{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:07:16Z","timestamp":1789376836235,"version":"build-2803163510"},"reference-count":57,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Parental perceptions, beliefs, attitudes, and knowledge may influence children\u2019s sugar exposure, but these cognitive constructs are distinct from children\u2019s actual intake. This review synthesised parental cognition regarding children\u2019s sugar consumption and secondarily examined its relationship with reported or measured intake and implications for caries prevention. Methods: PubMed, Scopus, PsycINFO, CINAHL, and Web of Science were searched for primary studies published from January 2016 to April 2026. Study selection and narrative synthesis followed PRISMA 2020. Results: We included 35 studies from ten countries: 19 cross-sectional, 6 qualitative, 4 experimental\/randomised, 2 pre-post, 1 longitudinal, and 3 other survey-based or mixed-design studies. Misperceptions of product healthfulness and limited knowledge of sugar content were common. Associations between cognition and children\u2019s intake were inconsistent; parental modelling, household availability, cultural norms, and commercial influences were also associated with sugar exposure. Most evidence was observational, measures were heterogeneous, and no study measured dental caries directly. Conclusions: Parental cognition is relevant but insufficient on its own to explain children\u2019s sugar exposure. Caries-preventive counselling should combine factual education with attention to caregiver behaviour and the home food environment.<\/jats:p>","DOI":"10.3390\/children13091236","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T08:10:23Z","timestamp":1789373423000},"page":"1236","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Parental Cognition Regarding Children\u2019s Sugar Consumption and Its Implications for Dental Caries Prevention: A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Areena","family":"Tahir","sequence":"first","affiliation":[{"name":"Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8864-3702","authenticated-orcid":false,"given":"Esther","family":"Garc\u00eda-Miralles","sequence":"additional","affiliation":[{"name":"Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0054-1005","authenticated-orcid":false,"given":"Juan Ignacio","family":"Aura-Tormos","sequence":"additional","affiliation":[{"name":"Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8841-7975","authenticated-orcid":false,"given":"Clara","family":"Guinot-Barona","sequence":"additional","affiliation":[{"name":"Dentistry Department, Medicine and Health Faculty, Catholic University of Valencia, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5722-0547","authenticated-orcid":false,"given":"Laura","family":"Marqu\u00e9s-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de Val\u00e8ncia, 46010 Valencia, Spain"},{"name":"Dentistry Department, Medicine and Health Faculty, Catholic University of Valencia, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/ipd.12484","article-title":"Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective","volume":"29","author":"Tinanoff","year":"2019","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_2","unstructured":"World Health Organization (2015). WHO Guideline: Sugars Intake for Adults and Children, World Health Organization."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Mumena, W.A. (2021). Consumption of free sugar predicts nutrient intake of Saudi children. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.782853"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e13671","DOI":"10.1111\/mcn.13671","article-title":"Sources and determinants of free sugars intake by 5-year-old Australian children in the SMILE cohort","volume":"20","author":"Ivaturi","year":"2024","journal-title":"Matern. Child Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s12966-017-0501-3","article-title":"The influence of parental practices on child promotive and preventive food consumption behaviors: A systematic review and meta-analysis","volume":"14","author":"Yee","year":"2017","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zahid, A., Davey, C., and Reicks, M. (2017). Beverage intake among children: Associations with parent and home-related factors. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14080929"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e12791","DOI":"10.1111\/ijpo.12791","article-title":"Misperceptions about added sugar, non-nutritive sweeteners and juice in popular children\u2019s drinks: Experimental and cross-sectional study with U.S. parents of young children (1\u20135 years)","volume":"16","author":"Harris","year":"2021","journal-title":"Pediatr. Obes."