"Just three more bites": an observational analysis of parents' socialization of children's eating at mealtime

Parent-child interaction during feeding or joint eating in parents of different weights

The current study investigates parent-child interaction during feeding or during joint eating, and aimed to explore differences in feeding interactions between mothers and fathers, as well as between overweight, obese and not overweight parents. 148 mothers and 148 fathers with children aged between 7 and 47months were observed during feeding of or joint eating with their child in the laboratory. The videotaped mother-child and father-child dyads were coded using the Chatoor Feeding Scale. This scale consists of 5 subscales: Dyadic Reciprocity, Dyadic Conflict, Talk and Distraction during Feeding, Struggle for Control, and Non-Contingency. Compared to mothers, fathers showed higher readings on the Talk and Distraction scale; in all other subscales no differences were found. The comparison between overweight, obese and not overweight mother-child dyads revealed no significant differences. Differences in father-child dyads between overweight, obese and not overweight fathers were identified in the subscale Struggle for Control: overweight fathers were marked by a higher amount of Struggle for Control than obese and not overweight fathers. Taken together, differences found in the present observational study are small to moderate, and thus the current results support extant literature demonstrating that there are no differences in feeding behaviour between mothers and fathers or between obese and non-obese parents.

Mealtime Observations and Parent-Report: Correspondence Across Measurement and Implications for Intervention

This study explored the relationship between self-reported and observed mealtime behaviour and examined concurrent predictors of observed child and parent mealtime behaviour. The sample consisted of 67 parents of 1.5- to 6-year-old children experiencing difficulties with their child's mealtime, and 33 parents who were not concerned with their child's mealtime behaviour. Parent-reported and observed mealtime data, and parent-reported mealtime cognitions were collected. Regression analyses indicated that consistent with hypotheses, observed and parent-reported mealtime behaviour were related. Observed child behaviour was predicted by self-reported parenting behaviour and observed positive parent behaviour, as well as parental cognitions. Observed parent behaviour was predicted only by self-reported parenting mealtime behaviour.

Reported and observed controlling feeding practices predict child eating behavior after 12 months

BACKGROUND

Controlling feeding practices are linked to children's self-regulatory eating practices and weight status. Maternal reports of controlling feeding practices are not always significantly related to independently rated mealtime observations. However, prior studies only assessed 1 mealtime observation, which may not be representative of typical mealtime settings or routines.

OBJECTIVES

The first aim was to examine associations between reported and observed maternal pressure to eat and restriction feeding practices at baseline (T1) and after ∼ 12 mo (T2). The second aim was to evaluate relations between maternal and child factors [e.g., concern about child weight, child temperament, child body mass index (BMI)-for-age z scores (BMIz)] at T1 and reported and observed maternal pressure to eat and restriction feeding practices (T1 and T2). The third aim was to assess prospective associations between maternal feeding practices (T1) and child eating behaviors (T2) and child BMIz (T2).

METHODS

A sample of 79 mother-child dyads in Victoria, Australia, participated in 2 lunchtime home observations (T1 and T2). BMI measures were collected during the visits. Child temperament, child eating behaviors, maternal parenting styles, and maternal feeding practices were evaluated at T1 and T2 via questionnaires. Associations were assessed with Pearson's correlation coefficients, paired t tests, and hierarchical regressions.

RESULTS

Reported restriction (T1) was inversely associated with observed restriction at T1 (r = -0.24, P < 0.05). Reported pressure to eat (T2) was associated with observed pressure to eat (T2) (r = 0.48, P < 0.01) but only for mothers of girls. Maternal weight concern was associated with reported restriction at T1 (r = 0.29, P < 0.01) and T2 (r = 0.36, P < 0.01), whereas observed restriction (T1) was prospectively associated child BMI at T2 (β = -0.18, P < 0.05).

CONCLUSIONS

Maternal reports may not always reflect feeding practices performed during mealtimes; it is possible some mothers may not be aware of their practices or observations may not capture covert controlling strategies.

"Dinner's ready!" A qualitative exploration of the food domain across the lifecourse

The influence of the childhood food domain on adult food-related practices is only partially understood. Through an interpretive study using in-depth life-story interviewing and narrative analysis, we aimed to discover how preferences and perceptions relating to the food domain become embodied during childhood, and once embodied, how these influence practices in adulthood. We observed distinct 'food mood' pathways seemingly anchored in childhood memories about dinnertime. One pathway led to food philosophies participants perceived to be beneficial for their health and wellbeing, whilst another led to perceptions of food as a chore and bore they would rather ignore. Parental attitudes were very important to the food domain of childhood, as this is now recalled through life-story narratives. Our findings suggest a positive relationship with the food domain needs to be fostered during childhood for the long-term protection and promotion of health and wellbeing in adulthood.

Development of the General Parenting Observational Scale to assess parenting during family meals

Background

There is growing interest in the relationship between general parenting and childhood obesity. However, assessing general parenting via surveys can be difficult due to issues with self-report and differences in the underlying constructs being measured. As a result, different aspects of parenting have been associated with obesity risk. We developed a more objective tool to assess general parenting by using observational methods during a mealtime interaction.

