Controlling Feeding Practices Research Articles

Teaching our children when to eat: how parental feeding practices inform the development of emotional eating—a longitudinal experimental design

Emotional eating in children has been related to the consumption of energy-dense foods and obesity, but the development of emotional eating in young children is poorly understood. We evaluated whether emotional eating can be induced in 5-7-y-old children in the laboratory and assessed whether parental use of overly controlling feeding practices at 3-5 y of age predicts a greater subsequent tendency for children to eat under conditions of mild stress at ages 5-7 y. Forty-one parent-child dyads were recruited to participate in this longitudinal study, which involved parents and children being observed consuming a standard lunch, completing questionnaire measures of parental feeding practices, participating in a research procedure to induce child emotion (or a control procedure), and observing children's consumption of snack foods. Children at ages 5-7 y who were exposed to a mild emotional stressor consumed significantly more calories from snack foods in the absence of hunger than did children in a control group. Parents who reported the use of more food as a reward and restriction of food for health reasons with their children at ages 3-5 y were more likely to have children who ate more under conditions of negative emotion at ages 5-7 y. Parents who overly control children's food intake may unintentionally teach children to rely on palatable foods to cope with negative emotions. Additional research is needed to evaluate the implications of these findings for children's food intake and weight outside of the laboratory setting. This trial was registered at clinicaltrials.gov as NCT01122290.

Investigating Relationships Between Paternal Perception of the Role of the Father and Paternal Feeding Practices

A father’s perception of his role or, how his partner views his role, at mealtimes influences his feeding practices is currently unknown. Therefore, the aim of this study was to evaluate the influence of father-reported maternal and paternal perceptions of the role of the father on child feeding practices, as well as child body weight. Biological fathers of varied racial, ethnic, education, and income backgrounds (n = 150) of preschool age children from a Northeastern state in the United States were interviewed one-on-one using the Role of the Father Questionnaire to assess a father’s perception of his role and of his partner’s perception of his role in mealtimes and The Child Feeding Questionnaire to assess paternal feeding practices. Height and weight for each father and child were measured. Linear regression was used to examine the relationship between the role of the father, paternal feeding practices and child BMI z-score. Overall, the findings revealed that only the father’s perception of his role at mealtimes was associated with higher perceived responsibility for child feeding (β = .033, p = 0.020), and lower use of controlling feeding practices, including pressure to eat (β = −.048, p = 0.029) and restriction (β = −.030, p = 0.05) and was not moderated by the father’s appraisal of his partner’s perception of his role at mealtimes. Thus, a father’s beliefs regarding his role at mealtimes, and not his views of the mother’s perception, may be related to his own feeding practices.

Child weight and parental feeding practices: a child-responsive model

Purpose– The majority of previous studies on parental feeding practices have focused on the effect of controlling feeding strategies on child eating and weight (i.e. parental influence on children). The present study turns the arrow in the opposite direction, and it aims to test a child-responsive model by exploring the process in which child weight status might influence parental feeding practices, addressing potential mediating effects of parental concern for child weight (i.e. child influence on parents).Design/methodology/approach– A cross-sectional survey was performed among parents of 10- to 12-year olds (n= 963). The survey questionnaire included measures of parental feeding practices and parents’ reports of child weight and height. Stepwise regressions were performed to reveal potential mediating effects of parental concern for child weight status on the associations between child BMI and a wide range of parental feeding practices.Findings– Our results suggest a mediating effect of parental concern for child overweight on the associations between child body mass index and controlling feeding practices such as restriction for weight and health purposes and responsibility for determining child portion sizes.Originality/value– This study provides an extension of previous research on parental feeding–child weight relationship. It includes a wider spectrum of feeding variables, and integrates parental concern for both child who is overweight and child who is underweight as potential mediators of the associations between child weight and parental feeding practices. Moreover, it has its focus on preadolescent children, while previous studies have focused on infants and young children.

