Child and parent predictors of picky eating from preschool to school age

Avoidant/Restrictive Food Intake Disorder: Review and Recent Advances

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder recently codified in DSM-5 that affects individuals of all ages. A proliferation of ARFID research has emerged over the years, and this review provides a brief overview of the current understanding of ARFID epidemiology, symptoms, comorbid conditions, assessment, and treatment. The review highlights recent research updates regarding ARFID among adults, putative neurobiological mechanisms underlying ARFID, and new treatment trials. Findings from this review demonstrate that ARFID is as prevalent as other eating disorders, even among adults, and is associated with significant medical and psychiatric comorbid conditions. New, promising treatments for children, adolescents, and adults are in the early stages of development. Several assessments are now available to aid in the screening and diagnosis of ARFID and have demonstrated cross-cultural validity. Areas for future research and clinical guidance, including unresolved questions regarding ARFID categorization and differential diagnosis, are discussed.

Autistic traits and ARFID-associated eating behaviors in preschoolers: Mediating effects of sensory processing patterns

OBJECTIVE

This study aimed to examine the association between autistic traits and Avoidant Restrictive Food Intake Disorder (ARFID)-associated eating behaviors in preschool-age children and investigated whether this association was mediated by sensory processing patterns.

METHOD

A cross-sectional, parent-reported study was conducted between July 2022 and March 2023 among 503 preschoolers aged 4-6 years in China. Parents provided assessments of their children's autistic traits using the Social Responsiveness Scale, sensory processing patterns using the Short Sensory Profile 2, and ARFID-associated eating behaviors using the Nine Items ARFID Screen. The mediation model based on ordinary least squares regression was employed to test the mediating effects of sensory processing patterns between autistic traits and ARFID-associated eating behaviors.

RESULTS

The results indicated significant associations among autistic traits, ARFID-associated eating behaviors, and sensory processing patterns. Moreover, mediation analyses revealed that sensory processing patterns played a partial mediating role in the relationship between autistic traits and ARFID-associated eating behaviors. Specifically, autistic traits were observed to weaken ARFID-associated eating behaviors, particularly picky eating and poor appetite, through Registration, while simultaneously fostering them through Sensitivity and Avoiding.

DISCUSSION

Our study is limited to some extent by the inability to draw longitudinal conclusions from cross-sectional data. Nevertheless, it underscores the significance of early identification and intervention for food avoidance/restriction behaviors due to sensory processing abnormalities in children with heightened autistic traits. This proactive approach may contribute to mitigating ARFID-associated eating behaviors that might drive clinical symptoms of ARFID.

Association of preschool children behavior and emotional problems with the parenting behavior of both parents

BACKGROUND

Parental behaviors are key in shaping children's psychological and behavioral development, crucial for early identification and prevention of mental health issues, reducing psychological trauma in childhood.

AIM

To investigate the relationship between parenting behaviors and behavioral and emotional issues in preschool children.

METHODS

From October 2017 to May 2018, 7 kindergartens in Ma'anshan City were selected to conduct a parent self-filled questionnaire - Health Development Survey of Preschool Children. Children's Strength and Difficulties Questionnaire (Parent Version) was applied to measures the children's behavioral and emotional performance. Parenting behavior was evaluated using the Parental Behavior Inventory. Binomial logistic regression model was used to analyze the association between the detection rate of preschool children's behavior and emotional problems and their parenting behaviors.

RESULTS

High level of parental support/participation was negatively correlated with conduct problems, abnormal hyperactivity, abnormal total difficulty scores and abnormal prosocial behavior problems. High level of maternal support/participation was negatively correlated with abnormal emotional symptoms and abnormal peer interaction in children. High level of parental hostility/coercion was positively correlated with abnormal emotional symptoms, abnormal conduct problems, abnormal hyperactivity, abnormal peer interaction, and abnormal total difficulty scores in children (all P < 0.05). Moreover, paternal parenting behaviors had similarly effects on behavior and emotional problems of preschool children compared with maternal parenting behaviors (all P > 0.05), after calculating ratio of odds ratio values.

CONCLUSION

Our study found that parenting behaviors are associated with behavioral and emotional issues in preschool children. Overall, the more supportive or involved the parents are, the fewer behavioral and emotional problems the children experience; conversely, the more hostile or controlling the parents are, the more behavioral and emotional problems the children face. Moreover, the impact of fathers' parenting behaviors on preschool children's behavior and emotions is no less significant than that of mothers' parenting behaviors.

Food and nutrition information requirements of Australian primary school parents

OBJECTIVE

To explore what Australian primary school parents want to learn about food and nutrition to improve their children's eating behaviours, as well as the associations between parents' personal and demographic characteristics and their views regarding their food and nutrition knowledge needs.

DESIGN

An online nationwide cross-sectional survey was conducted in 2021 using a mixed-methods approach. Logistic regression analysis was utilised to examine the relationship between parents' demographics, personal values and their views. Content analysis was performed using Leximancer.

SETTING

Australia.

PARTICIPANTS

Seven hundred and eighty-seven parents.

RESULTS

Fifty-one per cent wanted to learn more about food and nutrition to improve their children's healthy eating habits, and 77% of those preferred schools to provide that information. Online/printed newsletters and YouTube were the most preferred methods for receiving food and nutrition related information. Higher universalism-concern value (concern for the welfare of those in the larger society and world) scores were positively associated parents' preference for schools to provide food and nutrition-related information. Parents with non-English-speaking backgrounds and younger parents were more likely to want to learn about food and nutrition. Parents wanted to learn more about encouraging healthy eating, ideas for the lunchbox, food labels and age-specific portion sizes and recommendations.

