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Urkia-Susin I, Guenetxea-Gorostiza J, Rada-Fernandez de Jauregui D, Mazquiaran-Bergera L, Martinez O, Maiz E. Development and validation of the baby eating behaviour coding system (BEBECS) to assess eating behaviour during complementary feeding. Appetite 2024; 196:107257. [PMID: 38364972 DOI: 10.1016/j.appet.2024.107257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
Eating behaviour in children is a matter of study for which diverse tools have been designed. Coding systems for videotaped meals allow the extraction of detailed in vivo information; however, there is no tool available for infants following a Baby-Led Weaning (BLW) method. This study aimed to create and validate a new tool to assess eating behaviour in infants during weaning, applicable regardless of the complementary feeding method. The Baby Eating Behaviour Coding System (BEBECS) was developed comprising time variables, behaviours, feeder-led actions, and other meal-related variables. Sixty videos of infants aged 6-18 months following spoon-feeding (SF) or BLW methods were coded by two trained coders. These scores were analysed together with intake and maternal ratings of liking and calmness. Additionally, combined analysis and internal comparison assessed the possible differences in BEBECS variables between SF and BLW. Inter-rater and test-retest reliability had good to excellent agreement: Cohen's Kappa >0.75, Lin's CCC >0.70, and Intraclass Correlation Coefficient >0.75, for almost all variables. Infants' liking and intake of the offered food correlated positively with meal duration and total count of mouth approaches but negatively with having leftovers and time between mouth approaches. Infants' calmness and tiredness were negatively correlated. More food than initially offered was available during the meal in BLW but not in SF. There was a tendency towards more autonomous behaviour in BLW infants regarding changes observed in the time the food was in the mouth at each stage (6, 12, and 18 months). In conclusion, BEBECS has the potential to be a valid tool for application in the research of infant eating behaviour during weaning by trained coders.
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Affiliation(s)
- Iratxe Urkia-Susin
- Department of Pharmacy and Food Science (G3S Research Group), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Unibertsitateko Ibilbidea 7, 01006, Vitoria-Gasteiz, Araba, Spain; Bioaraba Health Research Institute, Nutrition and Food Safety Group Araba University Hospital, Vitoria-Gasteiz, Spain.
| | - Jone Guenetxea-Gorostiza
- Department of Preventive Medicine and Public Health, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Unibertsitateko Ibilbidea 7, 01006, Vitoria-Gasteiz, Araba, Spain; Biogipuzkoa Health Research Institute, Mental Health Group, Donostia, Spain
| | - Diego Rada-Fernandez de Jauregui
- Bioaraba Health Research Institute, Nutrition and Food Safety Group Araba University Hospital, Vitoria-Gasteiz, Spain; Department of Preventive Medicine and Public Health, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Unibertsitateko Ibilbidea 7, 01006, Vitoria-Gasteiz, Araba, Spain
| | - Leire Mazquiaran-Bergera
- Department of Preventive Medicine and Public Health, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Unibertsitateko Ibilbidea 7, 01006, Vitoria-Gasteiz, Araba, Spain; Biogipuzkoa Health Research Institute, Mental Health Group, Donostia, Spain
| | - Olaia Martinez
- Department of Pharmacy and Food Science (G3S Research Group), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Unibertsitateko Ibilbidea 7, 01006, Vitoria-Gasteiz, Araba, Spain; Bioaraba Health Research Institute, Nutrition and Food Safety Group Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Edurne Maiz
- Biogipuzkoa Health Research Institute, Mental Health Group, Donostia, Spain; Department of Clinical and Health Psychology and Research Methodology, Faculty of Psychology, University of the Basque Country UPV/EHU, Tolosa Hiribidea 70, 20018, Donostia, Gipuzkoa, Spain
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Xie Q, Yong C, Xiang C, Xi Y, Huo J, Liang J, Zou H, Pan Y, Wu M, Lin Q. The Impact of Caregiver Pressure to Eat on Food Neophobia in Children with Autism Spectrum Disorder: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:528. [PMID: 38790525 PMCID: PMC11119268 DOI: 10.3390/children11050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/17/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024]
Abstract
(1) Background: With autistic children's high pervasiveness of eating problems and inappropriate feeding behaviors by their caregivers, this study wanted to inspect the connection between caregivers' pressure to eat and food neophobia in these children. (2) Methods: Cross-sectional overview of 160 guardians of kids aged 2 to 7 years. After one-on-one questioning by the researcher, the collected information on the socio-demographic characteristics of the children with autism, caregiver feeding behavior, and new food neophobia (FN) scores was entered into the Questionnaire Star system. (3) Results: The mean FN score was 25.56 ± 6.46. The caregiver's pressure to eat positively related to children's FN (β = 0.164 95% CI, 0.078, 2.163). In these children, we found a negative correlation between FN score and the frequency of vegetable intake (p ≤ 0.001), fruit intake (p ≤ 0.05), aquatic product intake (p ≤ 0.05), and dietary diversity score (p ≤ 0.01), and positively correlated with the frequency of snack intake (p ≤ 0.05). (4) Conclusions: Caregiver pressure to eat was positively associated with high levels of FN in Chinese kids with ASD, which in turn negatively impacted dietary quality. To improve eating habits, caregivers should reconsider their feeding strategies and avoid using forceful methods to ease food neophobia in these children.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Qian Lin
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 172 Tongzipo Road, Changsha 410031, China; (Q.X.); (C.Y.); (C.X.); (Y.X.); (J.H.); (J.L.); (H.Z.); (Y.P.); (M.W.)
