The Baby's First Bites RCT: Evaluating a Vegetable-Exposure and a Sensitive-Feeding Intervention in Terms of Child Health Outcomes and Maternal Feeding Behavior During Toddlerhood.

BACKGROUND: Parenting interventions during the first years of life on what and/or how to feed infants during complementary feeding can promote healthy eating habits. OBJECTIVES: An intervention promoting repeated exposure to a variety of vegetables [repeated vegetable exposure (RVE); what] and an intervention promoting responding sensitively to child signals during mealtime [video-feedback intervention to promote positive parenting-feeding infants (VIPP-FI); how] were compared, separately and combined (COMBI), with an attention control condition (AC). Primary outcomes were vegetable consumption and self-regulation of energy intake; secondary outcomes were child anthropometrics and maternal feeding practices (sensitive feeding, pressure to eat). METHODS: Our 4-arm randomized controlled trial included 246 first-time Dutch mothers and their infants. Interventions started when infants were 4-6 mo old and ended at age 16 mo. The present study evaluated effects at 18 (t18) and 24 (t24) mo of age. Vegetable acceptance was assessed using three 24-h dietary recalls, self-regulation of energy intake by an eating-in-the-absence-of-hunger experiment and mother-report, and maternal feeding behavior by observation and mother-report. RESULTS: Linear mixed model and ANOVA analyses revealed no follow-up group differences regarding child vegetable intake or self-regulatory behavior. The proportion of children with overweight was significantly lower in the COMBI group, compared with the VIPP-FI group at t18 (2% compared with 16%), and with the AC group at t24 (7% compared with 20%), although this finding needs to be interpreted cautiously due to the small number of infants with overweight and nonsignificant effects on the continuous BMI z-score measure (P values: 0.29-0.82). Finally, more sensitive feeding behavior and less pressure to eat was found in the VIPP-FI and COMBI groups, compared with the RVE and AC groups, mostly at t18 (significant effect sizes: d = 0.23-0.64). CONCLUSIONS: Interventions were not effective in increasing vegetable intake or self-regulation of energy intake. Future research might usefully focus on risk groups such as families who already experience problems around feeding.This trial is registered at clinicaltrials.gov as NCT03348176.

Maternal sensitivity during mealtime and free play: Differences and explanatory factors.

Mealtime is a parent-toddler interaction that occurs multiple times a day. This study examined whether observed maternal sensitivity differed between a mealtime and free-play setting, aiming to explain differences between the two situations by studying moderating effects of children's eating behavior. The sample consisted of 103 first-time mothers and their 18-month-old children. Maternal sensitivity was assessed by coding videotaped interactions of free-play sessions and mealtimes, using the Ainsworth Sensitivity Scale (range 1-9). Additionally, child eating behavior during the meal was coded and also assessed through the Child Eating Behavior Questionnaire-Toddlers. First, a small but significant amount of stability was found between sensitivity during mealtime and sensitivity during play (r = 0.24). Second, mothers were more sensitive during free play (mean = 7.11) than during mealtime (mean = 6.52). Third, observed child eating behavior was related to maternal sensitivity during mealtime, with more food enjoyment being associated with higher levels of sensitivity, and more challenging child behavior with lower levels of sensitivity. Finally, when children showed a high degree of challenging behavior during the meal, there was more discrepancy between sensitivity during mealtime and free play. Our results highlight the importance of taking context into account when observing parental sensitivity.

Measurement of Family Management in Families of Individuals With Down Syndrome: A Cross-Cultural Investigation.

Down syndrome (DS) is the most common genetic cause of intellectual disability worldwide. The purpose of this analysis was to determine the internal consistency reliability of eight language versions of the Family Management Measure (FaMM) and compare family management of DS across cultures. A total of 2,740 parents of individuals with DS from 11 countries completed the FaMM. The analysis provided evidence of internal consistency reliability exceeding .70 for four of six FaMM scales for the entire sample. Across countries, there was a pattern of positive family management. Cross-cultural comparisons revealed parents from Brazil, Spain, and the United States had the most positive family management and respondents from Ireland, Italy, Japan, and Korea had the least positive. The rankings were mixed for the four remaining countries. These findings provide evidence of overall strong internal consistency reliability of the FaMM. More cross-cultural research is needed to understand how social determinants of health influence family management in families of individuals with DS.