Methods

The General Parenting Observational Scale (GPOS) was based on prior work of Baumrind, Maccoby and Martin, Barber, and Slater and Power. Ten dimensions of parenting were included; 4 were classified in the emotional dimension of parenting (warmth and affection, support and sensitivity, negative affect, detachment), and 6 were classified in the behavioral dimension of parenting (firm discipline and structure, demands for maturity, psychological control, physical control, permissiveness, neglect). Overweight children age 8–12 years old and their parent (n = 44 dyads) entering a weight control program were videotaped eating a family meal. Parents were coded for their general parenting behaviors. The Mealtime Family Interaction Coding System (MICS) and several self-report measures of general parenting were also used to assess the parent–child interaction. Spearman’s correlations were used to assess correlation between measures.

Results

The emotional dimensions of warmth/affection and support/sensitivity, and the behavioral dimension of firm discipline/structure were robustly captured during the family meals. Warmth/affection and support/sensitivity were significantly correlated with affect management, interpersonal involvement, and communication from the MICS. Firm discipline/structure was inversely correlated with affect management, behavior control, and task accomplishment. Parents who were older, with higher educational status, and lower BMIs were more likely to display warmth/affection and support/sensitivity.

Conclusion

Several general parenting dimensions from the GPOS were highly correlated with similar family functioning constructs from the MICS. This new observational tool appears to be a valid means of assessing general parenting behaviors during mealtimes and adds to our ability to measure parent-level factors affecting child weight-related outcomes. Future evaluation of this tool in a broader range of the population and other family settings should be conducted.

Correspondence between maternal determination of child fullness and young children's self-determined fullness level: results from a standardized laboratory protocol

BACKGROUND

This study examined maternal understanding and acceptance of young children's ability to self-assess fullness using a mixed-methods approach.

METHODS

Twenty low-income mothers of 5- to 7-year-olds participated in this semistructured laboratory study. After consumption of a buffet dinner meal, mothers were asked to indicate their perception of their child's fullness level, and children were also asked to self-assess their fullness level.

RESULTS

Five of the 20 mothers in the study were initially correct in their assessment of their child's level of fullness. Half of the incorrect mothers were willing to change their rating when informed that the child's fullness rating was different than her own.

CONCLUSIONS

Semistructured interview results provide suggestive evidence that some mothers believe they understand their child's fullness level better than their children. Given that mothers have the potential to override children's ability to self-regulate eating behavior, teaching mothers to understand and appreciate young children's ability to self-regulate eating is an important area for intervention.

Feeding practices of low-income mothers: how do they compare to current recommendations?

BACKGROUND

Despite a growing consensus on the feeding practices associated with healthy eating patterns, few observational studies of maternal feeding practices with young children have been conducted, especially in low-income populations. The aim of this study was to provide such data on a low income sample to determine the degree to which observed maternal feeding practices compare with current recommendations.

METHODS

Eighty low-income mothers and their preschool children were videotaped at dinner in their homes. Mothers were chosen from a larger study to create a 2 X 2 X 2 design: maternal ethnicity (African American vs. Latina) by child gender by child weight status (healthy weight vs. overweight/obese). Observers coded videotapes for a range of maternal feeding strategies and other behaviors.

RESULTS

Many mothers spent considerable time encouraging eating--often in spite of the child's insistence that he or she was finished. Mothers talked little about food characteristics, rarely referred to feelings of hunger and fullness, and made more attempts to enforce table manners than to teach eating skills. Latina mothers showed higher levels of teaching eating skills and encouraging their children to eat; African American mothers showed higher levels of enforcing table manners and getting children to clear their plates. Mothers of boys used more unelaborated commands and less questions/suggestions than mothers of girls. Finally, compared to mothers of overweight/obese children, mothers of healthy weight children showed higher levels of encouraging eating and lower levels of discouraging eating.

CONCLUSIONS

Most of the mothers in this study did not engage in feeding practices that are consistent with current recommendations. They did this, despite the fact that they knew they were being observed. These results should be used to inform future research about the motivations behind mothers' feeding practices and the development of interventions by helping identify areas in greatest need of change.

How do parents of adolescent patients with anorexia nervosa interact with their child at mealtimes? A study of parental strategies used in the family meal session of family-based treatment

OBJECTIVE

To examine the range and frequency of parental mealtime strategies used during the family meal session of Family-Based Treatment (FBT) for adolescent anorexia nervosa, and to explore the relationships between parental mealtime strategies, mealtime emotional tone and parental 'success' at encouraging adolescent food consumption.

METHOD

Participants were 21 families with a child aged between 12 and 18 years receiving FBT for adolescent anorexia nervosa. Video recordings of the family meal session (FBT session two) were coded using the Family Mealtime Coding System adapted in this study for use with adolescents (FMCS-A) to identify frequency of parental strategies, emotional tone of the meal (measured by adolescent positive and negative vocalisations) and frequency of prompted mouthfuls consumed by the adolescent (measured by the number of mouthfuls consumed by the adolescent immediately following parental interactions).

RESULTS

A range of parental mealtime strategies were in use. Those used repeatedly included direct eating prompts, non-direct eating prompts, physical prompts, and providing information or food-related choices. Several parental mealtime strategies (direct and non-direct eating prompts) were found to be consistently associated with the tone of adolescents' vocalisations and the number of mouthfuls consumed in response to a parental prompt.

DISCUSSION

Despite associations with negativity from the adolescent, the use of food-related prompts (both verbal and physical) seems to be associated with increased eating. This indicates the potentially important role of parental control of eating. Following replication, these findings might provide a focus for therapists when supporting and coaching parents during the family meal session.

