It must be just about every parent’s struggle – the constant attempts to increase the vegetable intake of our little bundles o’ joy, through their toddler years and beyond. Often it starts out fine – many the smug mother of an infant has boasted that her little one eats ALL his veggies… only to discover that toddlerhood is the great unpinning of it all (hmm, I remember being one of those mums…). I remember a parenting book that stated ALL children go through an “only peanut butter sandwiches” stage (excepting those with peanut allergies, I suppose). I can’t remember which book it was in – if you know it, send me the reference.
In Australia, 61% of children aged 4-8 eat the recommended serving of fruit, and only 3% are eating the suggested amount of vegetables (see here). It’s not getting better by the time we’re grown up either, with only 50% of us eating sufficient fruit, and 9% having an adequate vegetable consumption (see here).
So how can we right-set our children and start increasing their vegetable intake? An exciting new study offers a promising approach. Abigail Kennedy, Seth Whiting, and Mark Dixon trialled two Acceptance and Commitment Therapy (ACT) based interventions with a group of six children (aged 3-5). The results of their second intervention were startling: using ACT with an emphasis on values and committed action, paired with rewards delivered upon tasting foods, resulted in a 69.2% increase in the tasting of (previously undesired) vegetables; 25.3% for fruit; and 43.2% for beans.
What I particularly liked about their intervention (apart from its success), was its SIMPLICITY and, therefore, easy transference to the home setting.
Here are some key elements to try yourself at home:
1. Set the Scene
Children were given simple, clearly defined “rules” for engaging in the meal time. Compliance with these rules resulted in a sticker (chosen by the adult) on their sticker chart. The rules were:
- Stay in your seat
- Zero instances of yelling
- Zero instances of playing with food (putting food on the table/floor/chair, or throwing in the air)
Applying it at home: Keep it simple. Family rules could be determined by the whole family, and a visual reminder put up somewhere near the table. Children will watch what you do – do Mum and Dad yell at the table / fidget with their phones / etc?
2. Create some space around their thoughts
When children used phrases such as “I never eat this,” the facilitator reminded them that this was just a thought, and they could notice that as they notice any other thoughts.
Applying this at home: In addition to the reframe, remember that you and any other adults are also modelling attitudes to food. Do mum and dad eat their veggies? How do parents manage being served food they don’t like?
3. Encourage progress towards trying new foods
In this study, children played a game called “Look, Feel, Smell” in which they were presented with the (undesired) food items, without a requirement to eat, and encouraged to talk about what they observed with their senses (rather than thoughts) .
Applying this at home: Reward attempts that are a step closer to the behaviour you want. Before swallowing a new food, it is normal and helpful for a child to explore the food through touch, smell and taste. Another programme, the SOS Approach to Feeding, advocates for the use of a spitting bowl (at times) so that a child may taste a food without having to commit to swallowing (a barrier for some children). This idea was very counter-intuitive to us when we first came across it – and proved to be an essential step when our boys were toddlers.
4. Reward eating attempts
This is my FAVOURITE part of this study – it was the component that created the most change, and it was incredibly simple. Children were told “Today if you eat any amount of the [vegetable], you can choose one sticker from the special sticker box to put on your sticker card. If you do not eat any of this [food category] but sit calmly during the food activity, you will earn a sticker that I choose for you.”
That simple option, that children would be able to choose their own stickers for eating any amount of their veggies, resulted in a massive 69.2% increase in veggie tasting!
I could fall over, it’s so simple. The kids weren’t even offered anything they could trade their stickers for. Just being able to choose their own stickers was enough. Often when we think about “reward charts” we can go overboard and complicate things – and yet this simple, tiny, financially insignificant reward had a HUGE impact on these kids. (The authors note previous research has found that preschool children prefer to choose their reward rather than simply earning a previously specified reward – a handy tip to keep in mind)
Applying it at home: This is a great reminder that rewards needn’t be huge – but their existence can create change in a child’s motivation. I love this one because it doesn’t use unhealthy rewards (ie dessert / lollies) for healthy food choices. The authors of the study acknowledge they didn’t do long-term follow-up, and a phasing out of the rewards would be necessary. In your home, you might trade a full sticker sheet in for some kind of reward (think: extra 1:1 time with a parent / staying up past bedtime / a movie night – again keep it simple). Over time, you could also increase the behaviours required in order to earn stickers (eg eat larger quantities of the presented veggies; use utensils correctly), and gradually fade out as the child continues eating veggies as part of a newly formed healthy habit.
5. Don’t give up!
You’ve probably heard that children need to be presented with food many times over before they will eat it reliably. The authors note that “repeated exposure to food has been shown to result in more positive judgements of food” (Birch, McPhee, Shoba & Steinberg, 1987; cited in Kennedy, et al, 2014).
Applying it at home: Children take time to learn that food presented in different ways is still the same food. A child may eat raw carrots and yet balk at the cooked variety; eat chips but not mash; pumpkin in soup but not roasted… Each different presentation may need many multiple attempts before success is reached.
Over to you!
Which of these strategies have you already had success with? What else do you do in your house that helps?
Kennedy, A. E.; Whiting, S. W. and Dixon, M. R. (2014). Improving novel food choices in preschool children using acceptance and commitment therapy. Journal of Contextual Behaviour Science, 3, 228-235
Changing the way our children eat: a behavior analytic approach Giovambattista Presti, Silvia Cau, Paolo Moderato