Healthy eating in children
When asked
What does ‘healthy eating’ in children mean to you?, parents described healthy eating as a variety, balance, and range of foods (see Table
1). The importance of limiting certain foods, such as the intake of sugar, salt, and processed foods was also frequently mentioned.
Table 1
Parent responses to the question “What does ‘healthy eating’ in children mean to you?”
Vegetables | 9 | A variety, balance and range of foods |
Fruit | 9 |
Sweets/sometimes foods | 9 |
Variety | 9 |
Balance of food/nutrients | 7 |
Following food pyramid | 4 |
Dairy | 3 |
Meat | 3 |
Carb/wholegrains | 2 |
Fresh juice | 1 |
Reduced sugar | 4 | Limiting certain foods |
Homemade | 3 |
Reduced salt | 3 |
No junk/fast food/soft drinks | 3 |
Limited processing | 2 |
No preservatives | 1 |
Fussy eating/food refusal | 7 | Problems parents face in encouraging healthy eating in children |
Time poor re: meal plans & food preparation | 5 |
Extended family | 5 |
Perception that healthy food is expensive | 1 |
Lack of social support/advice | 1 |
Good attitude with eating | 2 | Importance of healthy eating habits |
Regular meals/intervals | 1 |
Good eating habits | 1 |
Although parents were not questioned about specific feeding practices, as this has been the focus of previous research [
41], and the aim of the current study was to gather information about parents’ knowledge of healthy eating, body image and how they use educational resources. Some parents did however, spontaneously report using negative feeding practices, such as restriction and overt control. This was particularly evident when parents discussed the problems they faced in encouraging healthy eating, which included: managing fussy eating, finding the time to prepare healthy meals, and coping with the influence of the child’s extended family and cultural background. For example, some parents whose own parents were immigrants to Australia, reported being frustrated with the ‘old culture’, which defined healthy eating in a different way to mainstream Australian culture. One parent said
“Western style is letting baby choose their food. In my culture we would put fruit/food in front of them and chase them around the house to get the food in…[but I] want to follow a different attitude and let the baby decide.”
Of those parents who used strategies to encourage healthy eating, the following were mentioned: encouraging a good attitude to healthy eating (e.g., not labeling food as good or bad, not using food as a reward, being a good role model by engaging in healthy eating in front of the child), the importance of regular family meal times (e.g., eating at the table and limiting television viewing), and encouraging good eating habits (e.g., making food appealing, involving the child in food preparation, dealing with resistance by persisting with presentation of novel foods, or not making a fuss if the child refuses a food). Although developing patterns or attitudes to food that would enable children to make their own healthy choices were mentioned by a small number of parents in some groups, parent discussions focused more heavily on encouraging a healthy diet (i.e., good nutrition) in their children.
When asked what resources parents were accessing for information about healthy eating, some parents reported not having accessed any. Parents who did not access resources reported not doing so because they felt their knowledge or informal support networks were already sufficient. For those who did, the following resources were reported: printed resources, such as books, recipes, research articles, health magazines, and booklets; internet based resources, such as websites and online parenting forums or blogs; professional support, such as their MCH nurse, dietitians, and childcare staff; an informal support network, for example, mother’s groups, family, friends, and other parents; and personal knowledge, including their own common sense, personal experiences, or cultural traditions.
Early Childhood Professionals viewed healthy eating very similarly to parents. They defined it as including a variety and balance of foods, as well as limiting certain foods. However, Early Childhood Professionals discussed healthy eating behaviors and habits much more often than parents; nearly half highlighted the importance of developing healthy eating behaviors in children, including empowering the child to choose which, and how much, nutritious foods to eat. For example, one professional said healthy eating is also when the “Child feeds themselves and gets to choose (reasonably) the quantity and which particular foods they want to eat…[when children are] self-empowered eaters”. Professionals also reported that common parent concerns were fussy eating, children’s portion sizes and not eating enough variety. MCH nurses specifically noted parental concerns around under-feeding or over-feeding their child. Directors also talked about parents being concerned that their child does not eat the same variety of food at home as at the childcare center. Many Early Childhood Professionals noted that parents typically become concerned about their child’s eating behaviors from birth, while others reported concerns arising when the child is six months old, when solids are often introduced. In line with parents’ reports, Early Childhood Professionals most frequently reported suggesting printed resources to parents, such as books, recipes, and government guidelines and initiatives, though some made reference to internet based resources as well.
