NOTICE: We are experiencing technical issues with Academy members trying to log into the JAND site using Academy member login credentials. We are working to resolve the issue as soon as possible. Alternatively, if you are an Academy member, you can access the JAND site by registering for an Elsevier account and claiming access using the links at the top of the JAND site. Email us at [email protected] for assistance. Thanks for your patience!

Development and Qualitative Pretesting of Child Feeding and Obesity Prevention Messages for Parents of Infants and Toddlers

Published:March 11, 2021DOI:



      Consistent, evidence-based child feeding guidance targeted to parents of children ages birth to 24 months (B-24) is needed for early childhood obesity prevention.


      The aim was to develop and pretest a comprehensive set of child feeding and obesity prevention messages for parents of children ages B-24.


      A qualitative, 2-phase protocol, grounded in social and behavior change, was used as a conceptual interview framework to pilot test early childhood feeding messages with parents.


      Participants were parents (n = 23) of children ages B-24.


      A core set of 12 messages and supporting materials were developed for parents of children ages B-24 based on previous research findings, current research evidence, and feeding guidance. Parents were individually interviewed using a semistructured script along with additional questions to rank perceptions of message qualities.

      Main outcome measures

      Overall comprehension, importance, believability, ease of implementation, and likelihood of use of messages were assessed.

      Statistical analysis performed

      Data analysis included qualitative thematic analysis and descriptive statistics for Likert-scaled responses.


      Participants were primarily female, non-Hispanic White, with a mean age of 33.3 ± 6.8 years and at least a bachelor’s degree. Overall, most messages were understood, believable, perceived as important, and feasible by parents. Messages related to starting solid foods, encouraging child control of intake and self-feeding, and food allergen guidance were perceived as more difficult and less likely to be implemented by parents.


      Additional research is needed to evaluate actual implementation of messages by diverse parents and resulting outcomes including impact on child weight.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hoffmann D.A.
        • Marx J.M.
        • Kiefner-Burmeister A.
        • Musher-Eizenman D.R.
        Influence of maternal feeding goals and practices on children’s eating behaviors.
        Appetite. 2016; 107: 21-27
        • Pérez-Escamilla R.
        • Segura-Pérez S.
        • Lott M.
        Feeding guidelines for infants and young toddlers: A responsive parenting approach. Healthy Eating Research.
        (Published 2017. Accessed March 14, 2020)
        • Kiefner-Burmeister A.E.
        • Hoffmann D.A.
        • Meers M.R.
        • Koball A.M.
        • Musher-Eizenman D.R.
        Food consumption by young children: A function of parental feeding goals and practices.
        Appetite. 2014; 74: 6-11
        • Patrick H.
        • Nicklas T.A.
        A review of family and social determinants of children’s eating patterns and diet quality.
        J Am Coll Nutr. 2005; 24: 83-92
      1. Wang Y, Wu Y, Wilson RF, et al. Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Jun. Report No.: 13-EHC081-EF. PMID: 23865092.