Child gender and weight status moderate the relation of maternal feeding practices to body esteem in 1st grade children

Prevention of body dissatisfaction development is critical for minimizing adverse effects of poor body esteem on eating behaviors, self-esteem, and overall health. Research has examined body esteem and its correlates largely in pre-adolescents and adolescents; however, important questions remain about factors influencing body esteem of younger children. The main purpose of this study was to test moderation by children's gender and weight status of the relation of maternal controlling feeding practices to 1st graders' body esteem. The Body Esteem Scale (BES) and anthropometric measurements were completed during one-on-one child interviews at school. Mothers completed the Child Feeding Questionnaire (restriction, monitoring, concern, self-assessed maternal weight). A total of 410 mother/child dyads (202 girls) participated. Percent of children classified as overweight (BMI-for-age ≥85th) was: girls – 29%; boys – 27%. Gender moderated the relation between restriction and body esteem (β = −.140, p = .05), with maternal restriction predicting body esteem in girls but not boys. The hypothesized three-way interaction among gender, child weight status, and monitoring was confirmed. Monitoring was significantly inversely related to body esteem only for overweight/obese girls (b = −1.630). The moderating influence of gender or gender and weight status on the link between maternal feeding practices and body esteem suggests the importance of body esteem interventions for girls as early as first grade.

Are body image and eating attitudes, behaviours, and knowledge of parents of pre-schoolers associated with parent feeding practices?

Some parent feeding practices have been linked to disordered eating and higher BMIs in children. Relatively little research has examined factors that influence parent feeding practices. The aim of this study was to identify relationships between the parent feeding practices that have been linked to unhealthy eating patterns in children, and parent body image, eating attitudes, behaviours, and knowledge. Participants were 326 parents of pre-school children from Victoria (97.5% mothers). Parents completed measures of parent body dissatisfaction, body image knowledge, dieting behaviours, and parent feeding practices of their child closest to four years old (58% girls, aged 2-6 years). Knowledge scores were inversely associated with a number of negative feeding practices, including instrumental feeding, and with the frequency of parents reporting negative behavioural intentions to brief vignettes reflecting appearance-based stigma. Parent weight and shape concerns were positively associated with restrictive feeding practices, including restricting high-fat foods in their pre-schooler. Parent dieting was positively related to restricting and controlling feeding practices. Given that such parent feeding practices are associated with long-term risk of weight gain and disordered eating in children, these findings highlight the need for prevention interventions for parents of pre-schoolers. This abstract was presented in the Parental Roles in Prevention and Support stream of the 2014 ANZAED Conference.

Feeding practices and child weight: is the association bidirectional in preschool children?

Parental feeding practices are associated with children's body mass index (BMI). It has been generally assumed that parental feeding determines children's eating behaviors and weight gain, but feeding practices could equally be a parent's response to child weight. In longitudinal analyses, we assessed the directionality in the relation between selected controlling feeding practices and BMI in early childhood. Participants were 4166 children from the population-based Generation R Study. BMI was measured at ages 2 and 6 y. With the use of the Child Feeding Questionnaire, parents reported on restriction, monitoring, and pressure to eat (child age: 4 y). BMI and feeding-behavior scales were transformed to SD scores. With the use of linear regression analyses, there was an indication that a higher BMI at age 2 y predicted higher levels of parental restriction (adjusted β = 0.07; 95% CI: 0.04, 0.10) and lower levels of pressure to eat (adjusted β = -0.20; 95% CI: -0.23, -0.17) 2 y later. Restriction at age 4 y positively predicted child BMI at 6 y of age, although this association attenuated to statistical nonsignificance after accounting for BMI at age 4 y (β = 0.01; 95% CI: -0.01, 0.03). Pressure to eat predicted lower BMI independently of BMI at age 4 y (β = -0.02; 95% CI: -0.04, -0.01). For both restriction and pressure to eat, the relation from BMI to parenting was stronger than the reverse (Wald's test for comparison: P = 0.03 and < 0.001, respectively). Monitoring predicted a lower child BMI, but this relation was explained by confounding factors. Although the feeding-BMI relation is bidirectional, the main direction of observed effects suggests that parents tend to adapt their controlling feeding practices in response to their child's BMI rather than the reverse. Therefore, some components of current programs aimed at preventing or treating unhealthy child weight may need to be carefully scrutinized, especially those targeting parental food-related restriction and pressure to eat.

