Infant temperament and mealtime distractions as predictors of preschool Children's bite speed during family mealtime.

Eating behaviors are shaped at an early age, persist into adulthood, and are implicated in the development of physical health outcomes, including obesity. Faster bite speed has been identified as an obesogenic eating behavior, prompting researchers to examine child and family factors associated with children's variability in bite speed. Child temperament, involving phenotypes of reactivity and regulation, and distractions in family food contexts are fruitful areas of investigation, but few studies have examined the interplay among these factors and their associations with bite speed. To address the gap in the literature, we examined relations between early child temperament, family mealtime distractions, and children's observed bite speed. Caregiver report of child temperament at 3 months was measured using the Infant Behavior Questionnaire Very Short Form - Revised. Child mealtime distractions and bite speed were assessed using family mealtime videos that were collected during home visits when children were 18-24 months of age (n = 109). Results revealed that children who were reported to be higher on orienting/regulation at 3 months, and who were more distracted during mealtimes at 18-24 months, had relatively slower bite speeds. No significant interactions were found. The findings from this correlational study inform further investigations into the implications of early temperament and food contexts for the development of eating behaviors implicated in obesity risk.

Father support for breastfeeding mothers who plan to utilize childcare: A qualitative look at Mothers' perspectives.

Breastfeeding exerts many health benefits for the infant and the benefit is affected by exclusivity and duration, however, most mothers in the U.S. breastfeed for a shorter duration than recommended. First-time mothers who return to work outside the home, utilize childcare, and pump to continue to provide human milk, all of which have been found to reduce breastfeeding duration individually, represent a subset of breastfeeding mothers facing several known barriers to breastfeeding continuation and at risk for early breastfeeding cessation. The aim of this study is to understand and describe the perceptions of first-time mothers with prenatal intentions to breastfeed and utilize childcare, of paternal support for the breastfeeding experience. A semi-structured interview guided data collection with 24 first-time breastfeeding mothers and responses were analyzed using thematic analysis. Two main themes from mothers' experiences highlight the perceptions of first-time mothers, who had prenatal intentions to breastfeed and utilize childcare, were shaped by the actions, behaviors, and beliefs of their partners throughout the breastfeeding process, as well as illustrate both mothers and fathers lack knowledge of how to optimally involve fathers in breastfeeding. Our findings extend evidence for two existing models of father support to promote breastfeeding as relevant to mothers who return to work outside the home and utilize childcare, and additionally identify an area of support not included in either model. Early and improved education that situates breastfeeding within the co-parenting relationship and includes paternal support for pumping has the potential to improve mothers' breastfeeding experience and breastfeeding duration through mothers' return to work and infants' transition to childcare.

Cross-sectional survey of factors associated with paternal involvement in the neonatal intensive care unit.

AIM AND OBJECTIVE: To describe factors associated with father involvement in the neonatal intensive care unit using the Heuristic model of the dynamic of parental behaviour and influence on children over time. BACKGROUND: Research shows that infants with involved fathers have better cognitive development, fewer crying episodes after caesarean birth, improved breastfeeding exclusivity and duration, and more regular sleep patterns. Preterm infants with involved fathers have improved cognitive development. DESIGN: This cross-sectional exploratory study used survey methodology to explore factors associated with father involvement in the neonatal intensive care unit. METHODS: The STROBE checklist for cross-sectional studies was used (see Appendix S2). Biological fathers of infants in a 97-bed neonatal intensive care unit in the southern USA completed a survey which asked about their involvement with their hospitalised infants and factors which affected that involvement. Eighty fathers completed the survey. RESULTS: Age ranged between 20-53 with 43% first-time fathers. Compared to less involved fathers, fathers who were more involved were younger, married or living with the mother, performed kangaroo care or fathers of multiple gestation. Fathers who had attended the delivery were more likely to bathe their infants than those who had not attended the delivery and fathers who performed kangaroo care felt more confident than those who did not. Compared to fathers who visited less often, fathers who visited more often were younger, had infants with a shorter hospitalisation time and lower acuity, and had fewer children in the family. CONCLUSIONS: Fathers are involved with their neonatal intensive care unit infants in many ways. Factors were identified that affect involvement in the neonatal intensive care unit. RELEVANCE TO CLINICAL PRACTICE: Results can help nurses in neonatal intensive care units worldwide facilitate father-infant interaction, identify fathers at risk for decreased involvement and advocate for institutional policy development for supporting neonatal intensive care unit father involvement.

