Maternal feeding practices and fussy eating in toddlerhood: a discordant twin analysis

Understanding bidirectional and transactional processes of child eating behaviours and parental feeding practices explaining poor health outcomes across infancy and early childhood in Australia: protocol for the Longitudinal Assessment of Children's Eating (LACE) study

INTRODUCTION

Child eating behaviours develop through interactions between the child's characteristics, psychological factors and the child's social environment and this affects the child's diet and weight. To examine the currently existing birth cohort studies examining child eating behaviours, a review was conducted. There are currently no birth cohorts that concurrently examine child eating behaviours, dietary intake, growth and parental feeding practices from birth into early childhood. Therefore, the primary objective of the Longitudinal Assessment of Children's Eating (LACE) study is to examine the bidirectional and transactional processes of child eating behaviours and parental feeding practices explaining poor dietary intake and excess weight across infancy and early childhood.

METHODS AND ANALYSIS

The LACE study will be a prospective, longitudinal parent-reported study following infants from younger than 4 months of age across nine waves of data collection: younger than 4 months, 4 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years and 5 years. Participants will be included if they are parents of infants younger than 4 months, 18 years or older, fluent in English and living in Australia at baseline. A sample size of 1210 is proposed. Participants will be recruited online via paid social media (Facebook and Instagram) advertisements. The study will examine child eating behaviours, body mass index Z-score, dietary intake, screen time, temperament, parent feeding practices and styles, and demographics. The data will be obtained using the online survey software Qualtrics. Data analyses will be conducted using Stata.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Deakin University Human Ethics Advisory Group, Faculty of Health (HEAG-H 120_2022). The findings from this study will be disseminated via presentations at scientific conferences and published manuscripts in peer-reviewed journals. Findings will be disseminated to the general public via mainstream media and to participants of the study with a summary of the findings.

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

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

Examining the whole plate: The role of the family context in the understanding of children's food refusal behaviors

INTRODUCTION

In the context of understanding children's food refusal behaviors, such as food fussiness and food neophobia, research has predominantly focused on the role of parental feeding strategies. However, little is known about which general family context variables add to the understanding of children's food refusal behaviors. The purpose of this study was to examine the relation between 1) parents' own use of maladaptive emotion regulation strategies when they are anxious, 2) parents' reactions towards their children's emotions in stressful situations, and 3) parenting styles on the one hand, and children's food refusal behaviors on the other.

METHODS

Mothers and fathers (N = 157) of young children (M = 4.64, SD = 1.7) completed a series of self- and parent-report questionnaires.

RESULTS

The model examining the role of parenting styles was found to be significantly related to food refusal behaviors in children. More specifically, the current findings demonstrate that higher levels of a coercive parenting style were associated with higher levels of both food fussiness and food neophobia in children. Furthermore, higher levels of a chaotic parenting styles were associated with higher levels of food neophobia in children. The models examining parents' maladjusted emotion regulation strategies when anxious and parents' reactions towards their children's emotions during stressful situations were not found to be significant.

CONCLUSIONS

Factors related to the parenting style appear to be important for understanding food refusal behaviors in children. Replication of the findings using longitudinal and observational designs is needed.

Food Parenting Practices and Child Eating Behaviors in Australian Families: A Cross-Sectional Sibling Design

BACKGROUND

Research on feeding in early childhood has focused primarily on parent-child dyadic interactions, despite parents enacting these practices within the complex dynamic of the family system.

OBJECTIVE

Using a sibling design, this study aimed to assess how parents may adapt their food parenting practices for siblings in response to differences in their eating behaviors.

DESIGN

A cross-sectional online survey was conducted between October and December 2022.

PARTICIPANTS/SETTING

Data were collected from parents (97.5% women) in Australia with 2 children aged 2 to 5 years (n = 336 parents and n = 672 children).

MAIN OUTCOME MEASURES

Survey items were completed for each sibling, and included four subscales of the Children's Eating Behaviour Questionnaire and seven subscales of the Feeding Practices and Structure Questionnaire-28.

STATISTICAL ANALYSES PERFORMED

Multiple linear regression models examined associations between within-sibling pair differences in child eating behaviors and food parenting practices, adjusting for differences in child body mass index z score, age, gender, and early feeding method.

RESULTS

Within-sibling pair differences in eating behaviors were associated with differences in some food parenting practices. For the fussier sibling, parents reported using more control-based practices, including persuasive feeding, reward for eating, and reward for behavior, and less of the structure-based practice, family meal settings (P values < 0.001). Similar directions of associations were found for persuasive feeding, reward for eating, and family meal settings with siblings who were slower eaters or more satiety responsive (P values < 0.007); however, no significant differences in reward for behavior were observed in relation to sibling differences in these eating behaviors. For the more food responsive sibling, parents reported using more control-based practices, including reward for behavior and overt restriction (P values < 0.002).

CONCLUSIONS

Within families, parents may adapt certain practices in response to differences in their children's eating behaviors. Interventions promoting responsive feeding should be designed to acknowledge the integral role of siblings in shaping parents' feeding decisions.

Sequential mediation of early temperament and eating behaviors in the pathways from feeding practices to childhood overweight and obesity

Introduction

Childhood eating behaviors and temperament may have important implication for constructing the pathways from maternal feeding practices to childhood overweight and obesity (OW/OB). Examining multiple feeding styles simultaneously to childhood OW/OB is critical through the mediators of early childhood temperament and eating behaviors.

Methods

This cross-sectional study recruited mothers mainly responsible for child care from two hospitals and two healthcare centers in eastern China. Sociodemographic characteristics, and data from the Infant Feeding Style Questionnaire (IFSQ), the short form of Children Behavior Questionnaire [Revised (IBQ-RSF)], and the Child Eating Behavior Questionnaire for toddler (CEBQ-T) were collected. Weight and recumbent length were measured to calculate the age- and sex-specific body mass index (BMI) z-scores (BMIz). The structural equation modeling (SEM) approach was used to examine direct and indirect pathways from five maternal feeding styles to childhood OW/OB through temperament and eating behaviors.

Results

A total of 486 children were recruited, 73 (15.02%) children were OW/OB; the age of the children was 14.55 (SD = 5.14) months, and the age of the mothers was 29.90 (SD = 3.63) years. The responsive feeding exerted significant direct (β = -0.098), indirect (β = -0.136) and total (β = -0.234) effects on childhood OW/OB. Restrictive feeding had significant direct (β = 0.222), indirect (β = 0.102) and total (β = 0.324) effects on childhood OW/OB. Indulgent feeding had significant direct (β = 0.220), indirect (β = 0.063), and total (β = 0.283) effects on childhood OW/OB. Pressuring feeding had significant direct (β = -0.116), indirect (β = -0.096) and total (β = -0.212) effects on childhood OW/OB.

Discussion

There was a direct effect of feeding practices on childhood OW/OB; feeding practices indirectly predicted childhood OW/OB through temperament and eating behaviors in children aged 6-23 months. This study could help governments agencies, policymakers, and healthcare workers to establish optimal intervention programs targeting feeding practices through childhood eating behaviors and temperament to prevent childhood OW/OB.

Mothers' descriptions of their feeding strategies in response to fussy eating with children of different levels of trait fussiness

Parent feeding practices influence a child's dietary intake. Many studies examining how parents react to children's fussy eating behaviours have been limited to questionnaire measures, which assess a limited number of feeding practices. There is a lack of research exploring the range of strategies parents use when their child is being fussy and/or refusing to eat. Therefore, the aims of this study are to describe the strategies used by mothers when their child is being fussy or refusing to eat, and to assess differences in the strategies depending on the child's trait fussiness levels. In 2018, 1504 mothers of children aged 2-5 years completed an online survey. Trait fussiness was assessed using the Children's Eating Behaviour Questionnaire. Mothers were also asked the open-ended question "What are the strategies you use when your child is being fussy or refusing to eat?". Inductive thematic analysis was conducted using NVivo. Themes were compared by child trait fussiness levels. Seven main themes were identified: child-led feeding/trust in child's appetite, spectrum of pressure, home or family strategies, different types of food offerings, communication, avoid certain strategies, and never or rarely fussy. Mothers of children with severe trait fussiness levels reported more pressuring or persuasive strategies. This study provides novel information regarding the diverse range of feeding practices parents use in response to children's fussy eating behaviours. Mothers used more feeding strategies typically associated with unhealthy dietary intake for children of high levels of trait fussiness. It is important that future interventions tailor the information to provide support to parents of children with high levels of trait fussiness regarding the use of feeding practices recommended to support healthy dietary intake.

