How to Feed 2- to 6-Year-Old Children Responsively in Childcare during COVID-19

Authors

Dipti Dev, Extension Specialist and Associate Professor, University of Nebraska–Lincoln

Madeleine Sigman-Grant, Nutrition Specialist and Professor Emerita, University of Nevada, Reno

Janice Fletcher, Professor Emerita of Child, Family and Consumer Studies, University of Idaho

Reviewers

Jill Cox, Child and Youth Development Specialist, Penn State Extension

Emily Hulse, Community Program Coordinator, Center for the Child and Community, Children’s Hospital and Medical Center, Lincoln, Nebraska

Donnia Behrends, Extension Educator, University of Nebraska Extension

This publication is intended to assist childcare and health care practitioners to implement responsive feeding in childcare facilities during the COVID-19 pandemic while practicing Centers for Disease Control and Prevention guidance. COVID-19 challenges mealtime routines and practices. Enhanced hygiene and health expectations for social distancing and meal service are necessary. We offer suggestions for maintaining children’s autonomy and involvement during mealtimes while setting structure and routines for a safe, pleasant mealtime environment. Even though the meal service has changed with COVID-19, the intent of the mealtime remains the same: to create a responsive eating atmosphere. Practitioners still support children through mealtime conversations, food-based sensory exploration activities, and modeling healthy eating. This document is intended for early education and childcare administrators, providers, teachers, cooks, health care consultants, and nutrition professionals, hereafter referred to as staff.

Federal Guidance and Meal Service. Due to the COVID-19 pandemic, the federal Centers for Disease Control and Prevention (CDC) provides guidance to pause family style meal service in early care and education (ECE) programs. Specifically, “If meals are typically served family style, plate each child’s meal to serve it so that multiple children are not using the same serving utensils (Centers for Disease Control and Prevention, 2020).” Family style meal service, based on responsive feeding, is a recommended practice for feeding young children in group settings.

Responsive feeding in early childhood settings means that staff provides healthful food, and they support children to eat according to their individual cues of hunger and satisfaction. Staff helps children recognize these cues, and trust them to eat according to their feelings. They avoid pressuring children to eat a certain food, more food, or less food. Staff are in tune with children’s developing food knowledge and eating skills, personal likes and dislikes, food refusal traits, temperament characteristics, and fears of food insecurity.

Table 1. Understanding the Adult’s and Child’s Role based on the Meal Service Style

Mealtime Roles	Family Style Meal Service	Plated Meal Service
Mealtime Roles	Family Style Meal Service	Table Side Plating with Child Input	Kitchen Plated or Table Side Plating without Child Input

Adult’s Role	Adults fill common bowls and pitchers, and place them at the table	Adults at the table ask each child which foods and how much they want before placing food on the plate	Adults place the food on the child’s plate and pre-pour the beverages
Child’s Role	High degree of child autonomy. As children serve themselves, they decide what and how much they want to eat	Moderate degree of child autonomy. As adults serve the food, the child gets to decide which foods and how much is placed on their plate.	Low degree of child autonomy. Children receive food pre-plated and pre-portioned. All children receive the same food components and the same amount of food.
National Guidance	Avoid during COVID-19 pandemic based on CDC guidance until further notice	All childcare programs can use, except those participating in CACFP	All childcare programs, including those participating in CACFP, can use this style of meal service*

Note. * Childcare programs participating in the U.S. Department of Agriculture’s Child and Adult Care Food Program (CACFP) must serve all food components with full minimum portions to each child’s plate. Note, that the child is never required to consume the full portions to be reimbursed. However, to qualify for reimbursement, CACFP participating childcare programs must serve children all food components and quantities specified by CACFP requirements for meals (Child and Adult Care Food Program, 2020).

Why It Is Important to Feed Children Responsively during Plated Meal Service?

While there are differences in meal service styles, there is clear guidance that children should never be required to consume full portions of each food served. This is consistent with guidelines from CACFP and also the Academy of Nutrition and Dietetics’ Benchmarks for Nutrition in Child Care (Benjamin-Neelon, 2018). CACFP regulations state that supervising adults should actively encourage—but not force—children to consume the full portion during the meal.

Responsive feeding strategies and routines apply to family style meal service, plated meal service, and lunch box meal service. In contrast to family style meal service where children choose what foods to eat and how much food to put on their plates, pre-plated meal service involves adults serving the food and children having limited choices about what or how much food appears on their plates. Therefore, children’s autonomy to make eating decisions is challenged. Some children may show distress by negotiating, refusing to eat, or withdrawing. Issues about how much or whether to eat specific foods become edgier when food and beverages are already on the plate or in a cup.