Providers perspectives on self-regulation impact their use of responsive feeding practices in child care.

Supporting children's self-regulation in eating through caregivers' practice of responsive feeding is paramount to obesity prevention, and while much attention has been given to supporting children's self-regulation in eating through parents' responsive feeding practices in the home setting, little attention has been given to this issue in childcare settings. This qualitative study examines childcare providers' perspectives on using responsive feeding practices with young children (2-5years). Individual semi-structured interviews were conducted with providers until saturation was reached. Data was analyzed using thematic analysis. The final sample included 18 providers who were employed full-time in Head Start or state-licensed center-based childcare programs, cared for children (2-5y), and were directly responsible for serving meals and snacks. Providers were primarily (67%) employed in childcare programs that served children from low-income families and received reimbursement for meals and snacks from the US Department of Agriculture's Child and Adult Care Food Program. Three factors emerged that shaped childcare providers' experiences using responsive feeding practices: the providers' perspectives about whether or not young children can self-regulate food intake, their understanding of Child and Adult Care Food Program (CACFP) portion size regulations, and the availability of food at the center where they worked. Future research should examine how childcare providers' understanding of children's ability to self-regulate their food intake, the appropriate use of the CACFP regulations in relationship to serving sizes, and having food available to offer seconds promotes providers' use of responsive feeding practices in center-based childcare programs and children's dietary behaviors.

Father involvement and maternal depressive symptoms in families of children with disabilities or delays.

This study examined the longitudinal association between fathers' early involvement in routine caregiving, literacy, play, and responsive caregiving activities at 9 months and maternal depressive symptoms at 4 years. Data for 3,550 children and their biological parents were drawn from the Early Childhood Longitudinal Study-Birth Cohort data set. Analyses in a structural equation modeling framework examined whether the association between father involvement and maternal depressive symptoms differed for families of children with autism spectrum disorder (ASD) and for families of children with other disabilities or delays from families of children who were typically developing. Results indicated that father literacy and responsive caregiving involvement were associated with lower levels of depressive symptoms for mothers of children with ASD. These findings indicate that greater father involvement may benefit families of children with ASD and highlight the need to support and encourage service providers to work with fathers.

Identifying elevated child weight from 3 to 24 months: Early transitions into nonparental care and to solid foods.

BACKGROUND: Early entry into nonparental care (NPC) and introduction to solid foods (ITS) have been linked to elevated weight, however, little research exists on the combined influence of these transitions on child weight over time. OBJECTIVES: Identify groups of children based on early NPC and ITS timing and examine whether NPC-ITS groups differentially affect child weight over time. METHOD: Data were drawn from STRONG Kids2 (n = 468). Primary predictors include NPC (by 3M)-ITS (< or ≥6M) groups; outcome variables include child weight-for-length/height z-scores (WFL/WFHz) (3, 12, 18, and 24 months). Multilevel regression was used to examine the NPC-ITS groups as predictors of child WFL/WFHz. RESULTS: Six groups were identified: 27% Parental Care-ITS before 6M, 31% Parental Care-ITS after 6M, 12% Daycare-ITS before 6M, 14% Daycare-ITS after 6M, 10% Kincare-ITS before 6M, and 7% Kincare-ITS after 6M. Children who were in daycare (regardless of ITS) or kincare-ITS before 6M demonstrated the highest WFL/WFHz over time, compared to their parental care counterparts. CONCLUSIONS: NPC-ITS combinations on child WFL/WFHz across the first 2 years of life highlight the need for a partnership approach among parental and nonparental caregivers to support the feeding of infants throughout the transition to solid foods.

