Original Article
The Variability of Young Children's Energy Intake
N Engl J Med 1991; 324:232-235January 24, 1991
- Abstract
- Abstract
Background.
Research conducted in the 1930s showed that, given nutritious choices, children can select an adequate diet without adult supervision. Paradoxically, children grew well and were healthy despite patterns of intake at individual meals that were unpredictable and highly variable.
Methods.
To investigate in more detail the energy intake of young children, we measured 24-hour food intake for 15 children, from two to five years of age, on six days. For each of the six days of the study, coefficients of variation were calculated for each child for each of the six meals and snacks (breakfast, lunch, dinner, and morning, afternoon, and evening snacks) and for total daily energy intake.
Results.
The children's intake at individual meals was highly variable, but total daily energy intake was relatively constant for each child. The mean coefficient of variation for each child's energy intake at individual meals was 33.6 percent; in contrast, the mean coefficient of variation for each child's total daily energy intake was 10.4 percent. In most cases, high energy intake at one meal was followed by low energy intake at the next meal, or vice versa.
Conclusions.
Although children's food consumption is highly variable from meal to meal, daily energy intake is relatively constant, because children adjust their energy intake at successive meals. (N Engl J Med 1991; 324: 232–5.)
Media in This Article
Figure 1
Body Weight and Mean Total Daily Energy Intake of 15 Children from Two to Five Years of Age.Figure 2
Coefficients of Variation for Total Energy Intake and for Intake at the Six Meals and Snacks for Individual Children (within-Subject Variation).Article Activity
- Article
THE maintenance of a positive energy balance is critical in sustaining growth and health in children. In pioneering research conducted 60 years ago, Clara Davis studied the intake patterns of a group of infants on a pediatric ward who selected their own diets for several months.1 , 2 Her findings revealed a paradox. On the one hand, in the absence of adult attempts to control the infants' food intake, they grew well and were healthy, leading Davis to suggest "the existence of some innate, automatic mechanism for its accomplishment." On the other hand, the children's mealtime patterns revealed that "tastes changed unpredictably..., refusing as we say 'to stay put.'... Meals were... a dietitian's nightmare."2 Davis' observations are consistent with parental reports that young children's eating behavior is erratic: they eat "like a bird" on one occasion and "like a horse" on another, and foods avidly consumed one day are rejected the next.
Subsequent research has demonstrated that infants and young children can modify their intake in response to the energy content of the diet.3 4 5 6 If young children are fed fixed volumes of a first course that is either high or low in energy content and are then given the opportunity to consume what they wish from an array of palatable foods, their energy intake is greater after the low-energy than after the high-energy first course.4 5 6 Whether children's energy intake at one meal influences their intake at subsequent meals is not known, however.
We hypothesized that the apparent contradiction in the findings reported by Davis could be resolved by an examination of the variability of energy intake both at mealtimes and over a 24-hour period. We focused on total daily energy intake because it is an accepted and widely used measure and because research on patterns of intake among free-living adults has suggested that systematic patterns in intake might emerge in this period.7 We undertook a study designed to investigate the meal-to-meal and day-to-day variability in children's energy intake, thus providing information about the precision of energy-intake regulation and about the period over which regulation occurs.
Methods
The study subjects were 15 normal preschool children, 7 boys and 8 girls, ranging in age from 26 to 62 months. All the children were attending a day-care center that served middle-income families. Children with food allergies or any chronic health problems and those who were below the 10th or above the 90th percentile for weight or height were excluded. The protocol was approved by the University of Illinois Institutional Review Board. Informed consent was obtained from the parents of each child before the study began.
