Feeding behaviors of low-income mothers: directive control relates to a lower BMI in children, and a nondirective control relates to a healthier diet in preschoolers

Evaluation of the Effect of Parenting Style and Parental Mealtime Actions on the Eating Behavior of Children with Epilepsy

BACKGROUND

Research on the interaction of parenting style, parents' mealtime behaviors, and children's eating behavior in the presence of chronic disease is limited. This study aimed to investigate the impact of parenting style and parental mealtime actions on the eating behavior of children with epilepsy.

METHODS

Thirty-one children with epilepsy, thirty-one healthy children (aged 4-9 years), and their parents were included. The Multidimensional Assessment of Parenting Scale (MAPS), Parent Mealtime Action Scale, Children's Eating Behavior Questionnaire, and Healthy Eating Index (HEI)-2015 were applied. The MAPS, HEI-2015 scores, and body mass index for age Z scores were similar in both groups (p > 0.05). In the epilepsy group, the food approach behavior score was higher, and positive correlations were noted between broadband negative parenting and food approach behavior, and the HEI-2015 score and broadband positive parenting (p < 0.05). Regression analysis showed that broadband negative parenting and snack modeling increased the food approach behavior in the epilepsy group. Owing to the chronic disease, the effects of parent-child interaction on the child's eating behavior in the epilepsy group differed from those of healthy children reported in the literature.

Impact of ¡Míranos! on parent-reported home-based healthy energy balance-related behaviors in low-income Latino preschool children: a clustered randomized controlled trial

BACKGROUND

Widespread establishment of home-based healthy energy balance-related behaviors (EBRBs), like diet, physical activity, sedentary behavior, screen time, and sleep, among low-income preschool-aged children could curb the childhood obesity epidemic. We examined the effect of an 8-month multicomponent intervention on changes in EBRBs among preschool children enrolled in 12 Head Start centers.

METHODS

The Head Start (HS) centers were randomly assigned to one of three treatment arms: center-based intervention group (CBI), center-based plus home-based intervention group (CBI + HBI), or control. Before and following the intervention, parents of 3-year-olds enrolled in participating HS centers completed questionnaires about their child's at-home EBRBs. Adult-facilitated physical activity (PA) was measured by an index based on questions assessing the child's level of PA participation at home, with or facilitated by an adult. Fruit, vegetable, and added sugar intake were measured via a short food frequency questionnaire, and sleep time and screen time were measured using 7-day logs. A linear mixed effects model examined the intervention's effect on post-intervention changes in PA, intake of fruit, vegetable, and added sugar, sleep time, and screen time from baseline to post-intervention.

RESULTS

A total of 325 parents participated in the study (CBI n = 101; CBI + HBI n = 101; and control n = 123). Compared to control children, CBI and CBI + HBI parents reported decreases in children's intake of added sugar from sugar-sweetened beverages. Both CBI and CBI + HBI parents also reported smaller increases in children's average weekday screen time relative to controls. In addition, CBI + HBI parents reported CBI + HBI parents reported increases in children's adult-facilitated PA, fruit and vegetable intake, and daily sleep time during weekdays (excluding weekends) and the total week from baseline to post-intervention, while children in the CBI increased sleep time over the total week compared to the children in the control group.

CONCLUSIONS

Parent engagement strengthened the improvement in parent-reported EBRBs at home in young children participating in an evidence-based obesity prevention program in a childcare setting. Future studies should investigate equity-related contextual factors that influence the impact of obesity prevention in health-disparity populations.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03590834. Registered July 18, 2018, https://clinicaltrials.gov/ct2/show/NCT03590834.

Exploration of Malaysian school-children's food preferences: what do we know?

BACKGROUND

Feeding practices exert a definite influence over children's experiences. This article aims to explore parental feeding practices and investigate the prediction domain of food preference from parent-child perspectives.

