Indulgent feeding style and children's weight status in preschool

CELEBRATE Feeding: A Responsive Approach to Food and Feeding in Early Learning Settings

Early learning and child care (ELCC) settings in Canada follow nutrition standards that outline food provisions, with many also encouraging responsive feeding practices that help to create a supportive environment for children. Caregivers who lack confidence in children's ability to regulate their own intake, or those who feel stressed about mealtime, may unknowingly engage in less responsive feeding practices. The CELEBRATE Feeding Approach is a flexible framework, driven by behaviour change theory, that builds on previous definitions and concepts of responsive feeding in ELCC environments. Through this approach, there is an intentional focus on supporting early childhood educators to implement feeding practices that are more responsive. The approach incorporates 13 target educator behaviours related to the three overlapping categories of CELEBRATE language, CELEBRATE Mealtime, and CELEBRATE Play. These practices recognize and support the development of a child's sense of autonomy, confidence, and self-regulation not only at mealtimes but also through play-based exploration and language that is used throughout the day around food and feeding. The goal is that children will be open to a wide variety of food, develop their self-regulation skills, and build the foundation for a positive relationship with food throughout their lifetime.

Food parenting at-home vs. in restaurants among African American parents of 3-to-8-year-old children

Feeding style refers to the approach that parents use to feed their child and the emotional climate during eating. Indulgent styles, characterized by low structure and high responsiveness, have been linked to childhood weight gain. Few studies have examined feeding styles within out-of-home contexts (e.g., restaurants), which are common eating environments for many families. This study sought to examine feeding styles at-home and in restaurants among African American parents. 52 African American parents with a 3-to-8-year-old child (M = 35.6 years, 86% mothers, 57% annual household income <$50,000, 57% Associate's degree or higher) who regularly dined at restaurants completed an online survey in winter 2022-2023. Parents reported on demographics, anthropometrics, and their feeding styles at home and in restaurants via The Caregiver's Feeding Style Questionnaire. Findings indicated that the indulgent style was the most common overall. Indulgent styles were more prevalent in restaurants (χ2 = 7.4, p = 0.007) than home, and authoritarian styles more prevalent at home (χ2 = 4.5, p = 0.03). Child weight status differed by feeding style in both contexts (p ≤ 0.04); indulgent styles in restaurants were linked to higher BMI z-scores, while authoritarian styles at home were linked to lower BMI z-scores. Higher parent BMI was linked to increased likelihood of having an indulgent style at home (OR = 1.13, p = 0.03), while lower parent BMI was linked to increased likelihood of the uninvolved style at home (OR = 0.76, p = 0.049). Overall, indulgent styles were common and more prevalent in restaurants, where they were linked to higher child weight status. Findings may inform future health promotion efforts in out-of-home eating contexts.

Association between parental feeding styles, body mass index, and consumption of fruits, vegetables and processed foods with mothers´ perceptions of feeding difficulties in children

BACKGROUND

Feeding difficulties (FDs) are complex phenomena influenced by parental factors, feeding behaviour, and cultural factors. However, studies of the influences of these factors on FDs incidence are scarce. Thus, this study aimed to identify the associations between mothers' perceptions of FDs in children and parental feeding styles, body mass index, and the consumption of fruits, vegetables and processed foods.

METHOD

Two hundred and fifty-seven mothers of children aged 1 to 6 years and 11 months participated in this cross-sectional study and self-completed electronic questionnaires on sociographic variables, parental feeding styles, the consumption of fruits, vegetables and processed foods and FDs. Nutritional status was classified by body mass index (kg/m2).

RESULTS

The prevalence of FDs in children was 48.2%, and the mean age was 43.8 (± 17.6) months. The indulgent parental feeding style was the most common (40.1%), followed by the authoritative (31.1%), authoritarian (23.7%), and uninvolved (5.1%) styles. An indulgent parental feeding style (OR: 4.66; 95% CI: 2.20-9.85), a high body mass index (OR: 1.35; 95% CI: 1.09-1.68), and the consumption of processed foods (OR: 5.21; 95% CI: 2.85-9.53) were positively associated with increased odds of the absence of FDs in children. The associations of authoritarian and uninvolved parental feeding styles and the consumption of fruits and vegetables with FDs in children were not significant.

CONCLUSION

This study identified multiple factors that are possibly associated with feeding behaviours in young children. However, further studies need to be undertaken to evaluate how such behaviours affect FDs.

Defining Parenting Practices for Reducing Sugar-Sweetened Beverage Consumption Among Preschoolers

While attempts have been made to organize parenting practices in a working system, there are problems that make it difficult to understand how parenting is related to children's eating behaviors. The purpose of this study was to evaluate the validity and reliability of a new instrument evaluating parenting practices toward sugar-sweetened beverages (SSBs) using the nine intervention functions of the Behavior Change Wheel. Each intervention function (education, persuasion, incentivization, coercion, training, restriction, environmental restructuring, modeling, and enablement) was applied to a parenting practice for having a preschooler consume no more than 8 oz of SSBs per week. A survey was developed to evaluate each practice. Forty-eight parents of preschoolers (2-5 years old) completed the survey, and the most utilized practices were modeling, creating a supportive home environment, persuading children, and restricting SSBs. The framework presented in this study can be useful for determining which parenting practices are acceptable and effective for promoting health behaviors among children.

Caregiver Influences on Eating Behaviors in Children: An Opportunity for Preventing Obesity

PURPOSE OF REVIEW

This review seeks to define caregiver practices that impact childhood eating behaviors and identify ways to utilize these relationships to prevent childhood obesity.

RECENT FINDINGS

Childhood obesity, which correlates with adult obesity and increased cardiovascular risk, is increasing in prevalence and severity. Caregivers play a significant role in shaping a child's eating behaviors and their predisposition to obesity. Maternal influences during pregnancy and infancy impact a child's future food preferences. Caregiver feeding styles (authoritarian, authoritative, indulgent, and uninvolved) are associated with distinct effects on children's eating behaviors and self-regulation. Authoritative feeding styles promote child autonomy while setting boundaries in the feeding environment. Early caregiver education and coaching regarding nutrition and feeding practices is beneficial to establishing healthy eating behaviors for children. Various caregivers, including parents, grandparents, siblings, teachers, and others, influence a child's eating habits at different stages of development. These caregivers can both positively and negatively impact a child's diet. Comprehensive interventions involving these various caregivers to promote healthy eating practices in children is ideal. Such interventions should be sensitive to cultural and environmental factors. Childhood obesity is a complex issue with long-term health effects. Early intervention using comprehensive approaches including all caregivers, community support, and public policies to address the social determinants of health will be beneficial. Future research should focus on valid outcome measures and equitable interventions that encompass all aspects of a child's life.

