The Feeding Practices and Structure Questionnaire: development and validation of age appropriate versions for infants and toddlers

Responsive feeding practices among Arabic and Mongolian speaking migrant mothers in Australia: A qualitative study

Establishing healthy feeding habits during infancy is crucial for optimal growth. However, certain parental feeding and cultural practices might hinder the development of children's healthy eating behaviours. This research explored responsive feeding practices among migrant mothers in Australia. Semi-structured telephone interviews were conducted in their native language with 20 Arabic and 20 Mongolian-speaking migrant mothers with children under 2 years old or currently pregnant. Thematic analysis was conducted using the framework method. Both cultural groups followed a variety of feeding practices, including on demand responsive feeding or structured schedules. Arabic-speaking mothers tended to demonstrate responsive feeding practices more frequently than Mongolian-speaking mothers, except for those using formula feeding, who consistently followed a fixed feeding routine. When introducing solid foods, mothers from both groups often overlooked their babies' hunger and satiety cues, frequently pressuring their children to finish their entire plate. One cited reason for this was the challenge parents faced in identifying such cues. Arabic-speaking mothers often supplemented with formula top-ups after introducing solid foods, due to the belief that breast milk or solid foods alone might not sufficiently nourish their infants. Additionally, some Arabic-speaking mothers used food-based rewards to encourage eating. Mongolian mothers expressed a cultural preference for chubby babies, a potential reason why they may have been inclined to pressure-feed their children. Moreover, both groups reported using digital devices to distract their children during meals. This study highlights the necessity of tailoring future resources and services related to responsive feeding practices to accommodate diverse literacy levels and cultural backgrounds.

Validity and reliability of the Yonsei lifestyle profile-active, balance, connection, diversity

INTRODUCTION

Lifestyle, defined as a way of living resulting from an individual's deliberate choices, is a crucial factor in improving and maintaining health. Consequently, the measurement and analysis of lifestyle are of significant importance. This study aims to validate the validity and reliability of the Yonsei Lifestyle Profile-Active, Balance, Connection, Diversity (YLP-ABCD) in measuring health-related lifestyles.

METHODS

Data were collected from 300 participants aged 55 and older using the YLP-ABCD. To analyse the validity and reliability of the YLP-ABCD, analysed using frequency, descriptive statistics, confirmatory factor analysis, and Rasch model analysis.

RESULTS

The results indicate that the YLP-ABCD, which consists of 35 items, demonstrates unidimensionality and local independence. The Rasch model confirmed the suitability of the 5-point Likert scale for the factors, excluding subfactors Balanced and Unbalanced. The item fit criteria (0.5 < MNSQ < 1.5) were met for all items. The distribution of the respondents' abilities suggests the need for additional items to measure their ability levels. Both the item and respondent separation indices and their reliabilities were satisfactory.

CONCLUSION

This study confirmed the utility of the YLP-ABCD as a valuable tool for measuring and understanding the multifaceted diversity of lifestyles. Therefore, by utilising YLP-ABCD to quantitatively measure health lifestyles, we anticipate contributing to improvements in human health and quality of life.

Parent feeding practices in infants and toddlers referred to a hospital-based feeding program in the United States

While considerable research exists on parent feeding practices for infants and toddlers, past research has not focused on children with feeding problems. The goal of this study was to identify parent feeding practices in a sample of infants (n = 178) and toddlers (n = 221) referred to a hospital-based feeding clinic and then examine how these parent feeding practices were correlated with specific feeding problems. Parents completed surveys to report child demographics, feeding problems, and use of 54 feeding practices. Forty-eight (88.8%) of 54 practices were utilized more often for toddlers than for infants. Exploratory factor analysis with the 54 practices and the full sample (n = 399) produced the 16-item Baby Parent Mealtime Action Scale (BPMAS) with three dimensions: Multiple Food Offers, Use of Cereal/Pureed Foods, Use of Toys/TV. Controlling for demographics, hierarchical regression examined how each BPMAS dimension was associated with five feeding problems (underweight, tube feeding, texture problems, limited diet, mealtime disruption). Multiple Food Offers (e.g., daily offering of vegetables, offering foods from the family meal) was the dimension most correlated with fewer feeding problems such as tube feeding (β = -0.220, p < 0.001), texture rejection (β = -0.361, p < 0.001), and limited diet variety (β = -0.175, p < 0.001), but also with more mealtime disruption (β = 0.231, p < 0.001). Use of Toys/TV was correlated with more mealtime disruption (β = 0.260, p < 0.001). In addition to demonstrating a correlation between parent feeding practices and feeding problems, this study also found adding cereal/pureed foods to be common and while the dimension, Use of Cereal/Pureed Foods, was not significantly correlated with any specific feeding problem, this dimension provides an expanded understanding of cereal usage.

