NHD Paediatric Hub

The influences surrounding children's dietary choices

Aliya heads up our Paediatric Hub this month. Here she focuses on the introduction of allergens during weaning, including the current guidelines and the growing evidence around how food allergies develop.

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Aliya Porter, RNutr

Freelance Registered Nutritionist

In this article Aliya looks at three areas that influence the dietary intake of a child but also their relationship with food which will have a long-lasting impact on their food choices into adulthood. With the rise in obesity, type 2 diabetes, eating disorders and many other food-related illnesses (both physical and mental), it is important to assess the food environment on an individual level and seek to make improvements where possible. This is not an easy process as so much is engrained in our culture, our society and our habits.

Children learn through the people and situations in their lives. They pick up cues from other people and this shapes their interactions with the world going forward. Their interactions with food are no different. They are shaped by their food environment. This is a complex web of different factors from those that influence parental food choices, such as budgets, times and preferences, to the surroundings in which food is offered to them.

The food we have available is not the whole picture when it comes to our diet. That is an obvious statement to a nutrition professional but isn’t always seen that way by the public. Messages on social media can also suggest it is just about having food available. Whether it is the time we have to plan, cook and shop, the skills we have to cook, our likes or dislikes, the money we have for fuel, the desire to cook or one of another plethora of things that influence the food we eat. When it comes to children’s food the situation is also complex.

The food a child has available to them depends on their caregivers but even beyond availability, there are several factors that will influence what they put in their mouths, and their interaction with food – in the long and short term.

This article will seek to address three areas that influence a child’s eating habits: role modelling, pressure and the room environment. This is not an exhaustive list of influences but highlights some key areas to consider.

Role modelling

Children learn from the people around them. They learn their social cues from watching people, they learn what is safe, they learn what is dangerous. They learn how to eat, when to eat, what to eat and why we eat. Children will be watching parents, grandparents, other children and caregivers. They will be learning.

There are numerous studies on parental influence on children’s food choices. One example shows that children whose parents eat more fruit and vegetables follow the same pattern and vice versa. (1)

It would be easy to think role modelling is just the child seeing their parent eat a healthy balanced diet but it is broader than that.

Role modelling needs to include:

  • sitting and eating with the child so they can see what the parent/caregiver is eating; (2)
  • having conversations with the child about their food – without adding pressure (which will be discussed in due course);
  • separating food from emotion and reward, for example avoiding saying things like, "it’s been a really hard day, I need some chocolate" or, "we are celebrating with a cake." The celebration or comfort is fine and having the food is also fine, however, if we can, we should avoid linking the two together, especially in front of children;
  • being careful about how we talk about weight and health around our children; avoiding fat shaming or blame eg. “I can’t eat that because I’m on a diet”, or “she probably doesn’t need more food”. This also includes having a positive view of food in terms of fuel and enjoyment., as well as, the role model eating a healthy balanced and varied diet in view of the child. (3,4)

Pressure

Pressure can negatively impact what and how much children eat (5)  and can also override internal hunger and fullness cues, creating patterns where children don’t know when they have had enough and eat for other reasons.

Pressure comes from several places. Force-feeding is classified as physical abuse (6) and should be avoided at all costs. Parents desperate to get their child to eat something may resort to this and will need to navigate mealtimes, as well as ensure the safety of the child.

But not all pressure is as extreme force-feeding.

Pressure can include:

  • requiring the child to finish everything on their plate
  • bribing
  • punishment for not eating
  • rewarding – “If you eat this then…”
  • requiring the child to stay at the time until everyone has finished
  • labelling a child a fussy or picky eater
  • overloading the plate
  • labelling food “healthy” or “unhealthy”, “good” or “bad”
  • social pressure when the child feels excluded from conversation
  • sensory pressure (which will be discussed below)

Pressure can affect a child’s short term food intake but it can also impact their long-term relationship with food.

US dietitian, Ellyn Satter, in her ‘Division of Responsibility’ model, takes the concept of pressure further explaining that parents have a responsibility to decide what will be provided, when it will be provided and where it will be provided, and the child has the responsibility to choose whether they want to eat and how much. She details in her work the ways pressure can be added that undermine the two parties taking on only their responsibility, including parents changing what they provide because of pressure from the child. (7) Her model provides children with security in that they know the boundaries but choose to be able to work within those boundaries.

Room environment

As well as having good role models and not adding pressure to a child to eat their food, the physical environment they are in can have an impact on what they eat.

