Parent-child Mealtime Interactions Research Articles

Factors associated with parenting stress in parents of 18-month-old children: Parenting stress in parents of toddlers.

Parenting stress is associated with less optimal outcomes for children. Risk factors contributing to parenting stress in healthy toddlers have received little empirical attention. This study sought to determine the factors that are associated with parenting stress in parents of 18-month-old children. We analysed cross-sectional survey data from a prospective cohort study focused on parent-child mealtime interactions. Families with an 18-month-old child were recruited in Columbus, Ohio, USA, between December 2017 and May 2019. Adjusted stepwise linear regression models estimated associations between child factors (e.g., temperament), parental factors (e.g., depressive symptoms), quality of romantic relationship factors (e.g., adult attachment style) and home environment factors (e.g., household income) and parenting stress (Parental Distress subscale of the Parenting Stress Index-4 Short Form). The 299 children included 129 (43%) females. Parents were on average 30.6 (SD 6.1) years old and included a diverse racial/ethnic cohort. Mean Parental Distress score was 24.3 (SD 6.8; score range 12-60). Higher Parental Distress scores were associated with greater parental depressive symptoms (B = 5.1 [95% CI: 2.4, 7.7]) and avoidant (B = 2.8 [95% CI: 0.9, 4.6]) attachment style. Other child, parental and home environment factors did not demonstrate statistically significant relationships with parental distress in the final model. Our findings align with recommendations for paediatric providers to screen for parenting stress and mental health.

Family mealtime behaviors in children who are tube fed and preparing to transition to oral eating: A comparison to other pediatric populations.

This study examined differences in observed mealtime behaviors between children preparing to transition to oral feeding and children with various other chronic illnesses using a standardized measure of mealtime beaviors. The parent-child mealtime relationship can become strained due to problematic mealtime behaviors that limit food intake, as well as inadvertent reinforcement of disruptive behavior by caregivers. Frequency/rate of behaviors were compared between children with tube feeding (CwTF) and from previous studies of children with chronic illnesses using the Dyadic Interactive Nomenclature for Eating (DINE). Parents of CwTF used more coaxing, physical prompts, and reinforcement during meals, while parents of children with chronic illnesses used more direct commands and engaged in more parent talk. Findings support differences in parent-child mealtime interactions and eating behaviors across pediatric illness subgroups.

Parental stress, anxiety and trait mindfulness: associations with parent-child mealtime interactions in children with type 1 diabetes.

Introduction This study examined how maternal and paternal stress, anxiety, and trait mindfulness, and child glycemic control are related to real-life parent-child interactions in families confronted with type 1 diabetes (T1D). Methods Parents reported on trait mindfulness, illness-related parenting stress, general stress, and state anxiety. Parent-child mealtime interactions were videotaped and scored in 33 families (31 mothers and 20 fathers) of children with T1D (5-12y., mean HbA1c = 7.22%). Results Parental stress and anxiety were related to more maladaptive and less adaptive parent-child interactions. For mothers, mindfulness was related to less observed discomfort of the child during injection. For fathers, more emotional involvement was related to better child glycemic control. Discussion Results indicate that parental stress and anxiety may be risk factors for maladaptive parent-child interactions.

NP31 Development of the Family Meal Project: A Family Nutrition Ecosystem Intervention to Prevent Childhood Overweight/Obesity

