The Feeding Doctor on Pinterest

irresponsible conclusions on prompting kids to try new foods

Posted by on Apr 9, 2013 in Blog Posts |

Eat-your-veggies-300x200
Some thoughts on the study, “Predicting Successful Introduction of Novel Fruit to Preschool Children.” From the Journal of the Academy of Dietetics and Nutrition. (links at bottom)
First and foremost, most of what busy clinicians (or parents, or “science reporters”) will read is the abstract or just the conclusion or press release, which is why I find this so troublesome.  Whenever you see “evidence based,” know how problematic that can be, when the study has major limitations.
Conclusions:
“Prompting a child to eat and using rewards or bargains during a positive mealtime interaction can help to overcome barriers to novel fruit consumption. Early introduction of solids is also associated with greater willingness to consume a novel fruit.”
So, if all you read is the conclusion, you might think, “Hey, it is evidence based to instruct parents to bribe kids, reward them, and prompt them; maybe by putting food on their plate, or holding it out to them.” And parents may think, “If one prompt is good, several must be better!”
I think this is an irresponsibly worded conclusion given how weak the study is in terms of generalizability, and real-world applications. Here are my concerns with the study:
  • Study participants were self-selecting volunteers. (Parents willing to take part in studies are likely different from other parents, perhaps having children of a more easy-going temperament who might be willing to sit around for hours in a lab, or parents who have enough time, transport, and support, who are interested in child development etc.) The study did acknowledge that the  parents were mostly well-educated, white and of high socioeconomic status
  • Only 25 children.
  • Served one meal in a laboratory setting. (Are the parents trying harder, being less or more forceful if they know exactly what behavior was being tested? Are older children trying to “be good” for the study?) The meal also had two sweet options and a bag of “crisps”, so the child may have been distracted, or full with the menu offered. (There are many variables you see.)
  • Parents were told they were being studied for ways to get kids to try new foods, that researchers were “interested in the types of strategies parents used to encourage children to try new foods.” How might these instructions have changed behavior?
  • Age range is 2-4 years, that is developmentally quite a large span.
  • Verbal and physical “prompts” in the conclusion? Seems so vague. Putting the food on the plate, or putting it in the child’s eye sight was considered a physical prompt. How far might parents take this?
  • They lump non-pressuring tactics like teaching: “There’s a stone inside” (fresh date), or frame of reference,  “Well, it’s like a big grape, isn’t it?”
    …with verbal prompts like, “Come and eat your date.” That’s a big difference, don’t you think?
  • 1/3 of the children tried and enjoyed the fruit, probably about the number who would have anyway, without any prompting. (See below.)

In general, what is so often lacking in studies and nutrition education is the issue of the feeding relationship, the parent observing and responding to the cues from the child. If a child resists, becomes upset, or is not open to verbal or physical prompts, then it doesn’t help. It is far too easy for this to turn into pressure. Making these sweeping statements based on one meal in a laboratory setting with 25 kids is irresponsible.

Do the parent and child arrive at the lab with no history? What is the child’s temperament? Do they battle over foods already? There are many known factors that influence the feeding relationship that were not included in the study.  Is the child one of the 1/3 of all children described as “picky,” who may have already been under great pressure and resisted over time? Are the children who enjoy the fruit part of the 1/3 (roughly) who are temperamentally more adventurous and more inclined to enjoy the food anyway? (See below.)

I just think it’s premature and dangerous to recommend pressuring tactics to get kids to try novel foods, when there is evidence that pressure backfires. Teaching parents to offer, model, not pressure and be responsive to their child’s needs would go a long way.

Other quotes from the study seem to indicate far more confusion and unclear results than the conclusion implies:

“Swallowing and enjoying the novel fruit, and the frequency of taste exposures to the novel fruit during the meal were related to physical prompting and the use of rewards and bargaining. However, these practices were also associated with children’s refusal behaviors such as physical and verbal refusal.”

“Where parents used greater verbal pressure and physical prompting, children more frequently refused the novel fruit physically and verbally, while also swallowing and enjoying it more frequently if physically prompted.”

“Rewarding/bargaining was also associated with a higher frequency of refusal, but also acceptance behaviors.”

“It is not unlikely that children who show greater refusal elicit greater verbal pressure or greater prompting from their parents.”

BELOW
This weekend we had a friend of M’s (C) over for dinner.  I made Annie’s yellow mac-n-cheese with peas mixed in (I asked C in advance if it was okay to mix them in or if I should cook them on the side. She shrugged and said, “It’s okay.”) There was a little left-over asparagus which I cut into chunks and dressed with EVOO and white balsamic, there was some raw cauliflower and a little Ranch, and our natural casing hotdogs… C said she had never tried raw cauliflower, or asparagus salad. I told her our only rule was she didn’t have to eat anything she didn’t want to, even if she put it on her plate. I described the sauce on the asparagus. She said, “I’ve never tried those,” and served herself two pieces of asparagus and a small piece of cauliflower. She went for more cauliflower, no more asparagus, and said mid-meal, “Hm, I like the peas in the mac-n-cheese, I’ll have to tell my dad.” (She also talked about how picky her little bother is, and how tired she is of eating mac-n-cheese all the time because it’s what he likes. Same family, different child and temperament and circumstances.)

What do you think of the conclusion, the study and the feeding relationship, and prompts?

 

This is from Ellyn Satter Institute website. There is a wealth of resources here worth checking out.

Go to the bottom of the feeding and eating articles and resources page under current and controversial to see the original PDF of this study, Satter’s and the author’s responses…

Share and Enjoy:
  • Print
  • Digg
  • Reddit
  • StumbleUpon
  • Tumblr
  • del.icio.us
  • Facebook
  • LinkedIn
  • Twitter