Systematic research review of observational approaches used to evaluate mother-child mealtime interactions during preschool years

BACKGROUND

The family meal and social interactions during the meal are important events in a child's life. Specifically, mealtime interactions have been linked to child weight status, the development of children's eating patterns, and socialization. Mealtime interactions may be observed and evaluated to provide insights into this important event beyond self-reported measurements.

OBJECTIVE

We aimed to identify, review, and examine studies in which mother-child mealtime behaviors were measured through observation.

DESIGN

MEDLINE Complete, PsycINFO, and PsycARTICLES were systematically searched by using sensitive search strategies. We included observational studies of mother-child eating and mealtimes and associations between mother-child interactions and preschool child eating or weight status published to March 2014.

RESULTS

Thirteen articles were included in our review. All studies but one were cross-sectional, and none of the studies evaluated how mutual dimensions (e.g., parent responsiveness to the child and child responsiveness to the parent) of dyadic interactions between mothers and children influence maternal feeding practices, children's eating, and weight. The parenting style was associated with maternal feeding practices but not directly with children's eating. Parental discouragements to eat and negative statements about food were associated with higher child weight status. Parental encouragement to eat was associated with higher child weight status as well as maternal body mass index. No associations were shown between maternal reports of feeding practices and observed maternal feeding practices.

CONCLUSIONS

Parents' overarching attitudes and approaches to parenting appear to be associated with their feeding practices or styles. Future studies should implement longitudinal observational methods with the capacity to measure levels of dimensions within bidirectional parent-child interactions and the extent to which these factors influence maternal practices, children's eating, and weight status.

Mealtime behaviors and food consumption of perceived picky and nonpicky eaters through home use test

Picky eating has been investigated through numerous surveys and food recalls, but few studies have applied in-home meal evaluations as a method to investigate behaviors and food preferences of children perceived by their parent to be a picky eater (PE) or nonpicky eater (NPE). A 2-wk in-home meal study was completed to investigate differences in PE and NPE mealtime behaviors and food selections using real-time parental observations. Parents (n = 170) and their 2- to 4-y-old children (83 PE and 87 NPE) evaluated 5 standardized meals in-home. Parents recorded their child's and their own hedonic liking of the products and completed an assessment of their child's behavior and consumption at each meal. Significant differences were found between perceived PE and NPE children for all 16 behaviors assessed. On average, perceived NPE were assessed to consume a higher percentage of the meal served and to have higher acceptance scores for most of the foods evaluated. Some foods, though, like breaded chicken and plain pasta, were liked equally by PE and NPE. Several significant differences in hedonic liking were revealed when PE children were compared to their parents. Yet, few differences in liking occurred between NPE children and their parents or between the 2 parental groups. Because study participants evaluated meals real-time rather than memory recall, the differences and similarities found between perceived PE and NPE may be considered direct experiential evidence with reduced subjective bias as created when subjects recall past experiences. Thus, findings from this study can provide the foundation to establish an objective definition and classification of PE and NPE.

Nutritional style of parents and examination of the effective factors

AIM

This study was performed to determine the nutritional style in parents who had children aged between 3 and 6 years and the effective factors.

MATERIAL AND METHODS

The sample number of this descriptive study was calculated with the sample formula for unknown population and the parents of 300 children aged between 3 and 6 years who attended a nursery school in the province of İzmir constituted the sample. The sample was reached in two periods. "The Sociodemographic Data Form" and "the Parent Nutritional Style Scale" were used as data collection tools. Written approval was obtained from the scientific ethics committee of the Ege University, Faculty of Nursery (B.30.2.EGE.0.82.00.00/29-288). The heights and weights of the children were measured by the investigators with certain measurement tools. The body mass index standard deviation score (BMI SDS) was calculated for each child. The children whose body mass index standard deviations were between +2 and -2 standard deviation were considered to have normal weight. The Auxology program was used to obtain these data. The body mass indexes of the parents were calculated according to the height and weight values stated by themselves. In analyses of the data, student's t-test and Mann-Whitney U test were used for comparison of two groups. Variance analysis and Kruskal-Wallis variance were used for multiple comparisons; Bonferrroni corrected Mann-Whitney U test and Shefee test were used for advanced analysis.

RESULTS

It was found that the variables including the age, education level, number of children, working status of the mothers and the perception of the child's weight by the mother affected the nutritional style of the parents. The mean "emotional" and "instrumental" nutrition subdimension scores of the mothers who were young, who had an education of primary school and who were housewifes, the mean "encouraging nutrition" subdimension scores of the mothers who had small for gestational age babies and the mean "emotional" nutrition sub-dimension scores of the mothers who perceived their babies' weights as lower than normal were found to be higher (p<0.05). No significant difference was found in the nutritional style in relation with the child's BMI SDS and the mother's own BMI.

CONCLUSIONS

The nutritional styles of parents are affected by some sociodemographic and anthropometric properties, but the relation with the child's weight should be demonstrated by observational studies.

