Feeding time

How do children learn to eat? Many readers will have personal experience of trying the main feeding strategies, classified as modelling; restricting access to food; pressure (including rewards used in a coercive context); encouragement (including rewards used to signify achievement); and repeated taste exposure (RTE).

Modelling is a process whereby human behaviour is learned by basing one’s own actions on the observed acts of another (Bandura, 1986). In this way, children’s eating behaviour has been shown to be socially modifiable by their peers (Birch, 1980), adults (Addessi et al., 2005), teachers (Hendy & Raudenbush, 2000), and fictional cartoon heroes (Duncker, 1938).Restrictive feeding practices involve limiting access to foods perceived as undesirable (Fisher & Birch, 1999). However, such practices can have unintended outcomes – research suggests that parents’ use of restrictive practices predicts higher, rather than lower, consumption (Birch et al., 2003). Similarly, pressuring a child to eat by requiring them to finish their food has been shown to be associated with reduced consumption and an increase in negative comments about the food (Galloway et al., 2006).

The effects of rewards within the food domain vary depending upon a range of factors. Using food as a reward, for example, ‘if you are good you can have an ice-cream’, tends to increase liking for that food (Mikula, 1989). However, reward scenarios such as ‘If you eat food A, you can have food B’ can reduce children’s liking for food A (Newman & Taylor, 1992), which possibly conflicts with intentions. Yet when this is expressed differently, as ‘Eat food A first and then food B’ (i.e. the contingency is removed), the divergence in liking for the two foods is less likely. Furthermore, requiring a child to eat a food in order to get a reward may have either positive or negative consequences. Coercive or negative scenarios such as ‘Eat food A and you can go out to play’, tend to reduce the child’s liking for the food (Birch et al., 1982). On the other hand, more positive scenarios, possibly involving verbal praise or indicators of achievement such as stickers, have been shown to enhance both liking and consumption (Horne et al., 2004).

The principles behind RTE originate from the ‘mere exposure hypothesis’, which states that repeatedly making a stimulus available enhances liking for that stimulus (Zajonc, 1968). With food stimuli, it has been shown that tasting, rather than just looking, is required (Birch et al., 1987), and it has been suggested that 8–15 taste exposures may be required before liking is enhanced (Sullivan & Birch, 1990).

How do we judge success in the context of feeding strategies? Outcomes are primarily consumption (Galloway et al., 2006), liking (Newman & Taylor, 1992) and choice (i.e. the selection of one food item over another) (Birch et al., 1987). These outcomes are interrelated. For example, the correlation between food likes/dislikes and consumption in three- to four-year-old children is 0.8 (Birch, 1979), and establishing liking for a range of healthy foods is essential for long-term, independent food choices (Cooke, 2007).

The child’s learning process does not always run smoothly, and some children can develop poor choice-making skills (Warwick et al., 1997), become picky eaters, or exhibit food neophobia – the rejection of novel foods (Dovey et al., 2008). Whereas children are willing to eat a wide variety of foods at age one to two years, by age four years, food neophobia results in this willingness declining to its lowest levels (Cashdan, 1994).

It is clear from the literature, therefore, that a substantive knowledge base has evolved regarding the mechanisms associated with social contexts through which three- to six-year-old children learn to eat. The home and school context, together with the social relationships within them are important influences on the developing child. So how do adults within these contexts typically interact with children at mealtimes to encourage eating? To what extent are the practices that have been extensively studied actually used?

At home
In the home setting, these questions were explored during a qualitative study involving mothers of children aged three to five years (Moore et al., 2007). The feeding strategies used largely matched those summarised above. Each mother had an extensive repertoire of techniques that she would draw on depending on the situation and her assessment of the child’s temperament. However, this repertoire generally included those techniques based on restriction and rewards, where the literature warns  of unintended consequences.

Mothers occasionally expressed concern over their child’s eating behaviours (Moore, Tapper & Murphy, 2010a). These mothers would be concerned about their child going hungry and, accordingly, viewed their primary feeding goal as consumption of the current meal. However, where this was not the case, mothers adopted a longer-term goal of ensuring the child consumed a balanced nutritional diet. Given that the average age of the children in this study was four years, none of the mothers exhibited an awareness that neophobic reactions were to be expected at this age (Cashdan, 1994), and none mentioned liking as a feeding goal, despite its recognised importance (Cooke, 2007). This meant that certain eating behaviours were viewed as problematic prematurely, there was tension in the feeding relationship, and less effective feeding goals were being pursued using strategies that could have adverse affects.

