It’s snack time at my sister’s house. My nieces are both served a bowl of blueberries. Bella, the 4-year-old, eats them and asks for more. Maddie, the 2-year-old, eats one, spits it out and then begs for “chips, please!”
It is difficult not to indulge that little face, especially when she asks so politely, but my sister is not giving up that easily. She knows that kids need to be introduced to new foods as many as 15 times to get over its “newness.” So she swaps the blueberries for sliced bananas, a known favorite, and says she’ll try again tomorrow.
These are the kinds of child-feeding practices parents of young children need to have in their arsenal to prevent early childhood obesity. It is no secret that obesity is an epidemic in our nation, but did you know that more than 20 percent of children ages 2 to 5 are overweight or obese?
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If you are thinking they’ll just “grow out of it” or it’s just “baby fat”, you might be surprised to learn that children who are overweight during early childhood are at least five times more likely than non-obese children to be overweight or obese as adults. However not all hope is lost — a child who reaches his or her second birthday at a healthy weight is less likely to become overweight at a later age. So the question becomes, how do we ensure that babies do not become overweight before it’s too late?
The first years of life are a critical period when a child is establishing the foundation for dietary habits and physical activity. This formative period is unique in that it is not necessary to change established dietary and physical activity habits, but to cultivate healthy ones from the start.
In these developmental years, infants and toddlers learn an enormous amount about food and eating. This is the period that they are taught when and how much to eat as well as what foods are appropriate to eat together and which foods are attributed to particular meal times. When parents provide exposure to healthy food, children like and prefer them.
Additionally, behavioral theories advise that making fruits and vegetables more accessible by making them easy to reach and in snack sizes may increase children’s intake. Research suggests that differences in the intake of energy appear as early as preschool years and that parents have great influence on regulation, not only in the foods that they provide and model but also through their child-feeding strategies.
Feeding practices such as prompting to eat (“finish your plate”), use of rewards (“dessert if you eat all your peas”), and restricting access to food have been found to be counterproductive and have well-established associations with poor child eating habits and child weight status. Instead, experts are shifting their mindset to parents being responsible for the types of food offered and the times they are offered, and children being responsible for the decision to consume what is offered or not.
A common suggested strategy is to sit and eat the same food as a “family-style” meal where children serve themselves from common serving bowls. This way parents are modeling healthy food consumption and children are given the opportunity to respond to their own hunger and fullness cues.
In the face of growing evidence that parents hold the key to preventing childhood obesity, we need to make sure that the researchers aren’t the only ones that know about child-feeding practices. Resources that work to provide education to parents, like healthychildren.org from the American Academy of Pediatrics, are a start.
So, maybe today it’s not blueberries, but we can still have hope for tomorrow.
Cynthia N. Lebron, MPH is a PhD candidate in prevention science and community health in the University of Miami Health System. For more information, visit umiamihealth.org/treatment-services/pediatrics.