Associations between behavioral self-regulation and external food cue responsiveness (EFCR) in preschool-age children and evidence of modification by parenting style

Decreased behavioral regulation is hypothesized to be a risk factor for excess weight gain among children, possibly via reduced appetite-specific regulation. Little research has specifically focused on behavioral regulation and food cue responsiveness, a conditioned precursor to eating, at a young age. This study examined the association between behavioral regulation and external food cue responsiveness among preschool-age children and explored if a more structured parenting style moderated that association. Baseline data from a prospective study on media use among preschool-age children (n = 83) in Northern New England were used. Parents reported on three domains of children's behavioral regulation (attentional focusing, inhibitory control, and emotional self-regulation), the children's external food cue responsiveness (EFCR), and their parenting styles (authoritative and permissive) via validated questionnaires. Mean age among children was 4.31 (SD 0.91) years, 57% of children were male, 89% were non-Hispanic white, and 26.2% had overweight or obesity. In a series of adjusted linear regression models, lower attentional focusing (standardized β, βs = -0.35, p = 0.001), inhibitory control (βs = -0.30, p = 0.008), and emotional self-regulation (standardized beta, βs = -0.38, p < 0.001) were each significantly associated with greater EFCR. In exploratory analyses, a more structured parenting style (more authoritative or less permissive) mitigated the associations between inhibitory control and EFCR (Bonferroni-adjusted p-interaction < 0.017). Findings support that lower attentional focusing, inhibitory control, and emotional self-regulation relate to greater ECFR in preschool-age children. The association between inhibitory control and EFCR may be modified by parenting style. Further research is needed to understand if children's responsiveness to external food cues may account for reported associations between lower behavioral regulation and adiposity gain over time.

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.

The longitudinal effects of maternal parenting practices on children's body mass index z-scores are lagged and differential

BACKGROUND

The longitudinal relation between parenting practices and styles with children's body mass index z-scores (zBMI) is poorly understood. Previous studies suggest the relationship may be complex, but small samples and short follow-ups diminish the strength of the evidence. The objectives of this study were to investigate whether the relationship is bidirectional, time-varying, and lagged using data from a large, representative birth cohort of Quebec children.

METHODS

Data were from the Québec Longitudinal Study of Child Development (QLSCD), a prospective birth cohort (n = 1,602). The mothers' interactions with their children (at ages 6, 8, 10, and 12 years) were utilized in factor analysis to identify three latent parenting practices (disciplinarian, lenient, and responsive). The parenting practices were analyzed with K-means clustering to identify the parenting styles. The temporal and bidirectional relationships were assessed in a cross-lagged path analysis using a structural equation modelling framework. Mixed models controlling for age, sex, income, mother's education, and whether the participant was first-born were estimated. Missing data were handled with full information maximum likelihood.

RESULTS

From the linear mixed models, greater lenient and responsive parenting practices were associated with higher zBMI (B = 0.03, p < 0.05) two years later. However, there was no evidence that the relationship was bidirectional nor that parenting style was predictive of children's zBMI.

CONCLUSION

While mothers' parenting practices were unaffected by their children's zBMI, parental practices were predictive of future zBMI among their prepubertal children. More in-depth exploration of parenting practices and their potential impact on pediatric weight is needed.

Differences in food parenting at home versus restaurants among parents of 3-to-8-year-old children

Indulgent parent feeding styles have been linked to less healthful eating behaviors and higher BMI among children. Restaurants are becoming a frequent eating environment for children. Frequent intake of food from restaurants has been associated with increased weight status, making restaurants a target for childhood obesity prevention efforts. Currently, little research has considered parent feeding styles in restaurants and how they might differ from the home setting. Given the increased frequency of children's restaurant consumption, examining parent feeding styles in restaurants may contribute to future research in this area. Therefore, the objective of this study was to examine parent feeding styles at home and in restaurants. Parents whose 3-to-8-year-old children dined out regularly completed a one-time, online survey in February/March 2022. The Caregiver's Feeding Style Questionnaire assessed parent feeding styles at home and in restaurants. Differences in feeding styles were examined across settings. Indulgent feeding styles were most common overall. Parents (n = 117; 92% mothers; 85% white; 61% reported household income > $75,000/year) reported higher demandingness at home (M = 2.6 ± 0.5) compared to restaurants (M = 2.4 ± 0.5; t(116) = 6.7, P < 0.001). Parents were more likely to use indulgent feeding styles (X² = 11.6, P < 0.001) and less likely to use authoritarian feeding styles (X² = 4.6, P < 0.05) in restaurants compared to the home, suggesting parent feeding styles are less structured in restaurants. Results may have implications for future healthy eating interventions in away-from-home contexts.

Indulgent Feeding Style Moderates the Association of Food Responsiveness to Body Mass Index Z-scores of Preschoolers

OBJECTIVE

To investigate the moderating role of caregiver feeding styles in the association between preschool children's food-approaching eating behaviors and body mass index (BMI) z-scores.

METHODS

This cross-sectional study examined 81 caregiver-preschooler dyads from low-income neighborhoods in Santiago, Chile. Moderated multiple linear regression analyses were used to determine the moderating effect of the indulgent feeding style in the relation between eating behaviors and BMI z-scores of preschool children.

RESULTS

The indulgent caregiver feeding style moderated the association between food responsiveness and BMI z-scores of preschoolers. In an indulgent feeding style, food responsiveness was associated with higher child BMI z-scores (β = 0.50; P < 0.001). There was no interaction between enjoyment of food and feeding styles in relation to children's BMI z-scores (β = 0.17; P = 0.58).

CONCLUSIONS AND IMPLICATIONS

An indulgent feeding style can be a risk factor for unhealthy weight outcomes in food responsive preschoolers, but not in those who enjoy food. Educating indulgent parents in the feeding context, and prioritizing children with food-approaching behaviors who are sensitive to external food cues may be effective for approaching childhood obesity.

