About feeding children: factor structure and internal reliability of a survey to assess mealtime strategies and beliefs of early childhood education teachers.

BACKGROUND: Children spend a substantial amount of time in early care and education (ECE) settings and may eat a majority of their diet in this setting. While there are several instruments focused on measuring factors of the ECE environment that may influence diet and weight outcomes, there are few comprehensive, valid, and reliable measures for collecting self-report of ECE providers' feeding practices. The purpose of this study was to establish the factor structure and internal reliability of a survey developed to measure practices and beliefs of ECE providers relative to feeding children. METHODS: Licensed ECE centers from CA, CO, ID and NV were included in this cross-sectional survey study. The sample was stratified by states and census regions to yield equal numbers of centers from each category. The total sample distribution included 1600 randomly selected centers and up to 8000 staff members (who represented teachers, aides, assistants, or cooks); 1178 surveys were completed. We conducted an exploratory, unrestricted factor analysis as well as parallel analyses to inform the number of factors to be extracted. RESULTS: Factors within Structural Mealtime Strategies included Adult Control of Foods Consumed (Kuder-Richardson [KR] = 0.67), Bribing with Sweet Foods (KR = 0.70), and Supportive Adult Roles at Mealtime (KR = 0.55). Factors in Verbal Mealtime Strategies included Supporting Children's Eating Self-regulation (KR =0.61), Pressure to Eat (KR = 0.58), and Social Comparisons (KR = 0.59). Beliefs about Mealtime factors were Autonomy Promoting (α = 0.64), Coercive Beliefs (α = 0.77), and Concern-Based Control (α = 0.60). CONCLUSIONS: The AFC Strategies and Beliefs Survey provides a promising self-report instrument with a strong factor structure consistent with the extant literature to measure practices and beliefs related to feeding and mealtimes in the ECE setting. Feeding young children in group settings differs in many ways from feeding in a family setting; hence it is important that measures such as the AFC Strategies and Beliefs Survey capture unique aspects of the ECE feeding environment.

Creating potential for common ground and communication between early childhood program staff and parents about young children's eating.

OBJECTIVES: To explore child care staff and parent perspectives and communications about children's eating in child care. DESIGN: Focus groups (FGs) conducted with child care staff and parents. SETTING: Four Western states in the United States. PARTICIPANTS: Thirty-nine child care staff in 7 FGs and 25 parents in 6 FGs. PHENOMENON OF INTEREST: Thoughts and concerns about children's eating and opportunities to improve communication between staff and parents. ANALYSIS: Content analysis (FG coding inter-rater reliability: staff = 0.74; parents = 0.81) and identification of meta-themes. RESULTS: Three meta-themes were identified: (1) recognition of positive influences of the child care setting in children's development of healthy eating; (2) concerns about children's eating in child care and at home; and (3) strategies to improve communications and transactions related to children's eating. CONCLUSIONS AND IMPLICATIONS: Staff reported that their roles included informing parents about food at mealtimes in child care (eg, menus, recipes) but also educating parents about child nutrition and feeding. Parents valued daily information about their child's eating to adjust home mealtimes and to feel connected to their child. Barriers to effective communication included limited time and concerns regarding parent reactions and defensiveness. Staff requested training about child nutrition and feeding and about sensitive communications with parents.

Child Care Mealtime and Active Play Partnerships (Child Care MAPP): evaluation of a training resource Web site for enhancing nutrition education communication.

The communication component of the Child Care MAPP Web site was designed according to an established theoretical base, and was critically reviewed. The communication materials were targeted for use by trainers who educate child care providers, and may be incorporated into higher education curricula to guide nutrition educators who will be working in child nutrition and child feeding programs. Evaluation of the impact of the communication materials on a group of trainers demonstrated a significant increase in participant confidence to communicate about nutrition. In particular, the child- and adult-centered phrases developed as a novel and developmentally appropriate approach to nutrition education were evaluated by respondents as useful, and were found to increase confidence to communicate with children. Future research should further examine the use of child-centered and adult-centered nutrition phrases in nutrition education and higher education, to determine whether the way in which adults talk with children improves children's knowledge about nutrition, and whether use of the phrases can positively affect children's nutrition behaviors.

Kindergarteners' entrée intake increases when served a larger entrée portion in school lunch: a quasi-experiment.