Body image in children
Not all parents could provide a definition for child body image, but when they did, parents most frequently suggested a child’s body image equated to their body size, appearance, or physical capabilities (see Table
2). For example, one parent said a good body image was
“As long as they are within the normal range…not looking too rotund and… the ribs aren’t showing so much…”. Parents also often defined body image as what their child’s body can do (e.g., having strength) and the way their child looks, with only a few parents using the academic definition of body image as a child’s thoughts and feelings about their body and appearance. Occasionally parents reported that if a child eats healthy food, they will have a healthy body size, so the child’s body image would not be a problem. In general, parents discussed body image as negative or problematic (i.e., thought of body image as equivalent to body dissatisfaction), and largely relevant to children who were overweight or outside of the ‘norm’ (i.e., shorter, fatter, different to others). Most parents suggested that problems with body image affected girls more often than boys. Some parents endorsed the thin ideal by suggesting that if children were thinner they were more likely to be successful, so feeling bad about being bigger was not a negative thing.
Table 2
Summary of parent responses to the question “What does ‘body image’ mean to you”?
Equates to body size/weight/appearance | 7 | Body image is about a child’s body size, appearance, or physical capabilities |
More about what body can do (e.g., strong/energetic) | 6 |
If child is healthy, body image shouldn’t be a problem | 2 |
Relates BI/size to food | 2 |
Not about looking a certain way | 1 |
Healthy eating & phys act = looking healthy = body image | 1 |
How child feels about self/body | 7 | Body image is a child’s perception and emotions related to their body |
Problematic e.g., ‘demons’ | 3 | Body Image is a problem for children |
Positive & negative | 1 |
Good body image is not expressing concern about the body | 1 |
Girls more than boys | 9 | Negative body image mostly affects girls |
Can affect anyone | 1 |
Being thin increases your chance of success | 2 | Endorsing the thin-ideal |
Given the uncertainty among participants about the meaning of body image, before asking parents any further questions the facilitator clarified that the researchers understood children’s body image as how the children thought and felt about their bodies, not just about how they looked. In addition, the facilitator explained that these thoughts and feelings could be positive or negative.
When asked about when children develop a sense of their own body image, parents most often reported that this occurred around three to four years of age. It was often noted that a child’s body image developed at a younger age in girls than in boys. Parents also frequently reported that children develop body dissatisfaction, or experience difficulty with body image, later on in childhood or adolescence, especially around puberty.
Although not specifically questioned on how parents become aware that their child was developing a body image, parents spontaneously reported the following behaviors as cues: through preferences in clothing and dressing themselves, wanting to look like another or to look a certain way, making comments about their own body (e.g., ‘I’m fat’) or making comments or teasing others (e.g., ‘you shouldn’t wear that because you’re fat’), copying what they see or hear from others (e.g., developing an interest in fashion or what their friends are wearing) and being conscious of their appearance, but not necessarily in a negative way.
Parents also often spontaneously discussed what influenced children’s body image development. Most parents mentioned socio-cultural factors, for example exposure to unrealistic images in the media, in children’s story books, and toys such as Barbie (see Table
3). Peers were also mentioned, especially in relation to children making body comparisons with peers. Less frequently observed comments about influences on body image included: parent’s own body image (e.g., weighing themselves and commenting on their own appearance), indirect comments about appearance (e.g., general appearance comments made about, or to, other people in front of their child, and the comments others make about their own appearance in front of the child), direct comments about their child’s appearance (e.g., the parent’s and other’s comments about how the child looks), siblings (e.g., one parent said “
I catch my 8 year old standing at the mirror checking herself out. Then I catch the 5 year old do[ing] exactly the same”), and the child’s body size (e.g., being taller or heavier than the ‘norm’).
Table 3
Summary of parent ideas about influences on child body image
Child’s body size (e.g., height or weight) | 3 | Child’s body size |
Parent’s body image (e.g., own body image impacting child) | 5 | Parent body image |
Parent weight/appearance behaviors (e.g., weighing self) | 1 |
Parent comments on own appearance | 2 |
Language (e.g., Fat) | 1 | Indirect comments |
Parent comments in general (e.g., Use of word fat) | 2 |
Parent comments about others around child | 2 |
Parent comments to others around child | 1 |
Others comments/behaviors about child appearance | 2 |
Parent comments to the child about their appearance (direct) | 1 | Direct comments |
Others commenting on child | 6 |
Sibling (e.g., imitating older) | 3 | Sibling |
Socio-cultural influences in general | 4 | Socio-cultural factors |
Media | 7 |
Children’s stories/books | 6 |
Barbie | 2 |
Activity (e.g., dancing) | 1 |
Role modelling (e.g., child influenced by someone they admire) | 1 |
Peers who are aware of their body image | 6 | Peers |
Start socialising with other children | 1 |
Starting kinder | 3 |
Starting school | 2 |
When asked about what resources parents used to learn about child body image, most participants reported not having looked for any information. For those parents who had looked, they reported a general lack of resources aimed at this age group or did not know where to look. Other parents reported using their personal knowledge or experience related to body image. Although many parents reported not knowing how to promote a positive body image in their children, some strategies they mentioned using included: placing an emphasis on health rather than appearance (e.g., discussing the body’s energy, strength, what it can do, and avoiding associating food with body size), talking about food in the context of health rather than weight (e.g., one parent said “..... if they’re having bacon and eggs and they cut away the fat or they see their father cutting away the fat, I tell them it has do with how your arteries behave when you put too much fat in. It’s nothing to do with having a large exterior…”), promoting body acceptance (e.g., encouraging their child to value different body shapes and sizes, and encouraging their child to be critical of what they see in the media), and avoiding ‘fat talk’ (e.g., not using the word ‘fat’ and being conscious of appearance related comments about their child and others).
