Peer-reviewed article
Multilevel factors influencing parental food decision-making across childhood stages in China: a qualitative study using a socioecological framework.
Tan PY, Yiga P, Bao Y, Gong YY, Ma R et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This qualitative study examined how parents in Zhejiang, China make food decisions for their children at different ages—infancy, preschool, and primary school. Researchers found that parental control over feeding decreases as children grow older, while convenience-oriented practices and processed foods increase during school years. Multiple factors shape these decisions, including child health priorities, food safety concerns, time pressure, nutrition knowledge, grandparents' influence, and digital marketing, with both supporting and hindering healthy eating patterns.
Key points
- Feeding strategies shift from strong parental control in infancy to increasing child autonomy in preschool and time-pressured routines in primary school age
- Greater reliance on energy-dense, processed or takeaway foods increases with school age, often driven by time constraints
- Grandparents, cultural food norms, traditional beliefs and digital information environments can either support or undermine healthy feeding decisions
- Balancing pathways supporting healthier behaviours include parental health prioritisation, stronger nutrition knowledge, and trust in school meals and health professionals
- Reinforcing pathways sustaining less healthy practices include time pressure, convenience reliance, indulgent grandparent caregiving, and digital marketing of unhealthy foods
Limitations
This is a qualitative study based on 29 caregivers in one region of China (Zhejiang), so findings may not generalise to other Chinese regions, rural areas, or different socioeconomic contexts. The study describes factors influencing decisions but does not measure actual health outcomes or the effectiveness of potential interventions.
Abstract
Introduction China faces a double burden of childhood malnutrition. Parents are key dietary gatekeepers, yet limited research has examined how food decision-making evolves across child developmental stages. This study explored multilevel, dynamic determinants of parental food choices across infancy, preschool and primary school age in Zhejiang, China. Methods Using visual ethnography, 29 caregivers completed 7-day photographic food diaries followed by in-depth interviews. Data were thematically analysed using an inductive-deductive approach within a socioecological framework. A causal loop diagram was developed to examine cross-level interactions. Results Feeding strategies shifted from strong parental control in infancy to increasing child autonomy during preschool years and to time-pressured, convenience-oriented routines in primary school age, often with greater reliance on energy-dense, processed or takeaway foods. Picky-eating strategies evolved from direct food and texture modifications in infancy to gradual exposure and experiential methods in older children. Across stages, parental decisions were shaped by interacting influences including child health priorities, food safety concerns, time constraints, nutrition knowledge and children's preferences. Grandparents, cultural food norms, traditional beliefs and digital information environments could either support or undermine healthy feeding. Systems analysis further identified reinforcing pathways, including time pressure, convenience reliance, greater child autonomy, grandparent caregiving (eg, indulgent practices), unclear age-specific guidance and digital marketing or misleading online information, that may sustain less healthy practices. In contrast, balancing pathways, including parental prioritisation of child health, stronger nutrition knowledge and trust in school meals and health professionals, supported healthier behaviours, including dietary diversity, home-cooked meals and appropriate supplement use. Conclusions Parental food decision-making is developmental, dynamic and shaped by interacting socioecological influences. System-based, age-specific interventions should provide clear guidance through trusted institutions, engage parents and grandparents, strengthen food safety and healthy food environments, regulate digital marketing of unhealthy foods and improve nutrition transparency to support healthier childhood diets in China.