The relation between family meals and health of infants and toddlers: A review.

Family meals are associated with multiple health benefits in children and adolescents including evidence that eating together as a family may play a role in reducing childhood obesity. The current review aims to investigate whether the beneficial health effects of the family meal also apply to infants and toddlers. PubMed, Web of Science, Scopus and PsycInfo were searched and 14 empirical studies were identified. The findings were discussed according to frequency of having a family meal and parental perception, associations between the family meal and health aspects (e.g., eating behaviors and diet quality) and causal influences of these associations. Descriptive data showed that mothers offer food at a structured mealtime, but that eating together as a family was not always upheld. The frequency of family meals was positively associated with more nutrient-dense food intake and a more balanced diet. Different advantages (e.g., social importance, practical considerations) and obstacles (e.g., planning, possible mess) of the family meal were mentioned by parents. Further, having structured mealtimes and family meals was associated with more food enjoyment and less fussy and emotional eating. Finally, no causal studies were identified. The limited number of studies suggests that the pattern of positive associations between family meal and child health which has been shown in older children may also exist in infants and toddlers. More specific research is needed to examine the causality of the associations between the family meal and health of the infant and toddler. The associations between the family meal and less fussiness and emotional eating, more food enjoyment and better nutrient intake suggest that the family meal is a valuable moment to promote healthy eating in toddlers and infants.

Interventions aimed at reducing obesity in early childhood: a meta-analysis of programs that involve parents.

BACKGROUND: Obesity is a growing problem even in very young childhood, resulting in high costs for individuals and society. As a response, numerous obesity prevention and intervention programs have been developed. Previous research has shown that early intervention programs are more effective when parents are involved, but the effectiveness of specific aspects of programs with parental involvement has not been investigated. This meta-analysis aims to investigate the features related to the effectiveness of different types of obesity intervention programs involving parents and targeting young children (0-6-year-olds). METHODS: The Web of Science, PubMed, PsycInfo, CINAHL, and ERIC databases were searched for childhood obesity prevention and intervention programs involving parents. Data were analyzed using the Comprehensive Meta-analysis (CMA) software. RESULTS: Fifty studies with effect sizes measured at short-term follow-up (within 3 months from the end of the intervention) and 26 studies with effect sizes measured at long-term follow-up (all reported in a total of 49 publications) were identified. The combined effect size of interventions was small but significant at short-term follow-up (d = .08, p < .01). The results suggested the presence of a potential publication bias in studies providing results at long-term follow-up, with a nonsignificant adjusted effect size (d = .02), which indicated that obesity interventions were not effective at long-term follow-up. Multivariate meta-regression analyses showed that interventions were more effective when including either interactive sessions or educational materials as opposed to those including both interactive sessions and noninteractive educational materials. No other moderators regarding sample characteristics, study design, or methodological quality were significant. CONCLUSION: Interventions targeting young children that require parental involvement are effective at short-term follow-up, specifically when interventions include one mode of intervention rather than two. However, results were not retained in the long run.

Attentional bias to activity of different parts of the body in children with functional abdominal pain: an experimental study.

OBJECTIVES: To investigate whether children with functional abdominal pain (FAP) show an attentional bias for their bodily activity, and whether receiving information about bodily activity influenced perception of bodily sensations. METHODS: A total of 30 children with FAP and 30 healthy children performed a dot-probe task, in which they were shown sham pictures about their bodily activity. RESULTS: Contrary to our hypotheses, no attentional bias for gut activity was found in either group. However, children with FAP were slower than healthy children on all supraliminal gut-activity trials, suggesting that pictures of gut activity distracted children with FAP from the task they were performing. Both groups showed an attention bias away from supraliminal pictures about heart activity. As hypothesized, more children with FAP than healthy children reported increases in pain after the experiment. CONCLUSIONS: Children with FAP seemed more strongly influenced by information about gut activity than healthy children. The present study should be replicated for intervention purposes.