Parental feeding practices as a response to child appetitive traits in toddlerhood and early childhood: a discordant twin analysis of the Gemini cohort

BACKGROUND

Parental feeding practices (PFPs) have been implicated in the development of children's eating behaviours. However, evidence suggests that feeding practices may also develop in response to their child's weight or emerging appetitive traits. We used the twin design to test the hypothesis that parents develop their feeding practices partly in response to their child's appetite.

METHODS

Data were from Gemini, a population-based cohort of 2402 British families with twins born in 2007. Psychometric measures of PFPs and appetite were completed by parents when their twins were 16-months and 5-years. Within-family analyses including all twins with available data in the sample (n = 1010-1858 pairs), examined if within-pair differences in PFPs were associated with differences in appetitive traits, controlling for differences in birth weight-SDS, early feeding method and child sex. In a subsample of twin pairs who were considerably discordant for appetitive traits by ≥ 1SD (n = 122-544 pairs), the direction and magnitude of within-pair differences in feeding practices was explored.

RESULTS

Within-family variation in parental feeding practices in toddlerhood and early childhood was low (discordance ranged from 0.1 to 6% of the sample), except for pressure to eat (toddlerhood: 19%; early childhood: 32%). Within-pair differences in all appetitive traits were associated with differential use of 'pressure to eat' at both 16-months and 5-years. In the subsample of twins most discordant for appetitive traits, parents used more pressure with the twin expressing lower food responsiveness, lower emotional overeating, lower food enjoyment, higher satiety responsiveness, slower speed of eating, higher emotional undereating and greater fussiness in toddlerhood and early childhood (p-values < 0.001). Effect sizes were small to large at 16-months (η2=0.02-0.09) and 5-years (η2=0.05-0.21).

CONCLUSION

Parents rarely varied their feeding practices between twins in toddlerhood and early childhood, except for pressure. Parents exerted greater pressure on their twin who expressed a poorer appetite compared to their co-twin, suggesting that parents develop a pressuring feeding style when their child expresses a poorer appetite or lower interest in, and enthusiasm for, eating. These findings could be used to guide interventions seeking to support parents in feeding their children in a way that nurtures the development of healthy eating behaviours.

'I'm having jelly because you've been bad!': A grounded theory study of mealtimes with siblings in Australian families

Obesity prevention interventions have been designed to promote responsive feeding in early childhood. However, existing interventions primarily target first-time mothers without considering the complexities of feeding multiple children within a family unit. By applying principles of Constructivist Grounded Theory (CGT), this study aimed to explore how mealtimes are enacted in families with more than one child. A mixed-methods study was conducted with parent-sibling triads (n = 18 families) in South East Queensland, Australia. Data included direct mealtime observations, semistructured interviews, field notes, and memos. Data were analysed using open and focused coding, during which constant comparative analysis was applied. The sample comprised of two-parent families with children ranging in age from 12 to 70 months (median sibling age difference = 24 months). A conceptual model was developed to map sibling-related processes integral to the enactment of mealtimes in families. Notably, this model captured feeding practices used by siblings, such as pressure to eat and overt restriction, that previously had only been described in parents. It also documented feeding practices used by parents that may occur only in the presence of a sibling, such as leveraging sibling competitiveness and rewarding a child to vicariously condition their sibling's behaviour. The conceptual model demonstrates complexities in feeding that give shape to the overall family food environment. Findings from this study can inform the design of early feeding interventions that support parents to remain responsive, particularly when their perceptions and expectations of siblings differ.

Prospective associations between parental feeding practices used in toddlerhood and preschool children's appetite vary according to appetite avidity in toddlerhood

Parental feeding practices are a key modifiable component of children's food environments. Evidence suggests that certain feeding practices may differentially influence children's eating behaviour or weight, depending on the child's temperament (e.g. emotionality). Building on this work, we tested the hypothesis that feeding practices during toddlerhood influence children's developing eating behaviours differently, depending on their appetite avidity (which is characterised by a larger appetite and greater interest in food). Data were from Gemini, a population-based cohort of British twin children born in 2007. Parental feeding practices were assessed at 15-months, and child appetite at 15-months and 5-years, using validated psychometric measures (n = 1858 children). Complex samples general linear models examined prospective associations between PFPs at 15-months and child appetitive traits at 5-years, adjusting for clustering of twins within families and for the corresponding child appetitive trait at 15-months, difference in age between timepoints, child sex, gestational age, and socioeconomic status. Moderation analyses revealed that pressuring a child to eat led to greater increases in emotional overeating from 15-months to 5-years, only for children with high (1 SD above the mean: B = 0.13; SE± = 0.03,p < 0.001) or moderate emotional overeating (mean: B = 0.07 ± 0.03,p < 0.001) in toddlerhood. Greater covert restriction predicted greater reductions in emotional overeating and food responsiveness from 15-months to 5-years, only for children with high emotional overeating (1 SD above the mean: B = -0.06 ± 0.03,p = 0.03) and low food responsiveness (1 SD below the mean: B = -0.06 ± 0.03,p = 0.04) in toddlerhood. These findings are consistent with the hypothesis that children with a more avid appetite in toddlerhood are differentially affected by parental feeding practices; caregivers of toddlers may therefore benefit from feeding advice that is tailored to their child's unique appetite.

Parental Feeding Practices and Children's Eating Behaviours: An Overview of Their Complex Relationship

Several studies have found an association between eating behaviours and weight status and obesity risk in childhood. Children's eating behaviours arise from a combination of genetic and environmental factors. Parents appear to play a central role in their development as the main responsible for shaping children's feeding environment and eating experiences. The purpose of this paper is to review the literature on parental influences on eating behaviours across childhood, mainly focusing on parental feeding practices. The associations between parental feeding practices and children's eating behaviours have been extensively studied. However, most of the findings come from cross-sectional studies, so the possibility of reverse causality cannot be ruled out (i.e., children's behaviours influencing parents). Most recently, a few longitudinal studies with a cross-lagged design have shown that the relationship between children's eating behaviours and parental feeding practices seems to be bidirectional, where it is not straightforward whether parental feeding practices are a predictor or a consequence of children's eating behaviours. Children's eating behaviours influence parents to adopt certain feeding practices, but these practices also influence children's behaviours over time. Parental feeding practices may have the potential to shape children's eating behaviours and should be targeted to promote the development of non-obesogenic traits. However, parent-child interactions are complex and therefore both parent and child characteristics and the family dynamics should be considered.

Factors associated with the early emergence of atypical feeding behaviours in infants and young children: A scoping review

BACKGROUND

Atypical feeding behaviours such as significantly limited food preferences, hypersensitivity to food textures or temperatures and pocketing food without swallowing are common concerns in child health. Current reports indicate an inter-relationship between early growth, feeding problems and developmental disorders, yet little is known about how these behaviours develop in early childhood. There is also a lack of consensus about clinical definitions for atypical feeding behaviours, diagnostic thresholds and the associated precursors. To date, there has been no synthesis of the extant literature about factors associated with the early onset of atypical feeding behaviours in young children.

OBJECTIVE

This scoping review aimed to characterize the factors associated with the early emergence of atypical feeding behaviours in typically developing young children.

METHODS

CINAHL, MEDLINE, PsycINFO and Scopus databases were searched. Studies published in the last 5 years were included if they examined factors associated with the development of atypical eating behaviours in infants and young children. Of the 2137 records obtained after the search strategy was applied, 202 full-text articles were retrieved for a more detailed examination and to ensure they met the inclusion criteria. This resulted in 54 studies being included in this scoping review.

RESULTS

Of the 54 studies, three studies analysed precursors responsible for atypical feeding behaviours, and 51 studies discussed the factors associated with the early emergence of feeding difficulties. Multiple factors, including genetic factors, breastfeeding, late introduction of solids and lumpy foods, complementary feeding techniques, parental mental health, prematurity and child factors including temperament, were identified. There is inconsistent evidence for the associations between breastfeeding exposure and feeding difficulties.

