Parental Perceptions and Childhood Dietary Quality

The early years represent a critical period of growth and development of health behaviours. While optimal child growth is associated with a complex set of factors, the importance of diet quality is undeniable. The objective of this narrative review is to examine contributors to child diet quality and parental perception and how such perceptions might affect child diet quality. An extensive literature search was conducted, generating a variety of sources including research trials (randomized and non-randomized), lab-based studies, cohort studies, topical reviews, government or NGO reports and grey literature. In addition, reflection and opinion, accrued through regular interaction with families, regarding some of the potential links has also been included. Parental perception of diet quality is influenced by many different social, biological economical and psychological factors. Research suggests that diet quality of today’s children is sub-optimal and a parent’s perception of their child’s diet may not accurately reflect this reality. Various parental attitudes and perceptions/misperceptions are important to address as knowledge awareness and beliefs can impact diet quality as can parental practices, and family structure. Issues related to socioeconomics and convenience, and a child’s preferences and their peer and/or social environment are also potential factors impacting child diet quality. Knowing that parents play such an integral role in the development and maintenance of their child’s health behaviours, addressing misconceptions and unhealthy parental beliefs about diet quality may be an important area for early intervention and prevention work in childhood obesity.

[1]  Mark Conner,et al.  The Social Psychology Of Food , 2002 .

[2]  J. Skinner,et al.  Children's food preferences: a longitudinal analysis. , 2002, Journal of the American Dietetic Association.

[3]  J. Dixon,et al.  Heading the table: parenting and the junior consumer , 2004 .

[4]  R C Whitaker,et al.  Maternal perceptions of overweight preschool children. , 2000, Pediatrics.

[5]  Cassandra M Johnson,et al.  It's who I am and what we eat. Mothers’ food-related identities in family food choice , 2011, Appetite.

[6]  M. Story,et al.  Nine out of 10 food advertisements shown during Saturday morning children's television programming are for foods high in fat, sodium, or added sugars, or low in nutrients. , 2008, Journal of the American Dietetic Association.

[7]  P. Veugelers,et al.  Children's preference for large portions: prevalence, determinants, and consequences. , 2007, Journal of the American Dietetic Association.

[8]  D. West,et al.  Parental Recognition of Overweight in School‐age Children , 2008, Obesity.

[9]  J. Turner,et al.  Food for thought: parents' perspectives of child influence , 2006 .

[10]  J. Spence,et al.  Food consumption patterns in preschool children. , 2012, Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada.

[11]  Bridget Kelly,et al.  Art of persuasion: An analysis of techniques used to market foods to children , 2011, Journal of paediatrics and child health.

[12]  L. Kupper,et al.  Like parent, like child: child food and beverage choices during role playing. , 2008, Archives of pediatrics & adolescent medicine.

[13]  P. Veugelers,et al.  Dietary Intake and Risk Factors for Poor Diet Quality Among Children in Nova Scotia , 2005 .

[14]  W. Dean,et al.  Determinants of children's use of and time spent in fast-food and full-service restaurants. , 2011, Journal of nutrition education and behavior.

[15]  Michael Siegrist,et al.  Convenience food products. Drivers for consumption , 2010, Appetite.

[16]  B. Metcalf,et al.  Parents' awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21) , 2004, BMJ : British Medical Journal.

[17]  J. Skinner,et al.  Revisiting the Picky Eater Phenomenon: Neophobic Behaviors of Young Children , 2000, Journal of the American College of Nutrition.

[18]  Sandra L. Calvert Children as Consumers: Advertising and Marketing , 2008, The Future of children.

[19]  T. Bohman,et al.  Low-Income, Overweight and Obese Mothers as Agents of Change to Improve Food Choices, Fat Habits, and Physical Activity in their 1-to-3-Year-Old Children , 2007, Journal of the American College of Nutrition.

[20]  P. Day,et al.  Obesity-promoting food environments and the spatial clustering of food outlets around schools. , 2011, American journal of preventive medicine.