Objective To develop a family nutrition ecosystem program to improve parent-child food interactions, family modeling and family food access by enhancing parent knowledge, attitudes and self-efficacy. Description Though childhood obesity is multi-causal, parents help shape children's eating behaviors making them an important target for nutrition education. In the current study, Social Cognitive Theory (SCT) informed the predicted pathways to parents’ health behavior change and the Theory of Diffusion of Innovation informed the planned dissemination of nutrition education information via interpersonal (in-person workshops), mass media (website) and social media. The resulting three-component intervention The Family Meal Project targets family mealtime interactions by applying an empirically supported parenting intervention to parent-child mealtime interactions, while attending to the unique considerations of Latino families representing this growing demographic in the targeted community. Component 1 involves multi-family groups (six, 2-hour sessions) that incorporate principles and strategies from, Parent-Child Interaction Therapy (PCIT), modified for diet behaviors and implemented by Masters level dietetic students. Groups include a family meal (with modeling and coaching), review of the past week, nutrition psychoeducation and goal setting. While parents participate in programming, children join health-related activities facilitated by research staff. Component 2 is a program support website (familymealproject.fiu.edu) available to parents at the start of the intervention and continuously updated to reflect parent feedback. Component 3 is a social-media based nutrition education extension containing food-related messages through Instagram, Facebook and Pinterest. Evaluation The program will be evaluated during Year 2 using a pre-post intervention design model. Participants will include families (n = 30) with at least one child (4-10 years) recruited from participating elementary schools (90% minority, 95% Hispanic). Repeated Measure ANOVAs and regression analysis will test changes over time. Qualitative data from interviews and focus groups will inform revisions to intervention. Conclusion and Implications We expect parents will exhibit increased knowledge of food and mealtime-related parenting behaviors, increase self-efficacy to provide healthy nutrition opportunities, and enhance their family nutrition ecosystem. Future directions include further testing in a randomized clinical controlled trial. Funding 2018-68001-27552.

Parent-child mealtime interactions associated with toddlers' refusals of novel and familiar foods

Parents' feeding practices have been associated with children's dietary quality and food acceptance, but previous studies have largely relied exclusively on questionnaires to assess both parent and child behavior. The current study explored the relationships between parents' reported and observed feeding practices and toddlers' food refusals.Sixty families with toddlers (12–36months-old) video recorded their children's dinners at home as well as a separate meal in which they offered the child a novel fruit or vegetable. Parents completed questionnaires about their feeding practices and children's picky eating and food neophobia. Videos were coded for parents' observed feeding practices at mealtimes and children's food refusals. Parents' feeding practices and children's food refusals were compared in families with children reported to be more picky and less picky eaters. The relationships between reported and observed feeding practices with observed food refusals were also assessed. It was hypothesized that parents' use of controlling and coercive prompts to eat would be associated with children's food refusals.Parent-reported picky eating was not associated with an increase in children's total food refusals, although reported neophobia was associated with more uses of crying, pushing food away, or verbally refusing a new food. More prompts to eat of any kind were associated with more food refusals. In regression models, more observed coercive-controlling prompts used by parents were associated with more food refusals by children. Parents of pickier eaters tended to use a lower proportion of autonomy-supportive prompts to eat, and these families also showed a stronger association between the use of controlling prompts and food refusals. These families may benefit the most from interventions aiming to reduce the use of controlling practices. Models using observed feeding practices were more strongly associated with children's food refusals than were parents' reported feeding practices. This highlights the importance of behavioral observation in this field.

Do maternal perceptions of child eating and feeding help to explain the disconnect between reported and observed feeding practices?: A follow-up study.

Research demonstrates a mismatch between reported and observed maternal feeding practices. This mismatch may be explained by maternal cognitions, attitudes, and motivations relating to dyadic parent-child feeding interactions. These complex constructs may not be apparent during observations nor evidenced in self-report questionnaire. Therefore, the aim of this study was to use a qualitative approach to gain a more nuanced and contextualized understanding of (a) maternal perceptions of children's food intake control; (b) how parent-child mealtime interactions influence maternal feeding practices; and (c) ways in which mothers may promote healthy child eating and weight outcomes. Semistructured telephone interviews were conducted with 23 mothers (M=38.4±3.7years of age) of preschool-aged children (M=3.8±0.6years of age, 19 were normal weight, 14 were girls), who had previously completed child feeding questionnaire and participated in two home-based mealtime observations, 12months apart. Interviews were recorded, transcribed, and themes extracted to create the database. Four major themes emerged: (a) Maternal confidence in children's ability to regulate food intake is variable; (b) Implementing strategies for nurturing healthy relationships with food beyond the dining table; (c) Fostering positive mealtime interactions is valued above the content of what children eat; and (d) Situation-specific practices and inconsistencies. Findings indicate that maternal feeding practices are shaped by both parent and child influences, and child feeding is mostly guided by controlling the family food environment, rather than by directly pressuring or restricting their child's eating. Results also highlighted the need for research to consider both parent and child influences on child feeding.