Benefits of Using Responsive Feeding

1. You support children’s autonomy in learning their role during mealtime
2. You support children’s self-regulation in eating
3. You support children’s awareness of food intake by helping them eat according to their hunger and satisfaction
4. You manage food acceptance and refusal by offering children a variety of foods without pressure to eat more, or eat less, or to eat a specific food
5. You meet science-based recommendations for feeding children
6. You influence children’s short and long-term healthy eating habits
7. You build mealtime relationships and environments that are more pleasant and less stressful for everyone

What Does Responsive Feeding Look like during COVID-19?

Consider the following routines and tips to keep mealtimes safe and positive for children and yourself during COVID-19.

1. Adjust Structure and Routine

Clear rules create predictability and provide structure and consistency for children. Because rules and expectations can encourage, teach, and reinforce behavior, you do not have to rely on rewards. – Teacher Observation

Structure reflects mealtime expectations (how often, what, and how much children eat). It includes consistent routines that are responsive to children’s safety, health, and nutritional needs.

Communicate with children about mealtime changes and new routines due to COVID-19. A child’s ability to predict what will happen next and how they will be treated improves their sense of security. When children trust and know what to expect, their thoughts can move from dealing with emotions to enjoying learning and exploration at mealtimes. Knowledge and calm emotions improve their willingness to try new things.

Strategies to Communicate with Children about Mealtime Routines While Supporting Their Autonomy

Let children know what food will be served at each meal and snack.
Explain to children that we have a new way of putting food on our plates. “I will put food on your plate, and pour the beverage in your cup. We will not pass around bowls and pitchers.”
Tell them, “Look at your plates and decide ‘what’ and ‘how much’ you want to eat from your plate.”
Communicate to them, “Look in your cups and decide ‘how much’ you want to drink from your cup.”
Tell them, “You may try a food, and decide if you like it or not.”
Assure them, “You do not have to eat all the food on your plate.”
If additional food is available, assure them, “You can have more food if you are hungry later.”
If the program allows adults to serve the food and the child gets to decide which foods and how much is placed on their plate, assure them, “You can say what food you want on your plate. Tell me how much.”

Strategies to Communicate with Families

Let families know about any changes to the mealtime routines.
If the program allows adults to serve the food tableside, and the child gets to decide which foods and how much is placed on their plate, assure families that while staff will be serving children during COVID-19, they will support children’s autonomy by allowing them to decide what and how much they want to eat from their plate. Children will never be pressured to eat or consume all the food on their plate.
Share mealtime pictures and anecdotes about how their child is responding to mealtimes, because they are unable to volunteer or eat meals with their child.

Setting Your Mealtime for Physical Distancing

There is no unified guidance regarding spacing of chairs and tables. It is imperative that staff find out about their professional and local guidance or regulations for table spacing in your locality.
Sit and eat meals with children in your classroom, rather than eating together in a cafeteria or group dining room.
Place tables apart, using your local guidance. Add additional tables as needed. If there is not enough space to safely distance children, offer two meal services by splitting the class. For example, some children might go to another area, while others eat their lunch. After the first group eats and goes to another activity, sanitize thoroughly before allowing the second group to eat.

Place children’s chairs at safe distances so that they are unable to share their food or utensils, but they can still talk with each other and staff.
Mark visual cues for each child’s space and area for eating. For example, leave an empty chair between each child, or place tape on the table to mark each child’s space.
Consider staff ratios and tables. More tables with fewer children can result in some children without staff seated at their table. For safety reasons, staff should consider selecting a seat at a table that gives broader visual supervision and quicker access to children.

Be flexible when staff chooses where to sit, considering specific needs of individual children. For example, sit close to children who are slower to adjust to changes.
Limit entry of other adults during mealtimes. For example, kitchen staff deliver food on a cart outside the classroom door. Volunteers and guests do not eat with the children and staff.
Use applications such as GroupMe (https://groupme.com/en-US/) to chat and coordinate with staff. With such applications, the cook, for example can text staff that they have left food on the cart outside the door, and staff do not have to visit the kitchen to check if food is ready.

