Nurses often perform nutritional assessments. For example, nurses pay special attention to what a breastfeeding mother ingests, help parents answer questions about when and what kind of foods should be introduced to an infant, and can be challenged to provide nutritious suggestions to parents of a finicky adolescent. Although educated to perform a nutritional assessment, nurses may not gather additional information about the nature of family meals. Yet, such information may highlight underlying unhealthy nutritional behaviors that could be addressed by asking a few questions that are broader in scope.

What do we know about family meals? A standard definition for what constitutes "family meals" has yet to be developed (McCullough, Robson, & Stark, 2016), with most investigators and experts defining it in terms of frequency by number of times a family shares a meal together. McCullough et al. suggest that family meals be viewed from a socioecological framework. Their three-circle framework has child eating behavior at the center, followed by family meals (amount consumed, family communication, and types of food). Family meal environment is the outermost circle of this framework and consists of meal frequency, family members present, and length and location of meals. In their systematic review, McCullough et al. found most studies included only one characteristic highlighted in their framework (most commonly included: meal frequency; least commonly included: location of meals). No study included all four characteristics. Frequency decreased as children aged, suggesting "adolescence is a critical period during which family meals are occurring less, which... can lead to increased risk for health risk behaviors" (McCullough et al., p. 638). Most studies were cross-sectional and focused on adolescents, limiting assessment of family meal characteristics over time. Future research should evaluate a more accurate picture of what occurs during family meals.

Why are family meal characteristics important? Researchers report an association between family meals and health outcomes (Fulkerson, Larson, Horning, & Neumark-Sztainer, 2014; Goldfarb, Tarver, Locher, Preskitt, & Sen, 2015; Hammons & Fiese, 2011). Hammons and Fiese found that children of families who eat three or more meals together per week are less likely to be overweight, eat unhealthy foods, or have nutritional health issues such as disordered eating than children who eat less than three meals with their families per week. They recognize a significant assumption underlying many studies: spending time with families is a positive experience. This is not true in all families. Adolescents may choose to skip family meals because of conflict between them and their parents. Family meal participation has been associated with decreased adolescent health risks such as illicit drug use (Goldfarb et al.). Positive health outcomes of shared meals, such as weight status, have been documented for adults as well (Fulkerson et al.).

What can nurses do? Assessment of family meals is multifactorial. Nurses can include questions about with whom children and adults eat, where meals occur, how quickly meals occur, how the pattern of meals differs from week to week, and how often the family eats together. Answers may provide a more holistic context from which to approach offering nutritional guidance. Given shared meals may not provide a healthy context for families, nurses should make an effort to assess the type of interactions that occur during shared meals. Nurses are well prepared to obtain this kind of information, as they have excellent interpersonal skills and the trust of their patients.

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