What can pediatricians learn from food depictions in children's books?

Picture books frequently portrayed food not merely as sustenance but as a vehicle for family connection, cultural memory, and emotional experience, according to Carol Duh-Leong, MD, MPP, who led a pediatric-informed content analysis of 159 US picture books.¹ The study, grounded in Duh-Leong's clinical experience with Reach Out and Read, examined how food and nutrition content appeared across a representative sample of children's literature, with coders documenting food types, mealtime depictions, and social drivers of nutritional health.

One unanticipated finding involved how food was physically staged within illustrations. Clinicians commonly rely on tools like MyPlate to counsel families on nutrition, but picture books rarely depicted food arranged on individual plates. Instead, food more often appeared in a communal, relational context than as an individually portioned meal.

"Food is conceptualized like on a table with people gathered around rather than necessarily on individual plates," Duh-Leong said, noting that this pattern reflected food's role as a relational experience rather than a strictly nutritional one. She illustrated the point with the chapter book Ramona and Her Father, which was not part of the formal sample but which she cited as an example of how food can signal both celebration and food insecurity within a single-family narrative.

The analysis also found that sweet flavors were the most commonly depicted taste, whereas fruit was the most frequently depicted food group overall—a pairing that Duh-Leong said was consistent rather than contradictory, since fruit itself is often rendered as sweet and appealing. She pointed to The Very Hungry Caterpillar, in which fruit and cake were portrayed with comparable indulgence, and to The First Strawberries, a retelling of a Cherokee origin story in which the taste of strawberries evokes memories of familial joy. Reflecting on that book, Duh-Leong said, "We're thinking about the flavors and the actual foods and the roles that they depict that extend beyond the actual taste and the sense, but then the feelings and the emotions and the situations that it evokes for people."

Duh-Leong said the findings support the use of picture books as a commercial-free, early-literacy-based tool for engaging children in conversations about the social, cultural, and nutritional functions of food, complementing existing anticipatory guidance frameworks used in primary care.

REFERENCES

1. Duh-Leong C, Klass P, Nagpal N, et al. Portrayals of food and nutrition in popular US picture books. Pediatrics. 2026;158(2):e2025074460. doi:10.1542/peds.2025-074460

2. American Academy of Pediatrics Council on Early Childhood. Literacy promotion: an essential component of primary care pediatric practice. Pediatrics. 2024;154(6):e2024069090