Complete 24-hour dietary information was obtained for each child for each Tuesday and Wednesday during three consecutive weeks. We chose the same two days each week because the children's schedules on those days were similar each week. During this period, the children ate in their usual home and day-care settings. They were offered the foods in menu 1 on Tuesday of each week, and the foods in menu 2 on Wednesday of each week. Meals were served at standard scheduled times; although the children had no control over when the meals were presented, they were free to consume what they wished at a particular meal. Foods providing approximately 11,300 kJ (2700 kcal) were offered each day to ensure that the children's intake was not limited by the availability of food. The estimated daily energy allowance for children from two to five years old is about 5860 kJ (1400 kcal).8 The foods served and the macronutrient composition of the menus are shown in Table 1Table 1
Menus Served to Children on Tuesday (Day 1 ) and Wednesday (Day 2) of Each Week, Including Macronutrient Content..The children's food intake was measured by weighing every food both before and after all six meals (breakfast, morning snack, lunch, afternoon snack, dinner, and evening snack) on each of the six study days. The first four meals each day were consumed at the day-care center, under the supervision of trained observers. Dinner and the evening snack were consumed at home. Foods for these two meals were prepared at the center, each food item was weighed in a separate container, and the foods were taken home in an insulated food container. Detailed instructions were given to the parents to minimize errors. The children ate directly from the containers, the uneaten portions were resealed in the containers, and the insulated food container, together with its contents, was returned to the research staff at the day-care center for weighing the following morning. Parents were carefully instructed not to allow other family members to consume the food and were trained to report spills and any departures from the prescribed procedures. We did not supply meals for the other members of the household, but the participating children typically ate with the family at their scheduled mealtime. The energy content and nutrient composition of the foods offered were calculated with use of the University of Minnesota Nutrition Database and Nutrient Calculation System.
Statistical Analysis
The coefficient of variation (CV) is defined as the standard deviation divided by the mean. The CV provided an index of the day-to-day variability in energy intake for each child at individual meals, as well as for total energy intake. Calculation of the CVs made it possible to compare the variability of measures with different mean values; for example, we could compare the variability of energy intake at individual meals to the variability of energy intake over a 24-hour period. To obtain a measure of the variability of intake at individual meals for the group of 15 children, the CVs for each child were averaged for each meal. These six composite CVs (one for each meal) were then averaged for all the meals to obtain one value for the variability of intake at each of the six meals. To obtain a composite CV for total daily energy intake, the 15 children's CVs for total daily energy intake were averaged. CVs for total energy intake were also calculated for five additional 24-hour periods, each of which included parts of two calendar days and an overnight fast. The first period began with the morning snack on day 1 and ended with breakfast on day 2, and the fifth period began with the evening snack on day 1 and ended with dinner on day 2. Correlations between energy intake at a given meal and intake at the next meal (for example, intake at breakfast and morning snack, or intake at morning snack and lunch) were calculated for each child. Negative correlations between energy intake at one meal and intake at the next were obtained when high-energy meals followed low-energy meals, or vice versa. A consistent pattern of negative correlation reflected compensation in energy intake at successive meals. For each child, the number of negative correlations obtained for two successive meals (ranging from 0 to 5) provided an index of meal-to-meal compensation in energy intake. The correlation between this compensation index and the CV for total energy intake was calculated for each child.
Results
Descriptive information on the children's total daily energy intake is shown in Figure 1Figure 1
Body Weight and Mean Total Daily Energy Intake of 15 Children from Two to Five Years of Age., which presents the mean total daily energy intake for the six study days for each child. Total daily energy intake for the group ranged from approximately 4600 to 7530 kJ (1100 to 1800 kcal) per day. The correlation between total daily energy intake and body weight was 0.76. As Figure 1 shows, there were large individual differences in total daily energy intake.Variability in Energy Intake within Subjects
Figure 2 shows the CVs for energy intake at each of the six meals and snacks and for total daily energy intake for each of the 15 children (within-subject CVs). In contrast to the large CVs for each of the six meals and snacks, the CV for total daily energy intake is relatively small. This pattern is clear in the mean within-subject CVs for individual meals; the CVs were 31 percent for breakfast, 30 percent for morning snack, 31 percent for lunch, 44 percent for afternoon snack, 30 percent for dinner, and 35 percent for evening snack. In contrast, the mean within-subject CV for total daily energy intake was 10.4 percent.
Within the constraint of fixed mealtimes, the children could modulate their total daily energy intake only by varying the amount of energy they consumed at individual meals. Adjustments in energy intake at successive meals could produce the pattern we observed: small CVs for total daily intake and large CVs for the individual meals (Fig. 2). As described in Methods, correlations between energy intake at one meal and intake at the next meal were used to investigate the possibility of meal-to-meal compensation in energy intake. A preponderance of negative correlations was noted: of the 75 correlations calculated (5 correlations for each of 15 children), 48 were negative, providing evidence of compensation in energy intake from one meal to the next.
