Use Of Restrictive Feeding Practices Research Articles

Factors That Affect Food Parenting Practices of Children With Food Allergies

ObjectivesThe prevalence of food allergies continues to increase. Literature shows child diagnosis of a food allergy has implications for parents (e.g., higher levels of anxiety), which can influence food parenting practices (FPP). As such, the primary aim of the current study was to investigate whether FPP differ between parents of children with and without a food allergy. The secondary aim was to investigate whether secondary factors, such as historical severity of allergic reaction, will also affect FPP.MethodsParticipants were parents of children (N = 399) who completed online surveys about health history, including food allergy history, and FPP (Child Feeding Questionnaire, Structure and Control in Parent Feeding). About one-quarter (24.6%; n = 98) of children had at least one food allergy. A series of ANOVAs were conducted to assess differences in FPP between children with and without food allergies. Secondary analyses were conducted among parents of children with food allergies to examine how professional diagnosis, parental food allergy, reaction severity, hospitalization history, and presence of other chronic conditions affect FPP.ResultsParents of children with food allergies were more likely to report limit setting FPP (p = .035); there were no other significant differences in FPP between children with and without food allergies (ps > .133). Among families with food allergies, parents whose children were not professionally diagnosed with a food allergy reported greater use of restrictive feeding practices (p = .019). Compared to parents without a food allergy, when both parent and child have a food allergy, parents reported higher pressure to eat (p = .006, p = .046), use of control (p = .039), and structured feeding routines (p = .039).ConclusionsCurrent findings illustrate that FPP are similar between parents of children with and without food allergies, with parents of children with food allergies engaging in more limit setting. However, in families with a food allergic child, other factors, such as parental food allergy history, were associated with increased use of controlling FPP. Given that food parenting practices have implications for child health, it is critical to work with parents of children with food allergies to help reduce use of controlling food parenting practices.Funding SourcesUniversity at Buffalo Experiential Learning Network.

Exploring the association between parental anti-fat attitudes and restrictive feeding practices in a British and Irish sample

Parental restriction of food intake has been associated with heightened eating disorder psychopathology in some longitudinal research. Yet, relatively little is known about the determinants of restrictive feeding practices. This cross-sectional study explored the association between parents' anti-fat attitudes and their use of restrictive feeding practices in a mixed British (41.10% England, 39.90% Scotland, 4.20% Other) and Irish (14.80%) sample. Parents and caregivers (N = 472; 94.10% female; 70.90% university level education) of children between the ages of 4–8 (48.20% female; 91.10% rated as “normal weight” by their parents) completed self-report questionnaires assessing their anti-fat attitudes (dislike, fear, and blame subscales), use of restrictive feeding practices (for weight control, health purposes, and covert restriction), and how influential their child's body-weight and -shape is for their perception of themselves as parents. Overall, our hypothesis that parental anti-fat attitudes would be significantly associated with restrictive feeding practices was supported. Anti-fat attitudes related to disliking higher body-weight people and blaming parents for their child's weight were significant predictors of all forms of restrictive feeding (all ps < .05). However, anti-fat attitudes related to fearing being a higher body-weight were not significant predictors of restrictive feeding for the purposes of health nor for covert restriction (ps > .05). Additionally, our hypothesis that the associations between anti-fat attitudes and restrictive feeding practices would be stronger for parents for whom their child's body-weight and -shape more strongly influenced how they judged themselves as parents was not supported (the interaction term was not significant in two out of three analyses). Future research is needed to investigate these associations across time and in samples of higher body-weight children.

Learning to overeat in infancy: Concurrent and prospective relationships between maternal BMI, feeding practices and child eating response among Hispanic mothers and children.

Parents play a key role in shaping children's eating behaviours and self-regulation. There is limited data on how maternal weight influences feeding practices in the first year of life. To examine the relationships between maternal BMI, feeding practices and infant eating behaviours related to self-regulation. Participants were 160 mother-infant dyads. A longitudinal design was used to examine concurrent and prospective associations between maternal 6-month postpartum BMI, mothers' feeding practices at 6 months (Infant Feeding Practices Questionnaire) and children's eating behaviours at 6 months (Baby Eating Behaviour Questionnaire) and 12 months (Child Eating Behaviour Questionnaire). Higher maternal BMI was associated positively with mothers' use of restrictive feeding practices (β = 0.036, p = 0.033), and inversely with responsivity to infant satiety cues (Spearman partial r = -0.249, p = 0.002) at 6 months. Mother's restrictive feeding practices were associated with infant food responsiveness (β = 0.157, p = 0.009) and emotional overeating (β = 0.118, p = 0.005) at 12 months. Maternal use of responsive feeding practices was associated with lower infant food responsiveness at 6 months (Spearman partial r = -0.173, p = 0.031) and lower emotional overeating at 12 months (Spearman partial r = -0.183, p = 0.022). Our findings add to studies suggesting that feeding practices can provide mechanistic pathways in the intergenerational transmission of obesity. Postpartum family-system approaches focusing on maternal health while integrating infant feeding guidance may confer benefits in improving maternal-child health.