[What do parents know of patient rights of minors in the Netherlands?] / Wat weten ouders over de patiëntenrechten van kinderen?

INTRODUCTION: In the Netherlands, medical decision-making without parental permission is allowed from the age of 16. The aim of this study was to examine parents' knowledge of this age-based framework to discover potential knowledge gaps that hinder the communication between doctors, parents, and their children. METHODS: Survey-based research was conducted to examine parents' knowledge of the age-based framework that applies to minors in Dutch healthcare. The survey was based on 5 topics: medical diagnosis and treatment, medical advice, reproductive and sexual health services, abortion, and euthanasia. The survey was sent to 1,010 Dutch parents, aged 35-55 years, with at least one child. The data were analysed using SPSS. Percentages and means were calculated. RESULTS: Parental knowledge of the age-based framework varied depending on the topic. CONCLUSION: This study provides insights into parents' current level of knowledge of the age-based framework that applies to minors in Dutch healthcare. This information is useful in the conversation between health care professional, parents, and their children.

Eating in the absence of hunger in 18-month-old children in a home setting.

BACKGROUND: Eating in the absence of hunger (EAH), the susceptibility to eat despite satiety, may increase overweight. While EAH has been established in school-aged children, less is known about it during toddlerhood. OBJECTIVES: This study assessed to what extent 18-month-old children eat in the absence of hunger, the stability of this behaviour at 24 months and the association of child eating behaviours with EAH. METHODS: Children were presented with four palatable finger foods (total 275 kcal) after dinner. Univariate GLM's assessed the association between EAH, child satiety and eating behaviours and energy intake of dinner at 18 and 24 months (n = 206 and 103, respectively). Another GLM was run to assess the association between EAH at both time points. RESULTS: Mean (±SD) energy intakes from dinner and finger foods were 240 kcal (±117) and 40 kcal (±37), respectively. No association was found between energy intake of dinner and finger foods. Enjoyment of food was significantly related to intake of finger foods (P = .005). EAH at 18 months predicted EAH at 24 months. CONCLUSION: Eighteen-month-old children ate in the absence of hunger, irrespective of satiety. Thus, preceding energy intake was not compensated for. Other factors, for example, enjoyment of food seem to determine finger food intake.

Child Care in Times of COVID-19: Predictors of Distress in Dutch Children and Parents When Re-entering Center-Based Child Care After a 2-Month Lockdown.

As a consequence of the outbreak of the Coronavirus Disease 2019 (COVID-19) child care facilities all over the world were temporarily closed to minimize the spread of the virus. In Netherlands, the first closure lasted for almost 2 months. The return to the child care center after this significant interruption was expected to be challenging, because earlier studies demonstrated that transitions into child care can be stressful for both children and their parents. The current paper retrospectively examined the distress of Dutch children (aged 0-4) and their parents during the first 2 weeks after the reopening of child care centers, and what factors accounted for individual differences in distress. In total, 694 parents filled out an online questionnaire about stress during closure and distress after the reopening of child care centers. Furthermore, questions regarding several demographic variables and child care characteristics were included, as well as questionnaires measuring child temperament, parental separation anxiety, and parental perception of the child care quality. Results showed that younger children and children with parents scoring higher on separation anxiety experienced more distress after the reopening, as reported by parents. Furthermore, children were more distressed upon return when they attended the child care center for less hours per week after the reopening, experienced less stress during closure, and grew up in a one-parent family. With regard to parental distress after the reopening, we found that parents scoring higher on separation anxiety and fear of COVID-19 experienced more distress. Moreover, parents experiencing less stress during closure and mothers were more distressed when the child returned to the child care center. Finally, concurrent child and parental distress after reopening were positively related. The results of the current study may help professional caregivers to identify which children and parents benefit from extra support when children return to the child care center after an interruption. Especially the role that parental separation anxiety played in predicting both child and parental distress deserves attention. More research is required in order to study the underlying mechanisms of these associations and to design appropriate interventions.