Is there a difference between center and home care providers' training, perceptions, and practices related to obesity prevention?

To compare the obesity related training, practices, and perceptions of home child care providers and center care providers. A self-administered survey was collected from child care providers who attended local child care training workshops in east central Illinois from March 2009 to August 2010. Study results were based on responses from 88 home care providers and 94 center providers. The survey questions addressed child care providers' training in the prior year, their obesity prevention practices including written policies, their perceptions of influences on children's health, and factors determining food menu selection. Paired t tests and Chi-square tests were used to compare the difference by child care type. 81.9% of home care providers and 58.6% of center care providers received nutrition training, while 66.7 and 43.0% of these providers received physical activity training, respectively. Nutrition content, guidelines or state regulations, and food availability were the most important factors that influenced both types of care providers' food service menus. Both care provider types perceived they have less influence on children's food preferences, eating habits, and weight status compared to the home environment. However, home care providers perceived a smaller discrepancy between the influences of child care and home environments compared to center care providers. Compared to center providers, home care providers were more likely to have had training, be involved with health promotion activities, and rate their influence higher on children's health behaviors. Findings underscore the need for obesity prevention efforts in both types of child care settings.

Prospective Associations Between Fathers' Engagement in Infant Caregiving and Their Weight-Related Behaviors and Mental Health.

Fathers' engagement in infant caregiving is linked with positive social, emotional, and developmental outcomes in children; however, its relationship with fathers' own health is largely unknown. This longitudinal study examined associations between fathers' caregiving engagement with their 6-month-old infants and their physical activity, sugar-sweetened beverage (SSB) consumption, nighttime sleep duration, and depressive symptoms 6 months later when infants were 12 months old. Participants were 143 fathers of infants (62.7% non-Hispanic White, 82.3% with a bachelor's degree). Fathers reported their frequency of engagement in seven caregiving activities when infants were 6 months old. Fathers' physical activity, SSB consumption, nighttime sleep duration, and depressive symptoms were assessed when infants were 6 and 12 months old. Multivariate logistic regression analysis was used to assess if fathers who reported higher infant caregiving at 6 months had more positive health outcomes at 12 months, controlling for fathers' age, race/ethnicity, education, employment, household income, and the outcome at 6 months. Fathers who reported higher caregiving engagement when infants were 6 months old had increased odds of being sufficiently physically active 6 months later (unadjusted odds ratio [OR] = 1.19, 95% confidence interval [CI] = [1.00, 1.41]; adjusted OR = 1.47, 95% CI = [1.11, 1.96]). No links were identified between fathers' caregiving engagement and their SSB consumption, nighttime sleep duration, or depressive symptoms. In summary, fathers' engagement in infant caregiving may be beneficial to their physical activity in the first year after birth. There was insufficient evidence in this study that the benefits of caregiving engagement were experienced broadly across multiple health outcomes.

Influences of Child Temperament and Household Chaos on Preschoolers' Emotional Eating.

Background: Emotional eating has been linked to child temperament and family environment factors, such as household chaos. However, few studies have examined how child and home characteristics independently and together influence children's overeating and undereating in response to negative emotions. Objective: The current study examined associations among child temperament, household chaos, and emotional eating in children 18-24 months of age, and interaction effects were also tested. Methods: The study included an analysis sample of 371 families participating in the larger STRONG Kids2 longitudinal birth cohort study (N = 468). The Early Childhood Behavior Questionnaire was used to assess child temperament at 18 months, and the Confusion, Hubbub, and Order Scale was used to assess disorganization in the household at 24 months. Child emotional eating at 24 months was assessed using parental reports of the Child Eating Behavior Questionnaire. Results: Negative affectivity and household chaos were independently associated with child emotional overeating. Negative affectivity, effortful control, and household chaos were significantly associated with emotional undereating. No significant interactions were found. Conclusions: Child temperament and household environment independently influence emotional eating in young children, highlighting the need to consider these factors in early prevention. Longitudinal studies are warranted to determine mechanisms that may be involved in these relations.