Using Face Coverings

Staff should wear face coverings (e.g. masks, face shields), as often as possible, including while serving food. When seated and eating with children, it is okay to remove masks
If children are wearing face coverings, establish a routine for removing them.
If children are wearing face coverings (e.g. masks, face shields), establish a sequence for putting them back on after post-meal handwashing and cleaning faces.
Wear a mask correctly for maximum protection. Don’t put the mask around the neck or up on the forehead

Note: CDC does not currently recommend use of face shields as a substitute for masks.

Strategies to Set Structure and Routine at Mealtime

Teach and supervise proper handwashing techniques before, during (when necessary if children accidently spilled something or touched a toy), and after mealtimes.
Use effective hygiene transitions before, during, and after mealtimes. Staff disinfect tables for mealtimes
Give each child their own eating utensils and napkins. Tell them, “We each have our own napkin and eating utensils. Only you can touch your napkin and eating utensils. That helps keep us safe and germ free. It helps keep us from getting sick.”
Plan for meal delays to avoid stressful mealtimes. For example, if children must wait for others to be served, have milk or water ready for each child as they sit down at the table. Have one teacher sit and focus on safe hygiene practices, while the other teacher plates meals.
Help children know what food to expect at meals. Describe menus and specific foods before the meal and again while serving children. “Today, our plates will have chicken and rice casserole, broccoli, and pears.” “I am putting chicken and rice casserole on your plate.”

Serve foods in a relaxed way, carefully and gently putting food on plates. Anticipate children’s preferences, such as whether they mind foods touching. Ask them, “Do you want the broccoli on the edge of your plate, or near the middle?”
Set expectations for table behaviors with adequate reasoning. For example,
- “Chew the food with your mouth closed, so that food does not fall out.”

“Keep your food on your plate. That keeps your food clean.”
“That is Maya’s napkin. It helps her keep her hands and face cleaner. Here’s your napkin. You can keep it in your space. It keeps your hands and face clean and safe from germs.”

Rules Must:	Instead of this . . .	Try saying this . . .
Benefit children’s development	“You must take a no-thank-you-bite.”	“If you do not want to try a food, you can say, ‘No, thank you. Maybe next time.’”
Be positively stated	“You cannot serve the food yourself.”	“The teacher will serve your food to your plates and cups today. We made extra space for you to eat. This keeps each of us safe from each other’s germs. Ms. Teacher will serve everyone the same food. Everyone will get the same amount of food. You can decide whether to use your spoon or fork to eat.”
Be reasonable for children to follow	“No talking while we eat”	“We like to talk with each other at meals. We can talk with each other, but we will each keep to our own space. That keeps our germs from spreading, so we won’t get sick.”
Be definable	“Wash your hands correctly.”	“Stay back from the sink while Antoine has water running. You may turn on the water when you see he has a paper towel drying his hands.”
Provide structure, not control	“You can’t sit that close. Move away.”	“Remember, it is kind to sit away from each other so we keep each other from getting sick.”

2. Support Children’s Self-Regulation

“After I started talking about hunger and fullness, the children are getting better at saying, ‘Oh, I think that’s all I need right now.’ I hear that a lot at the table.” – Teacher Observation

Self-regulation in eating is realizing when you feel hungry or satisfied. Then, you make choices about what and how much to eat as you respond to those feelings.

Consider children’s self-regulation needs as mealtime routines change. When family style routines are changed to kitchen-plated meal service or tableside plating, children may wonder if they must try all the foods or finish all the food on their plates. Some may worry if second helpings are allowed. Some may refuse the whole plate, because the food offerings are not appealing, food is a certain color, or one food is touching along food, and, some may literally move a specific food off their plate.

Responsive staff will consider children’s self-regulation of eating by observing their reactions. They anticipate children’s anxieties, and remind them that they can make choices about how much to eat and whether they will consume one food or another. They answer children’s questions, and use reassuring phrases and tone. They reinforce to children that they do not have to eat all the food on their plates, that they can stop eating when they are no longer hungry.

Strategies to Support Self-Regulation in Eating

Prompt children to describe their feelings of hunger and satisfaction. For example, “Is your stomach feeling empty? Are you hungry?” “Have you had enough? Does your tummy feel just right?”
Trust and respect children’s feelings of hunger and satisfaction when they are expressed. Support children to eat if they say they are hungry and to stop eating if they feel satisfied.
Use responsive language when communicating with children about hunger and satisfaction. For example, “We don’t have more bread. I see you’re still hungry. You can have some other foods.”
Model feelings of hunger and satisfaction by stating something like: “I don’t feel hungry anymore, so I am going to stop eating.”
Ensure that some foods are available in the classroom if children are still hungry.