METHODS

Two individual studies were conducted on Malay families with children aged 7-12 years. In Study 1, mothers (n = 17) participated in semi-structured focus group interviews on their knowledge of foods and feeding practices. In Study 2, parent-child pairs (n = 14) answered a 36-item, 5-point Likert scale Food Preference Questionnaire followed by virtual structured qualitative interviews. The interviews were digitally recorded, transcribed verbatim, back-translated and analysed according to the framework analysis technique.

RESULTS

In Study 1, mothers perceived vegetables, chicken, fish and plain water as healthy foods and drinks while discretionary options were snacks, fast foods and carbonated drinks. The mothers defined healthy foods as foods handled safely with health benefits. They used 'healthy' cooking methods to prepare preferred foods and overtly controlled the child's access to discretionary food. In Study 2, the food groups reported by parent-child pair's report were consistent for the most preferred foods [snacks, median (interquartile range), parent: 4.5 (1.0) vs. child: 4.5 (0.0), p &gt; 0.05] and least preferred food [legumes, parent: 2.0 (1.0) vs. child: 2.0 (1.0), p &gt; 0.05]. Parents emphasized taste as the key determinant of food preference.

CONCLUSION

These studies were the first to qualitatively explore parents' perceptions of foods affecting their feeding practices among the Malaysian community to highlight the cultural contribution. Key insights into children's food intake and factors influencing their food preferences were identified.

Parenting Styles, Food Parenting Practices and Dietary Intakes of Preschoolers

Previous evidence suggests that children’s eating behaviors were largely influenced by the parent and home eating structure. This study examined the relationship between parenting styles (including authoritative, authoritarian, indulgent, and uninvolved), food parenting practices (within Structure, Coercive Control, and Autonomy Support constructs) and dietary intakes of preschoolers. Children aged 3–5 years and their parents were recruited from preschools/daycare centers and parents completed the surveys (n = 166). Dietary intakes were collected using the Harvard Service Food Frequency Questionnaire (HSFFQ), parenting style was assessed using the Parenting Dimensions Inventory-Short Version (PDI-S), and food parenting practices were measured using Comprehensive Home Environment Survey (CHES). The results showed that food parenting practices had a higher number of specific significant findings on children’s nutrient and food group intakes than parenting styles. Correlation analyses showed positive parenting practices within Structure were significantly related to healthier children’s intakes (e.g., vegetables, iron, and folate) and less unhealthy dietary intakes (e.g., sweets and total fats). Regression models show that children with authoritative parents consumed more fruits compared to children with authoritarian parents and indulgent parents. The results addressed the importance of parental influences for preschoolers’ healthy dietary intakes, which suggested that future interventions and educational programs could enhance parenting practices to impact child diet.

Phenotypes of controlling feeding behaviours in mothers of toddlers: A mixed methods study

BACKGROUND

Maternal feeding behaviours, in particular controlling behaviours, are associated with risk of childhood obesity.

OBJECTIVES

To qualitatively examine patterns of mothers' beliefs and behaviours around controlling feeding through a semi-structured interview and to examine associations of those patterns with participant demographic characteristics and classical child feeding instruments.

METHODS

A convenience sample of mothers (N = 35) of toddlers (mean age 25 months) participated in a semi-structured interview about their child feeding beliefs and behaviours. Anthropometrics were measured. Transcripts were analyzed using narrative analysis for patterns from which two emerged, known as phenotypes. A coding scheme was created and reliably applied. Bivariate correlates of the phenotypes with participant child characteristics and mother self-reported feeding behaviours were examined.

RESULTS

The phenotypes were High Covert Control (n = 12) and Shared Control (n = 23). High Covert Control phenotype membership was correlated with higher child and mother BMI (body mass index) and child female sex. Shared Control phenotype membership was correlated with lower child and mother BMI and greater pressure to eat.

CONCLUSIONS

Two controlling feeding phenotypes emerged among mothers of toddlers, which were associated with participant characteristics including BMI, but did not map onto classical child feeding instruments.