Mutually Responsive Orientation: A novel observational assessment of mother-child mealtime interactions

Mother-child mealtime interactions during preschool years is an important but overlooked factor when evaluating the influence of parent-child relationships on child eating and weight. This paper describes the validation of the Mutually Responsive Orientation (MRO) coding system adapted for assessing parent-child interactions during food preparation and consumption situations. Home-based mealtimes of 94 mothers and their children (3.03 ± 0.75 years) were filmed at two time points, 12-months apart. Filmed dimensions of mutual mother-child responsiveness, shared positive affect, maternal control relating to food and child compliance were assessed. Objective BMI and maternal reports of parenting, feeding, child eating, diet and child temperament were also collected. Correlations, repeated measures ANOVAs and regressions were performed to examine the validity of MRO variables and their stability across both time points. Validation analysis showed the MRO coding system performed as expected: dyads with higher MRO scores expressed lower control/power assertion, lower child non-compliance, and greater committed compliance. The measure demonstrated sensitivity to specific contexts: maternal responsiveness, mother and child positive affect were higher during food consumption compared to food preparation. Coded dimensions were stable across time points, with the exception of decreases in maternal responsiveness in food consumption and child non-compliance in food preparation. MRO and maternal dimensions were correlated with maternally reported parenting and feeding measures. Maternal responsiveness (inversely) and child responsiveness (positively) were concurrently associated with child fussy eating, and child refusal was prospectively and inversely associated with child fussy eating. Findings suggest the adapted MRO coding system is a useful measure for examining observed parent-child mealtime interactions potentially implicated in preschoolers’ eating and weight development.

Feeding style and feeding practices and toddlers’ eating behaviors (379.1)

Objective: An authoritative feeding style has been associated with healthier diets in children. This study explores which practices mothers with different feeding styles report using and if these behaviors can be observed in mealtime interactions.Methods: A questionnaire about feeding styles and practices was completed by 1005 US mothers with children of 12‐36 months. 60 families with toddlers (also 12‐36 mo.) participated in an in‐home observational study of parent‐child mealtime interactions.Results: Authoritative parents were significantly more likely to report that they model and encourage healthy eating, allow children to choose which foods to eat and to participate in meal preparation. Authoritarian mothers reported using foods as rewards and encouraging children to clean their plate. Indulgent mothers often ate with their children and gave children control over how much to eat, and were less likely to restrict intake or use foods as rewards. Uninvolved mothers reported restricting foods to control their children’s weight. Parents of older children were more demanding than those of younger children, reflecting the child’s developing ability to regulate his behavior.Conclusions: Parents of different feeding styles report different feeding practices. Parents’ reported behaviors will be compared to those observed in the behavioral study and discussed in relation to the child’s eating behaviors.

Parent–child mealtime interactions in racially/ethnically diverse families with preschool-age children

Family meals may improve diet and weight outcomes in children; however, results from nationally representative samples suggest that these relationships vary by race/ethnicity. Observing parent–child mealtime interactions may lend insight to why racial/ethnic differences exist. In this pilot study, a multi-ethnic sample of low-income families (n=30) with a preschool-age child was videotaped during a dinner in their home. A global coding scheme was used to assess the following: ‘Action’ (behaviors that divert attention from eating), ‘Behavior Control’ (behaviors intended to modify another person’s behavior), and ‘Communication’ (i.e., meal-oriented, interpersonal, and critical). All families spent a significant amount of time in ‘action’ oriented behaviors that diverted their attention from eating. We also observed racial/ethnic differences in communication (i.e. critical) and behavior patterns (i.e. behavior control). This study demonstrated that this approach for observing parent–child mealtime interactions in a naturalistic setting among a diverse study sample was feasible; however, future studies should address how these patterns relate to dietary intake and weight status.