CONCLUSIONS

Findings can inform public health educators and assist them in designing future food and nutrition education programmes and resources targeting primary school parents.

Prevalence and recurrence of pica behaviors in early childhood within the ALSPAC birth cohort

OBJECTIVE

The present study examined prevalence and correlates of pica behaviors during childhood using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) study.

METHOD

Data on 10,109 caregivers from the ALSPAC study who reported pica behavior at 36, 54, 65, 77, and 115 months on their child were included. Autism was obtained through clinical and education records, while DD was derived from the Denver Developmental Screening Test.

RESULTS

A total of 312 parents (3.08%) reported pica behaviors in their child. Of these, 19.55% reported pica at least at two waves (n = 61). Pica was most common at 36 months (N = 226; 2.29%) and decreased as children aged. A significant association was found between pica and autism at all five waves (p < .001). There was a significant relationship between pica and DD, with individuals with DD more likely to experience pica than those without DD at 36 (p = .01), and 54 (p < .001), 65 (p = .04), 77 (p < .001), and 115 months (p = .006). Exploratory analyses examined pica behaviors with broader eating difficulties and child body mass index.

DISCUSSION

This study enhances understanding of childhood pica behaviors, addressing a significant gap in knowledge. Pica occurrence in the general population is poorly understood due to few epidemiological studies. Findings from the present study indicate pica is an uncommon behavior in childhood; however, children with DD or autism may benefit from pica screening and diagnosis between ages 36 and 115 months. Children who exhibit undereating, overeating, and food fussiness may also engage in pica behaviors.

Validation of the adult eating behavior questionnaire in a Norwegian sample of adolescents

Eating behaviors are related to health and well-being. To examine stability and change in eating behaviors throughout life, developmentally appropriate measures capturing the same eating behavior dimensions are needed. The newly developed Adult Eating Behavior Questionnaire (AEBQ) builds on the well-established parent-reported Children's Eating Behavior Questionnaire (CEBQ), and together with the corresponding Baby Eating Behavior Questionnaire (BEBQ), these questionnaires cover all ages. However, validation studies on adolescents are relatively sparse and have yielded somewhat conflicting results. The present study adds to existing research by testing the psychometric properties of the AEBQ in a sample of 14-year-olds and examining its construct validity by means of the parent-reported CEBQ. The current study uses age 14 data (analysis sample: n = 636) from the ongoing Trondheim Early Secure Study, a longitudinal study of a representative birth cohort of Norwegian children (baseline: n = 1007). Confirmatory factor analysis (CFA) was conducted to test the factorial validity of AEBQ. Construct validity was examined by bivariate correlations between AEBQ subscales and CEBQ subscales. CFAs revealed that a 7-factor solution of the AEBQ, with the Hunger scale removed, was a better-fitting model than the original 8-factor structure. The 7-factor model was respecified based on theory and model fit indices, resulting in overall adequate model fit (χ2 = 896.86; CFI = 0.924; TLI = 0.912; RMSEA = 0.05 (90% CI: 0.043, 0.051); SRMR = 0.06). Furthermore, small-to-moderate correlations were found between corresponding AEBQ and CEBQ scales. This study supports a 7-factor solution of the AEBQ without the Hunger scale and provide evidence of its construct validity in adolescents. Several of the CEBQ subscales were significantly associated with weight status, whereas this was the case for only one of the AEBQ scales.

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.

Child characteristic correlates of food rejection in preschool children: A narrative review

Dietary habits formed in early childhood are key for establishing a healthy diet later in life. Picky eating and food neophobia - the two main forms of food rejection in young children - form an important barricade to establishing such healthy habits. Understanding these types of food rejection is thus essential for promoting healthy eating behaviour in both children and adults. To this end, the present narrative review aims to provide an overview of food rejection research in preschool-aged children, focusing on recent advances in the cognitive literature. Specifically, we evaluate the link between children's cognitive development, chemosensory perception and affective evaluation of food, food knowledge, decision-making strategies, anxiety and disgust sensitivity, and food rejection behaviour. Longitudinal and experimental studies are necessary to establish how the relationships between food rejection and cognitive processes develop over time and to determine their causal directions.

Change in preference for vegetables and their perceptual attributes as a function of age and pickiness

Preference for vegetables is influenced by various factors, including demographic, psychological, socio-environmental, and genetic factors. This study confirmed that age, pickiness, and perceptual attributes were predictors of preference for vegetables and examined how preference for vegetables and their perceptual attributes varies with age and pickiness. Children (8-14 years, n = 420), youth (15-34 years, n = 569), middle-aged adults (35-64 years, n = 726), and older adults (65-85 years, n = 270) were asked which vegetables they liked (or disliked) and which perceptual attributes of each vegetable they liked (or disliked). On the basis of their responses, an overall preference score and a preference sub-score for each perceptual attribute were calculated. Participants in each age group were classified into four statuses (non-, mild, moderate, and severe) according to their pickiness scores. Multiple regression analysis revealed that age and preference sub-scores for eight perceptual attributes (sweetness, sourness, bitterness, umami, pungency, orthonasal aroma, texture, and appearance) were positive predictors of overall preference score and that pickiness score and four perceptual attributes (saltiness, astringency, retronasal aroma, and aftertaste) were negative predictors. In addition, overall preference score and preference sub-scores for perceptual attributes other than saltiness increased with increasing age group and decreasing picker status; however, preference sub-scores for at least one of the six perceptual attributes (bitterness, astringency, pungency, orthonasal aroma, retronasal aroma, and aftertaste) exhibited negative values in children, youth, and pickers (mild, moderate, and severe). The increase in preference for these perceptual attributes might be an indicator of the adultization of food perception and the expansion of food acceptance.