CONCLUSIONS

This study identified multiple factors potentially associated with the early onset of atypical feeding behaviours in young children; however, there is insufficient evidence at this time to support specific recommendations for early feeding practices in young children. More methodologically rigorous studies are needed to extend these findings.

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.

Characteristics of picky eater children in Turkey: a cross-sectional study

Objective

The aim of this study is to investigate the relations of picky eating habit of children with their nutrition, physical activity, screen time and sleep habits in the context of parental picky eating habit.

Methods

In a cross-sectional study a questionnare was applied to the parents of children aged 6–13 years in two provincies. The cases were analyzed as the overall group and the two subgroups in which both parents are not picky eater, and in which at least one parent was picky eater. Child's risk of being picky eater was analyzed by logistic regression.

Results

A total of 913 children and parent pairs were included in the study. The risk of picky eating of the child increases 2.85 (AOR: 1.67–4.88) times when only the mother was picky eater, 5.99 (AOR: 3.32–7.52) times when only the father was picky eater, and 22.79 (AOR: 6.95–74.71) times when both of the parents were picky eaters. In the subgroup in which at least one parent was picky eater, it was determined that children with physical activity duration of ≥ 1 h/day and sleep time of ≥ 9 h /day were less likely to be picky eater and the children with screen time of ≥ 2 h/day were more likely to be picky eaters.

Conclusion

Picky eating habit in childhood is related to the picky eating habit of the parents. In the context of this relationship, the picky eating habit of children is related to sleep, physical activity, screen time and other eating habits.

Influences on the dietary intakes of preschool children: a systematic scoping review

Background

Better diet quality of preschool children is associated with many important health outcomes, but there is significant room for improvement in many children’s dietary intakes. The determinants of children’s dietary intakes are complex and whole systems approaches may be effective tools for changing dietary intake. Collation of all the evidence available on determinants of preschool children’s dietary intake is necessary to ‘map’ the whole system of influence. Therefore, this systematic scoping review of available literature on determinants of dietary intakes in preschool children was undertaken.

Methods

The Joanna Briggs Institute methods for conducting a systematic scoping review were followed. Articles published since 2000 which assessed influences on the dietary intakes of preschool children were identified, yielding a total of 246 papers. Studies of children with clinical conditions (excluding obesity), or those conducted in middle and low-income countries were excluded, due to the different systems of influence in these populations. Data were extracted and information synthesised based on ecological level (child, parent, household, childcare, or wider determinants).

Results

Most articles focused on influences at the parental level (n = 118, 48%), followed by those at the child level (n = 73, 30%). Most of the studies were of cross-sectional design (n = 109, 44%). Whilst many studies considered influences at multiple ecological levels (n = 63, 26%) few analyses determined interactions between factors in their relationship with children’s dietary intakes, which is needed going forward using systems methods.

Conclusion

A wealth of evidence exists examining influences on the dietary intakes of preschool children and this information would benefit from analysis using a systems thinking approach in order to assess effective levers for intervention and what works, for whom, under what circumstances.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01254-8.

Relationships between feeding problems, eating behaviours and parental feeding practices in children with Down syndrome: A cross-sectional study

BACKGROUND

Research investigating feeding problems in children with Down syndrome is scarce. This study investigated feeding problems, eating behaviours and parental feeding practices in children with Down syndrome (n = 40), and typically developing (TD) children of the same age and sex (n = 40).

METHOD

Parents of children aged 6-months to 5-years in the UK completed questionnaires assessing their child's feeding problems and eating behaviours and parental feeding practices.

RESULTS

For children with Down syndrome, feeding problems were: significantly greater than for TD children; negatively associated with breast milk duration and appetite during exclusive milk feeding; and positively associated with drinking more slowly. For both groups, feeding problems were significantly correlated with more food avoidant eating behaviours.

CONCLUSIONS

This study provides new information about the relationships between feeding problems and eating behaviours in early development. Longitudinal research is needed to further investigate these relationships, so that effective support can be developed for families.

Development and application of specific questions to classify a child as food texture sensitive

Understanding food texture sensitivity in children is important in guiding food selection. The objective of this work was to develop a short questionnaire that could be completed by parents in nonclinical settings to provide a categorization for food texture sensitivity in children. This study evaluated the distribution of children as texture sensitive (TS) or non-texture sensitive (NTS) and the predictive validity of these questions to explain rejection of specific food textures. Three sets of survey data were examined, including data from a home-use test (HUT) in children with and without Down syndrome (DS), and lingual tactile sensitivity measured by grating orientation task (GOT). From three parent-completed surveys, the use of the questionnaire yielded a similar distribution of children in the TS category (16-22%) as previously reported. TS children (4-36 months) were more likely to reject specific food textures, including chewy, hard, lumpy, and "tough meat" (p < .05). A higher percentage of children with a diagnosis of DS were TS (36.9%). Children who were TS showed increased negative behaviors to foods and ate less than NTS children. In older children (5-12 years), TS children were fussier than NTS children (p < .001). Lingual tactile sensitivity was not significantly different by TS/NTS categorization (p = .458). This study demonstrated that the use of these five questions specific to food texture provides a useful tool in categorizing a child as TS/NTS, with this information being useful in selecting preferred food textures. Future studies involving these TS questions should perform psychometric assessments and measures of criterion validity using other questionnaires.

Complementary Feeding Methods-A Review of the Benefits and Risks

Complementary feeding methods have the potential to not only ensure a diet of nutritional adequacy but also promote optimal food-related behaviours and skills. While the complementary feeding practice known as baby-led weaning (BLW) has gained popularity, evidence supporting the potential benefits and/or risks for infant growth, development, and health warrants consideration. A review of 29 studies was conducted with findings indicating that parents who implement BLW typically have higher levels of education, breastfeed for longer, and differ in other personality traits. Fear of choking was an important factor in parents’ decision not to implement BLW; however, this fear was not supported by the literature. Benefits of BLW included lower food fussiness, higher food enjoyment, lower food responsiveness, and higher satiety responsiveness. While this profile of eating behaviours confers a reduced obesity risk, few studies have examined the relationship between BLW and infant growth robustly. BLW does not seem to increase the risk of inadequate zinc or iron intake; however, emphasis needs to be given to ensuring adequate intake of these micronutrients among all infants. A better understanding of the impacts of BLW is needed to inform evidence-based recommendations to support and guide parents in complementary feeding methods.

Food parenting practices and eating behaviors in childhood: a cross-lagged approach within the Generation XXI cohort

BACKGROUND

Food parenting practices have been associated with children's eating behaviors, but analyses exploring the bidirectional effects are limited.

OBJECTIVES

We aimed to examine the bidirectional relations between food parenting practices and the eating behavior of children from 4 to 7 y old.

METHODS

Participants are from the Generation XXI birth cohort (Portugal) assessed at both 4 and 7 y of age (n = 3698 singletons). A validated version of the Child Feeding Questionnaire and the overt/covert control scale were used. Three patterns of food parenting practices (Perceived Monitoring, Restriction, and Pressure to eat) were studied. Perception of children's eating behaviors (eating large amounts of food, eating very slowly, and food refusal) was reported by parents (measured using dichotomous questions). Cross-lagged analyses were performed to evaluate the direction of the associations (parenting practices at 4 y to behaviors at 7 y and the reverse).

RESULTS

Eating large amounts of food was unidirectionally associated with higher Restriction 3 y later (βstandardized = 0.047; 95% CI: 0.019, 0.075). Apart from Restriction, all associations had a bidirectional effect of similar magnitude. Eating large amounts of food and food refusal at age 4 influenced food parenting, such as Perceived Monitoring and Pressure to eat at age 7, but these practices were prospectively linked to these eating behaviors too (e.g., βstandardized = 0.033; 95% CI: 0.022, 0.064 for food refusal at age 4 and Pressure to eat at age 7, and βstandardized = 0.060; 95% CI: 0.034, 0.086, in the reverse direction). Parenting practices and children's eating behaviors showed significant moderate tracking (standardized path coefficients from 0.24 to 0.49).

CONCLUSIONS

Eating large amounts of food, eating slowly, and food refusal can influence parents to adopt certain food parenting practices, but these practices also influence children's behaviors after a few years. This reciprocal relation should be considered in future research. Parents should be advised to use food parenting practices associated with healthier eating behaviors.