Strategies to Support Self-Regulation in Eating If Children Are Experiencing Food Insecurity

If a child is experiencing food insecurity, it is particularly important for staff to make reassuring statements. Let children know they may eat until they are no longer hungry. Assure that there is more food at the program if they are hungry later. If seconds are not available, have some food available for children who are hungry after the meal.

Use a reassuring tone to highlight mealtimes. During snack time, tell children when the next meal is coming. For example, “After we have outside play, we will have lunch with rice and pork.”
Let children know what will be served, and when it will be served. For example, “Today, we have apples and cheese for a snack, and then we have work time. For lunch, we have broccoli and noodles.”
Assure children that there will be enough food here for them.
Use reassuring statements and tone of voice to support children’s self-regulation. For example, “You can stop eating if you feel satisfied or no longer hungry. If you are hungry later, there will be more food.”

3. Role Model Healthy Eating

“They learn from watching you! Eat healthy foods and the kids will too!” – Teacher Observation

Children tend to mimic adults. Staff can model physical distancing, hygiene, and eating a variety of food. They can eat the same foods as the children, showing acceptance and enjoyment of the plate of food. If food is not provided for staff, they can bring food similar to that being served to children.

Role Modeling Strategies

Wear a face covering while serving food, and other times of the day, as appropriate.
Wash hands for 20 seconds, using handwashing guidance from the health district.
Wash hands before, during (as needed), and after meals, and before putting a mask back on after meals.
Sit at the table with children during meals and snacks, and model physical distancing.
Eat the same plated foods as the children during meals and snacks, if available.
Introduce food and eating vocabulary words. This adds to children’s vocabulary for talking about the food placed on their plates. For example, “Some people say lettuce is crunchy.” “This casserole has potatoes, meat, and sliced carrots.”
If staff members have to bring their own food, plan ahead by reviewing the menu and including similar foods that will be served to the children.
Enthusiastically model eating healthy foods served at meal and snack times. For example, “These potatoes were cooked in the oven. They have a mild flavor.”
Withhold judgement and negative comments when talking to children and other adults about mealtime changes owing to COVID-19.

4. Engage Children in Food-Based Sensory Exploration

“My 3-year olds were not vegetable eaters, but now they are trying them. I started using words to describe foods, and then they want to know, ‘Is it hot or cold, crunchy or soft?’ So, then they try it, and they’ve done better with their vegetables.” – Teacher Observation

With COVID-19 restrictions, children’s eating autonomy can be reduced and there can be an increased likelihood of food refusal when they cannot put food on to their plates. Instead of pressuring children to try the food, engage their senses. Children are naturally curious about the world around them, even when they may be faced with things that make them uncomfortable. Menus can be chosen and food presented intentionally so that children have extra opportunity to use their senses of sight, smell, hearing, touch, and taste.

Strategies for Engaging Children in Food-Based Sensory Exploration

Switch from group hands-on food or cooking activities to individual experiences. For example, rather than passing a piece of fruit or vegetable from child to child at group time, each child gets their own to explore.
Make certain that children keep their food on their plates and in their own space.
Engage children’s senses by asking children what they expect the foods will be like (appearance, smell, sounds, texture, and taste).
Offer children ways to manage their food during mealtimes. Though children are not allowed to serve the food, they might add crackers to their soup, spread hummus on their pita bread, pour from their individual pitchers, or add individually portioned dressing to their salad. This helps children practice motor skills, and supports their autonomy for deciding how much to eat.
Suggest activities outside of mealtimes to help children strengthen hand skills used for eating. For example, incorporate sand into activities related to scooping, levelling, pouring.
Continue to offer food-based sensory activities with physical distancing and enhanced hygiene.

5. Manage Food Refusal by Modeling and Engaging Children’s Senses, Not Pressure

Young children often refuse unfamiliar or novel food. They also have preferred and disliked foods. With pre-plated food service, there may be more food refusal than with family style meals. When food is pre-plated, children who actively refuse the food will need reassurance about having undesired or unfamiliar food on their plate. Be ready to comfort them. They can assure children that they can decide how much or whether they want to eat the food.

