Preschoolers’ Dietary Behaviours: Parents’ Perspectives (2024)

Abstract

INTRODUCTION

Childhood obesity is associated with hypertension, type 2 diabetes mellitus, dyslipidemia, depression, and low self-esteem (1,2). Of Canadian children aged two to 11, 37% were overweight in 1998–99, including 18% who were considered obese. This figure was up from 1994–95, when 34% of two- to 11-year-olds were overweight, with 16% classified as obese (3). With obesity rates on the rise, it is particularly alarming that one in four preschoolers (aged two to five years) has been categorized as obese, especially because current estimates suggest 26% to 41% of obese preschoolers will become obese adults (3,4).

The importance of obesity prevention early in life is underscored by research findings that consistently confirm a correlation between childhood and adulthood obesity (2,5–9). The impact of obesity prevention may be especially potent in the preschool years because many lifelong habits are formed during this time, including the health-related behaviours associated with obesity, namely physical activity and dietary intake (2,10,11).

Parents, especially mothers, play a vital role in their preschoolers’ dietary patterns (6,8,10,12,13) and long-term feeding behaviours (14). Because parents tend to have foods in the house that they enjoy, with recurring exposure, children come to prefer and include many of these same foods in their diet (14). Unfortunately, sugar and fat are currently the most familiar and preferred foods in childhood (15). In fact, the previously reported main barriers to preschoolers’ healthy eating include the following: parents having insufficient time to prepare healthy meals; parents disliking the appearance, taste, and smell of healthy foods, and parents making unhealthy food choices easily accessible to their preschoolers (16). Not only do parents have the ability to facilitate unhealthy food choices, they also have the ability and influence to facilitate healthy food choices among preschoolers. Exploring parents’ opinions, perceptions, and insights about their preschoolers’ dietary intake patterns is therefore vital to understanding the role, and potential role, of food in preventing childhood obesity.

The current study was part of a larger obesity prevention study to explore parents’ perceptions of their preschoolers’ physical activity and screen-viewing behaviours, and what they believed would be an effective program to encourage appropriate behaviours (17–19). The original intention was to focus on physical activity and screen-viewing behaviours only. However, because of the emerging nature of qualitative research, it became clear that food issues were of paramount importance to parents, and time needed to be found for food-related discussions. Parents’ unsolicited perspectives were collected on the importance of healthy eating, challenges to healthy eating, and methods for facilitating healthy food choices among preschoolers.

METHODS

Ten semi-structured focus group interviews were conducted across London and Middlesex County. Each group had an average of seven parents of preschool-aged children (2.5 to five years old). A maximum variation sample of 71 parents participated in this study (20). The qualitative method of focus groups was chosen because understanding parents’ perspectives is essential to the successful development of an intervention targeting childhood obesity and healthy body-weight promotion. Also, focus groups are an efficient means of collecting insights from many people in a short time (20).

The Canadian Institutes for Health Research funded this project. Ethical approval was obtained through The University of Western Ontario.

Participants were recruited through flyers, information sheets, and site visits at community locations frequented by parents of preschool-aged children. Sites included five community play groups, three daycare centres, one community resource centre, and one workplace. Two of the ten sites were located in rural areas. Sites from different geographic areas were selected to provide a maximum-variation sample. hom*ogeneous participants were recruited for each focus group, and an overall sample of parents with diverse socioeconomic backgrounds (education level, income, employment status) was recruited.

To facilitate focus group attendance, we provided child care, bus tickets, and a meal for parents and children. Focus groups were also planned at times when parents would normally be at the selected location. Five focus groups needed to be rescheduled because of recruitment challenges. Attempts were also made to recruit a focus group of fathers and parents from an ethnic minority. Unfortunately, not enough participants were recruited. Participants included mostly mothers, and participation from minority groups was limited.

Participants were asked about their children’s physical activity and screen-viewing, and what they believed would characterize an effective program to encourage appropriate screen-viewing and physical activity behaviours in pre-schoolers. Although nutritional habits were not an intended area of research, open-ended questions revealed that these were a very important topic for parents. Questions included the following: “Is there anything else you would like to add or suggest as important aspects affecting childhood obesity besides physical activity and screen-viewing behaviours?” and “What do you think is the most important thing we discussed today?” In response to these questions, many parents presented food-related concerns within the focus groups, and the moderators made time for and facilitated these discussions.

All focus group meetings were facilitated by one of two experienced moderators and lasted for approximately 60–90 minutes. Upon completion, participants were asked to fill out a demographic form. Focus groups were audio-recorded and transcribed verbatim. Because of the emerging nature of qualitative research, the focus group questions evolved during the first four focus groups. Many strategies were employed to ensure data trustworthiness (Table 1). Saturation was reached by the tenth and final focus group (20).

