Young Children's Consumption Research Articles

The Longitudinal Associations Between Parental Feeding Practices and Fruit and Vegetable Consumption in Young Children: A Systematic Review

The Longitudinal Associations Between Parental Feeding Practices and Fruit and Vegetable Consumption in Young Children: A Systematic Review

Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children

High intake of ultraprocessed foods (UPFs) has been associated with higher cardiometabolic risk in adults; however, the evidence in children is limited. To investigate the association between UPF consumption and cardiometabolic risk factors in the Childhood Obesity Risk Assessment Longitudinal Study (CORALS). This baseline cross-sectional analysis was conducted using the data of CORALS participants recruited between March 22, 2019, and June 30, 2022. Preschool children (aged 3-6 years) were recruited from schools and centers in 7 cities in Spain. Inclusion criteria included informed consent signed by parents or caregivers and having a completed a set of questionnaires about the child's prenatal history at home. Exclusion criteria included low command of Spanish or unstable residence. Energy-adjusted UPF consumption (in grams per day) from food frequency questionnaires and based on the NOVA food classification system. Age- and sex-specific z scores of adiposity parameters (body mass index [BMI], fat mass index, waist-to-height ratio, and waist circumference) and cardiometabolic parameters (diastolic and systolic blood pressure, fasting plasma glucose, homeostasis model assessment for insulin resistance, high-density and low-density lipoprotein cholesterol, and triglycerides) were estimated using linear regression models. Of 1509 enrolled CORALS participants, 1426 (mean [SD] age, 5.8 [1.1] years; 698 boys [49.0%]) were included in this study. Mothers of children with high UPF consumption were younger, had a higher BMI, were more likely to have overweight or obesity, and had lower education levels and employment rates. Compared with participants in the lowest tertile of energy-adjusted UPF consumption, those in the highest tertile showed higher z scores of BMI (β coefficient, 0.20; 95% CI, 0.05-0.35), waist circumference (β coefficient, 0.20; 95% CI, 0.05-0.35), fat mass index (β coefficient, 0.17; 95% CI, 0.00-0.32), and fasting plasma glucose (β coefficient, 0.22; 95% CI, 0.06-0.37) and lower z scores for HDL cholesterol (β coefficient, -0.19; 95% CI, -0.36 to -0.02). One-SD increments in energy-adjusted UPF consumption were associated with higher z scores for BMI (β coefficient, 0.11; 95% CI, 0.05-0.17), waist circumference (β coefficient, 0.09; 95% CI, 0.02-0.15), fat mass index (β coefficient, 0.11; 95% CI, 0.04-1.18), and fasting plasma glucose (β coefficient, 0.10; 95% CI, 0.03-0.17) and lower HDL cholesterol (β coefficient, -0.07; 95% CI, -0.15 to -0.00). Substituting 100 g of UPFs with 100 g of unprocessed or minimally processed foods was associated with lower z scores of BMI (β coefficient, -0.03; 95% CI, -0.06 to -0.01), fat mass index (β coefficient, -0.03; 95% CI, -0.06 to 0.00), and fasting plasma glucose (β coefficient, -0.04; 95% CI, -0.07 to -0.01). These findings suggest that high UPF consumption in young children is associated with adiposity and other cardiometabolic risk factors, highlighting the need for public health initiatives to promote the replacement of UPFs with unprocessed or minimally processed foods.

The role of dairy consumption in the relationship between wealth and early life physical growth in India: evidence from multiple national surveys

