CELEBRATE Feeding: A Responsive Approach to Food and Feeding in Early Learning Settings

An adequate, varied, and nutrient-rich dietary intake influences the growth and development of young children and can contribute to a decreased risk of chronic disease [1,2]. However, when considering the overall health and well-being of children, focusing on intake alone does not adequately capture the impacts of food, feeding, and nutrition [1–5]. Responsive feeding practices contribute to children’s health outcomes through the validation of their internal hunger and satiety cues and their capacity to self-regulate energy intake [6,7]. Responsive feeding aims to strengthen the child’s self-efficacy, self-regulation, and emotional management throughout early development [7–10]. Yet, responsive feeding can have different interpretations in the literature and the concepts that contribute to responsive feeding are varied [8,11–15]. Originally rooted in active feeding [16,17] and responsive parenting [8,18], responsive feeding has been described as a reciprocal relationship between a child and their caregiver; it is often characterized by the child communicating feelings of hunger or satiety, followed by an appropriate response (or behaviour) from the caregiver [8,19].

Early learning and child care (ELCC) settings play an important role in shaping the overall feeding environment for young children. Regulated child care programmes in Canada follow nutrition standards that dictate food provisions [20,21], with many also including responsive feeding practices around mealtime to promote a healthy relationship with food (e.g., predictable meal routines, family-style meal service, and caregiver engagement) [22,23]. In the short term, responsive feeding helps to support the development of a positive eating experience through the understanding and recognition of internal hunger and satiety cues, the cultivation of skills required for optimal self-regulation and self-control of food intake, as well as emotional regulation related to food and feeding [3,7,10,24,25]. Responsive feeding also aligns with increased emphasis among ELCC curriculum frameworks on children as capable and curious, and the role of reflective practice among early childhood educators to value the cultural and social contexts of children [26]. While there is a current emphasis on responsivity in relation to early childhood education, caregivers who lack confidence in children’s ability to appropriately regulate their own intake, or those who feel stressed about mealtimes, may unknowingly engage in feeding practices that are less responsive [8,27,28]. Practices such as using food to encourage behaviour, using food as a reward, or pressuring a child to eat a certain amount or type of food are considered less responsive and less desirable practices. These behaviours have shown limited evidence of short-term effectiveness and have the potential for creating an unhealthy association with food, as well as the possibility to interfere with emotional regulation and under-or-over consumption [7,10,19,29–35].

CELEBRATE Feeding (Coaching in Early Learning Environments to Build a Responsive Approach to Eating and Feeding) was a feasibility study in eight ELCC settings in Nova Scotia and Prince Edward Island that aimed to enhance responsive feeding through an emphasis on a behaviour change system targeted to educators. The 6-month intervention included monthly coaching sessions by an early years nutrition coach (a registered dietitian) who observed and supported educators during mealtimes and throughout the day. The intervention also included various webinar training sessions and provision of food and feeding resources (e.g., handouts, books, and child-friendly utensils). The coaching strategies employed by the early years nutrition coach was informed by the behaviour change wheel (BCW), which was developed by Michie et al. (2011) through a synthesis of frameworks of behaviour change theory identified in a systematic literature review [36]. The BCW offers a stepwise method to develop a multilayered behaviour change intervention by identifying target behaviours and selecting corresponding intervention functions and policy categories to produce desired outcomes based on the conditions of the Capability, Opportunity, Motivation-Behaviour (COM-B) analysis [36]: Capability is considered as the educator’s psychological and physical capacity to engage in responsive feeding; Opportunity is the physical and social opportunities that influence responsive feeding in the ELCC setting; Motivation is the reflective and automatic processes, and responses of educators related to responsive feeding; together these target the educators’ Behaviour that supports a responsive feeding environment. The coaching strategies applied a COM-B analysis to support each child care centre with their unique circumstances and goals.

The CELEBRATE Feeding Approach was created as part of the CELEBRATE Feeding study to provide an initial framework of responsive feeding that is driven by behaviour change theory, considers the larger food and feeding environment, and is based on actionable target behaviours to inform best practices with educators working in ELCC settings. In this flexible approach, there is an intentional focus on supporting early childhood educators to implement the desired responsive feeding practices that recognize and support the development of a child’s sense of autonomy, confidence, and self-regulation skills at mealtime, but also beyond mealtime, through language that is used around food and feeding and play-based exploration.