Data collection and analysis took place simultaneously with a combination of the editing and template-organizing styles outlined by Miller and Crabtree (21). A minimum of two team members independently conducted inductive content analysis on each transcript and compared their findings. NVivo software was used to code and categorize emerging themes (QSR International, Victoria, Australia, 2002). Following the coding of all transcripts, data were examined for similarities and differences across the interviews and emerging themes were identified. A summary of the analysis was prepared and discussed.

The research team did have expectations and assumptions for this research, including the assumption that socioeconomic status (SES) would account for some variation in parental responses. During the research process, the research team met after all focus groups to discuss the findings. The researchers noted that parents were very keen, that all were concerned about their preschoolers’ health, and that parental responses varied by differing SES.

RESULTS

Table 2 provides a description of study participants. Parents identified food and food issues as key health-related behaviours among preschoolers. Parents discussed challenges to healthy eating. These included time limitations and societal pressures, and methods for facilitating healthy food choices, including bribery, education, and being creative with food. Participants from the lower SES group (annual family income <$24,999/year) voiced nutrition concerns similar to those of other parents, but just getting food on the table for their children was a more pressing priority.

DISCUSSION

Without any prompting to talk about food, parents introduced and stressed the importance of healthy eating habits during the preschool years. Having too little time, and societal impacts were revealed as major challenges to facilitating healthy eating among preschoolers; bribery, education, and being creative with food were viewed as effective methods for facilitating healthy eating.

This study indicates that parents view nutrition as a vital component of their preschoolers’ health-related behaviours, and that parents face challenges in providing their pre-schoolers with both physical activities and healthy meals. Parents in the current study worried about their children’s nutrition and struggled to find alternatives to unhealthy yet easy food choices. Nutrition education for both parents and children is the essential next step for promoting healthy eating among preschoolers.

Our findings are similar to previous researchers’ in terms of parents’ increasing reliance on fast food in today’s fast-paced society (14,16). Our finding that some parents were comfortable with their preschoolers’ consumption of unhealthy foods, as long as they were educated about healthy and unhealthy foods, is of concern; continued exposure to unhealthy foods increases children’s preferences for these foods (14). Consequently, children may come to like what is familiar to them, and although their parents have explained that certain food choices may not be healthy, the preschoolers may have a learned preference for these unhealthy foods (12,15). Parents need to be made aware that merely educating preschoolers about healthy choices is not sufficient to instill healthful eating patterns; being mindful and purposeful about the foods to which children have access is crucial.

Parents commonly used bribery to entice preschoolers to eat more nutritious foods, and this finding is similar to that of previous research (12). Despite the immediate benefit of successfully getting preschoolers to consume healthy foods, using unhealthy food as a reward can actually increase the child’s preference for the unhealthy food. In turn, this can deregulate the child’s ability to self-control hunger (8–9,12). Overconsumption and overweight are likely to result from this cycle. Parents might consider fun and attractive food presentation as a viable alternative for facilitating healthy eating among preschoolers.

We encourage future researchers to consider the current study’s limitations. Specifically, the use of only one data collection method provides room for bias and inaccuracy, despite the use of many strategies to ensure the trustworthiness of the data. These strategies would be further enhanced through the use of in-depth interviews to provide a better understanding of parents’ perceptions.

In addition, because the intended focus of this research did not include food, no previously developed food-related questions were available. Had we developed food-related questions before our focus groups, we likely would have uncovered even more information about parents’ insights into their preschoolers’ eating behaviours. However, regardless of these limitations, the current study offers valuable insights into parents’ perceptions of their preschoolers’ dietary behaviours.

RELEVANCE TO PRACTICE

Understanding parents’ perceptions of their preschoolers’ dietary habits is an important first step in the development of effective dietary intervention strategies leading to better nutritional habits. This study has significance for program planners and dietitians because it identifies current barriers that prevent parents from providing their preschoolers with healthful food choices. Health education interventions are a viable way to increase parents’ awareness of current unhealthy eating habits, and provide strategies to foster more healthful eating among their preschoolers.

Acknowledgments

This study was funded by the Canadian Institutes of Health Research (CIHR). The authors are thankful to Ms. Charlene Beynon, the director of the Public Health Research, Education and Development (PHRED) Program at Middlesex-London Health Unit, for her continuing support throughout the research project. The authors also are appreciative of Ms. Susan Buitinga, administrative assistant for the Bachelor of Health Sciences Program, for all of her assistance throughout the project.

Contributor Information

PATRICIA TUCKER, Faculty of Health Sciences, University of Western Ontario, London, ON.

JENNIFER D. IRWIN, Faculty of Health Sciences, University of Western Ontario, London, ON.

MEIZI HE, Middlesex-London Health Unit and Brescia University College, London, ON.

L. MICHELLE SANGSTER BOUCK, Middlesex-London Health Unit, London, ON.

GRAHAM POLLETT, Middlesex-London Health Unit, London, ON.

References