Child sitting in high chair being fed broccoli on fork by mom

Providing young children with repeated opportunities to try healthy foods, structured meal and snack environments, and the freedom to make their own food choices are key to helping them develop lifelong healthy eating habits, according to new national recommendations from a panel co-chaired by Jennifer Orlet Fisher of the College of Public Health, convened by Healthy Eating Research.

The new recommendations for children ages 2 to 8 supplement the existing U.S. Dietary Guidelines.

“The U.S. Dietary Guidelines for Americans represent the state-of-the-art understanding of what healthy diets look like. They tell us what to eat, but they don't necessarily tell us how to get there,” says Fisher, professor in the Department of Social and Behavioral Sciences and associate director of the college’s Center for Obesity Research and Education. “This report is very different in that it pulls together a broad body of scientific evidence on the hows of feeding young children. There's a big gap between knowing that children should eat vegetables and figuring out how to raise children to choose and enjoy those foods on their own. These guidelines represent the best of the scientific evidence to date on how to raise young kids with healthy eating habits.”

Healthy Eating Research, a program of the Robert Wood Johnson Foundation, convened the national panel of experts in 2020 to develop evidence-based best practices and recommendations for promoting healthy eating behaviors among children 2 to 8 years of age. The 15 panel members represented expertise in nutrition, pediatrics, psychology, child development, family medicine and sociology. The panel reviewed findings from systematic reviews and meta-analyses published over the last decade, as well as research articles on special topics (such as diversity, equity and inclusion; childcare and school-based interventions; and parenting interventions). An expert-led consensus process then was used to develop guidelines that take into consideration budgets, culture and personal preferences.

“Parents know their children best, and what works well for some families might not be a good fit for others. These recommendations provide parents with a state-of-the-art toolkit of science-backed resources and suggestions for feeding young children,” says Fisher.

The panel found the single most effective strategy to get children between 2 and 8 to eat healthy foods is providing repeated opportunities for children to try them. Children are developing awareness of the world and decision-making capabilities in this age range, and they may need to try something up to 15 times before liking new foods, the report states. 

“We have seen that parents or caregivers often will make a very quick determination whether kids like something or not and move on. Many parents don't want to see food wasted, or they don't have the resources to keep bringing home food that kids reject, or they’re just not interested in food battles at the table,” Fisher says. “But, in fact, one of the most powerful influences on acceptance is repeated exposure. What we've learned from the research is that children’s liking of a food is not a simple yes or no decision, but rather a developmental process that plays out over time.”

Creating a positive atmosphere around eating is an important key to success in promoting healthy eating habits.  Studies have shown that providing praise and encouragement as well as social modeling, especially from peers, encourages children’s willingness to try and like new foods.

The panel also found that supporting children’s independence in trying and learning to like new foods is more effective than pressuring children to eat. One recommended approach is giving children guided choices (for example, a choice of strawberries or grapes). Suggestions for building children’s autonomy in their food choice also include getting them involved in meal selection, preparation and cooking. 

Guidelines for structuring the food environment include offering vegetables as a before-dinner appetizer, allowing children the opportunity to eat healthy foods when hungry, keeping healthy foods easily available—such as a bowl of fresh fruit on the counter or cut vegetables in the refrigerator—and limiting the availability of unhealthy snacks and sweets in the house. The full report is available online.

The recommendations for establishing healthy eating habits in young children come at an important time, as childhood obesity rates continue to rise. In 1980, about 5 percent of the country’s children between ages 2 and 19 were experiencing obesity, according to CDC data. By 2018, it was more than 19 percent.

“We know rates are high, and kids don’t tend to grow out of it,” Fisher says. “There is a real, pressing need to understand how to raise kids with healthy eating habits that prevent lifelong chronic diseases.” 

The panel also recognized in its recommendations that many families experience food insecurity or lack reliable access to healthy food in their communities, making it difficult to feed their children, and that additional resources and policies are needed to ensure that all children in the United States have consistent access to nutritious and affordable food.