Fussy Eating Rescue, a mobile-web app for responsive feeding practises among parents of toddlers: protocol for a pilot randomised controlled feasibility trial

BACKGROUND

Fussy eating is most often a developmentally typical behaviour, generally presenting during toddlerhood. However, up to half of parents of young children are concerned about fussy eating, and this concern may mediate the use of nonresponsive feeding practises, such as coercive or unstructured feeding and using food to reward eating. Despite the high prevalence of parental concern for fussy eating and the negative impacts nonresponsive feeding practises have on children's health and diets, no previous digital intervention to improve the feeding practises of parents of toddlers concerned about fussy eating has been evaluated.

AIM

This article describes the protocol of a randomised controlled feasibility pilot aiming to evaluate Fussy Eating Rescue, a purely web app based intervention for parents of toddlers. The primary aim is to investigate feasibility and acceptability; secondary aims are to explore indications of intervention effect on parents' feeding practises or children's eating behaviours.

METHODS

Fussy Eating Rescue features include: (1) a Tracker, that allows parents to track repeated offers of food, (2) Topics, providing information on fussy eating, effective feeding strategies, and general nutrition, (3) Rescues, containing quick references to material supporting Topics contents, (4) Recipes, and (5) SMS notifications. Parents of toddlers (12-36 months old, n = 50) who have concerns about fussy eating will be recruited via Facebook. Parents will be randomised to an intervention group, which receives access to the app for 6 weeks, or to wait-listed control. Outcomes will be assessed at baseline and 6 weeks after app use, using online questionnaires and app usage statistics. Primary outcomes include participant retention rate, intervention engagement, app usability, perceived ease in using the app, perceived usefulness of the app, and user satisfaction. Secondary outcome measures include parents' feeding practises and children's eating behaviours.

DISCUSSION

Results will inform whether Fussy Eating Rescue is a feasible way to engage parents concerned for their toddler's fussy eating behaviours. If feasible and acceptable to users, a larger trial will further examine the efficacy of the Fussy Eating app in improving parents' feeding practises and children's eating behaviours.

TRIAL REGISTRATION

Prospectively registered with the Australian New Zealand Clinical Trials Registry on 15 July, 2021 (ACTRN12621000925842).

Examining links between child temperament and feeding, eating, and weight outcomes: An updated systematic review of the literature

BACKGROUND

Weight outcomes have been associated with child temperament, defined as individual differences in reactivity and self-regulation. The current systematic review aims to provide an updated summary of the evidence linking temperamental negative reactivity, surgency, and regulation superfactors to early childhood feeding, eating, and weight outcomes.

METHODS

PubMed, PsycINFO and Embase databases, as well as scientific meeting programs, were searched using keywords and subject headings. Publication dates were limited to 2012-2019 as prior reviews were published in 2012 and 2014. Identified studies were eligible if they included children ages 0-5 years, a measure of child temperament, and a measure of parent/caregiver feeding, child eating, or child weight. 7113 studies were identified and 121 met inclusion criteria.

RESULTS

Feeding, eating, and weight outcomes were largely unrelated to overarching negative reactivity, surgency, and effortful control superfactors. Examination of individual temperament dimensions suggested difficult temperament was frequently linked to non-responsive feeding practices, whereas elevated emotionality and decreased self-regulation were linked to maladaptive eating behaviors, and lower inhibitory control to adiposity. Analyses with infants reported greater percentages of significant associations compared to children, and cross-sectional studies generally reported fewer significant associations than other study designs.

CONCLUSIONS

Difficult temperament, greater emotionality and lower self-regulation and inhibitory control were the aspects of temperament most consistently related to poorer early childhood feeding, eating, and weight outcomes. Associations tended to be stronger in infancy, and when examined within a non-cross-sectional study design. Findings can inform the development of tailored efforts to promote healthy eating and growth throughout childhood.

How multiple threats to safety affects quality of life for picky eating adults: A new explanatory model

Picky eating describes a pattern of eating characterised by a narrow dietary range with rejection of both novel and familiar foods. Research has suggested that picky eating in adulthood is associated with several negative psychosocial outcomes including impaired quality of life. This research aimed to build and test a model explaining the relationship between picky eating and quality of life. 230 participants were recruited via online support forums for picky eating, and an undergraduate research participation scheme. Participants completed self-report measures of picky eating, sensory sensitivity, disgust, anxiety, fear of negative evaluation and eating related quality of life. Regression analysis indicated that picky eating, disgust sensitivity, anxiety, and fear of negative evaluation were all associated with impaired eating-related quality of life. A theoretical model was then devised which aimed to explain the interactions between these factors, and Path Analysis indicated that this model was a good fit for the data. This Safety in Picky Eating and Quality of life (SPEQ) model suggests that threat perception and the drive for safety underlies the relationship between picky eating and impaired quality of life. The SPEQ model provides a preliminary basis for understanding how picky eating impacts quality of life in adulthood.

Oral exploration and food selectivity: A case-control study conducted in a multidisciplinary outpatient setting

BACKGROUND

Pediatric feeding disorders (PFDs) are common, and their great phenotypic variability reflects the breadth of the associated nosological profiles. PFDs should be assessed and managed by multidisciplinary teams. Our study aimed to describe clinical signs of feeding difficulties in a group of PFD patients assessed by such a team, and to compare them with children in a control group.

