as coercion to infant feeding behavior (example food refusal). Daniels 7

Taste Development There are mechanisms of taste development and positively associated with: Mere exposure Medicine effect Flavor learning Flavor nutrient learning Mere exposure: the more exposure we have to a stimulus, the more we will tend to like it; foods which have been eaten more often tend to be liked more; this is the way that specific preferences grow in different cultures. Several studies suggest that an exposure based approach has promise for improving the quality of children’s diets. Particular strengths of the technique are its simplicity and relatively low demands of both parents and children. This one is huge and what I so recurrently throughout my research. Keep exposing your child to the food until they become familiar with it. Medicine effect: we like better a food that we eat when we are healthy rather than food proposed when we are ill. Flavor learning: between 2 foods of different taste, administered one added with sugar and one without, there is preference for the first food also when proposed without sugar. Taste realization for specific foods is a consequence of learning. Flavor nutrient learning: the more a food is energy-rich the more is appreciated, this is a prehistoric model. Man can recognize the most caloric foods indispensable to life. Scaglioni 25

Developing Eating Behaviors
“An enormous amount of learning about food and eating occurs during the transition from exclusive milk diet of infancy to the omnivore’s diet consumed by early childhood.” Birch and Fisher (1998) The biggest thing being said here is that developing your eating behavior is a learning experience. It is up to the parents of how these behaviors will be introduced and taught. Learning experience. Birch, fisher 1998 1

Influences of the Family Environment
**Hand out 1. Very commonly used by researchers to identify the influences of family was the Child Feeding Questionnaire. This can be found in your packet. It goes through many different questions for parents to answer about themselves and their children. Its main objective is to measure dimensions of parent eating behavior and child feeding practices.

Family Factors Parent Characteristics Child Characteristics
Parents’ weight status Dietary intakes Perceived responsibility for child feeding Eating Style Parent’s dietary intake Weight Food preferences Physical Activity Feeding practice Portion size Food available at home Food accessibility Eating locations ambient temperatures and lighting Family meals vs. eating away from the table Family income Physical activity This is a list of family factors that influence bidirectionally parents and child. It’s basically showing that all of the listed parent characteristics are what can potentially effect the child characteristics of dietary intake, eating style, weight, and physical activity on their children. Scaglioni Table 1. Scaglioni et al. (2008)

Regulatory Acts of Influence
Parents influence the development of children eating behaviors through a set of regulatory acts: Sustenance Stimulation Support Structure Surveillance Regulatory acts of influence aimed at helping children adapt to their environments. These are where parents are in control of what their child eats and the behaviors their child may have toward food. Sustenance: providing food (identifying what foods are made available to children, protection from environment threats) Structure: organizing eating environments Surveillance: monitoring and control over eating Scaglioni, Johannsen 15, 25

Parental Control Two primary aspects of control:
Restriction Pressure Restriction involves restricting children’s access to junk foods and restricting the total amount of food Pressure involves pressuring children to eat healthy foods and pressuring to eat more in general Parents may use a combination of these methods to obtain a desired result. For example, pressuring a child to eat healthy foods by using bribes or rewards consisting of sugary snacks that are otherwise restricted. Scaglioni, johannsen 15, 25

Children’s Self-Regulation
Birch et al. (1998) conducted research to show that children can self-regulate their food intake Study confirmed prediction and provided evidence that children can regulate their intake Study was to examine children’s intake across meals by using 24-hour self-selected energy intakes. To determine whether they could adjust intake in response to energy density of foods within meals, the researchers had children consume a fixed amount of a first course that varied in energy density, and looked at effects on children’s self-selected food intake in a second course. Prediction was that if children were responsive to the energy density of the first course, they would eat less in the self-selected second course after the high-energy than after the low-energy first course. Ellyn Satter said it best, “A infant/child is the best example of an appropriate eater.” They listen to their hunger cues and only use food when needed. 1, 25

Restriction Short-term and long-term effects on children’s intake
May actually promote their overconsumption of those foods Leads to focus on external cues (food portion size, rewards, and cleaning the plate) vs. internal cues (hunger and satiety) It enhances preference, increases attention and intake at first, then this curb increases intake increases eating in the absence of hunger, doesn’t produce ability to self-regulate diet but causes negative self evaluation, greater weight gain from 5-11 years old. May actually lead to increased desire for overconsumption of restricted foods when children are allowed free access to them and may result in poorer eating regulation to due focusing children’s attention on external cues (food portion size, rewards, and cleaning the plate) instead of allowing internal cues (hunger and satiety) to regulate their intake. Birch, Johannsen, Scaglioni 1, 15, 25