Maternal feeding stress during mealtimes as a mediator between child food fussiness and maladaptive feeding behaviors among mothers of preschoolers

Parenting stress has been linked to maladaptive feeding behaviors and adverse child outcomes. Maternal stress that is specific to child feeding during mealtimes has not been previously explored. We sought to examine our hypothesis that maternal feeding stress during mealtimes (MFS-mealtimes) mediates the association of child food fussiness and concern about child's diet with maladaptive feeding behaviors. Mothers (n = 100) were recruited through different preschoolers around the city of Jeddah, Saudi Arabia. Participants completed an online questionnaire, which included a newly developed MFS-mealtimes index (Cronbach's α = 0.89), the Child Feeding Questionnaire- Arabic (CFQ-A), and the child food fussiness scale. We conducted path analysis to test our hypothesis, and we used bivariate analyses to inform our path model. Mean child age was 4.76 years (SD = 0.62), and 62% of children were female. Mean maternal age was 33.9 years (SD = 5.83). Results from path analysis showed that concern about child's diet and child food fussiness were each associated with higher MFS-mealtimes (B = 0.11, 95% confidence interval (CI) = 0.01, 0.20, p < 0.05, and B = 0.29, 95% CI = 0.05, 0.53, p < 0.01, respectively). MFS-mealtimes was in turn associated with higher pressure to eat (B = 0.45, 95% CI = 0.18, 0.71, p < 0.05). Goodness of fit indices showed good model fit (p > X² = 0.83, SRMR = 0.005, and CFI = 1.00). Our findings suggest a novel approach for promoting a favorable mealtime environment. Parenting stress reduction interventions have been shown to be successful in reducing stress levels and may be utilized for minimizing feeding stress during mealtimes. Mothers of picky eaters may be specifically targeted for intervention programs. Long term consequences of excessive MFS-mealtimes, as well as variations between cultures need further evaluation.

Associations of parents' use of food as reward with children's eating behaviour and BMI in a population-based cohort

BACKGROUND

Parents' use of food as reward has been linked to children's dietary intake, but the association with children's eating behaviour and overweight risk is less clear.

OBJECTIVES

To examine the temporal association of using food as reward with eating behaviour, body mass index (BMI) and weight status of children.

METHODS

Participants were 3642 children of the population-based Generation R Study in the Netherlands (8.3% overweight/obese). Repeated assessments were collected at child ages 4 and 9 years, including measured anthropometrics and parent reports on feeding practises and eating behaviour.

RESULTS

Linear regressions and cross-lagged models indicated that parents' use of food as reward at child age 4 years predicted Emotional Overeating and Picky Eating at age 9 years. Reversely, higher Emotional Overeating and Food Responsiveness scores were associated with more use of food as reward over time. Using food as reward was not associated with children's satiety response, BMI or overweight risk.

CONCLUSIONS

A vicious cycle may appear in which children who display food approach behaviour are rewarded with food by their parents, which in turn might contribute to the development of unhealthy eating habits (emotional eating, fussiness). These findings warrant further research, to facilitate evidence-based recommendations for parents.

Parental feeding practices across child's weight status: Evidence of the Italian validation of the Child Feeding Questionnaire

OBJECTIVE

The main aim of this study was to assess the psychometric proprieties of the Child Feeding Questionnaire (CFQ) in Italian mothers.

DESIGN

Mothers completed the Italian version of the CFQ, and children's anthropometric data were collected. Construct validity of the CFQ was assessed by comparing three different models: (a) a seven correlated factors model in which all items were analysed; (b) a seven correlated factors model with composite items based on the Restriction factor and (c) an eight correlated factors model with a separate Reward factor. Measurement invariance using BMI categories and gender was evaluated. Furthermore, discriminant validity with group comparison was performed between BMI categories and gender.

SETTING

Italy.

PARTICIPANTS

A total of 1253 6-year-old Italian children (53·9 % male) attending elementary school (1st grade) and their mothers (mean age = 38·22 years; sd = 4·89) participated in this study.

RESULTS

The eight-factor model with a separate reward factor provided the best fit for the data. The strict invariance of the CFQ across child BMI categories and gender was confirmed. The CFQ internal consistency was acceptable for most subscales. However, two subscales showed no adequate values. As expected, the CFQ scales showed significant differences between BMI categories, while no gender-related differences were found.

CONCLUSIONS

The study indicated the Italian version of the CFQ to be factorially valid for assessing parental feeding practices of 6-year-old children across BMI categories. Future research should address low internal consistency in some of the CFQ subscales.

The relationship between caregivers' feeding practices and children's eating behaviours among preschool children in Ethiopia

Preschool age is a time when distinct eating behaviours are formed. Eating behaviours have been associated with underweight and poor growth as well as with overweight. However, the relationship between caregivers' feeding practices and children's eating behaviours remains poorly understood in developing countries. This study aims to evaluate the association between caregivers' feeding practices and eating behaviours among preschool children in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged between three and six years old. We used the Children Eating Behaviour Questionnaire and the Child Feeding Questionnaire to measure eating behaviour and caregivers' feeding practices respectively. A multiple linear regression was fitted to determine the association between caregivers' feeding practices and the multiple scales of children's eating behaviour while adjusting for potential confounders. Children whose caregivers practice food restriction tended to be more food responsive (β = .23, p < .001), tend to emotionally overeat (β = .09, p < .01), enjoy food more (β = 0.23, p < .001) and have more desire to drink (β = .24, p < .001). Meanwhile, children whose caregivers practiced pressure to eat were fussier about food (β = .09, p < .001), were more satiety responsive (β = .13, p < .001) and tended to eat slower (β = .10, p < .01). In Ethiopia, where under- and over-nutrition coexist among pre-school children, the results from this study underscore the importance of investigating eating behaviours at an early age, as these eating styles may contribute to children's poor nutritional status. It is also essential to include appropriate child eating behaviour and specific feeding practices components, together with responsive feeding in national nutritional programmes to improve the nutritional status of children aged 24-59 months.

The Relationships between Maternal Feeding Practices and Food Neophobia and Picky Eating

Food neophobia and picky eating (FNPE) are dietary behaviors that have been frequently reported to coexist in children. Parental concerns about these dietary behaviors may influence the feeding practices employed. In this cross-sectional study, we investigated the bidirectional associations of maternal feeding practices with children’s FNPE behaviors. Using a convenience sampling technique, mothers of 195 healthy children aged 1–7 years were invited to complete a sociodemographic questionnaire, rate their child’s FNPE, and rate the extent to which each feeding practice was employed with the child. Maternal reports indicated that 37.4% (n = 73) of the children exhibited severe FNPE. Multiple linear regression analyses showed positive two-way associations between the “pressure to eat” feeding strategy and FNPE, and negative two-way associations between a healthy home food environment and FNPE. However, maternal practices of teaching and monitoring were not found to be associated with FNPE. Given the bidirectional relationships observed between FNPE and maternal feeding practices, primary health care providers should address the feeding practices used with a child and indicate that coercive feeding practices are counterproductive. Intervention studies targeting mothers of children with FNPE are needed to investigate whether specific maternal practices are more effective than others.

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.

Bidirectional relationships between appetitive behaviours and body mass index in childhood: a cross-lagged analysis in the Generation XXI birth cohort

PURPOSE

Appetitive behaviours have been associated with body mass index (BMI). However, existing data were largely derived from cross-sectional studies and cannot provide insight into the direction of associations. We aimed to explore the bidirectionality of these associations in school-age children.

METHODS

Participants are from the Generation XXI birth cohort, assessed at both 7 and 10 years of age (n = 4264; twins excluded). The Children's Eating Behaviour Questionnaire (CEBQ) was used to measure appetitive behaviours (8 subscales). Anthropometrics were measured and WHO BMI z-score was calculated. Cross-lagged analyses were performed to compare the magnitude and direction of the associations (behaviours at 7 years to BMI z-score at 10 years and the reverse) (covariates: child's sex, physical exercise, maternal age and education; plus BMI z-score at age 7 or, in the reverse direction, the subscale score).