        • Daniels L.A.
        • Mallan K.M.
        • Nicholson J.M.
        • et al.
        An early feeding practices intervention for obesity prevention.
        Pediatrics. 2015; 136: e40-e49
        • Hohman E.E.
        • Paul I.M.
        • Birch L.L.
        • Savage J.S.
        INSIGHT responsive parenting intervention is associated with healthier patterns of dietary exposures in infants.
        Obesity (Silver Spring). 2017; 25: 185-191
        • Savage J.S.
        • Birch L.L.
        • Marini M.
        • Anzman-Frasca S.
        • Paul I.M.
        Effect of the INSIGHT responsive parenting intervention on rapid infant weight gain and overweight status at age 1 year: A randomized clinical trial.
        JAMA Pediatr. 2016; 170: 742-749
        • Dwyer J.T.
        The Feeding Infants and Toddlers Study (FITS) 2016: Moving forward.
        J Nutr. 2018; 148: 1575S-1580S
        • Miles G.
        • Siega-Riz A.M.
        Trends in food and beverage consumption among infants and toddlers: 2005-2012.
        Pediatrics. 2017; 139 (e20163290)
        • Perez-Escamilla R.
        • Meyers J.
        Preventing childhood obesity: Maternal-child life course approach. Child Health and Development Institute of Connecticut.
        (Published 2014. Accessed May 21, 2020)
        • Daniels L.A.
        • Mallan K.M.
        • Battistutta D.
        • Nicholson J.M.
        • Perry R.
        • Magarey A.
        Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity: outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules.
        Int J Obes (Lond). 2012; 36: 1292-1298
        • Fangupo L.J.
        • Heath A.L.
        • Williams S.M.
        • et al.
        Impact of an early-life intervention on the nutrition behaviors of 2-y-old children: A randomized controlled trial.
        Am J Clin Nutr. 2015; 102: 704-712
        • Spence A.C.
        • Campbell K.J.
        • Crawford D.A.
        • McNaughton S.A.
        • Hesketh K.D.
        Mediators of improved child diet quality following a health promotion intervention: The Melbourne InFANT Program.
        Int J Behav Nutr Phys Act. 2014; 11: 137
        • Wen L.M.
        • Baur L.A.
        • Simpson J.M.
        • Rissel C.
        • Wardle K.
        • Flood V.M.
        Effectiveness of home based early intervention on children’s BMI at age 2: Randomised controlled trial.
        Bmj. 2012; 344
        • Academy of Nutrition and Dietetics
        Dos and don’ts for baby’s first foods.
        (Published 2017. Accessed May 20, 2020)
        • American Academy of Pediatrics
        Infant food and feeding.
        (Published 2019. Accessed May 1, 2020)
        • World Health Organization
        Promoting proper feeding for infants and young children.
        (Published 2018. Accessed April 19, 2020)
        • Lessen R.
        • Kavanagh K.
        Position of the academy of nutrition and dietetics: Promoting and supporting breastfeeding.
        J Acad Nutr Diet. 2015; 115: 444-449
        • American Academy of Pediatrics
        Pediatric Nutrition.
        8th ed. American Academy of Pediatrics, 2019
        • Birch L.L.
        • Doub A.E.
        Learning to eat: birth to age 2 y.
        Am J Clin Nutr. 2014; 99: 723S-728S
        • Barrera C.M.
        • Hamner H.C.
        • Perrine C.G.
        • Scanlon K.S.
        Timing of introduction of complementary foods to US infants, National Health and Nutrition Examination Survey 2009-2014.
        J Acad Nutr Diet. 2018; 118: 464-470
        • Woo Baidal J.A.
        • Locks L.M.
        • Cheng E.R.
        • Blake-Lamb T.L.
        • Perkins M.E.
        • Taveras E.M.
        Risk factors for childhood obesity in the first 1,000 days: A systematic review.
        Am J Prev Med. 2016; 50: 761-779
        • United States Department of Agriculture
        Maximizing the message: Helping moms and kids make healthier food choices. Food and Nutrition Service.
        (Published 2017. Accessed April 2, 2020)
        • Heller R.
        • Chiero J.
        • Trout N.
        • Mobley A.R.
        Providers’ perceptions of child feeding and activity recommendations related to early childhood obesity prevention.
        FASEB J. 2017; 31: 432-433
        • Heinig M.J.
        • Follett J.R.
        • Ishii K.D.
        • Kavanagh-Prochaska K.
        • Cohen R.
        • Panchula J.
        Barriers to compliance with infant-feeding recommendations among low-income women.
        J Hum Lact. 2006; 22: 27-38
        • Russell C.G.
        • Taki S.
        • Azadi L.
        • et al.
        A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment.
        BMC Pediatr. 2016; 16: 69
        • Rylatt L.
        • Cartwright T.
        Parental feeding behaviour and motivations regarding pre-school age children: A thematic synthesis of qualitative studies.
        Appetite. 2016; 99: 285-297
        • Houts P.S.
        • Doak C.C.
        • Doak L.G.
        • Loscalzo M.J.
        The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence.
        Patient Educ Couns. 2006; 61: 173-190
      2. Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. Adult literacy in America: A first look at the findings of the National Adult Literacy Survey.Washtington, DC: US Department of Education; 2002.