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1017\/S1368980015000397","article-title":"Parents\u2019 beliefs about the healthfulness of sugary drink options: Opportunities to address misperceptions","volume":"19","author":"Munsell","year":"2016","journal-title":"Public Health Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"105471","DOI":"10.1016\/j.appet.2021.105471","article-title":"Parental perceptions and practices regarding sugar intake by school-aged children: A qualitative study with Portuguese parents","volume":"166","author":"Prada","year":"2021","journal-title":"Appetite"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1097\/MPG.0000000000001733","article-title":"Sugar in infants, children and adolescents: A position paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition","volume":"65","author":"Braegger","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e122","DOI":"10.1590\/1807-3107bor-2025.vol39.122","article-title":"Sugar consumption and early childhood caries: A systematic review and meta-analysis of cohort studies","volume":"39","author":"Echeverria","year":"2025","journal-title":"Braz. Oral Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1099\/mic.0.26082-0","article-title":"Are dental diseases examples of ecological catastrophes?","volume":"149","author":"Marsh","year":"2003","journal-title":"Microbiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/0022034510379602","article-title":"The role of bacteria in the caries process: Ecological perspectives","volume":"90","author":"Takahashi","year":"2011","journal-title":"J. Dent. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"nzab151","DOI":"10.1093\/cdn\/nzab151","article-title":"Caregivers\u2019 Understanding of Ingredients in Drinks Served to Young Children: Opportunities for Nutrition Education and Improved Labeling","volume":"6","author":"Jensen","year":"2022","journal-title":"Curr. Dev. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e76943","DOI":"10.2196\/76943","article-title":"Parent-Child Mutual Influences on Sugar-Sweetened Beverage Consumption Behaviors: Actor-Partner Analysis","volume":"8","author":"Lwin","year":"2025","journal-title":"JMIR Pediatr. Parent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1177\/0890117119868382","article-title":"Daily Adolescent Sugar-Sweetened Beverage Intake Is Associated With Select Adolescent, Not Parent, Attitudes About Limiting Sugary Drink and Junk Food Intake","volume":"34","author":"Imoisili","year":"2020","journal-title":"Am. J. Health Promot."},{"key":"ref_18","first-page":"127","article-title":"The Association between Maternal Nutrition Knowledge, Dietary Attitudes, and Dietary Behaviors Related to Sugar Intake, and Sugar Intake Reduction in Preschool Children","volume":"28","author":"Myeong","year":"2022","journal-title":"J. Korean Diet. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"105139","DOI":"10.1016\/j.appet.2021.105139","article-title":"Understanding individual and socio-cultural factors associated with Hispanic parents\u2019 provision of sugar-sweetened beverages to young children","volume":"161","author":"Beckman","year":"2021","journal-title":"Appetite"},{"key":"ref_20","first-page":"1","article-title":"Mothers\u2019 Nutritional Knowledge and Children\u2019s Consumption of Sugar Sweetened Beverages: Evidence from Mexico City","volume":"36","author":"Parker","year":"2026","journal-title":"Lat. Am. Econ. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Qiu, N., Moore, J.B., Wang, Y., Fu, J., Ding, K., and Li, R. (2021). Perceived parental attitudes are indirectly associated with consumption of junk foods and sugar-sweetened beverages among Chinese adolescents through home food environment and autonomous motivation: A path analysis. Nutrients, 13.","DOI":"10.3390\/nu13103403"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"106628","DOI":"10.1016\/j.appet.2023.106628","article-title":"Caregiver perceptions of snacks for young children: A thematic synthesis of qualitative research","volume":"188","author":"Killion","year":"2023","journal-title":"Appetite"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Van de Gaar, V.M., Jansen, W., Van der Kleij, M.J., Rossem, L., and Raat, H. (2016). Do children report differently from their parents and from observed data? Cross-sectional data on fruit, water, sugar-sweetened beverages and break-time foods. BMC Public Health, 16.","DOI":"10.1186\/s12889-016-2963-7"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e110","DOI":"10.4278\/ajhp.140103-QUAN-8","article-title":"Child and caregiver attitudes about sports drinks and weekly sports drink intake among U.S. youth","volume":"30","author":"Zytnick","year":"2016","journal-title":"Am. J. Health Promot."