RESULTS

In cross-lagged analyses, appetitive behaviours at 10 years of age (apart from emotional undereating) were shown to be reactive to the child BMI z-score at 7 years of age. Only slowness in eating was significantly related to subsequent BMI. However, the strongest association was from the child BMI z-score to the behaviour (β_standardized = - 0.028 compared with β_standardized = - 0.103, likelihood ratio test p < 0.001).

CONCLUSIONS

BMI at age 7 was related to appetitive behaviours at 10 years of age, rather than the reverse. This suggests that children with a higher BMI in middle childhood are at increased risk of developing an avid appetite over time.

A longitudinal study of eating behaviours in childhood and later eating disorder behaviours and diagnoses

BACKGROUND

Eating behaviours in childhood are considered as risk factors for eating disorder behaviours and diagnoses in adolescence. However, few longitudinal studies have examined this association.

AIMS

We investigated associations between childhood eating behaviours during the first ten years of life and eating disorder behaviours (binge eating, purging, fasting and excessive exercise) and diagnoses (anorexia nervosa, binge eating disorder, purging disorder and bulimia nervosa) at 16 years.

METHOD

Data on 4760 participants from the Avon Longitudinal Study of Parents and Children were included. Longitudinal trajectories of parent-rated childhood eating behaviours (8 time points, 1.3-9 years) were derived by latent class growth analyses. Eating disorder diagnoses were derived from self-reported, parent-reported and objectively measured anthropometric data at age 16 years. We estimated associations between childhood eating behaviours and eating disorder behaviours and diagnoses, using multivariable logistic regression models.

RESULTS

Childhood overeating was associated with increased risk of adolescent binge eating (risk difference, 7%; 95% CI 2 to 12) and binge eating disorder (risk difference, 1%; 95% CI 0.2 to 3). Persistent undereating was associated with higher anorexia nervosa risk in adolescent girls only (risk difference, 6%; 95% CI, 0 to 12). Persistent fussy eating was associated with greater anorexia nervosa risk (risk difference, 2%; 95% CI 0 to 4).

CONCLUSIONS

Our results suggest continuities of eating behaviours into eating disorders from early life to adolescence. It remains to be determined whether childhood eating behaviours are an early manifestation of a specific phenotype or whether the mechanisms underlying this continuity are more complex. Findings have the potential to inform preventative strategies for eating disorders.

Mindful feeding: A pathway between parenting style and child eating behaviors

Certain child eating behaviors (e.g., food fussiness, emotional overeating, and disruptive mealtime behaviors) can create challenges for caregivers and result in short- and long-term health consequences (e.g., lower fruit and vegetable intake, a deficiency of essential nutrients, greater intake of energy-dense foods and sugary beverages, and/or higher BMI) for the children. The role of mindful feeding-cultivating a present-centered awareness in the feeding context to increase parents' awareness of their own responsive (and non-responsive) feeding behaviors-has not been explored as it relates to parenting and children's problematic eating behaviors. The objective of this study was to understand whether the relations between parenting style and child eating behaviors often documented in the literature are mediated by mindful feeding. Using self-reports from Amazon's Mechanical Turk (MTurk) of 496 mothers and fathers of young children (age 2-7 years old), we explored whether mindful feeding mediates the relation between parenting style and child eating behaviors. As hypothesized, authoritative parenting was related to higher rates of mindful feeding (β=.16, 95% C.I. [.05, .18]), while authoritarian (β=-.34, 95% C.I. [-.32, -.17]) and permissive parenting (β= -.15, 95% C.I. [-.18, -.05]) were related to lower rates of mindful feeding. Mindful feeding mediated the relation between each parenting style and each child eating behavior (i.e., food fussiness, problematic mealtime behaviors, and emotional overeating). These findings suggest that that mindful feeding may be a promising new construct, and its relation to feeding interventions aimed at improving problematic child eating behaviors should be further evaluated.

Young adult nutrition and weight correlates of picky eating during childhood

OBJECTIVE

To identify whether picky eating during childhood is associated with dietary intake, weight status and disordered eating behaviour during young adulthood.

DESIGN

A population-based study using data from young adults who responded online or by mail to the third wave of the Project EAT (Eating and Activity in Teens and Young Adults) study in 2008-2009. Participants retrospectively reported the extent to which they were a picky eater in childhood, sociodemographic characteristics, disordered eating behaviours, usual dietary intake, and weight and height.

SETTING

Participants were initially recruited in the Minneapolis/St. Paul metropolitan area of Minnesota, USA, in 1998-1999.

PARTICIPANTS

The analytic sample included 2275 young adults (55 % female, 48 % non-Hispanic White, mean age 25·3 (sd 1·6) years).

RESULTS

Young adults who reported picky eating in childhood were found to currently have lower intakes of fruit, vegetables and whole grains, and more frequent intakes of snack foods, sugar-sweetened beverages and foods from fast-food restaurants. No associations were observed between picky eating in childhood and young adults' weight status, use of weight-control strategies or report of binge eating.

CONCLUSIONS

While young adults who report picky eating during childhood are not at higher risk for disordered eating, those who were picky eaters tend to have less healthy dietary intake. Food preferences and dietary habits established by picky eaters during childhood may persist into adulthood.

Defining picky eating and its relationship to feeding behaviors and weight status

We assessed the individual constructs that comprise "picky eaters" and determined the relationship of each construct to parental perception of their child's weight status, parental pressure-to-eat, and the child's body mass index z-score (BMIz). We developed a questionnaire including 7 commonly used measures of picky eating, which was completed by parents of 2-8 year-olds in pediatric clinics. We performed exploratory factor analysis, confirmatory factor analysis, and model fit. Regression models assessed the association of each picky eating factor to weight perception, pressure-to-eat, and BMIz. We identified three distinct picky eating factors: trying new foods, eating sufficient quantity, and desire for specific food preparation. Each factor had Cronbach's alpha > 0.7 and acceptable model fit. No factors were associated with weight perception. Parents who were more concerned their child did not eat enough were more likely to pressure-to-eat, and these children had lower BMIz. These components of picky eating should be addressed by primary care providers.

Family food environment factors associated with obesity outcomes in early childhood

Background

In attempting to gain understanding of the family food environment (FFE), as a central context for the development of obesity and obesogenic eating behaviours during early childhood, attention has largely focused on the relationships of individual variables. This fails to capture the complex combinations of variables children are exposed to. To more authentically reflect the impact of the FFE on the development of obesity and obesogenic eating behaviours during early childhood, this study aims to derive composites of FFE variables using factor analysis.

Methods

FFE and eating behaviour data were available from 757 Australian children (2.0–5.0 years) via a parent-completed online survey. Children were categorised as normal weight, overweight or obese, based on parent-reported anthropometry (underweight children were excluded).

Results

Eight FFE factors were derived. Scores for factors ‘Negative Feeding Strategies’ and ‘Negative Nutrition Related Beliefs’ increased with child BMI category, while ‘Use of TV and devices’ and ‘Parent’s Nutrition Knowledge’ decreased. The FFE factor ‘Negative Feeding Strategies’ was positively associated with food fussiness, food responsiveness and slowness in eating, and negatively associated with parent body mass index (BMI) score. The FFE factor ‘Negative Nutrition Related Beliefs’ was positively associated with food responsiveness, as well as positively with parent BMI, male children, breastfeeding less than 6 months, and low-income status. The FFE factor ‘Television (TV) and devices’ was only positively associated with residing in a capital city. The FFE factor ‘Parent’s Nutrition Knowledge’ was negatively associated with slowness in eating, breastfeeding less than 6 months and low-income status, and positively with parent stress and residing in a capital city.

Conclusion

Consideration of the composite effect of FFE on child’s eating behaviours and obesity outcomes is important in guiding future research and obesity prevention initiatives by providing a more authentic picture of the FFE children are exposed to. Examining factors of FFE variables in conjunction with psycho-social variables, further articulates the reciprocal influence of these variables on environmental constructs thus assisting in understanding of inequitable distribution of obesity risk.

*keywords

childhood obesity, eating behaviours, early childhood, Family Food Environment, Factor Analysis,

Early influencing factors on the development of sensory and food preferences

PURPOSE OF REVIEW

The current review focuses on studies investigating the factors related to the development of preferences for foods and sensory inputs (tastes, odours, and food textures) in the first years of life, which constitutes a specific window for food learning.