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Loth KA, Ji Z, Kohli N, Fisher JO, Fulkerson JA. Parents of preschoolers use multiple strategies to feed their children: Findings from an observational video pilot study. Appetite 2023; 187:106615. [PMID: 37236362 PMCID: PMC10358371 DOI: 10.1016/j.appet.2023.106615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 05/28/2023]
Abstract
The current study leveraged observational data collection methods to fill gaps in our understanding of parent approach to feeding as well as child responses to various parental approaches. Specifically, the study aimed to: 1) characterize the broad range of food parenting practices used by parents of preschoolers during shared mealtimes at home, including differences by child gender, and 2) describe child responses to specific parent feeding practices. Forty parent-child dyads participated by recording two in-home shared meals. Meals were coded using a behavioral coding scheme that coded the occurrence of 11 distinct food parenting practices (e.g. indirect and direct commands, praise, bribes) and eight child responses (e.g., eat, refuse, cry/whine) to food parenting practices. Results revealed that parents engaged in a broad range of food parenting practices at meals. On average, parents in our sample used 10.51 (SD 7.83; Range 0-30) total food parenting practices per mealtime with a mean use of 3.38 (SD 1.67; Range 0-8) unique food parenting practices per mealtime. Use of indirect and direct commands to eat were most common; direct and indirect commands were used by 97.5% (n = 39) and 87.5% (n = 35) of parents at meals, respectively. No statistically significant differences were observed by child gender. No one specific feeding practice consistently yielded compliance or refusal to eat from the child, instead child responses were often mixed (e.g., compliance followed by refusal and/or refusal followed by compliance). However, use of praise to prompt eating was the practice that most often resulted in child compliance; 80.8% of children complied following parent's use of praise as a prompt to eat. Findings deepen our understanding of the types and frequency of food parenting practices used by parents of preschoolers during meals eaten at home and illuminate child responses to specific food parenting practices.
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Affiliation(s)
- K A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St SE, Minneapolis, MN, 55414, USA.