Potential Consequences of Restriction
Birch & Fisher (1998) study Restricting consumption of “bad” foods and encouraging consumption of “good” foods does not provide a means of achieving healthy dietary habits Promotes children’s categorical thinking about “good” and “bad” foods The practice of restriction may send mixed messages to children Birch and Fisher (1998) found that when assessing parental opinions on the efficacy of using various practices to modify their children’s food preferences, 40% of parents spontaneously reported the belief that restricting or forbidding the consumption of a particular food would decrease their child’s preference for that food. A study by Murphy et al. concluded that children tended to indicate preference for fatty and sugary foods but that they also identified those foods as being high in fat and “not good for you” Mixed messages because these same forbidden foods are offered in positive social contexts such as parties, dinners out, and holiday celebrations, and restricted in others. Birch 1

Pressure May be counterproductive and reduce children’s ability to regulate their energy intake Fisher and Birch (2002) linked ‘pressure to eat’ to reduced consumption of fruit and vegetables in 5-year-old girls “Clean your plate” Common assumption in many studies: Controlling children’s intake of food is a causal factor in their poor eating patterns What I think of when I first hear of pressure is “make sure you clean everything off your plate”. It is mostly known that we now tell parents not to pressure your child to clean their plate. And it is exactly right in the reasons not to. It isn’t letting your child regulate their own energy intake. Children are smart enough to be able to regulate their own eating patterns. We must give them more credit that what we are giving now. Fisher, scaglioni, 11, 25

Potential Consequences of Pressure
Studies have shown that pressuring children to eat may increase chances of child becoming picky eater or neophobic May lead to: Increase preferences for high-fat and energy dense foods Limit children’s acceptance of a variety of foods Disrupt children’s regulation of energy intake by altering children’s responsiveness to internal cues of hunger and satiety 11, 25

These consequences occur when…
“…well-intended, but concerned parents assume that children need help in determining what, when, and how much to eat and when parents impose child-feeding practices that provide children with few opportunities for self-control.” Scaglioni et al. (2008) Really like this quote from one of the research articles I found. Scaglioni 25

Using Food as a Reward Promise of a reward (Ex. “Eat your peas and you can watch TV.”) Psychological research has shown that treating a food in this way actually decreases children’s liking for it Using a food as a reward (Ex. “You have been such a good girl, you can have some chocolate.”) appears to increase children’s liking The important factor here is the context which foods are presented. Chocolate is used in a positive context to reward good behavior whereas peas are used negatively as an undesirable means to a desirable end. The message to children is clear: chocolate equals pleasure, peas equals pain. Even as small non-food rewards may be useful in coaxing a reluctant child to taste something new, their over-use is likely to be counter-productive. Cooke L. 6

Using Food as a Reward Birch et al. (1998) found that children’s preferences for particular foods increased after the foods were used as a reward for performing a non-food related task. By making the availability of the reward food limited… Example: Do your chores and I will take you out for ice cream. So, by making the food reward being a food that the child has limited access to, it makes the child want it even more. Birch 1998 ↑ children’s liking for these foods 1

Parenting Style Parenting style is defined by a set of attributes, attitudes, and ways of interacting with children that can influence child outcomes Four general types of parenting have been identified: Authoritative Authoritarian Permissive Neglectful There is an increasing body of research on the role of parenting styles and risk of obesity in young children. It is very interesting how these different parenting styles can influence your child's eating patterns. **Handout 2 that puts all of these parenting styles in an organized way for you to understand the definition and effects of each style. Stang, Hennesy 14, 27

Authoritative Parenting
Characterized by caring parents who convey concrete, behavioral expectations and consistently enforce rules through the withdrawal of privileges Child-centered feeding style Associated with: Lower risk for child obesity Improved consumption of healthful foods High demand, high responsiveness A child-centered feeding style resembles an authoritative parenting style in which parents set concrete, age-appropriate expectations for children at meal times, but remain responsive to the child’s needs and behaviors. Authoritative parenting has generally been associated with a lower risk of child and adolescent obesity as well as an improved consumption of healthful foods when compared to children of parents who used other parenting styles. Stang, Pearson 14, 27