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

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

A qualitative exploration into momentary impacts on food parenting practices among parents of pre-school aged children

Food parenting practices have been identified as a potentially significant correlate of weight status and weight-related behaviors in children. The extent to which food parenting practices fluctuate across time and context is not well known. In particular, situational factors are thought to shape the types of food parenting practices used in the moment, but the nature of those factors remain unclear. In this paper data from interviews with parents (n = 40) of preschoolers was used to: 1) describe parents' day-to-day lived experiences of food parenting within the broad theoretical domains of coercive control, structure and autonomy support; 2) identify salient momentary factors that influence use of these food parenting practices; and 3) understand how these momentary factors impact the use of different types of food parenting practices. The feeding practices described by parents align well with the three overarching themes described within the literature: coercive control, autonomy support, and structure. Parents described using a combination of practices from within each of these domains; they also indicated that their feeding practices were easily influenced by momentary factors that impacted their food parenting within and across eating occasions. For the most part, parents described momentary factors (e.g. schedule changes, parental stress, child behavior) that shifted them away from structure and autonomy support feeding practices, towards indulgent and coercive feeding practices. Researchers should be aware of the likely interplay between different types of feeding practices as well as the potential that momentary factors may shift parents from one type of practice towards another. The use of novel data collection methods, such as ecological momentary assessment, that allow for exploration of food parenting practices as dynamic, rather than static, behaviors should be explored.

A qualitative study conducted in the USA exploring Latino fathers' beliefs, attitudes and practices related to their young children's eating, physical activity and sedentary behaviours

OBJECTIVE

Increasing evidence documents fathers' influential role in their children's eating, physical activity (PA) and sedentary behaviours (SB). We aimed to expand limited existing research examining fathers' influence in these areas by exploring Latino fathers' beliefs, attitudes and practices related to eating, PA and SB of their young children.

DESIGN

Seven focus group discussions were conducted in Spanish with Latino fathers (n 28) of children aged 2-8 years. Audio recordings were transcribed and translated verbatim without identifiers. Data were analysed using thematic analysis to identify key concepts and themes using NVivo 11 software.

RESULTS

Fathers expressed positive beliefs and attitudes about the importance of healthy eating for their young children, themselves and their families. Nevertheless, the majority reported familial practices including eating out, getting take-out, etc. that have been linked to increased obesity risk among Latino children. Fathers were more involved and engaged in children's PA than eating and feeding. However, several fathers reported engaging predominantly in sedentary activities with their children, appeared permissive of children's sedentary habits and struggled to set limits on children's screen-time.

CONCLUSIONS

We provide new information on Latino fathers' beliefs and child feeding and PA practices that may provide important targets for interventions aimed at promoting healthful eating and PA behaviours of Latino children. Future research should further quantify the influence of Latino fathers' parenting styles and practices on development of children's eating, PA and SB. This information is needed to identify risk factors amenable to interventions and to design culturally appropriate parenting and family-based interventions targeting Latino children's home environment and designed to meet this ethnic group's specific needs.

Directive and non-directive food-related parenting practices: Associations between an expanded conceptualization of food-related parenting practices and child dietary intake and weight outcomes

This study examines associations between an expanded conceptualization of food-related parenting practices, specifically, directive and non-directive control, and child weight (BMI z-score) and dietary outcomes [Healthy Eating Index (HEI) 2010, daily servings fruits/vegetables] within a sample of parent-child dyads (8-12 years old; n = 160). Baseline data from the Healthy Home Offerings via the Mealtime Environment (HOME Plus) randomized controlled trial was used to test associations between directive and non-directive control and child dietary outcomes and weight using multiple regression analyses adjusted for parental education. Overall variance explained by directive and non-directive control constructs was also calculated. Markers of directive control included pressure-to-eat and food restriction, assessed using subscales from the Child Feeding Questionnaire; markers of non-directive control were assessed with a parental role modeling scale and a home food availability inventory in which an obesogenic home food environment score was assigned based on the types and number of unhealthful foods available within the child's home food environment.