BACKGROUND: The influence of portion size on children's intake and self-regulation of food has gained attention; however, few studies have examined portion sizes in school lunch. This study investigated kindergarteners' intake when they were given different entrée portion sizes from the lunch menu. METHODS: Plate waste was used as a proxy to measure intake. A standardized lunch of chicken nuggets, rice, green beans, applesauce, and milk was served every Tuesday for 5 consecutive weeks at a Kinder Center. All menu items and the self-selection of 2, 3, or 4 nuggets were served the first week as a pilot. In the second and fourth weeks, trained servers preportioned kindergarteners' plates with 4 nuggets. In the third and fifth weeks, kindergarteners verbally self-selected 2, 3, or 4 chicken nuggets. A Mann-Whitney test was used to determine a significant difference in intake between the 2 days kindergarteners were allowed to select the portion size and the 2 days they were preportioned. RESULTS: A significant difference (p < .009) in intake was found between the self-selection of entrée portion size and the preportioned entrée regardless of sex or whether kindergarteners attended the am or pm session. No significant difference was found in milk, fruit, vegetable, or rice intake between choice and nonchoice lunches. In this study, kindergarteners ate more chicken nuggets when they were offered a larger portion size. CONCLUSIONS: Further investigation is needed on the impact of letting kindergarteners self-select portion sizes, and the potential negative outcomes of larger portion sizes on children's caloric consumption in elementary schools.

Six characteristics of nutrition education videos that support learning and motivation to learn.

OBJECTIVE: To identify characteristics in nutrition education video vignettes that support learning and motivation to learn about feeding children. METHODS: Nine focus group interviews were conducted with child care providers in child care settings from 4 states in the western United States: California, Idaho, Oregon, and Washington. At each focus group interview, 3-8 participants (n = 37) viewed video vignettes and participated in a facilitated focus group discussion that was audiorecorded, transcribed, and analyzed. RESULTS: Primary characteristics of video vignettes child care providers perceived as supporting learning and motivation to learn about feeding young children were identified: (1) use real scenarios; (2) provide short segments; (3) present simple, single messages; (4) convey a skill-in-action; (5) develop the videos so participants can relate to the settings; and (6) support participants' ability to conceptualize the information. CONCLUSIONS AND IMPLICATIONS: These 6 characteristics can be used by nutrition educators in selecting and developing videos in nutrition education.

How much is enough? Tablespoon per year of age approach meets nutrient needs for children.

BACKGROUND: Adults often ask health professionals for guidance on offering the appropriate serving sizes for young children and little research is available on whether serving size approaches meet children's nutrient needs. OBJECTIVE: Determine whether three serving size approaches for young children meet dietary standards for nutrient adequacy. DESIGN: We examined nutrient contents of three serving size approaches for children ages 2-5 years of age: 1 tablespoon per year of age (T/y), MyPyramid, and Child and Adult Care Food Program. Nutrient content of the three approaches were compared to the Estimated Energy Requirements (EER), Estimated Average Requirement (EAR), or Adequate Intake (AI) for each year of age for males and females; Analysis of Variance identified differences in nutrient content among the three approaches. RESULTS: Young children's nutrient requirements were met for most nutrients by all approaches. However, the recommendation for vitamin E, potassium, and fat were not met by any approach, for any year, for either girls or boys. Energy content of the T/y serving size approach was below the EER for each year of age and for both sexes but still met minimal vitamin and mineral needs. CONCLUSION: Health professionals can feel comfortable using any of the three approaches. However, the T/y approach is a more graduated serving size approach, may be more consistently age appropriate for young children, and may be implemented more easily by adults.

Attitudes, concerns, and likelihood for action related to young children's overweight among early childhood program staff.

For obesity prevention planning in early childhood programs, attitudes and actions of staff related to communicating with parents about young children's eating and weight need to be assessed. Early childhood program teachers (n = 271) working with children aged 3 to 5 years were surveyed by mail. Factor analysis provided patterns of response for multi-item questions. Respondents reported different levels of agreement and comfort regarding communicating concerns to parents about their child's weight and eating versus observations about the child's daily eating. Feelings about parent communication varied (worried, hesitant, responsible, and willing). Findings suggest opportunities for communication between program staff and parents.

Child care provider training and a supportive feeding environment in child care settings in 4 states, 2003.

