Maternal symptoms of stress, depression, and anxiety are related to nonresponsive feeding styles in a statewide sample of WIC participants

Applying the Family Stress Model to responsive feeding and early obesity prevention

Rapid weight gain during infancy and obesity during early childhood may lead to adverse health outcomes during later childhood and into adulthood, especially in families experiencing economic hardship. Families experiencing economic hardship may also experience food insecurity, which can impact child development and responsive feeding, an important target for obesity prevention in early life. The Family Stress Model suggests that stress, particularly economic hardship, can negatively impact parents' mental health, parenting, and quality of family relationships. This review proposes a conceptual model that expands upon the original Family Stress Model by including parent-child dyadic interactions during feeding (i.e., responsive feeding) as well as the coparenting relationship around feeding. Our conceptual model integrates responsive feeding into the Family Stress Model and includes the impact of food insecurity on feeding and child health outcomes. Such models that consider multiple influences on child development have implications for the design of effective interventions to promote healthy growth for entire families. Future directions in this research will empirically test the model and explore early intervention strategies that aim to promote responsive feeding, nutrition security, and health within families. Continuing interdisciplinary research between the fields of nutrition and family development will be key to addressing the complex interplay of family stressors, parent responsiveness, and childhood obesity.

The effects of parent-child dysfunctional interactions on early childhood weight: A serial mediation model through emotional feeding and child appetite traits

Parent-child dysfunctional interactions (PCDI) are known to contribute to children's weight status. However, the underlying mechanisms in how dysfunctional interactions between parent and child influence child weight are not clear. This study investigates the impact of PCDI on toddlers' weight, focusing on the potential serial mediation by maternal emotional feeding and child appetite traits. We conducted a secondary analysis of longitudinal data from a larger intervention trial to prevent childhood obesity in low-income Hispanic families. A total of 241 mother-child dyads were included in these analyses. Measurements were taken at various stages: PCDI at child age 19 months, maternal emotional feeding at 28 months, and both child appetite traits and weight-for-age z-score (WFAz) at 36 months. Serial mediation analyses revealed a significant indirect effect of early PCDI on later child WFAz through maternal emotional feeding and two child food approach traits (food responsiveness, emotional overeating) out of the eight child appetite traits assessed. PCDI at 19 months was associated with increased use of emotional feeding in mothers at 28 months, which was associated with heightened food responsiveness and emotional overeating in children at 36 months, which in turn was linked to greater child WFAz at 36 months. The findings of this study expand the understanding of the mechanisms underlying PCDI and child weight, emphasizing the interplay between maternal feeding practices and child appetite in the context of adverse parent-child interactions during early childhood.

Increasing Maternal Anxiety in the Pre- to Postpartum Transition Predicts Infant Feeding Practices and Beliefs

OBJECTIVE

Anxiety symptoms increase for some mothers in the perinatal period. Little is known about how increasing anxiety relates to infant feeding beliefs or weight-for-length. We examined relationships between clinically meaningful increases in maternal anxiety symptoms and perceptions of infant feeding behaviors and weight-for-length.

METHODS

Participants were 237 mothers with singleton pregnancies enrolled from obstetric care between 2015 and 2020 who completed the Infant Feeding Questionnaire (IFQ) at 6 months. Anxiety symptoms were measured during pregnancy (M = 24.6 weeks, SD = 6.3) and 6 weeks postpartum using the PROMIS-6A. Linear regression was used to test associations of prenatal, postpartum, or clinically meaningful increases in anxiety symptoms (ie, 3T-score increase) with two outcomes: IFQ (seven factors) and infant weight-for-length at age 6 months.

RESULTS

Prenatal symptoms were unrelated to IFQ factors. Postpartum symptoms predicted IFQ factors related to worry, such as concern for infant undereating/becoming underweight (B = 0.012, P = .02). Increasing symptoms predicted worry-related concerns as well as concern for infant hunger (B = 0.60, P ≤ .01) and greater preference for feeding on a schedule (B = 0.65, P ≤ .01). In a model including both increasing symptoms and postpartum symptoms, increasing anxiety symptoms drove associations with IFQ factors (eg, preference for feeding on a schedule, (B = 0.81, P = .01). Anxiety was unrelated to infant weight-for-length at 6 months.

CONCLUSIONS

Clinically meaningful increases in anxiety symptoms were associated with feeding beliefs related to worry. Increasing anxiety was a better predictor of feeding beliefs than the presence of pre- or postpartum symptoms alone. Mothers with increasing anxiety may benefit from support establishing health-promoting infant feeding practices.

Mental Health and Feeding Styles in Parents of Formula-Fed Infants

Background: Nonresponsive feeding styles can contribute to rapid weight gain in infancy and subsequent obesity in childhood. There is a need to investigate factors such as parental mental health symptoms (stress, depression, and anxiety) that may contribute to nonresponsive feeding styles. The purpose of this study was to investigate the relationship between parental mental health symptoms and feeding styles in parents of healthy, term formula-fed infants during the first year of life. Methods: A cross-sectional, descriptive correlational design was employed using online surveys. We recruited participants through Facebook groups and pediatricians' offices. Instruments included a demographic questionnaire, the Perceived Stress Scale-10, Patient Health Questionnaire-Depression Module-9, 7-item Generalized Anxiety Disorder Assessment, and Infant Feeding Style Questionnaire. Results: Participants were 306 parents of formula-fed infants. Greater depressive symptoms was the strongest predictor of the pressuring style (β = 0.54), while greater symptoms of stress (β = -0.13) and anxiety (β = -0.28) were associated with lower pressuring scores. Greater depressive symptoms was the strongest predictor of the laissez-faire style (β = 0.48), while greater symptoms of stress (β = -0.17) and anxiety (β = -0.23) were associated with lower laissez-faire scores. Engaging in ≤50% of the infant's feeds was the strongest control variable predictor for the pressuring and laissez-faire styles. None of the mental health variables were significantly related to the restrictive style. Conclusions: We recommend increased screening for depressive symptoms in parents of infants and responsive feeding support, especially for those experiencing depressive symptoms.

Biological and behavioral pathways from prenatal depression to offspring cardiometabolic risk: Testing the developmental origins of health and disease hypothesis

Given prior literature focused on the Developmental Origins of Health and Disease framework, there is strong rationale to hypothesize that reducing depression in the prenatal period will cause improvements in offspring cardiometabolic health. The current review outlines evidence that prenatal depression is associated with offspring cardiometabolic risk and health behaviors. We review evidence of these associations in humans and in nonhuman animals at multiple developmental periods, from the prenatal period (maternal preeclampsia, gestational diabetes), neonatal period (preterm birth, small size at birth), infancy (rapid weight gain), childhood and adolescence (high blood pressure, impaired glucose-insulin homeostasis, unfavorable lipid profiles, abdominal obesity), and into adulthood (diabetes, cardiovascular disease). In addition to these cardiometabolic outcomes, we focus on health behaviors associated with cardiometabolic risk, such as child eating behaviors, diet, physical activity, and sleep health. Our review focuses on child behaviors (e.g., emotional eating, preference for highly palatable foods, short sleep duration) and parenting behaviors (e.g., pressuring child to eat, modeling of health behaviors). These changes in health behaviors may be detected before changes to cardiometabolic outcomes, which may allow for early identification of and prevention for children at risk for poor adult cardiometabolic outcomes. We also discuss the methods of the ongoing Care Project, which is a randomized clinical trial to test whether reducing prenatal maternal depression improves offspring's cardiometabolic health and health behaviors in preschool. The goal of this review and the Care Project are to inform future research, interventions, and policies that support prenatal mental health and offspring cardiometabolic health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Maternal mental health is associated with children's frequency of family meals at 12 and 24 months of age

Diet during the child's first years is important for growth and development. In toddlerhood, higher diet quality is reported among children eating meals together with family. Although previous literature has documented several associations between maternal mental health and early child feeding practices, less is known about the relationship between maternal mental health and child frequency of shared family meals. This study explores associations between maternal symptoms of anxiety and depression, measured by The Hopkins Symptoms Checklist (SCL-8), and toddler participation in family meals. We used cross-sectional data from the Norwegian study Early Food for Future Health, in which participants responded to questionnaires at child age 12 (n = 455) and 24 months (n = 295). Logistic regression was used to explore associations between maternal mental health and child having regular (≥5 per week) or irregular (<5 per week) family meals (breakfast and dinner), adjusting for relevant child and maternal confounding variables. Children of mothers with higher scores of anxiety and depression had higher odds of Irregular family meals at both timepoints; (OR: 2.067, p = 0.015) and (OR: 2.444, p = 0.023). This is one of few studies exploring associations between maternal mental health and child frequency of shared family meals in early childhood, a period where the foundation for life-long health is shaped. Given the high prevalence of mental ailments and disorders, these findings are important and may inform future public health interventions. Further exploration of this relation is needed, including longitudinal research to test predictive associations and qualitative studies to increase insight and understanding.