Individual Differences in Patterns of Intake
The within-subject CVs for total daily energy intake were used in conjunction with the meal-to-meal correlations just described to examine the relation between a child's CV for total daily energy intake and the evidence of meal-to-meal compensation in energy intake. The relation between the number of negative meal-to-meal correlations and the child's CV for total energy intake was significant (r = -0.51, P<0.05). The children who had the smallest CVs for total daily energy intake had the strongest evidence of meal-to-meal compensation in energy intake.
For all 15 children, the CVs for total daily energy intake were smaller than the CVs for mealtime intake, but clear differences existed among individual children's patterns of mealtime energy intake. Figure 3Figure 3
Energy Intake at Mealtimes for Three Children with Low, High, and Median Coefficients of Variation for Total Daily Energy Intake. shows the patterns of intake for three children for each meal and snack on the six study days. The data shown are those for the children with the lowest CV (2.5 percent), the highest CV (17.5 percent), and the median CV (10.9 percent) for total daily energy intake. In addition to individual differences in the variability of energy intake, the children's intake profiles were also distinctive. These profiles are probably influenced by the preferences of the individual children for the foods offered. For example, the large and consistent peak for Subject 15 at dinner on Wednesday of each week may reflect that child's enthusiasm for macaroni and cheese.Period of Intake Regulation
We also investigated the variation in total energy intake over different 24-hour periods to determine whether there was something unique about the calendar day for the control of energy intake. The within-subject CVs for total daily energy intake reported above were calculated with use of the conventional 24-hour period (from morning to evening of a calendar day). We also used five additional 24-hour periods, all of which included an overnight fast. When calculated for the five other 24-hour periods, which included parts of two calendar days, the mean within-subject values were comparable to those for the calendar day (10.4 percent) — 10.9, 12.3, 11.5, 12.4, and 11.4 percent. The pattern of small within-subject CVs for total energy in comparison with the CVs for individual meals therefore was evident whether the data on intake were analyzed according to calendar day or according to 24-hour periods that included parts of two days and an overnight fast.
Discussion
For each child, energy intake at a given mealtime was highly variable. On two occasions when the same menu was offered, a child might consume a breakfast consisting of food providing 420 kJ (100 kcal); on another, he or she might consume foods providing 1470 kJ (350 kcal). In comparison with the variability of intake at mealtimes, the variability of total daily energy intake was low. This general pattern emerged consistently among the 15 children, despite individual differences in the degree of variability and the absolute level of energy intake. These findings are reminiscent of the contradictory picture presented by Davis' findings: children's intake at individual meals was unpredictable and highly variable, yet the children grew well and were healthy, suggesting the existence of some orderly control mechanism. Order appeared when a different level of analysis was adopted, and our results indicate that the resolution of the paradox may be found in the way energy intake is regulated over a longer period of time. Although each child's intake at individual meals was erratic, the existence of an orderly mechanism was evident in the relatively small CVs for total energy intake. The children's intake at individual meals was not independent, and there was evidence that high energy intake at one meal was often compensated for by low energy intake at the next, and vice versa.
Individual differences in the children's CVs for total daily energy intake were systematically related to individual differences in the patterns of meal-to-meal correlations. This pattern provides support for the view that the relatively small CVs for total energy intake were due in part to compensation in energy intake at successive meals. Simple correlations between one meal and the next provide a conservative estimate of energy compensation at successive meals, however, because they do not reflect compensation that may be occurring at meals eaten after the next meal; the meal-to-meal correlations we used fail, for example, to capture compensation at lunch for high or low energy intake at breakfast. Although some children showed little evidence of energy compensation at successive meals, all had CVs for individual mealtimes that were larger than their CVs for total daily energy intake. This pattern may have resulted from compensation at meals after the next meal for high or low energy intake earlier in the day.