Most Early Childhood Professionals identified body image as the child’s thoughts and feelings of their own body. A small number of Early Childhood Professionals, however, did define body image as how a person looks or their body size. All but one Early Childhood Professional reported that children develop a sense of their body image at a young age, from birth to five years old, with three to four years old being reported most frequently.
Early Childhood Professionals also often discussed the influences on child body image. They noted: family (e.g., parents and siblings who make comments about, or model the importance of, appearance); peers (e.g., through teasing or appearance-based comments if a child is different to the ‘normal’ body size); and other socio-cultural factors (e.g., through the media, clothing, and culture).
Many Early Childhood Professionals reported that body image was not yet an issue for parents, but that children’s body weight was cited as a common concern (e.g., one Maternal and Child Health nurse reported that “Around 12mths of age, parents often say ‘I don’t want to give my child too much because don’t want him to get fat’”). It should be noted that the final check-up performed by MCH nurses is when a child turns three and a half, and children in Victoria start primary school, and therefore exit childcare, at age 5. So Professionals were reporting on their experience of parents who had children at or under the age of 5 years. Professionals noted that when parents were concerned about body image, it was because they were worried about their child being overweight and getting teased, or their child looking underweight, even when they were in the healthy weight range. Professionals also reported that parents’ own experiences with their weight influenced their concerns about their child’s weight, along with pressure from other family members for their child to be big. The majority of Professionals had not provided any body image resources to parents, yet they noted that this was because of the young age of the children they saw and the lack of parents requesting such a resource.
What parents want from a healthy eating resource
When parents were asked what they would like to see in a new resource they reported wanting a resource to include (see Table
4): healthy eating strategies (e.g., dealing with fussy eating with minimal stress, how to get children to eat a wide variety of food), information about how to encourage good nutrition (e.g., making good nutrition a priority in the child’s life, understanding portion sizes for children, positive and negatives of limiting food choices), and recipe and meal ideas.
Table 4
Content parents would like in a new resource for parents to encourage healthy eating and body image in children
Strategies for encouraging healthy eating, which create minimal stress and overcome fussy eating | 9 | Healthy eating strategies |
Hiding food ideas | 1 |
How to get variety in food | 2 |
How to promote healthy habits around food (i.e., in the same way we have information about how to promote healthy sleep habits in children) | 5 |
Importance of healthy eating (i.e., how to make it a priority) | 1 | Food & Nutrition |
Information on portion sizes | 2 |
Nutrition information and how it relates to physical activity | 3 |
Food pros/cons/substitutes (e.g., skim vs full cream milk) | 4 |
Drinking water guidelines | 1 |
Health risks/implications associated with eating ‘unhealthy’ foods | 3 |
Ideas for healthy lunchbox | 2 | Recipe/Meal ideas |
Recipes/menus for healthy family meals | 7 |
Strategies for parent modelling healthy eating & body image | 2 | Parent modelling |
How to encourage positive body image (e.g., building child self-confidence/resilience) | 8 | Strategies for promoting positive body image |
How to talk about food/body (especially knowing what not to say/how to avoid things that will make it bad) | 4 |
How to teach child to accept differences in bodies | 2 |
How to deal with external influences on body image (e.g., other adults, children’s parties) | 6 | Dealing with external influences on body image |
Media literacy strategies | 2 |
What to do if child is over/underweight/not growing enough | 1 | Early detection/intervention strategies |
How to identify body image influences/risks & what to do about it | 4 |
The majority of Early Childhood Professionals suggested a stronger focus on educating parents about strategies for encouraging healthy eating in children (e.g., importance of healthy eating at a young age, modelling healthy eating, how to address fussy eating, and not using food as a reward, and the long term consequences of unhealthy eating in children). They also felt that it was important for parents to help children develop their own healthy eating habits by allowing children to have autonomy over their eating (i.e., parents provide healthy food choices and the child is then allowed to choose what they want to eat and how much). For example, when asked what kind of information a new education package should include, one professional said it is “Important to communicate that the child [should be] allowed to feed themselves as soon as possible. Allowing the child to choose the volume of food they need and the variety of foods they want ([though] it will change day to day and that’s ok), is part of the child being resilient.” In line with the request from parents about recipes, some Professionals suggested having healthy food ideas for children (e.g., school lunchbox ideas), along with providing information about quantities and portion sizes for children.