IntroductionPrevalence of undernutrition continues to be high in India and low household wealth is consistently associated with undernutrition. This association could be modified through improved dietary intake, including dairy consumption in young children. The beneficial effect of dairy on child growth has not been explored at a national level in India. The present analyses aimed to evaluate the direct and indirect (modifying association of household level per adult female equivalent milk and milk product consumption) associations between household wealth index on height for age (HAZ) and weight for age (WAZ) in 6-59 months old Indian children using data from of nationally representative surveys.MethodsTwo triangulated datasets of two rounds of National Family Health Survey, (NFHS-3 and 4) and food expenditure (National Sample Survey, NSS61 and 68) surveys, were produced by statistical matching of households using Non-Iterative Bayesian Approach to Statistical Matching technique. A Directed Acyclic Graph was constructed to map the pathways in the relationship of household wealth with HAZ and WAZ based on literature. The direct association of wealth index and its indirect association through per adult female equivalent dairy consumption on HAZ and WAZ were estimated using separate path models for each round of the surveys.ResultsWealth index was directly associated with HAZ and WAZ in both the rounds, but the association decreased from NFHS-3 (βHAZ: 0.145; 95% CI: 0.129, 0.16) to NFHS-4 (βHAZ: 0.102; 95%CI: 0.093, 0.11). Adult female equivalent milk intake (increase of 10gm/day) was associated with higher HAZ (β_NFHS-3=0.001;95% CI: 0, 0.002; β_NFHS-4=0.002;95% CI: 0.002, 0.003) but had no association with WAZ. The indirect association of wealth with HAZ through dairy consumption was 2-fold higher in NFHS-4 compared to NFHS-3.ConclusionsThe analysis of triangulated survey data shows that household level per- adult female equivalent dairy consumption positively modified the association between wealth index and HAZ, suggesting that regular inclusion of milk and milk products in the diets of children from households across all wealth quintiles could improve linear growth in this population.

Translating and Testing a Digital Game Promoting Vegetable Consumption in Young Children: Usability Study.

Promoting healthy eating in children is key to preventing chronic diseases, and vegetable consumption is notably lower than recommended in this population. Among the interventions tested, gamification has shown promise in promoting familiarization, increasing knowledge, and potentially increasing vegetable intake. This pilot study aimed first to translate the digital game "Veggies4myHeart" into French and to assess its influence on young children's preferences and willingness to taste vegetables when combined with repeated tasting and education. We also aimed to investigate the acceptability and applicability of the game in 2 classrooms. During 5 consecutive weekly sessions, children from 2 elementary classes played the digital game consisting of 5 mini games on different vegetables (lettuce, carrot, red cabbage, cucumber, and tomato) in pairs for 10-15 minutes. In addition, they discussed one of the vegetables and tasted the 5 vegetables in each session. Pretest and posttest food preferences and willingness to taste the vegetables were compared. Teachers participated in a semistructured interview. A total of 45 children aged 5 to 6 years tested the French version of the digital game. The children's declared food preferences were already high for carrot, cucumber, and tomato, with scores higher than 4 out of a maximum of 5. The scores did not change significantly after the intervention, except for red cabbage (pretest: mean 2.52, SD 1.49; posttest: mean 3.29, SD 1.67; P=.006) and a composite score (pretest: mean 3.76, SD 1.06; posttest: mean 4.05, SD 1.03; P=.001). Before the intervention, 18 (44%), 30 (73%), 16 (39%), 29 (71%), and 26 (63%) children out of 41 were willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. After the intervention, no significant statistical differences were observed, with 23 (51%), 36 (80%), 24 (53%), 33 (73%), and 29 (64%) children out of 45 willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. Teachers supported this tool combined with repeated tasting and education and highlighted facilitators and barriers that should be anticipated to improve implementation in schools. In this study, we translated an existing digital game applicable and acceptable to both children and teachers. A larger study is warranted to confirm the effectiveness of interventions using the digital game to promote vegetable preference, willingness to taste, and intake.

See and Eat! The impact of repeated exposure to vegetable ebooks on young children's vegetable acceptance

Vegetable consumption in young children in the UK is well below the recommended five child-sized portions per day. Effective and practical strategies are therefore needed to encourage vegetable consumption in young children. In this exploratory study, we examine the effects of visual familiarization to foods via See & Eat ebooks, which show vegetables on their journey from ‘field to fork’. As part of a larger study, in which 242 British families completed a range of measures about their family's eating habits, child's food preferences and potential parent and child predictors of these (Masento et al., 2022), parents were invited to download a See & Eat ebook about a vegetable their child did not eat. Thirty-six families participated in the intervention, looking at the ebook with their child for two weeks and reporting on their child's willingness to taste, intake and liking of the vegetable targeted by the ebook and a matched control vegetable before and after the intervention period. Results showed significant increases in parental ratings of children's acceptance of the target vegetable. Willingness to taste and intake ratings improved for the target vegetable, but not the control vegetable, while liking was reported to increase for both vegetables. These results corroborate previous research demonstrating the benefits of familiarising children with vegetables before they are offered at mealtimes and suggest that ebooks can be added to the set of tools parents can use to support children's vegetable consumption.