[21]  J. Wardle,et al.  Parental control over feeding and children's fruit and vegetable intake: how are they related? , 2005, Journal of the American Dietetic Association.

[22]  Margaret Ford,et al.  From Tastes Great to Cool: Children's Food Marketing and the Rise of the Symbolic , 2007, The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics.

[23]  Adam Drewnowski,et al.  Does social class predict diet quality? , 2008, The American journal of clinical nutrition.

[24]  Ulf Ekelund,et al.  Perception versus reality: awareness of physical activity levels of British children , 2010 .

[25]  J. Salmon,et al.  Associations Between the Home Food Environment and Obesity‐promoting Eating Behaviors in Adolescence , 2007, Obesity.

[26]  M. Barker,et al.  Workshop on ‘ Changing nutrition behaviour to improve maternal and fetal health ’ A review of factors affecting the food choices of disadvantaged women , 2009 .

[27]  J. Brug,et al.  A systematic review of environmental correlates of obesity-related dietary behaviors in youth. , 2006, Health education research.

[28]  E. M. Hetherington,et al.  Socialization, personality, and social development , 1983 .

[29]  G. Harris Introducing the Infant’s First Solid Food , 1993 .

[30]  R. Bassett,et al.  Autonomy and control: The co-construction of adolescent food choice , 2008, Appetite.

[31]  Sophie Nicklaus,et al.  Development of food variety in children , 2009, Appetite.

[32]  L. Birch,et al.  Does parenting affect children's eating and weight status? , 2008, The international journal of behavioral nutrition and physical activity.

[33]  F. Chaloupka,et al.  Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes , 2013, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[34]  B. Dennison,et al.  Predictors of dietary milk fat intake by preschool children. , 2001, Preventive medicine.

[35]  R. Battisti,et al.  Child feeding practices and perceptions of childhood overweight and childhood obesity risk among mothers of preschool children , 2007 .

[36]  P. Rozin,et al.  Changing children's food preferences: Parent opinions , 1989, Appetite.

[37]  Cassandra M Johnson,et al.  It's all about the children: a participant-driven photo-elicitation study of Mexican-origin mothers' food choices , 2011, BMC women's health.

[38]  J. Ordovás,et al.  Nutrition, metabolism and cardiovascular disease , 2011 .

[39]  L. Birch,et al.  Restricting access to palatable foods affects children's behavioral response, food selection, and intake. , 1999, The American journal of clinical nutrition.

[40]  Mark A Pereira,et al.  Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. , 2004, Pediatrics.

[41]  Karen Brown,et al.  Nutritional awareness and food preferences of young consumers , 2000 .

[42]  L. Birch Development of food preferences. , 1999, Annual review of nutrition.

[43]  A. Beardsworth,et al.  Managing to eat on a low income , 1995 .

[44]  M. Becker,et al.  The Health Belief Model: A Decade Later , 1984, Health education quarterly.

[45]  V. Rideout,et al.  Generation M2: Media in the Lives of 8- to 18-Year-Olds , 2010 .

[46]  Dale L Kunkel,et al.  Government can regulate food advertising to children because cognitive research shows that it is inherently misleading. , 2012, Health affairs.

[47]  S. Baxter,et al.  Trading of food during school lunch by first- and fourth- grade children , 2001 .

[48]  Connie Lim,et al.  Youth risk behavior surveillance - United States, 2009. , 2010, Morbidity and mortality weekly report. Surveillance summaries.

[49]  Heather Patrick,et al.  The benefits of authoritative feeding style: caregiver feeding styles and children's food consumption patterns , 2005, Appetite.

[50]  E. Roos,et al.  Parental family food choice motives and children’s food intake , 2012 .

[51]  M. Martínez-González,et al.  A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables , 2000, European Journal of Clinical Nutrition.

[52]  Tonya Arscott-Mills,et al.  Factors Associated With Parental Readiness to Make Changes for Overweight Children , 2005, Pediatrics.