Parental modelling of eating behaviours: observational validation of the Parental Modelling of Eating Behaviours scale (PARM)

Parents are important role models for their children's eating behaviours. This study aimed to further validate the recently developed Parental Modelling of Eating Behaviours Scale (PARM) by examining the relationships between maternal self-reports on the PARM with the modelling practices exhibited by these mothers during three family mealtime observations. Relationships between observed maternal modelling and maternal reports of children's eating behaviours were also explored. Seventeen mothers with children aged between 2 and 6 years were video recorded at home on three separate occasions whilst eating a meal with their child. Mothers also completed the PARM, the Children's Eating Behaviour Questionnaire and provided demographic information about themselves and their child. Findings provided validation for all three PARM subscales, which were positively associated with their observed counterparts on the observational coding scheme (PARM-O). The results also indicate that habituation to observations did not change the feeding behaviours displayed by mothers. In addition, observed maternal modelling was significantly related to children's food responsiveness (i.e., their interest in and desire for foods), enjoyment of food, and food fussiness. This study makes three important contributions to the literature. It provides construct validation for the PARM measure and provides further observational support for maternal modelling being related to lower levels of food fussiness and higher levels of food enjoyment in their children. These findings also suggest that maternal feeding behaviours remain consistent across repeated observations of family mealtimes, providing validation for previous research which has used single observations.

The influence of maternal infant feeding practices and beliefs on the expression of food neophobia in toddlers

Food neophobia is a highly heritable trait characterized by the rejection of foods that are novel or unknown and potentially limits dietary variety, with lower intake and preference particularly for fruits and vegetables. Understanding non-genetic (environmental) factors that may influence the expression of food neophobia is essential to improving children's consumption of fruits and vegetables and encouraging the adoption of healthier diets. The aim of this study was to examine whether maternal infant feeding beliefs (at 4 months) were associated with the expression of food neophobia in toddlers and whether controlling feeding practices mediated this relationship. Participants were 244 first-time mothers (M=30.4, SD=5.1 years) allocated to the control group of the NOURISH randomized controlled trial. The relationships between infant feeding beliefs (Infant Feeding Questionnaire) at 4 months and controlling child feeding practices (Child Feeding Questionnaire) and food neophobia (Child Food Neophobia Scale) at 24 months were tested using correlational and multiple linear regression models (adjusted for significant covariates). Higher maternal Concern about infant under-eating and becoming underweight at 4 months was associated with higher child food neophobia at 2 years. Similarly, lower Awareness of infant hunger and satiety cues was associated with higher child food neophobia. Both associations were significantly mediated by mothers' use of Pressure to eat. Intervening early to promote positive feeding practices to mothers may help reduce the use of controlling practices as children develop. Further research that can further elucidate the bi-directional nature of the mother-child feeding relationship is still required.

Portion sizes for children are predicted by parental characteristics and the amounts parents serve themselves

BACKGROUND

Children's energy intakes are influenced by the portions they are served. Factors influencing the amounts adults offer children are not well described.

OBJECTIVE

We assessed whether the amounts that were served to and consumed by children at meals were related to amounts that parents served themselves.

DESIGN

In this repeated-measures, cross-sectional observational study, 145 parents and their preschoolers (82 Hispanic, 57 African American, 6 unidentified) were recruited from Head Start settings in Houston, TX. The amounts served to and consumed by children and parents during 3 at-home evening meals were measured and analyzed. We assessed children's and parents' heights and weights, and body mass indexes (BMIs) were calculated. Associations between portions served for parents and children and between amounts served to and consumed by children were evaluated. Multiple linear regression was used to determine whether maternal characteristics (race-ethnicity, sociodemographic factors, and caregivers' BMIs) predicted the amounts caregivers served to children.

RESULTS

The amounts that parents served themselves were significantly associated with the amounts that they served to their children (r = 0.51, P < 0.0001). Multiple regression analysis showed that African American parents (compared with Hispanics) served more food to themselves and to their children (P < 0.01, R² = 6.9%) and that employed (compared with unemployed) parents served more food to their children (P = 0.025, R² = 3.3%). The amounts served to children were strongly associated with the amounts children consumed (r = 0.88, P < 0.0001). When parents served more to themselves, they also served more to their children (P < 0.001).

CONCLUSIONS

These findings underscore the strong relation between portions offered by caregivers and the amounts children consume at a meal and suggest that factors unrelated to the child (such as the amount a parent serves himself or herself) are important predictors of children's consumption. Efforts aimed at improving parents' recognition of developmentally appropriate portions for young children could be useful for future obesity-prevention efforts.

Exploring child-feeding style in childcare settings: how might nursery practitioners affect child eating style and weight?

Although considerable research has explored the role of parents in affecting child eating habits and weight, there has been little consideration of the impact of other key care providers in the early years. A controlling maternal child-feeding style (e.g. use of pressure to eat or restricting certain foods) has been associated with over consumption, fussy eating and weight issue. Conversely, responsive child-feeding styles whereby children are allowed to regulate their own intake but encouraged to eat a range of foods and try new tastes are associated with healthier eating styles and weight. Increasing numbers of preschool children now spend time in day care settings, many for up to fifty hours a week but interactions with caregivers during mealtimes remain unexplored. The aim of the current study was to begin to explore child-feeding styles of nursery practitioners working with children aged 0-5 years. Sixty three nursery practitioners completed an adapted version of the Child Feeding Questionnaire to examine their interactions with children during mealtimes. Themes included pressure to eat, encouragement to eat and use of reward. Typically practitioners reported responsive child-feeding styles with low levels of pressure to eat but high levels of encouragement to try new foods. Use of reward to eat certain foods or as a bribe to modify behaviour was however more common. The findings have important implications for understanding the role of childcare providers in affecting child eating habits and weight.