Child and Maternal Factors Associated with Feeding Practices in Children with Poor Growth

The development of adequate growth and healthy eating behaviors depends on nutritious food and responsive feeding practices. Our study examined (1) the relationship between maternal concern about child weight or perceived feeding difficulties and their feeding practices, and (2) the moderating role of child temperament and maternal mental health on their feeding practices. A cross-sessional study included mother-child dyads (n = 98) from a tertiary growth and feeding clinic. Children had a mean age of 12.7 ± 5.0 months and a mean weight-for-age z-score of -2.0 ± 1.3. Responsive and controlling feeding practices were measured with the Infant Feeding Styles Questionnaire. Spearman correlation and moderation analysis were performed. Maternal concern about child weight and perceived feeding difficulties were negatively correlated with responsive feeding (r = -0.40, -0.48, p < 0.001). A greater concern about child weight or perceived feeding difficulties was associated with greater use of pressure feeding practices when effortful control was low (B = 0.49, t = 2.47, p = 0.01; B = -0.27, p = 0.008). Maternal anxiety had a significant moderation effect on the relationship between feeding difficulty and pressure feeding (B = -0.04, p = 0.009). Higher maternal concern about child weight and perceived feeding difficulties were associated with less responsive satiety feeding beliefs and behaviors. Both child effortful control and maternal anxiety influenced the relationship between weight and feeding concerns and the use of pressure feeding practices.

Assessment of prenatal depression among U.S. pregnant women without access to paid sick leave and regular place of care: National Health Interview Survey of U.S.-born and non-U.S.-born

Prenatal depression is one of the most common risks during pregnancy. This study examined the prevalence and likelihood of prenatal depression association with sociodemographic factors, paid sick leave, and place of care among U.S. pregnant women. We conducted bivariate Chi-square tests to assess the statistical difference and multivariable logistic regression models to assess the association of prenatal depression using the National Health Interview Survey, cross-sectional data from 2010 to 2019 of pregnant women aged 18-44 years (N = 957). The prevalence of prenatal depression was 40.6%, 28.5%, and 27.2% among White, Black, and other racial pregnant women, respectively. Pregnant women with no regular/routine place of care had a prenatal depression prevalence rate of 58.1%, and those without access to paid sick leave had 46.9%. Also, pregnant women without access to paid sick leave were found to have an increased likelihood of reporting prenatal depression ([adjusted odds ratio] AOR = 2.50, 95% CI = 1.72-3.64), as well as those without a regular place of care (AOR = 2.43, 95% CI = 1.32-4.47). The findings identify factors that need to be addressed to minimize depression among U.S. pregnant women and establish the need for tailored interventions to address prenatal depression.

Nutrition-Related Experiences of Women With Perinatal Depression During the COVID-19 Pandemic: A Qualitative Study

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to the COVID-19 pandemic: (1) Adaptations in shopping and cooking behaviors; (2) increases in stress and declines in respite; (3) declines in support and increases in isolation; and (4) low levels of breastfeeding guidance. Our findings confirm the importance of resilience among women with perinatal depression and future research is needed to elucidate the mechanisms connecting resilience and dietary behaviors.

Maternal depressiveness and infant growth outcomes: Findings from the MAASTHI cohort study in India

OBJECTIVE

The study aims to examine the association between depressiveness in mothers on infant obesity and stunting at one year of age.

METHODS

We enrolled 4829 pregnant women, followed them up at public health facilities in Bengaluru for one year after birth. We collected information on women's sociodemographic characteristics, obstetric history, depressive symptoms during pregnancy and delivery within 48 h. We took infant anthropometric measurements at birth and one year. We used chi-square tests, and calculated an unadjusted odds ratio using univariate logistic regression. We used multivariate logistic regression to examine the association between maternal depressiveness, childhood adiposity, and stunting.

RESULTS

We found that the prevalence of depressiveness was 31.8% in mothers who delivered in public health facilities in Bengaluru. Infants born to mothers with depressiveness at birth had 3.9 times higher odds of having larger waist circumference than infants born to mothers with no depressiveness (AOR: 3.96, 95% Confidence Interval: 1.24,12.58) and 1.9 times higher odds of having a larger sum of skinfold thickness (AOR: 1.99, 95% CI: 1.18,3.38). Additionally, we found that infants born to mothers with depressiveness at birth had 1.7 times higher odds of stunting than infants born to mothers with no depressiveness (AOR: 1.72; 95%CI: 1.22,2.43) after adjusting for confounders.

CONCLUSION

Our study highlights a high prevalence of depressiveness among mothers seeking antenatal care at a public hospital is associated with an increased risk of infant adiposity and stunting at one year. Further research is needed to understand the underlying mechanisms and identify effective interventions.

Maternal feeding styles in infancy predict child body mass index z-scores at 72 months: findings from a cohort of Jamaican children

Objective

To explore whether maternal feeding styles at 12 months predict child Body Mass Index (BMI) z-scores at 72 months and evaluate whether BMI z-scores at 18 months mediates the association.

Methods

Data from 239 mother-child pairs participating in a parenting intervention were analyzed. Feeding information was ascertained at 12 months by questionnaire with feeding styles identified using factor analysis. Children's weight and length/height were measured at 18 and 72 months and BMI z-scores computed. Maternal sociodemographic data, depressive symptoms and language skills were obtained by questionnaire. Multilevel linear regression analysis was used to examine whether feeding styles predicted 72 month BMI z-scores. Complete case analysis was conducted and multiple imputation used to treat missing values of explanatory and outcome variables at 18 and 72 months. Mediational analysis was performed to assess the indirect effects of feeding styles on 72 month BMI z-scores via 18 month BMI z-scores.

Results

Restrictive feeding at age 12 months predicted higher 72 month BMI z-scores in both complete case analysis [β (95%CI): 0.19 (0.02, 0.37)] and multiple imputation [β (95%CI): 0.20 (0.02, 0.39)]. Uninvolved, forceful, indulgent and responsive feeding styles were not significant predictors of 72 month BMI z-scores. A significant indirect effect was observed between restrictive feeding and child BMI z-scores at 72 months via 18 month BMI z-scores [β (95% CI) 0.12 (0.03, 0.22)].

Conclusion

Restrictive feeding at 12 months was associated with higher BMI z-scores at 72 months and appeared to be mediated by BMI z-scores at 18 months.

Longitudinal Associations Among Food Insecurity During Pregnancy, Parental Mental Health Symptoms, Controlling Feeding Styles, and Infant Food Responsiveness

BACKGROUND

Research is needed to identify pathways by which household food insecurity (FI) contributes to parental controlling feeding styles and infant food responsiveness, 2 factors that play a role in shaping obesity risk across infancy and early childhood.

OBJECTIVES

This longitudinal study tested the hypothesis that prenatal FI would be positively associated with higher infant food responsiveness via greater parental mental health symptomatology and controlling feeding styles (pressuring, restrictive).

METHODS

Participants included a community sample of 170 birth parents and their infants participating in an ongoing longitudinal study. Parents self-reported household FI and mental health symptoms (depression and anxiety) during pregnancy. Postnatally, parents reported their mental health symptoms, their use of controlling feeding styles, and infant food responsiveness. Path analyses with bias-corrected 95% bootstrapped CIs tested direct and indirect associations between prenatal FI and infant food responsiveness.

RESULTS

Prenatal FI was indirectly associated with higher infant food responsiveness via greater parental mental health symptomatology and pressuring to finish (b = 0.01; 95% CI: 0.001, 0.025). Prenatal FI was associated with greater parental mental health symptomatology across the peripartum period (β = 0.54; P < 0.001), which in turn was associated with more pressuring to finish at 2 months pospartum (β = 0.29; P = 0.01) and higher infant food responsiveness at 6 months (β = 0.17; P = 0.04). There were no direct effects of prenatal FI on controlling feedings styles or infant food responsiveness.

CONCLUSIONS

Our findings point to parental mental health as a potential pathway by which FI may be associated with obesity-promoting parental feeding styles and infant appetitive behaviors. In addition to ensuring reliable access to enough quality food during pregnancy, multipronged assistance that promotes emotional well-being during the peripartum period and clinical guidance on noncontrolling feeding styles could benefit parent and infant health and well-being.

