|Year : 2014 | Volume
| Issue : 3 | Page : 612-616
Nutritional knowledge, attitude, and practice of parents and its impact on growth of their children
Fathea El-Nmer1, Aml A Salama2, Dalia Elhawary3
1 Department of Pediatric, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Residence of Family Medicine in Ministry of Health, Egypt
|Date of Submission||14-Nov-2013|
|Date of Acceptance||22-Mar-2014|
|Date of Web Publication||26-Nov-2014|
Aml A Salama
Department of Family Medicine, Faculty of Medicine, Menoufia University, Level 7, Flat 13, Borge Al-Atbaa, In Front of Liver Institute, Shibin El-Kom, Menoufia Governorate
Source of Support: None, Conflict of Interest: None
The aim of the study was to assess the effect of parental nutritional knowledge, attitude, and practice (KAP) on their children nutritional behavior and growth.
Good nutrition is cornerstone for growing children during early childhood and school-age years; children begin to establish habits for eating and exercise that stick with them for their entire lives. If children establish healthy habits, their risk for developing many chronic diseases will be greatly decreased.
Participants and methods
This was a cross-sectional study through multistage stratified random sampling technique. Bialla district of Kafr-Elsheikh governorate was selected randomly from 10 district of Kafr-Elsheikh governorate. Predesigned questionnaires that assess parents and children (KAP) were then given to parents and children and 120 pairs of completed questionnaires were returned.
There was no significant correlation between nutritional knowledge (KAP) of parents and nutritional practice of their children (P>0.05), whereas there was a significant correlation between parent's knowledge score and healthy food intake in general by children (r = 0.222; P < 0.05). There was no significant correlation between nutritional practice of children and their BMI and height, whereas there was significant correlation between nutritional practice of children and their weight. There was a highly significant correlation between social class of parents and their children nutritional behavior; in addition, there is significant correlation between father's education and mother's education and their children nutritional practice (χ2 = 15.3 and 14.6; P = 0.018 and 0.023, respectively).
There is no relationship between parents knowledge, attitude, and healthy food intake by their children. Parents education and socioeconomic status constituted important determinants of healthy food intake by their children.
Keywords: attitude, nutritional knowledge, parents and children, practice
|How to cite this article:|
El-Nmer F, Salama AA, Elhawary D. Nutritional knowledge, attitude, and practice of parents and its impact on growth of their children. Menoufia Med J 2014;27:612-6
|How to cite this URL:|
El-Nmer F, Salama AA, Elhawary D. Nutritional knowledge, attitude, and practice of parents and its impact on growth of their children. Menoufia Med J [serial online] 2014 [cited 2017 Dec 14];27:612-6. Available from: http://www.mmj.eg.net/text.asp?2014/27/3/612/145529
| Introduction|| |
Nutrition is a significant factor in the growth, development, and overall functioning of a child. Good nutrition provides the energy and nutrients essential to sustain life and promote physical, social, emotional, and cognitive development  . During early childhood, the body is growing at an alarming rate. This rate slows down after age 1 year and may occur in spurts throughout childhood, adolescence, and puberty. A child needs adequate dietary intake to provide enough nutrients and energy for him to grow, without reducing his body's ability to stay healthy. In addition, almost half of the adult skeletal mass is built during adolescence. A healthy diet, rich in calcium and other essential vitamins and minerals, will enable optimal skeletal and physical growth  . Children's poor diet does not only have direct negative effects on their weight and health, but also results in significant deficiencies in those nutrients playing an essential role in cognitive development  .