Previous research demonstrated that children can respond to the energy density of foods in regulating their intake at single meals.4 5 6 Our data provide evidence for the behavioral regulation of food intake by young children over 24-hour periods. In an earlier study by Harries et al.,9 the reported CVs for total daily energy intake were 18 percent for preschool children and ranged between 15 and 30 percent for young adults. Our values are similar but somewhat lower, perhaps because we were able to control the foods served to the children. However, Harries et al. did not obtain estimates of the variability of energy intake at individual meals that could be compared with their estimates of the variability of total daily energy intake.
In addition to providing basic information on the regulation of energy intake, these results have important practical implications. Many parents assume that their young children cannot adequately regulate their food intake, and parental observations of the erratic eating patterns of their children provide support for this belief. In response, parents often adopt coercive strategies in an attempt to ensure that the child consumes a nutritionally adequate diet. These strategies can include the use of threats and bribes and of rewards or punishment contingent on eating behavior. Previous research indicates that such control strategies are counterproductive10 , 11; parents' attempts to control their child's eating were reported more often by obese adults than by adults of normal weight.12 At least with respect to the regulation of energy intake, the results of our study suggest that coercive feeding strategies may also be unnecessary. As revealed by Clara Davis 60 years ago, the successful feeding of children is best accomplished by providing them with a variety of healthful foods and allowing them to eat what they wish.
Supported by the Procter & Gamble Company.
Source Information
From the School of Human Resources and Family Studies, University of Illinois at Urbana-Champaign (L.L.B., S.L.J., G.A.), and the Procter & Gamble Miami Valley Laboratories, Cincinnati (J.C.P., M.C.S.). Address reprint requests to Dr. Birch at the Child Development Laboratory, 1105 W. Nevada St., Urbana, IL 61801.
- References
References
1
Davis
Web of Science2
Davis
Web of Science | Medline3
Fomon SJ. Infant nutrition. 2nd ed. Philadelphia: W.B. Saunders, 1974
4
Birch
CrossRef | Web of Science5
Birch
Web of Science | Medline6
Birch
CrossRef | Web of Science | Medline7
Foltin
Web of Science | Medline8
Pellett
Web of Science | Medline9
Harries
CrossRef | Web of Science | Medline10
Birch
CrossRef | Web of Science11
Birch
CrossRef | Web of Science12
Costanzo
CrossRef
- Citing Articles (87)
Citing Articles
1
J. More. (2012) Evidence-based portion sizes for toddlers (aged 1-3 years). Nutrition Bulletin 37:1, 64-66
CrossRef2
Samantha A. Ramsay, Laurel J. Branen, Susan L. Johnson. (2012) How much is enough? Tablespoon per year of age approach meets nutrient needs for children. Appetite 58:1, 163-167
CrossRef3
Annemarie Olsen, Christopher van Belle, Karol Meyermann, Kathleen L. Keller. (2011) Manipulating fat content of familiar foods at test-meals does not affect intake and liking of these foods among children. Appetite 57:3, 573-577
CrossRef4
Helen Skouteris, Marita McCabe, Lina A. Ricciardelli, Jeannette Milgrom, Louise A. Baur, Nazan Aksan, Daniela Dell’Aquila. (2011) Parent–child interactions and obesity prevention: a systematic review of the literature. Early Child Development and Care1-22
CrossRef5
Laura Kane, Charlotte Wright, Wan Fathin Fariza, Marion Hetherington. (2011) Energy compensation in enterally fed children. Appetite 56:1, 205-209
CrossRef6
Robert D. Baker, Susan S. Baker. 2011. Infant and Toddler Nutrition. , 935-946.
CrossRef7
José L Santos, Judith A Ho-Urriola, Andrea González, Susan V Smalley, Patricia Domínguez-Vásquez, Rodrigo Cataldo, Ana M Obregón, Paola Amador, Gerardo Weisstaub, M Isabel Hodgson. (2011) Association between eating behavior scores and obesity in Chilean children. Nutrition Journal 10:1, 108
CrossRef8
Ewa A. SZYMLEK-GAY, Elaine L. FERGUSON, Anne-Louise M. HEATH, Elizabeth A. FLEMING. (2010) Quantities of foods consumed by 12- to 24-month-old New Zealand children. Nutrition & Dietetics 67:4, 244-250
CrossRef9
Maureen M. Black, Kristen M. Hurley. 2010. Infant Nutrition. , 33-61.
