Child weight status and accuracy of perceived child weight status as predictors of Latina mothers' feeding practices and styles

Parenting Practices to Prevent Childhood Obesity Among Hispanic Families: A Systematic Literature Review

Background: Childhood obesity disproportionately affects Hispanic families and remains an unresolved public health concern. Interventions to enhance health-related parenting practices may be a promising strategy to lower the risk for childhood obesity. However, there are scarce data on which parenting practices would be culturally relevant and contribute to lower the risk for childhood obesity among Hispanic families in the United States. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. An electronic database search of records was carried out in PubMed, CINAHL, PsycINFO, and Scopus to synthesize studies assessing associations or intervention effects of parenting practices on child BMI or other anthropometric measure among Hispanic parent-child dyads aged ≥18 and 2-12 years, respectively. Results: Of 1055 unique records identified, 17 studies were included. Most of these studies used a cross-sectional design (n = 10) and child BMI z-scores or BMI-for-age-sex percentiles as the outcome variable. Parenting practices to lower the risk for child overweight/obesity among Hispanic families included setting limits and providing routines (e.g., limited screentime), supporting a healthy lifestyle and physical activity (e.g., providing transportation to places for children's physical activities), and parenting feeding or diet-related practices (e.g., control the foods that children eat). Conclusion: Parenting practices that support healthy behaviors may be components of interventions to lower the risk for childhood obesity among Hispanic families.

Maternal concern and perception about child overweight risk, maternal feeding practices, and child eating behaviors: A cross-sectional study

Abundant efforts have been directed to understand the global obesity epidemic and related obesogenic behaviors. However, the relationships of maternal concern and perception about child weight with child eating behaviors in Saudi Arabia have not been investigated. Therefore, this study aimed to examine the associations of maternal concern and perception about child overweight risk with maternal feeding practices and child eating behaviors among mothers and their children in Saudi Arabia. Mothers of 115 children aged 3-5 years old were recruited from eight preschools. Child eating behaviors (enjoyment of food, responsiveness to foods, food fussiness, satiety responsiveness, and slowness in eating) and maternal feeding practices (restriction, monitoring, and using food as a reward), maternal concern about child weight, and maternal perception about child overweight risk were assessed using validated questionnaires. Multiple linear regression models, adjusted for maternal body mass index (BMI) and child's BMI-z score and sex, were tested to examine the independent associations of maternal concern and perception about child overweight risk with child eating behaviors and maternal feeding practices. Maternal concern about child weight was positively associated with food enjoyment in children (B = 0.14 [95% confidence intervals = 0.02,0.27]) and responsiveness to food (B = 0.16 [0.03,0.29]), whereas a negative association with child food fussiness was observed (B = -0.19 [-0.33, -0.04]). Maternal perception about child overweight risk and child slowness in eating were negatively associated (B = -0.72 [-0.16 to -0.28]). Maternal concern and perception about child overweight risk were not associated with maternal feeding practices. In conclusion, maternal concern and perception about child overweight risk were found to be associated with food approach eating behavior traits but not with maternal feeding practices. Mothers who are concerned about child weight or perceive their children as overweight may need guidance and support to promote healthy eating behaviors among their children. Future cross-cultural studies are needed to understand the underlying mechanisms for the influence of maternal concern and perception about child overweight risk on maternal feeding practices, child eating behaviors, and weight status of children.

Mother-child pairs' eating and feeding behaviours in two different nutritional status from two distinct provinces

Nutrition plays a crucial role for the bio-psycho-social growth and development of children. Mother-child pairs' eating-feeding problems can be hypothesized to relate to the child's nutritional status and living area. Our focus was to assess maternal attitudes and children's eating habits in thin and normal-weight children across two cities characterized by distinct socioeconomic and demographic profiles: Ankara and Şanlıurfa. This double case-control study included the mothers whose children are aged between 2 and 7 years old in both cities. Figure Rating Scale, Child Feeding Questionnaire and Behavioral Pediatrics Feeding Assessment Scale were filled by mothers of children. The mothers of thin children were concerned more about the weight of their children, felt more responsible for feeding their children, and use of pressured them to eat more frequently compared to normal-weight children's mothers in both cities. In Ankara, the duration of breastfeeding is longer, using formula is rarer and starting complementary food on time is more common, mother had higher scores on perceived responsibility, perceived child weight, and concern about child weight subscales; lower score on the restriction subscale compared to Şanlıurfa. Mothers of both thin and normal weight children in Şanlıurfa rated their children as weaker compared to those in Ankara. In conclusion, child eating behaviors and parental feeding practices were associated with the weight of children depending on demographic and sociocultural differences. Implementing customized, location-specific preventive educational initiatives on child feeding will not only foster behavioral changes but also yield valuable insights for shaping future interventions.