Authoritarian Parenting
Parents show less affection toward their children, exhibit controlling behaviors, often including physical or verbal reprimands, and are highly critical Parent-centered feeding style Authoritarian parenting style has been linked to an almost fivefold increase in risk for obesity High demand, low responsiveness Parent-centered feeding style is similar to authoritarian parenting, in which there is a high level of parental control over eating and a low level of responsiveness to the child’s needs, including his or her internal hunger or satiety cues. Has been linked to an almost fivefold increase in risk for obesity among children compared with the authoritative parenting style. 14, 27

Permissive Parenting Permissive parents are very affectionate toward their children and do not convey clear behavioral expectations Low demand, high responsiveness Recent study shows it may lead to child-initiated snacking and higher energy intake because of the lack of control of feeding situation Permissive- sometimes to the point of overindulgence. Low demand, high responsiveness. Indulgent parenting has been positively associated with BMI in low-income and rural families in the southern U.S. Study also linked permissive parenting to poor diet quality and higher weight among children Stang, Hennesy 14, 27

Neglectful Parenting Neglectful parenting is characterized by the absence of caring behaviors, few behavioral expectations, and little to no discipline Low demand, low responsiveness Recent study showed that children who described their parents as neglectful were more likely to: Eat less fruit Eat unhealthy snacks Skip breakfast Both permissive and neglectful parenting styles show a twofold risk of obesity when compared to authoritative parenting. Children from neglectful parents were more likely to eat less fruit, eat unhealthy snacks, and skip breakfast more often than children who described their parents as authoritative. Stang, Pearson 14, 27

Maternal Influences Mothers who used more control over their child’s food intake had children who showed less ability to regulate intake Mothers preoccupied with their own weight and eating are linked to higher levels of restricting daughters intake May place daughters at risk for developing problematic eating behaviors Mothers are of particular interest on children’s eating behavior because they have been shown to spend significantly more time than fathers in direct interactions with their children across several familial situations, including mealtimes. Restricting daughters intake to encourage weight loss over time. Scaglioni 25

Maternal Influences Recent study by May et al. (2007) found that of the mothers who classified their child as overweight, all stated that they pressured their child to eat the right foods and that they restricted sweets, junk foods, and favorite foods Mothers’ own eating behavior Emotional eating Rewards Interesting that we just discussed why these techniques may lead to eating problems in the future, and close to all parents reported using these techniques. Mothers tend to feed their children he same way that they eat themselves: mothers who offered food to deal with their child’s emotional distress were more likely to have a high level of emotional eating, and those who used food as a reward were more likely to present high levels of external eating (eating without listening to internal hunger cues). May, Lauzon-Guillain 18, 20

Key Factors of Influence
7

Potential Consequences of Parental Influences

Possible Consequences of These Influences
Food Neophobia Picky Eating Lack of diet quality Obesity Cooke, ventura 5, 17, 29

Food Neophobia Fear of a new food
Manifested in children as a reluctance to eat and/or avoid novel food Impoverished vs. 21st century food environment Challenge now is not to avoid poisoning, but obesity and chronic disease Affects both quality and development of children’s diet and food preferences Young children are also predisposed to be neophobic about food. Particularly toward the second year of life, coinciding with an important period of transition to an adult diet, there is a tendency to avoid novel foods. Food neophobia may now be maladaptive, hindering the development of a range of preferences and hence consumption of a varied diet. Natural instinct. In an poor food environment it makes sense to prefer foods that offer greater nutritional value and energy and these properties may be signaled by sweetness. Conversely, sour and bitter tastes may indicate the presence of toxins when children are encountering a new food, the tendency to reject it may be life-saving. The 21st century food environment is neither hostile or impoverished, however, and the challenge we now face is not to avoid starvation or poisoning, but obesity and chronic disease. Galloway, Russel, Cooke, Scaglioni 6,13, 24, 25

