Child Nutrition Programs Research Articles

Perceptions of Child Nutrition Programs: The Voices of Children, Parents, Volunteers, Program Coordinators and Educators

ABSTRACT Stakeholders' attitudes about and perceptions of school-based child nutrition programs (CNPs) in Ontario were examined through focus groups and individual interviews with children (n = 46), participating parents (n = 19), nonparticipating parents (n = 22), volunteers (n = 4), program coordinators (n = 8), and educators (n = 8). Most children did not perceive stigma in participating in a CNP, although older children were concerned about image and perceptions of others. Parents of participating children perceived benefits of CNPs beyond nutrition, such as social and family convenience. However, they were aware of stigmatization in the broader community. Nonparticipating parents recognized the need for these programs but questioned the potential for abuse of the program, assigning an element of blame to parents of participating children. Volunteers and program coordinators provided insight into the types of children who attend these programs and how parents sometimes kept children from attending. Educators were in full support of these programs but conceded that older children sometimes perceived participation as unacceptable. Social stigma associated with CNPs by the broader community may be reduced by improved knowledge and awareness of the funding, quality, and universality of these programs.

Best Practices Among Child Nutrition Programs in Ontario: Evaluation Findings

ABSTRACT Canada does not have federally funded child nutrition programs. Instead, programs are local endeavors. We evaluated programs in Ontario against the Breakfast for Learning Canadian Living Foundation Best Practices standards. Three hundred breakfast and snack programs were randomly selected; 39.4% responded. Data collection included a survey completed by program coordinators and site visits conducted by registered dietitians. Results indicate that programs are meeting some, but not all, of the best practices. Only 54.3% of breakfast and 66.0% of snack programs had paid program coordinators. Resources and strategies need to be developed to help all programs meet best practices.

Maternal Symptoms of Stress, Depression, and Anxiety Are Related to Nonresponsive Feeding Styles in a Statewide Sample of WIC Participants

Parenting, including nonresponsive feeding styles, has been related to under- or overweight among young children. The relationship between maternal mental health and feeding styles has not been examined. We hypothesized that mothers who report more symptoms of stress, depression, or anxiety report less responsive (e.g. more controlling, indulgent, and uninvolved) feeding styles than mothers who report fewer symptoms of stress, depression, or anxiety. Our analyses included 702 mother-infant pairs from a statewide sample of Special Supplemental Nutrition Program for Women, Infants, and Children mothers. We assessed maternal mental health and feeding styles by a telephone survey. After adjusting for potential confounding variables, maternal stress symptomatology was significantly associated with forceful (β = 0.03; 95% CI = 0.02, 0.05) and uninvolved (OR = 1.4; 95% CI = 1.1, 1.7) feeding style scores, maternal depression symptomatology was significantly associated with forceful (β = 0.03; 95% CI = 0.004, 0.05), indulgent (β = 0.03; 95% CI = 0.004, 0.06), and uninvolved (OR = 1.5; 95% CI = 1.001, 2.2) feeding styles scores, and maternal anxiety symptomatology was significantly related to restrictive (β = 0.11; 95% CI = 0.01, 0.21), forceful (β = 0.04; 95% CI = 0.02, 0.06), and uninvolved (OR = 1.4; 95% CI = 1.01, 1.9) feeding style scores. Among mothers who perceived their infant as temperamentally fussy, there was a significant positive relationship between restrictive feeding styles scores and 3 indices of maternal mental health (stress, β = 0.18; 95% CI = 0.07, 0.28; depression, β = 0.21; 95% CI = 0.04, 0.38; and cumulative mental health symptomatology, β = 0.29; 95% CI = 0.10, 0.48). Mothers who report stress, depression, or anxiety symptoms are at risk for nonresponsive feeding styles. These findings provide support for broadening the focus of existing child nutrition programs to include strategies that recognize how issues of maternal mental health can affect feeding styles.