Association between Australian-Indian mothers' controlling feeding practices and children's appetite traits

This cross-sectional study examined the association between controlling feeding practices and children's appetite traits. The secondary aim studied the relationship between controlling feeding practices and two proxy indicators of diet quality. Participants were 203 Australian-Indian mothers with children aged 1–5 years. Controlling feeding practices (pressure to eat, restriction, monitoring) and children's appetite traits (food approach traits: food responsiveness, enjoyment of food, desire to drink, emotional overeating; food avoidance traits: satiety responsiveness, slowness in eating, fussiness and emotional undereating) were measured using self-reported, previously validated scales/questionnaires. Children's daily frequency of consumption of core and non-core foods was estimated using a 49-item list of foods eaten (yes/no) in the previous 24 hours as an indicator of diet quality. Higher pressure to eat was associated with higher scores for satiety responsiveness, slowness in eating, fussiness and lower score for enjoyment of food. Higher restriction was related to higher scores for food responsiveness and emotional overeating. Higher monitoring was inversely associated with fussiness, slowness in eating, food responsiveness and emotional overeating and positively associated with enjoyment of food. Pressure to eat and monitoring were related to lower number of core and non-core foods consumed in the previous 24 hours, respectively. All associations remained significant after adjusting for maternal and child covariates (n = 152 due to missing data). In conclusion, pressure to eat was associated with higher food avoidance traits and lower consumption of core foods. Restrictive feeding practices were associated with higher food approach traits. In contrast, monitoring practices were related to lower food avoidance and food approach traits and lower non-core food consumption.

Testing Satter’s Division of Responsibility in Feeding in the context of restrictive snack-management practices

Testing Satter’s Division of Responsibility in Feeding in the context of restrictive snack-management practices

The relationship between controlling feeding practices and boys' and girls' eating in the absence of hunger

Parental controlling feeding practices have been directly associated with maladaptive child eating behaviors, such as eating in the absence of hunger (EAH). The aims of this study were to examine EAH in very young children (3–4years old) and to investigate the association between maternal controlling feeding practices and energy intake from a standardized selection of snacks consumed ‘in the absence of hunger’. Thirty-seven mother–child dyads enrolled in the NOURISH RCT participated in a modified EAH protocol conducted in the child's home. All children displayed EAH, despite 80% reporting to be full or very full following completion of lunch 15min earlier. The relationships between maternal and child covariates and controlling feeding practices and EAH were examined using non-parametric tests, and were stratified by child gender. For boys only, pressure to eat was positively associated with EAH. Neither restriction nor monitoring practices were associated with EAH in either boys or girls. Overall, the present findings suggest that gender differences in the relationship between maternal feeding practices and children's eating behaviors emerge early and should be considered in future research and intervention design.

The influence of maternal infant feeding practices and beliefs on the expression of food neophobia in toddlers

Food neophobia is a highly heritable trait characterized by the rejection of foods that are novel or unknown and potentially limits dietary variety, with lower intake and preference particularly for fruits and vegetables. Understanding non-genetic (environmental) factors that may influence the expression of food neophobia is essential to improving children's consumption of fruits and vegetables and encouraging the adoption of healthier diets. The aim of this study was to examine whether maternal infant feeding beliefs (at 4 months) were associated with the expression of food neophobia in toddlers and whether controlling feeding practices mediated this relationship. Participants were 244 first-time mothers (M = 30.4, SD = 5.1 years) allocated to the control group of the NOURISH randomized controlled trial. The relationships between infant feeding beliefs (Infant Feeding Questionnaire) at 4 months and controlling child feeding practices (Child Feeding Questionnaire) and food neophobia (Child Food Neophobia Scale) at 24 months were tested using correlational and multiple linear regression models (adjusted for significant covariates). Higher maternal Concern about infant under-eating and becoming underweight at 4 months was associated with higher child food neophobia at 2 years. Similarly, lower Awareness of infant hunger and satiety cues was associated with higher child food neophobia. Both associations were significantly mediated by mothers' use of Pressure to eat. Intervening early to promote positive feeding practices to mothers may help reduce the use of controlling practices as children develop. Further research that can further elucidate the bi-directional nature of the mother–child feeding relationship is still required.