The Children’s Food Neophobia Scale (FNS)
Measured by parents using a 7-point scale to answer following questions : My child is constantly sampling new and different foods. My child does not trust new foods. If my child doesn’t know what is in a food, she won’t try it. My child will eat almost anything. Measures the trait of food neophobia, which was defined as a reluctance to eat and/or avoidance of novel foods. Responses were on a 7-point scale with anchors of strongly disagree and strongly agree. Asks questions such as… Russel 24

Neophobia vs. Picky Eating
Defined: Unwillingness to try novel foods. Both Picky Eating Unwillingness to eat many familiar foods. Refusal of complete food groups or textures. Predicted by their mothers’ own high food neophobia scores and high levels of anxiety. Intense reactions to certain foods. May have a genetic basis. Consume fewer servings of vegetables. Distinct behavioral concepts. Predicted if they were breastfed fewer than 6 months If their mothers reported not having time to eat a healthful diet Both showed to consume fewer vegetables throughout each day, both are distinct behavioral concepts with different predictors. Food neophobia is when there is refusal of a complete food group or textures. Their mothers own high food neophobia scores and their own comparatively high levels of anxiety. Intense reactions to certain food groups such as vomiting, gagging, crying, or shaking. Pickiness, however, was predicted by experiential variables: girls were more likely to be picky if they were breastfed for fewer than 6 months, if their mothers reported not having time to eat a healthful diet, and if their mothers consumed a more limited variety of vegetables. *Explanation for breastfed >6 months are less picky is because they have been exposed to a diversity of flavors via breast milk early in life. Galloway 13

Effects of Neophobia Results from Galloway et al. (2003)
Of year-old girls, approximately 33% had medium to high scores on the FNS Significant relationship between food neophobia and vegetable consumption Results from Falciglia et al. (2000) Study looking at food neophobia in 10-year-old children and its affects on dietary variety Children with neophobia had less overall diet quality This particular study used the Child Feeding Questionnaire (to assess pickiness) and Food Neophobia Scale developed by Pliner (1992) Showed that girls with high neophobia and high pickiness reported to have significantly lower vegetable intake than girls categorized as low on both neophobia and pickiness. Mothers with food neophobia were more likely to have daughters with food neophobia. Less diet quality: lack of food variety and high intake of saturated fat Surprisingly, the high intake of saturated fat in the neophobic group was not explained by a higher intake of dairy products and meat. Galloway, Pliner, Falciglia 10, 13, 22

Neophobia ABC Nightline
*Stop at 3.22 minutes Extreme case that may not have to do with parental influences. Unknown reasons. Lots of research about neophobia. Erin’s particular case is quite common. Small list of foods that she will eat. She is very particular about how the foods are prepared. Some children with neophobia get sick and gag when consuming any of the foods they don’t like, some will even at the thought of them. As you can see, she could be nutritionally effected by eating such a small variety of foods.

Picky Eating Picky eating is characterized by consistently being unwilling to try new foods or having strong opinions about food preferences Using these techniques to encourage eating may cause the picky eater phenomenon: Reward Persuasion Punishment Children are smarter than we think. Once they realize that you are trying to get them to eat certain foods by using these techniques, they will recognize that there must be a reason you have to try so hard. Possibly because it is a food that isn’t very good. Shim, Carruth (Phenomenon) 3, 26

Picky Eater Phenomenon
Three primary concepts Developmental process for toddlers Personal preferences Family Understanding these concepts can help health care providers make appropriate recommendations to parents Purposed that the understanding of these concepts can guide primary care providers in making appropriate recommendations to parents to improve their child’s eating behavior. Picky eating is an aspect of child development/learning experience. Food acceptance patterns and the emergence of eating patterns are described as being related to physiologic growth, age, and emotional development. Children will develop their own personal preferences when given the appropriate told to do so. These food preferences are found through trial and error of the child. Young children simply eat what they like without worrying about the fat, cholesterol, or sodium content. Parent are their children’s greatest role models. Cathey 4