CrossRef10
Kathleen L. Keller, Adrienne Reid, Megan C. MacDougall, Hope Cassano, Joo Lee Song, Liyong Deng, Patricia Lanzano, Wendy K. Chung, Harry R. Kissileff. (2010) Sex Differences in the Effects of Inherited Bitter Thiourea Sensitivity on Body Weight in 4–6-Year-Old Children. Obesity 18:6, 1194-1200
CrossRef11
James A. Hanley, Jennifer A. Hutcheon. (2010) Does children's energy intake at one meal influence their intake at subsequent meals? Or do we just think it does?. Paediatric and Perinatal Epidemiology 24:3, 241-248
CrossRef12
Richard D. Mattes. (2010) Hunger and thirst: Issues in measurement and prediction of eating and drinking. Physiology & Behavior 100:1, 22-32
CrossRef13
Carlo Agostoni, Furio Brighenti. (2010) Dietary Choices for Breakfast in Children and Adolescents. Critical Reviews in Food Science and Nutrition 50:2, 120-128
CrossRef14
Olga Lopez-Dicastillo, Gunn Grande, Peter Callery. (2010) Parents’ contrasting views on diet versus activity of children: Implications for health promotion and obesity prevention. Patient Education and Counseling 78:1, 117-123
CrossRef15
France Bellisle. (2009) How and why should we study ingestive behaviors in humans?. Food Quality and Preference 20:8, 539-544
CrossRef16
Adwait Khare, J. Jeffrey Inman. (2009) Daily, Week-Part, and Holiday Patterns in Consumers' Caloric Intake. Journal of Public Policy & Marketing 28:2, 234-252
CrossRef17
L. Johnson, D. C. Wilks, A. K. Lindroos, S. A. Jebb. (2009) Reflections from a systematic review of dietary energy density and weight gain: is the inclusion of drinks valid?. Obesity Reviews 10:6, 681-692
CrossRef18
2009. References. , 335-389.
CrossRef19
Kristoffer S. Berlin, W. Hobart Davies, Debra J. Lobato, Alan H. Silverman. (2009) A Biopsychosocial Model of Normative and Problematic Pediatric Feeding. Children's Health Care 38:4, 263-282
CrossRef20
Ihuoma U. Eneli, Peggy Crum, Tracy L. Tylka. (2009) One-size-does-not-fit-all: A Case for Further Research on the Tenets of the Trust Model. Obesity 17:8, 1478-1480
CrossRef21
Marijn van Dijk, Sabine Hunnius, Paul van Geert. (2009) Variability in eating behavior throughout the weaning period. Appetite 52:3, 766-770
CrossRef22
L L Birch, A K Ventura. (2009) Preventing childhood obesity: what works?. International Journal of Obesity 33, S74-S81
CrossRef23
John M. Poothullil. (2009) Meal termination using oral sensory satisfaction: a study in non-obese women. Nutritional Neuroscience 12:1, 28-34
CrossRef24
Fiona McKiernan, Jenny A. Houchins, Richard D. Mattes. (2008) Relationships between human thirst, hunger, drinking, and feeding. Physiology & Behavior 94:5, 700-708
CrossRef25
(2008) Position of the American Dietetic Association: Nutrition Guidance for Healthy Children Ages 2 to 11 Years. Journal of the American Dietetic Association 108:6, 1038-1047
CrossRef26
Madeleine Sigman-Grant, Elizabeth Christiansen, George Fernandez, Janice Fletcher, Susan L. Johnson, Laurel Jean Branen, Beth Price. (2008) Hungry Mondays: Low-Income Children in Childcare. Journal of Hunger & Environmental Nutrition 2:4, 19-38
CrossRef27
Julie A. Mennella, Sophie Nicklaus, Amanda L. Jagolino, Lauren M. Yourshaw. (2008) Variety is the spice of life: Strategies for promoting fruit and vegetable acceptance during infancy. Physiology & Behavior 94:1, 29-38
CrossRef28
Jennifer O. Fisher, Tanja V.E. Kral. (2008) Super-size me: Portion size effects on young children's eating. Physiology & Behavior 94:1, 39-47
CrossRef29
Terence M. Dovey, Paul A. Staples, E. Leigh Gibson, Jason C.G. Halford. (2008) Food neophobia and ‘picky/fussy’ eating in children: A review. Appetite 50:2-3, 181-193
CrossRef30
F. McKiernan, J.H. Hollis, R.D. Mattes. (2008) Short-term dietary compensation in free-living adults. Physiology & Behavior 93:4-5, 975-983
CrossRef31
M. Dunitz-Scheer, M. Tappauf, K. Burmucic, P. Scheer. (2007) Frühkindliche Essstörungen. Monatsschrift Kinderheilkunde 155:9, 795-803
CrossRef32
Suzanne Domel Baxter. 2007. Nutrition for Healthy Children and Adolescents Aged 2 to 18 Years. , 285-344.
