How do children make food choices? Using a think-aloud method to explore the role of internal and external factors on eating behaviour

Research indicates that eating related problems, body weight and eating habits often start in childhood and track through to adulthood. To date, however, little is known about how children conceptualise food and the factors involved in their decision making processes. This qualitative study aimed to explore children's understanding of food and how this influences their food related decisions. Children (n = 27) aged 9-10 took part in a think-aloud study and voiced their thoughts whilst making different meals and snacks using pictures of food. Data were analysed using thematic analysis which described 3 core themes: i) drivers of food decisions (hunger, health, liking, emotions, availability) ii) sources of these drivers (parents, peers, routine); iii) polarised reasoning whereby food was often dichotomised as good or bad. Transcending these themes was the degree of deliberation whereby children showed decision making as automatic, considered or sanctioned. Finally, overarching their accounts was the notion of the transitioning child with children illustrating the shift between being a passive child whose decisions were made for them and an active child with autonomy and agency. The results illustrate the ways in which children begin to internalise the messages of others as they grow older which they incorporate into their own schema. These messages in turn form part of their heuristic system which enable less sanctioned decisions as children take ownership of their own eating behaviour. The results are discussed in terms of the implications for decision making and a framework for developing interventions.