DIRECTIVE CONTROL

Food restriction and pressure-to-eat were positively and negatively associated with BMI z-scores, respectively, but not with dietary outcomes.

NON-DIRECTIVE CONTROL

An obesogenic home food environment was inversely associated with both dietary outcomes; parental role modeling of healthful eating was positively associated with both dietary outcomes. Neither non-directive behavioral construct was significantly associated with BMI z-scores.

TOTAL VARIANCE

Greater total variance in BMI-z was explained by directive control; greater total variance in dietary outcomes was explained by non-directive control. Including a construct of food-related parenting practices with separate markers for directive and non-directive control should be considered for future research. These concepts address different forms of parental control and, in the present study, yielded unique associations with child dietary and weight outcomes.

Developmental and Environmental Influences on Young Children's Vegetable Preferences and Consumption

Food intake patterns begin to be shaped at the earliest points in life. Early exposures and experiences are critical for the acceptance of some foods, particularly healthful foods such as vegetables, which often have a bitter component in their flavor profiles. In addition to repeated exposure to these foods, the quality and emotional tone of parent-child interactions are important in facilitating children's acceptance of vegetables. During early childhood, parents are challenged by children's developmental characteristics related to eating, such as the emergence of child neophobia, and by individual characteristics of the child that are more biologically based, including genetic predispositions to bitter taste and sensory sensitivities. Experimental studies consistently show that repeated exposure to novel and rejected familiar foods is the most powerful method to improve acceptance. However, the manner and persistence with which these exposures are performed are critical. Research investigating influences on children's vegetable acceptance and ingestion has focused on associations among availability, parent intakes, child neophobia, and the parental feeding response to children's reluctance to try and consume vegetables. Because young children's dietary intakes are low and below dietary recommendations, investigations have focused more on factors that impede children's vegetable acceptance, such as controlling feeding practices, than on positive influences. Research that addresses the multifaceted nature of these interactions among different levels of social-ecological environment, individual traits, parental feeding styles and practices, and socioeconomic influences and that uses longitudinal designs and complex statistical approaches is called for to ascertain more effective methods to improve children's vegetable acceptance.

Reducing discretionary food and beverage intake in early childhood: a systematic review within an ecological framework

OBJECTIVE

To systematically review the literature and map published studies on 4-8-year-olds' intake of discretionary choices against an ecological framework (ANalysis Grid for Environments Linked to Obesity; ANGELO).

DESIGN

Articles were identified through database searches (PubMed, PyscINFO®, Web of Science) in February and March 2014 and hand-searching reference lists. Studies were assessed for methodological quality and mapped against the ANGELO framework by environment size (macro and micro setting) and type (physical, economic, policy and socio-cultural influences).

SETTING

Studies were conducted in the USA (n 18), Australia (n 6), the UK (n 3), the Netherlands (n 3), Belgium (n 1), Germany (n 1) and Turkey (n 1).

SUBJECTS

Children aged 4-8 years, or parents/other caregivers.

RESULTS

Thirty-three studies met the review criteria (observational n 23, interventions n 10). Home was the most frequently studied setting (67 % of exposures/strategies), with the majority of these studies targeting family policy-type influences (e.g. child feeding practices, television regulation). Few studies were undertaken in government (5·5 %) or community (11 %) settings, or examined economic-type influences (0 %). Of the intervention studies only four were categorised as effective.

CONCLUSIONS

The present review is novel in its focus on mapping observational and intervention studies across a range of settings. It highlights the urgent need for high-quality research to inform interventions that directly tackle the factors influencing children's excess intake of discretionary choices. Interventions that assist in optimising a range of environmental influences will enhance the impact of future public health interventions to improve child diet quality.

Use of the Environment and Policy Evaluation and Observation as a Self-Report Instrument (EPAO-SR) to measure nutrition and physical activity environments in child care settings: validity and reliability evidence

BACKGROUND

Early care and education (ECE) centers are important settings influencing young children's diet and physical activity (PA) behaviors. To better understand their impact on diet and PA behaviors as well as to evaluate public health programs aimed at ECE settings, we developed and tested the Environment and Policy Assessment and Observation - Self-Report (EPAO-SR), a self-administered version of the previously validated, researcher-administered EPAO.