CrossRef33
Tara L. LaRowe, Suzen M. Moeller, Alexandra K. Adams. (2007) Beverage Patterns, Diet Quality, and Body Mass Index of US Preschool and School-Aged Children. Journal of the American Dietetic Association 107:7, 1124-1133
CrossRef34
Tanja V E Kral, Myles S Faith. (2007) Child eating patterns and weight regulation: a developmental behaviour genetics framework. Acta Paediatrica 96, 29-34
CrossRef35
Amelia A. McCoy, Margaret A. Fox, Douglas E. Schaubel, Rita N. Ayyangar. (2006) Weight Gain in Children With Hypertonia of Cerebral Origin Receiving Intrathecal Baclofen Therapy. Archives of Physical Medicine and Rehabilitation 87:11, 1503-1508
CrossRef36
Sibylle Kranz, Terryl Hartman, Anna Maria Siega-Riz, Amy H. Herring. (2006) A Diet Quality Index for American Preschoolers Based on Current Dietary Intake Recommendations and an Indicator of Energy Balance. Journal of the American Dietetic Association 106:10, 1594-1604
CrossRef37
2006. Motivational Interviewing for Childhood and Parental Feeding Habits. , 55-65.
CrossRef38
Harsohena Kaur, Chaoyang Li, Niaman Nazir, Won S. Choi, Ken Resnicow, Leann L. Birch, Jasjit S. Ahluwalia. (2006) Confirmatory factor analysis of the child-feeding questionnaire among parents of adolescents. Appetite 47:1, 36-45
CrossRef39
Tracy L. Tylka. (2006) Development and psychometric evaluation of a measure of intuitive eating.. Journal of Counseling Psychology 53:2, 226-240
CrossRef40
Meredith Dolan, Tanja Kral, Myles Faith, Julia Kerns. 2005. Behavioral Aspects of Food Intake. , 209-225.
CrossRef41
Sophie Nicklaus, Claire Chabanet, Vincent Boggio, Sylvie Issanchou. (2005) Food choices at lunch during the third year of life: Increase in energy intake but decrease in variety. Acta Paediatrica 94:8, 1023-1029
CrossRef42
M Livingstone, K Rennie. 2005. Biobehavioral Determinants of Energy Intake and Childhood Obesity. , 101-118.