Fathers' child feeding practices: a review of the evidence

Despite their expanding role in child rearing, fathers are underrepresented in child feeding research. To address this knowledge gap and encourage father-focused research, this review compiles child feeding research that has included fathers and (i) documents characteristics of studies assessing fathers' feeding practices including study design, setting, recruitment strategies, participant characteristics, theoretical models utilized and measures of child feeding, (ii) outlines general patterns in fathers' feeding practices along with similarities and differences in mothers' and fathers' feeding practices, (iii) summarizes evidence on child and parent correlates of fathers' feeding practices and (iv) generates future research recommendations. A literature review of relevant articles published up to February 2014 was conducted. Studies were eligible for inclusion if they: (i) included fathers, or primary male caregivers, of children 2-18 years of age, (ii) measured fathers' child feeding practices or perceived role in child feeding through objective (e.g., meal observations) or subjective (i.e., fathers' self-report) methods, (iii) analyzed and presented data on fathers separately from mothers and (iv) were published in a peer reviewed journal in the English language. Twenty studies met eligibility criteria. Few studies included an operational definition of "father". Samples were generally small and focused on white, well-educated fathers, cohabiting with the child's mother. Most studies utilized self-report measures of child feeding practices that have not been validated specifically for use with fathers. Pressuring children to eat was a common feeding strategy adopted by fathers. Some differences were noted in mothers' and fathers' feeding practices; fathers were generally less likely to monitor children's food intake and to limit access to food compared with mothers. Child adiposity and a range of child and parent characteristics were associated with fathers' feeding practices. The literature on fathers' child feeding practices is scant. This review consolidates what is known to date and highlights focal areas for future research including the need to recruit diverse samples of fathers and utilize measures validated for use with fathers.

"It's like big mama's house": examining extended family influences on the dietary behaviors of African American children

The family environment plays an important role in influencing children's dietary behaviors. Traditionally, African American extended family members play a key role in child socialization. We examine the role of extended families in how children are socialized to adopt dietary norms. We conducted in-depth, semi-structured interviews with 24 individuals across eight family units to elicit information regarding the influences of culture and families on children's dietary behaviors. Findings suggest that families teach children to value activities that combine quality time and enjoying food together; adults are inconsistent in how they teach children to adopt desired dietary behaviors. This work has implications for improving family-based interventions for African American children through promoting healthful behaviors that are also respectful of family dietary traditions, improving communication between adults and children, and leveraging family members as attitudinal and behavioral referents.

Contributors to childhood obesity in Iran: the views of parents and school staff

OBJECTIVE

To explore the contextual influences on childhood obesity in Tehran, Iran to inform future development of an obesity prevention intervention for Iranian primary school children.

STUDY DESIGN

Qualitative study.

METHODS

Focus groups and interviews with parents and school staff were convened to explore their perceptions of the causes of childhood obesity. Eleven focus groups and three interviews were held with parents and school staff (88 participants in total) from three different socio-economic areas in Iran's capital city, Tehran. All the discussions were transcribed verbatim in Persian. An iterative thematic approach was used for data analysis.

RESULTS

Overall, the causes of childhood obesity were perceived to relate to macro-level policy influences, the school environment, sociocultural factors, and family and individual behavioural factors, acting in combination. A key emergent theme was the pervasive influence of Government policies on children's food intake and physical activity. Another key theme was the political and sociocultural context that does not support girls and women in Iran in having active lifestyles.

CONCLUSION

The findings suggest that parents and school staff have sophisticated views on the possible causes of childhood overweight and obesity which encompassed behavioural, structural and social causes. A prominent emerging theme was the need for state level intervention and support for a healthy environment. Any local initiatives in Iran are unlikely to be successful without such support.

WHAT IS KNOWN ON THIS SUBJECT

Childhood obesity is growing in Iran and it is seen as one of the features of the nutrition transition in developing countries. Findings from cross-sectional studies suggest a range of lifestyle factors contribute to obesity in the Iranian population.

WHAT THIS STUDY ADDS

This qualitative study explores the socioenvironmental changes contributing to childhood obesity in primary school-aged children in Iran. Findings have provided important contextual data on the perceived contributors to childhood obesity in Iran, such as macro-level policy influences on accessibility to healthy food and physical activity, competing priorities at school level, sociocultural influences on diet and physical activity and limited knowledge and skills of parents. This has laid the foundation for the development of appropriate childhood obesity prevention interventions.

Controlling parental feeding practices and child body composition in ethnically and economically diverse preschool children

Controlling parental feeding practices may be associated with childhood overweight, because coercive or intrusive feeding practices may negatively impact children's development of self-regulation of eating. This study examined pressuring or forcing a child (healthy or unhealthy foods) and restricting child from unhealthy or snack foods as two types of controlling feeding practices that explain unique variances in measures of child body composition (BMI, percent body fat, and parental perception of child weight). In an ethnically and economically diverse sample of 243 children aged 4-6years old and their biological parents (89% biological mothers, 8% biological fathers, and 3% step or grand-parent), descriptive statistics indicate ethnic and family income differences in measures of feeding practices and child body composition. Additionally, the two "objective" indices of body composition (BMI and percent body fat) were related to low pressure to eat, whereas the "subjective" index (perceived child weight) was related to restriction. Regression analyses accounting for ethnic and family income influences indicate that pressure to eat and restriction both explained unique variances in the two "objective" indices of body composition, whereas only restriction explained variance in perceived child weight. Findings have implications for helping parents learn about feeding practices that promote children's self-regulation of eating that simultaneously serves as an obesity prevention strategy.