RECENT FINDINGS

Foetal nutrition, intrauterine growth, and prematurity influence food preferences; this topic warrants more research to broaden our understanding of the 1000 days phenomenon. Although it is less studied than other sensory inputs, food texture acceptance, and the related sensitive period for texture introduction are attracting more attention, as is the impact of fat acceptance. Research should focus not on vegetables alone but on diverse foods whose consumption is encouraged (e.g., fishes and legumes). The role of parental feeding practices, as another major determinant, continues to inspire research exploring the bidirectional influences between children and caregivers. New interventions have confirmed the strong positive influence of repeated exposure to foods through familiarization via taste lessons, cooking, or play activities on acceptance. Interventions that consider individuals traits are necessary.

SUMMARY

Although new evidence is available, it remains a challenge to consider both individual traits and bidirectional influences between parents and children and to investigate this issue worldwide and in all socioeconomic status groups.

Prospects for early childhood feeding interventions: An exploration of parent's concerns and acceptability towards social media intervention opportunities

AIM

The present study aims to (i) consult with parents regarding child feeding concerns, as relevant to child feeding interventions, (ii) determine parents' willingness to participate in online and social media-based interventions and (iii) determine differences in intervention acceptability based on geographic diversity and demographic characteristics.

METHODS

Three hundred thirty Australian parents of children (2.0-5.0 years) with child feeding concerns participated in an online, cross-sectional survey. Kruskal-Wallis with Dunn's multiple-comparison test, using Bonferroni adjustment, was used to compare differences between variables and participants characteristics (region of residence, parent age, parent education and income).

RESULTS

About 53.9% of respondents were concerned about child fussy eating, with lack of time and child tantrums common barriers to addressing concerns. Respondents indicated that a combination of online platforms (websites, email, Facebook) was their preferred method of intervention participation, although, a combination of online and face-to-face methods also had modest preference, particularly among lower educated parents. Participants indicated that they would participate in an online intervention (participating once a week) for more than 12 weeks (42.7%), compared with only 4 weeks (participating once a week) for traditionally delivered interventions. About 32.4% of respondents said they would be concerned about their privacy in an online intervention.

CONCLUSIONS

Fussy eating is likely to be an appealing focus for future child feeding interventions, with strategies to address common barriers an important curriculum area. Online interventions are likely to offer an acceptable and plausible alternative to traditional interventions that are able to reach geographically diverse populations, although face-to-face intervention components still hold appeal.

Evidence for gene-environment correlation in child feeding: Links between common genetic variation for BMI in children and parental feeding practices

The parental feeding practices (PFPs) of excessive restriction of food intake (‘restriction’) and pressure to increase food consumption (‘pressure’) have been argued to causally influence child weight in opposite directions (high restriction causing overweight; high pressure causing underweight). However child weight could also ‘elicit’ PFPs. A novel approach is to investigate gene-environment correlation between child genetic influences on BMI and PFPs. Genome-wide polygenic scores (GPS) combining BMI-associated variants were created for 10,346 children (including 3,320 DZ twin pairs) from the Twins Early Development Study using results from an independent genome-wide association study meta-analysis. Parental ‘restriction’ and ‘pressure’ were assessed using the Child Feeding Questionnaire. Child BMI standard deviation scores (BMI-SDS) were calculated from children’s height and weight at age 10. Linear regression and fixed family effect models were used to test between- (n = 4,445 individuals) and within-family (n = 2,164 DZ pairs) associations between the GPS and PFPs. In addition, we performed multivariate twin analyses (n = 4,375 twin pairs) to estimate the heritabilities of PFPs and the genetic correlations between BMI-SDS and PFPs. The GPS was correlated with BMI-SDS (β = 0.20, p = 2.41x10^-38). Consistent with the gene-environment correlation hypothesis, child BMI GPS was positively associated with ‘restriction’ (β = 0.05, p = 4.19x10^-4), and negatively associated with ‘pressure’ (β = -0.08, p = 2.70x10^-7). These results remained consistent after controlling for parental BMI, and after controlling for overall family contributions (within-family analyses). Heritabilities for ‘restriction’ (43% [40–47%]) and ‘pressure’ (54% [50–59%]) were moderate-to-high. Twin-based genetic correlations were moderate and positive between BMI-SDS and ‘restriction’ (r_A = 0.28 [0.23–0.32]), and substantial and negative between BMI-SDS and ‘pressure’ (r_A = -0.48 [-0.52 - -0.44]. Results suggest that the degree to which parents limit or encourage children’s food intake is partly influenced by children’s genetic predispositions to higher or lower BMI. These findings point to an evocative gene-environment correlation in which heritable characteristics in the child elicit parental feeding behaviour.

It is widely believed that parents influence their child’s BMI via certain feeding practices. For example, rigid restriction has been argued to cause overweight, and pressuring to eat to cause underweight. However, recent longitudinal research has not supported this model. An alternative hypothesis is that child BMI, which has a strong genetic basis, evokes parental feeding practices (‘gene-environment correlation’). To test this, we applied two genetic methods in a large sample of 10-year-old children from the Twins Early Development Study: a polygenic score analysis (DNA-based score of common genetic variants associated with BMI in genome-wide meta-analyses), and a twin analysis (comparing resemblance between identical and non-identical twin pairs). Polygenic scores correlated positively with parental restriction of food intake (‘restriction’; β = 0.05, p = 4.19x10^-4), and negatively with parental pressure to increase food intake (‘pressure’; β = -0.08, p = 2.70x10^-7). Associations were unchanged after controlling for all genetic and environmental effects shared within families. Results from twin analyses were consistent. ‘Restriction’ (43%) and ‘pressure’ (54%) were substantially heritable, and a positive genetic correlation between child BMI and ‘restriction’ (r_A = 0.28), and negative genetic correlation between child BMI and ‘pressure’ (r_A = -0.48) emerged. These findings challenge the prevailing view that parental behaviours are the sole cause of child BMI by supporting an alternate hypothesis that child BMI also causes parental feeding behaviour.

Maternal feeding practices in relation to dietary intakes and BMI in 5 year-olds in a multi-ethnic Asian population

BACKGROUND

In Asia, little is known about how maternal feeding practices are associated with dietary intakes and body mass index (BMI) in preschoolers.

OBJECTIVE

To assess the relationships between maternal feeding practices with dietary intakes and BMI in preschoolers in Asia using cross-sectional analysis in the GUSTO (Growing Up in Singapore Towards healthy Outcomes) cohort.

PARTICIPANT SETTINGS

Mothers (n = 511) who completed the Comprehensive Feeding Practices Questionnaire (CFPQ) and a semi-quantitative Food Frequency Questionnaire (FFQ) when children were 5 years old.

STATISTICAL ANALYSIS

Associations between 12 maternal feeding practices (mean scores divided into tertiles) and children's dietary intakes of seven food groups and BMI z-scores were examined using the general linear regression model. Weight and height of the child were measured, and dietary intakes derived from the FFQ.

RESULTS

Compared to those in the low tertile, mothers in the high tertile of modelling healthy food intakes had children with higher intakes of vegetables[+20.0g/day (95%CI:11.6,29.5)] and wholegrains[+ 20.9g/day (9.67,31.1)] but lower intakes of sweet snacks[-10.1g/day (-16.3,-4.94)] and fast-foods[-5.84g/day (-10.2,-1.48)]. Conversely, children of mothers in the high tertile for allowing child control (lack of parental control) had lower intake of vegetables[-15.2g/day (-26.6,-5.21)] and wholegrains[-13.6g/day (-22.9,-5.27)], but higher intakes of sweet snacks[+13.7g/day (7.7, 19.8)] and fast-foods[+6.63g/day (3.55,9.72)]. In relation to BMI at 5 years, food restrictions for weight was associated with higher BMI z-scores [0.86SD (0.61,1.21)], while use of pressure was associated with lower BMI z-scores[-0.49SD(-0.78,-0.21)].

CONCLUSIONS AND IMPLICATIONS

Modelling healthy food intakes by mothers was the key feeding practice associated with higher intakes of healthy foods and lower intakes of discretionary foods. The converse was true for allowing child control. Only food restrictions for weight and use of pressure were associated with BMI z-scores.