The neglected ‘m’ in MCH programmes – why mental health of mothers is important for child nutrition

In most societies, mothers are the primary providers of nutrition and care to young children. This is a demanding task, and poor physical or mental health in mothers might be expected to have adverse consequences on their children's health, nutrition and psychological well-being. Child nutrition programmes do not adequately address maternal mental health. In this article, we consider the evidence from less developed countries on whether maternal mental health influences child growth, with respect to evidence from both observational studies and from clinical trials. We estimate how much of the burden of undernutrition might be averted in one setting, and propose that promoting maternal mental health and treating maternal mental illness offer important new opportunities to tackle the twin scourges of maternal ill-health and child undernutrition.

Non‐responsive feeding styles are related to maternal mental health symptomatology and low rates of breastfeeding

Objectives: To investigate whether feeding styles are related to maternal mental health and breastfeeding. Method: Analyses are based on 702 mother‐infant pairs from a statewide telephone survey of WIC mothers administered in English and Spanish; 64.1% had initiated breastfeeding. Results: In bivariate analyses, breastfeeding was related to responsive feeding (β =0.13; CI: 0.03, 0.22). In multivariate analyses, adjusting for maternal education, breastfeeding, race/ethnicity, and infant age and gender, maternal stress symptomatology was associated with forceful (β =0.03; CI: 0.02, 0.05) and uninvolved (OR=1.4; CI: 1.1,1.7) feeding styles, maternal depression symptomatology was associated with forceful (β=0.03; CI: 0.004, 0.05), indulgent (β=0.03; CI: 0.004, 0.06), and uninvolved (OR=1.5; CI: 1.001, 2.2) feeding styles, and maternal anxiety symptomatology was related to restrictive (β=0.11; CI: 0.01, 0.21), forceful (β=0.04; CI: 0.02, 0.06), and uninvolved (OR=1.4; CI: 1.01, 1.9) feeding styles. Conclusion: Mothers who report non‐responsive feeding styles report mental health symptomatology and low rates of breastfeeding. Findings provide support for broadening the focus of child nutrition programs to include feeding styles.

Mainstreaming interventions in the health sector to address maternal and child undernutrition

Mainstreaming interventions in the health sector to address maternal and child undernutrition

Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: a cluster randomised trial

Food-assisted maternal and child health and nutrition programmes usually target underweight children younger than 5 years of age. Previous evidence suggests that targeting nutrition interventions earlier in life, before children become undernourished, might be more effective for reduction of childhood undernutrition. We used a cluster randomised trial to compare two World Vision programmes for maternal and child health and nutrition, which included a behaviour change and communication component: a preventive model, targeting all children aged 6-23 months; and a recuperative model, targeting underweight (weight-for-age Z score <-2) children aged 6-60 months. Both models also targeted pregnant and lactating women. Clusters of communities (n=20) were paired on access to services and other factors and were randomly assigned to each model. Using two cross-sectional surveys (at baseline and 3 years later), we tested differences in undernutrition in children aged 12-41 months (roughly 1500 children per survey). Analyses were by intention to treat, both by pair-wise community-level comparisons and by child-level analyses adjusting for the clustering effect and child age and sex. This study is registered with ClinicalTrials.gov, number NCT00210418. There were no differences between programme groups at baseline. At follow-up, stunting, underweight, and wasting (using WHO 2006 reference data) were 4-6 percentage points lower in preventive than in recuperative communities; and mean anthropometric indicators were higher by +0.14 Z scores (height for age; p=0.07), and +0.24 Z scores (weight for age and weight for height; p<0.0001). The effect was greater in children exposed to the preventive programme for the full span between 6 and 23 months of age than in children exposed for shorter durations during this period. The quality of implementation did not differ between the two programmes; nor did use of services for maternal and child health and nutrition. The preventive programme was more effective for the reduction of childhood undernutrition than the traditional recuperative model.