Academy of Nutrition and Dietetics benchmarks for nutrition in child care 2011: are child-care providers across contexts meeting recommendations?

The Academy of Nutrition and Dietetics (Academy) recommends feeding practices for child-care providers to establish nutrition habits in early childhood to prevent obesity. With >12 million US children in child care, little is known about child-care providers' feeding practices. The purpose of this study was to examine child-care providers' feeding practices to assess whether providers met the Academy's benchmarks and whether attainment of benchmarks varied across child-care contexts (Head Start, Child and Adult Care Food Program [CACFP], and non-CACFP). Cross-sectional data was collected in 2011 and 2012 from 118 child-care providers who completed self-administered surveys regarding their feeding practices for 2- to 5-year-old children. χ(2) tests and analysis of variance were used to determine variation across contexts. Head Start providers sat more frequently with children during meals (P=0.01), ate the same foods as children (P=0.001), and served meals family style (P<0.0001) more often compared with CACFP and non-CACFP providers. Head Start providers (P=0.002), parents (P=0.001), and children (P=0.01) received more nutrition-education opportunities compared with CACFP and non-CACFP. Head Start providers encouraged more balance and variety of foods (P<0.05), offered healthier foods (P<0.05), modeled healthy eating (P<0.001), and taught children about nutrition (P<0.001) compared with CACFP and non-CACFP providers. Providers across all three contexts used significantly more non-internal than internal mealtime verbal comments (P<0.0001). Head Start providers had greater compliance with the Academy's benchmarks compared with CACFP and non-CACFP providers. Possible reasons for this compliance might be attributed to Head Start nutrition performance standards and increased nutrition-training opportunities for Head Start staff. Head Start programs can serve as a model in implementing the Academy's benchmarks.

Food parenting: a selective review of current measurement and an empirical examination to inform future measurement

BACKGROUND

Interactions between parents and children in regard to food are an important part of the development of food preferences and intake patterns for children. The measurement of this complex and multidimensional construct is very challenging.

METHODS

This article examines the current status of measurement in this domain in a selective review, considers qualitative input from parents and adolescents in an empirical examination of the topic, and makes concrete recommendations for the future.

RESULTS

Qualitatively, there were important differences between what the adolescents reported that their parents did to impact their eating habits, what parents of younger children report they currently do, and what researchers typically measure in research on parental feeding practices.

CONCLUSIONS

On the basis of these empirical findings and our review of the literature, we recommend that food parenting be measured on three levels: Feeding styles (e.g., authoritative), food parenting practices (e.g., restriction), and specific feeding behaviors (e.g., putting food out of the child's reach). Specific recommendations for future study are given for each level of measurement.

Food parenting measurement issues: working group consensus report

Childhood obesity is a growing problem. As more researchers become involved in the study of parenting influences on childhood obesity, there appears to be a lack of agreement regarding the most important parenting constructs of interest, definitions of those constructs, and measurement of those constructs in a consistent manner across studies. This article aims to summarize findings from a working group that convened specifically to discuss measurement issues related to parental influences on childhood obesity. Six subgroups were formed to address key measurement issues. The conceptualization subgroup proposed to define and distinguish constructs of general parenting styles, feeding styles, and food parenting practices with the goal of understanding interrelating levels of parental influence on child eating behaviors. The observational subgroup identified the need to map constructs for use in coding direct observations and create observational measures that can capture the bidirectional effects of parent-child interactions. The self-regulation subgroup proposed an operational definition of child self-regulation of energy intake and suggested future measures of self-regulation across different stages of development. The translational/community involvement subgroup proposed the involvement of community in the development of surveys so that measures adequately reflect cultural understanding and practices of the community. The qualitative methods subgroup proposed qualitative methods as a way to better understand the breadth of food parenting practices and motivations for the use of such practices. The longitudinal subgroup stressed the importance of food parenting measures sensitive to change for use in longitudinal studies. In the creation of new measures, it is important to consider cultural sensitivity and context-specific food parenting domains. Moderating variables such as child temperament and child food preferences should be considered in models.

Predicting successful introduction of novel fruit to preschool children

BACKGROUND

Few children eat sufficient fruits and vegetables despite their established health benefits. The feeding practices used by parents when introducing novel foods to their children, and their efficacy, require further investigation.

OBJECTIVE

We aimed to establish which feeding strategies parents commonly use when introducing a novel fruit to their preschool-aged children and assess the effectiveness of these feeding strategies on children's willingness to try a novel fruit.

DESIGN

Correlational design.

PARTICIPANTS/SETTING

Twenty-five parents and their children aged 2 to 4 years attended our laboratory and consumed a standardized lunch, including a novel fruit. Interactions between parent and child were recorded and coded.

STATISTICAL ANALYSES PERFORMED

Pearson's correlations and multiple linear regression analyses.

RESULTS

The frequency with which children swallowed and enjoyed the novel fruit, and the frequency of taste exposures to the novel fruit during the meal, were positively correlated with parental use of physical prompting and rewarding/bargaining. Earlier introduction of solids was related to higher frequency of child acceptance behaviors. The child's age at introduction of solids and the number of physical prompts displayed by parents significantly predicted the frequency of swallowing and enjoying the novel fruit. Age of introduction to solids and parental use of rewards/bargaining significantly predicted the frequency of taste exposures.

