The GAIN Study: Understanding What Helps Children Learn to Like and Eat New Foods

Nutrition supplements have tremendous impact upon the nutritional and developmental status of malnourished children. These products have been designed to be acceptable to children (often by adding nutritive sweeteners to make them more palatable), but to date there has been little rigorous testing of their palatability for infants, toddlers and young children. The overall goal of this project is to investigate whether:

1. children's acceptance of a nutrition supplement is associated with maternal persistence in offering the food to her child over a 2-week period;
2. an unsweetened version of the nutrition supplement differs in short- and long-term acceptance; and
3. maternal liking of the supplement is associated with her persistence in offering the food to her child.

More rigorous pre-testing of nutrition supplements, with a focus on palatability (i.e., observations of behavioral and facial responses to its taste) and its relation to children's acceptance (defined here as consumption), could provide important insights into the capacity for these products to transition from being perceived as "medicine" to being accepted as "food," or part of the usual child diet. A clearer understanding of the relation between observed child indicators of palatability and acceptance, both initially and over time (i.e., repeated exposure effects), is important for predicting the longer-term impacts on children's dietary intake, growth and health. Further, a better grasp of caregiver perceptions of the acceptability of these products, both their child's and their own, is critical in paving the way for overcoming barriers and identifying facilitators associated with longer-term acceptance of these nutritional supplements.

We secondarily will also explore the effects of potential mediators on caregiver persistence and infant acceptance of a sweetened and an unsweetened small-quantity lipid nutrition supplement (SQ-LNS) such as:

* Maternal feeding self-efficacy
* Caregiver food neophobia
* Caregiver feeding styles using the Infant Feeding Style Questionnaire
* Infant feeding history and food experience
* Toddler eating behaviors using the Child Eating Behavior Questionnaire for Toddlers
* Infant behaviors using the Infant Behavior Questionnaire-Revised (Garstein \& Rothbart 2003 Inf Behav Dev)

Eligibility Criteria:
Inclusion Criteria:

* Term birth (at least 37 weeks gestation)
* Experience with complementary foods
* Previous exposure to nuts (butters, powders, or other nut ingredients)
* Caregiver at least 18 years of age and \< 51 years of age
* Caregiver lives within 75 miles of the University of Colorado Anschutz Medical Campus
* Caregiver must feed the infant or toddler at least 50% of the time

Exclusion Criteria:

* Has a genetic disorder or developmental disability, as these conditions often result in feeding difficulties
* Has a reported illness or metabolic disorder (e.g., food allergy) that could affect food intake
* Was born prematurely (\< 37 weeks gestation)
* Caregiver is less than 18 years of age
* Caregiver lives more than 75 miles from the University of Colorado Anschutz Medical Campus
* Caregiver does not read and speak English
* Caregiver has a food allergy