| | - Z Ji
- Division of Biostatistics, School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - N Kohli
- Department of Educational Psychology, University of Minnesota, 56 E River Parkway, Minneapolis, MN, 55455, USA
| | - J O Fisher
- Center for Obesity Research and Education, Department of Social and Behavioral Sciences, College of Public Health, Temple University, 3223 N Broad Street, Philadelphia, PA, 19122, USA
| | - J A Fulkerson
- School of Nursing, University of Minnesota, 308 SE Harvard Street, Minneapolis, MN, 55455, USA
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Lipsky LM, Burger K, Cummings JR, Faith MS, Nansel TR. Associations of parent feeding behaviors and early life food exposures with early childhood appetitive traits in an observational cohort study. Physiol Behav 2023; 265:114175. [PMID: 36997010 PMCID: PMC10141500 DOI: 10.1016/j.physbeh.2023.114175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/09/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Child appetitive traits, eating styles that reflect responsiveness to external influences and internal hunger and satiety signals, are associated with eating behaviors and susceptibility to excess weight gain. However, relatively little is known about early life influences on child appetitive traits. This study investigated relations of early life maternal feeding behaviors and food exposures with appetitive traits at age 3.5 years. METHODS Participants of the Pregnancy Eating Attributes Study (PEAS) and follow-up study were enrolled in early pregnancy and followed prospectively. This analysis included data collected from baseline through child aged 3.5-years (n = 160). Child appetitive traits at age 3.5 years were measured using the Child Eating Behavior Questionnaire. Age at introduction to fruit, vegetables, discretionary sweets, and discretionary savory foods was assessed, along with intake frequency at infant ages 6, 9, and 12 months, and 2 years. Maternal feeding to soothe was assessed at child aged 3, 6, and 12 months. Maternal permissive feeding was assessed at child aged 2 years. Multiple linear regressions estimated relations of maternal feeding behaviors and infant food exposures with child appetitive traits at age 3.5 years, controlling for sociodemographics and breastfeeding duration. RESULTS Maternal feeding to soothe at 6 (r = 0.39, p < 0.001) and 12 months (r = 0.39, p < 0.001) was positively associated with permissive feeding at 2 years. Maternal feeding to soothe at 12 months and permissive feeding at 2 years were associated with greater child emotional overeating, emotional undereating, and desire to drink. Older age at introduction to fruit (β = 0.20±0.08, p = 0.01) and younger age at introduction to discretionary sweet foods (β = -0.07±0.04, p = 0.06) were associated with greater emotional overeating. Older age at introduction to vegetables (β = 0.22±0.11, p = 0.04) and less frequent feeding of fruit (β = -0.20±0.08, p = 0.01) were associated with greater food fussiness. CONCLUSIONS Associations of emotional eating with parent feeding behaviors and early life food exposures suggest the potential for interventions targeting early life feeding to have long-term impact on child appetitive traits and diet quality.
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Affiliation(s)
- Leah M Lipsky
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20817, United States of America.
| | - Kyle Burger
- Burger, PHD, MPH, RD. Assistant Professor, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, 2204 McGavran-Greenberg Hall CB# 7461, Chapel Hill, 27599 NC, United States of America
| | - Jenna R Cummings
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20817, United States of America
| | - Myles S Faith
- Department of Counseling, School, and Educational Psychology, Graduate School of Education, University at Buffalo - SUNY, 420 Bady Hall, Buffalo, NY, 14250, United States of America
| | - Tonja R Nansel
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20817, United States of America
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Yong C, Kuang X, Liu Y, Xiang C, Xi Y, Huo J, Liang J, Zou H, Lin Q. Parental food neophobia, feeding practices, and preschooler's food neophobia: A cross-sectional study in China. Appetite 2023; 185:106547. [PMID: 36958634 DOI: 10.1016/j.appet.2023.106547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 03/25/2023]
Abstract
This study explores the relationship between parental food neophobia, feeding practices, and preschoolers' food neophobia in China. METHODS A cross-sectional study was conducted among 1616 pairs of preschoolers and their parents. Electronic questionnaires were conducted to collect information about social and demographic characteristics, scores of food neophobia among both children and their parents, parents' feeding patterns and children's dietary quality. RESULTS Children's average food neophobia score was 23.72 ± 4.45. There was a positive correlation between parental food neophobia score (β: 0.154; 95%CI: 0.113, 0.195), pressure to eat (β: 0.694; 95%CI: 0.423, 0.964), postpartum breastfeeding initiation (β: 0.010; 95%CI: 0.002, 0.018), and children's score of food neophobia. However, parental modeling (β: -0.470; 95%CI: -0.732, -0.207) and the frequency of children eating with their families at home (β: -0.407; 95%CI: -0.707, -0.108) were negatively associated with children's food neophobia scores. The consumption frequencies of vegetables(P < 0.001), fruits(P < 0.001), domestic animals and poultry(P < 0.01), aquatic products(P < 0.05), beans and their products(P < 0.01), eggs(P < 0.05) and nuts(P < 0.05) and children's dietary diversity score (P < 0.001) are negatively associated with children' food neophobia score. While the consumption frequencies of fast food(P < 0.001), sweets(P < 0.01) and puffed/fried food(P < 0.001) were positively associated with children's food neophobia. CONCLUSION Chinese preschoolers' food neophobia needs more attention because children with high food neophobia tend to have lower dietary quality. Children whose parents have high-level food neophobia should be the focus of early prevention. Earlier postpartum breastfeeding, more use of parental modelling, less pressure to eat and higher frequency of children eating with families are helpful to reduce the incidence of children's food neophobia.