METHODS

In this case-control study, case group patients 1 to 6 years old were consecutively recruited through the multidisciplinary unit for the treatment of pediatric feeding difficulties based at Robert Debré Teaching Hospital in Paris, France. Children with an encephalopathy, severe neurometabolic disorder, or genetic syndrome (suspected or confirmed) were excluded. Members of the control group, consisting of children with no feeding difficulties (i.e., Montreal Children's Hospital Feeding Scale scores below 60) or severe chronic diseases, were recruited from a day care center and 2 kindergartens. Data from medical histories and clinical examination related to mealtime practices, oral motor skills, neurodevelopment, sensory processing, and any functional gastrointestinal disorders (FGIDs) were recorded and compared between groups.

RESULTS

In all, 244 PFD cases were compared with 109 controls (mean ages: cases, 3.42 [±1.47]; controls, 3.32 [±1.17]; P = 0.55). Use of distractions during meals was much more among PFD children (cases, 77.46%; controls, 5.5%; P < 0.001), as was conflict during meals. While the groups did not differ in their members' hand-mouth coordination or ability to grab objects, cases began exploring their environments later; mouthing, especially, was less common in the case group (cases, n = 80 [32.92%]; controls, n = 102 [94.44%]; P < 0.001). FGIDs and signs of visual, olfactory, tactile, and oral hypersensitivity were significantly more frequent among cases.

CONCLUSION

Initial clinical assessments showed that, in the children with PFDs, normal stages of environmental exploration were altered, and that this was often associated with signs of sensory hypersensitivity and digestive discomfort.

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.

Association between the dietary literacy of children's daily diet providers and school-age children's nutritional status and eating behaviours: a cross-sectional study

BACKGROUND

Overweight and obesity rates have increased rapidly in Chinese school-age children, and previous studies have indicated that poor dietary literacy can lead to unhealthy eating behaviours. However, few studies have investigated the association between the dietary literacy of daily diet providers and the eating behaviours and nutritional status of school-age children raised by the providers. Thus, we aimed to explore this association.

METHODS

We collected data on the eating behaviours and nutritional status of children in two primary schools in Anhui Province, as well as the dietary literacy of their daily diet providers. T-tests, one-way ANOVA, chi-square tests, and multiple linear regression were used to analyse the association.

RESULTS

We found significant differences in the scores on the Questionnaire of Children's Daily Diet Providers' Dietary Literacy (QCDDPDL) by region, relationship with the child, age, and educational level of the daily diet provider (all p < .05). Moreover, the children in the low QCDDPDL score group were inclined to engage in unhealthy eating behaviours such as emotional undereating and overeating (p < .05). In addition, the incidence of overweight and obesity was higher in the low QCDDPDL attitude score group than in the high score group (p = .006).

CONCLUSIONS

Our study showed that the dietary literacy of diet providers may influence children's health and eating behaviours. Improving the dietary literacy of diet providers may promote the health status and eating behaviours of school-age children.

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.

Picky Eating in Childhood: Associations With Obsessive-Compulsive Symptoms

OBJECTIVE

To test whether childhood picky eating (PE)-a behavior previously linked to many forms of psychopathology-is specifically associated with symptoms of obsessive-compulsive disorder (OCD).

METHODS

We investigated the relationship between PE and symptoms of several forms of psychopathology in two separate observational samples: a sample of 110 children (5 and 6 years old) and a sample of 210 children (8 and 9 years old) drawn from a longitudinal study. In each sample, regression models based on psychiatric symptoms or diagnoses were used to assess the specificity of PE associations while accounting for cooccurring symptoms or comorbidities.

RESULTS

Although bivariate associations emerged between PE and multiple forms of psychopathology, multivariate analyses revealed these associations were driven by a strong and specific association between PE and symptoms of OCD in both samples. Moreover, PE among 8- and 9-year-olds in the longitudinal study predicted emergence of additional later psychopathology, specifically attention-deficit/hyperactivity disorder (ADHD).

CONCLUSIONS

Findings suggest that PE, an easily identifiable clinical presentation, is also a specific marker for obsessive-compulsive symptomatology in school-age children and may impart risk for ADHD later in childhood.

The lived experience of parenting a child with sensory sensitivity and picky eating

“Picky eating” is a common behaviour seen in childhood in both clinical and nonclinical populations. Sensory processing difficulties have been repeatedly associated with food refusal and picky eating behaviours. The aim of this study was to explore the lived experiences of parents/caregivers who have a child displaying both sensory processing differences and picky eating behaviours utilising Interpretative Phenomenological Analysis (IPA). Participants were recruited from social media support groups for parents of picky eating children. Pre‐selection criteria utilised an adapted short sensory profile questionnaire to ensure the children displayed probable/definite taste‐smell, audio‐visual and tactile sensory sensitivities. Twelve participants fulfilling the required criteria were interviewed face to face utilising a semi‐structured interview schedule. Interviews were transcribed and analysed following IPA guidelines and three common themes are presented here: Battling for control of the sensory environment, Living with stigma and, disapproval, and Staying positive and moving forward. The findings show the very considerable day‐to‐day challenges of parenting a child with sensory issues with food, including a lack of support and criticism from others. It was apparent that the parents in our study gradually adopted a positive and accepting attitude to their child's eating. This acceptance allowed them to have positive interactions around food with their child such as cooking and playing with food, suggesting that experiential activities serve an important purpose in this population. Further research should examine whether parental interventions based on acceptance of child eating behaviour, and commitment to gradual positive food interactions would be the best strategy to support parents and children.

Picky eating in children with sensory processing difference led to specific behaviours around food, for example, the identification of very small sensory differences in foods, and between different brands of the same foods. This caused disruption at family mealtimes, extra food preparation work, and judgement from others.

