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Pediatric Healthcare Organizations Partner to Prevent Childhood Obesity

By Karen Giles Smith, MS, RD

“The ‘crisis of child overweight’ is actually a crisis of feeding and parenting in the broad sense, in that we are all responsible for our children. Child overweight is symptomatic of that crisis.”
— Ellyn Satter, MS, RD, LCSW, BCD

When it comes to raising children—including feeding them—parents do the best they can to help them grow up happily and healthfully. But a lack of knowledge and skill about child feeding can derail best intentions and hinder rather than foster a child’s ability to eat well.

Negative feeding behaviors, such as pressuring children to eat or restricting food, are becoming more common. According to research, 85% of parents interfere with their child’s eating.1 As a result, feeding problems such as obesity, anemia, dental caries, and nonorganic failure to thrive are on the rise.

Program Set in Motion

Wouldn’t it be wonderful if parents were taught proper feeding practices at an early stage in their child’s development? That’s exactly what the Santa Clara County Public Health Department in California set out to do to reduce known risk factors for obesity. The result is a countywide child-feeding intervention program called the Childhood Feeding Collaborative.

The Institute of Medicine’s 2004 report on preventing childhood obesity states that the ideal time to provide parent intervention to improve child-feeding practices is during early childhood. To improve parenting skills around feeding at the earliest opportunity, the collaborative uses grant funding to provide training for pediatric healthcare professionals, offer free classes for parents, and coordinate communication and referral efforts among healthcare providers, public health and nutrition programs, and child development providers (see “Network of Advocacy” below). 

At the collaborative’s core is the Division of Responsibility (DOR), a best-practice feeding model formalized by Ellyn Satter, MS, RD, LCSW, BCD, an authority on eating and feeding, and endorsed by the American Academy of Pediatrics. The DOR promotes an authoritative style of parenting in which parents are responsible for what they feed their children, and when and where feeding occurs. The child is responsible for how much and whether to eat within those structural guidelines.

The DOR is an evidence-based approach that supports parents as competent feeders and children as competent eaters, and it has been shown to lower childhood obesity risk. The vision of the collaborative is that “all families in Santa Clara County receive Division of Responsibility-based feeding guidance from each of their relevant service providers.”

Small Beginnings

How did such a comprehensive program get its start? More than 12 years ago, while working closely with hundreds of pediatricians, Carol Danaher, MPH, RD, of the Santa Clara County Public Health Department, recognized both a problem and an opportunity. “I kept hearing the pediatricians’ desperate concerns for families and how feeding was handled,” she explains.

Danaher discovered that the majority of these pediatricians weren’t aware of the DOR and were mystified that parents weren’t following their advice. “The starting point was to help pediatricians serve parents better.”

Danaher initiated the DOR trainings for pediatricians, social workers, mental health practitioners, nurses, and dietitians in Santa Clara County. The evaluations were encouraging. “The participants liked the sessions and noted they would change their practice because of it,” Danaher says.

Next, the Santa Clara County Public Health Department and Choices for Children, a community-based child care organization, partnered with pediatric clinics, managed care plans, WIC, and others to design, implement, and evaluate a pilot program to promote best feeding practices to low-income parents with young children. Pediatric healthcare providers received training in the DOR and how to refer parents to a two-hour class covering the DOR. Results showed the intervention significantly improved child-feeding directives and practices among pediatric healthcare providers and parents, respectively.2

The collaborative now is garnering national attention. “We’ve received comments and interest from all over the United States,” Danaher says. “Some healthcare professionals are revamping obesity prevention programs in their clinics and are interested in our program and the materials we’ve developed.”

For those aspiring to spearhead local collaboration efforts to improve child-feeding practices, Danaher suggests beginning with a narrow focus. Start locally with a single organization, such as a local dietetic association or PTA, gauge interest and support, and test possibilities.

“To be an effective spark plug in your community, you need to partner with others such as the head of pediatrics at a local hospital and a health plan,” she advises. “The new focus in public health and clinical is cross-collaboration. Public health departments are looking for ways to collaborate with local providers.”

In addition to strong partnerships, the success of the Childhood Feeding Collaborative is attributable to the repetitive, consistent messaging regarding the DOR that parents receive in various healthcare settings.

“I’m always impressed by how the DOR model resonates, especially with people who know children and child development well, like childcare providers,” Danaher says. “DOR is so logical.”

— Karen Giles-Smith, MS, RD, is a freelance writer based in Michigan and the health and wellness editor for Dairy Foods magazine. Her 23-year career in nutrition has encompassed clinical dietetics, nutrition education, and nutrition communications.

Network of Advocacy
The Childhood Feeding Collaborative supports coordinated communication among healthcare providers, public health and nutrition programs, and community-based organizations.

Healthcare Providers
  • County and community pediatric clinics
  • Managed care plans
  • Pediatric Healthy Lifestyle Center obesity intervention program (California)
Public Health and Nutrition Programs
  • WIC programs
  • Public health nurses
  • Adolescent Family Life Program (California)
  • Black Infant Health Program (California)
  • Breast-feeding promotion project
  • Mental health providers
  • Comprehensive Perinatal Services Program (California)
Community-Based Organizations
  • Community-based parent educators
  • Childcare providers
  • Family wellness court home visitors
Resources for Health Professionals References
  1. Orrell-Valente JK, Hill LG, Brechwald WA, Dodge KA, Pettit GS, Bates JE. “Just three more bites”: an observational analysis of parents’ socialization of children’s eating at mealtime. Appetite. 2007;48(1):37-45.
  2. Danaher CD, Fredericks D, Bryson SW, Agras WS, Ritchie L. Early childhood feeding practices improved after short-term pilot intervention with pediatricians and parents. Child Obes. 2011;7(6):480-487.