An examination of children's eating behaviours as mediators of the relationship between parents' feeding practices and early childhood body mass index z-scores.

SummaryObjectiveParent's use of restrictive feeding practices is associated with child weight. Similarly, the literature shows that children's eating behaviours are also associated with child weight. Given this interrelationship between children's eating behaviours, restrictive feeding practices and child weight, examination of possible mediator relationships is warranted. This study aimed to examine the relationships between overt restriction and covert restriction with child body mass index z‐scores (BMIz) and determine if children's eating behaviours (satiety responsiveness and food responsiveness) act as mediators.MethodParents of Australian children (n = 977) 2.0–5.0 years of age (49.4% male) provided data in an online survey on child eating behaviours, parent's restrictive feeding practices and child anthropometrics (modified z‐scores were created to screen for biologically implausible values). Correlation analysis was used to determine variables to include in mediation models. Hayes' PROCESS macros in spss was used to examine mediation, controlling for covariates of child BMIz.ResultsOvert restriction was the only parent feeding practice related to child BMIz (B = 0.132, P = 0.04). Mediation analysis showed that the indirect effect of overt restriction on child BMIz (controlling for child age, gender, parent BMI and income) became non‐significant when controlling for food responsiveness, thus suggesting full mediation, explaining 5.75% of the relation.ConclusionOvert restriction and covert restriction have distinctly different relationships with children's eating behaviours. Food responsiveness appears an important intermediary in the relationship between overt restriction and child BMIz.

Child body mass index, genotype and parenting in the prediction of restrictive feeding.

Restrictive feeding is implicated in pediatric obesity, and caregivers increase controlling feeding practices on the basis of higher child weight status. However, few studies have examined how child genetic and parenting characteristics together impact restrictive feeding. We examined whether child body mass index (BMI) status predicts caregiver use of restrictive feeding and if this association is moderated by (i) caregiver strategies to manage their children's distress and (ii) child variations in the catechol-O-methyltransferase (COMT) gene (Val158 Met, rs4680). Participants included 126 Caucasian children (50% girls) and their caregivers who were participating in a larger study in the USA. Caregivers reported on their feeding practices and responses to child distress when children were 2.5-3.5years of age. Child anthropometric measurements were also obtained. Restrictive feeding was assessed again 1-1.5years later. Genomic DNA was obtained from saliva samples, and COMT-rs4680 was genotyped using TaqMan® methodology. Child BMI percentile predicted subsequent caregiver restrictive feeding for children who were Met/Met and who had caregivers reporting higher use of negative responses to child distress. For Val carriers, BMI percentile predicted restrictive feeding when caregivers were below the mean on these responses. Caregivers are at risk for use of restrictive feeding practices when their children are at higher BMI percentiles, and this association increases when caregivers use more ineffective stress regulation practices and their children are homozygous for the Met allele. Prevention programmes might focus on parenting behaviours that foster emotion regulation and consider variation in child responses to parenting.

Testing the direction of effects between child body composition and restrictive feeding practices: results from a population-based cohort

Background: Parental restrictive feeding (i.e., limiting food intake of children) has been linked to childhood overweight. However, the directionality of the causal pathway remains unknown.Objective: The objectives of this study were to examine the bidirectional association of maternal restrictive feeding with children's weight and body composition across childhood and to explore a possible mediating role of maternal concern about child weight.Design: Data were available for 4689 mother-child dyads participating in Generation R, a prospective birth cohort in the Netherlands. At ages 4 and 10 y, restrictive feeding was assessed with the parent-reported Child Feeding Questionnaire, and children's body mass index (BMI) was measured. At age 6 y, fat mass index (FMI) and fat-free mass index (FFMI) were measured with dual-energy X-ray absorptiometry. Both directions of the relation between restriction and child body composition were examined with multivariable linear regression analyses and cross-lagged modeling. Mediation analyses were performed to examine concern about child weight (mother reported at child age of 10 y) as a potential mediator.Results: Higher child sex- and age-adjusted BMI SD scores (zBMI) at age 4 y predicted more restrictive feeding at age 10 y (B = 0.15; 95% CI: 0.11, 0.18). Both sex- and age-adjusted FMI SD scores (zFMI) and sex-and age-adjusted FFMI SD scores (zFFMI) at 6 y were also positively associated with restrictive feeding at 10 y. Maternal concern about child weight partially mediated these associations from child body composition to restrictive feeding (e.g., for zBMI at 4 y: Bindirect = 0.10; 95% CI: 0.07, 0.13). There was no temporal association from restrictive feeding at age 4 y to child zBMI at age 10 y after adjustment for baseline zBMI.Conclusions: The continued use of restrictive feeding practices at age 10 y appeared to be primarily a response of mothers to an unhealthy weight of their child rather than a cause of children's overweight. Guidelines discouraging restrictive feeding for preventing childhood overweight should therefore be reconsidered.