“Take a No Thank-You Bite” Head Start and Child Care Providers' Perceptions to Avoiding Controlling Feeding Practices

National childhood obesity prevention policies recommend that childcare providers avoid controlling feeding practices such as pressuring children to eat or restricting foods because they can contribute to the development of unhealthy eating behaviors and childhood obesity. Yet, research suggests that childcare providers control children's dietary intake during mealtimes. The objective of this study is to identify Head Start, Child and Adult Care Food Program (CACFP) funded and non-CACFP providers' motivators, facilitators and barriers for avoiding controlling feeding practices for preschool children in their care.

Effects of children's self-regulation of eating on parental feeding practices and child weight

The purpose of this study was to determine whether self-regulation of eating in minority preschool-aged children mediates the relationship between parent feeding practices and child weight. Participants were 299 low-income African American and Hispanic parents and their preschool-aged children who participated in Head Start. Parents completed questionnaires about controlling feeding practices (pressure to eat, restriction) and children's appetitive characteristics (enjoyment of food, food responsiveness, satiety responsiveness). Path analyses were used to determine whether children's self-regulation of eating mediated the relationship between feeding practices and child weight. Greater satiety responsiveness in African American preschool-age children partially mediated the inverse association between pressure to eat and children's weight, B (SE) = −0.073 (0.036), P < .05. Enjoyment of food and food responsiveness did not mediate the relationship between pressure to eat and weight in the African American sample, ps > .05, nor did appetitive characteristics mediate the relationship between restriction and child weight, ps > .05. Appetitive characteristics did not mediate the relationship between controlling feeding practices and child weight in the Hispanic sample, ps > .05. Implications include the need for culturally sensitive self-report measures and for researchers to account for the possible effects of racial/ethnic differences when designing interventions.

Perceptions of parental pressure to eat and eating behaviours in preadolescents: The mediating role of anxiety

Previous research suggests that parental controlling feeding practices are associated with children's overeating and undereating behaviours. However, there is limited research addressing the link between children's mental health symptoms (specifically anxiety and depression) and their reports of eating behaviours, despite knowledge that these psychopathologies often co-exist. The current study aimed to identify the relationships between preadolescents’ perceptions of their parents’ feeding practices with reports of their own anxiety, depression and eating behaviours. Three hundred and fifty-six children (mean age 8.75 years) completed questionnaires measuring their dietary restraint, emotional eating and external eating, as well as their perceptions of their parents’ use of pressure to eat and restriction of food. Children also completed measures of general anxiety, social anxiety and depression symptomology. Results indicated that preadolescents’ eating behaviours were associated with their perceptions of the controlling feeding practices their parents used with them. Preadolescents’ dietary restraint, emotional eating and external eating behaviours were positively associated with their reports of general and social anxiety, and depression symptomology. In addition, perceptions of parental pressure to eat were positively related to preadolescents’ anxiety and depression levels. Child anxiety (general and social) was found to mediate the relationship between perceptions of parental pressure to eat and preadolescents’ eating behaviours (dietary restraint, emotional eating and external eating). The results suggest that greater anxiety in preadolescents may explain why children who perceive greater pressure to eat by their parents are more likely to exhibit maladaptive eating behaviours.

