Kaitlyn Richardson

The Healthy Toddlers Trial Protocol: An Intervention to Reduce Risk

Factors for
Childhood Obesity in Economically and Educationally Disadvantaged
Populations
Childhood obesity is a growing problem in the U.S. and
prevention needs to start early because this is when dietary habits and
preferences are formed. Having a poor diet is a major risk factor for
developing obesity. In order to prevent obesity in children good
nutrition and healthy dietary behaviors need to be implemented early
in a childs life. This will ensure healthy growth and development in the
child. The time that this early implementation is most critical is when
the child is between nine and twenty-four months because this is when
the child starts to learn how to self-feed. As toddlers start to become
more independent and self regulate their eating, parents need to help
their child develop healthy eating habits. So as you can see the parent
has a lot of influence and responsibility in their childs development of
proper dietary habits. One of those influences is the parent toddler
relationship. A child learns about food intake from their parents. They
learn about what to eat and why to eat it. The parents shape a childs
food preferences and dietary behaviors. If parents try to form these
good habits early it will help to promote healthy growth and
development in their child. The environment also has an effect on a
childs nutrition. Having a positive mealtime environment influences
the mothers feeding practices which impacts the childs food intake. A
parents knowledge of healthy dietary behaviors, toddler feeding
practices, and nutrition has an impact on a childs nutrition and can
promote the development of obesity. Proper education for the parents
on how to develop positive eating behaviors early in their childs life
can have a positive effect on a childs health and thus help to prevent
obesity. While a poor diet poses a risk for the development of obesity in
all children, children who are economically disadvantaged are at a
higher risk. Because of their high risk of developing obesity,
economically disadvantaged children also have a higher risk of
developing other health issues like cardiovascular disease, type II
diabetes, and hypertension. The goal is to prevent obesity because it is
easier to prevent than to treat and it all begins with parent education.
The Healthy Toddlers Trial was designed to promote healthy
eating behaviors in toddlers before bad dietary habits are formed and
before obesity occurs in toddlers who are educationally and
economically disadvantaged. The aim of the this trial was to determine
what kind of effect home interventions that focused on parent
education had on economically and educationally disadvantaged
mother-toddler dyads as compared to standard parenting and nutrition
education. The focus of the intervention group is on the ability of the
mother during the feeding process as well as what feeding styles and

Kaitlyn Richardson
practices are appropriate. In contrast, the control group will not receive
this extensive amount of information on toddler feeding.
The trial was a randomized, short-term, longitudinal control trial
that took place in Colorado, Michigan, and Wisconsin and it included
mother-toddler participants that were economically and educationally
disadvantaged. To qualify for the trial the mothers had to be at least
18, and the children had to be between twelve and thirty-six months.
To be eligible for the trial the mother and child must also not have any
eating, physical, or chronic health problems. Participants for the
program could also be chosen via community programs such as WIC
and SNAP. Data was collected before the interventions, after the
intervention and six months after the intervention. The amount of
participants in the study was 300 for each group.
The intervention group was randomly picked and these
participants received eight in home lessons. The lessons were geared
towards teaching the parents about parental behaviors and fruit,
vegetable, and sweetened beverage consumption. The lessons also
included discussions between the mother and the instructor, hands on
activities, lessons plans and handouts, and recipes. The lessons were
taught by a paraprofessional, which is a peer instructor and each
lesson is about an hour long. Four follow up phone calls were made
after the eight in home lessons were completed. The expected
outcomes from this intervention is that the child will have an increase
in the consumption of fruits and vegetables and a decrease in the
consumption of sweetened beverages, as well as an improvement in
the toddlers eating skills. The parent should also show improvements
in their knowledge and attitude toward child feeding as well as their
ability to feed the child. Their feeding styles should have also improved
and their mealtime environment should also have made some positive
changes like no TV and eating as a family.
Those that were randomly assigned to the control group received
services from Building Strong Families and Expanded Food and
Nutrition Education Program, which provided lessons on parenting or
nutrition. These lessons did not include a lot of content on toddler
feeding. This group also received eight in home lessons and four follow
up phone calls like the intervention group. It too was one hour long and
taught by a paraprofessional.
The outcomes were measured in a variety of ways, one being
filling out questionnaires. The questionnaires that were used are as
follows: Child-Parent Mealtime Behavior Questionnaire which assessed
the toddlers feeding self regulation; Child-Parent Mealtime Observation
in which the observer rates the mother-child feeding interaction and
the toddlers eating behavior; Nutrition Attitudes Questionnaire which
assess the parents attitude in regards to feeding a child; Self Efficacy
Questionnaire which assess the parents report of their self efficacy in
toddler mealtime interaction; and Child Feeding Questionnaire which

Kaitlyn Richardson
assess the mothers feeding style. The other ways the outcomes were
measured was by doing a 3-day dietary record for their child, which
included two weekdays and one weekend (this was done before, after
and six months after the intervention); anthropometric assessment and
mealtime observations.
If the intervention was successful then we can conclude that it
was effective in helping to develop healthy eating skills in toddlers and
in helping to better the health of the children and prevent obesity. If
the intervention was effective, we can also conclude that it was
successful in providing nutrition education for parents of toddlers who
are economically and educationally disadvantaged. This study can be
used to determine which interventions work best for preventing
childhood obesity.
Some strengths of this intervention were that is was accessible
and feasible for its target population and that it can be used for people
outside of the target audience. Another strength is that this study will
help to more fully understand which interventions work best for
preventing obesity in toddlers. One limitation is that it was a
convenience sampling.
Reference
1. Horodynski M, Baker S, Coleman G, Auld G, Lindau J. The Healthy Toddlers Trial
Protocol: An Intervention to Reduce Risk Factors for Childhood Obesity in Economically
and Educationally Disadvantaged Populations. BMC Public Health 2011; 11:581