[53]  L. Rossen Restricting Unhealthful Food Advertising to Children and the First Amendment , 2011, Preventing chronic disease.

[54]  D. Reed,et al.  Perceived parenting behaviours predict young adolescents' nutritional intake and body fatness. , 2008, Maternal & child nutrition.

[55]  M. Mazzocchi,et al.  Policy Interventions to Promote Healthy Eating: A Review of What Works, What Does Not, and What is Promising , 2011, Food and nutrition bulletin.

[56]  D. Neumark-Sztainer,et al.  Mothers' perceptions of their adolescents' weight status: are they accurate? , 2004, Obesity research.

[57]  R C Whitaker,et al.  Why don't low-income mothers worry about their preschoolers being overweight? , 2001, Pediatrics.

[58]  L. Birch,et al.  Parental pressure, dietary patterns, and weight status among girls who are "picky eaters". , 2005, Journal of the American Dietetic Association.

[59]  T. Baranowski,et al.  Family and child-care provider influences on preschool children's fruit, juice, and vegetable consumption. , 2009, Nutrition reviews.

[60]  B. Popkin,et al.  Diet quality index: capturing a multidimensional behavior. , 1994, Journal of the American Dietetic Association.

[61]  Ilse De Bourdeaudhuij,et al.  Family food rules and healthy eating in adolescents. , 1997 .

[62]  L. Birch,et al.  Maternal influences on daughters' restrained eating behavior. , 2005, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[63]  Ofcom Childhood Obesity - food advertising in context , 2004 .

[64]  D. Neumark-Sztainer,et al.  Parenting style and family meals: cross-sectional and 5-year longitudinal associations. , 2010, Journal of the American Dietetic Association.

[65]  K. Adamo,et al.  Can We Modify the Intrauterine Environment to Halt the Intergenerational Cycle of Obesity? , 2012, International journal of environmental research and public health.

[66]  K. Glanz,et al.  Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. , 1998, Journal of the American Dietetic Association.

[67]  Jason J. Turner,et al.  What parents think: children and healthy eating , 2006 .

[68]  Chery Smith,et al.  Low-Income Minority and Homeless Mothers’ Perceptions of Their 9–13 Year-Old Children’s Weight Status, Diet, and Health , 2009, Maternal and Child Health Journal.

[69]  J. Brug,et al.  Parenting style and adolescent fruit consumption , 2003, Appetite.

[70]  Sandra C. Jones,et al.  ‘Like me, want me, buy me, eat me’: relationship-building marketing communications in children’s magazines , 2010, Public Health Nutrition.

[71]  A. Keane,et al.  Factors that Affect Food Choice , 1994 .

[72]  H. Binns,et al.  Parents' Perceptions of Their Child's Weight and Health , 2006, Pediatrics.

[73]  M. Raats,et al.  The role of consumers. , 2010, Nestle Nutrition workshop series. Paediatric programme.

[74]  D. Neumark-Sztainer,et al.  Fast food intake: longitudinal trends during the transition to young adulthood and correlates of intake. , 2008, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[75]  Heather Patrick,et al.  A Review of Family and Social Determinants of Children’s Eating Patterns and Diet Quality , 2005, Journal of the American College of Nutrition.

[76]  Nancy D. Brener,et al.  Youth risk behavior surveillance--United States, 2013. , 2014, MMWR supplements.

[77]  C. Cooper,et al.  Influences on the quality of young children's diets: the importance of maternal food choices , 2010, British Journal of Nutrition.

[78]  A. Brunt,et al.  The influence of cartoon character advertising on fruit and vegetable preferences of 9- to 11-year-old children. , 2012, Journal of nutrition education and behavior.

[79]  J. Wardle,et al.  Relationship between parental report of food neophobia and everyday food consumption in 2–6-year-old children , 2003, Appetite.

