A Missed Opportunity? Meal Provision in Early Childhood Education and Care Services in the Context of Socioeconomic Disadvantage.

OBJECTIVES: Early childhood education and care (ECEC) services are attended by most children before school entry, reaching many living in circumstances of poverty and providing opportunity to support their nutrition. In this study, we examine the extent to which this opportunity is being met, comparing two common types of service provision: centre- versus family- provided food. METHODS: Intensive in-situ observations were undertaken across 10 ECEC services in highly disadvantaged Australian communities. All meals provided to children aged 3.5-5 years across an ECEC day (N = 48), of which 11% were experiencing severe food insecurity, were photographed and analysed to assess nutritional adequacy with reference to national dietary standards. RESULTS: Meals provided did not meet national dietary recommendations for quality or quantity. Nutrition was least adequate in services with policies of family-provided food. These services were also those that served families experiencing the highest levels of severe food insecurity (29%). CONCLUSIONS: In the absence of policies for the provision of food in ECEC, services are not realising their potential to support child nutrition in the context of poverty presenting increased risk to lifetime trajectories of health and wellbeing. System level policy interventions are required to facilitate equitable access to nutritious food and attendant life chances.

Mealtimes in the context of poverty: Comparison of ECEC services providing food and those requiring food provided from home.

BACKGROUND: In developed economies, most children attend Early Childhood Education and Care (ECEC) services before school entry, many from early life and across long days. For this reason, ECEC services present significant potential to provide food environments that positively influence eating behaviours and food preferences with attendant effect on life course trajectories of health and wellbeing. Yet there is evidence that feeding practices that limit optimal ongoing nutrition, such as pressure and restriction, are amplified in ECEC services serving disadvantaged communities. We sought to identify underlying explanatory mechanisms through observation of children's feeding experiences and educator explanations comparing, family-provided and service-provided meals. METHOD: This study used qualitative analyses of educator interviews and observation records from 55 mealtimes in 10 ECEC services: 5 providing food and 5 requiring family food provision. RESULTS: High levels of concern drove educator's controlling feeding practices at mealtimes but presented differently across meal provision modes. In centres that provided food, educators' concern focused on food variety, manifesting in pressure to 'try' foods. In centres requiring family-provided food, concern focused on nutrition quantity and quality and manifested as control of order of food consumption and pacing of intake to ensure food lasted across the day. Interview data suggested that conflict aversion limited optimal nutrition. In centres providing food, this was seen in menus that prioritized child food preferences. In centres requiring family meal provision, conflict aversion was seen as reticence to discuss lunchbox contents with families. CONCLUSION: The findings direct attention to public health intervention. Currently, ECEC face significant barriers to realizing their potential to support child nutrition and establish positive life course trajectories of nutrition. To do so requires targeted supports that enable sufficient supply and quality of food in the context of poverty.

Meal provision in early childhood education and care programs: Association with geographic disadvantage, social disadvantage, cost, and market competition in an Australian population.

BACKGROUND: Across developed economies, most children attend early childhood education and care (ECEC) programs attending up to 10,000 h prior to school. These programs present significant opportunity for public health nutrition interventions through provision of healthy food. We sought to identify whether this opportunity is being taken through analysis of population data from Queensland, Australia. Specifically, we asked if meal provision occurs in locations where risk of food insecurity is high and how economic functioning of ECEC services is associated with meal provision. METHODS: Of ECEC services in Queensland, (N = 1623) administrative data on meal provision (2020) was available for 947 ECEC services (58.4% of cohort). We assessed the association of meal provision in these services with area indices of social disadvantage (geographic location, social disadvantage, proportion of child developmental vulnerability) and ECEC service economic functioning (fee structure, market competition). FINDINGS: ECEC services in remote and rural communities were less likely to provide meals. A similar but weaker trend was evident in socio-economically disadvantaged metropolitan communities. In these locations market competition increased likelihood of meal provision but without fee increase. INTERPRETATION: The competitive market works contrary to the potential for ECEC services to support child nutrition and promote public health. Children living in disadvantaged communities, where food insecurity is inevitably higher, are less likely to have meals provided by their ECEC service. Market competition increases the likelihood of meal provision, yet in disadvantaged communities, parents' ability to pay constrains fees that can be charged raising concern about food quality and effects on quality of provision more broadly. Systemic public supports to enable high quality food provision without compromising other aspects of quality, particularly in the most disadvantaged communities, should be a public health priority.