Effects of Picky Eaters
Study by Carruth et al. (2004) Determined picky eater status and energy/nutrient intakes 9-11 month-old infants associated with picky eater status were found to have significantly lower intakes of energy, total fat, folate, B12, thiamin, riboflavin, B6, calcium, magnesium, and zinc For all nutrients, mean intakes were above the RDA for picky and non-picky eaters Both groups (ages 7-8 months and 9-11 months) had 17 statistically significant differences in energy and nutrient intake associated with picket eater status. Carbohydrate, vitamin C, thiamin, riboflavin, niacin, vitamin E, and iron were significantly lower for the picky eater group (ages 7-8 months). Energy, total fat, folate, vitamin B-12, thiamin, riboflavin, vitamin B-6, calcium, magnesium, and zinc were lower for the picky eater group at 9-11 months. For all nutrients, mean intakes were above the RDA for picky and nonpicky eaters. Picky eaters were more likely to consumed sweetened cereals vs. unsweetened. Within the vegetable group, a higher percentage of picky eaters were reported to consume french fries. Carruth (Prevalence), Russel 2, 24

Obesity: Learned or Genetics?
Childhood obesity is thought to result from an interaction of multiple influences including genetic, familial, and environmental risk factors Genetic obesity risk factors Learned obesity risk factors Separating genetic from environmental (or learned) risk factors for early childhood obesity has been challenging for researchers. Parental obesity confers its risk for obesity in the offspring through both shared genes and environmental factors Research suggests that behaviors that are often considered to be environmental or learned obesity risk factors may in fact also be influenced by genetics. Stang, kral 27

Child Obesity Risk Appetitive traits have been recognized as having an impact on child food intake, therefore influencing child weight status Appetitive traits: Low response to internal satiety cues High response to external food cues Rewards/reinforcement Food preferences Its appetitive traits that have been recognized as having an impact of child food intake, therefore influencing child weight status. And as we already know and talked about, things such as pressure and certain parenting styles may interfere with internal satiety cues. Food cues- smell or taste of palatable foods Rewards- from eating preferred foods And these traits could be the result of genetics or environment. 27

Child Obesity Causes Authoritarian Parenting Parent Modeling
Children high risk for obesity Parent Modeling Research has shown that children’s intake of fruits and vegetables is associated with parents’ modeling of high levels of fruit and vegetable consumption Restriction Associated with higher BMI and body fat percentage This parenting style has been linked to an almost fivefold increase in risk for obesity among children when compared to any other feeding parenting style. Research has shown that parents, particularly mothers, who practice healthy eating behaviors and make healthy foods readily available correlates positively with children’s level of consumption. There are strong similarities that exist between children and their parents when it comes to food preferences as well as their food intake patterns and willingness to try new foods. Dietary restriction by parent has been associated with higher BMI and body fat in children, which is the opposite effect intended by this feeding practice. Stang 27

Recommendations for Practice Regarding Childhood Obesity and Increasing Food Variety

Registered Dietitian’s Role
Fox, Mary Kay et al. (2010) states, “Because children’s diets largely reflect household patterns, dietetics practitioners should use family-focused approaches to fostering the development of healthy eating habits.” So, the following information should help us, as RD’s, get a better idea of how to deal with these types of clients, and really see the whole picture and interact with both the parents and child. Fox et al. 12

Parents Perception Study by May et al. (2007)
Examined association between mothers’ perception and concern about children’s weight Not any of the overweight children were classified as overweight by his or her mother Further emphasizes the importance of communicating to parents their child’s weight-for-height status **Important on our part as RD’s and any health professional in public and private clinics to communicating to parents their child’s weight-for-height status based on accurate weight and height measurements. *It has shown that more mothers are concerned about their child being underweight than overweight. This could go both ways. If parents think child is overweight…may restrict. If parents think child is underweight….may pressure. May, Daniels 7, 20

Identifying Parenting Style
Many authors recommend targeting parenting and feeding styles Encourage authoritative feeding in interventions to prevent child overweight Anticipatory guidance: Provide parents with information before problems have already been established This was the child-centered feeding approach and linked to normal eating behaviors. **HANDOUT 3** Daniels 7

Exposure to New Foods Carruth et al. (1998) reported that young children need frequent exposures to new food items both at home and away from home to have the opportunity to learn about them Most limiting factor in development of food choices: Lack of offering specific foods to young children In a study in Pediatric Nursing journal found most of the 2-year-old children looked at needed to be exposed to a food as many as 10 times before they were willing to accept it. *A child cannot learn to accept a new item without frequent exposure. Cathey 4