The room environment includes:

  • how it looks (warm, inviting, dark, bright)
  • how it feels (hot, cold)
  • what it smells like – and the strength of those smells (positive and negatives ones)
  • how it sounds (again both positive and negatives ones)

For children with heightened senses, strong smells can be off-putting, as can loud or very bright environments. For these children, things like serving food away from the kitchen smells, opening a window, lowering the lights or having headphones on when eating can be helpful.

A consistent food environment reduces stress levels. This has been shown to be particularly important for people with autism, (8) although most children like consistency. Knowing when food will be offered, where and what the table rules are can help the child to feel comfortable.

The environment also includes where a child is to eat – at a table, on the floor, or moving around. Not only is sitting safer than moving around with food, sitting in a comfortable chair with a back and foot support helps a child to be secure and then focus more on the food than on maintaining posture,

Finally, the room environment includes social pressure or calm. A positive social environment would be one where the child can eat with others without the TV or other devices. (9) and be involved in conversation which is meaningful to them. (10) Social pressure includes a child being excluded from conversations, comparisons being made with other siblings/adults about the way they eat, being told to keep quiet, or stay at the table whilst adults finish.

CONCLUSION

The food environment a child grows up in will have long-term impact. Parents can play a role in building a positive food environment through role modelling, removing pressure and creating a good physical environment which meets the need of their child, as well as other areas this article has not been able to examine. Building this is not an easy process and parents need to feel supported on an ongoing basis (11), rather than be judged so they can access the resources and encouragement they need for the benefit of their children.

References

  1. Draxten M et al (2014). Parental role modelling of fruits and vegetables at meals and snacks is associated with children's adequate consumption. Appetite. 2014 Jul;78:1-7. doi: 10.1016/j.appet.2014.02.017. Epub 2014 Mar 12. PMID: 24630934; PMCID: PMC4034448. Accessed 12/9/23 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034448/
  2. Lytle LA et al (2010). Examining the Relationships Between Family Meal Practices, Family Stressors, and the Weight of Youth in the Family Published online: 7 December 2010 # The Society of Behavioral Medicine 2010 ann. behav. med. (2011) 41:353–362 DOI 10.1007/s12160-010-9243-z. Accessed 13/9/23 at https://watermark.silverchair.com/12160_2010_article_9243.pdf
  3. Vandeweghe L et al (2016). Perceived effective and feasible strategies to promote healthy eating in young children: Focus groups with parents, family child care providers and daycare assistants. BMC Public Health.2016;16:1045. doi: 10.1186/s12889-016-3710-9.
  4. Shier V et al (2016). Neighborhood and home food environment and children's diet and obesity: Evidence from military personnel's installation assignment, Social Science & Medicine, Volume 158, 2016, Pages 122-131, ISSN 0277-9536, https://doi.org/10.1016/j.socscimed.2016.03.043. Accessed 12/9/23 at https://www.sciencedirect.com/science/article/pii/S0277953616301435
  5. Haines J et al (2019). Nurturing Children's Healthy Eating: Position statement, Appetite, Volume 137, 2019, Pages 124-133, https://doi.org/10.1016/j.appet.2019.02.007. https://www.sciencedirect.com/science/article/pii/S0195666318313412
  6. Leicester Safeguarding Adults Board (2023). 3.1 Types and Patterns of Abuse and Neglect. Accessed at https://www.llradultsafeguarding.co.uk/abuse
  7. Ellyn Satter Institute (2023). Raise a healthy child who is a joy to feed: Follow the Satter Division of Responsibility in Feeding. Accessed 13/9/23 at https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/
  8. Park-Cardoso J & Silva APS. da (2023). Insistence on sameness for food space appropriation: An exploratory study on Brazilians with autism (self-)diagnosis in adulthood. Autism, 27(4), 938–951. https://doi.org/10.1177/13623613221121417
  9. Papamichael MM (2022). How do the home food environment, parenting practices, health beliefs, and screen time affect the weight status of European children? The Feel4Diabetes Study. Nutrition. Volumes 103–104, 2022, 111834, ISSN 0899-9007, https://doi.org/10.1016/j.nut.2022.111834. Accessed 13/9/23 at https://www.sciencedirect.com/science/article/pii/S0899900722002477
  10. Harte S et al (2019). Culture and community: observation of mealtime enactment in early childhood education and care settings. Int J Behav Nutr Phys Act 16, 69 (2019). https://doi.org/10.1186/s12966-019-0838-x
  11. Nowicka P et al (2021). Changing the Home Food Environment: Parents’ Perspectives Four Years after Starting Obesity Treatment for their Preschool Aged Child. International Journal of Environmental Research and Public Health. 2021; 18(21):11293. https://doi.org/10.3390/ijerph182111293

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