[Parenting stress, maternal feeding styles related to preschooler body mass index]

Introduction

Introduction: excess weight in childhood is influenced by multiple factors; parenting could contribute to this problem, given that during the infant stage the parents, and mainly the mother, are responsible for providing food and feeding their children. Objective: to explore the relationship of parenting stress and maternal feeding styles with preschool BMI. Materials and methods: a cross-sectional study. A total of 382 dyads, mother and child (3-5 years of age) participated. The children attended public preschool institutions. Participating mothers completed the Parenting Stress Scale and the Caregiver Feeding Styles Questionnaire. Weight and height were measured, and the child's BMI was calculated. Results: 34 % of the mothers more frequently used an indulgent style, 28.2 % of the preschool children had overweight-obese. Mothers with an authoritative style had the highest mean range of parenting stress compared to other categories (H = 15.302, gl = 3, p = 0.002). Maternal schooling, responsibility and demand dimensions were identified as contributing to preschooler BMI. Conclusion: parenting stress and feeding styles are variables that contribute to the risk of overweight-obesity in prescho.

Rationale, formative research, and protocol for Calma, Conversa, y Cría: A pilot mindful parenting intervention with Latina women

Background

Latina mothers' stress is associated with their children's health behaviors and risk for obesity; however, existing pediatric health promotion programs have not focused on maternal stress reduction.

Methods

Herein we describe a study design that will examine the acceptability and feasibility of Calma, Conversa, y Cría (CCC) a 6-week mindful parenting intervention designed to reduce stress. We present the results of qualitative research with Latina mothers and experts in Latinx health and mindfulness who provided culturally-relevant feedback on existing mindful parenting strategies to inform the development of CCC. Fifty Latina mothers of children ages 3-11 years will be randomly assigned to CCC or an enhanced usual care health education intervention. Acceptability will be assessed through participant satisfaction surveys and exit interviews. Feasibility will be determined through detailed tracking of recruitment, retention, and attendance rates. A signal regarding any group differences in maternal stress, health-related parenting practices, child diet, child physical activity, and child quality of life will be explored.

Discussion

The development of interventions that can reduce maternal stress and risk for obesity in Latinx children is critical to significantly reduce negative health impacts in this underserved population. Our approach includes the identification of effective cultural adaptations that should improve the feasibility and acceptability of mindful parenting strategies in Latinx families, ideally reducing maternal stress and improving parenting behaviors related to child health. If successful, CCC will be examined in a larger efficacy trial involving the measurement of objective biomarkers of children's chronic disease risk.

Examining the associations between mothers' motivation to regulate their own eating behaviors, food parenting practices and perceptions of their child's food responsiveness

Based on the Self-Determination Theory, this study examined: 1) how mothers' autonomous and controlled motivation to regulate their own eating behaviors relate to their food parenting practices, and 2) whether and how child food responsiveness (i.e., reactivity and attraction to food) interact with mothers' motivation to predict maternal food parenting practices. Participants were 296 French Canadian mothers of at least one child aged between 2 and 8 years old. Results of partial correlation analyses (controlling for demographics and controlled motivation) showed that maternal autonomous motivation to regulate their own eating behaviors was positively related to autonomy-promoting (i.e., child involvement) and structure-based (i.e., modeling, creating a healthy environment, monitoring) food parenting practices. In contrast, controlling for demographics and autonomous motivation, maternal controlled motivation was positively associated with food-related practices based on coercive control (i.e., the use of food to regulate the child's emotions, the use of food as a reward, pressure to eat, restriction for weight reasons, and restriction for health reasons). Furthermore, the child's food responsiveness was found to interact with mothers' motivation to regulate their own eating behaviors in the prediction of maternal food parenting practices such that mothers with high autonomous motivation or low controlled motivation were found to react with more structure-based (i.e., creating a healthy environment) and autonomy-based (i.e., child involvement) practices, as well as less controlling practices (i.e., the use of food to regulate the child's emotions), to a child who is highly responsive to food. In conclusion, findings suggest that guiding mothers toward developing a more autonomous and less controlled motivation to regulate their own eating behaviors might help them adopt more autonomy-promoting and structure-based and less controlling feeding practices, especially with children who are highly responsive to food.

