Responsive Feeding Environments in Childcare Settings: A Scoping Review of the Factors Influencing Implementation and Sustainability

Abstract

Children benefit from responsive feeding environments, where their internal signals of hunger and satiety are recognized and met with prompt, emotionally supportive and developmentally appropriate responses. Although there is existing research on responsive feeding environments in childcare, there is little synthesized literature on the implementation practices using a behavior change framework. This scoping review sought to explore the factors influencing the implementation and sustainability of responsive feeding interventions in the childcare environment, using the behavior change wheel (BCW). A total of 3197 articles were independently reviewed and 39 met the inclusion criteria. A thematic analysis identified the factors influencing the implementation and sustainability of responsive feeding, including the following: (1) pre-existing nutrition policies, (2) education and training, (3) provider beliefs and confidence, (4) partnership development and stakeholder engagement and (5) resource availability. The most common BCW intervention functions were education (n = 39), training (n = 38), environmental restructuring (n = 38) and enablement (n = 36). The most common policy categories included guidelines (n = 39), service provision (n = 38)and environmental/social planning (n = 38). The current literature suggests that broader policies are important for responsive feeding, along with local partnerships, training and resources, to increase confidence and efficacy among educators. Future research should consider how the use of a BCW framework may help to address the barriers to implementation and sustainability.

Identifying elevated child weight from 3 to 24 months: Early transitions into nonparental care and to solid foods

“…Because children in daycare demonstrated higher WFL/WFHz regardless of ITS timing, formalized NPC arrangements may eliminate the influence that ITS timing has on child weight. Although formalized care settings may follow guidelines, 38,39 caregivers may be unable to respond appropriately or swiftly to infant hunger and satiety cues due to higher infant‐to‐caregiver ratios and time constraints on feeding. This scenario may be suggestive of overfeeding or overeating in settings such as daycare where caregivers must simultaneously tend to multiple children.…”

Advancing assessment of responsive feeding environments and practices in child care

“…Coaching in Early Learning Environments to Build a Responsive Approach to Eating and Feeding (CELEBRATE Feeding) was a behaviour change theory-based feasibility study in Nova Scotia and Prince Edward Island (Canada) that aimed to enhance responsive feeding in child care settings through a coaching intervention based on practices that support responsive feeding environments. ( 33 ) The coaching intervention was informed by the Behavior Change Wheel (BCW) framework to guide behaviour change. ( 45 ) Within the BCW, intervention development comprises three steps, the first being understanding the behaviour.…”

“…(50)(51)(52) Our modified version of the EPAO in this study was created to align with the CELEBRATE Feeding project's responsive feeding approach (Rossiter MD, Young M, Dickson E, et al, under review) to inform coaching and data collection for the feasibility study. The modification began through a comprehensive review of the EPAO-2017 tool following a review of the literature (33) in consultation with the broader research team with expertise in child development, nutrition, and dietetics. Pilot testing our modified tool in local child care centres provided important local context and helped inform the tool's layout to facilitate data collection.…”

“…(19,32) Interventions to support responsive feeding are needed to address the unique barriers to implementation in child care settings. (33) Measurement of responsive feeding practices in child care can help inform public health nutrition interventions, but there are limited instruments that are used to observe and assess all aspects of responsive feeding in child care settings; rather, many of the existing tools are focused within the home environment with parent practices (34) or do not include both environmental and behavioural aspects of responsive feeding, including food-related practices that occur outside of meal time, such as food exploration and food-related play and activities. (35)(36)(37) One widely used and internationally recognized public health nutrition tool in child care environments that provides a foundation for these components of responsive feeding is the Environment and Policy Assessment and Observation instrument, 2017 version (EPAO-2017).…”

“…( 19 , 32 ) Interventions to support responsive feeding are needed to address the unique barriers to implementation in child care settings. ( 33 )…”