METHODS

Development of the EPAO-SR instrument included modification of items from the EPAO, community advisory group and expert review, and cognitive interviews with center directors and classroom teachers. Reliability and validity data were collected across 4 days in 3-5 year old classrooms in 50 ECE centers in North Carolina. Center teachers and directors completed relevant portions of the EPAO-SR on multiple days according to a standardized protocol, and trained data collectors completed the EPAO for 4 days in the centers. Reliability and validity statistics calculated included percent agreement, kappa, correlation coefficients, coefficients of variation, deviations, mean differences, and intraclass correlation coefficients (ICC), depending on the response option of the item.

RESULTS

Data demonstrated a range of reliability and validity evidence for the EPAO-SR instrument. Reporting from directors and classroom teachers was consistent and similar to the observational data. Items that produced strongest reliability and validity estimates included beverages served, outside time, and physical activity equipment, while items such as whole grains served and amount of teacher-led PA had lower reliability (observation and self-report) and validity estimates. To overcome lower reliability and validity estimates, some items need administration on multiple days.

CONCLUSIONS

This study demonstrated appropriate reliability and validity evidence for use of the EPAO-SR in the field. The self-administered EPAO-SR is an advancement of the measurement of ECE settings and can be used by researchers and practitioners to assess the nutrition and physical activity environments of ECE settings.

Sandwiches and subversion: Teachers' mealtime strategies and preschoolers' agency

Mealtimes are understudied processes in the social research on childhood. Our study uses ethnographic methods in two preschools in the southeastern United States to understand the types of strategies teachers use during meals and children's responses to these strategies. We identified three strategies teachers used to attempt to modify children's consumption: gatekeeping, directives, and hyperbolic justifications of consumption. We argue that children used agency to subvert to teachers' strategies using silent and verbal techniques, including attempting to open packages of restricted foods, pretending to eat, and refusing to eat. Their subversion manifested in either "dissent" or "feigned assent."

Maternal Feeding Goals Described by Low-Income Mothers

OBJECTIVE

To identify maternal feeding goals and examine associations of number and type of goals with mother and child characteristics.

DESIGN

Qualitative interviews about child feeding and quantitative assessment of goal prevalence and associations with mother and child characteristics.

SETTING

Southeastern Michigan.

PARTICIPANTS

A total of 287 low-income mothers (31% Hispanic or non-white) and their children ages 4 to 8 years.

MAIN OUTCOME MEASURE

Maternal feeding goals.

ANALYSIS

Themes were generated using the constant comparative method, individual interviews were coded, and the prevalence of feeding goals was determined. Regression analyses examined associations of mother and child characteristics with the number and type of feeding goals.

RESULTS

Thirteen maternal feeding goals were identified. The most prevalent were to restrict less nutrient-dense food (60%), promote autonomy around eating (54%), prevent obesity (53%), and promote fruits or vegetables (52%). A child who was female and heavier with an older, non-Hispanic white, more educated mother with less chaos in the home predicted more maternal feeding goals (all P < .05). Specific maternal and child characteristics were associated with individual feeding goals.

CONCLUSIONS AND IMPLICATIONS

Depending on their current goals for child feeding, some mothers may benefit from interventions focused on goal development, whereas other mothers may benefit from interventions designed to facilitate goal implementation.