Association Between Maternal Stress, Work Status, Concern About Child Weight, and Restrictive Feeding Practices in Preschool Children

Objectives To examine the relationship between maternal stress, work status, concern about child weight, and the use of restrictive feeding practices among mothers of preschool children. Methods 285 mothers of 2-to-5-year-old children completed an on-line survey. Questions included demographics, items from the Depression Anxiety Stress Scale, and the Child Feeding Questionnaire. Linear regression and ANOVA examined the relationship between maternal stress, work hours, concern about child weight, and the use of restrictive practices for one 2-to-5-year-old child living within the home. Results Mothers were 32.6 ± 5.2 years of age and spent 39.7 ± 12.0h/week at work. Seventy-one percent worked full time. Children were 3.4 ± 1.0 years of age and 51% male. Stress (3.41 ± 0.77, p ≤ 0.001) and concern about child weight (3.41 ± 0.77, p ≤ 0.00) were associated with the use of restrictive feeding practices. Mothers with severe/extremely severe stress used restriction more than mothers with normal stress, respectively (3.63 ± 0.80, 3.30 ± 0.81, p = 0.03). No difference was found among mothers with mild/moderate stress (3.50 ± 0.63, p = 0.06). There was no association between work hours (p = 0.50) or work status (p = 0.91) and the use of restrictive feeding practices. Conclusions Maternal stress and concern about child weight were associated with the use of restrictive feeding practices. Considering the current rates of childhood obesity in the United States, understanding factors that influence a child's food environment is advantageous and can help improve maternal and child health.

Alternatives to restrictive feeding practices to promote self-regulation in childhood: a developmental perspective.

Intake of energy-dense snack foods is high among US children. Although the use of restrictive feeding practices has been shown to be counterproductive, there is very limited evidence for effective alternatives to restriction that help children moderate their intake of these foods and that facilitate the development of self-regulation in childhood. The developmental literature on parenting and child outcomes may provide insights into alternatives to restrictive feeding practices. This review paper uses a model of parental control from the child development and parenting literatures to (i) operationally define restrictive feeding practices; (ii) summarize current evidence for antecedents and effects of parental restriction use on children's eating behaviours and weight status, and (iii) highlight alternative feeding practices that may facilitate the development of children's self-regulation and moderate children's intake of palatable snack foods. We also discuss recent empirical evidence highlighting the role of child temperament and food motivation related behaviours as factors that prompt parents to use restrictive feeding practices and, yet, may increase children's dysregulated intake of forbidden foods.

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

Effects of restriction on children’s intake differ by child temperament, food reinforcement, and parent’s chronic use of restriction

Parents’ use of restrictive feeding practices is counterproductive, increasing children’s intake of restricted foods and risk for excessive weight gain. The aims of this research were to replicate Fisher and Birch’s (1999b) original findings that short-term restriction increases preschool children’s (3–5y) selection, intake, and behavioral response to restricted foods, and to identify characteristics of children who were more susceptible to the negative effects of restriction. The experiment used a within-subjects design; 37 children completed the food reinforcement task and heights/weights were measured. Parents reported on their use of restrictive feeding practices and their child’s inhibitory control and approach. Overall, the findings replicated those of Fisher and Birch (1999b) and revealed that the effects of restriction differed by children’s regulatory and appetitive tendencies. Greater increases in intake in response to restriction were observed among children lower in inhibitory control, higher in approach, who found the restricted food highly reinforcing, and who had previous experience with parental use of restriction. Results confirm that the use of restriction does not reduce children’s consumption of these foods, particularly among children with lower regulatory or higher appetitive tendencies.