Mothers' perceptions of children's food behaviors: use of focus group interview study

Children's food behaviors have been expressed in a various ways because of recent changes in their family environment. Thus, this study was performed to investigate in-depth qualitative research on the mother's perception on children's food behaviors by focused group interview. This study was designed in four steps of planning, collection of participants, process, and analysis. Participants for the focus group interview were recruited and sampled from households with elementary school students in the Seoul and Gyeonggido areas. Groups were divided by total income and education expense levels. 1) High income household: It is better to improve currently existing web sites for nutrition education. 2) Mid income household: Easy, practical, and inexpensive off-line cooking class/nutrition education classes for mothers are needed. Nutrition programs for children should be developed through mass media and be promoted in the broadcasting circle. 3) Low income household: Motivation is required for mothers' education and the serious nutritional problems of children should be informed through mass media and home correspondence from school. And interesting educational materials should be developed for children to read whenever they want.

Implementing the Dietary Guidelines in Child Nutrition Programs Through Improved Recipes and the HealthierUS Schools Initiative

List and appropriately use resources from the Food and Nutrition Service, particularly the updated USDA Recipes for Schools, Recipes for Child Care, Menu Planner, and the HealthierUS School Challenge to implement the Dietary Guidelines for Americans 2005 in Child Nutrition Programs.

Value Enhanced Nutrition Assessment in the Special Supplemental Nutrition Program for Women, Infants and Children: Replacing Outdated Assessment Tools and Applying Adult Learning Theory to Behavior Change

Value Enhanced Nutrition Assessment in the Special Supplemental Nutrition Program for Women, Infants and Children: Replacing Outdated Assessment Tools and Applying Adult Learning Theory to Behavior Change

Developing a Performance Criteria Model for School Foodservice

Child nutrition programs (CNPs) including federal programs such as the National School Lunch Program (NSLP) and School Breakfast Program (SBP) have an overall goal to serve nutritious and appealing foods to help safeguard the health and well-being of the nation’s children. This study developed a performance criteria model for achieving the overall CNP goal for school foodservice by applying an analytic hierarchy process (AHP). A total of 39 performance criteria were identified and structured into a hierarchy of five major categories and 34 subcategories and criteria. Of the five major categories, the customer satisfaction category was rated as most important in achieving the overall CNP goal, followed by financial management, meal quality, program management, and operations management. Relative importance of subcategories and criteria were estimated. In addition, managerial implications of using the performance criteria model are discussed and future research ideas using AHP are suggested.

Nutritional Solutions to Major Health Problems of Preschool Children: How to Optimise Growth and Development

Significant opportunities to improve child health globally were provided in the second half of the 20th century. However malnutrition remains a major problem and in many countries the situation seems to have worsened. In a recent report about survival rate in childhood UNICEF remained that the United Nations first Millennium Goal was to eradicate extreme poverty and to reduce the proportion of people who suffer from hunger by half between 1990 and 2015 as measured by the percentage of children under five years of age who are underweight. The first Millennium Goal of the United Nations is to eradicate extreme poverty and to reduce the proportion of people who suffer from hunger by half between 1990 and 2015 as measured by the percentage of children under 5 y old who are underweight. (excerpt)

Evaluation of a Fruit and Vegetable Distribution Program—Mississippi, 2004-05 School Year

Although diets high in fruit and vegetables are associated with decreased risk for many chronic diseases, consumption of fruit and vegetables among children is below recommended levels. During the 2004-05 school year, the Mississippi Department of Education Child Nutrition Program initiated the Mississippi Fresh Fruit and Vegetable Pilot Program. The program was designed to 1) increase student access to fresh fruit and vegetables, 2) increase the degree of student preference for fruit and vegetables, and 3) increase fruit and vegetable consumption. The 25 schools selected to participate in the program distributed fresh fruit and vegetables free of charge during the school day and provided nutrition education activities to promote and support consumption of fruit and vegetables. An evaluation of the program was conducted using a pretest in the fall (before the program was implemented by the schools) and a posttest in the spring (at the end of the school year). This report summarizes the findings of that evaluation, which indicated that the program might have 1) increased the variety of fruit and vegetables ever tried by students from all three grades sampled (5th, 8th, and 10th); 2) increased the degree of preference for fruit among 8th-grade and 10th-grade students; 3) promoted positive attitudes toward eating fruit among 8th-grade students; 4) increased consumption of fruit, but not vegetables, among 8th-grade and 10th-grade students; and 5) decreased preference for fruit and vegetables, the belief that they could eat more vegetables, and willingness to try new fruit and vegetables among 5th-grade students. The results of this evaluation suggest that the distribution of fresh fruit at school free of charge to secondary school students might be an effective component of a comprehensive approach for improving student dietary behaviors; however, distribution of fresh vegetables might be more effective with changes in program implementation.