Concern Explaining Nonresponsive Feeding: A Study of Mothers' and Fathers' Response to Their Child's Fussy Eating

OBJECTIVE

To examine the role of parent concern in explaining nonresponsive feeding practices in response to child fussy eating in socioeconomically disadvantaged families.

DESIGN

Mediation analysis of cross-sectional survey data.

SETTING

Socioeconomically disadvantaged urban community in Queensland, Australia.

PARTICIPANTS

Cohabiting mother-father pairs (n = 208) with children aged 2-5 years.

MAIN OUTCOME MEASURE(S)

Two validated measures of nonresponsive feeding: persuasive feeding and reward for eating.

ANALYSIS

Mediation analysis tested concern as a mediator of the relationship between child food fussiness (independent variable) and parent nonresponsive feeding practices (dependent variables), adjusted for significant covariates and modeled separately for mothers and fathers.

RESULTS

Maternal concern fully mediated the relationship between child food fussiness and persuasive feeding (indirect effect: B [SE] = 0.10 [0.05]; 95% confidence interval [CI], 0.01-0.20). Concern also fully mediated the relationship between child food fussiness and reward for eating for mothers (indirect effect: B [SE] = 0.17 [0.07]; CI, 0.04-0.31) and fathers (indirect effect: B [SE] = 0.14 [0.05]; CI, 0.04-0.24) CONCLUSIONS AND IMPLICATIONS: Concern for fussy eating behaviors may explain mothers' and fathers' nonresponsive feeding practices. In addition to providing education and behavioral support, health professionals working with socioeconomically disadvantaged families can incorporate strategies that aim to alleviate parents' concerns about fussy eating.

Antecedents of picky eating behaviour in young children

Background

Picky eating behaviour in young children is a common concern for parents.

Objective

To investigate early life factors which are associated with a child becoming a picky eater.

Design

Singleton children from the Avon Longitudinal Study of Parents and Children were studied prospectively (n = 5758–6608). Parental-completion questionnaires were used to define ‘picky eating’ status at age 3 years, and child and parental feeding behaviours and practices throughout the first 2 years of life. Multinomial logistic regression models with 3 levels of picky eating (not, somewhat and very picky) as the dependant variables tested associations with antecedent variables, from pregnancy, and the first and second year of life, separately, then combining all significant variables in a final model.

Results

Feeding difficulties during complementary feeding and late introduction of lumpy foods (after 9 months) were associated with increased likelihood of the child being very picky. A strong predictor was the child being choosy at 15 months, particularly if the mother was worried about this behaviour. Many children (56%) were considered to be choosy at 15 months: 17% went on to be very picky at 3 years if the mother was not worried, compared with 50% if the mother was very worried by the choosiness. The mother providing fresh fruit and eating the same meal as the child were protective against later ‘picky eating’, while feeding ready-prepared food was predictive.

Conclusion

Advice and support to parents could help to reduce picky eating behaviour. Parents should be encouraged to introduce lumpy foods by 9 months, to feed fresh foods particularly fruit, and to eat with their children. Parents should be reassured that choosiness is normal and to continue to provide a variety of foods.

Picky eating in Swedish preschoolers of different weight status: application of two new screening cut-offs

Background

Characteristics of picky eaters of different weight status have not been sufficiently investigated. We used two newly developed screening cut-offs for picky eating in the Food fussiness (FF) subscale of the Child Eating Behavior Questionnaire (CEBQ) to investigate the prevalence and characteristics of picky eaters in preschool-aged children with thinness, normal weight, overweight or obesity.

Methods

Data for 1272 preschoolers (mean age 4.9 years) were analyzed. The parent-reported FF subscale ranges from 1 to 5, and two screening cut-offs were applied to classify children as picky eaters (3.0 and 3.33). Structural Equation Modeling was used to study associations with other factors in the CEBQ, the Child Feeding Questionnaire (CFQ) and the Lifestyle Behavior Checklist (LBC). Scores were compared separately for each weight status group.

Results

Nearly half of the children were classified as moderate or severe picky eaters (cut-off 3.0) and 30% as severe (cut-off 3.33). For both cut-offs, prevalence was significantly lower in the obesity group. Still, one-third of children with obesity met the cut-off of 3.0 and 17% met the cut-off of 3.33. While picky eaters displayed similar patterns across weight status groups, some differences emerged. Food responsiveness was lower for picky eaters, but the difference was significant only among children with obesity. Slowness in eating was not as pronounced among picky eaters in the obesity group. In the overweight and obesity groups, parents of picky eaters did not report as high pressure to eat, as compared to the thinness or normal weight groups; in the obesity group, parents of picky eaters also perceived their children’s weight as lower. In all weight status groups, parents of picky eaters were more likely to report their children had too much screen time, complained about physical activity, and expressed negative affect toward food.

Conclusions

Picky eating was less common but still prevalent among children with obesity. Future studies should investigate the potential influence of picky eating on childhood overweight and obesity. Moreover, as children with picky eating display higher emotional sensitivity, further research is needed to understand how to create positive eating environments particularly for children with picky eating and obesity.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0706-0) contains supplementary material, which is available to authorized users.

Health-related quality of life, temperament, and eating behavior among formula-fed infants in the Philippines: a pilot study

BACKGROUND

The rising prevalence of childhood obesity in Asia has led to interest in potential risk factors such as infant health-related quality of life (HRQoL), temperament and eating behaviors. This pilot study evaluated the utility of administering parent-reported outcome measures (PROMs) to explore these factors in Filipino infants and examined the relationships between these factors and infant sex, formula intake and weight, over time.

METHODS

Forty healthy, 4-week-old, formula-fed infants (n = 20 males) were enrolled in this 6-week, prospective, uncontrolled study during which infants were exclusively fed a standard term infant formula enriched with alpha-lactalbumin. On Day-1 and 42, anthropometrics were measured and mothers completed a 97-item measure of HRQoL [Infant Toddler Quality of Life Questionnaire (ITQOL)] covering 6 infant-focused and 3 parent-focused concepts and a 24-item measure of infant temperament [Infant Characteristics Questionnaire (ICQ)]. At Day-42, mothers also completed an 18-item measure of infant appetite [Baby Eating Behaviour Questionnaire (BEBQ)]. A 3-day formula intake diary was completed before Day-42. Nonparametric statistics were used to evaluate correlations among outcomes and compare outcomes by visit and sex.

RESULTS

Thirty-nine infants completed the study; similar results were observed in males and females. Completion of PROMs was 100% with no missing responses, but Cronbach's α was low for many concept scales scores. ITQOL scores [range 0 (worst)-100 (best)] were generally high (median ≥ 80) except for Day-1 and Day-42 Temperament and Mood and Day-1 General Health Perceptions scores. ITQOL but not ICQ temperament scores improved significantly between Day-1 and Day-42 (P < 0.01). Mean ± standard deviation BEBQ scores (range 1-5) were high for Enjoyment of Food (4.59 ± 0.60) and Food Responsiveness (3.53 ± 0.81), and low for Satiety Responsiveness (2.50 ± 0.73) and Slowness in Eating (1.71 ± 0.60). Better HRQoL scores were significantly (P < 0.05) associated with high General Appetite scores (3 ITQOL concepts, r = 0.32 to 0.54), greater Enjoyment of Food (4 ITQOL concepts, r = 0.35 to 0.42) and low levels of Slowness in Eating (7 ITQOL concepts, r = - 0.32 to - 0.47).

CONCLUSION

Findings demonstrated the utility of the ITQOL, ICQ and BEBQ for measuring HRQoL, temperament and eating behavior, and the need for further adaptations for use in Filipino infants.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02431377; Registered May 1, 2015.

Do Dads Make a Difference? Family Feeding Dynamics and Child Fussy Eating

OBJECTIVE

Few studies on child feeding have focused on family dynamics or disadvantaged families, yet feeding occurs in the complex social, economic, and relational context of the family. We examined how the level (high vs low) and concordance (concordant vs discordant) of nonresponsive feeding practices of mothers and fathers are associated with child fussy eating, in a socioeconomically disadvantaged Australian sample.

METHODS

Mother-father pairs (N = 208) of children aged 2 to 5 years old independently completed validated questionnaires reporting their "persuasive feeding," "reward for eating," "reward for behavior," and child's "food fussiness." The fussiness scores did not differ between mother-father pairs and were averaged to derive a single dependent variable. K-means cluster analyses were used to assign mother-father pairs to clusters for each feeding practice, based on mean scores. Three ANCOVAs, corresponding to each feeding practice, tested differences in child fussiness across clusters while controlling for covariates.

