Big hearts, small hands: a focus group study exploring parental food portion behaviours

'You just eyeball it': Parent and nursery staff perceptions and influences on child portion size: A reflexive thematic analysis

Background: Childhood obesity is one of the most serious public health epidemics of the 21st century. Observational studies report that increases in portion size (PS) have occurred in parallel with levels of obesity. Increased PSs of high-energy-dense foods can promote overeating, and without compensatory behaviours, can contribute to childhood obesity. Caregivers make decisions about PSs for children in the home and nursery environment, thus are gatekeepers to child food intake. Understanding caregiver PS decisions can aid in the best practice of PS provision to young children. The aim of this study was to explore parent and nursery staff influences on child PS selection and their suggestions for useful tools/strategies in PS decisions. Methods: A qualitative design was employed using focus group discussions (FGDs) with parents and nursery staff of children aged 3-5 years. FGDs were employed given their ability to generate rich data, as well as permit the exploration of collective perceptions, attitudes, behaviours and experiences. Data were analysed using an inductive, semantic approach to reflexive thematic analysis. Results: Four FGDs were conducted: two with parents (n = 13), two with nursery staff (n = 17). Four overarching themes were derived: (i) awareness of PS guidelines; (ii) control over PS; (iii) social influences on children's eating behaviours; (iv) child-specific, social and external factors influencing parent and nursery staff PS decisions. Additionally, participants discussed tools/strategies they believe would be useful in PS decisions. Conclusion: Data from the themes suggest that caregiver control, social, child-specific and external factors are more influential than PS guidelines in both parent and nursery staff PS decisions for young children aged 3-5 years. These findings can inform future childhood obesity prevention initiatives focussed on improving parent and nursery staff provision/use of age-appropriate PSs.

Child food portion sizes in the home environment: how do parents decide?

The consumption of larger portion sizes (PS) of food has been implicated in the increased prevalence of childhood obesity. The home is usually the first place children learn about food, however, little is known about how parents determine child PS in the home environment. This narrative review aimed to explore parental beliefs, decisions, strategies and barriers to the provision of appropriate food PS for children in the home environment. Results indicate that parental decisions on child food PS are based on the amounts they serve themselves, personal intuition and knowledge of child appetite. Owing to the habitual nature of food provision, parental decisions on child PS may be taken without conscious thought and/or could be part of a complex decision-making process influenced by several interlinked factors, including parental childhood mealtime experiences, other family members and child weight status. Strategies to determine child-appropriate PS include modelling the desired PS behaviour, use of unit-based food packaging and PS estimation aids, and providing the child with a degree of autonomy to rely on their own appetite cues. A lack of knowledge/awareness of PS guidance is a key barrier identified by parents to the provision of age-appropriate PS, warranting the inclusion of salient child-appropriate PS guidance within national dietary recommendations. Further home-based interventions to improve the provision of appropriate child PS are required, leveraged on parental strategies already in use, as outlined in this review.

Perceptions, attitudes and beliefs towards soya among healthy Asian women participating in a soya randomised controlled trial

The soya-breast cancer risk relationship remains controversial in Asia due to limited and inconsistent research findings and is exacerbated by difficulties in recruiting and retaining participants in intervention trials. Understanding public perceptions towards soya is important for designing effective intervention trials. Here, we administered a close-ended, quantitative survey to healthy, peri- and post-menopausal Asian women in the Malaysian Soy and Mammographic Density (MiSo) Study to assess perception towards soya and explore motivators and barriers that affect study adherence using the Capability, Opportunity, Motivation and Belief (COM-B) Model and Theoretical Domains Framework (TDF). Of 118 participants, the majority reported the belief that soya promotes good health (Supplement = 85⋅7 %, Diet = 90⋅0 %, Control = 87⋅9 %). Most participants reported obtaining information about soya from the internet (Supplement = 61⋅0 %, Diet = 55⋅3 %, Control = 35⋅9 %), while health professionals were least reported (Supplement = 9⋅8 %, Diet = 7⋅9 %, Control = 5⋅1 %). Stratified analyses by study completion and adherence status yielded comparable findings. By the end of the study, dietary arm participants reported a strong belief that soya has no impact on their health (Supplement = 7⋅1 % v. Diet = 20⋅0 % v. Control = 0⋅0 %, P = 0⋅012). Motivation and opportunity strongly facilitated soya consumption, while psychological capability was the most common barrier to consumption though less evident among dietary arm participants. While most Asian women have a positive perception towards soya, theory-based intervention trials are warranted to understand the perception-study adherence relationship and to accurately inform the public of the health effects of soya.