CONCLUSIONS

Prompting a child to eat and using rewards or bargains during a positive mealtime interaction can help to overcome barriers to novel fruit consumption. Early introduction of solids is also associated with greater willingness to consume a novel fruit.

A narrative literature review of the development of obesity in infancy and childhood

This narrative review explains the development of excess weight gain in babies and children. It takes a life course approach which includes genetics, pre-conception, pregnancy, infancy and childhood. The paper focuses on feeding behaviours, physical activity, parental influences and the wider social and environmental context. Risk factors which can cumulatively lead to excess childhood weight gain include: under- or overweight during pregnancy; the presence of diabetes during pregnancy; low or high birth weight; having obese parents; early weaning; prolonged formula feeding; rapid weight gain in the first year; disinhibited eating patterns and the consistent availability of energy dense food at home; feeding practices which are not responsive to the child's cues; insufficient sleep among preschool children; sedentary parents; low parental education; living in poor socio-economic circumstances; absence, or perceived absence, of safe play areas; parents who lack time or confidence to authoritatively parent; environments where there is poor access to affordable lower energy dense foods; and parents who do not accept that excess weight is a health problem. Recommendations for health professionals are made.

Development of the Child Mealtime Feeding Behavior Questionnaire

It has been suggested that parents’ feeding behaviors are associated with the eating behaviors of their children. The objective of this study was to develop the Child Mealtime Feeding Behavior Questionnaire (CMFBQ) to assess the strategies used by mothers in response to picky eating by their children at meals. The participants, 834 mothers of 3- to 6-year-old children attending kindergartens and nursery schools in Tokyo and Fukui, Japan, completed the self-administered questionnaires. Exploratory and confirmatory factor analyses of data obtained from these participants produced an 18-item scale with 4 subscales: “behavioral strategy,” “passive coercion,” “punishment and reward,” and “permission.” The internal consistency (Cronbach’s α) of these subscales ranged from .65 to .82. Maternal punishment and reward and maternal permission were positively associated with children’s picky eating; however, other behavioral strategies, including passive coercion, were not significantly related to children’s picky eating. The CMFBQ can assess the strategies used by mothers to encourage their children to eat meals. Researchers and health practitioners can use this measure to better understand how mothers motivate their children to eat meals and to consider the implications of these practices for children’s eating behaviors without placing an undue burden on respondents.

Maternal correlates of maternal child feeding practices: a systematic review

Establishing healthy eating habits early in life is one important strategy to combat childhood obesity. Given that early maternal child feeding practices have been linked to child food intake and weight, identifying the maternal correlates of maternal child feeding practices is important in order to understand the determinants of childhood obesity; this was the overall aim of the current review. Academic databases were searched for studies examining the relationship between maternal child feeding practices and parenting, personal characteristics and psychopathology of mothers with preschoolers. Papers were limited to those published in English, between January 2000 and June 2012. Only studies with mothers of normally developing children between the ages of 2 and 6 years were included. There were no restrictions regarding the inclusion of maternal nationality or socioeconomic status (SES). Seventeen eligible studies were sourced. Information on the aim, sample, measures and findings of these was summarised into tables. The findings of this review support a relationship between maternal controlling parenting, general and eating psychopathology, and SES and maternal child feeding practices. The main methodological issues of the studies reviewed included inconsistency in measures of maternal variables across studies and cross-sectional designs. We conclude that the maternal correlates associated with maternal child feeding practices are complex, and the pathways by which maternal correlates impact these feeding practices require further investigation.

Feeding behaviors of low-income mothers: directive control relates to a lower BMI in children, and a nondirective control relates to a healthier diet in preschoolers

BACKGROUND

A topic of interest in the etiology of child obesity is whether and how parental feeding behaviors are associated with the food intake and weight status of children.

OBJECTIVE

The objective was to explore whether and how directive (overt) and nondirective (covert and food environmental structure) types of parental feeding control were associated with children's food intake and weight status.

DESIGN

This was a cross-sectional exploratory study using structural equation modeling to determine directional associations between maternal feeding practices and children's food intake and weight status. Researchers collected data from 330 dyads of children aged 3-5 y and mothers participating in a federal preschool program for low-income families (Head Start) in Michigan. The mothers' feeding practices (directive and nondirective control), the children's food intakes, and the height and weight of both the mothers and children were measured. Structural equation models tested the relations between maternal feeding practices, the children's food intake, and weight status.

RESULTS

The structural equation model confirmed that children's weight status was inversely associated with mothers' directive control, and mothers' nondirective control was associated with children's intakes of more nutrient-dense foods and less energy-dense foods. No association was found between the mothers' directive control and the children's food intakes.

CONCLUSIONS

Mothers' use of nondirective feeding practices was associated with children's intakes of more nutrient-dense foods. However, use of more directive feeding control was associated with lower weight status in preschoolers of low-income mothers. These findings need to be examined in longitudinal studies. This trial was registered at clinicaltrials.gov as NCT01525186.