Mental health matters: Parent mental health and children's emotional eating

Parents' symptoms of anxiety and depression are associated with their increased likelihood of using nonresponsive feeding practices and with children's elevated obesity risk. These feeding practices, particularly persuasive-controlling feeding practices, have further been linked to children's emotional eating, including both emotional overeating and undereating. To help future research identify points of interventions to reduce children's maladaptive eating behaviors, the goal of this study was to determine whether persuasive-controlling feeding practices mediated the link between parent mental health and children's emotional eating. Feeding practices were measured by the FPSQ. Anxiety was measured by the GAD-7. Depression was measured by the CESD-R. Emotional eating was measured by the CEBQ. Survey data were collected from 259 U.S. parents of preschool children as a part of a larger study. Results from structural equation modeling showed that nonresponsive feeding behaviors mediated the relationship between parent mental health and children's emotional eating. Future longitudinal studies and clinical trials should examine whether and how persuasive-controlling feeding practices explain the link between parents' mental health and children's maladaptive eating behaviors, including emotional eating.

Process and effect evaluation of the app-based parenting program Samen Happie! on infant zBMI: A randomized controlled trial

Background

Although energy balance-related parenting practices are regarded critical components in the prevention of childhood obesity, most programs targeting parenting practices with respect to a wide range of energy balance-related behaviors were not aimed at high-risk families with a lower socioeconomic position (SEP).

Objective

The Samen Happie! app-based program aimed to stimulate healthy child weight development especially among families with a lower SEP, by encouraging healthy energy balance-related parenting practices.

Methods

A two-armed randomized controlled trial examined the process and effectiveness of the Samen Happie! program on child zBMI outcomes at 6- and 12-months follow-up. In total, 357 Dutch parents with infants aged 5-15 months old at baseline participated. Parents in the app condition (n = 179) received access to the Samen Happie! app and were compared to a waitlist-control condition (n = 178). Changes in zBMI were examined through linear mixed-effects models based on intention-to-treat and exploratory per-protocol principles.

Results

Process data showed low levels of sustained app use and moderate app acceptability. A general increase in child zBMI was observed in both conditions after 6 and 12 months. Intention-to-treat analyses using multiple imputations showed several statistically significant differences between conditions and high-risk subgroups. Specifically, at 6-months follow-up, zBMI increase was least pronounced in the app condition among children of parents with lower educational level. These findings were supported by exploratory per-protocol analyses including only frequent app users. In addition, per-protocol analyses showed benefits of app use at 6-months follow-up for children of parents with higher BMI. However, these effects were reversed at 12-months follow-up in both intention-to-treat and per-protocol analyses, where children of parents in the app condition in general increased the most in zBMI.

Conclusions

This study suggests that the Samen Happie! program might prevent zBMI increases after 6 months among children of parents with lower educational level, and children of parents with higher BMI who more frequently use the app. However, the app did not prevent increases in zBMI after 12 months. Future research should investigate strategies to increase sustained app use and engagement in mHealth parenting programs for childhood obesity as well as options to combine app-based programs with additional support strategies aimed at high-risk families.

Trial registration

Netherlands trial register (ID: NTR6938), https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6938.

Growth and growth trajectory among infants in early life: contributions of food insecurity and water insecurity in rural Zimbabwe

Introduction

Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied.

Methods

We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1-M18).

Results

A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=-0.09; 95% -0.19 to -0.13). From M6 to M18, poor food access was associated with lower LAZ (β=-0.11; 95% -0.20 to -0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time.

Conclusion

FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.

Psychological and social impact on parents of children with feeding difficulties

OBJECTIVES

The prevalence of feeding disorders (FDs) and picky eating in children is high in our region, based on the parents' perceptions. Although organic disease or a nutritional impact is rarely observed in these children, the problem frequently has an effect on family dynamics. We aimed to estimate the impact of these disorders on the stress level, quality of life and psychological health of families.

METHODS

Study of cases (FDs) and controls (healthy controls and controls with digestive disorders or other illness). We assessed parental stress and the risk of psychological distress in these families using validated scales (Parent Stress Index Short Form [PSI-SF] and Goldberg's General Health Questionnaire [GHQ-28]) and a parental opinion survey.

RESULTS

We collected a total of 238 surveys, 102 corresponding to healthy controls, 88 to controls with digestive disorders and 48 to children with FDs. We found that 45.8% of parents in the FD group felt neglected by their paediatricians and 47.9% did not agree with the paediatrician's recommendations. In addition, 54.2% reported limitations to their social life, 25% problems in their relationship, 47.9% feeling judged by others (12.5% by their own partner) for how they managed mealtimes, and 37.5% having sought or considered seeking psychological support. All these problems were significantly more frequent compared to controls. Based on the GHQ-28, the risk of anxiety and depression was more frequent in parents in the FD group: 54.2% compared to the reference (adjusted odds ratio [aOR] compared to controls, 4.18; 95% confidence interval [CI], 1.96-8.87; OR compared to sick controls, 6.25; 95% CI, 2.79-13.98) and 33.3% compared to the healthy control group. They also had higher stress scores (PSI-SF) compared to the healthy control group (adjusted mean difference [AMD], 21; 95% CI, 12.19-29.81) and the sick control group (AMD, 20; 95% CI, 9.81-30.19).

CONCLUSIONS

Parents of children with FDs have a high level of stress and risk of anxiety and depression, with repercussions at the social, family, couple and work levels. The relationship with the paediatrician may also be affected.

The association between parents' stress and parental feeding practices and feeding styles: Systematic review and meta-analysis of observational studies

In the extended UNICEF framework of early childhood nutrition, parents' stress is associated with parental feeding style. However, no comprehensive review has examined the association between parents' stress and feeding styles and practices. The objective of our review was to synthesise the current literature examining the association between parents' stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. We searched; MEDLINE, EMBASE, PSYCHINFO and CINAHL from 2019 to 2021. Two investigators independently extracted relevant data and assessed the study quality and the certainty of evidence. Data were pooled using generic inverse variance with fixed effects (<5 comparisons) or random effects (≥5 comparisons) and expressed as correlation coefficients with 95% confidence intervals (CI). Between study heterogeneity was assessed using Cochran's Q and quantified with I² . We identified 6 longitudinal and 11 cross-sectional studies, of which 4 studies provided sufficient data to be pooled. A very small correlation between general stress and restrictive feeding practices was observed (r = 0.06 [95% CI: 0.01-0.12]; no substantial heterogeneity (I²  = 0.00%, P_Q  < 0.85, very low certainty). No correlation between general stress and feeding pressure was identified (r = 0.06 [95% CI: -0.02 to 0.15]). Results showed that both general and parenting stress were associated with suboptimal breastfeeding practices and unresponsive feeding styles. Conclusion: This study demonstrated a low-to-moderate quality of literature for the inclusion of parents' stress in the extended UNICEF care model of child nutrition. Future research needs to explore this relationship longitudinally and in ethnic diverse populations to inform tailored interventions that promote responsive feeding practices.

Maternal Mental Health Status Is Associated with Weight-Related Parenting Cognitions, Home Food Environment Characteristics, and Children's Behaviors

Women experience anxiety, depression, and stress at higher levels than men and have more parenting responsibilities, especially establishing health practices in the home. Given children's vulnerability, this study aimed to increase understanding of how mothers' mental health status relates to maternal weight-related cognitions, home food environments, and child health via a cross-sectional survey design. In a cluster analysis, using maternal anxiety, depression, and stress assessments, we placed the sample of 531 mothers of school-age children into four clusters: Cluster 1 had the best mental health status, Cluster 2 had high stress, Cluster 3 had anxiety and moderate stress, and Cluster 4 had anxiety, depression, and high stress. Our results indicate an overall downward trend in weight-related cognitions as mental health worsened. Similarly, as mental health declined, so did home food environment characteristics, such as the greater use of non-recommended child feeding practices, fewer family meals, and greater sugar-sweetened beverage supplies. As mothers' mental health status became poorer, children's general health and mental health quality of life declined, and sugar-sweetened beverage intake increased. Our findings suggest that maternal stress, anxiety, and depression are moderately to strongly linked with mothers' cognitions, home food environments, and children's health. Our results also suggest that mental health interventions for mothers should assess cognitions and home food environments and consider the extent to which these factors are affecting family health.