[80]  S. Scaglioni,et al.  Influence of parental attitudes in the development of children eating behaviour , 2008, British Journal of Nutrition.

[81]  L. Birch,et al.  Infant dietary experience and acceptance of solid foods. , 1994, Pediatrics.

[82]  F. Naja,et al.  Dietary Intake and Nutrition-Related Knowledge in a Sample of Lebanese Adolescents of Contrasting Socioeconomic Status , 2011, Food and nutrition bulletin.

[83]  M. Marquis,et al.  Does eating while watching television influence children's food-related behaviours? , 2005, Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada.

[84]  F. Gilliland,et al.  Effects of ethnicity, family income, and education on dietary intake among adolescents. , 2003, Preventive medicine.

[85]  I. Pigeot,et al.  Parental perceptions of and concerns about child´s body weight in eight European countries - the IDEFICS study , 2014 .

[86]  W. Dean,et al.  Mothers and meals. The effects of mothers’ meal planning and shopping motivations on children's participation in family meals , 2010, Appetite.

[87]  Kyle R. Andrews,et al.  Parents as Health Promoters: A Theory of Planned Behavior Perspective on the Prevention of Childhood Obesity , 2010, Journal of health communication.

[88]  A. Hutchinson,et al.  Preparing meals under time stress. The experience of working mothers , 2010, Appetite.

[89]  Dawn Garrett-Wright Parental perception of preschool child body weight. , 2011, Journal of pediatric nursing.

[90]  L. Wichstrøm,et al.  Treatment of obesity in children: Parent's perceived emotional barriers as predictor of change in body fat. , 2011, Obesity research & clinical practice.

[91]  P. Adab,et al.  Advertising of food to children: is brand logo recognition related to their food knowledge, eating behaviours and food preferences? , 2007, Journal of public health.

[92]  H. P. Martin Nutrition: its relationship to children's physical, mental, and emotional development. , 1973, The American journal of clinical nutrition.

[93]  L. Birch,et al.  ‘Finish your soup’: Counterproductive effects of pressuring children to eat on intake and affect , 2006, Appetite.

[94]  Advertising influences on young children's food choices and parental influence. , 2012, The Journal of pediatrics.

[95]  M. Manco,et al.  Cross-Sectional Exploration of Maternal Reports of Food Neophobia and Pickiness in Preschooler-Mother Dyads , 2012, Journal of the American College of Nutrition.

[96]  B. Fiese,et al.  Is Frequency of Shared Family Meals Related to the Nutritional Health of Children and Adolescents? , 2011, Pediatrics.

[97]  G. Hastings,et al.  Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary , 2013, Appetite.

[98]  J. Sobal,et al.  Shopping for fruits and vegetables. Food and retail qualities of importance to low-income households at the grocery store , 2010, Appetite.

[99]  Binh T. Nguyen,et al.  Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, beverage, and nutrient intake. , 2013, JAMA pediatrics.

[100]  Kristen Harrison,et al.  Nutritional content of foods advertised during the television programs children watch most. , 2005, American journal of public health.

[101]  Anita Evans,et al.  Are parents aware that their children are overweight or obese? Do they care? , 2007, Canadian family physician Medecin de famille canadien.

[102]  C. Olson Food Insecurity in Women: A Recipe for Unhealthy Trade-offs , 2005 .

[103]  James U. Mcneal,et al.  Consumer behavior of Chinese children: 1995‐2002 , 2003 .

[104]  A. Kristal,et al.  Is there a consumer backlash against the diet and health message? , 2001, Journal of the American Dietetic Association.

[105]  S. Austin,et al.  Clustering of fast-food restaurants around schools: a novel application of spatial statistics to the study of food environments. , 2005, American journal of public health.

[106]  Richard Shepherd,et al.  Adolescent food choice: an application of the Theory of Planned Behaviour , 1995 .

[107]  P. Sjödén,et al.  Food and General Neophobia and their Relationship with Self-Reported Food Choice: Familial Resemblance in Swedish Families with Children of Ages 7–17 Years , 1997, Appetite.