Parent, child, and environmental predictors of vegetable consumption in Italian, Polish, and British preschoolers

This study compared the vegetable intake of preschool children from three European countries [Italy, Poland, and the United Kingdom (UK)] and explored the parent, child, and environmental factors that predicted intake in each country. A total of 408 parents of preschoolers (Italy: N = 61, Poland: N = 124, and UK: N = 225; child mean age = 32.2 months, SD = 9.47) completed an online survey comprising a set of standardised questionnaires. For all three countries, the questionnaires included measures of children's vegetable intake (VegFFQ), child eating behaviour (CEBQ-FF), parents' mealtime goals (FMGs), and sociodemographic questions about family background and environment. In the UK and Italy, additional questionnaires were used to assess child temperament (EAS-T) and parents' feeding practices (CFPQ). The results showed that the number of child-sized portions of vegetables consumed per day varied significantly across countries; Polish children consumed the most (∼3 portions) and Italian children the least (∼1.5 portions). Between-country differences were seen in parents' goals for family mealtimes; compared to Italian parents, Polish and UK parents were more motivated to minimise mealtime stress, increase family involvement in meal preparation, and share the same foods with family members. British and Italian parents also adopted different feeding practices; parents in the UK reported more use of healthy modelling behaviours and more use of foods to support their child's emotion regulation. In terms of child factors, Italian children were reported to be more emotional and more sociable than British children. Analyses of the relationships between the parent, child, and environmental factors and children's vegetable intake revealed both similarities and differences between countries. Negative predictors of vegetable intake included child food fussiness in the UK and Poland, child temperament (especially, shyness) in Italy, and the use of food as a reward and child emotionality in the UK. Positive predictors included the parental mealtime goal of 'family involvement' in the UK. These results highlight differences in the extent to which European preschoolers achieve recommended levels of vegetable intake, and in the factors that influence whether they do. The results suggest a need to develop healthy eating interventions that are adopted to meet the specific needs of the countries in which they are implemented.

Relationship Between Food Security Status in a Caregiver's Family of Origin and Current Feeding Practices Among Low-Income, Single, Female Primary Caregivers

A child's familial environment is paramount to the formation and maintenance of their health behaviors. Factors that influence a child's health behaviors include parental modeling, types of available food, timing of food availability, and characteristics of the home environment. Previous research has demonstrated an association between a caregiver's current food security status and feeding practices, but no studies have explored the association between food security in the caregiver's childhood and their current feeding practices. This study investigates the relationship between parental food insecurity (both current and childhood) and child feeding practices. The US Household Food Security Survey and the Child Feeding Questionnaire were completed by 103 low-income, single, female primary caregivers. Results indicated that caregivers who reported current food insecurity expressed greater tendency to pressure their children to eat. Caregivers who reported food insecurity during their childhood also expressed greater tendency to pressure their children to eat and a greater concern about their child's weight. These findings can serve in both research and clinical efforts as an early screening tool to indicate families most in need of accessible resources. Findings also help to highlight the transgenerational nature of food insecurity, including its residual effects on health behaviors.

Is emotional eating associated with behavioral traits and Mediterranean diet in children? A cross-sectional study

Background

Stress and negative emotions may impact on appetite, inducing some individuals to eat less and others to eat more. This behavior has been implicated in the onset of bodyweight problems and eating disorders in childhood. The aim of our study is to evaluate factors potentially associated with emotional eating in children.

Methods

The present cross-sectional study derives from a survey conducted in 2021 on 8–9 years old children attending 11 primary schools. A questionnaire was administered that contained multiple-choice items relating to the children and their mothers, and touching on all the factors thought to be associated with emotional eating as behavioral traits or adherence to Mediterranean diet. A multivariable logistic regression was performed to test the association.

Results

Emotional undereating was positively associated with emotional symptoms (OR 1.72; 95% CI 1.11–2.67); emotional overeating was positively associated with both emotional symptoms (OR 2.01; 95% CI 1.29–3.13) and hyperactivity (OR 2.80; 95% CI 1.59–4.92), and inversely associated with peer problems (OR 0.50; 95% CI 0.25–0.99). Emotional undereating was also positively associated with the number of siblings (OR 1.50; 95% CI 1.03–2.18), and inversely associated with a good adherence to the Mediterranean diet (OR 0.25; 95% CI 0.08–0.84).

Conclusions

The study found children’s emotional eating associated with both dietary patterns and behavioral traits (in particular emotional symptoms, hyperactivity and peer problems). It could be useful to improve parents’ awareness so that they can anticipate and pay more attention to this issue. Adherence to the Mediterranean diet should also be reinforced, by means of health promotion interventions at school, for example.

Family Feeding Practices of Parents on Prince Edward Island: A Focus on Responsive Feeding

The home environment and parental influence are strong predictors of eating behaviours in young children and can influence healthy development. The objective of this study was to describe the feeding practices of a sample of families on Prince Edward Island. Eleven parent participants were recruited, one-on-one interviews were held, and a thematic analysis was conducted. Conversations with parents revealed that the family feeding environment is influenced by a multitude of factors that change daily and need to be navigated based on the age of the child. Parents saw family meals as time together and an opportunity to model healthy eating behaviours; however, they faced several challenges at mealtimes, including perceived picky eating. Parents recognized their children's hunger and satiety cues, although they respected satiety signals more often if children ate what they perceived as a lot of food. Many parents used food as a reward to encourage their children to eat more but recognized that it could lead to the development of undesirable habits. Despite the complex factors that influence feeding, dietitians can work with families to foster a responsive feeding environment by encouraging family meals, recognizing and respecting hunger and satiety cues, and understanding typical changes in eating behaviours as children age.

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.

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

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

A synthesis of early antecedents of eating behavior and weight status in girls: The legacy of girls' NEEDS project

Dr. Leann Birch, an innovator in the field of children's eating behavior, was the first scientist to synergize the fields of developmental psychology and nutrition science. One of Leann's groundbreaking projects was the Girls' NEEDS Project (GNP), an NIH-funded observational study of the longitudinal development of eating and weight-related behaviors of girls across middle childhood and adolescence. At the time of GNP, obesity prevalence during childhood had roughly doubled during the previous two decades, research interest in dieting had increased as societal expectations of the 'thin ideal' got even thinner, and little was known about how environmental factors such as parenting influenced the development of maladaptive eating and weight-related behaviors. GNP resulted in over 70 publications, covering a range of topics from girls' dietary intake and physical activity to parental influences on girls' eating behavior, thus laying the groundwork for many topics in the obesity, food parenting, and dieting literature today. Therefore, this narrative review aims to summarize and synthesize the literature that resulted from the GNP and provide implications for future work building from this foundation.