Young children depend on their families and teachers to support their well-being and promote positive development, including eating behaviors. Children's food preferences and willingness to try new foods are influenced by the people around them  . Eating behaviors of children practice early in life affect their health and nutrition which are significant factors in childhood overweight and obesity  , and may continue to shape food attitudes and eating patterns through adulthood. Child-feeding practices determine the availability of various foods, the portion sizes that children are offered, the frequency of eating occasions, and the social contexts in which eating occurs. Parents can influence children's dietary practices in many areas: availability and accessibility of foods; meal structure and environment; adult food modeling; food socialization practices; and food-related parenting styles. Family meals may also contribute positively to children's nutrition beliefs and attitudes as well as to the onset and persistence of overweight in elementary school children  . Although children seem to possess an innate ability to self-regulate their energy intake, their food environment affects the extent to which they are able to exercise this ability. Offering large food portions (especially of high calorie, sweet, or salty foods), feeding practices that pressure or restrict eating, or modeling of excessive consumption can all undermine self-regulation in children. Perhaps, the best advice regarding child-feeding practices continues to be the division of responsibility between adult and child advocated by Satter and Madison  . According to this division, the role of parents and other caregivers in feeding is to provide positive structure, age-appropriate support, and healthful food and beverage choices. Children are responsible for whether and how much to eat from what adults provide. Mothers' attitudes of serving foods may influence children's attitude concerning likes and dislikes. Wenrich et al.  reported that family members' vegetable selection was affected by guardians' vegetable serving.
| Participants and methods|| |
Bialla district of Kafr-Elsheikh governorate was selected randomly, one of 10 districts of Kafr-Elsheikh governorate. Three primary schools were selected randomly from schools of Bialla district, and four classes were selected randomly from classes of the schools with children aged between 8 and 12 years. The sample size was calculated using EPI-INFO (CDC, Georgia, USA) program version 7 depending on the total number of students (age of 8-11 years) who registered in primary schools of Bialla district of Kafr-Elsheikh governorate during year 2012-2013. The sample size was 100 students. It was raised to 145 students to avoid the dropout of the students by incomplete questionnaires. Questions were explained in easy language for the students to understand and the researcher was sure of their understanding to each of the questions. Parents questionnaires were sent home and the language of some questions were modified to be easily understood by the parents. Incomplete questionnaires were excluded (about 25); hence the final study sample was about 120. The data from students were: age, sex, reported snack food intake, motivations to eat, number of meals, type of food, etc., and score was given according to their nutritional habits. The study was conducted during the period from the beginning of December 2012 to the end of September 2013. Participants were asked to state their age and sex. Socioeconomic standard was assessed through father education, occupation, income, and number of individual per room according to Ibrahim and Abdel-Ghaffar (1990), using the five parameters (occupation, education, family size, family income, and overcrowdedness). Parent knowledge about the nutrition in general and nutritional pattern of children in particular was assessed through 15 questions. In addition, their attitude and practice regarding nutrition of their children were assessed too. Practice question varied about the children intake of healthy food composition, food preferences, child-feeding practices, restaurant eating versus meals prepared at home, and family meals and its type reported yesterday and in general. Diet taken by children yesterday and in general was classified as healthy and unhealthy according to the nutritional needs of the children in food pyramid for healthy nutrition of children  . The main groups of food in the nutrition pyramid were considered as healthy food (bread and rice for example as a type of carbohydrates also protein as meat, fish, eggs, and milk products). Reported unhealthy foods were chocolate and fast food such as sandwiches' prepared out of home either as snacks or at meal time. Participants mentioned the meals items and then a snack food item was eaten both 'yesterday' and 'in general'. The score is given for perfect meal that contains all components of healthy food (fresh fruit, vegetables, legumes, and wholegrain cereal foods, as well as dairy and animal products) and takes score 2, whereas the meal that contain one or more unhealthy component (chocolate and fast food such as sandwiches' prepared out of home) is considered unhealthy and given score 1. They were analyzed in terms of total scores, which were 'unhealthy' and 'healthy' foods. These items were selected to provide some preliminary insights into the kinds of meals and snacks that children and their families eat.
It assessed basic knowledge, attitude, and practice (KAP) of the children about what they eat and healthy food in general. Food preference was scored and classified as healthy or unhealthy food preference to study the effect of child parameters such as knowledge of child and his socioeconomic status on this preference and the effect of this preference on his anthropometric measurements.