Participating in a Nutrition-Sensitive Agriculture Intervention Is Not Associated with Less Maternal Time for Care in a Rural Ghanaian District

Background

Nutrition-sensitive agriculture (NSA) interventions may increase farm-related work for mothers, with consequences for child nutrition. The Nutrition Links (NL) intervention provided mothers with poultry, gardening inputs, technical support, and education to improve livelihoods and child nutrition outcomes in rural Ghana.

Objectives

Our objective was to compare time allocated to child care by a cross-section of mothers in the intervention group of the NL intervention with the control group (NCT01985243).

Methods

A cross-section of NL mother-child pairs was included in a time allocation substudy [intervention (NL-I) n = 74 and control (NL-C) n = 69]. In-home observations of the mother-child pair were conducted for 1 min, every 5 min, for 6 h. Observations were categorized into 4 nonoverlapping binary variables as follows: 1) maternal direct care, 2) maternal supervisory care, 3) allocare, and 4) no direct supervision. Allocare was defined as care by another person in the presence or absence of the mother. Any care was defined as the observation of maternal direct care, maternal supervisory care, or allocare. Generalized linear mixed models with binomial data distribution were used to compare the child care categories by group, adjusting for known covariates.

Results

Maternal direct care (OR = 1.07; 95% CI: 0.89, 1.28) and any care (OR = 1.56; 95% CI: 0.91, 2.67) did not differ by intervention group. However, there was a higher odds of allocare (OR = 1.36; 95% CI: 1.04, 1.79) in NL-I than in NL-C women.

Conclusions

Maternal participation in an NSA intervention was not associated with a decrease in time spent directly on child care but was associated with an increase in care from other household and community members.The clinicaltrials.gov number provided is for the main NL intervention and not this current substudy.

Variation of parental feeding practices during the COVID-2019 pandemic: a systematic review

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is highly contagious and has resulted in a protracted pandemic. Infections caused by new coronavirus strains, primarily Delta and Omicron and currently highly prevalent globally. In response to the epidemic, countries, and cities implemented isolation and quarantine guidance, such as limiting social contact, which have affected the lifestyles and quality of life of the population. Parental feeding behaviors may vary as a result of factors such as prolonged home isolation of parents and children, lack of supplies during isolation, and stress. This study was designed to assess the available evidence and its implications for parental feeding practices in the context of COVID-19. We screened and reviewed research published in five electronic databases between 2020 and 2022, and eight studies met the selection criteria. Parents were observed to use a variety of feeding practices, including high levels of coercive control and reduction of rules and limits according to Vaughn’s food parenting constructs. The findings suggest that parental feeding practices are changing as a result of the pandemic and that more research is needed to further explore how to provide supportive feeding guidance to parents during emergencies in order to jointly promote child health.

Controlling feeding practices moderate the relationship between emotionality and food fussiness in young children

Emotional child temperament has consistently been found to be related to food fussiness. One factor that may exacerbate or reduce the risk conferred by children's emotionality is parent feeding practices during mealtimes. Specifically, the use of controlling feeding practices aimed at increasing food consumption may particularly affect children with an emotional temperament. The primary aim of this study was to investigate whether the association between child food fussiness and higher emotionality found in previous studies is moderated by maternal use of controlling feeding practices, namely verbal pressure, physical prompts and food rewards. Sixty-seven mother-child dyads were video-recorded during a meal in their home and mothers' use of controlling feeding practices during this meal were coded. Mothers completed a questionnaire assessing child temperament. Moderation analyses revealed that maternal use of verbal pressure and physical prompts moderated the relationship between higher emotionality and food fussiness, but maternal use of food rewards did not. These results indicate that the use of verbal pressure and physical prompts may have a particularly negative influence on fussy eating for children higher in emotionality.

Associations of mothers' and fathers' structure-related food parenting practices and child food approach eating behaviors during the COVID pandemic

BACKGROUND

During the COVID-19 pandemic, many mothers and fathers have spent more time at home with their children, warranting consideration of parenting practices around food during the pandemic as influences on obesogenic eating behaviors among children. Structure-related feeding practices, particularly around snacking, may be particularly challenging yet influential in the pandemic setting. Parent sex and levels of feeding-related co-operation among parents (co-feeding) are understudied potential influences on parent-child feeding relationships.

METHODS

We investigated relationships between structure-related parent feeding and child food approach behaviors during the COVID-19 pandemic, while considering potential moderating influences of parent sex and co-feeding levels. An online survey was completed by 318 parents (206 mothers and 112 fathers) of 2-12-year-olds who were living in states with statewide or regional lockdowns in May/June 2020 within the US. Mothers and fathers were drawn from different families, with each survey corresponding to a unique parent-child dyad. Parental stress/mental health, co-feeding (Feeding Coparenting Scale), structure-related food and snack parenting (Feeding Practices and Structure Questionnaire and Parenting around SNAcking Questionnaire), and child eating behaviors (Child Eating Behaviour Questionnaire) were assessed. Relationships of parents' structure-related food and snack parenting practices with their child's emotional overeating and food responsiveness behaviors were examined using structural equation modelling. Further, we investigated whether these relations were moderated by parent sex or level of co-feeding.

RESULTS

Parent sex differences were seen in parental stress, mental health, and co-feeding, but not in structure-related food and snack parenting or child food approach eating behaviors. Structure-related food parenting was negatively associated with emotional overeating. However, structure-related snack parenting was positively associated with emotional overeating and food responsiveness. While regression paths varied between mothers vs. fathers, as well as by co-feeding levels, neither parent sex nor co-feeding levels significantly moderated relationships between parent feeding and child eating variables.

CONCLUSIONS

Future studies of food and snack parenting and co-operation in relation to feeding among mothers and fathers within a familial unit may be critical to identify intervention strategies that draw on all family resources to better navigate future disruptive events such as the COVID-19 pandemic.

How Parenting and Family Characteristics Predict the Use of Feeding Practices among Parents of Preschoolers: A Cross-Sectional Study in Beijing, China

Parental coercive and structured feeding practices are linked with children’s weight gain. Thus, identifying their predictors will assist in childhood obesity prevention. We explored how parents’ concerns and perceptions of children’s weight, parenting stress, parenting competence, parents’ family roles, and only child status (of both parent and child) predict the use of restriction, pressure to eat, and monitoring practices among parents of preschoolers. Parent–child dyads (n = 2990) were recruited in Beijing in 2019. Parenting competence, parents’ weight perceptions and feeding practices were assessed using the Chinese version of Parenting Sense of Competence Scale and Child Feeding Questionnaire (CFQ), respectively. Parenting stress and other variables were collected through self-administered questionnaires. Multivariate linear associations between parents’ weight perceptions and feeding practices were significant among normal-weight children. Parents’ concerns about children being overweight were positively associated with restriction and monitoring, and negatively associated with pressure to eat. Higher levels of parenting stress and parenting competence significantly improved the adoption of restriction and pressure to eat. Parents’ only child status and that of children had an impact on parents’ feeding practices. The fathers’ feeding preferences were substantially different from what mothers preferred. In conclusion, such parenting and family characteristics significantly influenced feeding practices of preschoolers’ parents. These were long neglected in China.

A mixed methods study of siblings’ roles in maternal feeding practices in early childhood: an application of the learning from experience process

Background

Firstborn children have higher rates of obesity compared to secondborns, perhaps due, in part, to differential feeding practices. Despite the centrality of siblings in family life and potential for influence, almost nothing is known about the role of siblings in parent feeding practices in early childhood.

Methods

Participants (n = 117) were mothers of consecutively born siblings. Firstborns participated in an RCT that compared a responsive parenting intervention designed for primary prevention of obesity against a safety control. Secondborns participated in an observational cohort. Multilevel models tested whether and how firstborn characteristics (temperament, appetite, rapid weight gain) at 16 weeks and 1 year were associated maternal feeding practices of secondborns in infancy at 16 weeks, 28 weeks, and 1 year (food to soothe) and at ages 1, 2, and 3 years (structure-and control-based feeding practices). A purposive subsample (n = 30) of mothers also participated in semi-structured interviews to further illuminate potential sibling influences on maternal feeding practices during infancy and toddlerhood.

Results

Firstborn characteristics did not predict secondborn feeding in infancy (all ps > 0.05). Firstborn negative affect, however, predicted mothers’ less consistent mealtime routines (b (SE) = − 0.27 (0.09); p = 0.005) and more pressure (b (SE) = 0.38 (0.12); p = 0.001). Firstborn appetite predicted mothers’ less frequent use of food to soothe (b (SE) = − 0.16 (0.07); p = 0.02) when secondborns were toddlers. Firstborn surgency, regulation, and rapid weight gain, however, did not predict secondborn feeding practices during toddlerhood (all ps > 0.05). Interviews with mothers revealed three ways that maternal experiences with firstborns informed feeding practices of secondborns: 1) Use of feeding practices with secondborn that worked for the firstborn; 2) Confidence came from firstborn feeding experiences making secondborn feeding less anxiety-provoking; and 3) Additional experiences with firstborn and other factors that contributed to secondborn feeding practices.