Improving Access to School-Based Nutrition Services for Children with Special Health Care Needs

Schools are recognized as a key setting to address the increase in overweight among youth. As part of the coordinated school health model, nutrition services can positively impact the eating habits of America’s school children and play a role in reversing this trend. The requirement for school districts participating in the US Department of Agriculture’s child nutrition programs to implement local wellness policies in the 2006-2007 school year presents opportunities for registered dietitians (RDs) to be directly involved in helping schools create more healthful environments.

HACCP Readiness in Child Nutrition Programs: Temperature Measurement and Recording

HACCP Readiness in Child Nutrition Programs: Temperature Measurement and Recording

Efeito da suplementação de zinco a crianças de 1 a 5 anos de idade

OBJETIVO: Avaliar o impacto da suplementação com zinco sobre os parâmetros nutricionais e bioquímicos entre crianças de 12 a 59 meses de idade. MÉTODOS: Foi realizado um estudo clínico randomizado unicego com 58 crianças entre 12 e 59 meses participantes do Programa Governamental de Combate a Carências Nutricionais, que fornecia mensalmente 2 kg de leite fortificado com ferro. O grupo intervenção (n = 28) foi suplementado com 10 mg/dia de sulfato de zinco por 4 meses, e o grupo controle (n = 30) recebeu solução placebo. Para avaliação do estado nutricional, utilizaram-se os indicadores peso por estatura e estatura por idade, expressos em escores z, do padrão de referência NCHS (National Center for Health Statistics), parâmetros bioquímicos de ferro e zinco séricos e concentração de hemoglobina e hematócrito. RESULTADOS: A suplementação com zinco não interferiu significativamente sobre as condições antropométricas das crianças. Ambos os grupos apresentavam concentrações iniciais baixas de zinco sérico. Após o término do período de intervenção, a variação nos níveis médios de hemoglobina (p = 0,002) e as concentrações de hematócrito (p = 0,001), zinco (p = 0,023) e ferro séricos (p = 0,013) foram significativamente mais elevadas no grupo suplementado. CONCLUSÃO: A suplementação com zinco promoveu melhora na resposta hemoglobínica e normalizou a concentração sérica de zinco. Os resultados mostram a importância de se estabelecer políticas de combate a carências nutricionais que também possam dar atenção à carência de zinco.

Effects of zinc supplementation on 1- to 5-year old children

To assess the impact of zinc supplementation on nutritional and biochemical parameters among children aged 12 to 59 months. A blinded randomized clinical trial was carried out with 58 children aged 12 to 59 months included in the Programa Governamental de Combate a Carências Nutricionais (National Child Nutritional Program), which provided them with 2 kg of iron-fortified milk. The supplementation group (n = 28) received 10 mg/day of zinc sulfate for four months, and the control group (n = 30) received placebo. The following parameters were used to assess the nutritional status: weight-for-height and height-for-age expressed as z scores, according to National Center for Health Statistics (NCHS) standards, biochemical measurements of serum iron and serum zinc, and hemoglobin and hematocrit levels. Zinc supplementation did not have a remarkable influence on anthropometric parameters. Baseline serum zinc levels were low in both groups. After supplementation, variations in mean hemoglobin (p = 0.002), hematocrit (p = 0.001), serum zinc (p = 0.023), and serum iron (p = 0.013) levels significantly increased in the zinc supplementation group. Zinc supplementation improved hemoglobin response and normalized serum zinc concentration. The results show the importance of establishing policies for nutritional care that can tackle zinc deficiency as well.