Dads at Mealtimes: Associations between Food Security, Household and Work Chaos, and Paternal Feeding Practices among Australian Fathers Living with Disadvantage

Understanding how fathers engage in feeding while experiencing disadvantage is important for family-focused interventions. A cross-sectional online survey involving 264 Australian fathers was conducted to explore feeding involvement and the relationships between feeding practices, food insecurity, and household and work chaos. Practices related to coercive control, structure, and autonomy support were measured for two age groups (<2 years and 2-5 years). Multivariable linear regression was used to examine the associations for each practice. Three-quarters of the sample were food insecure, impacting adults more than children, and correlated with household chaos. Food insecurity was associated with increased 'persuasive feeding' and 'parent-led feeding' in younger children. Household chaos was positively associated with coercive control practices in both younger and older child groups, with the strongest associations for 'using food to calm' and 'overt restriction', respectively. In older child groups, household chaos was negatively associated with 'offer new foods' and 'repeated presentation of new foods'. Structure practices had no significant relationships with any factors, and work chaos did not predict any feeding practices. These findings emphasize a need for societal and structural support to address food insecurity and household chaos. Tailored strategies are crucial to support fathers in responsive feeding.

Development and validation of the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa

BACKGROUND

In Sub-Saharan Africa, the nutritional status of children born to teenage mothers deserves critical attention. Maternal knowledge and attitudes concerning infant and young child feeding (IYCF) may predict actual practices and child nutritional status. This study created and validated the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa.

METHODS

A literature search on IYCF knowledge and attitude gaps in teenage mothers generated scale items. Ten nutrition experts and six teenage mothers assessed content validity and comprehensibility, respectively. Construct validation was conducted by item response theory (IRT) and confirmatory factor analysis (CFA), in 150 teenage mothers in rural communities of Abuja, Nigeria. Model fit parameters were estimated by standardized chi-square tests. Internal consistency reliability was determined by marginal reliability and Cronbach's alpha. In a sub-sample of 40 women who completed the questionnaire two weeks later, test-retest reliability was assessed via intraclass correlations.

RESULTS

The IRT analysis retained 23 knowledge items on infant food type, breastfeeding and complementary feeding, with acceptable discrimination and difficulty. CFA produced a six-factor solution (exclusive breastfeeding, breast milk expression, meal frequency, responsive feeding, dietary diversity, and barriers) with 17 attitude items. Confirmatory fit and Tucker Lewis indices > 0.9; Root Mean Square Errors of Approximation and Standardized Root Mean Square Residuals < 0.08, showed good model fit. Overall Cronbach's alpha of the attitude scale (0.843), subscales (≥ 0.6) and high intraclass correlation coefficients (> 0.75) indicated reliability.

CONCLUSION

The Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa is a valid assessment tool for IYCF knowledge and attitudes of teenage mothers.

Examining the feasibility of a brief parent intervention designed to promote positive food communication with infants

BACKGROUND

Few prevention interventions exist focusing on supporting parents to use positive food communication at mealtimes, for the prevention of disordered eating. "Mealtime chatter matters (MCM)" is a brief intervention designed for parents of infants. The intervention was designed in collaboration with child health nurses (CHNs) to be embedded into usual care. The overall aim of this study was to test the feasibility of the intervention through examining the acceptability of the MCM content and resources and the potential impact of the intervention on parents.

METHODS

This pilot study utilised a mixed methods approach and took place within a regional child health service in Queensland, Australia (October 2021 to June 2022). Participants were parents of infants attending child health education groups and CHNs. The intervention consisted of a brief education session (including accompanying resources), facilitated by a Paediatric Dietitian. The acceptability of MCM content and resources was assessed by both parents and CHNs via self-reported questionnaires and the potential impact on parents assessed via pre-/post-self-reported questionnaires.

