Early Childhood Feeding: Assessing Knowledge, Attitude, and Practices of Multi-Ethnic Child-Care Providers

Abstract

Early childhood is a critical period for shaping and influencing feeding and lifestyle behaviors that have implications regarding future weight and health. With more women in the workforce, families have become reliant on childcare. Thus, the child-feeding relationship has become a shared responsibility between the parent and childcare provider. Little is known about the impact of childcare providers on development of early childhood feeding behaviors and subsequent risk for obesity, especially in the Hispanic ethnic group. This research examined child-feeding attitudes, practices and knowledge of multiethnic home-based and center-based childcare providers. Questionnaires were completed by a convenience sample of 72 providers, 50 of which completed a pre-and posttest on child feeding knowledge after receiving a 90-minute class based on Satter's division of responsibility feeding model during the spring of 2008. Results indicate many providers had practices consistent with this model. However, significant differences were reported by Hispanic providers, who were statistically more likely to encourage children to finish meals before dessert, prepare foods they perceived well-liked by children, coach children to eat foods perceived as appropriate, and not eat with children during mealtime. A significant increase in knowledge from 73% correct at pretest to 82% at posttest was noted, with significant increase in knowledge on five of 13 questions. However, knowledge was not always congruent with behavior. This study points to differences among providers based on ethnicity, and strongly recommends recruiting Hispanic childcare providers to participate in educational programs and community efforts to prevent obesity. INTRODUCTIONCurrently, 24% of children ages two to five and 33% of children ages six to 11 are overweight or obese (1), putting them at risk for adolescent and adult obesity and co-morbid disease (2,3). Particularly at risk are Mexican-American children, for whom elevated body mass indices are found in 30% of two to five year olds and in 43% of six to 11 year olds (1). Treatment of obesity is challenging, and long-term success modest (4). Consequently, preventative approaches should start in early childhood, a critical period for shaping and influencing feeding and lifestyle behaviors that impact future weight and health (5-11). Environmental factors can modulate feeding behaviors in children as young as two years of age (5,12,13). Parents and other role models who define the early childhood environment will influence a child's choices, preferences and quantities of food consumed (13)(14)(15)(16)(17)(18)(19).With more women in the workforce (20), up to 60% of children below six years of age spend at least 29 hours a week in a childcare setting (2,21,22). This suggests that children routinely eat several meals away from home each day. Childcare settings can support healthful feeding behaviors (23,24), and preschool is an optimal time to teach and practice healthful feeding habits (24). Little is know...

Nutrition and Physical Activity Environments of Home-Based Child Care: What Hispanic Providers Have to Say

“…Other researchers have also found that Hispanic providers have more demanding feeding practices, such as making children eat all the food on their plate, 16 and they are more likely to encourage children to finish their meals. 17 There appears to be a disconnect between the agreement of FCCH providers with the theory of ideal feeding practices and their actual practices. The providers' actual practice of feeding children in their FCCH could be encouraging excessive food intake and interfering with children's self-regulation of food.…”

Nutritional Quality of Meals Compared to Snacks in Child Care

“…Direct observation is the gold standard for evaluating nutritional practices and comparing foods and beverages served at meals versus snacks over the course of a week, but we were not able to conduct in-person assessments in this large sample of centers. Numerous published studies [27][28][29]38 have used surveys to elicit nutrition practices served in child-care settings, although surveys may be subject to self-report bias and nonresponse bias. Our data suggested, in fact, that directors may have underreported the frequency of service of foods with added sugars and sodium.…”

“…Staff sitting with children at meals has been reported to be common practice in some child-care settings 27,28 but not others. 27,29 Similarly, the extent to which child-care providers encourage-but not coerce-children to try new foods is highly variable. 25,[27][28][29] These studies highlight the need for additional information describing the food environment and caregivers' nutrition practices in order to focus intervention efforts.…”

“…27,29 Similarly, the extent to which child-care providers encourage-but not coerce-children to try new foods is highly variable. 25,[27][28][29] These studies highlight the need for additional information describing the food environment and caregivers' nutrition practices in order to focus intervention efforts. The purpose of this study was to compare the nutritional quality of meals and snacks in full-day child-care centers in southwestern Ohio and to describe nutrition-related practices in these settings.…”

Child Care Providers’ Perceptions of Children’s Lifestyles and Risk Factors for Obesity: A Focus Group Study

“…Moreover, the nurses acknowledged the necessity of cooperating with child care providers, but had no guidelines for how to achieve this [18]. The published methods of disease prevention and health promotion for preschool children have not specifically addressed the role of child care providers and public health nurses in the prevention of childhood obesity [23]- [26].…”