Do maternal body dissatisfaction and dietary restraint predict weight gain in young pre-school children? A 1-year follow-up study

Background: The relationships between maternal body image and eating concerns and increases in body mass index (BMI) in early childhood are poorly understood. Our aim was to test a model in which mothers’ BMI, body dissatisfaction, dietary restraint and concerns about their child’s weight were related to restrictive feeding practices and child BMIz change. Methods: Mothers of 2-year-old children (n=202, aged between 1.5 and 2.5years) reported concerns regarding their own and their child’s weight, their dietary restraint, and restrictive feeding practices. Height and weight were measured for children and reported by mothers at baseline and 1-year later. Results: Thirty five percent of mothers and 29% of children were in overweight or obese categories at baseline. Using path analysis, after adding an additional pathway to the proposed model the final model provided a good fit to the data (χ2 (8)=5.593, p=.693, CFI=1.000, RMSEA=.000), with maternal dietary restraint directly predicting change in child BMIz over the year. Concern about child’s weight and, to a lesser extent, maternal dietary restraint mediated the relationship between maternal body dissatisfaction and the use of restrictive feeding practices. However, the pathway from restrictive feeding practices to change in child BMIz was not significant. Conclusions: Mothers’ BMI and body dissatisfaction may contribute indirectly to weight change in their young children. Interventions targeting maternal body dissatisfaction and informing about effective feeding strategies may help prevent increases in child BMIz.

Children's Self-Regulation in Eating: Associations with Inhibitory Control and Parents' Feeding Behavior

Children who self-regulate while eating and children who show high global self-regulation abilities, such as inhibitory control, are less likely to be overweight than children who do not show the same capacities for self-regulation. This study examined the association between child self-regulation in eating and inhibitory control, and investigated whether self-regulation is related to parents' restrictive feeding practices. Sixty-three parents reported on their 3- to 9-year-old children's self-regulation in eating, inhibitory control, and their own feeding practices. Self-regulation in eating and inhibitory control were positively correlated, r = .54. Self-regulation in eating predicted parents' use of restrictive feeding practices above and beyond children's inhibitory control and parents' concerns about their children's weight, p < .01. When parents believed their children could self-regulate, they used less restrictive feeding practices. Because restriction can compromise self-regulatory abilities, early interventions should teach parents about children's nascent abilities in this domain.

Factors associated with parental use of restrictive feeding practices to control their children's food intake

There is a critical need to identify risk factors that make parents more likely to restrict their child's food intake. Child weight and ethnicity, parent weight, parent body dissatisfaction, and parent concern of child weight were examined as correlates of parent use of restrictive feeding practices in a diverse sample of 191 youth (ages 7–17). Participants attending a pediatric outpatient visit completed the Child Feeding Questionnaire (parent feeding practices and beliefs), the Figure Rating Scale (body dissatisfaction) and a demographic form. Parent BMI and child degree of overweight were calculated. Parent use of restrictive feeding practices was positively associated with parent BMI and was moderated by parent body dissatisfaction. Parent concern of child weight mediated the relationship between increasing child degree of overweight and parent use of restrictive feeding practices. There were no differences by child gender or ethnicity in parent use of restrictive feeding practices. These preliminary findings highlight the importance of assessing for underlying parent motivations for utilizing restrictive feeding practices and may help to identify and intervene with families at-risk for engaging in counterproductive weight control strategies. Continued identification of correlates of parent use of restrictive feeding practices is needed across child development and among individuals from diverse backgrounds.

Increased restrictive feeding practices are associated with reduced energy density in 4–6-year-old, multi-ethnic children at ad libitum laboratory test-meals

Increased reports of restrictive feeding have shown positive relationships to child obesity, however, the mechanism between the two has not been elucidated. This study examined the relationship between reported use of restrictive feeding practices and 4–6-year-old children's self-selected energy density (ED) and total energy intake from an ad libitum, laboratory dinner including macaroni and cheese, string beans, grapes, baby carrots, cheese sticks, pudding, milks, and a variety of sweetened beverages. A second objective explored the relationship between ED and child body mass index (BMI) z-score. Seventy (n=70) healthy children from primarily non-Caucasian and lower socioeconomic status families participated. Mothers completed the Child Feeding Questionnaire (CFQ) to assess restrictive feeding practices. Energy density (kcal/g) values for both foods and drinks (EDfood+drink) and ED for foods only (EDfoods) were calculated by dividing the average number of calories consumed by the average weight eaten across 4 meals. Higher maternal restriction was associated with lower EDfood+drink. In overweight and obese children only, higher maternal restriction was associated with lower EDfood. There was a non-significant trend for both ED measures to be negatively associated with child BMI z-score. Overall, restrictive feeding practices were not associated with child BMI z-score. However, when analyzing separate aspects of restriction, parents reported higher use of restricting access to palatable foods but lower use of using palatable foods as rewards with heavier children. Previous reports of positive associations between child obesity and restrictive feeding practices may not apply in predominantly non-Caucasian, lower socioeconomic status cohorts of children.

Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study

This study examines associations between parental feeding restriction at baseline and child body mass index (BMI) z-score at 3-year follow-up. Parents of 204 5–6-year-old and 188 10–12-year-old children completed the Child Feeding Questionnaire at baseline (2002/3). In 2002/3 and 2005/6, children's BMI z-score was calculated from measured height and weight. Analyses were stratified by age-group. The association of follow-up zBMI and baseline feeding restriction score was explored using (i) linear regression with adjustment for baseline zBMI and (ii) with further adjustments for baseline maternal BMI, maternal education level and child sex. Baseline restriction was associated with follow-up zBMI at 3 years in 5–6-year-old children and was largely unchanged when adjusting for child sex, maternal BMI and education. Restriction was not associated with follow-up zBMI in 10–12-year-old children. This longitudinal study adds important depth to our understanding of associations between restrictive feeding and change in zBMI, suggesting that restriction of energy-dense foods and drinks may be protective of unhealthy weight gain in younger children but may have no effect among older children. These findings support a reconsideration of the notion that restriction is likely to result in increased child weight.

Do obsessive compulsive symptoms mediate the relationship between maternal eating psychopathology and restrictive feeding practices?

Symptoms of maternal eating disorders have been linked with the use of maladaptive restrictive child feeding practices. However, how these symptoms impact upon restriction in child feeding is poorly understood. The aims of this research were to assess whether symptoms of obsessive compulsiveness, which are often comorbid with eating disorder symptoms, mediate the relationships between maternal eating disorder symptoms and the use of restrictive feeding practices. A total of 128 mothers of children aged 2-6 years completed measures of their restrictive feeding practices, symptoms of eating disorders, and obsessive compulsiveness. Maternal restriction was positively correlated with symptoms of drive for thinness, bulimia, and checking and cleaning obsessions and compulsions. Cleaning obsessions and compulsions mediated the relationships between maternal drive for thinness and feeding restriction. Cleaning obsessions and compulsions may help to explain the relationships between some symptoms of maternal eating disorders and the use of restrictive feeding practices.

Is Maternal Psychopathology Related to Obesigenic Feeding Practices at 1 Year?

To investigate the relationship between maternal psychopathological symptomatology during pregnancy and at 6 and 12 months postnatally and maternal use of controlling and restrictive feeding practices at 1 year. Eighty-seven women completed a measure of psychological distress during pregnancy and at 6 and 12 months postpartum, and at 12 months postnatally these women reported their usage of controlling and restrictive feeding practices and were observed feeding their infants. General psychological distress, particularly anxious psychopathology, during pregnancy and at 6 and 12 months postnatally was significantly associated with maternal use of restrictive feeding practices at 1 year, even when controlling for length of breast-feeding and the infants' weights at 1 year. Contrary to expectations, depression and eating psychopathology as measured by the SCOFF eating disorder measure during pregnancy or at 6 or 12 months postnatally were not associated with the use of controlling or restrictive feeding practices at 1 year. These findings indicate that anxious maternal psychopathology may partially explain the development of maternal use of restriction when feeding.

Learning to overeat: maternal use of restrictive feeding practices promotes girls' eating in the absence of hunger

Experimental findings causally link restrictive child-feeding practices to overeating in children. However, longitudinal data are needed to determine the extent to which restrictive feeding practices promote overeating. Our objectives were to determine whether restrictive feeding practices foster girls' eating in the absence of hunger (EAH) and whether girls' weight status moderates the effects of restrictive feeding practices. Longitudinal data were used to create a study design featuring 2 maternal restriction factors (low and high), 2 weight-status factors (nonoverweight and overweight), and 3 time factors (ages 5, 7, and 9 y). Mean EAH increased significantly (P < 0.0001) from 5 to 9 y of age. Higher levels of restriction at 5 y of age predicted higher EAH at 7 y of age (P < 0.001) and at 9 y of age (P < 0.01). Girls who were already overweight at 5 y of age and who received higher levels of restriction had the highest EAH scores at 9 y of age (P < 0.05) and the greatest increases in EAH from 5 to 9 y of age (P < 0.01). The developmental increase in EAH from 5 to 9 y of age may be especially problematic in obesigenic environments. These longitudinal data provide evidence that maternal restriction can promote overeating. Girls who are already overweight at 5 y of age may be genetically predisposed to be especially responsive to environmental cues. These findings are not expected to be generalized to boys or to other racial and ethnic groups.