Measurement invariance of the comprehensive feeding practices questionnaire in dual-earner parents with adolescent children in Chile

The Comprehensive Feeding Practices Questionnaire (CFPQ) has been evaluated in international studies, but the evaluation of its psychometric properties in Spanish, and in particular for parents of adolescents is still limited, and the invariance of measurement according to gender has not been evaluated. Therefore, the objectives of this study were: (1) To adapt the five-factor model of the CFPQ instrument to Spanish; (2) To examine the psychometric properties of this adaptation; and (3) To evaluate the measurement invariance of the model to verify the equivalence of measurement of the perceptions of food parenting practices between mothers and fathers belonging to nuclear, dual-earner families with adolescent children. Participants were 946 mothers and fathers from Southern Chile. Results showed that the conceptual equivalence for the CFPQ was achieved. An exploratory factor analysis was performed for a five-factor model: Monitoring, Child control, Restriction for weight control, Modeling and Environment. Horn's parallel analysis identified four factors, while factor loading analysis determined the removal of the environment factor. Confirmatory factor analysis presented good reliability values. Convergent and discriminant validity was confirmed, and medium-to-high levels of goodness of fit were obtained, eliminating two items. Results supported a final model of four factors and 19 items. Multigroup analysis of the measurement model verified the configural and metric invariance between fathers and mothers, while the scalar and strict partial invariance was verified. These findings are a relevant guide to measure factorial scores in the four-factor model of the CFPQ, establishing a characterization of feeding practices of parents and adolescents.

Introduction of a conversation starter tool to improve health habits in young children

BACKGROUND

Childhood overweight and obesity rates in the United States continue to climb. Providers must identify feasible interventions to improve health habits to prevent and treat obesity in children.

METHODS

Parents (n = 91) of four-to eight-year-old children were recruited and surveyed regarding their child's current health habits and perception of their child's weight status. A conversation starter tool was developed and utilized to improve health habits in children ages four-to-eight over a period of four-to-six weeks.

FINDINGS

Health habits in children improved in the comparison and intervention groups. There was a 42% improvement in health habits in the intervention group who chose a specific goal to work on compared to 30% improvement in the comparison group. There was no statistically significant relationship between health habit adherence and the assigned group when assessing the health habits individually.

DISCUSSION

Overall, 42% of the selected goals were met, according to parent report at the follow-up survey; however, use of the conversation starter tool did not demonstrate statistically significant improvement in health habits. Parental perception of children's weight status remained unchanged. Health habits in children improved in the comparison and intervention groups. Further studies should enroll a larger sample to assess differences between these two groups.

APPLICATION TO PRACTICE

The conversation starter tool was designed to be implemented into practice without the need for any specific training. The tool can be used on all children to promote improved health habits.

Review and meta-analysis for the caregiver's feeding styles questionnaire administered to low-income families