Maternal Feeding Styles and Child Appetitive Traits: Direction of Effects in Hispanic Families With Low Incomes

Feeding styles of parents have been associated with dietary quality/intake and weight outcomes; however, much of the research to date has been cross sectional and the direction of influence unclear. This prospective longitudinal study evaluated the direction of effects between feeding styles and child appetitive traits over time in a sample of 129 Hispanic parent/child dyads that participated in a larger study. Data analyzed for the current study were collected when the children were 4–5 years old and again at ages 7–9 years. Parents (all mothers) reported on their feeding styles and children's appetitive traits using well-established questionnaires. Cross-lagged panel analyses were used to examine the direction of effects. Fully adjusted models revealed that a number of children's appetitive traits at baseline predicted later feeding styles. A bi-directional relationship was found between authoritarian feeding and satiety responsiveness such that higher satiety responsiveness was associated with authoritarian feeding and vice versa. Lower satiety responsiveness was associated with indulgent feeding, whereas higher food responsiveness was associated with authoritarian feeding. Results show preliminary evidence that children's appetitive traits may shape mothers' approach to child feeding. There is also preliminary support for the protective role of an authoritarian feeding style in the self-regulatory processes around child appetitive traits among this population of Hispanic families with low-income levels. These results warrant continued research given that other studies have shown beneficial outcomes for authoritarian feeding among ethnically diverse families with low incomes.

Context Matters: Preliminary Evidence That the Association between Positive Affect and Adiposity in Infancy Varies in Social vs. Non-Social Situations

Previous studies have suggested that infants high in negative affect have higher levels of adiposity, arising in part via changes in nutrition (e.g., “feeding to soothe”). Few studies have examined whether positive affect shows similar or inverse associations with adiposity. The current study examined cross-sectional and longitudinal relationships between adiposity and observations of positive affect in both a social and a non-social context, using data from infants at four (n = 125) and 12 (n = 80) months of age. Our analyses did not find any cross-sectional associations between positive affect and adiposity (all p > 0.05). However, in the longitudinal analyses, positive affect in a non-social context, when observed at four months of age, was positively associated with weight-for-length at 12 months of age (zWFL; ß = 1.49, SE = 0.67, p = 0.03), while positive affect observed at four months of age in a social context was inversely associated with body fat percentage at 12 months of age (ß = −11.41, SE = 5.44, p = 0.04). These findings provide preliminary evidence that the p positive affect is related to adiposity in infancy and suggest that the direction of association (i.e., direct or inverse) may be specific to the context in which positive affect is measured. Future research should examine the role of nutritional status in any relationships between adiposity and emotion at this early stage.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Food Parenting Practices and Feeding Styles and Their Relations with Weight Status in Children in Latin America and the Caribbean

While a growing body of literature looks at the associations between food parenting practices, and feeding styles, and child’s weight status in developed countries, little is known for less developed countries, in general, and the Latin America and the Caribbean (LAC) region, in particular. This study systemically reviews and synthesizes existing evidence on the associations between child caregivers’ food parenting practices and feeding styles and 2 to 12-year-old child weight status. Keywords were used to search in PubMed, Web of Science, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature. Among the ten eligible articles, all of them reported significant associations between food parenting practices and feeding styles and child weight status. Existing studies have limitations, mainly related to cross-sectional convenience samples, which limit the generalization of the results. Additionally, small sample, heterogeneous feeding measures and weight related outcomes were other limitations. Future research is needed to understand caregiver–child interactions in the food situation and its link to child weight status in 2 to 12-year-old children in areas of LAC with diverse forms of malnutrition and contextual factors of countries.

A comparison between parent and grandparent dietary provision, feeding styles and feeding practices when caring for preschool-aged children

Grandparents are frequently called upon to provide childcare to young children. Consequently, grandparents may influence the development of children's eating habits and preferences and may require support with their approach to feeding young children. However, research into grandparental feeding behaviours is scarce. Understanding how grandparental feeding behaviours compare to parental feeding behaviours will further help to establish whether grandparents require specific interventions unique to the grandparental role or if current strategies that target parental feeding behaviour are also appropriate for grandparents. The aim of the present study was to explore the similarities and differences between parent and grandparent dietary provision, feeding practices and feeding styles to preschool-aged children. 72 parents and 44 unrelated grandparents of children aged 2-4 years old took part in an online study and completed an online 24-h dietary recall using myfood24® to assess dietary provision. Parents and grandparents were providing meals high in saturated fat and sodium and providing below recommended amounts of fruit and vegetables. Overall, feeding practices were similar between parents and grandparents. Although, grandparents scored lower on using food as a reward (p < 0.05) and creating a healthy food environment (p < 0.05) compared to parents. Whereas, parents scored higher for promoting balance and variety (p < 0.05). A range of feeding styles were found within each caregiver type, with no significant associations found between caregiver type and feeding style (p > 0.05). Strategies to promote healthy eating in young children should be expanded to also target grandparents who act as informal caregivers to preschool-aged children. However, since very few differences in feeding behaviour were reported the content of such strategies may not need to be adapted specifically for grandparents.

Infant temperament is associated with maternal feeding behaviors in early infancy

Parental feeding practices shape infant eating behaviors and may impact obesity risk. For example, feeding on a schedule and using food to soothe have been associated with greater infant weight gain and future obesity risk. Most studies focus on parental determinants of feeding practices, but infant temperament might influence feeding practices parents select. Studies examining associations of infant temperament with parental feeding practices in early infancy are needed. Thus, the purpose of this cross-sectional, observational study was to test the hypothesis that infant temperament would be associated with use of food to soothe and feeding on a schedule. Mother-infant dyads (N = 98) from 3 parent birth cohort studies presented for clinic visits at infant age of 3-5 months. Mothers completed a demographic questionnaire. Feeding practices (use of food to soothe and feeding on a schedule) and maternal perceptions of 3 dimensions of infant temperament (surgency, orienting/regulating, and negative affect) were collected by survey. Spearman partial correlations were used to examine if any of the 3 infant temperament dimensions were associated with use of food to soothe or feeding on a schedule, adjusting for maternal marital status, race/ethnicity, BMI, infant age at the visit, and infant weight-for-length z-score. Greater perceived infant surgency/extraversion was associated with greater use of food to calm (Spearman partial r = 0.25, p < 0.05), but not feeding on a schedule (Spearman partial r = -0.11, p = 0.31). Greater perceived infant negative affect was associated with greater use of food to calm (Spearman partial r = 0.21, p < 0.05). Perceived infant orienting/regulating was not associated with either of the feeding practices examined. These results provide evidence that as early as 3-5 months of age, perceived infant temperament is associated with maternal feeding practices which influence infant growth outcomes.

