Food preferences have been identified as a key determinant of children's food acceptance and consumption. The aim of this study was to identify factors that influence children's liking for fruits, vegetables and non-core foods. Participants were Australian mothers (median age at delivery=31years, 18-46years) and their two-year-old children (M=24months, SD=1month; 52% female) allocated to the control group (N=245) of the NOURISH RCT. The effects of repeated exposure to new foods, maternal food preferences and child food neophobia on toddlers' liking of vegetables, fruits and non-core foods and the proportion never tried were examined via hierarchical regression models; adjusting for key maternal (age, BMI, education) and child covariates (birth weight Z-score, gender), duration of breastfeeding and age of introduction to solids. Maternal preferences corresponded with child preferences. Food neophobia among toddlers was associated with liking fewer vegetables and fruits, and trying fewer vegetables. Number of repeated exposures to new food was not significantly associated with food liking at this age. Results highlight the need to: (i) encourage parents to offer a wide range of foods, regardless of their own food preferences, and (ii) provide parents with guidance on managing food neophobia.

Objective: To describe the quantity and diversity of food and beverage intake in Australian children aged 12-16 months and to determine if the amount and type of milk intake is associated with dietary diversity. Methods:Mothers participating in the NOURISH and South Australian Infant Dietary Intake (SAIDI) studies completed a single 24-hour recall of their child's food intake, when children (n=551) were aged 12-16 months. The relationship between dietary diversity and intake of cow's milk, formula or breastmilk was examined using one-way ANOVA.Results: Dairy and cereal were the most commonly consumed food groups and the greatest contributors to daily energy intake. Most children ate fruit (87%) and vegetables (77%) on the day of the 24-hour recall while 91% ate discretionary items. Half the sample ate less than 30 g of meat/alternatives. A quarter of the children were breastfeeding while formula was consumed by 32% of the sample, providing 29% of daily energy intake. Lower dietary diversity was associated with increased formula intake. Conclusions:The quality of dietary intake in this group of young children is highly variable. Most toddlers were consuming a diverse diet, though almost all ate discretionary items. The amount and type of meat/alternatives consumed was poor.Implications: Health professionals should advise parents to offer iron-rich foods, while limiting discretionary choices and use of formula at an age critical in the development of long-term food preferences.

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Objective: To evaluate dietary intake impact outcomes up to 3.5 years after the NOURISH early feeding intervention (concealed allocation, assessor masked randomized controlled trial). Methods: In this study, 698 first-time mothers with healthy term infants were allocated to receive anticipatory guidance on protective feeding practices or usual care. Outcomes were assessed at 2, 3.7, and 5 years (3.5 years post-intervention). Dietary intake was assessed by 24-h recall and Child Dietary Questionnaire. Mothers completed a food preference questionnaire and Children's Eating Behavior Questionnaire. Linear mixed models assessed group, time, and time 3 group effects.Results: There were no group or time 3 group effects for fruit, vegetable, discretionary food, and nonmilk sweetened beverage intake. Intervention children showed a higher preference for fruit (74.6% vs. 69.0% liked, P < 0.001), higher Child Dietary Questionnaire score for fruit and vegetables (15.3 vs. 14.5, target 18, P 5 0.03), lower food responsiveness (2.3 vs. 2.4, of maximum 5, P 5 0.04), and higher satiety responsiveness (3.1 vs. 3.0, of maximum 5, P 5 0.04). Conclusions: Compared with usual care, an early feeding intervention providing anticipatory guidance regarding positive feeding practices led to small improvements in child dietary score, food preferences, and eating behaviors up to 5 years of age, but not in dietary intake measured by 24-h recall.