Barriers and facilitators influencing parental adherence to prevention strategies for deformational plagiocephaly: Results from a scoping review

BACKGROUND

Deformational plagiocephaly can be prevented in many healthy infants if strategies are implemented early after birth. However, despite efforts to disseminate accurate information, parental adherence to evidence-based prevention strategies is a challenge. To date, factors - barriers and facilitators - influencing parental adherence to strategies have yet to be identified in a comprehensive manner.

OBJECTIVES

This scoping review aims to identify and synthesize current evidence on barriers and facilitators impacting adherence of parents of newborns to deformational plagiocephaly prevention strategies.

METHODS

This review followed the Joanna Briggs Institute (JBI) process guidelines. Seven electronic (Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, SPORTDiscus, Academic Search Complete, AMED, PsychINFO and Scopus) and two grey literature (Health Systems Evidence and Grey Literature Report) databases were searched. Studies published between 2001 and 2022 were included. The deductive thematic data analysis used was guided by the Capability, Opportunity, Motivation Behavioral Model (COM-B) of health behaviour change.

RESULTS

From a total of 1172 articles, 15 met the eligibility criteria. All components of the COM-B framework were identified. Capability-psychological and opportunity-environmental factors dominated the literature, whereas capability-physical, motivation and, in particular, opportunity-social factors were understudied. The most often reported barriers were a lack of knowledge of deformational plagiocephaly and the associated prevention strategies, ambiguous or inconsistent messaging, intolerance of babies to prone positioning and a lack of time. The most frequently reported facilitators were an awareness of deformational plagiocephaly, postural asymmetry and prevention strategies, skill acquisition with practice, accurate convincing information, scheduled time and environmental organization to position the baby at home.

DISCUSSION

Recommendations focused on diffusing accurate and detailed information for parents. Our review also suggests a gap regarding the comprehensive identification of factors influencing parental adherence to deformational plagiocephaly prevention strategies. Further studies exploring comprehensive opportunity-social and motivation factors influencing parental adherence to deformational plagiocephaly prevention strategies are warranted to inform prevention programmes and foster better infant outcomes.

Family mealtime emotions and food parenting practices among mothers of young children: Development of the Mealtime Emotions Measure for Parents (MEM‐P)

Family mealtimes can be important for supporting children's healthy development, yet the emotional context of mealtimes can vary considerably, likely impacting their overall success and enjoyment. Yet, despite having an important role, little is known about how parents emotionally experience mealtimes with their family. The first aim of the current study was to assess the factor structure of a novel self‐report measure to assess parents’ emotional responses experienced during family mealtimes (Mealtime Emotions Measure for Parents; MEM‐P). The second aim was to examine relationships between maternal mealtime emotions and their food parenting practices. Mothers of children aged between 1.5 and 6 years participated in this study. Mothers were invited to complete an online questionnaire measuring family mealtime emotions, anxiety, depression and food parenting practices. Exploratory factor analysis produced a three‐factor solution comprising both positive and negative emotion subscales: MEM‐P Efficacy; MEM‐P Anxiety; MEM‐P Stress and Anger. Mothers' positive mealtime emotions (mealtime efficacy) were related to greater use of practices promoting autonomy, providing a healthy home food environment, and modelling healthy eating. Higher anxiety about mealtimes was related to greater reports of child control over eating, and mealtime stress and anger was associated with greater use of food to regulate emotions. These findings highlight novel relationships between how mothers emotionally experience family mealtimes and the food parenting practices they use with their children. It is important to develop resources to help promote positive maternal experiences of family mealtimes and food‐based interactions.

Mothers of young children experience a range of positive and negative emotions around family mealtimes.

Mothers' mealtime emotions are related to the food parenting practices they report using with their children.

Mothers with more positive emotional experiences of family mealtimes (i.e., greater mealtime efficacy) also reported higher use of food parenting practices which promote autonomy in children (e.g., involvement, balance and variety, teaching about nutrition) and which provide feeding structure (e.g., healthy food environment; modelling healthy eating).

Some parents may benefit from further support to help them promote more positive mealtime experiences and food‐based interactions.