Parent-Child influences on child eating self-regulation and weight in early childhood: A systematic review

Individual differences in child eating self-regulation are associated with excess weight gain and may be explained, in part, by the family feeding environment and a child's general propensity to self-regulate outside of the context of eating (i.e., general self-regulation). Several studies have examined the associations between food parenting behaviors, child eating and general self-regulation, and child weight separately. However, there are a paucity of data on whether and how these factors interact to confer risk for weight gain in early childhood. The current systematic review identified 32 longitudinal studies that examined unidirectional or bidirectional associations among one or more of the following paths: food parenting behaviors and child eating self-regulation (path 1); child eating self-regulation and child weight (path 2); child eating self-regulation and child general self-regulation (path 3); food parenting behaviors and child general self-regulation (path 4); and child general self-regulation and child weight (path 5). Results indicated relationships of food parenting behaviors to child eating self-regulation, child weight to child eating self-regulation, and child general self-regulation to child weight. However, there were scant longitudinal data that examined paths 3 and 4. Further research on the developmental correlates of child eating self-regulation is needed to identify parent and child targets for early childhood obesity prevention.

Vegetable parenting practices vary by feeding styles among middle class mothers of young children

The optimal approach to feeding preschool children balances expectation setting (demandingness) with responsivity to the child (responsiveness), and ideal feeding practices use environmental structuring and covert, non-directive control strategies while maintaining responsiveness. However, research has not examined the extent to which demandingness and responsiveness in feeding style is concordant with structure, responsiveness and control (directive and non-directive) in feeding practices. We classified the feeding style of 122 parents of preschoolers as authoritative (high demandingness/high responsiveness), authoritarian (high demandingness/low responsiveness), indulgent (low demandingness/high responsiveness), or uninvolved (low demandingness/low responsiveness). Parents reported on their frequency of use of 31 vegetable parenting practices (VPPs), that were classified into the domains of structure, control and responsiveness, and subcategorized as effective (likely to obtain the desired change without increasing child obesity risk) or ineffective (unlikely or increases risk) by expert consensus. We hypothesized that parents with an authoritative feeding style would have the highest effective structure, responsiveness and control VPPs, and the authoritarian style would differ with less responsiveness VPPs. We also hypothesized that the indulgent feeding style would have low levels of structure and control VPPs and high ineffective responsiveness VPPs. As expected, we found that parents with an authoritative feeding style reported using more effective structure and responsiveness VPPs. Surprisingly, parents with an authoritarian feeding style did not have VPPs which differed from those with an authoritative feeding style, and parents with an indulgent feeding style had surprisingly high effective control VPPs. Further research into the similarities and differences between parents' overall approach to feeding and their use of feeding practices related to specific foods is warranted, which may help inform the design of more effective interventions aimed at improving child dietary quality.

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.

Infant and preschooler feeding behaviors in Chinese families: A systematic review

A systematic review was conducted on the literature on feeding behaviors in Chinese families of children under 6 years old. Forty relevant publications were identified, of which 33 were published in Chinese, 7 in English. All studies were questionnaire-based and used a cross-sectional research design. Approximately half of the studies reported a score for each feeding practice/style, based on a Likert scale; the other half dichotomized these scores into a percentage of the population that reported frequent use of the behaviors. The most commonly reported feeding style of Chinese caregivers was a locally defined "active response" style that somewhat resembled authoritative parenting. The most commonly reported feeding practices were praise, encouraging trying new foods, encouragement of balanced diet and encouragement of healthy eating. Some behaviors showed a great deal of variance in prevalence between studies, which may be at least partially due to differences in methodology and how behaviors were defined. Some feeding behaviors varied in frequency depending on the child's age, although longitudinal studies are needed to better understand how these evolve over time. Child body composition was also associated with feeding behaviors use, although the direction of the association cannot be determined due to the cross-sectional nature of the research. There is still an important gap in the literature regarding the feeding behaviors of non-maternal caregivers, as grandparents often play an important role in childcare in China.

Twelve-Month Efficacy of an Obesity Prevention Program Targeting Hispanic Families With Preschoolers From Low-Income Backgrounds

OBJECTIVE

Assess effects of an obesity prevention program promoting eating self-regulation and healthy preferences in Hispanic preschool children.

DESIGN

Randomized controlled trial with pretest, posttest, 6- and 12-month assessments. Fourteen waves, each lasting 7 weeks.

SETTING

Families recruited from Head Start across 2 sites.

PARTICIPANTS

Two hundred fifty-five families randomized into prevention (n = 136) or control (n = 119).

INTERVENTION

Prevention received curriculum; control received no curriculum.

MAIN OUTCOME MEASURE(S)

Feeding knowledge/practices/styles (parent); body mass index percentile, eating self-regulation, trying new foods, and fruit/vegetable consumption (child).

ANALYSIS

Multilevel analyses for nested data (time points within families; families within waves) and multinomial regression.

RESULTS

Program increased mothers' repeated presentation of new foods (P < 0.05), measured portion sizes (P < 0.05), child involvement in food preparation (P < 0.001), feeding responsiveness (P < 0.001), knowledge of best feeding practices (P < 0.001), and feeding efficacy (P < 0.05); reduced feeding misconceptions (P < 0.01) and uninvolved feeding (P < 0.01). Effects on child eating behavior were minimal. At 12 months, children in the prevention group were less likely to have overweight (P < 0.05) or obesity (P < 0.05).

CONCLUSIONS AND IMPLICATIONS

Program effects emphasize the importance of feeding approaches in reducing childhood obesity.