RESULTS

Forty-six parents of infants (aged < 8 months) and six CHNs who hosted the intervention and observed the program's delivery participated in the study. MCM content and resources were highly acceptable to parents and CHNs, as both qualitative and quantitative data concurred. How the program may have potentially impacted parenting practices was unclear from the survey results and further investigation is required to better understand these. Tangible lessons and opportunities to further test this intervention were clear from current results.

CONCLUSION

Overall, MCM was acceptable to both parents and CHNs, with the content and resources both being highly valued. Parents reported the content to be informative and engaging and CHNs were keen to have such an intervention available in the future. However, further modification and testing is required of MCM. This feasibility study is an essential first step in supporting parents and CHNs to access an evidence-based intervention with the aim of preventing disordered eating.

TRIAL REGISTRATION

Griffith University Human Research Ethics Committee (2021/577) and Gold Coast Hospital and Health Service Human Research Ethics Committee (QGC/76618).

A Responsive Feeding Questionnaire Based on Self-Determination Theory for Caregivers of Chinese Toddlers

OBJECTIVE

To develop and test the psychometric properties of a responsive feeding questionnaire (RFQ) on the basis of Self-Determination Theory for caregivers of toddlers aged 12-24 months in China.

DESIGN

Item generation, preliminary evaluation items, refinement questionnaire, and psychometric properties testing.

SETTING

Toddlers' caregivers from Shandong Province, China, were surveyed online between June 2021 and February 2022 (n = 616).

MAIN OUTCOME MEASURE

Content, face, and construct validity and reliability of the RFQ.

ANALYSIS

Content validity was performed on the basis of expert panel feedback and cognitive interviews among caregivers. Construct validity was evaluated using principal component analysis with varimax rotation. Test-retest reliability was conducted with a sample of 105 caregivers.

RESULTS

Over 3 phases of testing, a new instrument was developed to measure responsive feeding in toddler caregivers. The instrument was reliable, with an internal consistency of 0.87 and an intraclass correlation of 0.92. The principal component analysis identified a 3-factor solution (autonomy support, positive involvement, appropriate response) aligning with a theoretical framework from Self-Determination Theory. The final version of the instrument included 23 items.

CONCLUSIONS AND IMPLICATIONS

The 23-item RFQ has been validated in a Chinese population. Future research needs to validate this instrument in other countries and with children of different ages.

Bidirectional associations between parental feeding practices, infant appetitive traits and infant BMIz: a longitudinal cohort study

BACKGROUND

Little is known about the pathways linking parent feeding practices with appetitive traits and BMIz throughout infancy. This study examined bidirectional associations between parental feeding practices, infant appetitive traits, and infant BMIz.

METHODS

Parents (n = 380) of infants aged less than 6 months at baseline reported their feeding practices (using the Feeding Practices and Structure Questionnaire (FPSQ) for infants and toddlers), infant appetitive traits (using the Baby Eating Behaviour Questionnaire) and infant BMIz (parent-reported) at three timepoints (< 6 months, ~ 9 months, ~ 12 months) up to 12 months of age. Cross-lagged models examined bidirectional associations between parent feeding practices, infant appetitive traits and infant BMIz.

RESULTS

There was strong continuity across the three timepoints for maternal feeding practices, infant appetitive traits, and infant BMIz. Infant food avoidance was prospectively associated with higher parental persuasive feeding. Infant BMIz was prospectively associated with higher parent-led feeding. Parent use of food to calm was prospectively associated with lower infant BMIz, and infant BMIz was prospectively associated with higher infant food approach. Feeding on demand was prospectively associated with lower infant food approach.

CONCLUSION

This study highlights the complex associations between parental feeding practices, infant appetitive traits and infant BMIz. The study demonstrated that both child and parent effects are important, suggesting a need for tailored programs beginning in infancy to promote and support infant appetitive traits and parent feeding practices that support healthy development.

