Academic journal article Childhood Obesity

Child Care Provider Adherence to Infant and Toddler Feeding Recommendations: Findings from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) Study

Academic journal article Childhood Obesity

Child Care Provider Adherence to Infant and Toddler Feeding Recommendations: Findings from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) Study

Article excerpt

[Author Affiliation]

Rachel E. Blaine. 1 Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.

Kirsten K. Davison. 1 Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.

Kathryn Hesketh. 2 University College London Institute of Child Health, London, United Kingdom.

Elsie M. Taveras. 3 Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.

Matthew W. Gillman. 4 Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.

Sara E. Benjamin Neelon. 5 Department of Community and Family Medicine, Duke University Medical Center and Duke Global Health Institute, Durham, NC.

Address correspondence to: Rachel E. Blaine, MPH, RD, Doctoral Graduate, Department of Nutrition, Harvard School of Public Health, 401 Park Drive, Landmark Center, 3E010, Boston, MA 02228, E-mail: rblaine@mail.harvard.edu

Introduction

In recent decades, the prevalence of childhood obesity in the United States has increased 3-fold among even the youngest children.1 Despite recent plateaus in the prevalence of childhood obesity, nearly 1 in 10 children under the age of 24 months still exceeds the 95th percentile of weight for length, and the threat to child health remains a significant concern.2-4 Children who experience rapid weight gain before entering elementary school are more likely to be overweight or obese later in life, especially if they are African American, Latino/a, or come from low-income families.5-7

Seventeen percent of American children ages birth to 2 years spend time in center-based child care, making it the most utilized form of child care outside of the home.8 In 2011, the Institute of Medicine (IOM) released a comprehensive report outlining evidence-based recommendations for preventing obesity in early child care settings serving children ages 0-5 years.9 The IOM report identified two overarching nutrition-related goals for obesity prevention in child care: (1) promote the consumption of a variety of nutritious foods, and encourage and support breastfeeding during infancy, and (2) create a healthy eating environment by being responsive to children's hunger and fullness cues.9

Responsive feeding refers to caregiver behaviors that encourage children to self-regulate their food intake or allowing children to leave food unfinished.9-11 For exclusively breast- or bottle-fed infants, responsive feeding might mean feeding based on an infant's cues to hunger. For weaned infants and toddlers, responsive feeding practices may include allowing children to leave food unfinished or serving meals family style so that children may choose which foods they would like to eat. The IOM recommends children begin self-serving foods family style, defined as, "allowing children to serve themselves when serving from common bowls" by 1 year of age in child care settings.9 Nonresponsive feeding practices, such as urging children to eat more or using food to control behavior, are associated with both increased food intake and increased BMI in young children, including infants.10-15

Although current IOM feeding recommendations apply to all children ages 0-5 years, we hypothesized that providers caring for infants (age <1 year) may practice more recommended behaviors than teachers caring for toddlers (ages 1-2 years), owing to infants' developmental needs requiring more attentive feeding and lower state-mandated caregiver-to-child ratios for infants compared to toddlers.16 The IOM report called for enhanced training of early child care providers, but given that there are few studies describing feeding practices of providers serving children younger than 2 years, it is difficult to identify specific areas for training support. …

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