What parents want from a body image resource
As shown in Table
4, parents reported wanting a body image resource to include: strategies for promoting positive body image in their child (e.g., how to talk about food and the body in ways that won’t negatively affect their child’s body image). For example, one parent questioned
“How do I explain to a five year old that they are not fat…how do they even know that word?”. Parents also wanted information on how to deal with external influences (including messages from the media), and on early detection and intervention strategies (i.e., how to identify problems with their child’s body image, risk factors, influences, and what parents can do about them).
Many Professionals concurred with parents, suggesting that a resource that gives parents guidance on how to talk about body image with their child, and when parents should be concerned about their child’s body image, would be extremely useful. The Professionals also mentioned the importance of highlighting how parental modelling, genetics and sociocultural factors all influence body shape and size. MCH nurses in particular suggested that having information about physical changes that occur as a child gets older, how these changes relate to children’s food requirements, and how children will naturally develop different body sizes, would be helpful for parents.
As shown in Table
5, parents frequently reported wanting something quick, simple, and easy to read, with options provided for further reading. Participants mentioned a preference for dot points using clear and plain language, following a factsheet format. A quick-guide ‘do’s and don’t’s’ checklist was mentioned by some, though the idea of providing realistic guidelines, with tips and stories from other parents, was highly endorsed. Parents also wanted the resource to be easily accessible (e.g., across multiple formats, such as internet and in print) and appropriate for all families (e.g., across culture and education levels). Parents also wanted information to be evidence-based with acknowledgments of the evidence source. One parent reported wanting
“Dot points…of evidence-based research....to quickly get information and then read on if you want, with resources at the bottom”. Parents also mentioned a preference for an educational resource they could use with their child, such as a book, toy, or game activity.
Table 5
Format parents would like for a new resource for parents to encourage healthy eating and body image in children
Something we can come back to | 5 | Ongoing resource |
Book | 4 | Paper resource |
Booklet | 7 |
Downloadable booklet | 2 |
paper | 1 |
Folder for fact sheets | 1 |
Website | 8 | Electronic resources |
Online forum | 3 |
Email | 3 |
Facebook | 1 |
Blogs | 1 |
Electronic resource | 1 |
Flyers to advertise website | 3 |
Seminar/info night | 5 | Seminars |
- with follow-up session | 1 |
DVD/video | 3 | Visual |
Visual/graphs/pics | 3 |
Multiple formats | 1 | Other |
Multilingual | 1 |
Simple/easy/quick (parents are busy) | 7 | Quick/Brief |
Brief, with options for further reading | 7 |
Target to all parents & children (e.g., Genders, cultures, SES, rural) | 8 | Be accessible to wide range of parents |
Accessible | 4 |
Realistic/applicable guidelines/options | 9 | Realistic guidelines |
Dos & don’ts (promote health, avoid damage) | 3 |
Checklist | 1 |
Evidence based research | 8 | Evidence base |
Reasons for strategies (why it will work) | 2 |
Acknowledge source of info | 1 |
Resource for child (e.g., book/toy/activity/app) | 7 | Child resource |
Tip sheets/fact sheets/dot points (but not too many) | 6 | Tip sheets/dot points |
Clear/plain language | 1 |
Parent tips/stories - yes | 5 | Parent stories |
- not helpful (do not include) | 2 |
Resource for instructors e.g., Dance/sport | 1 | Supplement for non-parents |
Parents reported wanting to access a resource about healthy eating and body image when it is developmentally relevant to their child’s age. However, the age at which healthy eating was deemed relevant was very young (e.g., between birth and six months), whereas the age of relevance for body image was considered much older (e.g., when the child becomes concerned with their body, in late childhood or around puberty). Although parents did not want to introduce the concept of body image to their child too early, they did nevertheless want to be aware of risk factors and strategies to help prevent body dissatisfaction. One recommendation to overcome this conflict in timing was to provide a resource that parents could revisit when relevant to their individual circumstance. Others reported wanting resources for healthy eating and body image to be provided separately; a healthy eating resource when their child was around six months old, and a body image resource once their child was three years.
Consistent with the parents’ views, the majority of Professionals thought the internet would be the best way to deliver information to parents, including having an online forum where parents could share their experiences. Having seminars or visual presentations, ideas for further reading, and printed resources (e.g., factsheets, pamphlets, booklets, parent newsletters) were also recommended. Professionals suggested that the resource should be quick and easily accessible, updatable, ongoing and not tokenistic. They thought it was important to include flexible options for parents to explore. Through provision of such a resource in their centres, Professionals reported being likely to engage in assisting parents to help promote healthy eating and positive body image in their preschool children.