The CELEBRATE Feeding Approach builds on previous definitions and concepts of responsive feeding by highlighting the importance of language, play, diversity, inclusion, and the celebration of food and feeding in ELCC environments. The approach was developed through an iterative process with an initial exploration of individual responsive feeding practices and elements that support responsive feeding environments based on a scoping review [37]. The research team drafted an initial approach that included critical behaviours in responsive feeding and engaged a broader advisory committee in review and refinement based on the literature and provincial nutrition standards in ELCC. The advisory committee included academics and government partners from different backgrounds, including early childhood education, health promotion, nutrition and dietetics, and child and youth study. Collectively, the research team and advisory committee identified potential target behaviours of educators that exemplify responsive feeding using the COM-B system [36]. This distillation process resulted in the identification of 13 target educator behaviours presented in three overlapping categories (Figure 1): CELEBRATE language (talk about food using neutral language; communicate with children about when food is offered and when it will be offered again; limit pressure on children to eat; talk about different cultures, food practices, preferences, and allergies; have positive conversations at mealtime that are not about food; and limit the use of food as a reward); CELEBRATE mealtime (establish consistent and responsive feeding routines; support children to decide what and how much to eat from the foods offered; encourage children to serve themselves; sit with children and eat the same food; and limit rewarding children for eating); and CELEBRATE play (provide repeated opportunities to explore new foods and textures; and facilitate play related to food, cooking, and mealtime). Target behaviours were included based on their likelihood of occurrence (or non-occurrence) in ELCC settings, the impact of the practice (or absence of the practice) on the responsiveness of the environment, and the potential spillover effect(s) on classroom/educator procedures and/or behavioural outcomes. The three categories were established to demonstrate commonalities within the identified behaviours, as well as to provide situational context to help educators identify and prioritize behaviours. The three categories overlap to highlight the interconnectivity of the behaviours and reinforce the applicability of behaviours beyond their primary category. For example, language-related target behaviours could be practiced at mealtime and during play, and play-related behaviours can be incorporated into mealtime.

When practiced individually, a target behaviour can improve the responsiveness of the feeding environment. When multiple behaviours are implemented, there is a compounding effect; the more behaviours present in the child care room/setting, the more responsive the environment. Optimally, all educators will consistently engage in all 13 target behaviours to create the most responsive feeding environment. The social, behavioural, and cultural impacts of the recommended practices were taken into consideration during the development of the approach; there may be situations in which the identified behaviour(s) cannot/should not be applied. For example, some behaviours may not be appropriate or may require further consideration, depending on the child’s developmental needs and/or clinical recommendations from relevant professionals. Food exploration and exposure through play is another target behaviour where consideration is required before implementation; this practice should be culturally sensitive and recognize the complexity of social circumstances (e.g., food insecurity). The CELEBRATE Feeding Approach is consistent with provincial ELCC guidelines and provides a more expansive approach with specific and targeted behaviours to support educators in implementing responsive feeding practices in broader spheres of influence.

Although the characteristics of responsive feeding have been documented, and elements are at times incorporated into ELCC nutrition standards and healthy eating guidelines, there is a gap between what is known about best practices and what is done day-to-day, particularly in ELCC programmes [38]. Responsive feeding practices appear straightforward, but establishing and sustaining them can be challenging due to a wide range of cultural and social beliefs around feeding young children [10,33], as well as competing demands on the caregiver or educator for time and resources.

The CELEBRATE Feeding Approach provides an initial framework based on evidence in literature and nutrition standards to support dietitians working with early childhood educators in ELCC settings. Further testing and refinement is underway in ELCC to ensure comprehensive representation of evidence-based behaviours that contribute to responsive feeding environments and practices. The approach focuses on a respectful and collaborative feeding connection that supports a child’s hunger and satiety cues and embraces a positive and inclusive learning environment that fosters a child’s confidence, self-regulation, and healthy development. Through strategic behaviour change techniques, dietitians can apply the CELEBRATE Feeding Approach to advocate for children to be exposed to a variety of foods, using a variety of exposure methods, in a predictable, safe, and supportive environment, without the pressure to eat more or less of certain foods. In the spirit of accepting children where they are as eaters and surrounding them with support and patience as they navigate the food environment in ELCC settings, the goal is that children will be open to a wide variety of food, develop their self-regulation skills, and build the foundation for a positive relationship with food throughout their lifetime.