Promoting Responsive Feeding in Early Care and Education Settings: Contextual Correlates and Measurement Issues

• In Event: The Impact of Healthful Nutrition Practices in Early Childhood Classrooms on Child Learning and Development

Abstract

Early childhood educators offer a promising avenue in shaping children’s dietary behaviors through the implementation of evidence-based responsive feeding practices (EBPs) during mealtimes.1,2 However, research suggests that educators have limited implementation of EBPs indicating a missed opportunity for influencing children’s health outcomes.3–5

The objective of this abstract is to synthesize findings regarding the factors influencing educator uptake of responsive feeding EBPs, discuss measurement issues and provide implications for future research.

Responsive feeding EBPs have shown to encourage children’s healthy eating behaviors at mealtimes. These include: enthusiastic role modeling and making positive comments about the food served,6 repeated exposure while engaging children in food-based sensory exploration, cueing children to their internal signals of hunger and fullness and allowing children to serve themselves1,2,7 Conversely, controlling feeding practices such as pressuring children to eat and using food as reward should be avoided as they could negatively influence acceptance of targeted foods, self-regulation of eating, and increase risk for overweight/obesity in children.4,6,8,9

There is a documented gap between EBPs and educators’ actual feeding practices. Specifically, educators are more likely to use controlling practices and have limited implementation of EBPs.3,5 While many studies have reported individual-level correlates such as knowledge and beliefs,10–12 there is a need to examine contextual factors as they may reduce individual-level barriers and improve uptake of EBPs. Limited studies focusing on contextual factors report mealtime routines, professional development, federal regulations, center-level policy and, family engagement as an opportunity to improve EBPs in ECE.

The measurement of feeding practices in ECE also warrants attention. Of 83 studies reviewed, we identified 37 self-report measures, 28 live observational tools, and two video coding approaches. Previous research has underscored the need for observational measures for capturing feeding practices because the self-report surveys may not be reflective of educator’s practices.13 The majority of self-report measures had some indicators of reliability and validity (e.g., test re-test, internal consistency, inter-rater reliability; criterion, construct and convergent validity).

Although teachers indicate on self-report surveys limited use of controlling feeding practices, their verbal communication implies the use of such practices warranting a need for observational measures.5,13 Examples of observational tools that have been published for use in a childcare setting include: Table Talk measures educator mealtime verbal communication,14 the Feeding behavior coding system measures feeding practices and styles,15 and the Environment and Policy Assessment and Observation- Extended Feeding Practices16 attempts to capture both mealtime practices, interactions, and mealtime environment. Existing observation methods have included tests for validity (content, face, convergent) and for reliability with interrater/inter-observer being tested most frequently. Yet, these instruments do not currently capture key contextual factors (e.g. peer modeling, educator response to child food refusal, policy), pose challenges for establishing inter-rater reliability as many items are not quantifiable or have been validated for use only in family childcare homes or have not been validated yet.

Given that educators feeding practices offer a promising avenue to influence children’s dietary behaviors, it is critical to understand the correlates of mealtime feeding practices and address the measurement issues.

Authors

• Dipti Dev

• Taren Swindle, University of Arkansas for Medical Sciences