In early childhood, healthy eating habits lay the foundation for lifelong wellness, helping prevent many chronic health issues.
Promoting these habits is particularly important for children in rural communities, where resources are sometimes limited. Research shows that rural children are 26% more likely to experience obesity than their urban peers.
Because obesity is a leading risk factor for serious diseases such as diabetes, cancer and heart disease, Dipti Dev, associate professor of child, youth, and family studies and Nebraska Extension specialist, is spearheading a five-year, $3.2 million project funded by the National Institutes of Health designed to help rural child care programs foster healthy eating habits among young children by promoting responsive feeding practices.
“Rural children and their caregivers face unique challenges with diet and nutrition,” she said. “In-home child care settings are especially vital in rural areas because they provide flexible schedules that suit the needs of farmers and other rural families.”
Central to the project is Ecological Approach To (EAT) for Prevention, an online, multilevel rural community engagement program designed to equip child care providers with responsive feeding skills. This approach encourages children to self-regulate their food intake and make conscious choices about eating, guided by their hunger and fullness cues.
Although national policies emphasize the need for responsive feeding in child care settings, their effectiveness in rural, in-home child care programs remains understudied. EAT for Prevention helps providers learn and practice these skills, ultimately enhancing children’s diets.
Dev’s earlier research indicates children in the program eat more fruits, vegetables and whole grains. Providers also reported lower stress during meals and noted that children seemed more engaged — and even expanded their vocabularies through mealtime conversations.
“Mealtime offers a unique opportunity to engage children, yet it’s often treated as a break,” Dev said. “By actively involving children, they become more inclined to try new foods and develop a positive relationship with healthy eating.”
Building on these early findings, Dev’s team will conduct a randomized trial involving 200 children, ages 3-5, from 100 rural in-home child care settings. Researchers will observe lunchtime at each site to measure what foods children are served and how much they eat.
Changes in children’s diet and BMI will be measured and skin carotenoid changes will be evaluated using a Veggie Meter® device, which assesses skin carotenoids as biomarkers for fruit and vegetable intake.
Providers’ feeding practices will also be monitored through surveys and observations. Nebraska Extension professionals will serve as coaches, offering tailored guidance based on each provider’s mealtime routines and challenges with children’s eating behaviors.
By building rural child care program capacity to adopt responsive feeding practices, she said, providers can serve as powerful role models, helping children learn to tune into their hunger and fullness cues, make nutritious food choices and build lasting habits.
The project is housed at the Nebraska Center for Research on Children, Youth, Families and Schools, and the Nebraska Center for Prevention of Obesity Diseases (NPOD). Along with Dev, the research team from the University of Nebraska–Lincoln includes Lisa Franzen-Castle, associate dean for faculty affairs, College of Education and Human Sciences; Lisa Knoche, CYFS co-director; and Natalie Koziol, CYFS research associate professor.
Another partner, Professor David Dzewaltowski of the University of Nebraska Medical Center College of Public Health, has been a mentor and collaborator to Dev since 2019.
Dev will also collaborate with local communities, Extension professionals and researchers from seven universities, as well as the Nebraska Department of Education, and the Nebraska Department of Health and Human Services.
Sustainability, Dev said, is key to the project’s success, especially for small rural businesses working to create healthy environments for children.
“Webinars alone don’t drive real change,” she said. “Providers need personalized, ongoing feedback that aligns with their goals and unique needs.”
Dev expects this first-of-its-kind study on responsive feeding practices to have far-reaching impacts on research, policy and practice, and to build capacity among rural child care providers to address childhood obesity.
“I envision Nebraska leading the way in this area, advancing best practices in responsive feeding to create healthier futures for rural children across the nation,” she said.
Learn more about this project in the CYFS Research Network.
College of Education and Human Sciences
Child, Youth and Family Studies
Nutrition and Health Sciences