Measurement of body weight and height and calculation of body mass index
All participants were asked to remove their shoes and socks, after which their height and body weight were measured in units of 0.1 cm and 0.1 kg, respectively, while they were wearing light clothing. BMI was calculated as body weight (kg) divided by the square of the height (m 2 ).
Score of centile is performed according to Egyptian centiles as the following (Egyptian growth charts 2002):
- Child with BMI below 5th centile is considered underweight.
- Child with BMI from above or equal to 5th centile to below 85th centile is considered normal.
- Child with BMI equal or above 85th centile but less than 95th centile is considered overweight.
- Child with BMI equal or above 95th centile is considered obese.
| Results|| |
Nutritional knowledge (KAP) of parents regarding nutritional practice of their children shows no significant correlation (P > 0.05) ([Table 1]). There was a significant correlation between parent's knowledge score and healthy food intake in general by children ([Table 2] and [Figure 1]). There was no significant correlation between nutritional practice of children and their BMI and height, whereas there was significant correlation between nutritional practice of children and their weight. No significant correlation was found between nutritional practice and children's height and BMI ([Table 3]). There was a highly significant correlation between social class of parents and their children nutritional behavior. Another significant correlation was demonstrated between father's education and mother's education and their children nutritional practice ([Table 4]).
|Table 1: Correlation between nutritional knowledge (knowledge, attitude, and practice) of parents and nutritional practice of their children |
Click here to view
|Table 2: Correlation between nutritional knowledge of parents and healthy food intake of their children |
Click here to view
|Table 3: Correlation between nutritional practice of children and their anthropometric measures |
Click here to view
|Table 4: Effect of parent parameters on their children nutritional practice |
Click here to view
|Figur 1: Significant correlation between parent's knowledge score and intake of healthy food by children in general.|
Click here to view
| Discussion|| |
In this study, there was no significant correlation between nutritional knowledge (KAP) of parents and nutritional practice of their children ([Table 1]).
These results are in disagreement with the results of Fisher and Birch  who showed that parents shape the development of children's eating behaviors, not only by the foods they make accessible to children, but also by their own eating styles, behavior at meal times, and child-feeding practices. Parent's child-feeding practices are associated with children's eating behaviors, including specific eating styles, food selection and preferences, and the regulation of energy intake.
In this study, there was a significant correlation between nutritional knowledge of parents and healthy food intake of their children (fresh fruit, vegetables, legumes and wholegrain cereal foods, as well as dairy and animal foods). The mean of the score for parent knowledge about healthy food intake was 6.1 ± 2.57 (R = 0.222, P = 0.015) ([Table 2]).
This result agreed with the study conducted by Al-Shookr et al.  in Oman, who showed that there was a positive relationship between children's dietary food intake scores and the mothers' nutritional knowledge and attitude scores. Nutritional knowledge was related to dietary intake, highlighting the fact that nutrition-related education and information for mothers can improve their offspring's dietary intake in Oman.
The results disagreed with the study by Variyam et al.  who showed that there is considerable evidence that most parents have a reasonable understanding of which foods are beneficial and which foods are deleterious to their children's health. Parents consistently report being concerned about their children's diet  and claim that the food choices they offer their children reflect these concerns; however, studies have shown that they feed their children a less healthy diet than that they consume themselves  . The available evidence suggests that, in many families, there is a discrepancy between the stated attitudes and behaviors of parents and the actual food provided to the children.
In this study, the correlation between nutritional practice of children and their BMI and height showed no significant correlation (R = −0.038, P = 0.682), whereas there was significant correlation between nutritional practice of children and their weight ([Table 3]).
In this study, parent parameters affecting their children nutritional practice, such as parents education, showed significant relationship for mother and father (P = 0.023 and 0.018, respectively) ([Table 4]).
