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Childhood obesity is a major health problem. Effective strategies are necessary to promote healthy eating in toddlers. The Nutrition Education Aimed at Toddlers project examined rural, low-income caregivers' knowledge, attitudes, mealtime practices, and dietary intake before and after a nutrition program. A convenience sample of 38 families participated in the study; 19 attended classes, and 19 did not. Six months after the lessons, no significant differences were found between groups; however, the resultant dietary, feeding knowledge, attitudinal, and behavioral data provide a valuable description regarding a hard to reach, high-risk population. However, caregivers' perceptions about feeding their toddlers differed from their reported dietary intakes of dairy, fruits, and vegetables. It appears that knowledge is insufficient to change eating habits. Identification of the issues that prevent caregivers in providing proper feeding is needed for a lasting change of eating habits.

The Healthy Toddlers (HT) curriculum, a series of 8 weekly lessons available in English and Spanish, was designed to promote the development of healthy eating habits at an early age through effective nutrition and parenting education. Curriculum content was based on topics of interest to parents and research indicating that although most mothers knew that it was important to feed their children healthy food, they needed strategies and skills to help them accomplish this goal. Healthy Toddlers used a learner-centered approach, based on the Social Cognitive Theory, which addresses both cognitive and environmental influences on behavior. The curriculumwas developed and field tested with 628 families over 3 years in Colorado, Michigan, and Wisconsin. The data gathered are in the process of being analyzed. The HT curriculum emphasized the roles of mothers and toddlers during feeding; that is, mothers determine what the toddler is offered to eat and where and when he eats, and the toddler decides whether and how much he eats. Key concepts in lessons

Background The number of overweight children in America has doubled to an estimated 10 million in the past 20 years. Establishing healthy dietary behaviors must begin early in childhood and include parents. The Healthy Toddlers intervention focuses on promoting healthy eating habits in 1- to 3-year-old children utilizing the Social Cognitive Theory and a learner-centered approach using Adult Learning principles. This Healthy Toddlers Trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mothers of toddlers. The intervention focuses on: (a) promoting healthy eating behaviors in toddlers while dietary habits are forming; and (b) providing initial evidence for the potential of Healthy Toddlers as a feasible intervention within existing community-based programs. Methods/Design This describes the study protocol for a randomized control trial, a multi-state project in Colorado, Michigan, and Wisconsin with economically and educationally disadvantaged mother-toddler dyads; toddlers are between 12 and 36 months. The Healthy Toddlers intervention consists of eight in-home lessons and four reinforcement telephone contacts, focusing on fruit, vegetable, and sweetened beverage consumption and parental behaviors, taught by paraprofessional instructors. Healthy Toddlers uses a randomized, experimental, short-term longitudinal design with intervention and control groups. In-home data collection (anthropometric measurements, feeding observations, questionnaires, 3-day dietary records) occurs at baseline, immediately following the intervention, and 6 months after the intervention. Main toddler outcomes include: a) increased fruit and vegetable consumption and decreased sweetened beverage consumption; and b) improved toddler-eating skills (self-feeding and self-serving). Main parent outcomes include: a) improved psychosocial attributes (knowledge, attitudes, self-efficacy, feeding style) related to child feeding; b) provision of a more positive mealtime physical environment (turning off the TV); and c) creation of a more positive mealtime social environment (sitting down together for meals). Discussion If this project is successful, the expected outcomes are that the intervention will be effective in helping toddlers develop healthy eating skills that contribute to improve overall health and development and to the prevention of obesity. Trial registration Current Controlled Trials ACTRN12610000981022