[108]  The use of negative themes in television food advertising , 2012, Appetite.

[109]  T. Baranowski,et al.  Children's fruit and vegetable intake: Socioeconomic, adult-child, regional, and urban-rural influences , 1995 .

[110]  William Damon,et al.  Child Development Today and Tomorrow , 1988 .

[111]  Dimitri A. Christakis,et al.  Nutrition Menu Labeling May Lead to Lower-Calorie Restaurant Meal Choices for Children , 2010, Pediatrics.

[112]  M. Kersting,et al.  Convenience food in the diet of children and adolescents: consumption and composition , 2008, British Journal of Nutrition.

[113]  Jennifer L. Harris,et al.  Protecting young people from junk food advertising: implications of psychological research for First Amendment law. , 2012, American journal of public health.

[114]  C. Forrest,et al.  Children's eating behavior: the importance of nutrition standards for foods in schools. , 2011, The Journal of school health.

[115]  N. Cavazza,et al.  Structure of the relationship between parents’ and children's food preferences and avoidances: An explorative study , 2008, Appetite.

[116]  L. Birch,et al.  Development of eating behaviors among children and adolescents. , 1998, Pediatrics.

[117]  D. Schlundt,et al.  Care giver perception of children's obesity-related health risk: a study of African American families. , 2000, Obesity research.

[118]  C. Vögele,et al.  The role of parental control practices in explaining children's diet and BMI , 2008, Appetite.

[119]  I. Bourdeaudhuij,et al.  Family Members' Influence on Decision Making about Food: Differences in Perception and Relationship with Healthy Eating: , 1998 .

[120]  M. Stephens,et al.  Cost of eating: whole foods versus convenience foods in a low-income model. , 2010, Family medicine.

[121]  G. Harris Development of taste and food preferences in children , 2008, Current opinion in clinical nutrition and metabolic care.

[122]  C. Perry,et al.  Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents. , 2003, Journal of the American Dietetic Association.

[123]  J. R. Simpson,et al.  Parents report intrapersonal, interpersonal, and environmental barriers to supporting healthy eating and physical activity among their preschoolers. , 2008, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[124]  E. Waters,et al.  Healthy eating, activity and obesity prevention: a qualitative study of parent and child perceptions in Australia. , 2005, Health promotion international.

[125]  Y. Manios,et al.  Diet quality of preschool children and maternal perceptions/misperceptions: the GENESIS study. , 2009, Public health.

[126]  M. Noakes,et al.  Understanding parent concerns about children’s diet, activity and weight status: an important step towards effective obesity prevention interventions , 2009, Public Health Nutrition.

[127]  L. Birch,et al.  Restricting Access to Foods and Children's Eating , 1999, Appetite.

[128]  M. Beydoun,et al.  Do nutrition knowledge and beliefs modify the association of socio-economic factors and diet quality among US adults? , 2008, Preventive medicine.

[129]  R. Klesges,et al.  Parental influence on food selection in young children and its relationships to childhood obesity. , 1991, The American journal of clinical nutrition.

[130]  K. Adamo,et al.  Using path analysis to understand parents' perceptions of their children's weight, physical activity and eating habits in the Champlain region of Ontario. , 2010, Paediatrics & child health.

[131]  Alan S. Brown,et al.  “You Will Eat All of That!”: A retrospective analysis of forced consumption episodes , 2002, Appetite.

[132]  L. Dubois,et al.  A Nutritional Comparison of Foods and Beverages Marketed to Children in Two Advertising Policy Environments , 2012, Obesity.

[133]  C. Currie,et al.  Young people's health in context. Health Behaviour in School-aged Childre (HBSC) study: international report from the 2001/2002 study. , 2004 .

