Jean D. Skinner

Do Food-Related Experiences in the First 2 Years of Life Predict Dietary Variety in School-Aged Children?

OBJECTIVE To determine if food-related experiences in the first 2 years of life predict dietary variety in school-aged children. DESIGN/SETTING Child/mother pairs were interviewed 7 or 8 times when children were 2 to 24 months using a randomized incomplete block design to schedule interviews. Each child/mother pair was interviewed when the child was ages 6, 7, and 8 years. PARTICIPANTS Child/mother pairs (n = 70) were continuous participants in the longitudinal study. MAIN OUTCOME MEASURES Dependent variables were childrens vegetable and fruit dietary variety, assessed from 3 days of dietary data at ages 6, 7, and 8 years. Independent variables from the first 2 years of life were selected from the longitudinal data set. ANALYSES General linear models. Adjustments for age that vegetables (or fruits) were introduced in the diet. RESULTS Vegetable variety in the school-aged child was predicted by mothers vegetable preferences, R2 =.084. Fruit variety in the school-aged child was predicted by breast-feeding duration and either early fruit variety (R2 =.254) or fruit exposure (R2 =.246). CONCLUSIONS/IMPLICATIONS Nutrition education messages for mothers should emphasize the importance of early food-related experiences to school-aged childrens acceptance of a variety of vegetables and fruits.

Feeding Behaviors and Other Motor Development in Healthy Children (2–24 Months)

Objectives: To monitor infant’s gross, fine and oral motor development patterns related to feeding. Design: An incomplete block design was used with 57 to 60 (sample=98) mothers interviewed when their children were 2, 3, 4, 6, 8, 10, 12, 16 and 24 months (within ± 5 days of birth date). Each mother had 5 to 6 interviews. Setting: Selected developmental feeding behaviors were monitored using in-home interviews conducted by trained interviewers (n=2). At each interview, mothers reported the child’s age when behaviors first occurred, and anthropometric measurements were performed. Subjects: Subjects were healthy white children who lived mostly in homes with educated two-parent families of upper socioeconomic status. Results: Mean behavioral ages were within normal ranges reported in the literature, whereas individuals exhibited a wide diversity in reported ages. Examples of gross motor skills (age in months, ± SD) included sitting without help (5.50 ± 2.08) and crawling (8.00 ± 1.55). Mean ages for self-feeding fine motor skills showed children reaching for a spoon when hungry (5.47 ± 1.44), using fingers to rake food toward self (8.87 ± 2.58) and using fingers to self-feed soft foods (13.52 ± 2.83). Oral behaviors included children opening their mouth when food approached (4.46 ± 1.37), eating food with tiny lumps (8.70 ± 2.03) and chewing and swallowing firmer foods without choking (12.17 ± 2.28). Conclusions: Mean ages for feeding behaviors occurred within expected age ranges associated with normal development. However, mothers reported that individual children exhibited a wide age range for achieving these behaviors. Our results should be considered in counseling mothers about infant feeding practices.

Fruit Juice Intake Is Not Related to Children's Growth

Background. Excessive fruit juice intake (>12 ounces/day) has been reported to be associated with short stature and obesity in preschool children. Objective. To confirm whether excess fruit juice intake was associated with short stature and obesity in preschool children, we assessed growth parameters and fruit juice intake in 105 white children, ages 24 to 36 months. Methodology. Mothers were interviewed twice by a registered dietitian when children were age 24, 28, or 32 months (interview 1) and when children were age 28, 32, or 36 months (interview 2); interviews were assigned randomly. At each interview mothers provided 3 days of dietary data (one 24-hour recall and a 2-day food record) and the registered dietitian weighed the child and measured his/her height. Dietary data were analyzed using Nutritionist IV software. Each childs body mass index (wt/ht2) and ponderal index (wt/ht3) were calculated for each interview. Growth parameters of children consuming <12 ounces/day 100% fruit juice were compared with those consuming ≥12 ounces/day using the Students t test, χ2, Fishers exact test, and mixed model repeated measures analyses (PROC MIXED). Results. Results consistently indicated no statistically significant differences in childrens height, body mass index, or ponderal index related to fruit juice intake. Intakes of soda pop were negatively related to intakes of milk and fruit juice although intakes of milk and fruit juice were not related. Conclusions. The consistent lack of relationship between childrens fruit juice intake and growth parameters in our study does not support previous recommendations to limit the intake of 100% fruit juice to <12 ounces/day.