Conclusions

Some firstborn characteristics and maternal experiences with firstborns as well as maternal psychosocial factors may have implications for mothers’ feeding practices with secondborns. Together, these mixed methods findings may inform future research and family-based interventions focused on maternal feeding of siblings in early childhood.

Risk Factors Associated with Perinatal Relapse to Opioid Use Disorder

The recent opioid epidemic in the United States has led to rising prevalence of maternal opioid use disorder (OUD). First-line treatment for maternal OUD involves the use of opioid agonist pharmacotherapy, such as methadone or buprenorphine, in addition to cognitive behavioral therapy and counseling. The management of maternal OUD can become overwhelming for both patients and clinicians, especially during the early postpartum period. Therefore, it is imperative that clinicians understand the impact of additional stressors in caring for these patients. Maternal chronic opioid dependence can lead to neonatal opioid withdrawal syndrome after birth. This multisystem condition affects neonatal neurobehavioral functioning and has significant human and socioeconomic consequences. First-line treatment for this syndrome involves intensive nonpharmacologic comforting measures, with maternal presence and involvement being central to ensuring the success of such measures. In this review, we describe the factors that place pregnant and postpartum women with OUD at risk of returning to illicit opioid use. We evaluate these multifaceted personal, social, societal, and systemic factors to inform the development of future clinical care initiatives.

Postpartum Symptoms of Depression are Related to Infant Feeding Practices in a National WIC Sample

OBJECTIVE

To examine the association between elevated maternal postpartum depression symptoms and select targets of nutrition education within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), including infant feeding beliefs, feeding practices, and dietary intake choices.

DESIGN

Longitudinal analysis of secondary data from the WIC Infant and Toddler Feeding Practices Study-2.

SETTING

Eighty WIC sites.

PARTICIPANTS

The WIC Infant and Toddler Feeding Practices Study-2 participants interviewed through 13 months postpartum (n = 1,851).

MAIN OUTCOME MEASURES

Latent factor variables for infant feeding beliefs, feeding practices, and dietary intake choices.

ANALYSIS

Confirmatory factor analysis using structural equation modeling; multivariable linear regression models.

RESULTS

Biological mothers with elevated postpartum depression symptoms engaged in significantly less optimal feeding practices than biological mothers with fewer symptoms of depression, in multivariable analyses controlling for sociodemographic variables (β = -0.26; P = 0.02). Maternal depression symptoms were not significantly associated with infant feeding beliefs or dietary intake choices.

CONCLUSIONS AND IMPLICATIONS

Maternal depression symptoms are specifically associated with infant feeding practices. The Special Supplemental Nutrition Program for Women, Infants, and Children could consider screening for depressive symptoms and referring mothers for treatment. For mothers with elevated depression symptoms, nutrition education may need greater emphasis on healthy and safe feeding practices.

Associations between infant and maternal characteristics measured at child age 5 months and maternal feeding styles and practices up to child age two years

Facilitating positive feeding practices from infancy may be an important strategy to prevent childhood overweight and obesity. Since the feeding situation early in life constitutes a bidirectional relationship, it is important to understand the impact of both maternal and infant characteristics on maternal feeding practices to intervene in a customized and tailored way. Few studies have concurrently examined associations between maternal and infant characteristics in relation to early maternal feeding practices. The aim of the present study was to explore potential associations between infant and maternal characteristics measured at child age five months, and maternal feeding styles and practices during the child’s first two years. Cross-sectional data from a Norwegian randomized controlled trial in which participants responded to questionnaires at child age 5 months (n = 474), 12 months (n = 293) and 24 months (n = 185) were used to explore potential associations. All maternal and child predictor variables were collected at child age five months. Maternal feeding styles and practices were mapped using subscales from the Infant Feeding Questionnaire at child age 5 and 12 months and the Child Feeding Questionnaire and the Parental Feeding Style Questionnaire at child age 24 months. The subscale-scores were split into roughly equal tertiles, and the upper or lower tertile for the outcome of interest were used to create binary outcome variables. Multivariable binary logistic regression models were conducted for each outcome. We found that maternal education and mental health symptoms as well as infant weight, temperament and feeding mode were associated with maternal feeding styles and practices over time. Our findings indicate that risk factors which may have long-term implications for child weight and health outcomes can be identified early. Larger, population-based studies with a longitudinal design are needed to further explore these pathways.

Maternal Stress and Infant Feeding in Hispanic Families Experiencing Poverty

OBJECTIVES

Maternal stress has been associated with early child obesity through pathways related to decreased exclusive breastfeeding and increased nonresponsive maternal-infant feeding styles. We sought to gain an in-depth understanding of how maternal stress, sadness, and isolation are perceived to affect feeding, in order to inform modifiable targets of intervention.

METHODS

We conducted semi-structured qualitative interviews with Hispanic mothers living in poverty with young infants between 3 and 7 months old (n = 32) from the intervention group of a randomized controlled trial of an early child obesity prevention intervention (Starting Early Program). Bilingual English-Spanish interviewers conducted the interviews, which were audio recorded, transcribed, and translated. Building on an existing theoretical framework developed by the National Scientific Council on the Developing Child, we used an iterative process of textual analysis to code the transcripts, until thematic saturation was reached.

RESULTS

Three key themes were described: 1) maternal stress responses were varied and included positive (brief and mild), tolerable (sustained but limited long-term impacts), or toxic stress (sustained and severe); 2) buffers included support from family, infants, health care providers, social service programs, and community organizations; 3) perceived effects on infant feeding included decreased breastfeeding due to concerns about stress passing directly through breast milk and indirectly through physical closeness, and increased nonresponsive feeding styles.

CONCLUSIONS

Maternal stress, particularly toxic stress, was perceived to negatively affect infant feeding. Mothers reported disrupting healthy feeding to avoid infant exposure to stress. Interventions to enhance buffering may help to mitigate toxic stress and promote healthy feeding interactions.

Maternal characteristics influence infant feeding styles in Caribbean women

OBJECTIVE

To examine associations between maternal characteristics and feeding styles in Caribbean mothers.

DESIGN

Participants were mother-child pairs enrolled in a cluster randomised trial of a parenting intervention in three Caribbean islands. Maternal characteristics were obtained by questionnaires when infants were 6-8 weeks old. Items adapted from the Toddler Feeding Behaviour Questionnaire were used to assess infant feeding styles at the age of 1 year. Feeding styles were identified using factor analysis and associations with maternal characteristics assessed using multilevel linear regression.

SETTING

Health clinics in St. Lucia (n 9), Antigua (n 10) and Jamaica (n 20).

PARTICIPANTS

A total of 405 mother-child pairs from the larger trial.

RESULTS

Maternal depressive symptoms were associated with uninvolved (β = 0·38, 95 % CI (0·14, 0·62)), restrictive (β = 0·44, 95 % CI (0·19, 0·69)) and forceful (β = 0·31, 95 % CI (0·06, 0·57)) feeding and inversely associated with responsive feeding (β = -0·30, 95 % CI (-0·56, -0·05)). Maternal vocabulary was inversely associated with uninvolved (β = -0·31, 95 % CI (-0·57, -0·06)), restrictive (β = -0·30, 95 % CI (-0·56, -0·04)), indulgent (β = -0·47, 95 % CI (-0·73, -0·21)) and forceful (β = -0·54, 95 % CI (-0·81, -0·28)) feeding. Indulgent feeding was negatively associated with socio-economic status (β = -0·27, 95 % CI (-0·53, -0·00)) and was lower among mothers ≥35 years (β = -0·32, 95 % CI (-0·62, -0·02)). Breast-feeding at 1 year was associated with forceful feeding (β = 0·41, 95 % CI (0·21, 0·61)). No significant associations were found between maternal education, BMI, occupation and feeding styles.

CONCLUSION

Services to identify and assist mothers with depressive symptoms may benefit infant feeding style. Interventions to promote responsive feeding may be important for less educated, younger and socio-economically disadvantaged mothers.

