In a recent article published in Child Development, researchers presented the findings of a randomized controlled trial (RCT) evaluating the effects of Recipe 4 Success, a preventive intervention implemented across seven cities, villages, and towns of Wisconsin and Pennsylvania in the United States of America (USA).
The RCT examined the effects of this intervention on parents' sensitive scaffolding, responsive food parenting practices, toddlers' self-regulation, and healthy eating habits.
Recipe 4 Success intended to enhance the benefits of another home visit program called Early Head Start, which aimed at supporting poor families to nurture the social, emotional, and physical health of their young children.
About the study
In the current RCT, researchers covered 242 parents and their two-year-old toddlers from families who completed assessments in English.
Nearly 65% of eligible families participated in this study, completed their baseline assessments one week before implementing the study interventions, and randomly received the Recipe 4 Success preventive or control interventions. Accordingly, intervention and control groups had 123 and 119 families, respectively.
The study intervention comprised highly structured food preparation lessons, each requiring ~45 minutes to complete. The home visitors implemented 90-minute long baseline and postintervention assessments (similar in content) in 12 consecutive weeks.
Recipe 4 Success recipes featured three to five low-cost ingredients, including at least one fruit or vegetable, a protein source, and a microwave or a freezer for preparation.
The team of 10 project interviewers trained all home visitors in study procedures, provided ongoing supervision, and discussed the progress of lessons throughout the program weekly over a 30-minute group conference call.
Further, they assessed intervention fidelity via digital audio recordings of home visits wherein home visitors tutored lessons 4, 7, and 10.
This study included three measures of parents' sensitive scaffolding, all rated during three-minute structured interactions in which parents and toddlers worked together on unfamiliar tasks, e.g., bowling with a stuffed ball and pins. The first and second measures of parents' sensitive scaffolding assessed four core parenting skills and how often parents exhibited seven learning support behaviors (e.g., quizzing what toddlers already knew), respectively. The third measure assessed the parent's ability to structure all three tasks and promote toddlers' success and maximum independence.
This study also included two measures of responsive food parenting practices, where the first reflected parent's ability to arouse curiosity and interest in healthy food, and the second rated parent's ability to show overall sensitivity and willingness to follow toddlers' lead regarding what they preferred to eat.
Further, this study included four and three measures of behaviors related to toddlers' self-regulation and toddlers' healthy eating habits.
Living in poverty and experiencing chronic stress hinders parents from providing sensitive scaffolding and responding to children.
They speak to their children less and ask fewer questions to guide their learning, which adversely affects their development, especially language skills, a predictor of growth in self-regulation. They also tend to prohibit their children more and provide fewer affirmations, further impairing their children's self-regulation and sense of autonomy.
Intervention parents displayed higher levels of all core parenting behaviors. For instance, they praised children for persistence and effort and provided choices to foster autonomy. They also exhibited higher levels of learning support.
Intervention recipients adopted responsive and noncoercive strategies to introduce novel healthy foods to their toddlers while respecting children's autonomy to eat what they preferred.
Living in poverty lowers psychological and physiological self-regulation in children; however, high levels of parents' sensitivity and warmth could moderate its effects. Evidence suggests that children with poor self-regulation at age 3 have a higher body mass index (BMI) by age 12.
The Recipe 4 Success intervention promoted toddlers' self-regulation, including their ability to delay gratification, resist temptation, concentrate, pay attention, and comply with parental requests. Accordingly, these toddlers had fewer eating and sleep problems.
When faced with food insecurity, parents prioritize their children's eating rather than promoting healthy eating habits. Around age 2, toddlers form taste preferences; thus, promoting healthy eating habits during this period helps maintain healthy eating habits in adulthood. Communities with lower average incomes and high proportions of residents of color have no/minimal access to nutrient-dense foods. Thus, their children eat food high in calories (energy-dense) but low in essential nutrients.
The trial results showed that Recipe 4 successfully promoted healthy eating habits in toddlers. At the end of the 12-week intervention, toddlers who participated in Recipe 4 Success began eating healthy foods daily. If sustained and built upon in early childhood, healthy eating habits have long-term implications for physical health.
Recipe 4 Success represents an addition to the relatively small cadre of preventive interventions that improve self-regulation during the toddler years. It could also help improve family-level risks that are endemic to poor households and promote protective factors associated with long-term health and well-being.
The trial results suggest that policymakers and practitioners should focus on developing and implementing effective preventive interventions that address the needs of parents and children (two generations) to promote healthy development. Receiving the right amount of support at the right time may be one of the most effective means of promoting resilience among families living in poverty.
Most importantly, since the current Recipe 4 Success RCT involved racially and ethnically diverse families living in poverty, it substantiated the value of a community-based participatory research approach.
- Nix, R. L., Gill, S., Hostetler, M. L., Feinberg, M. E., Francis, L. A., Stifter, C. A., McNeil, C. B., Kidder, S. M., Jones, D. E., Park, Y. R., Kim, C. N., Engbretson, A. G., Braaten, S. M. and Tamkin, V. L. (2023) Child Development. doi: 10.1111/cdev.14006 https://srcd.onlinelibrary.wiley.com/doi/10.1111/cdev.14006