Content and Validity of Claims Made about Food Parenting Practices in United Kingdom Online News Articles

The objective of this study was to qualitatively summarise the content of online news articles pertaining to food parenting practices and determine whether this content is substantiated by the scientific literature. News article data were identified and collected from United Kingdom online news published during 2010–2017 period using the News on the Web corpus. A coding framework was used to categorise the content of news articles to identify information related to food parenting practices. Then, claims made about food parenting practices were extracted from relevant news articles. Each claim was evaluated to determine the extent to which any claims were supported by the available scientific research evidence. The study identified ten claims across thirty-two relevant online news articles. Claims made across the news articles reported on the following food parenting practices: food restrictions, food-based threats and bribes, pressure to eat, use of food to control negative emotions, food availability, food preparation, and meal and snack routines. Eight out of the ten claims identified did not refer to scientific research evidence. News articles frequently lacked detail and information to explain to readers why and how the use of certain food parenting practices could have a lasting impact on children’s health outcomes. Considering the influence that news media has on parents, the reporting of food parenting practices in news articles should aim to provide a balanced view of the published scientific evidence and recognise the difficulties and barriers that prevent the use of helpful and healthy food parenting practices. The study results in this paper could be used to aid and structure of the dissemination of food parenting practice research findings in the media, inform public health education to influence perceptions of unhelpful food parenting practices, and promote parental use of responsive food parenting practices.

Children and young people's mental health in the English-speaking Caribbean: a scoping review and evidence map

Internationally, there is a wealth of research suggesting that many children and young people experience mental health problems. However, the evidence from low- and middle-income countries and developing nations is generally limited. This scoping review aimed to add to the body of evidence by providing an overview of the available research literature on children and young people's (CYP's) mental health in the English-speaking Caribbean region. Seven key online academic databases and grey literature sources were searched until January 2021. Records were screened against predefined criteria and suitable articles retrieved. Relevant information was then charted and summarized. All stages of the review were informed by expert consultations. Ninety-six articles from 7901 records met the inclusion criteria. Most of the studies were conducted in Jamaica, Trinidad and Tobago and Barbados while fewer studies reported findings from St Lucia, The Bahamas and St Kitts and Nevis. Research funding was not frequently reported, and participants were predominantly recruited in education settings. There was a substantial focus on depressive symptoms and behaviour problems. Little or no research was available for younger children (< 12), complex clinical cases or commonly under-represented groups. Four unique interventions were identified of which one intervention showed no significant impact on CYP. Among the commonly used outcome measures only the Jamaican Youth Checklist (teacher-reported), Beck Depression Inventory-II, Brief Screen for Depression, Trinidad and Tobago Youth Survey and Minnesota Multiphasic Personality Inventory had evidence for psychometric validity within this population. We discuss future directions, implications and recommendations for research, practice, policy and training.

When do children learn how to select a portion size?

The reduction of portion sizes supports weight-loss. This study looks at whether children have a conceptual understanding of portion size, by studying their ability to manually serve a portion size that corresponds to what they eat. In a clinical setting, discussion around portion size is subjective thus a computerised portion size tool is also trialled, with the portion sizes chosen on the screen being compared to amounts served manually. Children (n = 76) age 5-6, 7-8 and 10-11 were asked to rate their hunger (VAS scale), liking (VAS scale) and 'ideal portion size for lunch' of eight interactive meal images using a computerised portion size tool. Children then manually self-served and consumed a portion of pasta. Plates were weighed to allow for the calculation of calories served and eaten. A positive correlation was found between manually served food portions and the amount eaten (r = 0.53, 95%CI [0.34, 0.82, P < .001), indicating that many children were able to anticipate their likely food intake prior to meal onset. A regression model demonstrates that age contributes to 9.4% of the variance in portion size accuracy (t(68) = -2.3, p = .02). There was no relationship between portion size and either hunger or liking. The portion sizes chosen on the computer at lunchtime correlated to the amount manually served overall (r = .34, 95%CI [0.07, 0.55], p < .01), but not in 5-6-year-old children. Manual portion-size selection can be observed in five-year olds and from age seven, children's 'virtual' responses correlate with their manual portion selections. The application of the computerised portion-size tool requires further development but offers considerable potential.