Maternal Attentional Control Moderates the Association Between Increased Depression and Controlling Feeding Practices During the COVID-19 Pandemic

Parental distress is associated with less healthful child feeding practices. In this preliminary study, we examined how changes in distress from before to during the COVID-19 pandemic were associated with similar changes in feeding practices in a sample of mothers of preschool-aged children. In addition, we examined how pre-pandemic laboratory measures of maternal self-regulation moderated this association. A total of 36 mothers from an ongoing study on parent and child self-regulation completed surveys assessing parental distress (i.e., maternal depression, parenting stress) and child feeding practices during pandemic-related stay-at-home orders in May-June 2020. These mothers had completed the same measures approximately 2 years earlier, along with laboratory assessments of inhibitory and attentional control. Pre-pandemic laboratory measures of attentional control significantly moderated the association between increased maternal depression and use of controlling feeding practices, such that mothers with better attentional, but not inhibitory, control scores did not show an effect of increased depression on feeding practices. These results provide preliminary evidence that acute increases in parental distress associated with "stay-at-home" orders affect feeding practices, specifically for mothers with lower levels of attentional control abilities.

Associations between Paternal Anxiety and Infant Weight Gain

The aim of this study was to examine the relationship between parental anxiety (father-only, mother-only, or both) and infant weight change. We performed a secondary data analysis among 551 children in the Avon Longitudinal Study of Parents and Children, a birth cohort with weight measurements collected prospectively at 4, 8, and 12 months of age. Paternal and maternal anxiety symptoms were based on the eight-item anxiety subscale of the Crown-Crisp Experiential Index. Scores in the top 15% at 8 weeks postpartum were classified as high anxiety. Generalized Estimating Equations were employed to estimate the joint association between parental anxiety and change in child weight-for-age z-score. Children who had fathers, but not mothers, with anxiety showed a 0.15 (95% CI: 0.01, 0.29) greater increase in weight-for-age z-score than children with neither parent anxious. This result suggests that paternal anxiety, not maternal anxiety, was associated with increases in child weight gain in the first year of life. Public health practitioners and clinicians should consider the use of robust measures of both maternal and paternal anxiety in the postpartum period, in addition to the suggested screening for postpartum depression. Given the limitations of the study, this study should be considered preliminary and hypothesis generating.

Stressed out and fed up: The effect of stress on maternal feeding behaviors and the moderating role of executive function

Stress is associated with a range of unhealthy eating habits, yet few studies have examined how stress may influence the intergenerational transmission of eating habits from parents to their children. Specifically, there is a lack of data regarding the role of stress on feeding practices. Moreover, most work investigating the associations between parental stress and their feeding behaviors has been correlational, limiting our understanding of causality. In the current study, we used an experimental design, induced high and low stress in mothers using a standard laboratory stressor, and observed mother-child interactions during a snack break. We also examined the potential role of maternal executive functioning (EF) for buffering the effects of stress on maternal feeding behaviors. Levels of maternal stress were manipulated with the Trier Social Stress Task (TSST) in a community sample (N = 80 dyads, Child M_age = 41.89 months, female = 43). We measured maternal EF with a series of computerized tasks. Maternal feeding behaviors were coded for controlling behaviors, which included pressuring and restricting behaviors. Results indicate a main effect of stress on controlling feeding behaviors, such that mothers in the high-stress condition exhibited higher levels of controlling behaviors. The effect of stress on controlling feeding behaviors was ameliorated among mothers with higher levels of EF after controlling for child age and income. Results provide causal evidence for the role of stress on feeding behaviors and suggest EF as a factor to be considered in the treatment and prevention of diet-related illnesses.

The relationship between COVID-related parenting stress, nonresponsive feeding behaviors, and parent mental health

COVID-19 has disrupted the lives of families across the United States and all over the world. Stress is known to have a negative impact on parent-child feeding interactions; hence, the purpose of this study is to examine how COVID-related parenting stress, which was measured using a newly developed scale, is related to parent mental health, nonresponsive feeding, and children's self-regulation of eating. 119 parents of children ages 2-7 years old filled out questions about COVID-related parenting stress, mental health, nonresponsive feeding behaviors, and children's self-regulation of eating. A series of multiple regressions were run to predict parent anxiety and psychological distress from COVID-related parenting stress. COVID-related parenting stress was found to be a significant predictor of both parent anxiety and psychological distress. When COVID-related parenting stress was further broken down into COVID-Related Job/Financial Security Stress and COVID-Related Family Safety/Stability Stress, COVID-Related Job/Financial Security Stress predicted psychological distress while COVID-Related Family Safety/Stability Stress predicted parent anxiety. Moderation analyses were also run to test the difference across the parents of children under 5 years of age and those of children who were 5 years of age and older regarding the association of COVID-related parenting stress and either parent anxiety or psychological distress. There was no significant difference across age. Lastly, COVID-related parenting stress and nonresponsive feeding practices were simultaneously entered into a multiple regression to predict children's self-regulation of eating, and COVID-related parenting stress and parent distrust in appetite were both found to decrease children's ability to self-regulate energy intake. Based on findings from this study, researchers interested in improving children's self-regulation of eating and long-term health outcomes should continue to target the reduction of nonresponsive parent feeding behaviors, but they should also aim to look beyond specific parent feeding behaviors by attempting to help parents manage stressors in their lives.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-021-02333-y.

Is the Prospective Link between Parental Stress and Adolescent Snack Intake or Weight Outcome Mediated by Food Parenting Practices?

Parental stress may influence adolescents’ food intake and weight development over time, however, it is largely unknown why this is the case. This study examines whether the link between parental stress and adolescents’ snack intake and weight outcome is mediated by food parenting practices (FPPs). Participants included 400 parents and their adolescent children (aged 12–16) who completed questionnaires. The Perceived Stress Scale (PSS) was used to assess parental general stress levels and the Adolescent Food Parenting Questionnaire (AFPQ) to assess FPPs. Multiple mediation analyses with parallel mediators were performed, with parental general stress as an independent variable and adolescent snack intake and zBMI as dependent variables. FPPs (autonomy support, coercive control, modeling, healthy structure, snack structure) were entered as mediators in the model, adjusted for covariates. Autonomy support mediated the link between parental general stress and adolescent savory snack and sweet snack intake at follow-up. Parents who reported higher stress levels provided less autonomy support, which resulted in more adolescent snacking. None of the other FPPs mediated any link between parental stress and intake or weight outcome, and no significant indirect effects were observed with zBMI as an outcome variable. Further research should replicate this finding and may further examine underlying mechanisms.

Infant feeding experiences and concerns among caregivers early in the COVID-19 State of Emergency in Nova Scotia, Canada

The global emergency caused by the novel coronavirus (COVID-19) pandemic has impacted access to goods and services such as health care and social supports, but the impact on infant feeding remains unclear. Thus, the objective of this study was to explore how caregivers of infants under 6 months of age perceived changes to infant feeding and other food and health-related matters during the COVID-19 State of Emergency in Nova Scotia, Canada. Four weeks after the State of Emergency began, between 17 April and 15 May 2020, caregivers completed this online survey, including the Perceived Stress Scale. Participants (n = 335) were 99% female and mostly White (87%). Over half (60%) were breastfeeding, and 71% had a household income over CAD$60,000. Most participants (77%) received governmental parental benefits before the emergency, and 59% experienced no COVID-19-related economic changes. Over three quarters of participants (77%) scored moderate levels of perceived stress. Common themes of concern included social isolation, COVID-19 infection (both caregiver and infant), and a lack of access to goods, namely, human milk substitutes ('infant formula'), and services, including health care, lactation support, and social supports. Most COVID-19-related information was sought from the internet and social media, so for broad reach, future evidence-based information should be shared via online platforms. Although participants were experiencing moderate self-perceived stress and shared numerous concerns, very few COVID-19-related changes to infant feeding were reported, and there were few differences by socio-economic status, likely due to a strong economic safety net in this Canadian setting.

Health-Related Quality of Life and Distress of Parents of Children With Avoidant Restrictive Food Intake Disorder

OBJECTIVES

Health-related quality of life (HRQOL) of children with avoidant restrictive food intake disorder (ARFID) is impaired.

AIM

To measure HRQOL and distress of parents of children with ARFID.

METHODS

Cross-sectional cohort study. Parents of children with ARFID, visiting our multidisciplinary feeding team, completed questionnaires on the online Quality of Life in Clinical Practice portal; the Questionnaire for Adult's Health Related Quality of Life to assess parental HRQOL and the Distress Thermometer for Parents. Reference groups of parents of healthy (HC) and chronically ill children (CIC) were used.