Parental Involvement, Child Temperament, and Parents' Work Hours: Differential Relations for Mothers and Fathers.

This study examined how child temperament was related to parents' time spent accessible to and interacting with their 2-year-olds. Bivariate analyses indicated that both fathers and mothers spent more time with temperamentally challenging children than easier children on workdays, but fathers spent less time with challenging children than easier children on non-workdays. After accounting for work hours, some associations between temperament and fathers' workday involvement dropped to non-significance. For fathers, work hours also moderated the relation between irregular temperament and workday play. For mothers, work hours moderated the relation between both difficult and irregular temperament and workday interaction. Mothers also spent more time with girls (but not boys) who were temperamentally irregular. Results speak to the influence of child temperament on parenting behavior, and the differential construction of parenting roles as a function of child characteristics and patterns of work.

Fathers' food parenting: A scoping review of the literature from 1990 to 2019.

BACKGROUND: While food parenting is a robust area of inquiry, studies have largely focused on mothers. Given the diversity of family structures today and increases in fathers' engagement in caregiving, fathers' food parenting warrants attention. OBJECTIVE: We present a scoping review of research on fathers' food parenting (1990-2019). Eligible studies included peer-reviewed research published in English documenting fathers' food parenting and presenting results for fathers separate from mothers. RESULTS: Seventy-seven eligible studies were identified. Most studies were based in the U.S (63.6%) and utilized a cross-sectional design (93.5%). Approximately half of studies used a validated measure of food parenting (54.5%) and slightly less than 30% utilized theory (28.6%). Many studies did not report information on fathers' residential status (37.7%) or their relationship to the target child (biological vs social) (63.6%). Content analysis of study findings showed that: fathers are involved in food parenting, but at lower levels than mothers; there are few consistent mother-father differences in food parenting practices; and fathers' controlling food parenting is linked with negative nutrition outcomes in children while responsive food parenting is linked with positive child outcomes. CONCLUSION: To better inform family interventions to prevent childhood obesity, future food parenting research with fathers should recognize the diversity of family structures and utilize prospective, theory-based, designs.

The Differential Impact of Early Father and Mother Involvement on Later Student Achievement.

The purpose of this exploratory study was to examine the direct and indirect effects of early parenting on later parental school involvement and student achievement. The sample, pulled from the first and second waves of the Panel Study of Income Dynamics - Child Development Supplement data set, consisted of 390 children ages 2-5 at time 1 and their families. Fathers' and mothers' participation in five dimensions of early parenting behaviors were assessed at time 1, while later parental school involvement and student achievement were assessed at time 2. Although early paternal and maternal parenting behaviors were not directly related to later student achievement, differences were revealed in the pattern of relationships between early parenting and later parental school involvement for fathers and mothers. In addition, fathers' later school involvement was found to be negatively related to student achievement while maternal school involvement was found to be positively related to student achievement. These findings provide partial support for the hypothesized differential relationship between fathers' and mothers' early parenting and later student achievement.

An Exploratory Look at the Role of Childcare Providers as a Support and Resource for Breastfeeding Mothers.

