This study highlights the problem of child obesity in Ireland and the fact that parents underestimate this problem with only 28.8% of the parents questioned here recognising that their child was overweight or obese. Our study also brings attention to the types of food eaten by children in the hospital setting, in particular the abundance of chips and the lack of dairy products, fruit and vegetables. Our study has limitations. It is a questionnaire administered prospectively but based on parental recall, which therefore is likely to introduce recall bias. Furthermore, parents may have modified their responses due to their awareness that a paediatrician was administering the questionnaire. However, this would imply that their answers are more likely to overestimate the nutritional content of their children’s diets. It is also a small study; however it is a good representation of a population of paediatric in-patients in an Irish regional hospital. There was also incomplete recording of height and weight among patients thus limiting the numbers with BMI values included in our evaluation. Thirteen patients did not have a height, two patients did not have a weight and two patients did not have either a height or a weight measured. Six patients were unable to weight bear, one child refused to be measured and one oncology patient was in isolation. However, nine patients were discharged before a height and/or a weight was taken. This issue needs to be addressed by hospital staff as, not only is it a vital part of hospital admission which should be routinely documented, but it would also serve to reinforce to parents the importance of monitoring children’s growth. Although the reason for admission was documented, the length of admission was not recorded.
Four respondents were not parents. One was a significantly older sister, one was a grandmother and two were aunts all of whom were caring for the child while they were an inpatient and would also have cared for the child at some point at home as well, for example while the mother was at work. Before administering the questionnaire, each person was asked if, as the child’s caregiver at that time, were they confident about answering the questions and all responded that they were.
Children with chronic conditions were included in order to get a broader perspective of parent's opinions with regard to hospital food, from a representative general paediatrics population. We wanted to include those who would have had several admissions previously or a more prolonged admission and thus would have more exposure to the hospital food, while also including parents of otherwise healthy children for whom it would have been their first encounter with hospital food. It is likely that most of the children with chronic medical conditions would have received dietetic input previously, and so it is likely that these families had more knowledge about principles of nutrition in paediatrics. If these patients were excluded, the data would likely show poorer knowledge of nutrition. However, including these patients means that the data are representative of general paediatric inpatients and are generalisable to other general paediatric hospital populations.
Several parents commented that they would have been happy for their child to have chips and chicken nuggets for one night in hospital, but when they were admitted for a more prolonged period this choice of food and lack of variety and healthy options can become very frustrating.
One of the strengths of our study is that it is novel, with no similar study being done previously in Ireland. Additionally, it reflects parents’ opinions with regard to daily diet recommendations, the hospital food and their children’s weights. Our study may help encourage hospital staff to tackle the problem of child obesity while children are in hospital. Hospitals sometimes fail to encourage healthy eating to children and families and previous studies have shown that children make poor food choices even when given healthy food options [16
]. Therefore, we suggest that Irish hospitals should improve the nutritional value of the food that is served to children in hospital and use hospital admissions as an opportunity to promote healthy eating habits. This study also suggests that parents need more education on healthy eating and the nutritional needs of their children. Routine recording of children’s height and weight by hospital staff, with calculation and explanation to parents of their child’s BMI centile, would provide an opportunity for health care professionals to communicate and reinforce healthy living principles to children and their parents.