RESULTS

Four clusters were identified for each feeding practice-concordant: (1) high (MHi/FHi) for both parents and (2) low (MLo/FLo) for both parents; and discordant: (3) high for mother but low for father (MHi/FLo); and (4) low for mother but high for father (MLo/FHi). For "persuasive feeding," MLo/FLo reported lower levels of fussiness compared with MHi/FLo, MHi/FHi, and MLo/FHi (p values < 0.05). For "reward for eating," MLo/FLo reported lower levels of fussiness than did MHi/FHi (p < 0.05). Child fussiness did not differ across "reward for behavior" clusters.

CONCLUSION

In socioeconomically disadvantaged families, when parents are concordant in avoiding nonresponsive feeding practices, less child "food fussiness" is reported. Findings suggest that feeding interventions should consider inclusion of both parents in 2-parent households.

Eating behavior traits associated with demographic variables and implications for obesity outcomes in early childhood

Despite ongoing investigation of children's eating behaviors to better understand the etiology of childhood obesity, few studies have aimed to determine differences in eating behavior based on psycho-social variables reflective of 'stressful' life circumstance. Cross-sectional data collected from parents of 977 Australian children (2.0-5.0 years) in an online survey was used to determine associations between parent-reported Children's Eating Behavior Questionnaire [CEBQ] sub-scales, child BMI z-scores and psycho-social variables. When examined individually, all CEBQ sub-scales, except Slowness in Eating, were associated with BMI z-score (Food Responsiveness B = 0.226, p = 0.003, Enjoyment of Food B = 0.169, p = 0.035, Food Fussiness B = -0.139, p = 0.024, Satiety Responsiveness B = -0.318, p = 0.001). On examining CEBQ sub-scales along with psycho-social demographic variables, only Food Responsiveness and Satiety Responsiveness were retained, along with being a boy, child age, and parent BMI. Food Responsiveness was positively associated with parental stress and child age and negatively with parent BMI, while Enjoyment of Food was positively associated with child sleep duration, single parent status, and negatively with breastfeeding less than 6 months and parental depression. Satiety Responsiveness was positively associated with parent BMI and child age, and negatively with child sleep duration, while Food Fussiness was positively associated with child age and breastfeeding less than 6 months, and negatively with sleep duration, parental depression and single parent status. Attention to eating behaviors and associated psycho-social variables may provide opportunity for targeted obesity prevention initiatives.

Appetitive traits associated with higher and lower body mass index: evaluating the validity of the adult eating behaviour questionnaire in an Australian sample

BACKGROUND

The aims of this study were to evaluate the factor structure of the newly developed Adult Eating Behaviour Questionnaire (AEBQ) (Hunot et al., Appetite 105:356-63, 2016) in an Australian sample, and examine associations between the four food approach and four food avoidance appetitive traits with body mass index (BMI).

METHODS

Participants (N = 998) recruited between May and October 2016 via a university research participation scheme and online social network sites completed an online version of the AEBQ and self-reported demographic and anthropometric data. Of the sample, 84.8% were females, 29.6% had completed a university degree and the overall mean age was 24.32 years (SD = 8.32). Confirmatory factor analysis (CFA) was used to test three alternative factor structures (derived from issues raised in the original development study): the original 8 factor model, a 7 factor model with Food Responsiveness and Hunger scales combined, and a 7 factor model with the Hunger scale removed.

RESULTS

The CFA revealed that the original 8 factor model was a better fit to the data than the 7 factor model in which Food Responsiveness and Hunger scales were combined. However, while reliability estimates for 7 of the 8 scales were good (Cronbach's α between 0.70-0.86), the reliability of the Hunger scale was modest (0.67) and dropping this factor resulted in a good fitting model. All food avoidance scales (except Food Fussiness) were negatively associated with body mass index (BMI) whereas Emotional Overeating was the only food approach scale positively associated with BMI.

CONCLUSIONS

The study supports the use of the AEBQ as a reliable and valid measure of food approach and avoidance appetitive traits in adults. Longitudinal studies that examine continuity and stability of appetitive traits across the lifespan will be facilitated by the addition of this measurement tool to the literature.

Perceived fussy eating in Australian children at 14 months of age and subsequent use of maternal feeding practices at 2 years

Background

Concerns about fussy eating are common amongst parents of young children. However, studies of the long-term impact of fussy eating show mixed results with regard to adequacy of dietary intake and child growth. This may be in part because there is no accepted definition of fussy eating and studies measure the construct in different ways, commonly relying on parent perception. This longitudinal analysis explores maternal and child characteristics associated with maternal perception of her toddler as a fussy eater in early toddlerhood and subsequent use of feeding practices at 2 years.

Methods

Mothers completed a self-administered questionnaire at child age 14 months, describing perception of their child as fussy/not fussy and child behaviour. Intake was assessed using a single 24-h recall and weight was measured by research staff. At child age 2 years mothers completed the validated 28-item Feeding Practices and Structure Questionnaire (FPSQ-28).

Weight-for-age z-score (WAZ) was derived from WHO standards. Gram daily intake of fruit, vegetables and meat/alternative and a dietary diversity score were determined. Maternal/child characteristics independently associated (p ≤ 0.05) with perception of child as a fussy eater were determined using logistic regression. Variables were combined in a structural equation model assessing the longitudinal relationship between child/maternal characteristics, perception of child as a fussy eater and eight FPSQ factors.

Results

Mothers’ (n = 330) perception of her child as a fussy eater at age 14 months, was associated with higher frequency of food refusal and lower WAZ (R² = 0.41) but not dietary intake. Maternal perception as fussy (age 14 months) was associated with four FPSQ factors at 2 years (n = 279) - Reward for Eating, Reward for Behaviour, Persuasive Feeding and Overt Restriction, x²/df = 1.42, TLI = 0.95, CFI = 0.95, RMSEA = 0.04(0.03–0.05), PCLOSE = 0.99.

Conclusions

Lower relative child weight and food refusal prompted mothers to perceive their child as fussy. These behaviours in healthy weight children most likely reflect self-regulation of energy intake and neophobia. This perception was prospectively associated with use of non-responsive feeding practices, which may increase obesity risk. Future interventions could directly address perceptions of growth and fussiness, supporting parents to understand food refusal as developmentally appropriate behaviour in healthy young children.

Trial registration

ACTRN12608000056392. Registered 29 January 2008.

Electronic supplementary material

The online version of this article (10.1186/s12966-017-0582-z) contains supplementary material, which is available to authorized users.

Time to re-think picky eating?: a relational approach to understanding picky eating

Background

Estimates of picky eating are quite high among young children, with 14-50% of parents identifying their preschoolers as picky eaters. Dietary intake and preferences during the preschool years are characterized by slowing growth rates and children developing a sense of autonomy over their feeding and food selection. We argue that the current conceptualization of picky eating defines acts of resistance or expressions of preference (acts of autonomy) by a child as deviant behaviour. This conceptualization has guided research that uses a unidirectional, parent to child approach to understanding parent-child feeding interactions.

Objectives

By reviewing the current feeding literature and drawing parallels from the rich body of child socialization literature, we argue that there is a need to both re-examine the concept and parent/clinician perspectives on picky eating. Thus, the objective of this paper is two-fold: 1) We argue for a reconceptualization of picky eating whereby child agency is considered in terms of eating preferences rather than categorized as compliant or non-compliant behaviour, and 2) We advocate the use of bi-directional relational models of causality and appropriate methodology to understanding the parent-child feeding relationship.

Discussion

Researchers are often interested in understanding how members in the parent-child dyad affect one another. Although many tend to focus on the parent to child direction of these associations, findings from child socialization research suggest that influence is bidirectional and non-linear such that parents influence the actions and cognitions of children and children influence the actions and cognitions of parents. Bi-directional models of causality are needed to correctly understand parent-child feeding interactions.

Conclusions

A reconceptualization of picky eating may elucidate the influence that parental feeding practices and child eating habits have on each other. This may allow health professionals to more effectively support parents in developing healthy eating habits among children, reducing both stress around mealtimes and concerns of picky eating.