Introduction: The childcare setting remains largely unexplored as a potential barrier to breastfeeding continuation and, therefore, the lack of interventions targeting childcare providers may be a missed opportunity for improved breastfeeding support. This article explores the perceptions of 25 first-time breastfeeding mothers on navigating the critical transition to childcare and the role of childcare providers regarding breastfeeding support. Methods: Mothers were selected if they indicated an intent to breastfeed on a prenatal questionnaire and had enrolled their child in childcare. Semistructured interviews guided by Bronfenbrenner's bioecological model were conducted to capture mothers' experiences. Responses were analyzed utilizing thematic analysis to generate themes rooted in mothers' experiences with childcare and breastfeeding. Results: A thematic analysis resulted in three key themes: Providers are not Critically Evaluated, A Stressful Transition, and Childcare as a Service, not Support. These themes indicated that although mothers intended to continue breastfeeding during and after the transition to childcare, they had not previously given much consideration to the childcare setting beyond that of a service provider. Conclusion: Findings illustrate new considerations to support modern breastfeeding mothers through the transition to work and childcare are needed such as basic and practical education and training to prepare childcare providers to support breastfeeding mothers in the way that best meets their needs, enhanced education for mothers on how to seek and evaluate providers for breastfeeding competence, and policy initiatives focused on fostering engagement between mothers and providers. By taking mothers' perceptions into consideration, researchers, practitioners, and policymakers can offer breastfeeding support that mothers will be receptive to and more likely to engage with, thereby advancing the health of both mothers and infants.

Household Chaos, Maternal Emotional Responsiveness, and Child Eating Behavior: A Moderation Analysis.

OBJECTIVE: To address calls for a resilience-informed approach to understand the cause and prevention of childhood obesity, the current study aims to investigate the independent and interactive associations between household chaos, maternal emotional responsiveness, and eating behavior in early childhood. METHOD: A sample of (n = 108) families of 18- to 24-month-olds completed self-report surveys and consented to home visits as part of the larger STRONG Kids 2 (N = 468) study. Videotapes of family mealtimes were collected during home visits and coded for observed maternal emotional responsiveness. Mothers completed questionnaires assessing maternal emotional responsiveness, household chaos, and child eating behaviors. Moderation analyses assessed independent and interactive effects of chaos and emotional responsiveness on child appetite self-regulation. RESULTS: In moderation analyses controlling for demographic covariates, higher levels of chaos were associated with more emotional overeating and with more food responsiveness, but only among children of mothers observed engaging in low levels of responsiveness at mealtimes. There was no association between chaos and eating behavior among children of mothers observed engaging in high levels of emotional responsiveness at mealtimes. There was also no independent or interactive association between chaos and child eating behaviors characterized by food avoidance. CONCLUSION: Preliminary evidence suggests that maternal emotional responsiveness at mealtimes may attenuate the deleterious effects of chaos on child overeating and food responsiveness. Future research should prioritize using longitudinal designs, developing observational assessments of early childhood eating behaviors, and understanding these processes among families exposed to greater socioeconomic adversity.

Engaging Fathers in Early Obesity Prevention During the First 1,000 Days: Policy, Systems, and Environmental Change Strategies.

OBJECTIVE: Fathers are critical stakeholders in childhood obesity prevention but are difficult to engage. This review presents a new approach to engaging fathers in obesity prevention during the first 1,000 days. METHODS: The review focuses on five existing health and social service programs, including prenatal care, pediatric care, the Special Supplemental Nutrition Program for Women, Infants, and Children, home visiting, and Early Head Start. For each program, the obesity prevention services provided, evidence of father engagement, and barriers thereto are outlined. Subsequently, policy, systems, and environmental strategies are outlined to address the noted barriers and promote father engagement. RESULTS: Although the programs hold great promise in bringing obesity prevention services to fathers, barriers to their engagement are present in the inner (e.g., limited hours of operation, lack of father-specific materials and programming) and outer (e.g., lack of model programs, best practice models, and consistent funding) settings of programs. Policy, systems, and environmental strategies to increase father engagement focus on earmarked funding, changes to national practice guidelines and practitioner training requirements, and the establishment of father-engagement performance metrics. CONCLUSIONS: Increasing father involvement in the specified programs will likely increase their engagement in early obesity prevention in an efficient and sustainable manner.

Associations between father availability, mealtime distractions and routines, and maternal feeding responsiveness: An observational study.