Snack Portion Sizes for Preschool Children Are Predicted by Caregiver Portion Size, Caregiver Feeding Practices and Children's Eating Traits

Caregivers are mostly responsible for the foods young children consume; however, it is unknown how caregivers determine what portion sizes to serve. This study examined factors which predict smaller or larger than recommended snack portion sizes in an online survey. Caregivers of children aged 2 to 4 years were presented with 10 snack images, each photographed in six portion sizes. Caregivers (n = 659) selected the portion they would usually serve themselves and their child for an afternoon snack. Information on child eating traits, parental feeding practices and demographics were provided by caregivers. Most caregivers selected portions in line with recommended amounts for preschool children, demonstrating their ability to match portion sizes to their child′s energy requirements. However, 16% of caregivers selected smaller than recommended low energy-dense (LED, e.g., fruits and vegetables) snacks for their child which was associated with smaller caregiver′s own portion size, reduced child food liking and increased satiety responsiveness. In contrast, 28% of caregivers selected larger than recommended amounts of high energy-dense (HED, e.g., cookies, crisps) snacks for their child which were associated with larger caregiver′s own portion size, greater frequency of consumption, higher child body mass index (BMI), greater pressure to eat and lower child food liking. These findings suggest that most caregivers in this study select portions adjusted to suit their child′s age and stage of development. Future interventions could provide support to caregivers regarding the energy and nutrient density of foods given the relatively small portion sizes of LED and large portions of HED snacks offered to some children.

Maternal Decisions on Portion Size and Portion Control Strategies for Snacks in Preschool Children

Caregivers are responsible for the type and amount of food young children are served. However, it remains unclear what considerations caregivers make when serving snacks to children. The aim of the study was to explore mothers' decisions and portion control strategies during snack preparation in the home environment. Forty mothers of children aged 24-48 months participated in the study. Mothers prepared five snack foods for themselves and their child whilst verbalizing their actions and thoughts. Mothers were then asked about their portion size decisions in a semi-structured interview. Transcripts were imported into NVivo and analyzed thematically. Three key themes were identified: (1) portion size considerations, (2) portion control methods, and (3) awareness and use of portion size recommendations. Transient, food-related situational influences influenced mothers and disrupted planning and portion control. Food packaging and dishware size were used as visual cues for portion control; however, these vary widely in their size, thus emphasizing mothers' uncertainty regarding appropriate portion sizes. Mothers called for portion size information to be accessible, child-centered, and simple. These findings reveal multiple considerations when deciding on the correct snack portion sizes for children. These decisions are complex and vary across situations and time, and according to the types of snacks offered.

Who is responsible for assessing children's weight status? - a qualitative study of health professionals in regional Australia

Background

Currently in Australia there is a lack of clarity regarding routine assessment of primary school aged children’s weight status despite it being the first step in the identification of overweight and obesity. The National Health and Medical Research Council Obesity Guidelines recommend primary health care professionals include routine weight status assessment in consultations with children yet research suggests this rarely occurs in practice.

This study aimed to determine the views of primary health care professionals regarding routine weight status assessment in primary school aged children and to establish the barriers to assessing children’s weight status.

Methods

Using the case study of a regional town, Rockhampton, purposeful sampling was used to represent the key primary health care settings and professional groups. Interviews were conducted with 31 health professionals. Data were collected and analysed guided by two frameworks, the Capability, Opportunity, Motivation and Behaviour and Theoretical Domains Frameworks.

Results

Eight themes emerged from data and these were relevant to the three levels of influence on the routine weight status of assessment, system, setting and individual. System level themes related to having a formalised program for the undertaking of routine weight status assessment in primary school aged children, increasing the population’s awareness about the importance of the weight status check and limited public health services available for management of childhood overweight and obesity. Setting level theme regarded the location where routine weight status in primary school aged children could be undertaken. Four themes at the individual level of influence on the routine weight status assessment related to the primary health professionals’ roles, barriers to assessing children’s weight status, methods of weight status assessment and starting a weight related conversations with families.

Conclusion

The Government, primary health care services, professional organisations and associations as well as health professionals must commit to long-term implementation of the Obesity Guidelines. Immediate action to improve the undertaking of routine weight status assessment in children must be taken by each health service and health professional. Strategies should aim to positively affect motivation to assess children’s weight status as it is the central component in creating change in practice.

Australian parents' experiences when discussing their child's overweight and obesity with the Maternal and Child Health nurse: A qualitative study

AIMS AND OBJECTIVES

To explore parents' experiences when discussing child overweight issues with the Maternal and Child Health nurse.

BACKGROUND

Community-based child and family health nurses are in a unique position to discuss child overweight and obesity with parents. However, studies of parents' experiences in this context are lacking.