[134]  J Brug,et al.  Determinants of fruit and vegetable consumption among 6-12-year-old children and effective interventions to increase consumption. , 2005, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[135]  F. Bunn,et al.  Parental perceptions regarding healthy behaviours for preventing overweight and obesity in young children: a systematic review of qualitative studies , 2010, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[136]  D. Neumark-Sztainer,et al.  Parenting Characteristics in the Home Environment and Adolescent Overweight: A Latent Class Analysis , 2010, Obesity.

[137]  S. Gelman,et al.  Children's use of adult testimony to guide food selection , 2008, Appetite.

[138]  B. Wansink Nutritional Gatekeepers and the 72% Solution , 2006, Journal of the American Dietetic Association.

[139]  A. Drewnowski Obesity, diets, and social inequalities. , 2009, Nutrition reviews.

[140]  B. Popkin,et al.  The nutrition transition: worldwide obesity dynamics and their determinants , 2004, International Journal of Obesity.

[141]  I. Pigeot,et al.  Parental perceptions of and concerns about child's body weight in eight European countries – the IDEFICS study , 2013, Pediatric obesity.

[142]  P. Caplan Too hard to swallow? The palatability of healthy eating advice , 2013 .

[143]  L. Birch,et al.  Mothers' child-feeding practices influence daughters' eating and weight. , 2000, The American journal of clinical nutrition.

[144]  John Reed,et al.  Final summary report , 1992 .

[145]  C. Forestell,et al.  Increasing children's consumption of fruit and vegetables: Does the type of exposure matter? , 2012, Physiology & Behavior.

[146]  B. Lin,et al.  Mother's Nutrition Knowledge and Children's Dietary Intakes , 1999 .

[147]  L. Birch Development of food acceptance patterns in the first years of life , 1998, Proceedings of the Nutrition Society.

[148]  L. Birch,et al.  Young girls' emerging dietary restraint and disinhibition are related to parental control in child feeding , 2000, Appetite.

[149]  Didier Garriguet Canadians' eating habits. , 2007, Health reports.

[150]  D. Baumrind,et al.  Rearing competent children. , 1989 .

[151]  D. Levitsky,et al.  Children eat what they are served: the imprecise regulation of energy intake , 2005, Appetite.

[152]  M. Roberts Negotiating Food Choice: Parents’ perception of children’s eating behaviour. , 2006 .

[153]  Pat Caplan,et al.  Food, health, and identity , 1997 .

[154]  E. Frazão,et al.  Are Healthy Foods Really More Expensive? It Depends on How You Measure the Price , 2012 .

[155]  E. Maccoby,et al.  Socialization In The Context Of The Family: Parent-Child Interaction , 1983 .

[156]  L. Birch,et al.  Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. , 2001, Pediatric clinics of North America.

[157]  A. Lluch,et al.  Family resemblance in energy and macronutrient intakes: the Stanislas Family Study. , 1996, International journal of epidemiology.

[158]  D. Dzewaltowski,et al.  Model of the home food environment pertaining to childhood obesity. , 2008, Nutrition reviews.

[159]  K. Ball,et al.  Family food environment and dietary behaviors likely to promote fatness in 5–6 year-old children , 2006, International Journal of Obesity.

[160]  S. Stewart,et al.  Family structure, nonresident father involvement, and adolescent eating patterns. , 2007, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[161]  N. Binkin,et al.  What is common becomes normal: the effect of obesity prevalence on maternal perception. , 2013, NMCD. Nutrition Metabolism and Cardiovascular Diseases.

[162]  Lyn Craig,et al.  Does Father Care Mean Fathers Share? , 2006 .

[163]  C. Seaman Healthy eating for children under two years ‐ just what is appropriate? , 1997 .

[164]  J. Spence,et al.  Diet quality, nutrition and physical activity among adolescents: the Web-SPAN (Web-Survey of Physical Activity and Nutrition) project , 2009, Public Health Nutrition.

[165]  W. Wills,et al.  Making sense of eating, weight and risk in the early teenage years: views and concerns of parents in poorer socio-economic circumstances. , 2006, Social science & medicine.