Responsive feeding and frequency of family mealtimes are related to healthier eating behaviors and weight outcomes in children and adolescents. Distractions at mealtimes are related to greater intake of unhealthy food and a less positive mealtime emotional climate. However, there is little understanding of the effects of routines and father availability on distractions at family meals, and there is limited research investigating the effects of distractions among all family members on maternal feeding practices in toddlerhood. This study aims to characterize distractions at family mealtimes and examine associations between father availability, distractions, and observed responsive feeding. Descriptive analyses, nonlinear mixed models, and path analyses were conducted using observational (home-based family mealtimes) and self-report data collected from a subsample of families (n = 109) of 18- to 24-month-old children in the larger STRONG Kids 2 Study (N = 468). Between fathers, mothers, and children, families spent almost half of the mealtime distracted. Fathers and mothers engaged in about equal amounts of distractions, and children engaged in more technology-related distractions than parents. Fathers' absence at the mealtime was associated with more child distractions and less maternal feeding responsiveness. Lower paternal total distractions, maternal non-technology-object-related distractions, and higher household income were significantly associated with more observed maternal feeding responsiveness. Future research should investigate how father availability and family mealtime distractions may be associated directly and indirectly with children's eating behaviors and weight outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The STRONG Kids 2 Birth Cohort Study: A Cell-to-Society Approach to Dietary Habits and Weight Trajectories across the First 5 Years of Life.

BACKGROUND: Dietary habits formed during the first 5 y of life portend lifelong eating patterns. OBJECTIVE: The Synergistic Theory Research Obesity and Nutrition Group (STRONG) Kids 2 birth cohort study aimed to examine multilevel predictors of weight trajectories and dietary habits including individual biology, child socioemotional and behavioral characteristics, family environment, and child care environment over the first 5 y of life. This report describes recruitment strategies, an overview of survey measures, and basic descriptive statistics of the cohort. METHODS: The cohort includes 468 mothers and their offspring. A brief survey was completed at a 1-wk home visit including child's birth weight, intent to breastfeed, collection of an infant stool sample, and additional contact information should the family move. Mothers completed surveys including diet, child temperament, family environment, and child care when their child was 6 wk, 3, 12, 18, 24, 36, 48, and 60 mo of age. Height and weight of the mother and child were collected at each visit. Stool samples of the child were collected at each visit as well as saliva at 1 visit. RESULTS: Close to half of the mothers were either overweight (24.2%) or obese (25.2%) prepregnancy. At 6 wk of age, 32.9% of the children were overweight and 31.4% were obese based on direct measurement. CONCLUSIONS: The STRONG Kids 2 research team has adopted a socioecological model that accounts for multiple influences on children's health including biological, child social and behavioral, family household organization, and community factors. The study is limited by a relatively educated and nondiverse sample. However, variations in maternal and child weight may inform future prevention programs and policy aimed at improving the diet and health of children under the age of 5 y.This trial was registered at clinicaltrials.gov as NCT03341858.

Sources of Information and Support for Breastfeeding: Alignment with Centers for Disease Control and Prevention Strategies.

BACKGROUND AND OBJECTIVES: Research consistently supports health benefits of breastfeeding; however, rates in the United States remain below Healthy People 2020 goals. To increase breastfeeding, information and support are needed from multiple sources. Given differences in breastfeeding rates by demographic characteristics, sources of information and support may also differ. In addition, recent research suggests potential differences in health outcomes related to feeding method (direct breastfeeding only, feeding expressed human milk, combination-feeding with formula). This study examined (1) information and support received within Centers for Disease Control and Prevention (CDC)-defined strategies for supporting breastfeeding mothers, (2) differences in rates of information and support received by demographics, and (3) associations with feeding method at 6 weeks postpartum. MATERIALS AND METHODS: A sample of 447 women participating in the Synergistic Theory Research Obesity and Nutrition Group (STRONG) Kids 2 study completed surveys with questions from the CDC Survey on Infant Feeding Practices II related to sources of information and support for breastfeeding and breast pump use, and about demographics and feeding method at 6 weeks postpartum. RESULTS: Frequencies of supports received within each category indicate that professional supports were the most pervasive, followed by support from friends and relatives. However, women at greater risk for breastfeeding cessation (lower education, Women, Infants, and Children participants, single mothers) received information and support at lower rates. Education and information support was the only source significantly associated with feeding method. CONCLUSION: New approaches are needed to increase efficacy of information delivery, especially for at-risk populations, to better meet CDC recommendations.