Measurement challenges for childhood obesity research within and between Latin America and the United States

Childhood obesity is a major public health challenge across Latin America and the United States. Addressing childhood obesity depends on valid, reliable, and culturally sensitive measurements. Such progress within and between countries of the Americas could be enhanced through better measurement across different age groups, different countries, and in sending and receiving communities. Additionally, better and more comparable measurements could accelerate cross-border collaboration and learning. Here, we present (1) frameworks that influenced our perspectives on childhood obesity and measurement needs across the Americas; (2) a summary of resources and guidance available concerning measurement and adaptation of measures for childhood obesity research; and (3) three major areas that present challenges and opportunities for measurement advances related to childhood obesity, including parental behavior, acculturation, and the potential to incorporate ethnographic methods to identify critical factors related to economics and globalization. Progress to reduce childhood obesity across the Americas could be accelerated by further transnational collaboration aimed at improving measurement for better surveillance, intervention development and evaluation, implementation research, and evaluation of natural experiments. Additionally, there is a need to improve training related to measurement and for improving access to valid and reliable measures in Spanish and other languages common in the Americas.

Grandparental dietary provision, feeding practices and feeding styles when caring for preschool-aged grandchildren: A systematic mixed methods review

Grandparents are frequently relied upon to care for their preschool-aged grandchildren. These early years are a crucial age in the development of dietary habits and preferences. This review aims to determine grandparental dietary provision, feeding practices and feeding styles when caring for their preschool-aged grandchildren. Medline, PsycInfo and Web of Science were searched in January 2020. A systematic mixed methods approach was used to synthesize the qualitative (n = 13) and quantitative (n = 7) articles describing grandparents' feeding styles (n = 9), feeding practices (n = 14) and dietary provision (n = 18). Grandparents are serving large portion sizes and encouraging their grandchildren to eat frequently. Results are mixed for the types of foods provided; grandparents provide discretionary foods high in sugar and fat, and some also choose more expensive core foods as treats (e.g., berries). Grandparents engage in feeding practices that promote healthy eating (e.g., creating a healthy feeding environment) and promote autonomy and independence (e.g., considering their grandchild's preferences). However, they also use some coercive feeding practices (e.g., using food as a reward) and may be using indulgent feeding styles, which can be conducive to obesogenic dietary intakes. Interventions targeting grandparents could be an effective way to improve dietary-related health outcomes in young children.

Maternal feeding style and child weight status among Hispanic families with low-income levels: a longitudinal study of the direction of effects

BACKGROUND

The home environment is a central and modifiable influence on the development of childhood obesity. Evidence supports the central role of parents in shaping problematic child eating behaviors and excess weight. Most studies of feeding emphasize parent-driven influences without taking into account the child's role in eating interactions. Few studies have addressed the bi-directional nature of feeding dynamics in studies of young children.

METHODS

The goals of this study were: 1) to examine if parental feeding styles during preschool (4-5 years) predict child weight status at 7-9 years, and 2) to examine the direction of effects between parental feeding styles and child weight status over time. Participants were part of a larger longitudinal study of Hispanic Head Start families living in the West South Central United States. Data from mother/child dyads were collected at three time points: Time 1 (ages 4-5), Time 2 (ages 5 ½-6 ½), and at Time 3 (ages 7-9). Only data from the Times 1 and 3 were used in the current analyses. A total of 128 mothers and their children had data on all variables needed for the analyses. Assessments included parent-reported feeding styles, feeding practices, acculturation, child eating behaviors, and child height and weight. Hierarchical regression was used to examine the first aim; a cross-lagged panel analysis examined the second aim.

RESULTS

An indulgent parental feeding style at ages 4-5 was associated with increased child BMI z-score at ages 7-9. Indulgent feeding significantly contributed to child BMI z-score beyond demographics, baseline child BMI z-score, parental acculturation, and child eating behaviors. Regarding the direction of effects in parental feeding interactions, the cross-lagged analyses showed that both indulgent feeding style and authoritative feeding style at Time 1 positively predicted child BMI z-scores at Time 3. Child effects were significant as well. Child BMI z-score at Time 1 positively predicted indulgent feeding and negatively predicted authoritarian feeding at Time 3.

CONCLUSIONS

Indulgent feeding should be addressed in future family-focused childhood obesity initiatives focused on young children and their parents.

Using the Very Short Form of the Children's Behavior Questionnaire for Spanish-Speaking Populations in Low- and Middle-Income Countries: A Psychometric Analysis of Dichotomized Variables

While the psychometric properties of the Spanish version of the Very Short Form of the Children’s Behavior Questionnaire (CBQ-VSF) have been assessed in the US and Europe in samples composed of middle- and high-income parents with high levels of education, no studies have tested the instrument in low-income Spanish-speaking populations living in low- and middle-income countries. To fill this gap, our cross-sectional study assessed the psychometric properties of the Spanish version of the CBQ-VSF version in a sample of 315 low-income and low-educated parents with preschool children living in the Caribbean Region of Colombia. While our findings revealed problems that were similar to those identified in previous assessments of the CBQ-VSF Spanish version, they also showed unique problems related to the sociodemographic characteristics of our sample, containing many individuals with a low income and low educational level. Most of the participants gave extreme responses, resulting in a notable kurtosis and skewness of the data. This article describes how we addressed these problems by dichotomizing the variables into binary categories. Additionally, it demonstrates that merely translating the CBQ-VSF is insufficient to be able to capture many of the underlying latent constructs associated with low-income and low-educated Latino/Hispanic populations.

Parent Feeding Practices in the Context of Food Insecurity

The process of feeding is complex and highly dependent on parent, child, social, and environmental factors. Given the rising rates of food insecurity and concomitant poor nutrition and health, the purpose of this article was to outline the important and complex ways in which the context of food insecurity can impact parent feeding practices. Key factors discussed here include the impact of food insecurity on: expectations for motherhood, structural constraints, stress and depression, parents’ perceptions of health and child weight, and intergenerational transmission of parent feeding practices. Future research needs are also identified and discussed.

General Parenting and Hispanic Mothers' Feeding Practices and Styles

Previous research has shown that general parenting styles, general parenting dimensions, maternal feeding styles, and maternal feeding practices all show specific relationships with the weight status of young children. This study examined the relationships between general parenting and maternal feeding styles/practices in a sample of 187 Hispanic mothers with low incomes. As part of a larger study, mothers of preschool children were recruited through Head Start programs and completed validated questionnaires assessing their general parenting, feeding styles, and feeding practices. Results identified numerous associations between general parenting dimensions and specific feeding practices: i.e., maternal nurturance was positively associated with healthy eating guidance and feeding responsiveness; inconsistency was positively associated with restriction for weight and promotion of overconsumption; follow through on discipline was positively associated with monitoring, healthy eating guidance, and feeding responsiveness; and family organization was positively associated with monitoring and healthy eating guidance. General parenting styles were associated with feeding practices as well, with authoritative mothers showing the highest levels of healthy eating guidance and authoritarian mothers showing the lowest levels of monitoring. There were no significant associations between mothers' general parenting styles and mothers' feeding styles. Implications of these findings for the prevention of childhood obesity are considered.