        • Safeer R.S.
        • Keenan J.
        Health literacy: The gap between physicians and patients.
        Am Fam Phys. 2005; 72: 463-468
        • Health Communication Capacity Collaborative
        How to design SBCC messages.
        (Published 2017. Accessed May 2, 2020)
        • Heller R.L.
        • Chiero J.D.
        • Puglisi M.
        • Mobley A.R.
        Feeding infants and toddlers: A qualitative study to determine parental education needs.
        Child Obes. 2019; 15: 443-450
        • Saumure K.
        • Given L.M.
        Convenience Sample.
        in: Given L.M. The SAGE Encyclopedia of Qualitative Research Methods. SAGE, 2008: 125
        • Snyder L.B.
        Health communication campaigns and their impact on behavior.
        J Nutr Educ Behav. 2007; 39: S32-S40
        • Thomas D.R.
        A general inductive approach for analyzing qualitative evaluation data.
        Am J Eval. 2006; 27: 237-246
        • Tuckett A.G.
        Applying thematic analysis theory to practice: a researcher’s experience.
        Contemp Nurse. 2005; 19: 75-87
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101
        • Patton M.Q.
        Enhancing the quality and credibility of qualitative analysis.
        Health Serv Res. 1999; 34: 1189-1208
        • Institute of Medicine Committee on Health Literacy
        Health Literacy: A Prescription to End Confusion.
        National Academies Press, 2004
        • DHHS, Agency for Healthcare Research and Quality
        The Joint Commission: Advancing effective communication, cultural competence, and patient-and family-centered care: a roadmap for hospitals.
        (Published 2010. Accessed March 4, 2020)
        • Meyer R.
        Infant feeding in the first year. 2: Feeding practices from 6-12 months of life.
        J Fam Health Care. 2009; 19: 47-50
        • Togias A.
        • Cooper S.F.
        • Acebal M.L.
        • et al.
        Addendum guidelines for the prevention of peanut allergy in the United States: Summary of the National Institute of Allergy and Infectious Diseases-sponsored expert panel.
        J Acad Nutr Diet. 2017; 117: 788-793
        • Turner P.J.
        • Campbell D.E.
        Implementing primary prevention for peanut allergy at a population level.
        JAMA. 2017; 317: 1111-1112
        • Herbert L.J.
        • Mehta P.
        • Sharma H.
        Mealtime behavior among parents and their young children with food allergy.
        Ann Allergy Asthma Immunol. 2017; 118: 345-350
        • Huh S.Y.
        • Rifas-Shiman S.L.
        • Taveras E.M.
        • Oken E.
        • Gillman M.W.
        Timing of solid food introduction and risk of obesity in preschool-aged children.
        Pediatrics. 2011; 127: e544-e551
        • Gregory J.E.
        • Paxton S.J.
        • Brozovic A.M.
        Pressure to eat and restriction are associated with child eating behaviours and maternal concern about child weight, but not child body mass index, in 2- to 4-year-old children.
        Appetite. 2010; 54: 550-556
        • Harrison M.
        • Brodribb W.
        • Davies P.S.W.
        • Hepworth J.
        Impact of maternal infant weight perception on infant feeding and dietary intake.
        Matern Child Health J. 2018; 22: 1135-1145
        • Wehrly S.E.
        • Bonilla C.
        • Perez M.
        • Liew J.
        Controlling parental feeding practices and child body composition in ethnically and economically diverse preschool children.
        Appetite. 2014; 73: 163-171
        • Martin-Biggers J.
        • Spaccarotella K.
        • Hongu N.
        • Alleman G.
        • Worobey J.
        • Byrd-Bredbenner C.
        Translating it into real life: A qualitative study of the cognitions, barriers and supports for key obesogenic behaviors of parents of preschoolers.
        BMC Public Health. 2015; 15: 189
        • Centers for Disease Control and Prevention
        Breastfeeding report card.
        (Published 2018. Accessed May 11, 2020)
        • Marduel Boulanger A.
        • Vernet M.
        Introduction of new food textures during complementary feeding: Observations in France.
        Arch Pediatr. 2018; 25: 6-12
      3. D.R. Wittink and L.R. Bayer, The measurement imperative, Marketing Research : a magazine of management and applications. - Chicago, Ill: American Marketing Assoc.; Vol. 6 (4), 1994, p. 14-23


      R. L. Heller is a medical science liaison, Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH; at the time of the study, she was a graduate research assistant, Department of Nutritional Sciences, University of Connecticut, Storrs, CT.


      A. R. Mobley is an associate professor, Department of Health Education and Behavior, University of Florida, Gainesville, FL; at the time of the study, she was an associate professor, Department of Nutritional Sciences, University of Connecticut, Storrs, CT.