An agent-based model of child sugar-sweetened beverage consumption: implications for policies and practices

A strong body of evidence links young children's intake of sugar-sweetened beverages (SSBs) with myriad negative outcomes. Our research provides insight into whether and to what extent potential intervention strategies can reduce young children's consumption of SSBs. We built an agent-based model (ABM) of SSB consumption representing participants in the Project Viva longitudinal study between ages 2 and 7 y. In addition to extensive data from Project Viva, our model used nationally representative data as well as recent, high-quality literature. We tested the explanatory power of the model through comparison to consumption patterns observed in the Project Viva cohort. Then, we applied the model to simulate the potential impact of interventions that would reduce SSB availability in 1 or more settings or affect how families receive and respond to pediatrician advice. Our model produced age-stratified trends in beverage consumption that closely match those observed in Project Viva cohort data. Among the potential interventions we simulated, reducing availability in the home-where young children spend the greatest amount of time-resulted in the largest consumption decrease. Removing access to all SSBs in the home resulted in them consuming 1.23 (95% CI: 1.21, 1.24) fewer servings of SSBs per week on average between the ages of 2 and 7 y, a reduction of ∼60%. By comparison, removing all SSB availability outside of the home (i.e., in schools and childcare) had a smaller impact (0.77; CI: 0.75, 0.78), a reduction of ∼40%. These results suggest that interventions reducing SSB availability in the home would have the strongest effects on SSB consumption.

Trends in use of specialized formula for managing cow's milk allergy in young children.

Excessive use of specialized formula for cow's milk allergy was reported in England, but complete analysis has not been undertaken and trends in other countries are unknown. Some specialized formula products, especially amino-acid formula (AAF), have high free sugars content. We evaluated specialized formula trends in countries with public databases documenting national prescription rates. Cross-sectional analysis of national prescription databases in the United Kingdom, Norway and Australia. Outcomes were volume and cost of specialized formula, and proportion of infants prescribed specialized formula. Expected volumes assumed 1% cow's milk allergy incidence and similar formula feeding rates between infants with and without milk allergy. Prescribed volumes of specialized formula for infants rose 2.8-fold in England from 2007 to 2018, with similar trends in other regions of the United Kingdom. Volumes rose 2.2-fold in Norway from 2009 to 2020 and 3.2-fold in Australia from 2001 to 2012. In 2020, total volumes were 9.7- to 12.6-fold greater than expected in England, 8.3- to 15.6-fold greater than expected in Norway and 3.3- to 4.5-fold greater than expected in Australia, where prescribing restrictions were introduced in 2012. In Norway, the proportion of infants prescribed specialized formula increased from 2.2% in 2009 to 6.9% in 2020, or 11.2- to 13.3-fold greater than expected. In 2020, specialized formula for infants cost US$117 (103 euro) per birth in England, US$93 (82 euro) in Norway and US$27 (23 euro) in Australia. Soya formula prescriptions exceeded expected volumes 5.5- to 6.4-fold in England in 1994 and subsequently declined, co-incident with public health concerns regarding soya formula safety. In 2020, 30%-50% of prescribed specialized formula across the three countries was AAF. In England, Norway and Australia, specialized formula prescriptions increased in the early 21st century and exceeded expected levels. Unnecessary specialized formula use may make a significant contribution to free sugars consumption in young children.