Eating behavior and familial interactions of children with loss of control eating: a laboratory test meal study

Loss of control (LOC) eating in children leads to excessive weight gain. However, few studies have investigated the eating behavior of children with LOC eating and psychological and familial factors that maintain the eating behavior. This study sought to measure food intake in children with LOC eating and to examine maintenance through negative mood and parent-child mealtime interactions. Children with or without LOC eating (n = 120, aged 8-13 y) consumed a parent-child test meal and a child-only meal, consisting of snack food, after the induction of negative mood. Food intake, mood, sense of LOC, hunger, satiety, and mealtime interactions were assessed. Regardless of mood induction, children with LOC eating showed a greater intake of energy, fat, and protein and a greater sense of LOC than did those without LOC in the child-only snack group, which was accounted for by greater baseline hunger and satiety. Independently, children with high recurrent LOC eating had a greater food intake at both test meals than did those with low recurrent LOC eating. Overall, mealtime interactions did not differ between groups, but parents of children with LOC eating expressed more weight-related critique than did parents of children without LOC eating outside negative mood induction. Predictors of food intake were greater antecedent hunger or less satiety, stronger antecedent sense of LOC, and more weight-related critique. The results showed objective abnormalities in the eating behavior of children with LOC eating that were mostly unrelated to negative mood or dysfunctional mealtime interactions. Further research is required to specify factors maintaining LOC eating.

Mealtime Interactions Relate to Dietary Adherence and Glycemic Control in Young Children With Type 1 Diabetes

OBJECTIVE—This study examined the relationships between parent-child mealtime interactions and dietary adherence and glycemic control in young children with type 1 diabetes. It was hypothesized that young children who exhibited disruptive mealtime behaviors would have more dietary deviations (poorer dietary adherence) and poor glycemic control. It was also hypothesized that parents of young children who used ineffective/coercive parenting strategies at mealtimes would have children with more dietary deviations and poor glycemic control. RESEARCH DESIGN AND METHODS—A total of 35 families of children (aged 2.2–7.9 years) with type 1 diabetes were recruited from a pediatric hospital. Families had at least three meals videotaped in their home, which were coded for parent, child, and eating behaviors, using the Dyadic Interaction Nomenclature for Eating. Children’s dietary adherence was assessed according to deviations from the prescribed number of carbohydrate units per meal. Children’s average glycemic excursion was assessed prospectively for 2 weeks, using a standardized home blood glucose meter. RESULTS—Findings demonstrated significant positive relationships between children’s mealtime behavior, dietary deviations, and glycemic control. An examination of parent behaviors revealed significant positive correlations between parents’ use of ineffective/coercive parenting strategies and children’s dietary deviations and glycemic control. CONCLUSIONS—This was the first study to examine the relationship between parent-child mealtime interactions and health outcomes in young children with type 1 diabetes. The mealtime problems examined can be improved through specific behavioral interventions. Future research is needed to examine how parent-child interactions at mealtimes relate to children’s health outcomes to inform clinical care.

Mealtime Interactions Relate to Dietary Adherence and Glycemic Control in Young Children With Type 1 Diabetes

This study examined the relationships between parent-child mealtime interactions and dietary adherence and glycemic control in young children with type 1 diabetes. It was hypothesized that young children who exhibited disruptive mealtime behaviors would have more dietary deviations (poorer dietary adherence) and poor glycemic control. It was also hypothesized that parents of young children who used ineffective/coercive parenting strategies at mealtimes would have children with more dietary deviations and poor glycemic control. A total of 35 families of children (aged 2.2-7.9 years) with type 1 diabetes were recruited from a pediatric hospital. Families had at least three meals videotaped in their home, which were coded for parent, child, and eating behaviors, using the Dyadic Interaction Nomenclature for Eating. Children's dietary adherence was assessed according to deviations from the prescribed number of carbohydrate units per meal. Children's average glycemic excursion was assessed prospectively for 2 weeks, using a standardized home blood glucose meter. Findings demonstrated significant positive relationships between children's mealtime behavior, dietary deviations, and glycemic control. An examination of parent behaviors revealed significant positive correlations between parents' use of ineffective/coercive parenting strategies and children's dietary deviations and glycemic control. This was the first study to examine the relationship between parent-child mealtime interactions and health outcomes in young children with type 1 diabetes. The mealtime problems examined can be improved through specific behavioral interventions. Future research is needed to examine how parent-child interactions at mealtimes relate to children's health outcomes to inform clinical care.