"Great Job Cleaning Your Plate Today!" Determinants of Child-Care Providers' Use of Controlling Feeding Practices: An Exploratory Examination.

BACKGROUND National early childhood obesity prevention policies recommend that child-care providers avoid controlling feeding practices (CFP) (eg, pressure-to-eat, food as reward, and praising children for cleaning their plates) with children to prevent unhealthy child eating behaviors and childhood obesity. However, evidence suggests that providers frequently use CFP during mealtimes. OBJECTIVE Using the Academy of Nutrition and Dietetics (2011) benchmarks for nutrition in child care as a framework, researchers assessed child-care providers' perspectives regarding their use of mealtime CFP with young children (aged 2 to 5 years). DESIGN Using a qualitative design, individual, face-to-face, semi-structured interviews were conducted with providers until saturation was reached. PARTICIPANTS/SETTING Providers were selected using maximum variation purposive sampling from varying child-care contexts (Head Start, Child and Adult Care Food Program [CACFP]-funded centers, non-CACFP programs). All providers were employed full-time in Head Start or state-licensed center-based child-care programs, cared for children (aged 2 to 5 years), and were directly responsible for serving meals and snacks. MAIN OUTCOME MEASURE Child-care providers' perspectives regarding CFP. STATISTICAL ANALYSES PERFORMED Thematic analysis using NVivo (version 9, 2010, QSR International Pty Ltd) to derive themes. RESULTS Providers' perspectives showed barriers, motivators, and facilitators regarding their use of mealtime CFP. Providers reported barriers to avoiding CFP such as CFP were effective for encouraging desired behaviors, misconceptions that providers were encouraging but not controlling children's eating, and fear of parents' negative reaction if their child did not eat. Providers who did not practice CFP were motivated to avoid CFP because they were unnecessary for encouraging children to eat, and they resulted in negative child outcomes and obesity. Facilitators as an alternative to CFP included practicing healthful feeding practices such as role modeling, peer modeling, and sensory exploration of foods. CONCLUSIONS Training providers about negative child outcomes associated with CFP, children's ability to self-regulate energy intake, and differentiating between controlling and healthful feeding strategies may help providers to avoid CFP.