The same study also asked the mothers how they had acquired their skills. All relied on intuition and self-learning, drawing on their experience with the child in question and its siblings, together with their personal childhood. Other, albeit less common, sources of information included television, female relatives or friends, and information relayed via schools as a result of projects or school policies.

At school
Schools potentially provide between 25 and 33 per cent of a child’s daily nutrient intake (Gregory, 2000), which implies that the child’s nutritional learning experiences are not (or should not be) confined to the home. Contemporary ‘whole-school approaches’ build the child’s knowledge and behaviours through the curriculum as well as their experiences within the wider school context (Parsons et al., 1996). This includes the food eaten or available in school. In addition, the Healthy Schools Scheme aims to promote children’s health by considering matters such as nutrition (Health Education Board for Scotland, Health Promotion Wales, Health Education Authority, & Health Promotion Agency for Northern Ireland, 1996). Indeed, eating within the school context has been embraced by policy initiatives at school, local and national level.

School meal services in the UK have been the subject of transformation programmes, which gathered momentum during 2005 (Evans & Harper, 2009). This coincided with the television series Jamie’s School Dinners, and school meals have attracted media attention ever since. The revision of nutritional standards for school meals is a primary objective of the national transformation programmes. So too is the re-skilling of catering staff, which received particular attention within the Jamie Oliver TV series. But are nutritional guidelines and cooking skills the only issues? How do school meal staff (i.e. catering staff and lunchtime supervisors) who interact with hildren during the school meal encourage eating?

Before exploring these questions, it is worth pausing to understand the environment in which the children eat and the staff work. The primary school dining hall environment was explored during a qualitative case study (see Moore, Murphy et al., 2010). For the most part, the dining halls were dual-purpose spaces that were used for teaching or other school activities outside the lunchtime. Therefore, lunchtimes were time constrained which meant that eating was often rushed. Children sat on communal tables, typically eating off plastic food trays with plastic cutlery, and segregated from those eating packed lunches. Lunchtime supervisors undertook an extensive array of tasks ranging from maintaining discipline, caring for children and clearing up in an environment that was dynamic as well as subject to time constraints. Once children finished eating, the focus of lunchtime supervision switched to the playground such that older children received little attention whilst eating.

In this environment, the children’s food choices were often less than desirable – for example, sausage and ice-cream or bread and chips (Moore, Tapper & Murphy, 2010b). The food was mostly served from a serving hatch by the school cooks – which represented an opportunity to influence the children’s choice-making skills. However, even if a well-balanced plate was served, children were not guaranteed to eat it. Away from the serving hatch, in the main dining hall, although lunchtime supervisors could not influence what food the child had selected, they could influence what food they actually ate. Furthermore, they felt it was their role to do so. As had previously been found with mothers in the home (Moore et al., 2007), the feeding strategies used by school meal staff largely matched those summarised at the beginning of this article. The exceptions were modelling feeding strategies, which were possibly expected to be absent, as staff and children were not engaged in common activities. In addition, staff were not aware that liking was a feeding goal they could modify, even though food dislikes were the most common issue they reported.

School meal staff reported that they used previous experience gained within  their professional roles and/or their roles as mothers and grandmothers to guide their feeding interactions (Moore, Murphy et al., 2010). Formal training programmes were available for some school meal staff.

In the case of cooks, the school meal transformation programmes had prioritised their re-skilling (Evans & Harper, 2009), and there was evidence of such training being rolled out, and of it addressing the issue of encouraging children to choose the food on offer. However, promoting food choices was approached more from a marketing perspective than from the theoretical perspective presented at the beginningof this article. Unlike cooks, lunchtime supervisors were employed by schools rather than catering companies, and training fell within the school’s remit (and budget). Formal training was less common and usually related to managing general behaviour and playground supervision rather than eating behaviour.
Intuition or information?

In summary, by comparing naturally occurring feeding interactions between adults and young children in homes and schools, a number of similarities are suggested:
I    alignment between the feeding strategies used and those reported in the literature;
I    a lack of awareness of some of the subtleties of the feeding relationship, such as the importance of liking as a feeding goal, or the potential negative consequences associated with the use
of rewards; and
I    a reliance upon intuition and experience rather than formalised information or training.

Thus, there appears to be a mismatch between the information available within the literature and that disseminated to parents and school meal staff. Given the current emphasis on healthy eating, should information about what to feed young children be complemented with information about how to feed them?

