This study, a cluster randomized trial, aimed to promote a healthy and varied diet among toddlers in kindergarten. The primary objectives were to reduce food neophobia in toddlers, and promote healthy feeding practices among kindergarten staff and parents. Secondary objectives were to increase food variety in toddlers’ diets and reduce future overweight and obesity in these children. The intervention finished in 2014. Eighteen randomly selected kindergartens located in two counties in Norway with enrolled children born in 2012 participated in the intervention.
A 9-week multi-component intervention was implemented, with four main elements: 1) kindergarten staff implemented a pedagogical tool (Sapere method) in daily sessions to promote willingness to try new food; 2) kindergarten staff prepared and served the toddlers a cooked lunch from a menu corresponding to the pedagogical sessions; 3) kindergarten staff were encouraged to follow 10 meal principles on modeling, responsive feeding, repeated exposure, and enjoyable meals; and 4) parents were encouraged to read information and apply relevant feeding practices at home. The control group continued their usual practices. Preference taste tests were conducted to evaluate behavioral food neophobia, and children’s height and weight were measured. Parents and staff completed questionnaires before and after the intervention.
A qualitative paper on kindergarten personnel’s perceptions of the study was published in Appetite. Altogether, 15 kindergarten staff were interviewed using a semi-structured interview guide. The focus group interviews were analyzed using qualitative content analysis. A main finding was that all kindergarten staff perceived the sensory education sessions as successful and reported that both toddlers and staff expanded their food vocabulary and increased their attention to sensory impressions of food. However, the staff reported that some toddlers were less willing to taste new lunch dishes than to taste new foods in the sensory education sessions. The staff also noted that the guidelines for feeding practices resulted in unfamiliar situations at the lunch table. The staff agreed that cooking novel foods was time consuming and left less time for other tasks. Finally, all kindergarten staff expressed that they would like to continue with portions of the food intervention.
Another paper explored the associations the level of food neophobia and the frequency of toddlers' intake of fish, meat, berries, fruit, vegetables, and sweet and salty snacks. Parents of 505 toddlers completed a questionnaire assessing the degree of food neophobia in their toddlers (mean age 28 months, SD ± 3.5), and frequency of intake of various foods. Food neophobia was rated by the Children's Food Neophobia Scale (CFNS, score range 6-42). Associations between CFNS score and food frequency were examined using hierarchical multiple regression models, adjusting for significant covariates. Toddlers with higher CFNS scores had less frequent intake of vegetables (β = -0.28, p < 0.001), berries (β = -0.17, p = 0.002), fruits (β = -0.16, p < 0.001), and fish (β = -0.15, p = 0.001). No significant associations were found for CFNS score and frequency of toddlers' intakes of meat or of sweet and fatty snacks. These findings suggest that food neophobia in toddlers is associated with lower diet quality, and indicate a need for intervention studies to address the food neophobia.
Funding: The Norwegian Women's Public Health Association
Project leader: Nina Øverby
PhD: Sissel H Helland
Food for preschoolers 2.0 (Barns matmot 2.0)
A cluster randomized web-based intervention trial among one-year-old children in kindergarten to reduce food neophobia and promote healthy diets.
Background: A child’s first years of life are crucial for cognitive development and future health. Studies show that a varied diet with a high intake of vegetables is positive for weight development, mental health and cognitive development. A low intake of vegetables is one of the greatest challenges in children’s diets in Norway. Interventions that can increase children’s intake of vegetables should have an early onset to overcome children’s neophobia (reluctance to taste and eat new foods).
Aim of the study: To develop and measure the effect of two different interventions among one-year-old children in kindergartens in four counties in Norway.
Methods: Forty-six kindergartens were randomised to one of three groups: two different intervention groups and one control group. Parents and staff were asked to complete digitally distributed questionnaires addressing food neophobia, food habits and neurodevelopment before and after the intervention period of approximately three months. Parents and kindergarten staff had access to a study web page including information about the study, informational videos and recipes. 246 children were included in the study.
Results: Ten individual telephonic interviews with kindergarten teachers who took part in the intervention study were conducted using a semi-structured interview guide. The kindergarten teachers found the intervention easy to implement, and they were surprised by the foods 1-year-olds like and how the intervention increased their food acceptance. This age window of opportunity seems to be underused in kindergartens. By using the strategies described in the intervention, kindergarten staff effectively took advantage of this opportunity and consequently, child and kindergarten staff behaviour in relation to food was enhanced[NCØ1] .
Funding: The Norwegian Women's Public Health Association