Revisiting the Picky Eater Phenomenon: Neophobic Behaviors of Young Children

Objectives: To compare picky eater behaviors (food neophobia) of children as toddlers and at 42 to 84 months of age and to assess their mothers’ neophobic behaviors. Methods: In a follow-up study of toddlers’ picky eater behaviors, trained interviewers conducted four in-home interviews with mothers (n = 71) when their children were 42, 60, 72 and 84 months of age. Mothers reported children’s diets (1 weekend day and 2 week days, 12 days total) and their behaviors; weight and height were measured. An additional interview at 48 months involved only mothers’ behaviors. Nutritionist IV software, correlations, t tests and repeated measures ANOVA were used to determine nutrient intake, behavioral relationships and differences by picky eater status. Mothers’ descriptions of the children’s food neophobia and bothersome behaviors were analyzed by qualitative methods. Results: Mothers reported children’s neophobic behaviors at all ages. Mothers’ and children’s behaviors were significantly and consistently correlated for number of attempts before deciding an unfamiliar food was disliked (p < 0.01) and trying unfamiliar foods away from home (p < 0.01). Other behavioral associations were significantly related for some ages but not for all the children’s ages. There were no significant differences by picky eater status for nutrient intake or height and weight at any age. Mothers most frequently attempted unfamiliar entrees away from home because of social setting/relationships. About 20% of mothers attempted unfamiliar foods or new recipes just because they were different. Conclusions: Findings suggest that some neophobic behaviors of children did not improve with maturity. Mothers’ perceptions about their children’s picky eater status were inconsistent over time.

A longitudinal study of children's juice intake and growth : The juice controversy revisited

OBJECTIVES To determine associations between childrens longitudinal juice intake and growth parameters at age 72 months and to determine childrens beverage intake patterns over time. SUBJECTS/SETTING White children (n = 72) residing in the vicinity of a Southern US city participated in a longitudinal study. METHODS Seven in-home interviews were conducted per child when each child was between 24 and 72 months of age. The 7 sets of 3-day dietary data were analyzed for beverage intake, categorized as juice (100% juice only), milk, carbonated beverages, and other drinks (e.g., lemonade, tea, juice drinks). The following growth parameters were determined for each child at age 72 months: height, weight, body mass index (measured as kg/m2), and ponderal index (measured as kg/m3); the 3 latter are measures of overweight. STATISTICAL ANALYSES Associations between longitudinal juice intake and each growth parameter were tested with general linear models. Repeated measures analysis of variance tested changes in beverage intakes over time. RESULTS There were no statistically significant associations between juice and childrens height, weight, or body mass index, as tested by general linear models. Childrens longitudinal juice intake was negatively related to ponderal index (beta = 0.065, P = .050). Childrens juice intake decreased significantly between ages 2 and 6 years, from 6.8 to 3.6 oz/day (P = .0001); intakes of carbonated beverages and other drinks increased from 1.7 to 3.8 oz/day (P = .0016) and from 2.7 to 6.2 oz/day (P = .0001), respectively. APPLICATIONS/CONCLUSIONS Childrens longitudinal juice intake was not associated with either short stature or overweight. As juice consumption decreased, intakes of less nutritious beverages increased. Consumption of 100% juices should be encouraged by health professionals and parents/caregivers.

Longitudinal Study of Nutrient and Food Intakes of White Preschool Children Aged 24 to 60 Months

OBJECTIVE To determine nutrient and food intakes of 72 white preschool children primarily from families of middle and upper socioeconomic status and to compare childrens nutrient intakes with current recommendations. DESIGN Six in-home interviews were conducted with mothers when children were 24 to 60 months old; at each time mothers provided 3 days of dietary information on the child. Children and mothers independently provided information on the childs favorite and least favorite foods at 42 and 54 months. SUBJECTS Preschool children (24 to 60 months old) participating in a longitudinal study. STATISTICAL ANALYSES Mean nutrient intakes were compared with the most recent Recommended Dietary Allowances/Adequate Intakes. Differences over time were tested with repeated-measures analysis of variance; gender differences were determined with t tests. Food frequencies (i.e., percentage of children consuming specific foods) were determined from dietary recalls and food records. Dietary variety was assessed with the Variety Index for Toddlers or the Variety Index for Children. RESULTS Means were consistently less than the RDA/AI for energy, zinc, folate, and vitamins D and E. Energy, carbohydrate, and fat intakes were highest (P < or = .01) at 60 months. Boys consumed more (P < or = .05) protein (10 g), calcium (197 mg), magnesium (35 mg), and pantothenic acid (0.8 mg) at 60 months than did girls. Foods most commonly eaten were fruit drink, carbonated beverages, 2% milk, and french fries. The vegetable group consistently had the lowest variety scores; vegetables also dominated least favorite foods lists. APPLICATIONS Parents need to be encouraged to include more sources of zinc, folate, vitamin E, and vitamin D in childrens diets. Parents should also encourage their children to eat more vegetables, zinc- and folate-fortified cereals, lean red meats, seafood, vegetable oils, and low-fat milk.