Informing Infant Nutrition: Timing of Infant Formula Advice, Infant Formula Choice and Preparation in the First 6 Months of Life

OBJECTIVE

To examine the sources and timing of advice formula feeding parents receive and how this and other factors influence the choice of formula product and formula preparation.

DESIGN

Components of a cross-sectional survey.

SETTING

A child and family health service in New South Wales, Australia.

PARTICIPANTS

Parents (n = 153) who were fully or partially formula feeding infants aged 0-6 months and who visited the service's facilities or its social media site.

VARIABLES MEASURED

Type of formula, preparation of formula, and use and sources of formula feeding advice.

ANALYSIS

Descriptive statistics, Mann-Whitney U or Pearson's chi-square tests, and inductive content analysis.

RESULTS

The most common source of formula feeding advice was the formula tin/packet (96.6%). Although 79.2% received advice from a health professional, only 18.9% reported receiving this advice before using formula. Approximately half (48.0%) of the parents chose a standard cow's milk-based formula. The most common reason for their choice of formula type/brand was a personal recommendation (53.0%). Parents' responses indicated that nearly half (46.3%) incorrectly prepared the formula.

CONCLUSION AND IMPLICATIONS

Although health professional advice was widely received, this was rarely before starting formula. Despite the current national infant feeding regulations, parents who were not exclusively breastfeeding their infants did not always receive timely, health professional advice about formula feeding.

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

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

Macrophages in Renal Injury, Repair, Fibrosis Following Acute Kidney Injury and Targeted Therapy

Acute kidney injury (AKI) is a renal disease with a high incidence and mortality. Currently, there are no targeted therapeutics for preventing and treating AKI. Macrophages, important players in mammalian immune response, are involved in the multiple pathological processes of AKI. They are dynamically activated and exhibit a diverse spectrum of functional phenotypes in the kidney after AKI. Targeting the mechanisms of macrophage activation significantly improves the outcomes of AKI in preclinical studies. In this review, we summarize the role of macrophages and the underlying mechanisms of macrophage activation during kidney injury, repair, regeneration, and fibrosis and provide strategies for macrophage-targeted therapies.

Responsive feeding values and practices among families across the Canadian Maritime provinces

Children benefit from responsive feeding practices where their internal signals of hunger and satiety are valued and met with prompt, emotionally supportive, and developmentally appropriate responses. Using an online survey, this study describes responsive feeding values and practices among parents of young children (0-5 years) (n = 1039) across 3 Canadian Maritime provinces. Independent-samples t-tests and 1-way ANOVA were performed to determine the differences in survey questions related to the responsive feeding practices and values. First-time parents and parents with younger children report implementing more consistently some of the challenging responsive feeding practices, such as avoiding pressuring their children to eat, compared with parents with multiple children and parents with children ages 3-5 years. Parents often have well-intended reasons to encourage their children to eat; however, these can coincide with non-responsive practices with food such as pressuring, rewarding, and restriction. These coercive practices may be ineffective and counterproductive as they reinforce reasons to eat unrelated to appetite and self-regulation. Preschool and early feeding interventions that support parents in understanding normal child development, including typical eating behaviours and self-regulation, could help to equip them for challenging feeding experiences and encourage long-term responsive feeding practices. Novelty: First-time parents and parents with younger children report more consistently avoiding pressuring their children to eat, compared with parents with multiple children and parents with children ages 3-5 years. Parents often have well-intended reasons to encourage their children to eat; however, these can coincide with non-responsive practices such as pressuring, rewarding, and restriction.

Infant Appetitive Phenotypes: A Group-Based Multi-Trajectory Analysis

Background: Examining appetitive traits with person-centered analytical approaches can advance the understanding of appetitive phenotype trajectories across infancy, their origins, and influences upon them. The objective of the present study was to empirically describe appetitive phenotype trajectories in infancy and examine the associations with infant and parent factors.

Materials and Methods: In this longitudinal cohort study of Australian infants, parents completed three online surveys ~3 months apart, beginning when the infant was <6 months. Appetitive traits were assessed with the Baby Eating Behavior Questionnaire (BEBQ) and parent feeding practices with the Feeding Practices and Structure Questionnaire (FPSQ) infant and toddler version. Parent demographics and cognitions were also collected. Infant weight and length were transcribed from health records and converted to a BMI z-score. Group-based trajectory modeling identified appetitive phenotype trajectories using the BEBQ. Multilevel modeling examined change in feeding practices and child BMI z-score over time by appetitive phenotype trajectories.