Effectiveness of the Eggs Make Kids Demand-Creation Campaign to Improve Household Availability of Eggs and Egg Consumption in Young Children in Nigeria

ObjectivesTo determine the effectiveness of the “Eggs Make Kids Smart & Bright and Strong & Active” demand-creation campaign on caregivers’ behavior towards eggs, caregivers’ willingness-to-pay for eggs, the availability of eggs in household, and the consumption of eggs in children 6–59 months of age in Kaduna state, Nigeria.MethodsAn egg demand-creation campaign in Kaduna state targeting families of children 6–59 months of age was implemented between October 2019 and December 2020. A quasi-experimental design was used to evaluate the impact of the campaign. The intervention arm received emotionally compelling radio and TV advertisement and promotional activities and advertising at point-of-purchase, schools, and health facilities about eggs; the comparison arm received no intervention. Children 6–59 months of age in both arms (intervention n = 1359; comparison n = 1485) were assessed 14 months apart before and after the implementation of the intervention. Intent-to-treat analyses with analysis of covariance method were used to assess impact of the intervention on caregivers’ behavior towards eggs, caregivers’ willingness-to-pay for eggs, the availability of eggs in household, and the consumption of eggs in children 6–59 months of age. Analyses were adjusted for possible confounders and perceived effects of SARS-CoV2 on household finances and food consumption.ResultsThere was improved prevalence of household egg acquisition in the intervention arm compared to the comparison arm (odds ratio = 1.34, p-value < 0.0001). The intervention arm showed larger improvements in caregiver self-efficacy (β = 0.242, p-value = 0.004) and intent to feed eggs (β = 0.080, p-value = 0.021) than the comparison arm. No effects were found on child egg consumption or caregivers’ willingness-to-pay for eggs.ConclusionsIn Nigeria, a 14-month egg demand creation campaign improved household egg acquisition and benefited caregiver self-efficacy and intent to feed eggs but did not improve child egg consumption. Further research is needed to identify how to increase child egg consumption in the context of availability of eggs in households and favorable caregiver behavior.Funding SourcesFunding for this study was provided by the Netherland's Ministry of Foreign Affairs.

Which Nutrition Interventions Increase Fruit/Vegetable Acceptance and Consumption in Young Children and Can Be Successfully Implemented in a Restaurant Setting?

Which Nutrition Interventions Increase Fruit/Vegetable Acceptance and Consumption in Young Children and Can Be Successfully Implemented in a Restaurant Setting?

Fish and Complementary Feeding Practices for Young Children: Qualitative Research Findings From Coastal Kenya

ObjectivesTo assess the potential barriers and facilitators to fish consumption during the complementary feeding period in two coastal counties of Kenya with high rates of child malnutrition. MethodsThis qualitative study was part of a mixed-methods formative research investigation to examine the role of sustainable fish production and access to fish foods in coastal communities in Kenya. Twenty in-depth interviews were conducted with primary caregivers of children less than five years (n = 12) and community health workers and nutritionists (n = 8) in Kilifi County and Kwale County. Interviews were transcribed, translated and analyzed. A conceptual framework was developed based on the analysis to illustrate major factors and pathways influencing decisions to feed fish in the complementary feeding period. ResultsComplementary feeding practices reported by caregivers showed a low level of fish consumption in young children and delayed introduction of fish to the diet. Findings indicate that fish consumption was impacted by factors related to accessibility, food preferences, and caregiver’s knowledge and beliefs. Access to fish was driven primarily by cost, proximity to locations where different fish types were sold, gendered purchasing behavior and the seasonal availability of fish foods. In some cases, the high cost of fish outweighed positive associations or perceived nutritional benefits when deciding whether to feed fish to children. Caregivers’ knowledge, beliefs, and food preferences also impacted consumption, with mixed perceptions regarding the importance of fish as a source of protein and other nutrients. These direct factors were influenced by prominent community figures such as elder women and health workers, whose own beliefs and understandings were impacted by underlying cultural norms, potentially limiting fish consumption. ConclusionsUnderstanding current attitudes and beliefs toward fish consumption during the complementary feeding phase is a critical first step towards the creation of more effective policies and interventions that incorporate sustainable fish foods to address significant nutritional disparities that exist in the study population. Funding SourcesThis study was supported by the United States Agency for International Development (USAID) Feed the Future Innovation Lab for Fish.

Unraveling the Impact of Pneumococcal Conjugate Vaccines on Ambulatory Antibiotic Drug Consumption in Young Children: An Interrupted Time-Series Analysis.