Observations of Maternal Feeding Practices and Styles and Young Children's Obesity Risk: A Longitudinal Study of Hispanic Mothers with Low Incomes

Background: Maternal feeding practices and styles are well-established correlates of children's BMI z-scores in the preschool years. Most studies, however, are cross-sectional, using maternal self-reports to examine feeding. This study examined, over a 3½-year period, the relationship between observed and self-reported feeding practices/styles and children's BMI z-scores in a sample of Hispanic mothers with low incomes and their preschool children. Methods: One hundred eighty-seven mothers were observed feeding their 4- to 5-year old during a buffet meal in a laboratory setting and completed self-report measures on their feeding practices and styles. Children's BMI z-scores were assessed at this visit and 3½ years later. Results: Consistent with previous research, observed and self-reported pressure to eat and/or authoritarian feeding were negatively associated with children's BMI z-scores at the first time point; observed discouraging eating was positively associated. However, children's BMI z-scores 3½ years later, controlling for Time 1 BMI z-scores, were positively associated with observed pressure to eat. Observed maternal reasoning and self-reported monitoring of children's eating behavior at Time 1 were negatively associated with later BMI z-scores. Only self-reported feeding styles predicted later children's BMI z-scores, with indulgent and authoritative styles positively associated with children's BMI z-scores at the third time point. Conclusions: These findings demonstrate that mothers who ignore their children's fullness cues and pressure them to eat have children who are at greater risk for the development of later obesity. Implications for the development of family-focused childhood obesity prevention programs are discussed.

Development of the Impact of a Preschool Obesity Prevention Intervention Enhanced With Positive Behavioral Supports for Mississippi Head Start Centers

OBJECTIVE

To describe the methodology of the Impact of a Preschool Obesity Prevention intervention enhanced with positive behavioral supports.

DESIGN

The social ecological model serves as the conceptual framework for this study, which has a within- and between-subjects design with an intervention group and a delayed intervention control group. This 3-year project will use formative methods to pretest materials in Year 1, collect data pre- and postintervention with a follow-up at 4 months in Years 2 and 3, and conduct summative and process evaluation in Year 3.

SETTING

Head Start centers in Southern and East-Central Mississippi counties.

PARTICIPANTS

Three hundred parents with 3-year-old children enrolled in 9 Head Start centers (53 classrooms) and 75 Head Start teachers.

INTERVENTIONS

During Year 2, Hip Hop to Health Jr., Parent-Child Interaction Therapy, and Positive Behavior Interventions and Supports will be implemented.

MAIN OUTCOME MEASURES

Primary outcomes include changes in parenting and teacher practices. Secondary outcomes include parent feeding styles as well as weight status and dietary intake. Variables will be measured using anthropometrics and validated surveys.

ANALYSIS

The primary analysis will be a multilevel 2 × 3 mixed ANOVA.

Permissive parenting of the dog associates with dog overweight in a survey among 2,303 Dutch dog owners

Overweight/obese dogs are at increased risk of health issues and it is up to the dog owner to uphold successful weight management. In children, overweight relates to their parent’s permissive style of parenting. We predicted that permissive dog-directed parenting likewise associates with a dog being overweight (including obesity). If styles in parenting dogs indeed associate with a dog’s overweight, these may provide action points for effective weight management. For 2,303 Dutch dog owners, answers on their dog’s (nine-point scale) body condition scores were compared to ways of parenting the dog. We used an adapted version of the 32-item Parenting Styles and Dimensions Questionnaire and compared the distributions of dog counts across aggregated body condition score categories of underweight (scores one to three), healthy-weight (scores four and five) and overweight/obese (scores six to nine) with Chi-square tests across the quartiles of a given parenting style. Overweight/obese dogs were overrepresented in the quartile of dog owners with the highest level of permissive parenting, which is in line with findings on parenting styles and overweight/obesity in children. Supplementary logistic regression analyses on the likelihood of dogs being overweight/obese (i.e. having a body condition score of six or higher) confirmed the importance of parenting and identified the risk factors of dogs having little exercise, being of older age, neutered or owned by someone with lower level education. Our results indicate that strategies to promote proper weight management in dogs could benefit from addressing especially a dog owner’s permissiveness in parenting his/her dog.

Examining Determinants and Co-associations Between Fruit and Vegetable and Sugar-Sweetened Beverage Monitoring Practices Among a Sample of Low-Income Hispanic Mothers

The etiology of obesity is complex, and a growing body of research suggests that changing two or more behaviors at the same time will likely have a stronger impact than changing one behavior in isolation. A lack of fruit and vegetable (FV) intake and high sugar-sweetened beverage (SSB) consumption are two behaviors related to childhood obesity in the Hispanic community. The purpose of this study was to evaluate theory-based determinants of monitoring practices of FV and SSB among Hispanic mothers with young children using the reasoned action approach. The study also examined the co-associations among the theoretical antecedents for both behaviors. Surveys were distributed in several community settings to urban Hispanic mothers (n = 238) of 2-5-year-old children. Surveys assessed FV and SSB monitoring practices, attitudes, perceived norms, perceived behavioral control (PBC), and intentions. Two models were evaluated using structural equation modeling: attitudes, perceived norms, and PBC of both behaviors were associated with intentions for both behaviors, and PBC and intentions were associated with monitoring practices of FV and SSB. Both models had adequate fit (FV (CFI = 0.973; GFI = 0.980; RMSEA = 0.121); SSB (CFI = 0.994; GFI = 0.993; RMSEA = 0.066)). PBC for both FV and SSB monitoring was significantly associated with SSB monitoring, whereas FV intentions was only significantly associated with FV monitoring. Results from this study gives evidence that among Hispanic mothers, FV and SSB monitoring behaviors are interrelated. To promote SSB monitoring, more implementation strategies (i.e., skills-based interventions) are warranted, whereas to promote FV monitoring, motivational strategies are warranted.