CrossRef43
Gordana Mrdjenovic, David A. Levitsky. (2005) Children eat what they are served: the imprecise regulation of energy intake. Appetite 44:3, 273-282
CrossRef44
Sarah J. Mason, Gillian Harris, Jacqueline Blissett. (2005) Tube Feeding in Infancy: Implications for the Developmentof Normal Eating and Drinking Skills. Dysphagia 20:1, 46-61
CrossRef45
Annatjie M. Smith, Saartjie Roux, N.T. (Raj) Naidoo, Daniel J.L. Venter. (2005) Food choices of tactile defensive children. Nutrition 21:1, 14-19
CrossRef46
Stephen C. Woods, Stephen C. Benoit, Deborah J. Clegg, Randy J. Seeley. (2004) Regulation of energy homeostasis by peripheral signals. Best Practice & Research Clinical Endocrinology & Metabolism 18:4, 497-515
CrossRef47
M. B. E. Livingstone, P. J. Robson, J. M. W. Wallace. (2004) Issues in dietary intake assessment of children and adolescents. British Journal of Nutrition 92:S2, S213
CrossRef48
Louise Thibault, Stephen C. Woods, Margriet S. Westerterp-Plantenga. (2004) The utility of animal models of human energy homeostasis. British Journal of Nutrition 92:S1, S41
CrossRef49
Kathryn N. Parkinson, Charlotte M. Wright, Robert F. Drewett. (2004) Mealtime energy intake and feeding behaviour in children who fail to thrive: a population-based case-control study. Journal of Child Psychology and Psychiatry 45:5, 1030-1035
CrossRef50
Kristen L. McConahy, Helen Smiciklas-Wright, Diane C. Mitchell, Mary Frances Picciano. (2004) Portion size of common foods predicts energy intake among preschool-aged children. Journal of the American Dietetic Association 104:6, 975-979
CrossRef51
(2004) Position of the American Dietetic Association: Dietary Guidance for Healthy Children Ages 2 to 11 Years. Journal of the American Dietetic Association 104:4, 660-677
CrossRef52
Myles S Faith, Kathleen L Keller. (2004) Genetic architecture of ingestive behavior in humans. Nutrition 20:1, 127-133
CrossRef53
M. B. Schwartz, R. Puhl. (2003) Childhood obesity: a societal problem to solve. Obesity Reviews 4:1, 57-71
CrossRef54
R.A.M Dossa, E.A.D Ategbo, J.M.A van Raaij, C de Graaf, J.G.A.J Hautvast. (2002) An appropriate tool for appetite testing and evaluation in young children in Benin. Appetite 38:2, 99-109
CrossRef55
Christina M Morgan, Marian Tanofsky-Kraff, Denise E Wilfley, Jack A Yanovski. (2002) Childhood obesity. Child and Adolescent Psychiatric Clinics of North America 11:2, 257-278
CrossRef56
H Sepp. (2002) The contribution of food groups to the nutrient intake and food pattern among pre-school children. Food Quality and Preference 13:2, 107-116
CrossRef57
Suzanne Domel Baxter. 2001. Nutrition for Healthy Children and Adolescents Ages 2 to 18 Years. .
CrossRef58
L.L Birch, J.O Fisher, K Grimm-Thomas, C.N Markey, R Sawyer, S.L Johnson. (2001) Confirmatory factor analysis of the Child Feeding Questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite 36:3, 201-210
CrossRef59
TIFFANY TIBBS, DEBRA HAIRE-JOSHU, KENNETH B SCHECHTMAN, ROSS C BROWNSON, MARILYN S NANNEY, CHERYL HOUSTON, WENDY AUSLANDER. (2001) The relationship between parental modeling, eating patterns, and dietary intake among African-American parents. Journal of the American Dietetic Association 101:5, 535-541
CrossRef60
H Sepp, M Lennernäs, R Pettersson, L Abrahamsson. (2001) Children's nutrient intake at preschool and at home. Acta Paediatrica 90:5, 483-491
CrossRef61
Blandine Bril, Estelle Hombessa‐Nkounkou, Jean‐François Bouville, Célina Ocampo. (2001) From milk to adult diet: A comparative study on the socialization of food. Food and Foodways 9:3-4, 155-186
CrossRef62
S Saarilehto, S Keskinen, H Lapinleimu, H Helenius, O Simell. (2001) Connections between parental eating attitudes and children's meagre eating: questionnaire findings. Acta Paediatrica 90:3, 333-338
CrossRef63
Jennifer O. Fisher, Rachel K. Johnson, Christine Lindquist, Leann L. Birch, Michael I. Goran. (2000) Influence of Body Composition on the Accuracy of Reported Energy Intake in Children. Obesity 8:8, 597-603
CrossRef64
B. Young, R. Drewett. (2000) Eating behaviour and its variability in 1-year-old children. Appetite 35:2, 171-177