Micronutrient Sprinkles are effective at reducing anemia among children 6–24 months in rural Haiti

We evaluated the effectiveness of 2-mo of Sprinkles containing 12.5 mg of Fe, 5 mg Zn, 400 mcg Vit A, 160 mcg folic acid and 30 mg Vit C in reducing anemia (hemoglobin (Hb) <10 g/dL) in children 6 to 20 mo at baseline. Groups of children receiving take-home rations of fortified wheat-soy blend (WSB) in the context of a maternal and child health and nutrition program were randomized to receive (S-WSB) (N=254) or not receive (WSB) (N=161) 30 sachets of Sprinkles for 2 months. At baseline, 53% of S-WSB children and 37% of WSB children were anemic (p<0.05). At endline, anemia dropped to 29% in S-WSB (p=0.00), and increased to 45% (p=0.07) in WSB (p=0.00 for differences in before/after change). Mean endline Hb, adjusted for baseline Hb, age and sex, was higher in the S-WSB group than the WSB group (p=0.00). Mean Hb increased by +0.5 g/dL in the S-WSB group (p=0.00), and declined by −0.2 g/dL in the WSB group (p=0.00). Changes in Hb were largest in youngest compared to oldest children (adjusted diff.= +1.08 and +0.10 between treatment groups for children 6–8.9 mo and 18–20.9 mo at baseline respectively). Effects were also greatest (+0.85 g/dL) among children who were anemic at baseline. The results show that 2 mo of micronutrient Sprinkles are effective in improving Hb levels and reducing anemia in populations with a high prevalence of anemia, such as rural Haiti. A companion abstract (Loechl et al) also demonstrates the feasibility of this delivery system for Sprinkles. [Support: Micronutrient Initiative, World Vision-Haiti, Govt. of Germany; USAID through FANTA/AED]

Feasibility of distributing micronutrient Sprinkles along with take‐home food aid rations in rural Haiti.

Through a trial embedded within a maternal child health and nutrition program in Haiti, we determined that Sprinkles were effective in reducing anemia in children < 24 mo (see Menon et al.) We also sought to assess: 1) whether it is feasible to distribute Sprinkles along with the monthly take-home food rations provided by the program; 2) whether mothers could learn how to use Sprinkles appropriately after just one training session provided at the Mothers’ Clubs (MC) – the program’s venue for behavior change and communication. We examined acceptability of the Sprinkles intervention by mothers and staff using observations at food (and Sprinkles) distribution points, exit interviews with mothers, and focus group discussions (FGD) with mothers and staff. We found that Sprinkles were packaged and distributed as planned. Interviews confirmed that mothers understood how to use the Sprinkles and nearly universally reported following recommended practices. FGDs with mothers revealed good acceptability and appreciation of the Sprinkles; FGDs with staff suggested that inclusion of Sprinkles in the on-going program entailed a modest, but acceptable increase in workload. Within this well-established MCHN program, it proved feasible to distribute Sprinkles and to ensure their appropriate use. The Mothers’ Clubs and food distribution points proved to be excellent venues for educating mothers and distributing the Sprinkles, respectively. [Support: Micronutrient Initiative, World Vision-Haiti, USAID through FANTA/AED, Govt. of Germany].

Evaluación de un programa de política social: Programa Materno Infantil y Nutrición

This study is based on an evaluation of the Maternal and Child Health and Nutrition Program (PROMIN) targeting pregnant women and their children under five years of age. The objective was to identify the conditioning factors for the Program's implementation in Rosario, Argentina. There were three levels of analysis: the organizational environment as perceived by the Executive Directors of the Health and Child Development Centers; management of interventions by the health teams; and the community's perception of the program's accessibility and acceptability. Two centers were chosen for the year 1998. Empirical evidence was obtained through quantitative and qualitative procedures. The results suggest that the two centers' respective organizational environments influenced the intervention strategies. The goal for coverage had been set at 80%. Documentation of the interventions by the two teams shows a partial and heterogeneous implementation. In terms of accessibility, mothers recognize the institutions by their reputation, quality of services, and extra services beyond the PROMIN basics. Acceptability is expressed as the provision of supplementary nutrition.