The Impact of Picture Books on Children's Intake, Liking, and/or Willingness to Taste Vegetables: Systematic Review.

INTRODUCTION: Repeated exposure is effective at increasing preschool children's vegetable acceptance and consumption; however, some parents may find it challenging to expose children to tasting a food the recommended times (> 10). This review examines the evidence for the use of picture books as an alternative strategy to promote preschool-aged children's intake, liking, and/or willingness to taste vegetables. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic search of four databases was conducted using terms for three concepts: picture/storybook exposure; AND willingness to taste, liking, or consumption of vegetables; AND child. Inclusion criteria included intervention studies examining the impact of at least one picture or storybook on preschool-aged children's intake, liking, and/or willingness to taste vegetables. Two reviewers independently screened titles, abstracts, and full texts. Data from 20% of the included studies were extracted by two authors for consistency; the remaining data were extracted by one author. Quality assessment and risk of bias were assessed using the GRADE approach and Academy of Nutrition and Dietetics Quality Criteria Checklist. RESULTS: The review included 16 studies with a mean sample size of 85, interventions lasting between 3 days and 12 weeks, and child age ranging from 18 months to 6 years. Ten studies found that picture books increased children's vegetable intake, seven increased liking, and three increased willingness to taste vegetables. CONCLUSION: The evidence from this review demonstrates that picture books are effective at increasing children's intake, liking, and/or willingness to taste vegetables. Future research should include follow-up assessments and larger sample sizes.