RESULTS

Eighty-five mothers and 62 fathers of 89 children with ARFID (58% female, median age 1.9 years) were included (response rate 68%). No differences were found regarding HRQOL in 11 of 12 domains between parents of children with ARFID and HC. Mothers of children with ARFID reported significantly higher HRQOL regarding pain and fathers a significantly lower HRQOL on depressive emotions compared to HC. No differences were found in overall and clinical distress scores between parents of children with ARFID and HC/CIC. Mothers of children with ARFID had significantly higher distress scores regarding cognitive problems compared to HC and parenting problems in children <2 years compared to HC/CIC. Significantly higher distress scores on parenting problems in children <2 years were found in fathers of children with ARFID compared to HC/CIC.

CONCLUSION

Most HRQOL and distress scores of parents of children with ARFID were comparable to reference groups. Since parents of children with ARFID perceive a lack of understanding and support from the environment, professionals should suggest peer support through patient's organizations. Furthermore, it is important to offer professional support since parents indicated that they would like to talk to a professional about their situation.

Parental stress, food parenting practices and child snack intake during the COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to the lives of families. This study aimed to investigate the impact of pandemic-associated stress on food parenting practices including interactions surrounding snacks, and child diet.

METHODS

Parents (N = 318) of 2-12-year old children completed a cross-sectional online survey assessing current COVID-19-specific stress, pre-COVID-19 stress, financial stress (e.g. food insecurity), food parenting practices, and child snack intake frequency. Structural Equation Modeling was used to model simultaneous paths of relationships and test direct and indirect effects.

RESULTS

Stress, including financial hardship, was higher compared with before the crisis. The majority of children had regular mealtimes and irregular snack times. Higher COVID-19-specific stress was associated with more non-nutritive use of food and snacks (e.g. emotional and instrumental feeding), but also more structure and positive interactions (e.g. eating with or engaging with child around mealtimes). Higher COVID-19-specific stress was also associated with greater child intake frequency of sweet and savory snacks, with some evidence for mediation by snack parenting practices.

CONCLUSION

Our findings indicate that stress associated with the COVID-19 pandemic may be linked to child snack intake with potential impacts on child obesity risk, and suggest several modifiable points of intervention within the family context.

Feeding style profiles are associated with maternal and infant characteristics and infant feeding practices and weight outcomes in African American mothers and infants

Much literature links individual feeding styles to infant feeding practices and growth; however, parents' feeding styles are not discrete and may vary by context. We use latent profile analysis (LPA) as a person-centered approach to categorize infant feeding style patterns, test factors predicting profile membership, and examine if profiles are associated with infant feeding and weight. Additionally, we test the impact of a responsive feeding intervention on profile membership and stability. Data come from 270 African-American women and infants participating in the Mothers and Others Study, an early life obesity prevention intervention. LPA was used to categorize mothers across five constructs (laissez-faire, pressuring, restrictive, responsive and indulgent) measured at 28-weeks gestation and 3- and 15-months postpartum. Adjusted multinomial regression and regression models test the characteristics associated with profile membership and the associations between profile membership and breastfeeding and infant weight-for-age z-score (WAZ). We identified two groups (Positive and Less Responsive) prenatally, an additional group (High Controlling) at 3 months and a fourth group (High Indulgent) at 15 months. Several characteristics differed between the groups, including maternal age, income and depressive symptoms, infant sex and temperament, and treatment group. Mothers in the Positive group were more likely to breastfeed at 3 months. Infants with mothers in the High Controlling group had higher WAZ at 15 months. The intervention was associated with more Positive feeding practices at 15 months and a greater likelihood of remaining in the Positive group across the study. LPA identified profiles that are associated with maternal and infant characteristics and treatment group and with better feeding practices and growth outcomes, providing preliminary evidence that early intervention promoting more responsive feeding profiles may improve infant outcomes.

Maternal stress and depressive symptoms and adolescents' body mass index: a prospective study

Background

Growing evidence suggests that maternal mental health issues are associated with (young) children’s weight outcomes. However, most studies have been limited by cross-sectional designs and have been aimed at (younger) children. The current prospective study focuses on the link between maternal mental health (i.e., psychological stress and depressive symptoms) and adolescents’ zBMI development.

Methods

The participants in the present study were part of wave 1 and 2 of a longitudinal study on Dutch adolescents’ and their parents’ health behavior. Adolescents (aged 10–14) and their parents were recruited through six secondary schools in the South and the East of the Netherlands. For this study, we only included biological mothers and their adolescent children who participated in both waves, with data on the main measures in both waves, leaving a final sample of 336 biological mother-child dyads. Adolescents height and weight were measured, and both parents and adolescents filled in validated questionnaires on perceived stress and depressive symptoms and answered additional questions concerning domain-specific stress. Regression analyses were performed in R to examine longitudinal links between maternal stress and depressive symptoms at baseline (T1) and adolescents’ BMI standard deviation scores (zBMI) 6 months later (T2), corrected for baseline zBMI and covariates.

Results

Maternal general perceived stress (β = .20, p = .002) at T1 preceded higher adolescents’ zBMI at T2, after controlling for baseline zBMI and other covariates, whereas maternal depressive symptoms at T1 (β = −.05, p = .44) and other domain-specific stress did not (maternal financial stress, maternal stress at work, maternal stress at home). Additionally, lower educational level among adolescents (β = .16, p = .001) and adolescent depressive symptoms (β = .16, p = .001) was associated with a higher zBMI at T2.

Conclusions

Results suggest that maternal general stress, but not depressive symptoms, may influence adolescents’ weight development. Our findings warrant future investigation on whether and how general stress among mothers may predict weight increases of their adolescent offspring.

Effects of Parenting and Perceived Stress on BMI in African American Adolescents

OBJECTIVE

This study set out to examine the role of parenting practices in protecting or exacerbating the negative effects of parent and adolescent stress on adolescent body mass index (BMI) over time. Separate longitudinal models were conducted to evaluate how parenting practices interacted with parental perceived stress and adolescent perceived stress in predicting adolescent BMI.

METHODS

Baseline data were collected from 148 African American adolescents (Mage = 12.93, SD = 1.75; Mz-BMI = 0.78, SD = 0.50; MBMI%-ile = 96.7, SD = 3.90) and their caregivers (Mage = 44.45, SD = 8.65; MBMI = 37.63, SD = 8.21) enrolled in the Families Improving Together for Weight Loss trial. Adolescents self-reported their perceptions of caregiver parenting style and feeding practices. Both caregivers and adolescents self-reported their perceptions of chronic stress. BMI for parents and adolescents was assessed objectively at baseline and 16 weeks post-intervention.

RESULTS

Hierarchical regression models predicting adolescent BMI z-score (z-BMI) indicated a significant interaction between parental perceived stress and parental pressure to eat. Simple slopes analyses demonstrated that for those parents that exhibit higher pressure to eat, parent stress was positively associated with adolescent z-BMI.

CONCLUSIONS

These findings provide preliminary support suggesting that certain parenting practices interact with chronic stress on adolescent weight-related outcomes and that future interventions may consider integrating these factors.

Head Start Parents With or Without Food Insecurity and With Lower Food Resource Management Skills Use Less Positive Feeding Practices in Preschool-Age Children

BACKGROUND

Food resource management (FRM), strategies to stretch limited food resource dollars, may mitigate the impact of household food insecurity (HFI) on family members, including young children. However, little is known about how FRM and HFI are associated with child feeding practices.

OBJECTIVES

The study aimed to explore relationships between HFI, FRM, and child feeding practices of low-income parents.

METHODS

In a cross-sectional sample of 304 Head Start households, caregivers completed the USDA HFI module [classifying them as either food secure (FS) or food insecure (FI)], FRM behavior subscale (classifying them as being high or low in management skills based on a median score split), Comprehensive Feeding Practices Questionnaire, and Perceived Stress Scale. Households were categorized into 4 HFI-FRM subgroups: FS/high FRM (30.6%), FS/low FRM (31.3%), FI/high FRM (18.8%), and FI/low FRM (19.4%). Multivariable linear regression was used to examine whether feeding practices differed across HFI-FRM categories and whether the addition of parental perceived stress contributed to differences in feeding practices by HFI-FRM group.

RESULTS

In our study, 38% of households were FI. Compared to the FS/high FRM group in the adjusted models, the FS/low FRM group used less monitoring (-0.53; 95% CI: -0.78 to -0.28), modeling (-0.38; 95% CI: -0.64 to -0.13), and involvement (-0.57; 95% CI: -0.82 to -0.32) in feeding. A similar pattern emerged for the FI/low FRM group. The use of food as a reward was higher in the FI/high FRM (0.35; 95% CI: 0.02-0.67) and FI/low FRM groups (0.33; 95% CI: 0.01-0.66) compared to the FS/high FRM group. Perceived stress was positively associated with the use of negative, controlling feeding practices, and contributed to differences in using food as a reward within the HFI-FRM group.