INTRODUCTION: Strategies to prevent adult chronic diseases, including obesity, must start in childhood. Because many preschool-aged children spend mealtimes in child care facilities, staff should be taught supportive feeding practices for childhood obesity prevention. Higher obesity rates among low-income children suggest that centers providing care to these children require special attention. We compared self-reported feeding practices at child care centers serving low-income children on the basis of whether they received funding and support from the Child and Adult Care Food Program (CACFP), which suggests supportive feeding practices. We also assessed training factors that could account for differences among centers. METHODS: Eligible licensed child care centers (n = 1600) from California, Colorado, Idaho, and Nevada received surveys. Of the 568 responding centers, 203 enrolled low-income families and served meals. We analyzed the responses of 93 directors and 278 staff for CACFP-funded centers and 110 directors and 289 staff from nonfunded centers. Chi square analyses, pairwise comparisons, t tests, and multiple linear regressions were used to compare CACFP-funded and nonfunded centers. RESULTS: Significant differences were noted in 10 of 26 feeding practices between CACFP-funded and nonfunded centers. In each case, CACFP-funded centers reported practices more consistent with a supportive feeding environment. Forty-one percent of the variance could be explained by training factors, including who was trained, the credentials of those providing training, and the type of training. CONCLUSION: Our findings suggest that when trained by nutrition professionals, child care staff learn, adopt, and operationalize childhood obesity prevention feeding guidelines, thereby creating a supportive mealtime feeding environment.

"Are you done?" Child care providers' verbal communication at mealtimes that reinforce or hinder children's internal cues of hunger and satiation.

OBJECTIVE: To explore the verbal communication of child care providers regarding preschool children's internal and non-internal hunger and satiation cues. METHODS: Video observation transcripts of Head Start staff (n=29) at licensed child care centers in Colorado, Idaho, and Nevada were analyzed for common themes. RESULTS: Adults' verbal communication with children at mealtimes emphasized non-internal cues: (1) cueing children to amounts without referencing children's internal cues; (2) meal termination time; (3) asking children if they wanted more without referencing their internal cues; (4) asking children if they were done without referencing their internal cues; (5) telling children to take, try, eat, or finish food; (6) praising children for eating; and (7) telling children about food being good for you. Adults demonstrated an overriding effort to get children to eat. CONCLUSIONS AND IMPLICATIONS: Training needs to be developed that gives specifics on verbally cueing young children to their internal hunger and satiation cues.

About feeding children: mealtimes in child-care centers in four western states.

This study was conducted to describe mealtimes and explore routines, policies, and training in child-care centers. Following an intensive review of mealtimes, staff and director questionnaires were created. Using a stratified random sampling protocol and following the Tailored Design Method, directors and staff from licensed child-care centers from California, Colorado, Idaho, and Nevada were surveyed. Center and staff characteristics were compared among the four states and three census areas using analysis of variance and chi(2) analyses, as appropriate. To adjust for multiple comparisons, a stringent P value of <0.001 was used for post hoc comparisons. Responses were received from 568 centers (representing 1,190 staff and 464 directors). Mealtimes generally occurred in the classroom, where an adult sat at the table with the children, served some food, poured the drinks, and ate some of the center-provided food. Less than half of centers reported using "family-style" service, although this style allows children the opportunity to self-serve food. Staff received substantially less training on feeding children (42%) than on nutrition (68%) and child development (95%). These findings bring focus to the need to educate child-care staff and directors about the impact of mealtime environments on child health and development.

Understanding patient experiences with goal setting for diabetes self-management after diabetes education.

Diabetes educators need to understand self-care experiences of patients with diabetes in the early stage after diagnosis and education. A survey assessed patient-generated measures of experiences with goals (self-care behaviors) after diabetes education among patients with type 2 diabetes (N = 97) between 6 months and 1.5 years since diagnosis. Most patients set goals during diabetes education and thought that the goals were useful. There is evidence suggesting that patients experiencing difficulty with traditional self-care behaviors may use approaches to evaluate their diabetes control that are not encouraged in diabetes education, such as monitoring their physical and emotional feelings. Implications for diabetes education and counseling practices are suggested.

Snack consumption and waste by preschool children served "cute" versus regular snacks.

OBJECTIVE: To determine if preschool children would eat and waste different amounts of food when served snacks in a regular versus a "cute" form. DESIGN: Preschool children were served 6 snacks in a cute form and the same snacks in a regular form using the same food components during 24 snack sessions. Children served as their own controls. SUBJECTS/SETTING: Thirty-nine children ages 36 to 60 months (20 girls, 19 boys) in a university child development laboratory. MAIN OUTCOME MEASURES: Snack portions eaten and wasted and time for eating. ANALYSIS: Data were analyzed using a 2 3 6 factorial analysis of variance, with snack form (cute or regular) and snack components as the 2 factors. RESULTS: There was no significant difference in children's snack consumption or waste between cute and regular versions of snacks. It took children an average of 2 minutes longer to eat the cute snacks. CONCLUSIONS AND IMPLICATIONS: There is no apparent advantage to serving cute snacks in terms of increased consumption or decreased waste. Further research should be conducted on children's mealtime behaviors when served cute foods to learn more about children's responses to the overall appearance of their food.