Abdominal pain in Dutch schoolchildren: relations with physical and psychological comorbid complaints in children and their parents.

OBJECTIVES: Children with functional abdominal pain (FAP) frequently report comorbid complaints such as anxiety and activity limitations. Their parents often experience heightened levels of anxiety, depression, and somatization. The aim of the present study was to investigate whether these comorbid complaints in children and their parents are specific for FAP or can also be found in a community sample. PATIENTS AND METHODS: Six hundred sixty-five schoolchildren (ages 7-18 years) filled out questionnaires concerning AP, activity limitations, somatic complaints, quality of life, and symptoms of anxiety and depression. A total of 391 of their parents filled out questionnaires concerning parental anxiety, depression, and somatization. Pearson correlations and multiple regression analyses were performed. RESULTS: A total of 56.5% of the children reported AP at least once in a 2-week period. Univariate relations with AP were found for activity limitations (r = 0.392), somatic complaints (r = 0.408), 3 of 5 domains of quality of life (r ranging from -0.120 to -0.209), and symptoms of anxiety and depression (r, respectively, 0.329 and 0.361). Multivariate analyses showed only significant relations for female sex (ß = 0.230), younger age (ß = -0.077), activity limitations (ß = 0.247), somatic complaints (ß = 0.170), and depressive symptoms (ß = 0.093). CONCLUSIONS: Activity limitations, somatic complaints, and depressive symptoms are related to AP in the general population, whereas a reduced quality of life, anxiety, and parental internalizing problems seem specific comorbid complaints for FAP. Future research on parental internalizing problems, quality of life, and anxiety as risk factors for FAP is warranted.

Down or up? Explaining positive and negative emotions in parents of children with Down's syndrome: Goals, cognitive coping, and resources.

BACKGROUND: Some studies find that parents of children with Down's syndrome may experience symptoms of depression, while other studies find that parents adapt well. This study aimed to clarify this variability in adaptive strength by investigating a stress-coping model to explain depressive symptoms and positive affect. METHOD: Questionnaires were completed by 553 parents of children (aged 0-18) with Down's syndrome, containing measures of goal disturbance, cognitive coping, social support, partner bonding, and coping self-efficacy. RESULTS: Different models for positive affect and depressive symptoms were found. The coping strategies of self-blame and rumination were positively related to depressive symptoms, and positive reappraisal was positively related to positive affect. Partner bonding characteristics played relevant roles in both models, as did coping self-efficacy and goal disturbance. Social support seemed mainly relevant in explaining positive affect. CONCLUSIONS: Different psychological factors were related to depressive symptoms and positive affect in parents of children with Down's syndrome. Implications are discussed.

Maternal Feeding Practices, Health Cognitions, and Children's Eating Styles and Weight Status.

OBJECTIVE: To examine the relationship between maternal cognitions related to promoting a healthy lifestyle in their child, maternal feeding practices, children's eating styles, and child weight status in children aged 4 to 6 years. METHODS: Cross-sectional questionnaire data were collected in 251 Dutch mothers of preschoolers. Structural equation modeling was used to test the fit of a model that assumed maternal health cognitions would predict maternal feeding practices, which in turn would predict children's eating styles and child weight status. Explorative analyses were conducted to examine child characteristics as predictors of maternal health cognitions and feeding practices. RESULTS: Mothers with higher self-efficacy used fewer pressure-to-eat feeding techniques, which in turn was related to less avoidant eating styles in children. In addition, mothers who perceived more benefits of a healthy lifestyle used more restriction techniques, which in turn predicted a more approach-oriented eating style in children, which was also related to higher child standard deviation scores body mass index. Finally, children with an avoidant eating style had mothers who perceived more barriers and reported less self-efficacy. CONCLUSION: Self-efficacy and perceived benefits relate to maternal feeding practices and eating styles of the child. However, more perceived benefits of a healthy lifestyle were associated with inadequate feeding practices. Therefore, interventions targeted at mothers to reduce child overweight should focus not only on reinforcing perceived benefits of a healthy lifestyle but also on how the mother can translate her attitudes into adaptive parenting to achieve the desired health outcomes.