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"van de Gaar, V.M., van Grieken, A., Jansen, W., and Raat, H. (2017). Children\u2019s sugar-sweetened beverages consumption: Associations with family and home-related factors, differences within ethnic groups explored. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4095-0"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1038\/s41366-018-0021-5","article-title":"Parents\u2019 considerable underestimation of sugar and their child\u2019s risk of overweight","volume":"42","author":"Dallacker","year":"2018","journal-title":"Int. J. Obes."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1177\/0890117118763008","article-title":"Adolescent Sugar-Sweetened Beverage Intake is Associated With Parent Intake, Not Knowledge of Health Risks","volume":"32","author":"Lundeen","year":"2018","journal-title":"Am. J. Health Promot."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1016\/j.amepre.2018.04.018","article-title":"Health warning labels correct parents\u2019 misperceptions about sugary drink options","volume":"55","author":"Moran","year":"2018","journal-title":"Am. J. Prev. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1177\/0009922817696466","article-title":"Parental Knowledge of AAP Juice Guidelines Is Associated With Parent and Children\u2019s Consumption of Juice and Sugar-Sweetened Beverages in an Underserved Population","volume":"57","author":"SanGiovanni","year":"2018","journal-title":"Clin. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.2105\/AJPH.2018.304691","article-title":"Sugar-Sweetened Beverage Attitudes and Consumption During the First 1000 Days of Life","volume":"108","author":"Morel","year":"2018","journal-title":"Am. J. Public Health"},{"key":"ref_31","first-page":"191","article-title":"Caregivers\u2019 knowledge of sugar and control over children\u2019s sugar consumption","volume":"41","author":"Kim","year":"2019","journal-title":"Pediatr. Dent."},{"key":"ref_32","first-page":"119","article-title":"Parents\u2019 preferences and perceptions of their children\u2019s consumption of sugar and non-nutritive sugar substitutes","volume":"41","author":"Smith","year":"2019","journal-title":"Pediatr. Dent."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bradley, J., Gardner, G., Rowland, M.K., Fay, M., Mann, K., Holmes, R., Foster, E., Exley, C., Don Bosco, A., and Hugueniot, O. (2020). Impact of a health marketing campaign on sugars intake by children aged 5\u201311 years and parental views on reducing children\u2019s consumption. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-8422-5"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Eliason, J., Acciai, F., DeWeese, R.S., Todd, M., and Ohri-Vachaspati, P. (2020). Children\u2019s consumption patterns and their parent\u2019s perception of a healthy diet. Nutrients, 12.","DOI":"10.3390\/nu12082322"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"nzaa140","DOI":"10.1093\/cdn\/nzaa140","article-title":"Associations between child and parent knowledge of added sugar recommendations and added sugar intake in multiethnic elementary-aged children","volume":"4","author":"Landry","year":"2020","journal-title":"Curr. Dev. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1002\/hpja.257","article-title":"\u2018When we were young, it really was a treat; now sugar is just the norm every day\u2019\u2014A qualitative study of parents\u2019 and young adults\u2019 perceptions and consumption of sugary drinks","volume":"31","author":"Miller","year":"2020","journal-title":"Health Promot. J. Austr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s12937-020-00610-3","article-title":"Patterns of food parenting practices regarding junk food and sugary drinks among parent-child dyads","volume":"19","author":"Thomson","year":"2020","journal-title":"Nutr. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"105234","DOI":"10.1016\/j.appet.2021.105234","article-title":"Awareness of and reactions to the health harms of sugary drinks: An online study of U.S. parents","volume":"164","author":"Carl","year":"2021","journal-title":"Appetite"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1007\/s40368-021-00648-9","article-title":"Parental perspectives towards sugar-sweetened beverages and policies: A qualitative study","volume":"22","author":"Chan","year":"2021","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.jneb.2021.04.463","article-title":"What\u2019s in your drink? Poster educates families about sugar content and fatty liver disease","volume":"53","author":"Lee","year":"2021","journal-title":"J. Nutr. Educ. Behav."