Pneumococcal conjugate vaccines (PCVs) reduce respiratory infections in young children, the main antibiotic consumers. Following PCV implementation, dispensed antibiotic prescription (DAP) rates in young children were expected to decline. Computerized data on DAP for children <5 years were examined during a 13-year period (including 4 pre-PCV years). All DAPs from clinics with ≥50 insured children, active both pre- and post-PCV implementation were included. Interrupted time-series with segmented regression was applied to analyze monthly DAP rate trends, adjusted for age, ethnicity, and season. Incidence rate ratios (IRRs) of DAPs during the late PCV13 period versus 4 years pre-PCV were calculated both as absolute rate ratios (aIRRs) and relative to expected rates (rIRRs). Of 1 090 870 DAPs, 57% were in children <2 years. All-DAP rates peaked in the cold season. Post-PCV7/PCV13 implementation, all DAP rates abruptly and significantly declined, reaching a plateau within 5 years. This was largely driven by amoxicillin/amoxicillin-clavulanate (75% of DAPs). Age <2 years and Bedouin ethnicity were significantly associated with higher pre-PCV DAP rates but with faster and greater decline post-PCV, achieving near elimination of gaps between ages and ethnic groups. Overall reduction (95% CIs) in DAP rates per 1000 was estimated between aIRR (344.7 [370.9-358.4]) and rIRR (110.4 [96.9-123.7]) values. Shortly following PCV implementation, overall DAP rates showed an abrupt, steep decline, stabilizing within 5 years, in parallel to post-PCV respiratory infection trends previously described in this population, suggesting causality. The variable patterns of certain drug categories suggest additional influences beyond PCV.

Using Mobile Device Sampling to Objectively Measure Screen Use in Clinical Care

The widespread cultural adoption of media devices (eg, smartphones and tablets) in the last decade has changed the nature of screen time and consumption in young children. The single-user platforms of media devices promote solitary use1 and allow access to streaming videos, gaming, and the Internet: anytime and anywhere. Moreover, unlike traditional television viewing, mobile devices use gamification and persuasive design to grab and maintain the user’s attention. Media viewing is an environmental factor that has a direct impact on young children’s health and development.2–7 Unfortunately, the large majority of preschoolers are exceeding screen time guidelines8 at a time when their learning capacity is vast. Accordingly, pediatricians have a role in guiding families in adopting healthy device habits.9 Traditionally, clinicians have relied on caregiver reports of child screen use to guide clinical recommendations, but these reports may be inaccurate,10 casting doubt on their utility for evaluating problematic media habits. What if clinicians could more accurately capture children’s mobile device use to help families gain awareness on how digital media use … Address correspondence to Libby Matile Milkovich, MD, Division of Developmental and Behavioral Health, Department of Pediatrics, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: emilkovich{at}cmh.edu

Adversity exposure and obesogenic food consumption in young children: The transgenerational role of emotion dysregulation.

Childhood adversity is linked with unhealthy eating behaviours and obesity, but the mechanisms underlying this association are unclear, specifically the transgenerational behavioural precursors that develop in early childhood. To determine whether adversity predicts change in obesogenic food consumption through child emotion dysregulation, and whether caregiver emotion dysregulation modifies this association. Participants included 190 low-income caregiver-child dyads (mean child age = 4.31 years [SD = 0.85]). Cumulative lifetime adversity exposure was assessed via study-created measure. The Difficulties with Emotion Regulation Scale and Emotion Regulation Checklist assessed caregiver and child emotion dysregulation, respectively. Children's obesogenic food consumption was assessed at two time points 6 months apart using a caregiver-report measure: the Children's Eating Habits Questionnaire. Moderated mediation models were tested using autoregressive structural equation modelling. Cumulative lifetime adversity was associated with child emotion dysregulation only when caregiver emotion dysregulation was high. Child emotion dysregulation in turn was associated with greater obesogenic food consumption 6 months later. Among young children with caregivers high in emotion dysregulation, cumulative lifetime adversity was linked to an increase in obesogenic food consumption through child emotion dysregulation.