Parents all expressed a need for better awareness and support from health professionals and the wider public. Those who used online support groups found great comfort and advice from parents experiencing similar problems

Parents seemed to go on a journey of acceptance of their child's behaviour, and tried to adopt positive food parenting strategies. In particular, they used experiential learning strategies such as playing with, cooking with, and shopping for food which allowed them to interact with their child and food in a positive way.

Oral Sensory Sensitivity Influences Attentional Bias to Food Logo Images in Children: A Preliminary Investigation

Background

Children's sensory processing patterns are linked with their eating habits; children with increased sensory sensitivity are often picky eaters. Research suggests that children's eating habits are also partially influenced by attention to food and beverage advertising. However, the extent to which sensory processing influences children's attention to food cues remains unknown. Therefore, we examined the attentional bias patterns to food vs. non-food logos among children 4-12 years with and without increased oral sensory sensitivity.

Design

Children were categorized into high (n = 8) vs. typical (n = 36) oral sensory sensitivity by the Sensory Profile-2. We used eye-tracking to examine orientation and attentional bias to food vs. non-food logos among children with high vs. typical oral sensory sensitivity. We used a mixed model regression to test the influence of oral sensory sensitivity to attentional biases to food vs. non-food logos among children.

Results

Results showed that children with high oral sensory sensitivity showed attentional biases toward non-food logos; specifically, children with high oral sensory sensitivity oriented more quickly to non-food logos as compared to food logos (p < 0.05), as well as spent more time looking at non-food logos as compared to food logos (p < 0.05). Findings were in the opposite direction for children with typical oral sensory sensitivity.

Conclusion

Sensory sensitivity may be an individual characteristic that serves as a protective mechanism against susceptibility to food and beverage advertising in young children.

Beyond emotion: online takeaway food consumption is associated with emotional overeating among Chinese college students

BACKGROUND

Online takeaway food has become very popular in China. However, the potential effects of online takeaway food consumption on eating behaviours among individuals during the transition stage from adolescence to young adulthood have not yet been assessed.

OBJECTIVE

This study aimed to examine the effects of takeaway food consumption on emotional overeating behaviour among college students.

METHODS

Data were collected from 1450 college students from six universities in Anhui, China. The frequency of emotional overeating during the past 4 weeks was assessed by the emotional overeating questionnaire (EOQ). Data on the frequency of online takeaway food consumption and other potential risk factors at the individual, interpersonal, physical environment, and macro-system levels were assessed by questionnaire. Multilevel linear regression analyses were employed to explore the association between takeaway food consumption and emotional overeating behaviour.

RESULTS

Compared to those who consumed online takeaway food less than 1 day per week, participants who consumed this food 4-5 days per week and participants who consumed this food 6-7 days per week had significantly higher EOQ scores (β = 0.14, p < 0.05 and β = 0.67, p < 0.001, respectively). More frequent consumption was associated with higher EOQ scores (p for trend < 0.001).

CONCLUSION

A higher frequency of takeaway food consumption was associated with an elevated risk of emotional overeating among college students independent of personal emotional status and other potential confounders at the interpersonal, physical environmental and macro-system levels.

LEVEL OF EVIDENCE

Level V; cross-sectional descriptive study.

Picky Eating in Children: A Scoping Review to Examine Its Intrinsic and Extrinsic Features and How They Relate to Identification

The health benefits and importance of family mealtimes have been extensively documented. Picky eating can impact this complex activity and has numerous extrinsic (or external) and intrinsic (or internal) features. Occupational therapists work with children and their families by looking at both intrinsic and extrinsic influences and are therefore well-placed to work within this context. This scoping review comprises a comprehensive search of key health industry databases using pre-determined search terms. A robust screening process took place using the authors pre-agreed inclusion and exclusion criteria. There were 80 studies that met the inclusion criteria, which were then mapped using content analysis. The most common assessments used to identify picky eating relied on parental reports and recall. Often additional assessments were included in studies to identify both the intrinsic and extrinsic features and presentation. The most common reported intrinsic features of the child who is a picky eater included increased sensitivity particularly to taste and smell and the child's personality. Extrinsic features which appear to increase the likelihood of picky eating are authoritarian parenting, rewards for eating, and pressuring the child to eat. Most commonly reported extrinsic features that decrease the likelihood of picky eating are family meals, responsive parents, and involving the child in the preparation of food. In conclusion, there is a lack of published papers addressing the role of occupational therapists in the assessment and identification of picky eating in children. There appears to be a complex interplay between intrinsic and extrinsic features which impact caregiver responses and therefore on the picky eater.

Picky Eating in School-Aged Children: Sociodemographic Determinants and the Associations with Dietary Intake

Children exhibiting picky eating behavior often demonstrate strong food preferences and rejection of particular foods or food texture, which may lead to limited dietary variety and possibly inadequate or unhealthy diet. Yet, the relationship between picky eating and nutrient intake in school-aged children has not been established previously. This study aimed to investigate the sociodemographic determinants of picky eating and the associations between picky eating and dietary intake in children. Data of 424 healthy Saudi children aged 6–12 years were collected from their mothers. A child’s picky eating habits were captured using a validated questionnaire. Sociodemographic characteristics of the children were assessed. Dietary data, including 24 h dietary recalls and frequency of fruit, vegetable, and milk consumption, were collected by dietetic professionals using phone-administered interviews. Compared to those of normal-weight mothers, children of mothers with obesity had higher odds of being in the highest tertile of picky eating (OR = 1.93; 95% CI 1.02, 3.63). Children exhibiting higher levels of picky eating consumed less fruits (B = −0.03; 95% CI −0.06, −0.01), vegetables (B = −0.05; 95% CI −0.07, −0.02), and protein (B = −0.21; 95% CI −0.33, −0.09), and had higher consumption of trans fatty acid intake (B = 1.10; 95% CI 0.06, 2.15). Children with higher levels of picky eating presented unhealthy dietary behaviors. Future studies are needed to examine the long-term effect of picky eating on cardiovascular health. Dietary behaviors of mothers with obesity must be taken into consideration when designing intervention programs aiming to improve eating behaviors of children.