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Affiliation(s)
- Cuiting Yong
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha, 410078, China.
| | - Xiaoni Kuang
- Department of Child Care, Changsha Maternal and Child Health Care Hospital, 416 Chengnan East Rd of Yuhua District, Changsha, 410007, China.
| | - Yan Liu
- Department of Child Care, Changsha Maternal and Child Health Care Hospital, 416 Chengnan East Rd of Yuhua District, Changsha, 410007, China.
| | - Caihong Xiang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha, 410078, China.
| | - Yue Xi
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Jiaqi Huo
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha, 410078, China.
| | - Jiajing Liang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha, 410078, China.
| | - Hanshaung Zou
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha, 410078, China.
| | - Qian Lin
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha, 410078, China.
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Abstract
PURPOSE OF REVIEW To discuss recent evidence on the influence of complementary feeding (CF) timing, content and feeding methods on childhood obesity risk. RECENT FINDINGS The evidence-base is limited by heterogeneity, risk of bias and the predominance of observational studies. The content of the diet and feeding practices are more influential than timing for obesity risk. There is limited evidence that CF introduction before 4 months may be associated with increased risk. Intake of animal protein, particularly dairy protein, may contribute to rapid weight gain; protein from infant/follow-on formula shows the most robust association with later obesity risk. Evidence linking sugar intake to obesity risk is limited, but intake should be as low as possible given there is no nutritional requirement. Responsive feeding (RF) practices may promote appropriate infant growth and reduce risk. The effect of baby-led weaning (BLW) is inconclusive. SUMMARY Recent evidence supports current recommendations to avoid high protein intakes, especially from infant/follow-on formula, for infants in high income countries; and to promote RF practices for all infants. Studies in low- and middle-income countries are required to define optimal CF practices given increasing rates of child obesity alongside double-burden malnutrition.
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Affiliation(s)
- Kulnipa Kittisakmontri
- Nutrition Research Group, Population, Policy & Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mary Fewtrell
- Nutrition Research Group, Population, Policy & Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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Karssen LT, Larsen JK, Burk WJ, Kremers SPJ, Hermans RCJ, Ruiter ELM, Vink JM, de Weerth C. Process and effect evaluation of the app-based parenting program Samen Happie! on infant zBMI: A randomized controlled trial. Front Public Health 2022; 10:1012431. [PMID: 36620259 PMCID: PMC9822729 DOI: 10.3389/fpubh.2022.1012431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Levie T. Karssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands,*Correspondence: Levie T. Karssen ✉
| | - Junilla K. Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - William J. Burk
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Stef P. J. Kremers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Roel C. J. Hermans
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Emilie L. M. Ruiter
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jacqueline M. Vink
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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van Vliet MS, Mesman J, Schultink JM, Vereijken CMJL, Martens VEG, van der Veek SMC. Maternal sensitivity during mealtime and free play: Differences and explanatory factors. INFANCY 2022; 27:630-644. [PMID: 35332653 DOI: 10.1111/infa.12465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
Mealtime is a parent-toddler interaction that occurs multiple times a day. This study examined whether observed maternal sensitivity differed between a mealtime and free-play setting, aiming to explain differences between the two situations by studying moderating effects of children's eating behavior. The sample consisted of 103 first-time mothers and their 18-month-old children. Maternal sensitivity was assessed by coding videotaped interactions of free-play sessions and mealtimes, using the Ainsworth Sensitivity Scale (range 1-9). Additionally, child eating behavior during the meal was coded and also assessed through the Child Eating Behavior Questionnaire-Toddlers. First, a small but significant amount of stability was found between sensitivity during mealtime and sensitivity during play (r = 0.24). Second, mothers were more sensitive during free play (mean = 7.11) than during mealtime (mean = 6.52). Third, observed child eating behavior was related to maternal sensitivity during mealtime, with more food enjoyment being associated with higher levels of sensitivity, and more challenging child behavior with lower levels of sensitivity. Finally, when children showed a high degree of challenging behavior during the meal, there was more discrepancy between sensitivity during mealtime and free play. Our results highlight the importance of taking context into account when observing parental sensitivity.
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Affiliation(s)
- Merel S van Vliet
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Judi Mesman
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Janneke M Schultink
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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