Associations between food provision and feeding practices in socially disadvantaged childcare centres.

Preschool children consume a large proportion of their daily food intake in their childcare settings. These settings, therefore, provide important opportunities for children to experience food socialisation, and related positive nutrition. Yet, the extent to which these opportunities are taken, particularly in socioeconomically disadvantaged areas where risk of poor nutrition is high, is not well documented. This study focused on 10 childcare centres in socially disadvantaged locations and examined daily feeding practices via direct in-situ observation (n = 189 children observed). Centres were randomly selected based on type of food provision: centre-provided (n = 5 centres) or family-provided (n = 5 centres). Analyses showed that where food was family-provided, educators were significantly more likely to use controlling feeding practices, including pressuring children to eat, restricting food choices and rushing children into finishing meals. These practices were particularly evident during mid-morning meals, where pressuring children to eat healthy foods first, was more often observed. Further research and interventions that target feeding practices in childcare are indicated and should consider how source of food provision impacts upon these practices.

What children bring to the table: The association of temperament and child fussy eating with maternal and paternal mealtime structure.

Fussy eating is a nuanced, mealtime-specific behaviour associated with difficult temperament but has been rarely examined within the context of mealtime structure. The aim of this study was to a) examine associations between child temperament, and mothers' and fathers' structure-related feeding practices and b) explore whether these associations were mediated by child fussy eating. Cohabiting mother-father pairs (N = 205) of children aged between 2- to 5-years residing in a socioeconomically disadvantaged Australian city completed self-reported, validated measures of child temperament, food fussiness and structure-related feeding practices (structured meal timing, structured meal setting and family meal setting). Child temperament was associated with maternal and paternal structure-related feeding practices, such that more difficult temperament was associated with less mealtime structure. Mothers' perception of child food fussiness mediated the relationship between difficult temperament and increased provision of alternative meals to the child from the rest of the family. Additionally, mothers' and fathers' perception of child food fussiness mediated the relationship between difficult child temperament and lower frequency of sitting at a table together for family meals. Therefore, perceptions of child food fussiness may explain why mothers and fathers use less structure at mealtimes with children who have more difficult temperaments. These results suggests that similar intervention approaches can be used for both mothers and fathers from socioeconomically disadvantaged families to target fussy eating and structure the mealtime environment. Promoting mealtime structure to facilitate parents' appropriate responses to food refusal or difficult behaviour at mealtimes is indicated.

What's the fuss about? Parent presentations of fussy eating to a parenting support helpline.

OBJECTIVE: To characterise parent presentations of fussy eating and mealtime interactions at a point of crisis, through analyses of real-time recordings of calls to a parenting helpline. DESIGN: Qualitative analysis included an inductive thematic approach to examine clinical parent presentations of fussy eating and derive underlying themes relating to mealtime interactions. SETTING: Calls made to the Child Health Line regarding feeding concerns were recorded and transcribed verbatim. SUBJECTS: From a corpus of 723 calls made during a 4-week period in 2009, twelve were from parents of children aged 6-48 months. RESULTS: Parents of infants (≤12 months, n 6) presented feeding concerns as learning challenges in the process of transitioning from a milk-based to a solid-based diet, while parents of toddlers (13-48 months, n 6) presented emotional accounts of feeding as an intractable problem. Parents presented their child's eating behaviour as a battle (conflict), in which their children's agency over limited intake and variety of foods (child control) was constructed as 'bad' or 'wrong'. Escalating parent anxiety (parent concern) had evoked parent non-responsive feeding practices or provision of foods the child preferred. CONCLUSIONS: Real-time descriptions of young children's fussy eating at a time of crisis that initiated parents' call for help have captured the highly charged emotional underpinnings of mealtime interactions associated with fussy eating. Importantly, they show the child's emerging assertion of food autonomy can escalate parents' emotional distress that, in the short term, initiates non-responsive feeding practices. The current study identifies the importance of educational and emotional support for parents across the period of introducing solids.