Responsive Feeding Environments in Childcare Settings: A Scoping Review of the Factors Influencing Implementation and Sustainability

Feeding behavior in caregivers of 6- to 24-month-old infants and young children: a cross-sectional study from a district in a first-tier city in the southwestern region of China

BACKGROUND

This study aimed to identify the correlation between feeding behavior of caregivers and feeding outcome of 6-24 months old infants and young children in a first-tier city in the southwestern region of China. The influencing factors of feeding behavior were explored in this study.

METHODS

This cross-sectional study was conducted in 3 community health service centers in Chengdu, China from November 2017 to January 2018. A total of 725 infants and their caregivers participated in this study. Infant and young child feeding index (ICFI) was used to evaluate food preparation behavior. A questionnaire designed based on responsive feeding behavior (RFB) was used to evaluate the interaction behavior in the feeding process. The Z-score and the Montreal Children's Hospital Feeding Scale (MCH-FS) were used to evaluate the feeding outcomes.

RESULTS

The prevalence of short stature and feeding difficulties was 12.1% and 61.5%, respectively, among infants and young children. The RFB score negatively correlated with feeding difficulties but did not statistically significantly correlate with malnutrition rate. The RFB score was influenced by caregivers' relationship with the child and health belief, including self-efficiency, benefit perception, attention to searching information on websites, and attention to employing professional nurses. ICFI negatively correlated with the rate of underweight but did not statistically significantly correlate with feeding difficulties. ICFI was influenced by the caregivers' age, registered residence, and health belief, including obstacle perception and attention to reading a book on feeding.

CONCLUSIONS

Searching the information regarding RFB on websites and making a feeding plan with the help of professional nurses may enhance caregivers' RFB. Convenient and attractive reading materials might help caregivers overcome obstacles and adopt better feeding behavior.

'For me it's just the conversation:' responsive feeding influences among early childhood educators

OBJECTIVE

Early learning and childcare (ELCC) programmes play an important role in shaping children's eating behaviours and long-term health by establishing a responsive feeding environment that encompasses not only mealtime behaviours but also extends to play activities and language used throughout the day. Despite their potential benefits, many ELCC centres do not consistently implement responsive feeding behaviours, facing challenges with organisational and behavioural changes within these environments. This study aims to identify influences on responsive feeding behaviours among early childhood educators prior to an intervention.

DESIGN

A qualitative study guided by the Behaviour Change Wheel framework and Capability Opportunity Motivation - Behaviour (COM-B) model. Semi-structured interviews and focus groups were conducted, recorded and transcribed verbatim. Thematic analysis was employed to identify themes, categorising them within the corresponding COM-B domains.

SETTING

Canada.

PARTICIPANTS

Forty-one ELCC staff in various roles across eight centres from two provinces in eastern Canada.

RESULTS

Fifteen influences, spanning across all six domains of the COM-B model, were identified, highlighting gaps in educators' knowledge and skills, varied approaches to food and feeding, and the interactions with children, parents, and co-workers on mealtimes dynamics. Additionally, costs, centre location and other physical resources emerged as enabling opportunities for responsive feeding behaviours.

CONCLUSIONS

These findings offer a comprehensive exploration of the diverse factors influencing responsive feeding behaviours among educators, each varying in its potential for future behaviour change intervention.

CELEBRATE Feeding: A Responsive Approach to Food and Feeding in Early Learning Settings

Early learning and child care (ELCC) settings in Canada follow nutrition standards that outline food provisions, with many also encouraging responsive feeding practices that help to create a supportive environment for children. Caregivers who lack confidence in children's ability to regulate their own intake, or those who feel stressed about mealtime, may unknowingly engage in less responsive feeding practices. The CELEBRATE Feeding Approach is a flexible framework, driven by behaviour change theory, that builds on previous definitions and concepts of responsive feeding in ELCC environments. Through this approach, there is an intentional focus on supporting early childhood educators to implement feeding practices that are more responsive. The approach incorporates 13 target educator behaviours related to the three overlapping categories of CELEBRATE language, CELEBRATE Mealtime, and CELEBRATE Play. These practices recognize and support the development of a child's sense of autonomy, confidence, and self-regulation not only at mealtimes but also through play-based exploration and language that is used throughout the day around food and feeding. The goal is that children will be open to a wide variety of food, develop their self-regulation skills, and build the foundation for a positive relationship with food throughout their lifetime.

