Date Presented 3/30/2017
The Mealtime PREP intervention shows promise to improve dietary variety and mealtime behaviors and lower risk of nutritional deficiency in toddlers with sensory food aversions. Moderate to large effect sizes were observed in a small sample of 11 families trained to deliver this intervention in the home.
Primary Author and Speaker: Angela Caldwell
Contributing Authors: Roxanna Bendixen, Cynthia Danford, Lauren Terhorst, Elizabeth Skidmore
BACKGROUND: Picky eating habits are common among young children. Occupational therapists often treat children with sensory food aversions (SFA), who avoid foods based on sensory characteristics, commonly fruits and vegetables (Chatoor, 2009). Avoidance of fruits and vegetables increases a child’s risk for obesity, and interventions that promote healthy dietary variety are the recommended first line of defense against this global public health crisis (Karnik & Kanekar, 2012; World Health Organization, 2015).
Behavioral and exposure-based interventions have improved intake of specific foods, but interventions that increase overall dietary variety are needed (Marshall, Ware, Ziviani, Hill, & Dodrill, 2015). The enhancement of family meal routines using evidence-based strategies is a theoretically promising method to improve dietary variety in toddlers. The Mealtime PREP (Promoting Routines of Exploration and Play) intervention outlines a systematic approach to overcoming barriers that parents face when attempting to integrate intervention into daily routines (McConnell, Parakkal, Savage, & Rempel, 2015).
PURPOSE: The purpose of this study is to evaluate outcomes of dietary variety and mealtime behaviors in young children with SFA after parent-led intervention delivery. We aimed to answer the following research question: What are the effects of training parents of toddlers with SFA to deliver the Mealtime PREP intervention during daily meals?
DESIGN: This study used a repeated-measures pretest–posttest design. Families were recruited through local early intervention agencies, primary care physicians, day care centers, and social media advertisements. Eligible families included a toddler (age 18–36 mo) who met all four criteria for SFA and had at least one parent who was fluent in English.
METHOD: The Mealtime PREP intervention is made up of three components (family meals, positive reinforcement, and food exploration and play) that parents learn to deliver one at a time. This behavioral activation approach to parent training facilitates changes in daily routines. An occupational therapist with 9 yr of clinical experience trained parents to deliver the daily intervention over four sessions and collected data on 11 children through parent completion of a 3-day food diary, the Child Food Inventory, the Behavioral Pediatric Feeding Assessment, and the NutriSTEP Toddler nutrition screen. All assessments were completed before and after completion of at least 16 parent-led intervention sessions. Effect sizes (Cohen’s d) were calculated using pre- and posttest group means.
RESULTS: Large effect sizes for the Mealtime PREP intervention were found for increases in variety of fruits and vegetables (d = 0.94), improved child mealtime behaviors (d = 1.13), and decreased risk of nutritional deficiency (d = 0.89) after intervention. On average, children ate two more fruits and vegetables after parent training than they did at baseline. A moderate effect size was observed for improved dietary variety overall (d = 0.41), with children accepting, on average, four more food options after intervention than they did at baseline. Additionally, caregivers reported, on average, four less behavioral problems during mealtimes after the intervention than at baseline (d = 1.30).
CONCLUSION: The Mealtime PREP intervention shows promise for improving dietary variety and mealtime behaviors in toddlers with sensory food aversions. While generalizability is limited due to the small sample size, observed feeding outcomes warrant further investigation of this intervention.
IMPACT STATEMENT: Systematic approaches to parent training to motivate change in daily routines are needed in pediatric practice. This study suggests that a behavioral activation approach to parent-mediated intervention is promising for improving dietary variety and mealtime behaviors in young children.
References
Chatoor, I. (2009). Diagnosis and treatment of feeding disorders in infants, toddlers and young children. Washington, DC: Zero to Three.
Karnik, S., & Kanekar, A. (2012). Childhood obesity: A global public health crisis. International Journal of Preventative Medicine, 3, 1–7. https://doi.org/10.1201/b18227-3
Marshall, J., Ware, R., Ziviani, J., Hill, R. J., & Dodrill, P. (2015). Efficacy of interventions to improve feeding difficulties in children with autism spectrum disorders: A systematic review and meta-analysis. Child: Care, Health and Development, 41, 278–302. https://doi.org/10.1111/cch.12157
McConnell, D., Parakkal, M., Savage, A., & Rempel, G. (2015). Parent-mediated intervention: Adherence and adverse effects. Disability and Rehabilitation, 37, 864–872. https://doi.org/10.3109/09638288.2014.946157
World Health Organization. (2015). Childhood overweight and obesity: Global strategy on diet, physical activity and health. Retrieved from http://www.who.int/dietphysicalactivity/childhood/en/