These results agreed with a study conducted in Oman by Al-Shookri  ; they showed the effect of both levels of mother's education and work on their attitudes toward healthy eating. It was found that there was an inverse relationship between maternal work level and scores of healthy eating attitudes; however, the difference between high and low maternal work level in their effect on healthy eating attitudes was not significant. In contrast, the results showed that, as the educational level of the mother increased, their attitudes toward healthy eating also increased.
In contrast to the current study, Vereecken et al.  studied the dietary intake in adolescents and found a higher intake of healthy items and a lower intake of less healthy items such as soft drinks and coffee in children whose parents had higher levels of occupation.
| Conclusion|| |
Parents shape the development of children's eating behaviors, not only by the foods they make accessible to children, but also by their own eating styles, behavior at meal times, and child-feeding practices. There was no significant correlation between nutritional knowledge (KAP) of parents and nutritional practice of their children, whereas there was a relationship between parents knowledge, attitude, and healthy food intake by children. Nutritional practice of children affects positively on their weight. Social class of parents, father's education, and mother's education have great influence on children's nutritional behavior.
| Acknowledgements|| |
Conflicts of interest
There are no conflicts of interest.
| References|| |
|1.||Taras H. Nutrition and student performance at school. J Sch Health 2005; 75 :199-213. |
|2.|| Renae Brinkman J. Food and drink,why is a healthy diet important for child development?; 2013. Available at: http://www.livestrong.com. [Last assessed on 2013 April 01]. |
|3.|| Lambert J, Agostoni C, Elmadfa I, Hulsof K, Krause E, Livingstone B, et al. Dietary intake and nutritional status of children and adolescents in Europe. Br J Nutr 2004; 92:S147-S211. |
|4.|| Bellows L, Anderson J. The food friends: encouraging preschoolers to try new foods. Young Children 2006; 61 :37-39. |
|5.|| Clark H, Goyder E, Bissel P, Blank L, Peters J. How do parents' child-feeding behaviours ýnfluence child weight? Implications for childhood obesity policy. J Public Health 2007; 29 :132-141. |
|6.|| Gable S, Chang Y, Krull JL. Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children. J Am Diet Assoc 2007; 107 :53-61. |
|7.|| Satter EM. Appendix C, What surveys say about our eating. Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook. Madison, WI: Kelcy Press; 2008. |
|8.|| Wenrich TR, Brown JL, Miller DM, Kelley KJ, Lengerich EJ. Family members' ýnfluence on family meal vegetable choices. J Nutr Educ Behav 2010; 42 :225-233. |
|9.|| USDA. (2011). USDA dietary guidelines. Food Pyramid Guideline and wellness. Available at: http://www.keepkidshealthy.com/nutrition/food_pyramid.html. [Last assessed on 2013 March 15]. |
|10.||Fisher JO, Birch LL. Restricting access to foods and children's eating. Appetite:1999; 32 :405-419. |
|11.||Al-Shookri A, Al-Shukaily L, Al-Tobi L. Effect of mothers nutritional knowledge and attitudes on Omani children's dietary intake. Oman Med J 2011; 26 :253-257. |
|12.||Variyam J, Blaylock J, Lin B, Ralston K, Smallwood D. Mother's nutrition knowledge and children's dietary intakes. Am J Agric Econ 1999; 81 :373-384. |
|13.||Contento IR, Basch C, Shea S, Gutin B, Zybert P, Michela JL, Rips J. Relationship of mothers' food choice criteria to food intake of preschool children: identification of family subgroups. Health Educ Q 1993; 20 :243-259. |
|14.||Alderson TSJ, Ogden J. What do mothers feed their children and why? Health Educ Res 1999; 14 :717-772. |
|15.||Vereecken C, Huybrechts I, Van Houte H, Martens V, Wittebroodt I, Maes L. Results from a dietary intervention study in preschools 'Beastly Healthy At School'. Int J Public Health 2009; 54 :142-149. |
[Table 1], [Table 2], [Table 3], [Table 4]