Tips for Managing Food Refusal

Teach children polite ways to refuse food by stating, “If you don’t want the food say, ‘No thank you, maybe next time.’”
Acknowledge that everyone has likes and dislikes by using phrases such as, “Everyone likes different foods. Everyone has different taste buds. It is okay to have likes and dislikes. If you try the food next time, you may like it.”
If children do not want a certain food on their plates, tell them, “You don’t have to eat it, if you don’t like it.”
If a child does not want to swallow the food, have a napkin ready for them to spit the food into it. Staff will throw away the napkin and food and follow with handwashing.
Observe children’s reactions to pre-plated foods, and plan non-meal activities that help children learn about foods without pressure to eat specific foods.
Avoid telling children to eat to please other people. For example, avoid saying, “I know you don’t want to eat those peas, but I am glad you tried them for me.” Or, “Mommy will be happy you tried broccoli today.”

Feeding Practice	Instead of saying this . . . Pressure	Try saying this . . . Engage children’s senses or role model
Trying the Food	“Take a no-thank-you-bite”	“The apple smells sweet. Do you want to try it, and decide if it is sweet?”
Eating the Food	“Eat the fruit, and then you can go outside.”	“When you eat the fruit, tell us if you think it is hard or soft.”
Finishing the Food	“Are you done?”	“You stopped eating. Does your body have all the food it needs?”
Be Judgement-free	“Mommy will be so happy today, because you tried the cauliflower.”	“You tried cauliflower for the first time! Was it crunchy or soft?

Refer to the chart above for strategies to try responsive feeding practices instead of pressuring children to eat.

The Ecological Approach to Family Style Program

The Ecological Approach To (EAT) Family Style program is a resource designed to teach educators how to implement responsive feeding practices. The strategies listed above are some examples from the program. The EAT Family Style curriculum includes strategies and videos for implementing responsive feeding in classroom settings, interactive online lessons, and goal setting.

If you would like to learn more about the EAT Family Style program, visit the program’s website at https://go.unl.edu/eatfamilystyle or email eatfamilystyle@365groups.unl.edu.

Additional Resources

Dev, D.A, Sigman-Grant, M., & Fletcher, J. (2020, August 11). Feeding Young Children Responsively During COVID-19 [Webinar]. Penn State Extension. https://tinyurl.com/y38znp4v

Fletcher, J., Sigman-Grant, M., Dev, D.A, Fodor, J., & Hobbs, J. (2020, June 11). Transitioning from Family Style Service to Pre-Plated Meal Service. IdahoSTARS. https://idahostars.org/About-Us/Updates/transitioning-from-family-style-service-to-pre-plated-meal-service

Acknowledgments

We thank UNL Children’s Center child care director Callie Wilhite, teachers, and cooks who were interviewed to share their experiences transitioning from family style meal service to pre-plated meal service. We are also grateful to childcare teachers for providing us pictures of their mealtimes during COVID-19. Finally, we will like to thank Carly Hillburn and Rachel Maloy, students working with Dr. Dev, for assisting with the development of the publication.

References

Benjamin-Neelon, S. E., 2018, Position of the Academy of Nutrition and Dietetics: Benchmarks for nutrition in child care: Journal of the Academy of Nutrition and Dietetics, v. 118, p. 1,291–1,300.

Centers for Disease Control and Prevention (August 2020) Considerations for Wearing Masks @ https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.htm (Accessed August 2020).

Centers for Disease Control and Prevention, 2020, Coronavirus disease 2019 (COVID-19): Guidance for child care programs that remain open, at https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-childcare.html (accessed July 2020).

Child and Adult Care Food Program, 2020, Child meal pattern requirements: U.S. Department of Agriculture, Food and Nutrition Service, at https://cdn.education.ne.gov/wp-content/uploads/2019/11/Child-Meal-Pattern-Rev-9.17.pdf (accessed July 2020).

Fletcher, J., Sigman-Grant, M., Dev, D., Fodor, J., and Hobbs, J., 2020, Transitioning from family style service to pre-plated meal service: Maintaining responsive feeding and responsive eating in during COVID19 pandemic: Idaho STARS, at https://idahostars.org/About-Us/Updates/transitioning-from-family-style-service-to-pre-plated-meal-service (accessed July 2020).

This publication has been peer reviewed.

Nebraska Extension publications are available online at http://extensionpubs.unl.edu/.

Extension is a Division of the Institute of Agriculture and Natural Resources at the University of Nebraska–Lincoln cooperating with the Counties and the United States Department of Agriculture.

Nebraska Extension educational programs abide with the nondiscrimination policies of the University of Nebraska–Lincoln and the United States Department of Agriculture.

G2328 · Youth & Families: Foods & Nutrition

Issued August 2020