A standing-room only crowd of more than 200 conference attendees heard new insights into how children choose the foods they eat, what their eating behaviors are and how the industry and parents can give children access to healthy food environments that shape those food choices.

"Children's decision making has few dimensions," explained Dr. Adam Drewnowski (CQ), director of the Center for Public Health Nutrition and professor of epidemiology at the School of Public Health, University of Washington, Seattle. Not surprisingly, children lean toward sweets like cookies, chocolate, fruits and juices as well as salty foods that make them feel full like French fries and pizza. But environment, peer groups, family, and exposure to a variety of menu items play a key role in children's food choices.

"Kids are not as complicated as adults and are not making food choices based on health," said Dr. Jennifer Orlet Fisher, an associate professor of public health at Temple University, Philadelphia. "Preference trumps all. Children eat what they like and leave the rest."

In her studies, she found children like fat and sugar and somewhat surprisingly, fruit is at the top of the list of food choices, followed by starches, meat and eggs, dairy and vegetables. She said it's not surprising kids like candy and cake over peas and carrots.

"Children do not naturally like healthy foods. They need to learn to like those healthy foods," Fisher said. "They also like what they know."

Repeat exposure creates a food familiarity that also drives food choices for children, which explains why many children repeatedly choose chicken nuggets and cheese, as she found in a study of preschoolers. Taste preferences are evident shortly after birth, with children preferring sweet and salty tastes first and rejecting bitter and sour tastes.

With that familiarity, she said, often comes food neophobia, better known as the picky eater, which peaks between two and six years of age when eating habits become established. This can be overcome by presenting small tastes of foods or in the case of one broccoli study, offering a side of ranch dip to entice the child.

Fisher recommends diversifying diets in pregnant and nursing women since diets are determined "long before they taste their first bite of solid food." Parental behavior also drives healthy food choices that are available, accessible and familiar.

"When children are watching adults, they more quickly try new foods and accept new foods particularly when the adult is enthusiastic," Fisher said. "What doesn't work is pressuring kids to eat. And if you bribe kids with dessert, they will end up disliking the vegetables even more."

Parents who also get their kids involved in food preparation and tasting, she said, provide a positive experience to promote acceptance of healthy foods.