School Age Children Background - NCS Dietary Assessment Literature Review

See School Age Children Tables and Exhibits

This group encompasses both middle childhood (between the age of 5 and 10 years) and preadolescence (generally age 9 to 11 year in girls and 10 to 12 years for boys). During the school age years, children continue to grow physically at a steady rate through a series of irregular growth spurts that last an average of 8 weeks and occur three to six times a year (159). Appetite and intake generally increase before a growth spurt and decrease during periods of slower growth.

In the school age years, children experience tremendous cognitive, emotional, and social growth and development (159). Children develop self-efficacy and the ability to focus on several aspects of a situation at the same time. They develop increased cause and effect reasoning; become able to classify, reclassify, and generalize; and learn to read and write. Children transition from consuming most food intake under adult control and supervision to taking increasing responsibility for their food choices.

Parents and primary caretakers remain the surrogate reporters of children's intake until their cognitive and literacy skills are sufficiently developed to permit independent reporting of their own food intake. The cognitive abilities required to self-report food intake include an adequately developed concept of time, a good memory and attention span, and a knowledge of the names of food (160;161). These abilities develop rapidly from age 8 years and studies in the early 1990s provided evidence that by age 10 years (fourth grade), children can reliably report their food intake for the previous 24 hours (161-164). However, the average age at which children develop the cognitive skills relevant to self-reporting of diet intake differs cross-culturally and between individuals (165), and the minimum age at which children gain the ability to conceptualize the time frame used in dietary instruments (24 hours, 1 week, 1 month) is not well established. The ability of children younger than 10 years to give valid responses to food frequency questionnaires covering periods greater than 1 day is questionable because of their inability to conceptualize frequency and averaging (166;167). The need for adult assistance in dietary reporting is also driven by the limited scope of the child's experience and knowledge of food preparation. Children may be inattentive to aspects of food and drink that are of interest to interviewers (e.g., brand names, fat content of milk) (165).

Baranowski and Domel (160) proposed a cognitive processing model to understand how children recall dietary data. The model includes three structural components – sensory register, short-term memory, and long-term memory – that can be applied to categorize the errors in children's dietary reporting. These components result from attention, perception (or interpretation), organization, retention, retrieval, and response formulation. Further work on the model showed that during self-report of intake, children employ a number of retrieval mechanisms: visual imagery (appearance of food), usual practice (familiarity with food), behavior chaining (association with preferred food or favorite activity during a meal or day), and preference (favorite food) (168). Perceived importance of food also affects recall ability in children (169). Further research is needed to refine the model and advance dietary assessment methodology for children.

Exhibit 5.1 compares dietary assessment methodological issues relevant to school age children and adolescents. Preadolescent children are transitioning between the two age groups, and many adolescent issues assume importance as children mature.

Exhibit 5.1. Respondent-observer issues in the dietary assessment of school age children and adolescents.^a

a. Adapted from Livingston and Robson, 2000 (161).