Indirect Calorimetry Overestimates Oxygen Consumption in Young Children: Caution is Advised Using Direct Fick Method as a Reference Method in Cardiac Output Comparison Studies

Direct Fick method is considered a standard reference method for estimation of cardiac output. It relies on indirect calorimetry to measure oxygen consumption. This is important as only a minor measurement error in oxygen consumption can result in false estimation of cardiac output. A number of studies have shown that indirect calorimetry overestimates oxygen consumption in adults. The aim of this prospective single center observational method comparison study was to compare the determination of oxygen consumption by indirect calorimetry and reverse Fick method in pediatric patients. Forty-two children mean age 352 days (range 30 to 1303 days) and mean weight 7.1 kg (range 2.7–13.6 kg) undergoing corrective cardiac surgery were included in the study. The mean (standard deviation) oxygen consumption by reverse Fick method was 43.5 (16.2) ml/min and by indirect calorimetry 49.9 (18.8) ml/min (p < 0.001). Indirect calorimetry overestimated the reverse Fick oxygen consumption by 14.7%. Bias between methods was 6.5 (11.3) ml/min, limits of agreement (LOA) − 15.7 and 28.7 ml/min and percentage error of 47.7%. A significant bias and large percentage error indicates that the methods are not interchangeable. Indirect calorimetry and the direct Fick method should be used with caution as a reference method in cardiac output comparison studies in young children.

Measuring Cowpea Consumption in Young Children and Pregnant Women in Ghana

Measuring Cowpea Consumption in Young Children and Pregnant Women in Ghana

Mothers' beliefs about indigenous and traditional food affordability, availability and taste are significant predictors of indigenous and traditional food consumption among mothers and young children in rural Kenya.

To examine mothers' and young children's consumption of indigenous and traditional foods (ITF), assess mothers' perception of factors that influence ITF consumption, and examine the relationship between perceived factors and ITF consumption. Longitudinal study design across two agricultural seasons. Seven-day FFQ utilized to assess dietary intake. Mothers interviewed to assess their beliefs about amounts of ITF that they or their young children consumed and on factors that influence ITF consumption levels. Seme sub-County, Kenya. Mothers with young children. Less than 60 % of mothers and children consumed ITF at time of assessment. Over 50 % of the mothers reported that their ITF consumption amounts and those of their children were below levels that mothers would have liked for themselves or for their young children. High cost, non-availability and poor taste were top three reasons for low ITF consumption levels. Mothers who identified high cost or non-availability as a reason for low levels of ITF consumption had significantly lower odds of consuming all ITF except amaranth leaves. Mothers who identified poor taste had significantly lower odds of consuming all ITF except green grams and groundnuts. Similar relationships were noted for young children's ITF consumption levels. A majority of the mothers reported that they and their children did not consume as much ITF as the mothers would have liked. Further studies should examine strategies to improve availability and affordability of ITF, as well as develop recipes that are acceptable to mothers and children.

Animal Source Food Consumption in Young Children from Four Regions of Ethiopia: Association with Religion, Livelihood, and Participation in the Productive Safety Net Program.

Introduction: Child undernutrition remains a challenge globally and in the geographically diverse country of Ethiopia. Improving dietary diversity and consumption of animal source foods are important for improving child nutrition and corresponding health outcomes. Objective: The objective of the study was to identify household and community factors associated with consumption of animal source foods among 6 to 36-month-old children from four regions of Ethiopia. Methods: A cross-sectional survey using multistage probability sampling in eight geographic zones and four regions of Ethiopia took place in 2015 with parents/caretakers of 6 to 36-month-old children. Data was collected on demographic information, proxy indicators of socioeconomic status, and food consumed by the child the day before the survey. Results: Increased child age, pastoral livelihood, Muslim religion, and participation in the Productive Safety Net Program were associated with increased consumption of animal source foods. Odds of animal source foods consumption increased by 8% with each 3-month age increase. Children from pastoralist households were the most likely to have consumed animal source foods in the preceding 24 hours as compared with those in agro-pastoralist households (0.21 times as likely) or those in agriculturalist/farming households (0.15 times as likely). The odds of consumption of animal source foods for families with food aid or safety net support was 1.7 times greater among those receiving traditional support from the Productive Safety Net Program and 4.5 times greater for those in the direct support arm of the program. Conclusions: The findings illustrate the importance of accounting for local context and community characteristics, such as livelihood and religion, when undertaking programming designed to improve diversity of children’s diets through increasing animal source foods. In addition, the Productive Safety Net Program may be a critical determinant of dietary diversity for young children in these regions.

