Research reportA comparison of parental views of their pre-school children’s ‘healthy’ versus ‘unhealthy’ diets. A qualitative study
Introduction
The deleterious effects of diets that are energy-dense and poor in essential nutrients are increasingly prominent, both in the impact on obesity prevalence as well as general health and wellness (Wang & Lobstein, 2006). In Australia the National Nutrition Survey recently recorded low intakes of fruit and vegetable and high intakes of non-core (discretionary) foods in children across the various age ranges (Department of Health, 2008) in contrast to recommended dietary guidelines, where the recommended daily intake is two serves of vegetables and one serve of fruit for children between two to eight years of age.
Evidence suggests that early food exposure can predict food preferences in adolescence (Skinner, Carruth, Bounds, & Ziegler, 2002) with increased prevalence of poor dietary habits tracking from early childhood into adulthood (Gunnell et al., 1998, Ritchie et al., 2001). It is also well understood that existing and habitualised behaviours are generally difficult to change (Jager, 2003). An expanding body of research suggests the importance of both early intervention (Wen et al., 2009, Worobey et al., 2004) and the role of effective parent feeding practices in promoting healthy diets (Birch, 2006, Ventura and Birch, 2008). Therefore, healthy eating behaviours need to be encouraged and nurtured early in life.
Young children primarily rely on parents or primary carers to provide their diets (Campbell & Crawford, 2001). Accordingly, the optimal time to promote and encourage healthy child eating behaviours is via parents during the formative pre-school years (Fisher, Mitchell, Wright, & Birch, 2002). Contributing factors to children’s diets that have been identified include the child’s home food environment, style of parenting, parent feeding practices and attitudes, parent general nutrition knowledge, parent role-modelling of eating behaviour, and food availability (Blaylock et al., 1999, Campbell et al., 2010, Fisher and Birch, 2002, Gibson et al., 1998, Hubbs-Tait et al., 2008, Hughes et al., 2005). Importantly, while some nutrition knowledge is necessary, it may not be sufficient. For instance parenting styles were shown to be independently associated with children’s fruit and vegetable and non-core food consumption (Peters, Dollman, Petkov, & Parletta, 2013); limiting consumption of specific foods may be counterproductive (Campbell et al., 2010); food used as a contingency for reward has been associated with reduced preference for the contingency food while the restricted or reward food has been associated with increased preference (Birch et al., 1984, Newman and Taylor, 1992).
Our review of interventions looking at parental influence on diets of two-five year old children found that while 17 interventions seeking to improve child diet and/or BMI focussed on parents of this age group, very few of these were ranked as high quality studies. This and other research suggests that more work needs to be done to identify effective strategies for parents to encourage healthy eating in their young children (Hesketh et al., 2005, Peters, Sinn, et al., 2013). A concurrent review evaluated qualitative research exploring parenting practices, parent’s nutrition knowledge and child diet, and identified common barriers to providing healthy diets for young children (Peters, Dollman, et al., 2013, Peters, Parletta, et al., 2013, Peters, Sinn, et al., 2013). As detailed in this review, these barriers included the availability of fast food options that were considered to be satiating and value for money, compared to a common perception of healthier foods costing more and not satisfying the appetite; cultural differences in attitudes, perceptions and concerns regarding the promotion of a healthy child diet; variations in the interpretation and definition of ‘health’; misconceptions that a heavier child is a healthier child and therefore indicative of good parenting; that the child is predisposed to overweight/obesity and/or would outgrow the condition; that picky eaters would not eat enough, and that denying a request for food is tantamount to starving the child (Peters, Dollman, et al., 2013, Peters, Parletta, et al., 2013, Peters, Sinn, et al., 2013.
Additionally, the abovementioned review identified a lack of qualitative research with parents of young children evaluating parental influences on children’s diets, in accordance with calls for more in-depth exploration of parent feeding strategies and beliefs as a high research priority in our current obesogenic environment (Brewis & Gartin, 2006). Therefore, this study aimed to explore these feeding strategies and beliefs via semi-structured focus group interviews with parents of children aged 2–5 years, contrasting and comparing responses from parents of children identified as having ‘healthy’ and ‘unhealthy’ diets, and included discussion of (1) parent perceptions of effective feeding practices; (2) parental views on the influences of home food availability and accessibility; (3) understanding of healthy child diet; and (4) facilitators and barriers to providing healthy foods for young children.
Section snippets
Sample selection
The target group was parents of 2–5 year old children. Purposive sampling techniques were used to recruit a subset of parents who consented to future contact in another research project (Peters, Dollman, et al., 2013) where it was stipulated that eligible parents were required to have a child aged 2–5 years and be able to read English to complete the questionnaires. Additionally parents who agreed to participate in the present study were selected according to their child’s fruit and vegetable
Results
A total of 20 parents (17 mothers and 3 fathers) participated, detailed in Table 1, and were all part of two parent households. The ‘healthy’ group consisted of 8 mothers and 2 fathers whereas the ‘unhealthy’ group consisted of 9 mothers and 1 father. Participant ages ranged from 31 to 41 years in the ‘healthy’ group and 24–54 years in the ‘unhealthy’ group; household annual incomes were on average $10,000 higher in the ‘healthy’ group ($92,740) with nine families in the ‘unhealthy’ group and all
Discussion
To our knowledge the methodology presented here is a unique concept designed to compare and contrast perception of child diet between parents of children with higher and lower fruit and vegetable consumption (‘healthy’ versus ‘unhealthy’). Discussions revealed that participating parents, whether their children had healthy or unhealthy diets, were unanimous in reporting a desire to provide their notions of a healthy diet when preparing and serving food for their children. Other similarities in
Conclusion
It appears that when organising and worrying about food provision for child consumption, lack of knowledge, and inconsistent parenting within the primary home environment promoted stress for both parents and children in the ‘unhealthy’ group. These parents reportedly use negative practices to control and encourage consumption (such as using contingency/reward foods and disguising vegetables) whereas parents of the ‘healthy’ group appeared to promote child autonomy within clearly defined
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