Caregiver Influences on Eating Behaviors in Young Children: A Scientific Statement From the American Heart Association

A substantial body of research suggests that efforts to prevent pediatric obesity may benefit from targeting not just what a child eats, but how they eat. Specifically, child obesity prevention should include a component that addresses reasons why children have differing abilities to start and stop eating in response to internal cues of hunger and satiety, a construct known as eating self‐regulation. This review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self‐regulation during early childhood. First, we discuss the evidence supporting an association between caregiver feeding and child eating self‐regulation. Second, we discuss what implications the current evidence has for actions caregivers may be able to take to support children's eating self‐regulation. Finally, we consider the broader social, economic, and cultural context around the feeding environment relationship and how this intersects with the implementation of any actions. As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children. It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community‐based care providers.

Short-Term Effects of an Obesity Prevention Program Among Low-Income Hispanic Families With Preschoolers

OBJECTIVE

To assess the short-term effects of an obesity prevention program promoting eating self-regulation and healthy food preferences in low-income Hispanic children.

DESIGN

Randomized controlled trial with pretest, posttest, and 6- and 12-month assessments.

SETTING AND PARTICIPANTS

Head Start and similar early learning institutions in Houston, TX, and Pasco, WA. A total of 255 families with preschoolers randomized into prevention (n = 136) and control (n = 119) groups.

INTERVENTION

Multicomponent family-based prevention program. Fourteen waves lasted 7 weeks each with 8-10 mother-child dyads in each group.

MAIN OUTCOME MEASURES

Parent assessments included feeding practices, styles, and knowledge. Child assessments included child eating self-regulation, willingness to try new foods, and parent report of child fruit and vegetable preferences. Parent and child heights and weights were measured.

ANALYSIS

Multilevel analyses were employed to consider the nested nature of the data: time points within families within waves.

RESULTS

The program had predicted effects on parental feeding practices, styles, and knowledge in the pre- to post-comparisons. Effects on child eating behavior were minimal; only the number of different vegetables tried showed significant pre-post differences.

CONCLUSIONS AND IMPLICATIONS

Short-term effects of this prevention program highlight the importance of family-focused feeding approaches to combating child overweight and obesity.

Pairing Feeding Content With a Nutrition Education Curriculum: A Comparison of Online and In-Class Delivery

OBJECTIVE

To develop a childhood obesity prevention program, Food, Feeding and Your Family (FFYF), which encourages eating self-regulation in young children. This article describes the research methods for FFYF. Activities that will be used to guide the development of the program are illustrated in a logic model.

DESIGN

A randomized control trial will be conducted with participant groups randomized into 1 of 3 conditions: (1) in-class delivery of feeding content and nutrition education, (2) online delivery of feeding content and in-class delivery of nutrition education, and (3) nutrition education only. Assessments will be collected at baseline, program completion, and 6 and 12 months after completion of the program.

SETTING

Study will be conducted through the Expanded Food and Nutrition Education Program in Colorado and Washington State.

PARTICIPANTS

Parents with 2- to 8-year-old children will be recruited from affiliated community agencies, 540 participants across both states.

INTERVENTIONS

FFYF derives content from an empirically validated parental feeding program, Strategies for Effective Eating Development, and will be administered with Eating Smart • Being Active, an evidence-based, nutrition education curriculum.

MAIN OUTCOME MEASURES

Parents will report on feeding practices, child eating behaviors, feeding styles, and acculturation.

ANALYSIS

Because of the nested nature of the data, multilevel analyses will be used: time points, within parents, and within groups.

Mental health symptoms are related to mothers' use of controlling and responsive child feeding practices: A replication and extension study

Parents have an important role in feeding their children. Parents' child feeding practices can be influenced by numerous factors. The presence of mental health symptoms can be associated with more controlling, less sensitive parent-child feeding interactions. However, it is not known whether mental health symptoms are related to parents' use of responsive, more autonomy supportive feeding practices which are important for promoting children's healthy eating habits. This study therefore aimed to examine the relationships between mental health symptoms and the use of controlling and responsive child feeding practices. A community sample of 415 UK mothers with a child age 2-4 years took part. They completed self-report measures of their levels of anxiety, depression and disordered eating behaviours as well as a comprehensive measure of their child feeding practices. The presence of mental health symptoms was significantly associated with greater self-reported use of controlling feeding practices, such as more restriction for weight control and using food as a reward. Maternal symptoms of anxiety and depression were related to lower use of modelling and monitoring but to giving children more control around food. Mothers' restrained and external eating behaviours were associated with greater use of several responsive feeding practices, including encouraging balance and variety, involvement, and teaching about nutrition. Together, these findings highlight the broad impact that mental health symptoms can have on mothers' controlling and responsive child feeding interactions. Interventions to support families to promote healthy child eating habits need to be aware of the role of even fairly mild, non-clinical levels of mental health symptoms on maternal sensitivity and involvement in feeding their children.

Consistency Between Parent-Reported Feeding Practices and Behavioral Observation During Toddler Meals

OBJECTIVE

To assess whether feeding questionnaire responses reflect observed mealtime behavior.

DESIGN

Cross-sectional associations between self-reported and observed behaviors.

SETTING

Participants' homes.

PARTICIPANTS

Parents (n = 75) of toddlers (mean age = 24.7 months) in the US.

MAIN OUTCOME MEASURES

Feeding behavior questionnaires and coded videos of children's dinner meals.

ANALYSIS

Parents' questionnaire responses of "never" (or "rarely") considered consistent with video observation if behavior was not observed; responses of "always" (or "most of the time") if behavior observed at least once. Proportion (%) of participants observed performing each behavior was calculated for the groups of parents reporting that they "never," "sometimes," or "always" used that feeding practice. These were compared across the 3 response groups.

RESULTS

Parents reported 6 behaviors consistently (≥70% agreement): allowing child to eat as much as wanted, helping child eat, prompting child to eat, television/screens on during meal, nonfood rewards, and hurrying child. The remaining 8 behaviors fell below the threshold. For many behaviors, all response groups (never, sometimes, always) had similar rates of participants demonstrating the behavior. Only 5 behaviors had observed rates falling in the expected direction (frequency of always > sometimes > never). For some behaviors, the "sometimes" group had a higher (eg, clean plate) or lower (praise) frequency than the other 2 groups.

CONCLUSIONS AND IMPLICATIONS

Self-reported questionnaire responses predicted whether some, but not all, behaviors were observed. Parents' use of "sometimes" remains difficult to interpret as parents may use "sometimes" inconsistently across behaviors and perhaps to mitigate socially undesirable responses. Self-reports of "sometimes" performing a behavior may have limited utility for prediction of behavior and likely requires additional exploration with the respondent.