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2308","DOI":"10.1017\/S1368980022000751","article-title":"Caregivers\u2019 provision of sweetened fruit-flavoured drinks to young children: Importance of perceived product attributes and differences by socio-demographic and behavioural characteristics","volume":"25","author":"Choi","year":"2022","journal-title":"Public Health Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Christensen, B.J., Bestle, S.M.S., Trolle, E., Biltoft-Jensen, A.P., Matthiessen, J., and Lassen, A.D. (2022). A qualitative evaluation of social aspects of sugar-rich food and drink intake and parental strategies for reductions. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191811647"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e13338","DOI":"10.1111\/mcn.13338","article-title":"Marketing of sugar-sweetened children\u2019s drinks and parents\u2019 misperceptions about benefits for young children","volume":"18","author":"Phaneuf","year":"2022","journal-title":"Matern. Child Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1093\/ajcn\/nqac008","article-title":"Nutrition-related claims lead parents to choose less healthy drinks for young children: A randomized trial in a virtual convenience store","volume":"115","author":"Hall","year":"2022","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S807","DOI":"10.2105\/AJPH.2022.307024","article-title":"Effects of Sugary Drink Countermarketing Videos on Caregivers\u2019 Attitudes and Intentions to Serve Fruit Drinks and Toddler Milks to Young Children","volume":"112","author":"Harris","year":"2022","journal-title":"Am. J. Public Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.jand.2022.01.002","article-title":"Beverage Characteristics Perceived as Healthy among Hispanic and African-American Parents of Young Children","volume":"122","author":"Sylvetsky","year":"2022","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Zhang, R., Yang, Q., Tang, Q., Xi, Y., Lin, Q., and Yang, L. (2022). Is Adolescents\u2019 Free Sugar Intake Associated with the Free Sugar Intake of Their Parents?. Nutrients, 14.","DOI":"10.3390\/nu14224741"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"daae146","DOI":"10.1093\/heapro\/daae146","article-title":"Adding sugar to children\u2019s beverages: A theory of planned behavior study of Lebanese mothers","volume":"39","author":"Kassem","year":"2024","journal-title":"Health Promot. Int."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Talati, Z., Charlesworth, J., Mackenzie, K., McAlpine, T., Myers, G., Miller, C., Dana, L.M., O\u2019Connor, M., Mullan, B.A., and Dixon, H.G. (2024). Exploring Sugary Drink Consumption and Perceptions among Primary-School-Aged Children and Parents in Australia. Nutrients, 16.","DOI":"10.3390\/nu16193320"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"00469580251359507","DOI":"10.1177\/00469580251359507","article-title":"An Exploratory Qualitative Study of Beverage Sweetening Practices in Middle Eastern Families","volume":"62","author":"Kassem","year":"2025","journal-title":"Inquiry"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"105353","DOI":"10.1016\/j.foodqual.2024.105353","article-title":"Parental norms and attitudes in relation to children\u2019s sugar consumption: A mediation analysis of the \u2018Are You Too Sweet?\u2019 intervention study","volume":"123","author":"Bestle","year":"2025","journal-title":"Food Qual. Prefer."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Cui, Y., Bai, Y., and Liu, C. (2025). Parental Dietary Knowledge, Income and Students\u2019 Consumption of Sugar-Sweetened Beverages in China: Evidence from Longitudinal Study. Nutrients, 17.","DOI":"10.3390\/nu17213356"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Fuster, M., Wang, Y., Stoecker, C., Rose, D., Hofmann, L.P., Pasterz, A., and Knapp, M. (2025). Factors Associated with High Sugary Beverage Intake Among Children in Louisiana: A Survey of Caregivers in New Orleans and Baton Rouge. Nutrients, 17.","DOI":"10.3390\/nu17050799"},{"key":"ref_54","unstructured":"Aromataris, E., and Munn, Z. (2020). JBI Manual for Evidence Synthesis, JBI."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"17030","DOI":"10.1038\/nrdp.2017.30","article-title":"Dental caries","volume":"3","author":"Pitts","year":"2017","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1177\/00220345231160756","article-title":"Microbial indicators of dental health, dysbiosis, and early childhood caries","volume":"102","author":"Kahharova","year":"2023","journal-title":"J. Dent. Res."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/9\/1236\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T08:56:52Z","timestamp":1789376212000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/9\/1236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,12]]},"references-count":57,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["children13091236"],"URL":"https:\/\/doi.org\/10.3390\/children13091236","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,12]]}}}