Cochrane for Clinicians

Putting Evidence into Practice

Interventions for Increasing Fruit and Vegetable Consumption in Children Five Years and Younger


Am Fam Physician. 2018 Oct 1;98(7):419-420.

Author disclosure: No relevant financial affiliations.

Clinical Question

How effective are interventions to increase consumption of fruits and vegetables in children five years and younger?

Evidence-Based Answer

Child feeding interventions are effective in the short term (i.e., less than 12 months) for increasing a child's intake of fruits and vegetables, but only by less than 5% of the recommended daily allowance. Conversely, parental nutrition education and multicomponent interventions, such as combining preschool policy with parental education, are not effective.1 (Strength of Recommendation: C, based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series.)

Practice Pointers

Lower-than-recommended fruit and vegetable consumption is associated with multiple chronic disease processes.2,3 In the United States, 24% of young children do not meet daily recommendations for fruit intake and 85% do not meet daily recommendations for vegetable intake (i.e., three to four servings for each).4 Interventions that encourage healthy childhood dietary habits might lead to continued healthy choices as adults, potentially reducing the risk of associated chronic diseases.

This Cochrane review included 55 trials and 11,108 participants.1 The authors evaluated four strategies with 33 trials examining child feeding interventions, 13 trials examining parental nutrition education, eight examining multicomponent interventions, and one that looked at child nutrition education. Child feeding interventions included repeated exposures, offering a choice of vegetables vs. the adult selection, pairing of foods with positive stimuli, and providing flavor interventions such as vegetables served with liked familiar foods or salted vs. unsalted vegetables. Parental nutrition education was delivered in both health care and home settings, from dietitians and using print or interactive materials. Multicomponent interventions included preschool policy changes, garden-based interventions, or teacher and parent curriculum development.

Author disclosure: No relevant financial affiliations.


show all references

1. Hodder RK, Stacey FG, O'Brien KM, et al. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev. 2018;(1):CD008552....

2. World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series no. 916. Geneva, Switzerland: WHO; 2003. Accessed April 10, 2018.

3. Liu RH. Health-promoting components of fruits and vegetables in the diet. Adv Nutr. 2013;4(3):384S–392S.

4. Usual dietary intakes: food intakes, U.S. population, 2007–10. Epidemiology and Genomics Research Program. National Cancer Institute. Updated May 20, 2015. Accessed April 2, 2018.

5. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: U.S. Government Printing Office; December 2010. Accessed April 10, 2018.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at



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