CONCLUSIONS

Suboptimal child feeding is evident in low-income caregivers with low FRM skills, with or without food insecurity. Promoting high FRM skills, in addition to addressing food insecurity, could potentially synergistically improve child feeding practices in low-income households.

Effect of a Home-Visiting Intervention to Reduce Early Childhood Obesity Among Native American Children: A Randomized Clinical Trial

Importance

Early childhood obesity disproportionately affects Native American communities. Home visiting is a promising strategy for promoting optimal infant growth in this population.

Objective

To assess the impact of a brief home-visiting approach, Family Spirit Nurture (FSN), on sugar-sweetened beverage (SSB) consumption, responsive parenting and infant feeding practices, and optimal growth through 12 months post partum.

Design, Setting, and Participants

This study was a 1:1 randomized clinical trial comparing FSN with an injury prevention education control condition in a reservation-based community. Participants were Navajo mothers 13 years or older with infants younger than 14 weeks recruited between March 22, 2017, and May 18, 2018, and followed up through 12 months post partum. Intent-to-treat analyses were conducted.

Interventions

The 6-lesson FSN curriculum, delivered 3 to 6 months post partum by Navajo paraprofessionals, targeted optimal responsive and complementary feeding practices and avoidance of SSBs. The control group received 3 injury prevention lessons.

Main Outcomes and Measures

Primary outcomes established a priori were infant SSB consumption and responsive parenting and complementary feeding practices (responsive feeding scale, age at complementary food introduction, and percentage of mothers who introduced complementary food to infants at 6 months of age or older). The secondary outcome was the effect of the intervention on infant body mass index z scores (zBMIs).

Results

A total of 134 Navajo mothers of infants younger than 14 weeks were enrolled in the randomized clinical trial, including 68 (mean [SD] maternal age at enrollment, 27.4 [6.4] years) in the intervention group and 66 (mean [SD] maternal age at enrollment, 27.5 [6.1] years) in the control group. Intervention participants reported statistically significantly lower infant SSB consumption through 12 months post partum (mean [SE], 0.56 [0.12] cups per week in the intervention group and 1.78 [0.18] cups per week in the control group; incidence rate ratio, 0.31; 95% CI, 0.19-0.50). Improvements in responsive feeding practices were observed through 9 months post partum (mean [SE], 3.48 [0.07] in the intervention group and 3.22 [0.08] in the control group) (difference, 0.26; 95% CI, 0.06-0.47); statistical significance was lost at 12 months post partum. Age at which the infant was given first food was younger in the intervention group (mean [SE] age, 4.61 [0.21] months in the intervention group and 5.28 [0.23] months in the control group) (difference, -0.67; 95% CI, -0.04 to -1.29). Infants in the intervention group had lower zBMI at 6 and 9 months compared with those in the control group (mean [SE] at 9 months, 0.27 [0.14] in the intervention group and 0.81 [0.14] in the control group; difference, -0.54; 95% CI, -0.94 to -0.14). The 12-month between-group difference was meaningful but not statistically significant (mean [SE], 0.61 [0.16] in the intervention group and 1.07 [0.20] in the control group; difference, -0.46; 95% CI, -0.92 to 0.01).

Conclusions and Relevance

Infants of Native American mothers who participated in a home-visiting intervention had substantially lower SSB consumption and improvements in responsive feeding practices and infant zBMI scores, suggesting the intervention is effective for promoting healthy infant feeding and growth.

Trial Registration

ClinicalTrials.gov Identifier: NCT03101943.

Clinical strategies for addressing obesity in infants and toddlers

ABSTRACT

Babies' earliest food experiences have a lifelong impact on eating preferences and dietary habits, laying the foundation for obesity risk. NPs have the opportunity to provide education about healthy infant feeding practices before the growth trajectory becomes abnormal and focus intensive education on at-risk families.

Feeding and Growth in Infants With Cleft Lip and/or Palate: Relationships With Maternal Distress

OBJECTIVE

To examine relationships between early feeding and growth and maternal distress in infants with and without cleft lip and/or palate (CL/P).

DESIGN

Cross-sectional.

SETTING

Pediatric academic medical center in the Midwestern United States.

PARTICIPANTS

Mothers of infants 1 to 12 weeks old with CL/P (n = 30) and without CL/P (control group, n = 30) were recruited at craniofacial clinic or pediatrician appointments.

MAIN OUTCOME MEASURE(S)

Maternal responses on the Feeding/Swallowing Impact Survey (FS-IS), Parenting Stress Index, Fourth Edition, Short Form (PSI-4-SF), and Edinburgh Postnatal Depression Scale. Infant feeding history and growth measurements were obtained.

RESULTS

Having an infant with CL/P revealed greater impact on maternal health-related quality of life due to feeding problems (F = 4.83, P = .03). Mothers of infants with CL/P reported average range Total Stress scores on the PSI-4-SF, which were higher than controls (F = 4.12, P = .05). Edinburgh Postnatal Depression Scale scores did not differ between groups. Compared to controls, infants with cleft palate had lower percentiles for weight (t = 4.13, P = .04) and length (t = 2.93, P = .01). Higher FS-IS scores were associated with longer feeding duration (r = 0.32, P = .01) and lower weight (r = -0.31, P = .02) and length (r = -0.32, P = .02).

CONCLUSIONS

Despite receiving early team care and feeding interventions, mothers of infants with CL/P reported higher stress and more challenges with feeding and growth. Future studies should examine targeted psychosocial interventions to improve feeding and growth outcomes in infants with CL/P.

The association between maternal depressive symptomology and child dinner dietary quality among Hispanic Head Start families

Dietary quality is important for children’s growth and development. Poor dietary quality and maternal depression are prevalent among low-income, Hispanic families. Maternal depression likely influences child feeding before and during the meal. This secondary data analysis of an observational feeding study (2007–2008) examined how maternal depressive symptomology relates to dietary quality of dinner served to and consumed by Head Start preschoolers in Houston, TX (n = 82 mother-child dyads). A digital photography method assessed food served and consumed by the child at three separate dinner meals in families’ homes. Healthy Eating Index-2010 (HEI) was calculated and averaged across the three meals to measure dietary quality (possible range 0–100). Maternal depression was assessed by the Centers for Epidemiologic Depression Scale (CES-D, possible range 0–60). A series of linear regression models were developed, regressing the total CES-D score and all four CES-D subscales onto both the dietary quality of the meal served and consumed. Dinners served had a HEI of 45.70 ± 9.19 and dinners consumed had a HEI of 44.65 ± 7.34. Clinically significant depressive symptomology (CES-D ≥ 16) was reported by 28% of mothers. Maternal depressive symptomology and the dietary quality served were not related. Controlling for dietary quality served, total CES-D and somatic complaints subscale scores were associated with lower dietary quality consumed (respectively, β = −0.16, p < 0.05 and β = −0.23, p < 0.01). Among low-income, Hispanic families, maternal depressive symptomology was predictive of the dietary quality consumed, but not served. Together, these findings reinforce the importance of parent feeding behaviors and emotional climates during dinner.

Associations of maternal resources with care behaviours differ by resource and behaviour

Care is important for children's growth and development, but lack or inadequacy of resources for care can constrain appropriate caregiving. The objectives of this study were to examine whether maternal resources for care are associated with care behaviours specifically infant and young child feeding, hygiene, health-seeking, and family care behaviours. The study also examined if some resources for care are more important than others. This study used baseline Alive & Thrive household surveys from Bangladesh, Vietnam, and Ethiopia. Measures of resources for care were maternal education, knowledge, height, nourishment, mental well-being, decision-making autonomy, employment, support in chores, and perceived instrumental support. Multiple regression analyses were conducted to examine the associations of resources for care with child-feeding practices (exclusive breastfeeding, minimum meal frequency, dietary and diversity), hygiene practices (improved drinking water source, improved sanitation, and cleanliness), health-seeking (full immunization), and family care (psychosocial stimulation and availability of adequate caregiver). The models were adjusted for covariates at child, parents, and household levels and accounted for geographic clustering. All measures of resources for care had positive associations with care behaviours; in a few instances, however, the associations between the resources for care and care behaviours were in the negative direction. Improving education, knowledge, nutritional status, mental well-being, autonomy, and social support among mothers would facilitate provision of optimal care for children.