Implementing the Academy of Nutrition and Dietetics Benchmarks for Nutrition Education for Children: Child-Care Providers' Perspectives.

BACKGROUND: National childhood obesity prevention policies recommend that child-care providers educate young children about nutrition to improve their nutrition knowledge and eating habits. Yet, the provision of nutrition education (NE) to children in child-care settings is limited. OBJECTIVE: Using the 2011 Academy of Nutrition and Dietetics benchmarks for NE in child care as a guiding framework, researchers assessed child-care providers' perspectives regarding delivery of NE through books, posters, mealtime conversations, hands-on learning, and sensory exploration of foods to young children (aged 2 to 5 years). DESIGN: Using a qualitative design (realist method), individual, semistructured interviews were conducted until saturation was reached. PARTICIPANTS/SETTING: The study was conducted during 2012-2013 and used purposive sampling to select providers. Final sample included 18 providers employed full-time in Head Start or state-licensed center-based child-care programs in Central Illinois. MAIN OUTCOME MEASURE: Child-care providers' perspectives regarding implementation of NE. STATISTICAL ANALYSES PERFORMED: Thematic analysis to derive themes using NVivo software. RESULTS: Three overarching themes emerged, including providers' motivators, barriers, and facilitators for delivering NE to children. Motivators for delivering NE included that NE encourages children to try new foods, NE improves children's knowledge of healthy and unhealthy foods, and NE is consistent with children's tendency for exploration. Barriers for delivering NE included that limited funding and resources for hands-on experiences and restrictive policies. Facilitators for delivering NE included providers obtain access to feasible, low-cost resources and community partners, providers work around restrictive policies to accommodate NE, and mealtime conversations are a feasible avenue to deliver NE. Providers integrated mealtime conversations with NE concepts such as food-based sensory exploration and health benefits of foods. CONCLUSIONS: Present study findings offer insights regarding providers' perspectives on implementing NE in child care. Drawing from these perspectives, registered dietitian nutritionists can train providers about the importance of NE for encouraging healthy eating in children, integrating NE with mealtime conversations, and practicing low-cost, hands-on NE activities that meet the food safety standards for state licensing. Such strategies may improve providers' ability to deliver NE in child-care settings.

Engaging Parents to Promote Children's Nutrition and Health.

PURPOSE: Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers' (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children's health. DESIGN: Qualitative. SETTING: State-licensed center-based childcare programs. PARTICIPANTS: Full-time childcare providers (n = 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience. METHODS: In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted. RESULTS: Two overarching themes were barriers and strategies to communicate with parents about children's nutrition. Barriers to communication included-(a) parents are too busy to talk with providers, (b) parents offer unhealthy foods, (c) parents prioritize talking about child food issues over nutrition, (d) providers are unsure of how to communicate about nutrition without offending parents, and (e) providers are concerned if parents are receptive to nutrition education materials. Strategies for communication included-(a) recognize the benefits of communicating with parents about nutrition to support child health, (b) build a partnership with parents through education, (c) leverage policy (federal and state) to communicate positively and avoid conflict, (d) implement center-level practices to reinforce policy, and (e) foster a respectful relationship between providers and parents. CONCLUSION: Policy and environmental changes were recommended for fostering a respectful relationship and building a bridge between providers and parents to improve communication about children's nutrition and health.