Associations between supportive and undermining coparenting and controlling feeding practices

Parents play an important role in shaping child eating and weight outcomes through feeding practices. Controlling feeding practices are positively related to child obesogenic eating and obesity risk. Although many parents' characteristics have been examined in relation to controlling feeding practices, less is known about the role of coparenting. The current study seeks to examine whether coparenting (supportive versus undermining) predict controlling feeding practices (use of food for emotion regulation, food as a reward, pressure to eat, restriction for health, restriction for weight). A total of 160 parents (56% females) of preschool-aged children between 3- and 5-years old completed an online survey. After accounting for parent characteristics (i.e., sex, BMI, age), regression analyses showed that supportive coparenting was not predictive of controlling feeding practices. However, regression analyses showed that undermining coparenting predicted greater use of food for emotion regulation, food as a reward, and restriction for weight, but was not predictive of pressure to eat and restriction for health. Implications associated with these findings are discussed.

Gender and racial/ethnic differences in food selectivity in children with intellectual disabilities

BACKGROUND

We examined differences in food selectivity by gender and parent race/ethnicity in children with intellectual disabilities.

METHOD

A convenience sample of 56 children with intellectual disabilities was analysed. A modified Youth/Adolescent Food Frequency Questionnaire and a 3-day food record were used to measure child food refusal rate and food repertoire, respectively.

RESULTS

Boys were about twice as likely to refuse total foods (rate ratio = 2.34, 95%CI = 1.34-4.09) and fruits (rate ratio = 2.03, 95%CI = 1.04-3.95) and 54% more likely to refuse vegetables (rate ratio = 1.54, 95%CI = 0.93-2.54). Children with Hispanic parents were twice as likely to refuse vegetables compared to children with non-Hispanic White parents (rate ratio = 2.00, 95%CI = 1.03-3.90). In analyses stratified by the presence or absence of co-occurring probable autism spectrum disorder, boys had greater food selectivity than girls.

CONCLUSIONS

This study expands our understanding of food selectivity in children with intellectual disabilities.

A longitudinal study of maternal feeding and children's picky eating

This study aimed to estimate the rate of persistent picky eating (PE) in children 3-8 years of age, and to characterize children with PE and their mothers. From a base sample of 1055 mothers of children 3.4 ± 1.3 years old, we selected those who described their children as picky eaters (PEs; n = 185, 17.5%) for a longitudinal study. 109 PE dyads participated, as well as a matched comparison group of dyads without PE (n = 106). At T1 mothers self-reported on trait anxiety, perfectionism, attachment style; as well as on the child's behavioral problems, their temperament, and their executive function. The participants were re-evaluated twice, at two-year intervals (T2 and T3). At T2 the mothers self-reported on their personality, on their child feeding practices, and reported their child's eating behavior. At T3 the mothers self-reported on their feeding style and the children self-reported on a pictorial frequent food questionnaire. PE persisted throughout T2 and T3 in 22.5% of T1 PE children in the longitudinal study, or in 3.94% of the base sample. The child characteristics that distinguished the PE and non-PE groups at T1 predicted 9-10% of the variance of T3 PE. Maternal feeding practices at T2 contributed 1-2% to the explained variance. It can be concluded that for the overwhelming majority of children, PE is a passing phase. Maternal feeding practices have limited long-term influence on children's PE. Unless PE is persistent and severe, parents would best be advised to relax their feeding efforts.

Assessment of the nutritional status of children according to maternal reports: Are mothers' perceptions of their children's appetite accurate?

INTRODUCTION

This study determined whether there is a difference in the nutritional status of children with good and poor appetites, as reported by their mothers.

METHODS

In all, 70 volunteer mothers of children aged 6-60 months participated in the study. Information about the nutrition of the child was obtained from the mothers via a questionnaire.

RESULTS

Based on the mothers' statements, no significant difference was found in the mean or median values of the anthropometric measurements between children with good and poor appetites (p>.05), and no significant difference was observed between daily consumed energy and macro- and micronutrients (p>.05). While the blood zinc levels of children with a good appetite were higher than those with a poor appetite (p<.05), there was no difference regarding other parameters (p>.05).

CONCLUSION

In this study, no significant difference was evident between children defined as having good or poor appetite by their mothers, especially in terms of energy and nutrients.

Maternal Depressive Symptoms and Perceived Picky Eating in a Low-Income, Primarily Hispanic Sample

OBJECTIVE

Feeding concerns are common in the first 2 years of life and typically reflect maternal perceptions occurring within the larger context of the parent-child relationship. We aimed to determine whether (1) maternal depressive systems predicted perceived picky eating, mediated by maternal negative perceptions; (2) receipt of the Video Interaction Project (VIP) parenting intervention impacted perceived picky eating through this pathway; and (3) perceived picky eating was associated with child growth or subsequent dietary patterns.

METHODS

We performed a partial longitudinal analysis of 187 low-income, predominantly Hispanic mother-child dyads enrolled in a randomized controlled trial of the VIP. Mother-infant dyads were enrolled postpartum in an urban public hospital. Participants randomized to the VIP met with an interventionist on days of well-child visits; sessions were designed to facilitate interactions in play and shared reading through provision of learning materials and review of videotaped parent-child interaction; the curriculum did not contain feeding-specific elements. We used structural equation modeling to determine direct, indirect, and total effects of maternal depressive symptoms, maternal negative perceptions, and the VIP on perceived picky eating. We then tested associations between perceived picky eating and (1) child growth, using multivariable linear regression and multilevel modeling; and (2) subsequent child dietary consumption, using multivariable multinomial logistic regression.