Toddlers’ Food Preferences: Concordance with Family Members’ Preferences

Abstract To determine the food preferences of toddlers and the concordance with preferences of their family members, 118 children, ages 28 to 36 months, were assessed with a written questionnaire completed by their mothers. The questionnaire included 196 foods commonly eaten across the U.S. Response categories were [food] never offered, never tasted, [child] likes and eats, dislikes but eats, likes but does not eat, and dislikes and does not eat. Similar questionnaires were completed by mothers (n = 117), fathers (n = 96), and an older sibling (n = 47) of the child. Results indicated strong concordance (82.0–83.3%) of food preferences between the child and other family members. Similarity between foods never offered to the child and the mothers dislikes was significant at p = .005. On the average, children had been offered 77.8% of the 196 foods and liked 81.1% of the foods offered to them. Foods liked and eaten by over 95% of the children included French fries, pizza, potato chips, apple juice, bananas, saltine crackers, spaghetti, biscuits, rolls (white), and popcorn. No single food was disliked and not eaten by a majority of the children. Results suggest that the most limiting category related to food preferences were those foods never offered to the child.

Preschoolers’ Food Product Choices at a Simulated Point of Purchase and Mothers’ Consumer Practices

Abstract The objective of this study was to determine the positive attributes of familiar food products as reported by preschool children and to assess their mothers’ consumer practices. At two in-home interviews, children (n = 34, ages 60 and 69 months) were asked to select one food from nine pairs of familiar foods (cereals, beverages, yogurt, and gummy candies). Concurrently but separately, their mothers (n = 34) completed a consumer questionnaire. Childrens cognitive development levels were assessed. Statistical Analysis System (SAS) was used to compute descriptive statistics and quantitative analyses for categorizing childrens reasons for food choices in a simulated point of purchase decision. Most children selected one of the paired foods based on a single attribute (e.g., character/action figure or type of product). At 69 months, single attributes reported earlier changed (e.g., characters to taste). Findings indicate that most children were in the preoperational stage of development. They did not select foods using several attributes, which would indicate a higher level of cognition. For mothers, economic factors had the most influence on their consumer practices. Preschool childrens food selections were influenced by a single attribute of the product/packaging at 60 and 69 months of age. Parents need information about preschoolers’ single attribute selection process and to use that process to teach better food selection.

Can goal setting as a component of nutrition education effect behavior change among adolescents

We developed a nutrition education behavior change strategy for high school health classes, and we implemented and evaluated the strategy with 159 adolescents in 12 classes in 6 schools. We used a pre-/postassessment, treatment/ control group experimental design with two treatment groups—one received only the behavior change strategy and one received the strategy plus a traditional knowledge-oriented component. Based on an individualized nutrient intake analysis of a three-day food record, each adolescent in a treatment group selected improvement of one nutrient as a goal. The dependent variable was change in intake of the goal nutrient, analyzed with separate statistical models for each of 6 nutrients. Independent variables in each model were treatment, school, gender, goal, nutrition attitude scores, and nutrition knowledge scores. Although treatment and school were not significant variables, goal was related (p < .01) to behavior change for each of the 6 nutrients. Adolescents who set a goal related to calcium, vitamin A, or vitamin C increased intake and those with a sodium-related goal decreased sodium intake. Gender was related to change for calcium, vitamin A, and folic acid, with males making significant improvements. Nutrition attitudes and knowledge generally were not related to dietary change. Knowledge scores increased significantly in both treatment groups.

Mothers' Sources of Information About Feeding Their Children Ages 2 Months to 54 Months

The purpose of this study was to determine sources and types of information about child feeding practices that were received by 62 mothers with children aged 2 to 54 months. Each mother participated in 10 or 11 in-home interviews. Data analyses included chi-square testing for differences in information sources over time and content analyses to develop information themes. As sources, citations for professionals and magazines decreased, with no significant changes for relatives over time. After 24 months, newspapers, television, and friends were reported more frequently than earlier. Mothers reported multiple and concurrent information sources over time. Thus, nutrition educators have concurrent and multiple opportunities to disseminate nutrition information.