Kristi B. Adamo and Kendra E. Brett
Key Points
• Diet quality is imperative for appropriate child growth and development.
• There are many complex and integrated factors that infl uence diet qual- ity and how a parent perceives their child’s diet quality.
• Parents are their child’s primary role model and thus bear considerable responsibility for shaping diet quality and feeding behaviours.
• Parenting style can strongly infl uence diet quality and eating behav- iours in children.
• A parent’s perception of child’s weight status, depending on its refl ec- tion of reality, can positively or negatively affect diet quality.
• Family structure can signifi cantly infl uence diet quality.
• In general, children’s diet quality does not meet recommendations for optimal growth and development. However a parent’s perception of their child’s diet may not accurately refl ect this reality.
Introduction
This chapter will focus on diet quality in children and specifi cally the parental perception of diet qual- ity and how this might impact eating behaviours.
There are two interrelated factors to be described:
1. The impact of parental perceptions (knowl- edge, beliefs, attitudes, self-effi cacy) on diet quality of a child
2. The actual parental perception of diet quality (i.e. realism vs. idealism)
Why We Care
The early years represent a critical period of growth and development of health behaviours.
The global increase in child obesity and comor- bid conditions [ 1 ], phenotypes once reserved only for the adult population, indicates that health behaviours have changed over time. While there is a complex set of factors associated with opti- mal growth and development, one cannot deny the role of eating habits and diet quality. In the case of children, it is universally accepted that parents/guardians are primarily responsible for food procurement, choices and meal preparation, and conventional wisdom suggests that parents want to provide them with the necessary tools to ensure healthy growth and development. There are of course many contributors, both non- modifi able such as biological, societal, environ- mental, and socioeconomic as well as modifi able contributors to healthy growth and development which include dietary and physical activity or sedentary behaviours.
Parents can be a strong positive infl uence (good model, encourage high quality choices, exposure to a wide array of healthful choices), or conversely, a powerful negative infl uence (setting a poor example, making the easy and often less healthy choice, food rewards of low quality, inap- propriate snacking, lack of control or heavy restriction) on diet quality. Like any relationship, the one between parents and children is complex and multilayered. Most people, regardless of whether they are a parent or not, have been caught
not ‘practicing what they preach’ and it is not uncommon for children to hold back information, or hide behaviours from their parent(s). This may start as early as the preschool years. Therefore, it should not be surprising that a parent’s percep- tion of a child’s behaviour, in this case eating behaviour and diet quality, may not be refl ective of the true situation. We know from other work that there exists a lack of awareness for various health-related concepts, such as parents not rec- ognizing obesity in their own children [ 2 ]. There are many potential reasons and biases related to this concept which will be touched on later (see Table 14.1 ). Additionally, the commonly held parental perception that they have little or no con- trol over their child’s eating behaviour may also lead to detrimental diet quality.
Importance of Diet Quality
Diet quality is strongly related to the physical and cognitive development of children [ 3 ], and thus a proper diet with adequate nutrition is of the utmost importance during critical developmental stages. In the early 1900s in Europe and North America, malnutrition was a salient child-health concern due to inadequate supplies of healthy foods (high in protein and vitamins), and the focus of healthy eating was related to achieving adequate growth and maintaining strength in the children. Currently, in developed countries, the problem is quite the opposite; increased exposure to poor-quality food due to an overabundance of low nutrient, energy dense foods including nutri- tionally unbalanced snacks, convenience and fast foods [ 4 ] resulting in high calorie, but nutrient- poor diets (i.e. diets that are not meeting current dietary recommendations known to reduce dis- ease risk). This nutrition transition is being expe- rienced by many developing nations as well [ 5 ] and is a major health concern as it has led to an increase in so-called ‘diseases of affl uence’ in children. While conditions such as obesity, high blood pressure, and type 2 diabetes have been linked to caloric excess and diets high in fat, sugar and salt and low in fi bre, many children are not meeting the recommended intakes of certain
Table 14.1 Common parental misperceptions about dietary behaviours and diet quality and their associated dangers What the parent perceives What is the ‘true’ situation
Child to have a high quality diet because of parental misconceptions of what constitutes healthy eating
Lack of healthy eating due to misguided unhealthy choices, despite believing that what they are doing is healthy
May have self perceptions about healthy eating that are not in keeping with the actual guidelines
Parents may be mislead by advertising and serve low nutrient energy dense foods, over processed foods
In order to improve their child’s diet quality (i.e. encourage them to eat their veggies) or ensure their child is eating enough, they must pressure the child to eat or use ‘preferred’
food as a reward
Pressure feeding is detrimental to development of appropriate satiety cues and may lead to undesirable eating practices
Rewarding with preferred food or treats may have short term successes but is not benefi cial in the long term
Their child has a diet as good as it is going to get given they are working within their current limitations (budget, accessibility)
Choices being made are not ideal and thus child’s diet is less than satisfactory
They have no control over their child’s eating i.e. fatalistic perception/external locus of control
May results in the provision of very limited variety of food items without the recognition that they do have control and have many more options or choices regarding food that can increase their child’s diet quality
They are serving healthy food of high quality, therefore portion control is unnecessary
The over consumption of even ‘healthy’ foods can lead to excess calorie consumption and weight gain over time
That restrictive eating will produce healthy children with good eating habits
Child may develop restrictive eating style and may suppress feelings of hunger
Being too health conscious and restrictive, without moderation can be counter productive, resulting in children who may binge on treats outside of the home
Restrictive eating focuses children’s attention on restricted foods, increasing their desire to obtain and consume the foods
That a healthy weight child means that the child is eating healthy (i.e. high diet quality)
A thin child may not have healthy eating habits; thin ≠ healthy What a child eats is still important for macronutrients and fi bre, and can have major impacts on health
That their child has adequate diet quality because the parent packed the child’s lunch for school and limits snacks at home (assumption)
Once at school the child does not necessarily eat what is provided, they may trade the unwanted items, selectively eat only the unhealthy treats provided possibly throwing out unwanted items, older kids might buy food in the vending machines, the cafeteria or local convenience stores or food establishments
Children of a certain age are able to help themselves to food and/or snacks without the parental awareness
That their child does not notice ‘adult snacks’
or parental unhealthy eating patterns
There should not be unhealthy adult-only food Children may learn to seek these forbidden foods That telling a child that certain food is ‘good’
for them or ‘bad’ for them will lead to high quality diet
This may not be the case since simply stating good for you or bad for you may not be enough. There needs to be an explanation or reasoning behind why a child needs to eat more of one food and less of another Parents must also model good eating behaviour. Encouraging moderation and decision making is important (i.e. if you are going to have that cookie now, you cannot have cake later on)
Their child to be a ‘fussy eater’ because they dislike healthy foods
Parent might not want to take responsibility for their child’s poor eating habits and may only provide preferred foods to avoid confl ict thereby not encouraging their child to try new foods or provide the opportunities for their child to expand their palate
Parents perceive their child as too immature or incompetent to make healthy nutritional choices
Although children may choose to make ‘unhealthy’ choices, they may also choose ‘healthy’ options if they are given the opportunity to decide for themselves
Parents perceive their child’s diet quality to be high because they eat everything that is served
This can be a positive behaviour if the food served is of high quality but if the parent’s perception is skewed, the diet quality may be suboptimal
This chart describes dietary misperceptions that are commonly held by parents and the potential detrimental effects that these misperceptions may have on the child’s diet and dietary behaviours