RESULTS

Maternal depressive symptoms had significant total effects on negative maternal perceptions (β = 0.32, p < 0.001) and perceived picky eating (β = 0.21, p < 0.01) after controlling for potential confounders. This effect was partially mediated by maternal negative perceptions (indirect effect: β = 0.06, p = 0.04). When used in the model as the predictor, the VIP had a significant total effect on perceived picky eating (β = -0.16, p = 0.02), which was partially mediated by maternal depressive symptoms and negative perceptions (indirect effect: β = -0.05, p = 0.02). Perceived picky eating was not associated with child diet at age 2 years or adiposity from 6 months to 3 years.

CONCLUSION

Maternal concerns about picky eating may reflect deeper depressive symptoms and negative perceptions of her child's behavior. Interventions designed to facilitate positive parenting in general may lessen feeding-specific concerns, such as picky eating. Although reassurance about growth and nutritional outcomes for children perceived as picky eaters is appropriate, clinicians should also consider probing for underlying symptoms of depression that could lead to eating concerns.

Maternal prompting types and child vegetable intake: Exploring the moderating role of picky eating

BACKGROUND

It is unknown if using different maternal prompting types is associated with vegetable intake in children perceived to be picky versus non-picky.

OBJECTIVES

1) To test the correlation of counts of maternal prompting types with child vegetable intake, and picky eating, 2) to examine the interaction of prompting types and picky eating status on vegetable intake.

DESIGN/METHODS

Low-income mother-child dyads (N = 199, mean child age 6.0 years) participated in a videotaped laboratory eating protocol with green beans, a familiar vegetable. A coding scheme was developed and reliably applied to categorize mothers' prompting types. The prompting types were: Coercive Control (Sub-Categories: Reward and Pressure-to-Eat), Autonomy Promotion (Sub-Categories: Modeling, Reasoning, Praise, and Question), and Total Prompts (sum of all prompts). Mothers completed questionnaires. Bivariate analyses tested the association between counts of maternal prompting types with amount of green beans eaten, and picky eating. Regression analyses examined the interaction of picky eating status with counts of maternal prompting type on amount of green beans eaten.

RESULTS

Mothers used on average 1.66 prompts. Greater use of Coercive Control, Autonomy Promotion-Modeling, and Total Prompts were all inversely correlated with amount of green beans eaten. Greater use of Autonomy Promotion-Praise was directly correlated with amount of green beans eaten. In stratified models, greater use of Coercive Control prompts was negatively associated with amount of green beans eaten by the child in non-picky eaters, but not in picky eaters. There was no interaction between other prompting types and child picky eating status in predicting amount eaten. All p-values <0.05.

CONCLUSIONS

Mothers use different prompting types to encourage their children to eat vegetables depending on their picky eating status, most of which may be correlated with reduced intake.

Food neophobia and pickiness among children and associations with socioenvironmental and cognitive factors

Food neophobia and picky eating are common behaviors exhibited among children that may impact their nutritional health. Due to the limited data available regarding food neophobia and pickiness in Saudi Arabia, this study aimed to estimate the prevalence of picky eating and food neophobia among Saudi children and to examine the association of socioenvironmental and cognitive factors with food neophobia and pickiness. The study included 216 healthy children with no known allergy, aged 3-7 years old, recruited from six schools in Jeddah, Saudi Arabia. A questionnaire was utilized to collect sociodemographic information from parents. Food neophobia and pickiness were evaluated using 2 separate scales. Socioenvironmental factors that may contribute to the development of food neophobia and pickiness were evaluated, such as breastfeeding duration and weaning practices, parental strategies, peer modeling, and social facilitation. Sensory sensitivity and disgust were also evaluated to assess the association with cognitive factors. Linear regression analysis with 95% confidence intervals was used to test the associations with the selected socioenvironmental and cognitive factors. The majority of children showed moderate to severe food neophobia and pickiness (98.6% and 89.8%, respectively). The socioenvironmental factors of peer modeling and selected parental strategies were found to have a significant association with food neophobia and pickiness. Assessed cognitive factors were found to be associated with food neophobia and pickiness. Future studies investigating causes of food neophobia and food pickiness among children are warranted.

Picky eating in children: causes and consequences

Picky eating is a common behaviour in early childhood. There is neither a universally accepted definition of picky eating, nor is there agreement on the best tool to identify it. Causes of picky eating include early feeding difficulties, late introduction of lumpy foods at weaning, pressure to eat and early choosiness, especially if the mother is worried by this; protective factors include the provision of fresh foods and eating the same meal as the child. The consequences for the child's diet include poor dietary variety and a possible distortion of nutrient intakes, with low intakes of iron and zinc (associated with low intakes of meat, and fruit and vegetables) being of particular concern. Low intakes of dietary fibre, as a result of low intakes of fruit and vegetables, are associated with constipation in picky eaters. There may be developmental difficulties in some children with persistent picky eating. There is little evidence, however, for a consistent effect of being a picky eater on growth trajectories. There may be a small subgroup of children in whom picky eating does not resolve who might be at risk of thinness during adolescence, or of developing an eating disorder or adult picky eating: these children need to be identified at an early age to enable support, monitoring and advice to be offered to parents. Strategies for avoiding or ameliorating picky eating include repeated exposures to unfamiliar foods, parental modelling of eating fruit and vegetables and unfamiliar foods, and the creation of positive social experiences around mealtimes.

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.

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.

