Blaine Rachel E, Davison Kirsten K, Hesketh Kathryn, Taveras Elsie M, Gillman Matthew W, Benjamin Neelon Sara E
1Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
2University College London Institute of Child Health, London, United Kingdom.
Child Obes. 2015 Jun;11(3):304-13. doi: 10.1089/chi.2014.0099. Epub 2015 Apr 28.
Identifying characteristics associated with the Institute of Medicine's (IOM) recommended feeding practices among infant and toddler care providers in child care centers could help in preventing childhood obesity.
In 2009, at baseline in a pilot intervention study of 29 licensed Massachusetts child care centers with at least 50% of enrolled children identified as racial minorities, 57 infant and 109 toddler providers completed feeding questionnaires. To assess provider adherence to six IOM-recommended behaviors, we used cluster-adjusted multivariable logistic regression models including provider type (infant or toddler), race, education, and center Child and Adult Care Food Program (CACFP) participation.
In multivariable analysis, CACFP participation was associated with providers sitting with children at meals (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.2-21.7), offering fruits and vegetables (OR, 3.3; 95% CI 1.7-6.2), and limiting fast food (OR, 3.5; 95% CI, 1.8-6.7). Providers at centers serving meals family style were less likely to allow children to leave food unfinished (OR, 0.27; 95% CI, 0.09-0.77). Infant providers were more likely than toddler providers to sit with children at meals (OR, 6.98; 95% CI, 1.51-32.09), allow children to eat when hungry (OR, 3.50; 95% CI, 1.34-9.16), and avoid serving sugary (OR, 8.74; 95% CI, 3.05-25.06) or fast foods (OR, 11.56; 95% CI, 3.20-41.80).
CACFP participation may encourage IOM-recommended feeding practices among infant and toddler providers. Child care providers may benefit from education about how to feed infants and toddlers responsively, especially when offering foods family style. Future research should explore ways to promote child-centered feeding practices, while addressing barriers to providing children with nutrient-rich foods.
确定与医学研究所（IOM）在儿童保育中心的婴幼儿护理提供者中推荐的喂养方式相关的特征，可能有助于预防儿童肥胖。
2009年，在对马萨诸塞州29家持牌儿童保育中心进行的一项试点干预研究的基线阶段，这些中心至少50%的在册儿童被认定为少数族裔，57名婴儿护理提供者和109名幼儿护理提供者完成了喂养调查问卷。为了评估提供者对IOM推荐的六种行为的依从性，我们使用了聚类调整多变量逻辑回归模型，包括提供者类型（婴儿或幼儿）、种族、教育程度以及中心的儿童和成人护理食品计划（CACFP）参与情况。
在多变量分析中，参与CACFP与提供者在进餐时与儿童一起就座（比值比[OR]，5.2；95%置信区间[CI]，1.2 - 21.7）、提供水果和蔬菜（OR，3.3；95% CI 1.7 - 6.2）以及限制快餐（OR，3.5；95% CI，1.8 - 6.7）有关。以家庭方式提供膳食的中心的提供者不太可能允许儿童剩饭（OR，0.27；95% CI，0.09 - 0.77）。与幼儿护理提供者相比，婴儿护理提供者更有可能在进餐时与儿童一起就座（OR，6.98；95% CI，1.51 - 32.09）、允许儿童饿了就吃（OR，3.50；95% CI，1.34 - 9.16）以及避免提供含糖（OR，8.74；95% CI，3.05 - 25.06）或快餐（OR，11.56；95% CI，3.20 - 41.80）。
参与CACFP可能会鼓励婴幼儿护理提供者采用IOM推荐的喂养方式。儿童保育提供者可能会从关于如何以响应式方式喂养婴幼儿的教育中受益，尤其是在以家庭方式提供食物时。未来的研究应探索促进以儿童为中心的喂养方式的方法，同时解决为儿童提供营养丰富食物的障碍。