CrossRef65
J.L. Carper, J. Orlet Fisher, L.L. Birch. (2000) Young girls' emerging dietary restraint and disinhibition are related to parental control in child feeding. Appetite 35:2, 121-129
CrossRef66
M. B. E. Livingstone, P. J. Robson. (2000) Measurement of dietary intake in children. Proceedings of the Nutrition Society 59:02, 279-293
CrossRef67
Rachel K. Johnson. (2000) Changing eating and physical activity patterns of US children. Proceedings of the Nutrition Society 59:02, 295-301
CrossRef68
Stewart Agras, Lawrence Hammer, Fiona McNicholas. (1999) A prospective study of the influence of eating-disordered mothers on their children. International Journal of Eating Disorders 25:3, 253-262
CrossRef69
(1999) Position of The American Dietetic Association. Journal of the American Dietetic Association 99:1, 93-101
CrossRef70
Leann L. Birch. (1998) Development of food acceptance patterns in the first years of life. Proceedings of the Nutrition Society 57:04, 617-624
CrossRef71
Bridget Young, Robert Drewett. (1998) Methods for the analysis of feeding behaviour in infancy: Weanlings. Journal of Reproductive and Infant Psychology 16:1, 27-44
CrossRef72
(1998) Abstracts of Communications. Proceedings of the Nutrition Society 57:01, 1A-33A
CrossRef73
Laurel Branen, Janice Fletcher, Linda Myers. (1997) Effects of Pre-portioned and Family-style Food Service on Preschool Children's Food Intake and Waste at Snacktime. Journal of Research in Childhood Education 12:1, 88-95
CrossRef74
SHARON M. PEARCEY, JOHN M. DE CASTRO. (1997) Food Intake and Meal Patterns of One Year Old Infants. Appetite 29:2, 201-212
CrossRef75
JOHN C. PETERS. (1997) Fat Substitutes and Energy Balance. Annals of the New York Academy of Sciences 827:1 Lipids and Sy, 461-464
CrossRef76
I. Skohn, K. Axelsson, P. Ghannad, O. Hernell, Y.B. Wahlin. (1997) Nutrient intake and weight development in children during chemotherapy for malignant disease. Oral Oncology 33:5, 364-368
CrossRef77
Rosenbaum, Michael, Leibel, Rudolph L., Hirsch, Jules, . (1997) Obesity. New England Journal of Medicine 337:6, 396-407
Full Text78
MARCIA NAHIKIAN-NELMS. (1997) Influential Factors of Caregiver Behavior at Mealtime. Journal of the American Dietetic Association 97:5, 505-509
CrossRef79
LEANN L. BIRCH, JENNIFER O. FISHER. (1997) Food Intake Regulation in Children.. Annals of the New York Academy of Sciences 819:1 Nutritional I, 194-220
CrossRef80
Catherine Mogharreban, Marcia Nahikian-Nelms. (1996) Autonomy at mealtime: Building healthy food preferences and eating behaviors in young children. Early Childhood Education Journal 24:1, 29-32
CrossRef81
ELLYNM. SATTER. (1996) Internal Regulation and the Evolution of Normal Growth as the Basis for Prevention of Obesity in Children. Journal of the American Dietetic Association 96:9, 860-864
CrossRef82
Michèle Deheeger, Mouna Akrout, France Bellisle, Claude Rossignol, Marie-Françoise Rolland-Cachera. (1996) Individual patterns of food intake development in children: A 10 months to 8 years of age follow-up study of nutrition and growth. Physiology & Behavior 59:3, 403-407
CrossRef83
Linda V Van Horn, Phyllis Stumbo, Alicia Moag-Stahlberg, Eva Obarzanek, Virginia W Hartmuller, Rosanne P Farris, Sue Y.S Kimm, Margaret Frederick, Linda Snetselaar, Kiang Liu. (1993) The Dietary Intervention Study in Children (DISC): Dietary assessment methods for 8- to 10-year-olds. Journal of the American Dietetic Association 93:12, 1396-1403
CrossRef84
G.H. Beaton, V. Tarasuk, G.H. Anderson. (1992) Estimation of possible impact of non-caloric fat and carbohydrate substitutes on macronutrient intake in the human. Appetite 19:2, 87-103
CrossRef85
KENNETH A. PERKINS. (1992) Effects of tobacco smoking on caloric intake. Addiction 87:2, 193-205
CrossRef86
(1991) The Variability of Young Children's Energy Intake. New England Journal of Medicine 324:25, 1816-1817
Full Text87
Forbes, Gilbert B., . (1991) Children and Food — Order Amid Chaos. New England Journal of Medicine 324:4, 262-263
Full Text
- Letters