Parental modelling of eating behaviours: observational validation of the Parental Modelling of Eating Behaviours scale (PARM)

Parents are important role models for their children's eating behaviours. This study aimed to further validate the recently developed Parental Modelling of Eating Behaviours Scale (PARM) by examining the relationships between maternal self-reports on the PARM with the modelling practices exhibited by these mothers during three family mealtime observations. Relationships between observed maternal modelling and maternal reports of children's eating behaviours were also explored. Seventeen mothers with children aged between 2 and 6 years were video recorded at home on three separate occasions whilst eating a meal with their child. Mothers also completed the PARM, the Children's Eating Behaviour Questionnaire and provided demographic information about themselves and their child. Findings provided validation for all three PARM subscales, which were positively associated with their observed counterparts on the observational coding scheme (PARM-O). The results also indicate that habituation to observations did not change the feeding behaviours displayed by mothers. In addition, observed maternal modelling was significantly related to children's food responsiveness (i.e., their interest in and desire for foods), enjoyment of food, and food fussiness. This study makes three important contributions to the literature. It provides construct validation for the PARM measure and provides further observational support for maternal modelling being related to lower levels of food fussiness and higher levels of food enjoyment in their children. These findings also suggest that maternal feeding behaviours remain consistent across repeated observations of family mealtimes, providing validation for previous research which has used single observations.

An interactive parents' guide for feeding preschool-aged children: pilot studies for improvement

There are few motivational materials to help families with limited resources develop optimal, practical feeding strategies for young children to reduce dietary risk for poor diet and weight status. Formative evaluation strategies consisting of both qualitative and quantitative data helped to refine the parent feeding guide Eat Healthy, Your Children are Watching, A Parent's Guide to Raising a Healthy Eater. An interdisciplinary planning team developed a five-topic, multimedia, interactive guide addressing the strategies most associated with improved diet quality and weight status of children aged 3 to 5 years. Research staff conducted iterative phases of field testing, reformatting, in-depth interviews, and materials testing with Head Start or Supplemental Nutrition Assistance Program-Education caregivers (N=38) of children aged 3 to 5 years during 2011 and 2012. Convergence of feedback from caregivers' interviews and each booklet's attention, relevance, confidence, and satisfaction subscale scores were used to determine and affirm areas for improvement. Lower than desired attention, relevance, confidence, and satisfaction scores (optimal score=5) in 2011 and too much text resulted in revisions and reformatting that improved scores from 3.8 to 4.9 in 2012. The revision of materials to reflect less text, additional white space, checklists of mealtime behaviors, and learning activities for preschool-aged children resulted in dramatically improved materials and greater acceptance by parents, as shown by both quantitative and qualitative evaluations. Formative evaluation procedures involving the use of data-based decision making allowed for the development of intervention materials that met the unique needs of the population served.

Controlling parental feeding practices and child body composition in ethnically and economically diverse preschool children

Controlling parental feeding practices may be associated with childhood overweight, because coercive or intrusive feeding practices may negatively impact children's development of self-regulation of eating. This study examined pressuring or forcing a child (healthy or unhealthy foods) and restricting child from unhealthy or snack foods as two types of controlling feeding practices that explain unique variances in measures of child body composition (BMI, percent body fat, and parental perception of child weight). In an ethnically and economically diverse sample of 243 children aged 4-6years old and their biological parents (89% biological mothers, 8% biological fathers, and 3% step or grand-parent), descriptive statistics indicate ethnic and family income differences in measures of feeding practices and child body composition. Additionally, the two "objective" indices of body composition (BMI and percent body fat) were related to low pressure to eat, whereas the "subjective" index (perceived child weight) was related to restriction. Regression analyses accounting for ethnic and family income influences indicate that pressure to eat and restriction both explained unique variances in the two "objective" indices of body composition, whereas only restriction explained variance in perceived child weight. Findings have implications for helping parents learn about feeding practices that promote children's self-regulation of eating that simultaneously serves as an obesity prevention strategy.