Ellyn Satter on Exposure
Ellyn Satter, expert authority on eating and feeding, states the following: “Your child will warm up slowly to unfamiliar foods and may have to see, watch you eat, touch or taste a food 15 or 20 (or even more) times before he learns to like it.” “Be patient and persistent, but don't pressure. Children generally need to be offered a food 5 to 20 times - or even more - before they learn to enjoy it.” Ellyn Satter 9

Availability Parents can shape their child’s food preferences by exposing them to healthy foods at home and make them more accessible Frequent exposure to an unfamiliar food results in: Increased consumption Liking and preference for that food Many researchers suggest that parents need ideas concerning age appropriate experiences needed to help the toddler learn to accept a wide array of foods and to ingest adequate amounts of needed nutrients and energy. Kral, Rhee 17, 23

Availability Children are more likely to eat these foods when they are made available to them in the home Encourage parents to keep fruits, vegetables, and other healthy foods available and easily accessible for their children Encourage parents to put fruits and vegetables in place where the child can easily reach them (in a bowl on the table or on a lower shelf in the refrigerator) and preparing them into sizes that are easy to eat (fruit cut into bite-sized pieces). This may increase child’s intake of these foods. A study showed that the availability and accessibility of fruits and vegetables in the home accounted for 35% of the variance in reported consumption of those foods. Rhee, kral 17, 23

Increasing Portions Recent study by the AND was purposed to assess whether increasing portion sizes of fruits and vegetables would increase intake for children Portions of fruits and vegetables were doubled on children’s plate Vegetable intake was increase by 37% and fruit intake was increased by 70% Mathias 19

Modeling Parents can indirectly influence their children’s eating habits by modeling good eating behaviors Enthusiastic and positive comments Eating similar foods with similar colors Combination of these behaviors may promote healthy eating behaviors among children *Unfortunately, modeling of negative behaviors can have an equally strong, but opposite effect, and has been associated with the development of emotional eating, snacking, and body dissatisfaction. Rhee 23

Parent Role Modeling “Do as I do” rather than “do as I say”
Studies show fruit and vegetable consumption is higher in children who eat the same food as parents at mealtimes 25

Recommendations for Practice Regarding Food Neophobia

SOS Feeding Therapy The Sequential Oral Sensory (SOS) approach is a developmental feeding therapy that allows the child to interact with the food in a playful, non-stressful way Helps increase the child’s comfort level by exploring different properties of foods, including the color, shape, texture, smell, taste and consistency Feeding therapists who use a systemic hierarchy to feeding. Starting with getting comfortable having the food in the same room as them. Then moving to touching the food, playing with the food, and eventually eating the food. In talking with the feeding therapists, they always emphasized how important it was to have the parents on the same page as well. It isn’t therapy just for the child, but for the parents as well. Easter seals 8

Interaction with Feeding Therapists
STOP 4:45. So, this is often time the types of patients that feedings therapists see. And their approach often times is SOS Feeding therapy. In the sessions I have observed, they look a lot like that one. Use many different techniques to “wake up” the oral senses. They are also always giving huge praise to the child for little steps. Erin’s story ended with having great success after working with the feeding therapists. She now has a “food adventure” once a week. Every meal logged, every bite recorded. She is now eating bacon and cheeseburgers. Still didn’t eat pizza, but was continuing to work on it.

Who needs it? Transitions from tube to oral feeding
Eats less than 20 different foods Poor weight gain Limited variety of tastes and textures Difficulty with transitioning to advanced textures Maladaptive behaviors around eating Experiencing power struggle during meals Easter seals 8

RD Role with Feeding Therapy
Assess child’s nutritional needs Nutrition support may be necessary Work with feeding therapist to determine the appropriate approach 8

Conclusion Parents play a pivotal role in the development of their child’s food preferences and energy intake. There are potential health consequences regarding particular feeding practices. Strategies should be provided for parents to avoid development of risky eating behaviors. Health professionals have the responsibility of speaking to parents about influence they pose on their child's eating behaviors.

Leave with a few words.. “Childhood offers a unique opportunity to positively influence the adoption of healthful eating and physical activity patterns that could be sustained throughout life.” Story et al. 2002 28

Special Thank You… Tricia Zuercher, RD, LDN Anna Binder
Luncheon Preceptor Anna Binder Luncheon Buddy Golda Ewalt, RD, LDN Internship Director

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Parental Influences on Child Eating Behaviors

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