Home feeding environment and picky eating behavior in preschool-aged children: A prospective analysis

OBJECTIVE

Picky eating is prevalent in young children and is associated with poor dietary quality and nutrient deficiencies. Identifying predictors of picky eating could inform the development of anticipatory feeding guidance for parents and caregivers of young children. This study identified the association between factors of the home feeding environment with picky eating behavior in a cohort of preschool-aged children.

METHODS

Parents of preschool-aged children (n = 497) completed questionnaires including measures of the home feeding environment (i.e., television during mealtime, family mealtime routines, and feeding practices) and child picky eating behavior. The questionnaire was repeated one year later, in which 326 parent-child dyads participated. Logistic regression was used to determine the cross-sectional and prospective associations between home feeding environment measures and child picky eating behavior outcomes.

RESULTS

Child control over feeding and watching television during mealtime were associated with higher odds of picky eating behavior in both cross-sectional and prospective analyses. A higher sense of positive climate during family meals and mealtime ritualization was associated with lower odds of picky eating behavior one year later.

CONCLUSION

The home feeding environment plays a role in the development of young children's picky eating behavior. Avoiding the television and maintaining parent control of food choices during mealtimes could lead to improvements in children's food preferences and dietary intake.

Emotional Over- and Undereating in Children: A Longitudinal Analysis of Child and Contextual Predictors

Eating more or eating less in response to negative emotions, called emotional over- and undereating, is common in children, but research on the etiology of these behaviors is in its infancy. Drawing on a large, representative community sample of Norwegian children followed up on a biennial basis from 6 to 10 years of age (analysis sample: n = 802), child and contextual predictors (i.e., child temperament, depression symptoms, serious life events, family functioning, parental sensitivity and structuring) of change in emotional over- and undereating were examined. Results revealed that low (temperamental) soothability and less parental structuring at age 6 predicted increased emotional overeating at age 10 and that lower family functioning at age 6 predicted more emotional undereating during the same period.

Sensory sensitivity mediates the relationship between anxiety and picky eating in children/ adolescents ages 8-17, and in college undergraduates: A replication and age-upward extension

This study explores the relationships among anxiety, sensitivity to sensory stimuli, and picky eating (PE). An earlier study in 95 children ages 5-10 found that sensory sensitivity fully mediated the relationship between anxiety and picky eating. We replicated this finding in a sample of 158 children, ages 8-17, and in 813 young adult college students. As in the previous child sample, the relationship between anxiety and picky eating appears to be mediated by sensory sensitivity. This relationship extends into adolescence and young adulthood and holds even in a sample of children with obsessive-compulsive-spectrum and anxiety disorders. However, there may be developmental differences in the relationship between sensory sensitivity and PE; the magnitude of this relationship was significantly greater for children than young adults. Although there was a trend towards a stronger relationship in a subsample of young adults with high anxiety, the effect was still smaller than that observed in children, suggesting that this difference is developmental and not completely driven by higher anxiety in the child sample. Sensory sensitivity is a candidate mechanism of picky eating, although the cross-sectional nature of this study means that we cannot address whether it is an etiological or maintaining mechanism, or both. Implications for behavioral treatment of picky eating in clinically anxious and non-clinical samples are discussed.

Observing Maternal Restriction of Food with 3⁻5-Year-Old Children: Relationships with Temperament and Later Body Mass Index (BMI)

Overt parental restriction of food has previously been associated with child weight; however, most research has relied on self-reported feeding behaviour, or observations which give little opportunity to observe restriction of food. Using a novel lab-based observational technique to increase the opportunity to observe maternal feeding restriction, we explored the relationships between maternal restriction, child responses to restriction and child temperament with child body mass index (BMI) Z-scores over time. Sixty-two mother child dyads were recruited to the study when their children were aged 3⁻5 years and were followed up 2 years later (N = 39 dyads). Families were observed during a feeding interaction in the laboratory where cookies were offered with the main meal to increase the opportunity for maternal restriction of food. Feeding observations were coded and child temperament and BMI were measured. Controlling for current child BMI Z-scores, greater maternal verbal and physical restriction of food at 3⁻5 years was related to higher child BMI Z-scores at 5⁻7 years. More emotional children were less likely to experience restriction and less likely to accept attempts to restrict their food intake. Further research should consider children&rsquo;s reactions to parental feeding behaviours in greater depth and explore how feeding practices interact with child temperament in the prediction of changes in child weight.

Socioeconomic Position and Picky Eating Behavior Predict Disparate Weight Trajectories in Infancy

Infant weight gain has long-term implications for the establishment of overall health. We examined whether socioeconomic position (SEP), the use of pressure as a feeding practice, and picky eating relate to changes infant in weight-for-length (WFL). A modified developmental design was used to examine whether current levels of child picky eating, parental use of pressure, and SEP were associated with changes in WFL during infancy. Health providers distributed survey packets during routine well-child visits made in the homes of families with young children in New Zealand (n = 193). Primary caregivers of young children provided their child's current level of picky eating, their use of pressure, and their SEP. They also reported their child's professionally-measured WFL from birth, 8, 15, and 21 months of age. A multi-level modeling analysis yielded an interaction between SEP and picky eating in predicting infant weight change over time. Children who had a low SEP and were not picky eaters were on the highest WFL trajectory and children who had a low SEP and were picky eaters were lowest on the WFL trajectory. A main effect revealed that higher levels of parental pressure predicted lower WFL in infants at each age, but did not interact with SEP or picky eating. Findings from this study indicate that the combination of eating behavior and SEP are associated with differential infant growth patterns. These results suggest that eating behavior and SEP should be included in the development of interventions designed to achieve healthy weight during childhood.