Sue N. Moore is at the Cardiff Institute of Society and Health, Cardiff University
[email protected]

References

Addessi, E., Galloway, A.T., Visalberghi, E. & Birch, L.L. (2005). Specific social influences on the acceptance of novel food in 2–5 year old children. Appetite, 45(3), 264–271.
Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: Prentice Hall.
Birch, L.L. (1979). Preschool children's food preferences and consumption patterns. Journal of Nutrition Education, 11(4), 189–192.
Birch, L.L. (1980). Effects of peer models' food choices and eating behaviours on preschoolers food preferences. Child Development, 51(2), 489–496.
Birch, L.L., Birch, D., Marlin, D.W. & Kramer, L. (1982). Effects of instrumental consumption on children's food preference. Appetite, 3(2), 125–134.
Birch, L.L., Fisher, J O. & Davison, K.K. (2003). Learning to overeat. American Journal of Clinical Nutrition, 78(2), 215–220.
Birch, L.L., McPhee, L., Shoba, B.C. et al. (1987). What kind of exposure reduces children's food neophobia? Looking vs tasting. Appetite, 9(3), 171–178.
Cashdan, E. (1994). A sensitive period for learning about food. Human nature, 5(3), 279–291.
Cooke, L. (2007). The importance of exposure for healthy eating in childhood. Journal of Human Nutrition and Dietetics, 20(4), 294–301.
Dovey, T.M., Staples, P.A., Gibson, E.L. & Halford, J.C.G. (2008). Food Neophobia and 'picky/fussy' eating in children. Appetite, 50(2–3), 181–193.
Duncker, K. (1938). Experimental modification of children's food preferences through social suggestion. Journal of Abnormal and Social Psychology, 33, 489–507.
Evans, C E.L. & Harper, C.E. (2009). A history and review of school meal standards in the UK. Journal of Human Nutrition and Dietetics, 22(2), 89–99.
Fisher, J.O. & Birch, L.L. (1999). Restricting access to palatable foods affects children's behavioural response, food selection and intake. American Journal of Clinical Nutrition, 99(6), 1264–1272.
Galloway, A.T., Fiorito, L.M., Francis, L.A. & Birch, L.L. (2006). ‘Finish your soup’: Counterproductive effects of pressuring children to eat on intake and affect. Appetite, 46(3), 318–323.
Gregory, J. (2000). National Diet and Nutrition Survey: Young people aged 4 to 18 years. Volume 1. London: The Stationery Office.
Health Education Board for Scotland, Health Promotion Wales, Health Education Authority, & Health Promotion Agency for Northern Ireland. (1996). The European network of health promoting schools: introduction – the UK project. Health Education Journal, 55(4), 447–449.
Hendy, H.M. & Raudenbush, B. (2000). Effectiveness of teacher modelling to encourage food acceptance in pre-school children. Appetite, 34, 61–76.
Horne, P.J., Tapper, K., Lowe, C.F. et al. (2004). Increasing children’s fruit and vegetable consumption. European Journal of Clinical Nutrition, 58(12), 1649–1660.
Mikula, G. (1989). Influencing food preferences of children by 'if-then' instructions. European Journal of Social Psychology, 19(3), 225–241.
Moore, S.N., Murphy, S., Tapper, K. & Moore, L. (2010). The social, physical and temporal characteristics of primary school dining halls and their implications for children’s eating behaviours. Health Education, 110(5), 399–411.
Moore, S.N., Tapper, K. & Murphy, S. (2007). Feeding strategies used by mothers of 3-5-year-old children. Appetite, 49(3), 704–707.
Moore, S.N., Tapper, K. & Murphy, S. (2010a). Feeding goals sought by mothers of 3–5-year-old children. British Journal of Health Psychology, 15(1), 185–196.
Moore, S.N., Tapper, K. & Murphy, S. (2010b). Feeding strategies used by primary school meal staff and their impact on children’s eating. Journal of Human Nutrition and Dietetics, 23(1), 78–84.
Newman, J. & Taylor, A. (1992). Effect of a means-end contingency on young children’s food preferences. Journal of Experimental Child Psychology, 53(2), 200–216.
Parsons, C., Stears, D. & Thomas, C. (1996). The health promoting school in Europe. Health Education Journal, 55(3), 311–321.
Sullivan, S.A. & Birch, L.L. (1990). Pass the sugar, pass the salt: Experience dictates preference. Developmental Psychology, 26(4), 546–551.
Warwick, J., McIlveen, H. & Strugnell, C. (1997). Meal preferences amongst nine to fifteen year old Ulster schoolchildren. Appetite, 28(1), 86.
Zajonc, R.B. (1968). Attitudinal effects of mere exposure. Journal of Personality and Social Psychology Monograph Supplement, 9(2, Pt 2), 1–27.