The Caregiver's Feeding Styles Questionnaire (CFSQ) is a well-established measure which uses scores along two dimensions of demandingness and responsiveness to classify low-income parents into one of four feeding style typologies (authoritative, authoritarian, indulgent, and uninvolved; Hughes, et al., 2005). The measure is widely used by researchers to explore the relationship between feeding style and child weight status but has not been evaluated comprehensively in a review or meta-analysis. The aims of this study were to 1) compare established median cutoffs for responsiveness and demandingness in parent feeding (k = 5; see Hughes et al., 2012) to current median splits along these two dimensions for a larger sample of articles (k = 19) and 2) evaluate the relation between children's BMI, demandingness and responsiveness, and parent feeding style categories. Results indicated that the cutoffs for responsiveness and demandingness initially established based on five studies of low-income families did not differ significantly with the addition of 19 studies. Child BMI z-scores (k = 8) were above average for all four parent feeding style categories and highest for indulgent parents, which was consistent with the literature outlining low-income children at higher risk for obesity and children of indulgent parents being particularly at risk. While heterogeneity of samples should be considered, study results suggested that the CFSQ distribution for responsiveness and demandingness was relatively generalizable across low-income samples, though heterogeneity was higher among caregiver's feeding style categories. Furthermore, the study confirmed that parent feeding styles were related to child weight status in a meaningful way, but all children in these low-income samples, on average, were heavier than their same-aged peers across all parent feeding styles.

How do Central American Parents in the United States View the Importance of and Obtain Information About Behaviors Associated with the Risk of Early Childhood Obesity?

Background: Data suggest that Latinx preschool-age children are at increased risk of obesity. The fastest-growing Latinx population in the United States originates from El Salvador, Guatemala, and Honduras, also known as the Northern Triangle countries. Purpose: To describe how Central American parents from the Northern Triangle countries perceive the importance of energy balance-related behaviors (EBRBs), their preferred sources to obtain information about EBRBs, and to assess whether these differ by parent's gender and country of the nativity. Methods: Cross-sectional survey. Results: Seventy-four parents with at least one child between 2 and 5 years of age participated in the study. More than half were immigrants from El Salvador, Guatemala, and Honduras and were classified as having low acculturation. Mothers perceived consuming >5 fruits and vegetables daily, limiting sugar-sweetened beverages consumption, and having <2 hours daily screen time as extremely important, whereas fathers perceived these behaviors as being less important. Although a higher proportion of foreign-born than US-born parents perceived most of the assessed EBRBs (4 out of 6) as extremely important, these differences were not significant. Parents reported multiple sources to obtain EBRB-related information. Direct person-to-person interactions were the most commonly preferred sources, with pediatricians being the top source (97.3%), followed by other parents (86.5%), and WIC professionals (74.3%). Pediatricians were the preferred source to obtain information about EBRBs, irrespective of parent's gender and country of the nativity. A higher proportion of US-born than foreign-born parents reported a preference to obtain EBRB-related information from other parents. Conclusions: Findings suggest the significance of understanding how Central American parents perceive the importance of EBRBs and the sources they would prefer to obtain information for their children's EBRBs. Study findings have implications for health education and obesity prevention interventions designed to reach and deliver key evidence-based child health information to Central American parents from the Northern Triangle countries in the United States.

Longitudinal associations between early child weight gain, parent feeding, child self-regulation, and later child body mass index

BACKGROUND

Few longitudinal studies have examined associations of child weight trajectories, maternal demandingness and responsiveness during feeding, and child self-regulation.

OBJECTIVE

We examined if child weight-for-length trajectories from 6 weeks to 2 years of age were associated with maternal demandingness and responsiveness at child age 3 years old, and if maternal feeding dimensions predicted child BMI trajectories from 4.5 to 7.5 years among Mexican American children from low-income families. Child self-regulation was evaluated as a potential mechanism linking maternal feeding with child BMI.

METHOD

Child (N = 322) weight and length/height were assessed at 10 timepoints from 6 weeks through 7.5 years. Mothers completed the Caregiver Feeding Style Questionnaire when the child was 3 years of age.

RESULTS

A steeper slope of weight-for-length z scores from 6 weeks to 2 years (indicating more rapid weight gain) was associated with less maternal demands during feeding at 3 years. More maternal demandingness at child age 3 years predicted lower child BMI at 4.5 years, but not trajectories from 4.5 to 7 years. Child self-regulation was not associated with child BMI from 4.5 to 7.5 years.

CONCLUSION

The findings highlight how the relationship between mothers and children during feeding can be bidirectional and potentially influenced by the developmental stage.

