“I Just Try to Keep Her Quiet and Happy” The Role of Caregiver Feeding Practices in Early Childhood Obesity Prevention
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CitationBlaine, Rachel E. 2015. “I Just Try to Keep Her Quiet and Happy” The Role of Caregiver Feeding Practices in Early Childhood Obesity Prevention. Doctoral dissertation, Harvard T.H. Chan School of Public Health.
AbstractChildren’s diet is a key driver of childhood obesity, and thus understanding the role of caregivers in mediating the frequency and content of foods offered to children is critical to developing population-based interventions to support healthy behaviors. The main objective of this thesis is to describe multi-ethnic caregiver feeding practices in the context of childhood feeding recommendations through three studies.
The first study presents cross-sectional survey data on the feeding practices of n=166 infant/toddler child care providers serving minority children in Boston, examining their adherence to current feeding guidelines. In multivariable analysis, center Child and Adult Care Food Program (CACFP) participation was associated with providers sitting with children at meals (OR=5.2; 95% CI 1.2-21.7), offering fruits and vegetables (OR=3.3; 95% CI 1.7-6.2), and limiting fast food (OR=3.5; 95% CI 1.8-6.7). These findings suggest that CACFP participation may encourage positive feeding behaviors among child care providers.
Next, using qualitative in-depth interview data (n=47) low-income multi-ethnic caregivers’ conceptualizations of preschoolers’ snacking in the context of television (TV) viewing are described. Using schema theory to frame data analysis, interview transcripts were coded using the constant comparative method and emergent themes identified. TV viewing was an important component of caregivers’ schemas around child snacking, as they were aware of and accommodated preschoolers’ snacking and TV viewing which was described as routine, positive, and useful for non-nutritive purposes such as family bonding and managing children’s behavior.
Finally, cross-sectional survey data from n=271 low-income parents of multi-ethnic children (2-12 years) is presented to identify both reasons and frequency that children receive snacks and the association between these reasons and children’s diet. Using multivariate logistic regression, children were significantly less likely to adhere to dietary recommendations (e.g. soda, fruit/vegetable consumption) when parents offered snacks for non-nutritive reasons like rewarding behavior (OR=0.83; 95% CI 0.70-0.99), celebrating events/holidays (OR=0.72; 95% CI 0.52-0.99), or achievements (OR=0.82; 95% CI 0.68-0.98). For caregivers/parents, public health messages should encourage “screen free” snacking, healthy snack options, and guidance for managing children’s behavior without using snacks or TV. Future research should explore ways to promote child-centered feeding practices both in child care and at home.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:16121140