How children are fed matters just as much as what

How children are fed – that is, the overall emotional atmosphere, including caregiver wishes and demands during mealtimes – matters just as much as what they are fed, when it comes to beating obesity and heart disease, a new scientific statement from the American Heart Association has said. 

The statement, titled Caregiver Influences on Eating Behaviors in Young Children was published yesterday in the Journal of the American Heart Association.  It is the first statement from the Association that has focused on providing evidence-based strategies for parents and caregivers to create a healthy food environment for young children which supports the development of positive eating behaviors and the maintenance of a healthy weight in childhood, thereby reducing the risks of overweight, obesity and cardiovascular disease later in life.

While many children are born with an innate ability to stop eating when they are full, they are also influenced by the overall emotional atmosphere of meal times, including caregiver wishes and demands. If children feel under pressure to eat in response to caregiver wants, it may be harder for them to listen to their individual internal cues that tell them when they are full.

Allowing children to choose what and especially how much to eat within an environment composed of healthy options encourages children to develop, and eventually take ownership of, their decisions about food and may help them develop eating patterns linked to a healthy weight for a lifetime, according to the statement authors.

Dr Alexis Wood, writing group chair for the scientific statement, said that when sharing mealtimes with children, parents and caregivers should consider building a positive food environment centered on healthy eating habits, rather than focusing on rigid rules about what and how a child should eat.

The statement suggests that parents and caregivers should be positive role models by creating an environment that demonstrates and supports healthy food choices, rather than an environment focused on controlling children’s choices or highlighting body weight. Parents and caregivers should encourage children to eat healthy foods by:

• providing consistent timing for meals;
• allowing children to select what foods they want to eat from a selection of healthy choices;
• serving healthy or new foods alongside foods children already enjoy;
• regularly eating new, healthy foods while eating with the child and demonstrating enjoyment of the food;
• paying attention to a child’s verbal or non-verbal hunger and fullness cues; and,
• avoiding pressuring children to eat more than they wish to eat.

Dr Wood acknowledged that some parents and caregivers may find it difficult to allow children to make their own food decisions, especially if the children become reluctant to try new foods and/or become picky eaters. 

These behaviors are common, she said, and considered normal in early childhood, between the ages of one and five years, as children are learning about the tastes and textures of solid foods. In an effort to overcome these challenges, many parents and caregivers resort to imposing rules around eating (no dessert if you don’t eat your vegetables!) or rewards (one more bite and you can have some ice cream!) or punishments (you can’t leave the table until you eat all your food) which may have long-term, negative consequences. 

“An authoritarian eating environment does not allow a child to develop positive decision-making skills and can reduce their sense of control, which are important developmental processes for children,” Dr Wood said. 

In addition, the authoritarian approach has been linked to children being more likely to eat when they are not hungry and eating less healthy foods that are likely higher in calories, which increase the risk of overweight and obesity and/or conditions of disordered eating.

On the other hand, an indulgent approach, where a child is allowed to eat whatever they want whenever they want, does not provide enough boundaries for children to develop healthy eating habits. Research has also linked this “laissez-faire” approach to a greater risk of children becoming overweight or having obesity.

Research does suggest that some strategies can increase children’s dietary variety during the early years if they are “picky” or “fussy” about foods. Repeatedly offering children a wide variety of healthy foods increases the likelihood they will accept them, particularly when served with foods they prefer. 

In addition, caregivers or parents who enthusiastically eat a food may also help a child accept this food. Modeling eating healthy foods – by caregivers, siblings and peers – is a good strategy for helping children to be open to a wider variety of food options.

“Children’s eating behaviors are influenced by a lot of people in their lives, so ideally, we want the whole family to demonstrate healthy eating habits,” said Dr Wood.

It is important to note that not all strategies work for all children, and parents and caregivers should not feel undue stress or blame for children’s eating behaviours. 

“It is very clear that each child is an individual and differs in their tendency to make healthy decisions about food as they grow. This is why it is important to focus on creating an environment that encourages decision-making skills and provides exposure to a variety of healthy, nutritious foods throughout childhood, and not place undue attention on the child’s individual decisions,” she added.

The statement authors encourage policies that address barriers to implementing the statement’s recommendations within the wider socioeconomic context, including social determinants of health such as socio-economic status, food insecurity and others. 

While efforts that encourage caregivers to provide a responsive, structured feeding environment could be an important component of reducing obesity and cardiometabolic risk across the lifespan, they note that they will be most effective as part of a multi-level, multi-component prevention strategy.