Playing with food: The effects of food pre-exposure on consumption in young children

Recent research has shown that pre-exposure to food can lead to reduced subsequent consumption in older children and adults when they focus on a task with a non-eating goal during exposure. One assumption is that the reduced consumption is a consequence of self-regulation that helps to concentrate on the task. Because self-regulatory mechanisms are still under development in young children, we studied the effects of food pre-exposure in young children under the age of six (N = 81). Children played a memory game with real sweets (food pre-exposure) or similar non-food stimuli (non-food pre-exposure) and we measured their subsequent food consumption. In contrast to the findings with older children in other studies, we found that pre-exposure led to an increase (not a decrease) in subsequent consumption. This effect was stronger among children with a higher BMI. Food exposure paradigms might not lead to the desired reduction in food intake in young children, whose BMI is positively associated with food reactivity. Thus, food exposure must continue to be considered a strong risk factor for obesity in young children.

Strategies for public health initiatives targeting dairy consumption in young children: a qualitative formative investigation of parent perceptions.

Dairy products contain essential nutrients to ensure healthy growth and bone development in children. However, a significant proportion of children in developed countries fail to consume the daily recommended intake of dairy products. Parents are the gatekeepers of familial nutritional intake and represent a potential vehicle through which to increase dairy consumption in children. As such, formative research was conducted to gain insight into parents' perceived barriers to and benefits of purchasing and consuming dairy products and to develop innovative message content that could be utilized in future public health campaigns. Seven in-depth group interviews were conducted in two phases between February and May 2015. Interviews were conducted in local recreational centres and libraries in British Columbia, Canada. Mothers (n 21, mean age 38 (sd 5) years) and fathers (n 9, mean age 38 (sd 3) years) of children aged 4-10 years. Parents perceived both positive and negative physical outcomes associated with consuming dairy. Lack of trustworthy information was a frequently discussed barrier theme to purchasing and consuming dairy products. Mothers were concerned about the cost of dairy products. Differences in purchasing and consumption strategies were reported between parents of children who consumed adequate dairy and those who did not. Parents believed the most appropriate communication channel was through print material. Messages targeting parents, as a means of increasing dairy consumption in children, should address barriers identified by parents. In addition, practical tips should be provided to promote purchasing and consumption of dairy products.

Child Centered Nutrition Phrases: Messaging Increases Young Children's Consumption of Healthful Foods

Communication strategies that promote young children's healthful eating have received limited empirical study, particularly in early childhood education (ECE) settings. This study examines the effect of developmentally appropriate nutrition phrases on young children's food behavior. Eighty-seven children aged 3-6 years attending two ECE programs participated in a within-subject experiment. For the six-week taste activity intervention, each child was randomly assigned a repeated exposure (RE) and a child-centered nutrition phrase (CCNP) food (quinoa, lentils, tomato, or bell pepper). A consumption trial measured individual intake pre- and post-treatment and at one month post-treatment. Grams consumed data were log-transformed then submitted to a 2-level random effects model with time of assessment, phrase condition, their interaction, pre-preference for the foods, and pre-exposure to the foods at level 1; and site, child age, income, parent education level, and parent nutrition knowledge at level 2. Consumption of the CCNP food across the sample increased more than foods using RE alone. Children exposed to the CCNPs consumed 8.95g more of their target food post-treatment and 17.9g more at the one month post-assessment. A site effect was detected. Children from one ECE program accounted for the increased consumption of the CCNP food within the sample. Children attending the second site consumed less of the CCNP food than the RE food. Strategic use of developmentally appropriate nutrition messaging in ECE programs may be an effective strategy for increasing food consumption, but further research is needed to better understand contextual factors.