Mother's feeding practices for children 3-10 years of age and their associations with child demographics

The present study examined relationships between mothers' feeding practices and child demographics such as gender, age, weight status, and family income. This cross-sectional analysis was conducted using data from 2259 children between 3 and 10 years of age who were sampled for the development of the Parent Mealtime Action Scale. No child gender differences were found in mothers' feeding practices. Older children received more Fat Reduction and Many Food Choices, but less Positive Persuasion, Use of Rewards, Insistence on Eating, and Special Meals, with differences in these feeding practices being most notable from before to after school age. Overweight children received less Insistence on Eating and more Fat Reduction than underweight or normal weight children. Children with the lowest family incomes received less Fat Reduction, less Daily FV Availability, more Use of Rewards. Results suggest that mothers respond to changing conditions, possibly including feedback from school nurses, increases in children's weight status, and availability of financial resources.

Children's weight status and maternal and paternal feeding practices

Child obesity has become a major concern of health researchers. This study explores the association between parental feeding practices and children's weight status. The study also examines whether maternal and paternal feeding practices lead to significantly different children's weight outcomes. By analyzing samples of 312 children (aged 9-11 and 13-15) and their parents, randomly selected from the Houston Metropolitan Statistical Area, the results show that parental feeding practices are linked to children's weight status. The finding that maternal and paternal feeding practices do not have significantly different effects on children's weight highlights an equivalent role of maternal and paternal feeding practices in shaping children's weight status.

Parental eating disorder symptoms and observations of mealtime interactions with children

OBJECTIVE

To examine relationships between parental eating disorder symptomatology and observed feeding interactions with children.

METHOD

Twenty-three mother-father pairs of children between 18 months and 5 years completed a self-report measure of eating disorders and were observed during a family mealtime.

RESULTS

Parental reports of eating disorder symptoms were related to observations of greater pressurizing by both parents, maternal restriction of children's food intake and use of incentives to eat, more mouthfuls of food eaten by the child, and less food refusal.

DISCUSSION

Observed controlling feeding practices are related to symptoms of eating disorders in nonclinical groups of mothers and fathers, highlighting one mechanism by which eating distress may be transmitted within families.

Confirmatory factor analysis of a questionnaire measuring control in parental feeding practices in mothers of Head Start children

Parental control in child feeding has focused primarily on directive types of control, such as pressure to eat and food restriction. This study aimed to develop an instrument to assess other types of directive control and two additional aspects of parental child feeding, non-directive and food environmental control. Mothers of Head Start children (n=330) completed a 29-item instrument designed to assess these three feeding constructs and reported their children's food intakes. Researchers measured heights and weights of both mothers and children. Confirmatory factor analysis revealed that the model with three constructs did not provide an acceptable fit to the data, but an alternative model with seven sub-constructs did (Chi-square=330, df=228 p<.05, CFI=.942, RMSEA=.037). The latter model included 24 items loading onto one of the following seven factors: high control, high contingency, child-centered feeding, encouraging nutrient-dense foods, discouraging energy-dense foods, mealtime behaviors, and timing of meals. By allowing researchers to quantitatively measure feeding practices in parents with limited resources, this instrument may contribute to an improved understanding of how parental child feeding behaviors can influence children's food intakes and weight status.

Finishing the family meal. The interactional organisation of satiety

This paper provides an extended review of psychological, sociological and interactional research on mealtimes and satiety (fullness), arguing for a focus on how fullness and finishing a meal is interactionally achieved. Drawing on three specimen data fragments from contrasting family settings, routinely used resources for pursuing completion and expressing satiety are described. We show how checks on completion are tailored to children according to their age, the intimate knowledge family members have of one another and attuned to contingencies, such as, whether there is a further course to be offered. Equally, that in teaching children how to eat together with others, the family also transmits and transforms all manner of other eating practices such as how to comply, or not, with requests to finish. A central aim of the article is to complement the many studies of satiety that have explained its physiological aspects by providing the familial logics that are expressed in bringing the meal to a close. We offer a suggestive analysis, based on conversation analytic principles, to illustrate our argument and to provide a starting point for further work in this field. Where bodies of work have previously used mealtimes as a convenient setting for accessing other social practices, this article turns its focus back toward the tasks of dining together.

The beneficial effect of family meals on obesity differs by race, sex, and household education: the national survey of children's health, 2003-2004

Studies have indicated that family meals may be a protective factor for childhood obesity; however, limited evidence is available in children with different racial, socioeconomic, and individual characteristics. The purpose of this study was to examine family meal frequency as a protective factor for obesity in a US-based sample of non-Hispanic white, non-Hispanic black, and Hispanic children age 6 to 11 years, and to identify individual, familial, and socioeconomic factors that moderate this association. Data were from the 2003 National Survey of Children's Health (n=16,770). Multinomial logistic regression analyses were used to test the association between family meal frequency and weight status, and the moderating effects of household structure, education, poverty level, and sex, by racial group. Non-Hispanic white children who consumed family meals every day were less likely to be obese than those eating family meals zero or a few days per week. A moderating effect for sex was observed in non-Hispanic black children such that family meal frequency was marginally protective in boys but not in girls. Higher family meal frequency was a marginal risk factor for obesity in Hispanic boys from low-education households, but not in girls from similar households. In conclusion, family meals seem to be protective of obesity in non-Hispanic white children and non-Hispanic black boys, whereas they may put Hispanic boys living in low-education households at risk. Greater emphasis is needed in future research on assessing why this association differs among different race/ethnic groups, and evaluating the influence of the quality and quantity of family meals on child obesity.