Exploration of Changes in Low-Income Latino Families’ Beliefs about Obesity, Nutrition, and Physical Activity: A Qualitative Post-Intervention Study

Objective: To investigate changes in beliefs around obesity, nutrition, and physical activity among low-income majority Latino families who participated in a community-based family-inclusive obesity intervention. Methods: Six focus groups were conducted with a predominately Latino low-income population, who completed the Healthy Living Program (HeLP). Two groups were conducted in English and four groups were conducted in Spanish, and were recorded, translated, transcribed, and analyzed for thematic content. Two coders independently coded transcripts then reflexive team analysis with three members was used to reach consensus. Results: Thirty-seven caregivers representing thirty-three families participated in focus groups. A number of themes emerged around changes in beliefs about obesity, nutrition, and physical activity (PA) as a result of the HeLP curriculum. Regarding obesity, the themes that emerged focused on the acceptability of children being overweight and the importance of addressing weight at an early age. Changes in beliefs regarding nutrition emerged, noting changes in the use of food as a reward, the multiple benefits of a healthy diet, and for some participants change in their beliefs around the adaptability of traditional foods and habits. Regarding physical activity, themes emerged around the difficulty of engaging in PA due to unsafe conditions and finding creative indoor and outdoor activities with whole family participation and becoming aware of the benefits of PA. Conclusions: Parental changes in beliefs about obesity, nutrition, and physical activity as a result of a family-inclusive weight management program in a population of low-income predominately Latino families can aid and inform the development of future weight management programs for this population.

Child feeding practices in children with Down syndrome in relationship to ethnicity and BMI

Children with Down syndrome (DS) exhibit higher overweight and obesity rates than their typically developing peers, although it is unknown whether parent feeding practices for children with DS are associated with child weight status or parental and demographic factors, especially in the Hispanic and Latino populations. A prospective study of 68 children with DS from 2 to 7 years of age, who received care at a single, large, pediatric academic hospital was conducted to evaluate parent child feeding practices. Parents completed the Child Feeding Questionnaire+ (CFQ+) assessing seven primary factors of feeding practices and comparisons to children without DS were conducted. Data for body mass index (BMI) and BMI-for-sex/age z score (BMIz scores) were collected in clinic at the time of CFQ+ completion for both parent and child. Parents of children with DS endorsed higher perceived responsibility but lower concern about child weight and restriction compared to previously reported feeding practices in typically developing children. Hispanic/Latino parents of children with DS reported higher perceived responsibility and monitoring than non-Hispanic/Latino parents of children with DS. Higher BMIz scores in children with DS correlated with greater perceived child weight (p = 0.001) and concern about child weight (p = 0.008). Differences in BMIz scores were observed when comparing sex/ethnicity groups as determined by one-way ANOVA (F(3,64) = 4.170, p = 0.009); with Hispanic/Latino boys with DS more likely to have obesity. Our results suggest a need for specific DS Guidelines to educate providers and parents of children with DS on recommended feeding practices prior to parental concern about their child's weight, especially in the Hispanic/Latino population.

Intergenerational Transmission of Child Feeding Practices

This study assessed the relationships between parents’ retrospective recollections of their mothers’ child feeding practices (CFP), current disordered eating (DE) and current CFP (how they now feed their children). 174 Israeli parents (136 mothers, 38 fathers; 40.1 ± 6.9 years of age) of children between the ages of 2 and 18, living at home, completed questionnaires online assessing demographics, retrospective recollections of the CFP that their mothers used when they were children, current CFP and current DE. Specific aspects of retrospectively recalled maternal CFP were significantly associated with the same aspects of current CFP. Current DE mediated the association between retrospectively recalled maternal CFP and current CFP and moderated the association between current concern about child’s weight and pressure for child to eat. Results highlight that the way adults pass on their feeding practices to their children is strongly influenced by their childhood recollections of their mothers’ concern about their weight, pressure for them to eat or restriction of their food intake. People often strive to behave differently from their parents, especially in the realm of food and eating. However, our findings suggest that parental CFP can become entrenched and can be passed on to our children.