Results: At time 1, 380 participants completed the survey (mean infant age 98 days), 178 at time 2 (mean infant age 198 days), and 154 at time 3 (mean infant age 303 days). Three multi-trajectory appetitive phenotype groups were identified and labeled as (Phenotype 1) food avoidant trending toward low food approach (21.32% of infants), (Phenotype 2) persistently balanced (50.53% of infants), and (Phenotype 3) high and continuing food approach (28.16% of infants). Formula feeding was more common in Phenotype 1 (p = 0.016). Parents of infants in Phenotype 1 were more likely to rate them as being more difficult than average, compared to infants with phenotypes 2 or 3. Phenotype 2 had the greatest increase in persuasive feeding over time [0.30; 95% CI (0.12, −0.47)].

Conclusions: Distinct multi-trajectory appetitive phenotype groups emerge early in infancy. These trajectories appear to have origins in both infant and parent characteristics as well as parent behaviors and cognitions. The infant multi-trajectory appetitive phenotype groups suggest that for some infants, difficulties in self-regulating appetite emerge early in life. Investigation of infant multi-trajectory appetitive phenotype groups that utilize a range of measures, examine relationships to key covariates and outcomes, and extend from infancy into childhood are needed.

Engaging New Parents in the Development of a Peer Nutrition Education Model Using Participatory Action Research

This study investigated the implementation model and research methods of a peer education program for new parents focused on infant feeding and nutrition. Two hundred and sixty-nine parents with an infant aged birth to two years old were invited to become co-researchers in a Participatory Action Research (PAR) study over three years. Data included focus group and online participant meeting transcripts, social media data, correspondence between the implementation team and peer educators, and field notes. All data were consolidated regularly and discussed by project participants and the research team. After each PAR cycle, structured content analysis was conducted, informing the next iteration of the implementation model and research methods. Participating parents were highly engaged in child feeding peer-to-peer education, but felt more effective and comfortable being considered as a child-feeding information resource sharer or 'champion' rather than a formal peer educator. Similarly, quantitative data collection was only effective when it was integrated seamlessly into the implementation model. PAR methodology suited the diversity and dynamic real-life study setting, facilitating substantial improvements to the peer nutrition intervention model and data collection methods. Our study demonstrated that a genuine collaboration between health professionals and participants to implement research in practice can achieve both intervention outcomes and research aims.

Infant eating behaviors and Milk feeding independently predict infant size

OBJECTIVES

This study investigates the association of infant eating behaviors with infant size, and if those associations are mediated by infant feeding.

METHODS

Mothers with infants less than 12 months of age and living in Central North Carolina were enrolled (N = 61). Data were collected at baseline and at 3- and 6-month follow up visits. Modified constructs from the Baby Eating Behavior Questionnaire (BEBQ) and Child Eating Behavior Questionnaire (CEBQ) measured parents' perceptions of infant eating behaviors related to food approach (enjoyment of food, and food responsiveness) and food avoidance (food fussiness, satiety responsiveness, and slowness in eating). Linear mixed effects models tested longitudinal associations among infant eating behavior ratings, infant feeding (breastfeeding intensity, timing of introduction of complementary foods), and anthropometry (weight, length, and weight-for-length z-scores). Path analyses were stratified by age and tested for direct and indirect effects of mothers' ratings of infant eating behaviors and infant feeding on infant anthropometry.

RESULTS

Linear mixed models showed that general appetite was associated with higher weight-for-age, and satiety responsiveness was associated with lower length-for-age. Path analyses showed that infant milk feeding did not mediate associations. Breastfeeding intensity was independently associated with lower weight- and length-for-age z-scores. Age at complementary feeding initiation was associated with lower length-for-age z-scores.

CONCLUSIONS

Associations between parental perceptions of general appetite, satiety responsiveness, and infant weight and length are observed early in life. These findings suggest that parental perceptions of infant eating behaviors may contribute to the early developmental programming of later health outcomes.