Predictors of Head Start and Child-Care Providers' Healthful and Controlling Feeding Practices with Children Aged 2 to 5 Years

Few child-care providers meet the national recommendations for healthful feeding practices. Effective strategies are needed to address this disparity, but research examining influences on child-care providers' feeding practices is limited. The purpose of this study was to identify determinants of child-care providers' healthful and controlling feeding practices for children aged 2 to 5 years. In this cross-sectional study, child-care providers (n=118) from 24 center-based programs (six Head Start [HS], 11 Child and Adult Care Food Program [CACFP] funded, and seven non-CACFP) completed self-administered surveys during 2011-2012. Multilevel multivariate linear regression models were used to predict seven feeding practices. Working in an HS center predicted teaching children about nutrition and modeling healthy eating; that may be attributed to the HS performance standards that require HS providers to practice healthful feeding. Providers who reported being concerned about children's weight, being responsible for feeding children, and had an authoritarian feeding style were more likely to pressure children to eat, restrict intake, and control food intake to decrease or maintain children's weight. Providers with nonwhite race, who were trying to lose weight, who perceived nutrition as important in their own diet, and who had a greater number of nutrition training opportunities were more likely to use restrictive feeding practices. These findings suggest that individual- and child-care–level factors, particularly provider race, education, training, feeding attitudes and styles, and the child-care context may influence providers' feeding practices with young children. Considering these factors when developing interventions for providers to meet feeding practice recommendations may add to the efficacy of childhood obesity prevention programs.

From the Editor

This first issue of the journal for 2014 heralds a new focus allowing for a greater number of manuscripts on original research. The March issue is characterised by an array of studies in practice domains, alongside novel areas of food composition and dietetics education. In the first paper, Tyrovolas et al. associated with the Mediterranean Islands Study share their findings on dietitians' influence on the dietary habits of older adults. Adherence to the Mediterranean diet pattern was associated with the presence of a dietitian and the level of adherence was linked to the level of education of the dietitian. This study has significant implications for the development of the profession. Drilling down to the level of work of dietitians in hospital and outpatient settings, Milosavljevic et al. report in a novel ethnographic study that draws attention to the amount of time spent on duties other than direct patient care. Both these studies provide cause for reflection on the value of dietetic practice in healthcare services. This extends to the topic of the next paper from New Zealand, where Parry Strong et al. present research on training in nutrition for practice nurses in the primary healthcare setting. In more traditional research in the clinical setting, Farrer and Golley report on a pilot study testing the effects of a very low calorie diet in the short term as part of the dietary management package for type 2 diabetes. Their assessments of feasibility provide useful insights into staged care in this domain. The community and public health nutrition section begins with a paper on a survey of Indian mothers residing in Australia. Mehta et al. focused on the issue of controlling feeding practices and its links with ‘picky eaters’. Further research on the influences on children's dietary habits was reported by Roberts et al. critiquing the voluntary codes of practice for food advertising and finding that past problems still exist. Likewise, in their research on the saturated fat and sodium content of fast foods, Antoniolli et al. argue that there is a need for improvement, suggesting extending the standards for options promoted on nutritional grounds to the menu overall. In a paper for the journal on food composition, Liu, Greenfield and Fraser report on the vitamin D content of Australian eggs and provide some useful insight into the methodology associated with the development of data on food composition. The final set of papers in this issue focus on Dietetic Education, with Ferguson et al. researching the case for the clinical educator role. This pairs well with the Desbrow et al.'s study on curriculum innovation that targets research capacity within the profession. Both these papers herald important strategic developments for the profession, the benefits of which may well appear in future issues of the journal.

Maternal controlling feeding practices and girls’ inhibitory control interact to predict changes in BMI and eating in the absence of hunger from 5 to 7 y

Mothers use a range of feeding practices to limit children's intake of palatable snacks (eg, keeping snacks out of reach, not bringing snacks into the home), but less is known about the effects of these practices on children's eating and weight outcomes. The objective was to identify distinct feeding practice profiles and evaluate the interactive effects of these profiles and girls' temperament (inhibitory control and approach) on girls' eating behaviors and weight outcomes at 5 and 7 y. Participants included 180 mother-daughter dyads; measures were mothers' reports of controlling feeding practices and girls' height and weight, eating in the absence of hunger (EAH) at 5 y, and inhibitory control (a measure of behavioral inhibition) and approach (a measure of appetitive motivation) at 7 y. Latent profile analysis of maternal feeding practices showed 4 feeding profiles based on maternal use of limit-setting practices and keeping snacks out of girls' physical reach, a restrictive practice: Unlimited Access to Snacks, Sets Limits+Does Not Restrict Snacks, Sets Limits+Restricts High Fat/Sugar Snacks, and Sets Limits+Restricts All Snacks. Girls whose mothers used Sets Limits+Restricts All Snacks had a higher approach and EAH at 5 y. Low inhibitory control girls whose mothers used Sets Limits+Restricts All Snacks or Unlimited Access to Snacks had greater increases in EAH and body mass index (BMI) from 5 to 7 y. Effects of maternal control on girls' EAH and BMI may differ by the type of practice used (eg, limit-setting or restrictive practices). Girls with low inhibitory control were more susceptible to the negative effects of low and high control.