Maternal Perception of the Child’s Weight, Lifestyle Problems and Self-Efficacy to Deal with Them

Objectives: To associate the maternal perception of the child’s weight (MPCW) and the child’s nutritional status. To describe child’s lifestyle behavior problems (CLBPs) and maternal self-efficacy (SE) to deal with them, as well as to verify differences according to children with and without overweight-obesity (OW-OB) and MPCW. Material and methods: There was participation of 274 dyads (mother-preschool child). MPCW was assessed through words and images. The mothers answered the Lifestyle Behaviour Checklist. The child’s weight and height were measured. Results: 18.8 % (n = 13) of the mothers of children with OW-OB and 78.8 % (n = 160) of the mothers of children without OW-OB obtained adequate MPCW values through words (X2 = 77.759; DoF = 1; p < .001). It was identified that the mothers of children with OW-OB reported more CLBPs and less SE. When the child’s OW-OB is perceived through words, there are more CLBPs (F = 17.041; p = .001) and less SE (U = 1,118; p = .015). Conclusions: Inadequate MPCW was predominant in mothers of children with OW-OB. When OW-OB is perceived, there are more CLBPs and fewer SE. It is recommended to promote adequate MPCW, particularly in mothers of children with OW-OB. Images assist in the identification of the child’s OW-OB more than to classify it into a category.

Maternal perception, concern and dissatisfaction with child weight and their association with feeding practices in the Generation XXI birth cohort

What a mother thinks about her child's weight status might influence what and how she feeds her child. We examined the association between maternal perception, concern and dissatisfaction with child weight alongside feeding practices. Participants were from the Generation XXI birth cohort (n = 3233). A validated version of the Child Feeding Questionnaire and the Overt/Covert Control scale were used. Associations were evaluated by linear regression models (β coefficients and 95 % confidence intervals (95 % CI) with Bonferroni correction). Perceived underweight was associated with practices promoting food intake, such as higher pressure to eat at ages 4 and 7 years (β = 0·229; 95 % CI: 0·059, 0·398 and β = 0·190; 95 % CI:0·005, 0·376, respectively) and lower restriction at age 4 (β = -0·175; 95 % CI: -0·0310, -0·039). At age 7, perceived overweight was associated with higher covert control (β = 0·203; 95 % CI: 0·029, 0·376). Mothers who were concerned about child weight reported higher restriction (β = 0·226; 95 % CI: 0·142, 0·310 at 4 years and β = 0·261; 95 % CI: 0·169, 0·353 at 7 years) and covert control (β = 0·183; 95 % CI: 0·083, 0·282 at 4 years and β = 0·171; 95 % CI: 0·073, 0·269 at 7 years). Maternal desire for a heavier child was associated with higher pressure to eat at both ages (β = 0·285; 95 % CI: 0·163, 0·406 and β = 0·393; 95 % CI: 0·266, 0·520), while the desire for a thinner child was related to higher covert control at 7 years of age (β = 0·158; 95 % CI: 0·001, 0·316). Maternal perceptions and concern for child weight status are associated with feeding practices independently of actual weight status.

Exploring Determinants of Parent Behaviors During Eating Episodes

OBJECTIVE

To develop a conceptual model of determinants of parent feeding behaviors with preschoolers.

DESIGN

Semistructured in-depth interviews were collected and transcribed verbatim.

SETTING

University of Houston.

PARTICIPANTS

Parents of preschool-aged children (aged 2-5 years).

PHENOMENON OF INTEREST

Determinants of parent behaviors during eating episodes with preschoolers.

ANALYSIS

Trained coders conducted thematic analysis with constant comparison of all interviews.

RESULTS

The final sample (n = 20) included predominantly white (60%), married (70%) mothers (75%) from middle socioeconomic conditions (100% had at least some college education; 70% had a household income >$50,000). Five categories of themes emerged: child behaviors, proactive parent behaviors, reactive parent behaviors, contextual factors, and parent beliefs. The themes were organized into a conceptual model to describe how parents and children influenced each other's behaviors depending on the context and parent beliefs of themselves and their child.

CONCLUSIONS AND IMPLICATIONS

A conceptual model outlining several determinants of parent feeding behaviors among preschoolers was developed. Next steps in the research are to validate the conceptual model identified in this qualitative study on a large, nationally representative sample.