METHOD

Ten mothers of children identified as overweight or obese from regional Victoria, Australia, were interviewed in 2017. Data were analysed using an inductive qualitative thematic approach. The COREQ guidelines were used to ensure study rigour.

RESULTS

In summary, the analysis revealed experiences of Maternal and Child Health nurses "brushing over" the topic, with a lack of information provided about how to tackle the problem at home. The interpersonal relationship aspect of continuity of care was described as facilitating awareness of the child's overweight, although mothers expressed confusion about what constituted a "healthy weight range." While some mothers perceived the nurse's role was to offer evidence-based information and support, others saw the family doctor as the appropriate health professional to address the problem.

CONCLUSION

The findings of this study indicate that parents are often left unsure how to manage their child's weight despite the child being identified as overweight or obese by their Maternal and Child Health nurse.

RELEVANCE TO CLINICAL PRACTICE

Discussions about overweight and obesity may be facilitated by continuity of care where established relationships serve as a facilitator for effective communication. The findings further indicate a need for more structured support of Maternal and Child Health nurses working with parents of young children identified as overweight or obese, including ongoing education, skill development and improved understanding of parental health literacy and its links to childhood obesity.

Plating up appropriate portion sizes for children: a systematic review of parental food and beverage portioning practices

Consumption of larger portion sizes is associated with higher energy intake and weight status in children. As parents play a pivotal role in child feeding, we synthesized literature on 'parental portioning practices' using a mixed methods systematic design to inform future strategies addressing portion sizes served to children. Electronic databases PubMed, EMBASE, SCOPUS, PsycINFO and CINAHL Plus were searched. Two reviewers independently screened 385 abstracts and assessed 71 full-text articles against eligibility criteria: studies assessing portioning of foods or beverages by parent(s) with ≥1 child aged 2-12 years. Narrative synthesis of 14 quantitative studies found that portion sizes parents serve vary substantially and are influenced by amounts parents serve themselves, perceived child hunger and parent and child body size. Thematic synthesis of 14 qualitative studies found that parents serve the portion sizes they learn to be appropriate for their child to be fed. Portioning is influenced by parents' desires for a healthy child with a balanced diet. Future guidance on appropriate portion sizes for children would ideally present recommended portion sizes for first serving, incremental with age. Future research is however needed to assess the adoption and efficacy of providing such guidance to families.

Understanding the science of portion control and the art of downsizing

Offering large portions of high-energy-dense (HED) foods increases overall intake in children and adults. This is known as the portion size effect (PSE). It is robust, reliable and enduring. Over time, the PSE may facilitate overeating and ultimately positive energy balance. Therefore, it is important to understand what drives the PSE and what might be done to counter the effects of an environment promoting large portions, especially in children. Explanations for the PSE are many and diverse, ranging from consumer error in estimating portion size to simple heuristics such as cleaning the plate or eating in accordance with consumption norms. However, individual characteristics and hedonic processes influence the PSE, suggesting a more complex explanation than error or heuristics. Here PSE studies are reviewed to identify interventions that can be used to downsize portions of HED foods, with a focus on children who are still learning about social norms for portion size. Although the scientific evidence for the PSE is robust, there is still a need for creative downsizing solutions to facilitate portion control as children and adolescents establish their eating habits.

Friday Night Is Pizza Night: A Comparison of Children's Dietary Intake and Maternal Perceptions and Feeding Goals on Weekdays and Weekends

Childhood obesity is a serious issue in the U.S. While obesity is the result of a multitude of factors, a great deal of research has focused on children's dietary intake. While children's eating patterns vary throughout the week, not much else is known about weekday-weekend differences. Therefore, the current study examined differences in the frequency and portion size of school-age children's consumption of common foods and beverages, as well as mothers' perceptions of those items and their child feeding goals, on weekdays and weekends. A total of 192 mothers of children aged 7 to 11 were recruited through Amazon's Mechanical Turk. Results showed a consistent pattern of more frequent consumption and larger portions of unhealthy foods and beverages on weekends. This aligned with mothers' perceptions of those foods and beverages as weekend items, as well as their feeding goals of health and price being less important on weekends. It is quite possible that weekends are viewed as having less structure and facilitate schedules that allow children to consume more meals away from home. These findings shed light on additional risk factors in children's eating patterns and highlight the serious implications that day of the week can have on childhood obesity.