Identifying elevated child weight from 3 to 24 months: Early transitions into nonparental care and to solid foods

BACKGROUND

Early entry into nonparental care (NPC) and introduction to solid foods (ITS) have been linked to elevated weight, however, little research exists on the combined influence of these transitions on child weight over time.

OBJECTIVES

Identify groups of children based on early NPC and ITS timing and examine whether NPC-ITS groups differentially affect child weight over time.

METHOD

Data were drawn from STRONG Kids2 (n = 468). Primary predictors include NPC (by 3M)-ITS (< or ≥6M) groups; outcome variables include child weight-for-length/height z-scores (WFL/WFHz) (3, 12, 18, and 24 months). Multilevel regression was used to examine the NPC-ITS groups as predictors of child WFL/WFHz.

RESULTS

Six groups were identified: 27% Parental Care-ITS before 6M, 31% Parental Care-ITS after 6M, 12% Daycare-ITS before 6M, 14% Daycare-ITS after 6M, 10% Kincare-ITS before 6M, and 7% Kincare-ITS after 6M. Children who were in daycare (regardless of ITS) or kincare-ITS before 6M demonstrated the highest WFL/WFHz over time, compared to their parental care counterparts.

CONCLUSIONS

NPC-ITS combinations on child WFL/WFHz across the first 2 years of life highlight the need for a partnership approach among parental and nonparental caregivers to support the feeding of infants throughout the transition to solid foods.

Advancing assessment of responsive feeding environments and practices in child care

Child care environments offer an ideal setting for feeding interventions. CELEBRATE Feeding is an approach implemented in child care environments in two Maritime Provinces in Canada to support responsive feeding (RF) to foster children's self-efficacy, self-regulation, and healthy relationships with food. This study aimed to describe RF in child care using established and enhanced scoring frameworks. The Environment and Policy Assessment and Observation (EPAO) was modified to reflect RF environments and practices, resulting in our modified EPAO and a CELEBRATE scale. Observations were conducted in 18 child care rooms. Behaviours and environments were scored on both scales, creating 21 RF scores, with a score of '3' indicating the most responsiveness. Descriptive analyses of the scores were conducted. The overall room averages were Mean (M) = 41.00, Standard Deviation (SD) = 7.07 (EPAO), and M = 37.92 SD = 6.50 (CELEBRATE). Most responsive scores among rooms within our EPAO and CELEBRATE scales, respectively, were 'educators not using food to calm or encourage behaviour' (M = 2.94, SD = 0.24; M = 2.98, SD = 0.06) and 'not requiring children to sit at the table until finished' (M = 2.89, SD = 0.47; M = 2.97, SD = 0.12). The least responsive scores within the EPAO were 'educator prompts for children to drink water' (M = 0.78, SD = 0.94) and 'children self-serving' (M = 0.83, SD = 0.38). The least responsive in the CELEBRATE scale were 'enthusiastic role modelling during mealtime' (M = 0.70, SD = 0.68) and 'praise of mealtime behaviour unrelated to food intake' (M = 0.74, SD = 0.55). The CELEBRATE scale captured unique observation information about RF to allow documenting change over time with detailed measurement to inform and support nutrition interventions within child care environments.

Remembered childhood mealtime experiences influence on early childcare and education staff

Parent feeding styles, behaviors, beliefs, and practices are associated with developing children's eating behaviors. However, many children spend considerable time in childcare; thus, are exposed to child-feeding practices of other adults, e.g., early care and education (ECE) staff. Limited research exists on how and whether current classroom feeding practices of ECE staff associate with their own childhood experiences. The About Feeding Children survey, conducted in 2005, examined self-reported feeding practices and beliefs and personal characteristics of ECE staff in Western United States. An exploratory factor analysis of questions related to childhood experiences (N = 1189), revealed two Mealtime Factors: Remembered Adult Control and Remembered Child Autonomy Support. Structural equation modeling was conducted to examine the hypothesis that these remembered experiences would be associated with current feeding practices (Structural Mealtime Strategies, Verbal Mealtime Strategies, and Beliefs about Mealtimes). For each outcome, models had good to moderate fit. Across models, Remembered Autonomy Support was associated with less control, bribing, autonomy undermining, and concern-based control beliefs and greater support at meals and autonomy promoting beliefs in teachers' classroom feeding practices. More research is called for to consider whether reflection on remembered childhood experiences might be beneficial to consider during ECE staff training related to feeding young children.