Relation of parenting styles, feeding styles and feeding practices to child overweight and obesity. Direct and moderated effects

The purpose of this study was to evaluate the direct and interacting relations of parenting styles, feeding styles, and feeding practices to child overweight and obesity. Participants were 144 mothers and children under 6 years of age. Mothers completed questionnaires about parenting and feeding styles and feeding practices. Researchers weighed and measured mothers and children or obtained measurements from a recent health report. Feeding practices were not directly related to child weight status. Compared to the uninvolved feeding style, authoritative and authoritarian feeding style categories were linked to lower odds of overweight. Feeding practices interacted with authoritative and authoritarian parenting styles to predict obesity: (1) healthful modeling was associated with 61% (OR = 0.39) reduced odds of obesity in children of authoritative mothers but with 55% (OR = 1.55) increased odds in children of non-authoritative mothers and (2) covert control was linked to 156% (OR = 2.56) increased odds of obesity in children of authoritarian mothers but with 51% (OR = 0.49) decreased odds in children of non-authoritarian mothers. Healthful modeling interacted with feeding style demandingness to predict overweight and with responsiveness to predict obesity. Findings suggest the need for research and interventions on mechanisms mediating between feeding practices and obesity in families characterized by non-authoritative parenting styles.

Maternal psychological factors and controlled child feeding practices in relation to child body mass index

BACKGROUND

The rise of childhood obesity in Western society has focused attention on parental feeding practices. Despite evidence that controlled feeding influences child weight, there is a paucity of research examining predictors of controlled feeding. The aim of this study was to determine whether maternal antenatal and/or concurrent anxiety and depressive symptoms, including stress, predicted controlled feeding and whether maternal controlled feeding practices, in turn, predict child BMI.

METHODS

In total, 203 mothers participated in a longitudinal follow-up survey. Mothers' self-reported symptoms of anxiety and depression were measured both in pregnancy and at 2-7 years postpartum. Maternal-reported child BMI and maternal use of restriction, pressure to eat, and monitoring were measured at 2-7 years postpartum.

RESULTS

Feeding practices were not uniformly predictive of child BMI. Maternal use of restriction and monitoring were partially positively predicted by concurrent maternal stress and negatively partially predicted by concurrent depression. Thus, mothers enduring high stress appeared to employ more controlled feeding patterns, whereas mothers experiencing depression seemingly employed lower levels of controlled feeding.

CONCLUSIONS

Findings that maternal anxiety and depression affect levels of controlled feeding are of particular interest and broadly supportive of the few existing studies. Given the mixed results linking controlled feeding to child BMI reported in previous research, further work is required to determine the relationships between maternal mood, child feeding practices, and BMI.

Measuring parent food practices: a systematic review of existing measures and examination of instruments

During the last decade, there has been a rapid increase in development of instruments to measure parent food practices. Because these instruments often measure different constructs, or define common constructs differently, an evaluation of these instruments is needed. A systematic review of the literature was conducted to identify existing measures of parent food practices and to assess the quality of their development. The initial search used terms capturing home environment, parenting behaviors, feeding practices and eating behaviors, and was performed in October of 2009 using PubMed/Medline, PsychInfo, Web of knowledge (ISI), and ERIC, and updated in July of 2012. A review of titles and abstracts was used to narrow results, after which full articles were retrieved and reviewed. Only articles describing development of measures of parenting food practices designed for families with children 2-12 years old were retained for the current review. For each article, two reviewers extracted data and appraised the quality of processes used for instrument development and evaluation. The initial search yielded 28,378 unique titles; review of titles and abstracts narrowed the pool to 1,352 articles; from which 57 unique instruments were identified. The review update yielded 1,772 new titles from which14 additional instruments were identified. The extraction and appraisal process found that 49% of instruments clearly identified and defined concepts to be measured, and 46% used theory to guide instrument development. Most instruments (80%) had some reliability testing, with internal consistency being the most common (79%). Test-retest or inter-rater reliability was reported for less than half the instruments. Some form of validity evidence was reported for 84% of instruments. Construct validity was most commonly presented (86%), usually with analysis of associations with child diet or weight/BMI. While many measures of food parenting practices have emerged, particularly in recent years, few have demonstrated solid development methods. Substantial variation in items across different scales/constructs makes comparison between instruments extremely difficult. Future efforts should be directed toward consensus development of food parenting practices constructs and measures.