BackgroundLittle is known about the influence of parental attributes and parental screen time behaviours on pre-schooler’s screen time and weight status in low-to-middle income countries. The purpose of this study was to examine the relationships between parental screen time, parental self-efficacy to limit screen time, child screen time and child BMI in preschool-aged children in Brazil.MethodsThree hundred eighteen parent-child dyads from Caruaru, Brazil completed a survey measuring sociodemographic data, weekday and weekend screen time, and parental self-efficacy for limiting screen time. Height and weight were measured and used to derive BMI and BMI percentile. Observed variable path analysis was used to evaluate the relationships between the parental and child variables.ResultsAnalyses were conducted for screen time on weekdays and weekend days. Parental screen time was positively associated with child screen time, either directly (weekdays = β = 0.27, p < 0.001, weekends = β = 0.24, p < 0.001) or indirectly through reduced self-efficacy to limit child screen time (weekdays = β = − 0.15, p = 0.004, weekends = β = − 0.16, p = 0.004). After controlling for household income, parental occupation, and parental BMI, greater child screen time on weekends, not weekdays, was associated with higher child BMI percentile (β = 0.15, p = 0.006).ConclusionsParental screen time and self-efficacy to limit screen time are important influences on child screen time and weight status in pre-schoolers from Brazil. Reducing parental screen time and increasing parental confidence to limit screen time may be effective strategy to prevent overweight in Brazilian pre-schoolers.

Background: Childhood obesity is a global problem. Early obesity prevention interventions are complex and differ in effectiveness. Novel frameworks, taxonomies and experience from the Early Prevention of Obesity in CHildren (EPOCH) trials were applied to unpack interventions. Objectives: Deconstruct interventions into their components (target behaviours, delivery features and behaviour change techniques [BCTs]). Identify lessons learned and future recommendations for intervention planning, delivery, evaluation and implementation. Methods: This multi-methods study deconstructed the four EPOCH interventions into target behaviours, delivery features and BCTs from unpublished and published materials using systematic frameworks. Additionally, semi-structured interviews were conducted with intervention facilitators and principal investigators. Results: Each trial targeted between 10 and 14 obesity-related behaviours. Key variations in delivery features related to intensity, delivery mode and tailoring. BCTs consistently used across trials included goal-setting, social support, shaping knowledge, role-modelling and credible source. Recommendations from interview analyses include the importance of stakeholder collaboration and consideration of implementation throughout the study process. Conclusions: The combination of frameworks, methodologies and interviews used in this study is a major step towards understanding complex early obesity prevention interventions. Future work will link systematic intervention deconstruction with quantitative models to identify which intervention components are most effective and for whom.

BackgroundConcerns about fussy eating are common amongst parents of young children. However, studies of the long-term impact of fussy eating show mixed results with regard to adequacy of dietary intake and child growth. This may be in part because there is no accepted definition of fussy eating and studies measure the construct in different ways, commonly relying on parent perception. This longitudinal analysis explores maternal and child characteristics associated with maternal perception of her toddler as a fussy eater in early toddlerhood and subsequent use of feeding practices at 2 years.MethodsMothers completed a self-administered questionnaire at child age 14 months, describing perception of their child as fussy/not fussy and child behaviour. Intake was assessed using a single 24-h recall and weight was measured by research staff. At child age 2 years mothers completed the validated 28-item Feeding Practices and Structure Questionnaire (FPSQ-28).Weight-for-age z-score (WAZ) was derived from WHO standards. Gram daily intake of fruit, vegetables and meat/alternative and a dietary diversity score were determined. Maternal/child characteristics independently associated (p ≤ 0.05) with perception of child as a fussy eater were determined using logistic regression. Variables were combined in a structural equation model assessing the longitudinal relationship between child/maternal characteristics, perception of child as a fussy eater and eight FPSQ factors.ResultsMothers’ (n = 330) perception of her child as a fussy eater at age 14 months, was associated with higher frequency of food refusal and lower WAZ (R 2 = 0.41) but not dietary intake. Maternal perception as fussy (age 14 months) was associated with four FPSQ factors at 2 years (n = 279) - Reward for Eating, Reward for Behaviour, Persuasive Feeding and Overt Restriction, x 2/df = 1.42, TLI = 0.95, CFI = 0.95, RMSEA = 0.04(0.03–0.05), PCLOSE = 0.99.ConclusionsLower relative child weight and food refusal prompted mothers to perceive their child as fussy. These behaviours in healthy weight children most likely reflect self-regulation of energy intake and neophobia. This perception was prospectively associated with use of non-responsive feeding practices, which may increase obesity risk. Future interventions could directly address perceptions of growth and fussiness, supporting parents to understand food refusal as developmentally appropriate behaviour in healthy young children.Trial registration ACTRN12608000056392. Registered 29 January 2008.Electronic supplementary materialThe online version of this article (10.1186/s12966-017-0582-z) contains supplementary material, which is available to authorized users.

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.