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.

Adolescents' Level of Eating Psychopathology Is Related to Perceptions of Their Parents' Current Feeding Practices

This study aimed to examine the relationships between adolescents' eating disorder attitudes and their perceptions of the feeding practices that their parents/caregivers currently use. Boys and girls (N= 528) aged 13-15 completed self-report measures of their levels of eating psychopathology and their parents' current feeding practices and reported their own height and weight. For girls, greater perceived pressure from parents to eat food and lower perceived parental responsibility for food were significantly related to more unhealthy eating-related attitudes. Similar to girls, lower perceived parental responsibility for food was significantly related to greater levels of eating psychopathology in boys. Greater perceived parental restriction of foods was also significantly related to greater eating psychopathology in boys. These results suggest that adolescents' perceptions of their parents' use of more controlling feeding practices are related to greater prevalence of unhealthy eating-related attitudes. Such findings have potentially important implications for the prevention of disordered eating in adolescents.

Outcomes of an Early Feeding Practices Intervention to Prevent Childhood Obesity

The goal of this study was to evaluate outcomes of a universal intervention to promote protective feeding practices that commenced in infancy and aimed to prevent childhood obesity. The NOURISH randomized controlled trial enrolled 698 first-time mothers (mean ± SD age: 30.1 ± 5.3 years) with healthy term infants (51% female) aged 4.3 ± 1.0 months at baseline. Mothers were randomly allocated to self-directed access to usual care or to attend two 6-session interactive group education modules that provided anticipatory guidance on early feeding practices. Outcomes were assessed 6 months after completion of the second information module, 20 months from baseline and when the children were 2 years old. Maternal feeding practices were self-reported by using validated questionnaires and study-developed items. Study-measured child height and weight were used to calculate BMI z scores. Retention at follow-up was 78%. Mothers in the intervention group reported using responsive feeding more frequently on 6 of 9 subscales and 8 of 8 items (all, P ≤ .03) and overall less controlling feeding practices (P < .001). They also more frequently used feeding practices (3 of 4 items; all, P < .01) likely to enhance food acceptance. No statistically significant differences were noted in anthropometric outcomes (BMI z score: P = .10) nor in prevalence of overweight/obesity (control 17.9% vs intervention 13.8%; P = .23). Evaluation of NOURISH data at child age 2 years found that anticipatory guidance on complementary feeding, tailored to developmental stage, increased use by first-time mothers of "protective" feeding practices that potentially support the development of healthy eating and growth patterns in young children.

An exploratory study of associations between Australian‐Indian mothers' use of controlling feeding practices, concerns and perceptions of children's weight and children's picky eating

AbstractAimThis cross‐sectional study explores associations between migrant Indian mothers' use of controlling feeding practices (pressure to eat, restriction and monitoring) and their concerns and perceptions regarding their children's weight and picky eating behaviour.MethodsA total of 230 mothers with children aged 1–5 years, residing in Australia for 1–8 years, participated by completing a self‐reported questionnaire.ResultsPerceptions and concerns regarding children's weight were not associated with any of the controlling feeding practices. A positive association was noted between pressure‐feeding and perceptions of pickiness after adjusting for covariates: children's age, gender and weight‐for‐age Z‐score. Girls, older children, and children with higher weight‐for‐age Z‐scores were pressure‐fed to a greater extent.ConclusionsThis study supports the generalisation of findings from Caucasian literature that pressure‐feeding and perceptions of pickiness are positively related.