Healthier Children's Meals in Restaurants: An Exploratory Study to Inform Approaches That Are Acceptable Across Stakeholders.

OBJECTIVE: Assess parents', children's, and restaurant executives' perspectives on children's meals in restaurants.

DESIGN: Cross-sectional.

SETTING: Parents and children completed predominantly quantitative surveys at 4 quick- and full-service restaurant locations. Telephone interviews were conducted with executives representing additional restaurants.

PARTICIPANTS: Parents (n = 59) and their first- through fourth-grade children (n = 58); executives (n = 4).

VARIABLES MEASURED: Parent/child perspectives on child meal selection and toy incentives in restaurants; executives' views on kids' meals and barriers to supplying healthier kids' meals.

ANALYSIS: Frequencies, thematic analysis.

RESULTS: A total of 63% of children ordered from children's menus, 8% of whom ordered healthier kids' meals. Half of parents reported that children determined their own orders. Taste was the most common reason for children's meal choices. Most (76%) children reported visiting the restaurant previously; 64% of them placed their usual order. Parents' views on toy incentives were mixed. Themes from executive interviews highlighted factors driving children's menu offerings, including children's habits and preferences and the need to use preexisting pantry items. Executives described menu changes as driven by profitability, consumer demand, regulation, and corporate social responsibility.

CONCLUSIONS AND IMPLICATIONS: Findings can inform the development of restaurant interventions that are effective in promoting healthier eating and are acceptable to parents, children, and restaurant personnel.