Varied diets and persistence in exposing infants and children to healthy foods, even when they don't like them at first, are key to promoting healthy eating behaviors, a new review paper has concluded.

Published on Dec. 20, in Obesity Reviews, the lead author is Stephanie Anzman-Frasca, PhD, assistant professor in the Department of Pediatrics in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. Anzman-Frasca is a researcher in the Department of Pediatrics' behavioral medicine division.

"The goal was to review the literature in order to make recommendations to parents and caregivers on how they can best encourage children's healthy eating starting as early as possible," said Anzman-Frasca.

Like mother, like baby

The researchers based their recommendations on data gathered from more than 40 peer-reviewed studies on how infants and young children develop preferences for healthy foods, especially vegetables and fruits.

Healthy eating starts during pregnancy, the authors point out. "Flavors of Mom's diet reach the child in utero," said Anzman-Frasca, "so if she's eating a healthy diet, the fetus does get exposed to those flavors, getting the child used to them."

After birth, if the mother breastfeeds, the baby also benefits from exposure to flavors from her healthy diet through the breastmilk.

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These early exposures familiarize the baby with specific flavors as well as the experience of variety and set the stage for later acceptance of healthy flavors in solid foods.

Serve healthy foods, repeat, serve healthy foods, repeat

Even after infancy, repeatedly exposing children to foods that they previously rejected can help them to accept and like the food. "This method of simply repeating the child's exposure to healthy foods has a robust evidence base behind it," Anzman-Frasca said. "There are many studies with preschoolers who start out not liking red peppers or squash, for example, but after five to six sessions where these foods are repeatedly offered, they end up liking them."

However, the review pointed out, one study has found that in low-income homes, parents do not serve previously rejected foods because of the desire not to waste food. The authors call for interventions to promote repeated exposure to healthy foods in these environments, while addressing challenges parents face.

Other conclusions are:

Vary foods during the prenatal period, early milk feeding and toddlerhood, taking advantage of periods when neophobia -- the rejection of novel things -- is lower.

Strategies besides repeated exposure, such as rewarding the intake of healthy foods, might work in some situations, but there is some evidence that these strategies could also dilute the power of repeated exposure to healthy foods. Researchers suggest starting with simple approaches like repeated exposure -- or caregivers and siblings modeling the consumption and enjoyment of healthy foods -- reserving other strategies for cases where they are needed to motivate initial tasting.

Larger-scale changes to make healthy choices easy choices in children's everyday environments can help caregivers to use recommended strategies to increase acceptance of healthier foods successfully. For example, making healthy side dishes and beverages the default accompaniments in kids' meals in restaurants can increase children's exposure to these items.

"Overall, based on all the studies we reviewed, our strongest recommendation to parents and caregivers is 'don't give up!'" Anzman-Frasca emphasized.