Psychological factors addressed in cognitive behaviour therapy for paediatric functional abdominal pain: Which are most important to target?

The effectiveness of cognitive behaviour therapy for paediatric functional abdominal pain leaves room for improvement. We studied which factors addressed in cognitive behaviour therapy relate most strongly to the physical and psychological functioning of children with functional abdominal pain and are thus most important to target. Questionnaires were filled out by 117 children with functional abdominal pain and their parents. Multiple regression analyses showed that children's passive coping and parental and children's positive cognitions relate to child functioning. Negative cognitions and parental solicitous behaviour were unrelated to child functioning. Cognitive behaviour therapy for functional abdominal pain may benefit most from changing children's passive coping and promoting positive cognitions.

Cognitive coping, goal self-efficacy and personal growth in HIV-infected men who have sex with men.

OBJECTIVE: The relationships between cognitive coping strategies, goal self-efficacy and personal growth were studied in HIV-positive men who have sex with men. METHODS: All members of a national organization for people living with HIV received a call for participation. The Cognitive Emotion Regulation Questionnaire, the Goal Obstruction Questionnaire and the Personal Growth Scale were filled out at home by 104 HIV-infected men. RESULTS: Thinking about joyful and pleasant issues instead of thinking about being HIV-positive, thinking about what steps to take and how to handle being HIV-positive, thoughts of attaching a positive meaning to being HIV-positive, thoughts of playing down the seriousness of being HIV-positive or emphasizing its relativity when compared to other events, thoughts of putting the blame of being HIV-positive on others (inversely) and the extent to which one considers oneself able to reengage in alternative meaningful goals were related to personal growth. CONCLUSION: The study showed that both cognitive coping strategies and goal self-efficacy were related to personal growth. The findings suggest that mainly positive ways to handle being HIV-infected are related to personal growth. PRACTICE IMPLICATIONS: These findings suggested that intervention programs for people with HIV should pay attention to cognitive coping strategies and goal self-efficacy.

Goal disturbance, cognitive coping and psychological distress in HIV-infected persons.

This study aims to explore the relationships between cognitive coping, goal disturbance and psychological distress in HIV-infected persons. A sample of 43 HIV positive persons completed questionnaires that assessed cognitive coping, goal frustration, depressive symptoms and quality of life. Goal frustration and, to a lesser extent, the cognitive coping strategy 'positive reappraisal' were related to psychological distress. Intervention programmes might usefully implement the topics of goal disturbance and positive reappraisal.

The association between overweight and internalizing and externalizing behavior in early childhood.

OBJECTIVE: The aim of this study was to examine bidirectional associations between overweight and behavior problems during early childhood taking into account the adiposity rebound, which is the turning point in the nonlinear development of Body Mass Index in early childhood. METHODS: Longitudinal data from 6624 Dutch children in the Generation R Study were used to analyze the association between measured overweight and scores on the internalizing and externalizing scale of the Child Behavior Checklist between one-and-a-half, three and six years. The adiposity rebound was determined for each child by estimating the lowest point in their growth curve. Cross-lagged modeling was used to test (bi)directional associations. RESULTS: Both body mass and behavior problems were modest to highly stable from age one-and-a-half to six years. Externalizing and internalizing behavior were both associated with later overweight, although effect sizes were small (ßs ranged between 0.06 and 0.07, ps < 0.05). No significant associations in the other direction were found. Controlling for adiposity rebound did not change the pattern of associations. There was a moderating effect of gender, and ethnicity, and timing of adiposity rebound. CONCLUSION: Behavior problems in early childhood may put children at risk for overweight at a later age. This implies that young children with behavior problems may benefit from careful monitoring of eating behavior and weight development. Future studies should take the adiposity rebound into account.

Cognitive behavior therapy for pediatric functional abdominal pain: a randomized controlled trial.

OBJECTIVE: This randomized controlled trial investigated the effectiveness of a 6-session protocolized cognitive behavior therapy (CBT) compared with 6 visits to a pediatrician (intensive medical care; IMC) for the treatment of pediatric functional abdominal pain (FAP). METHODS: One hundred four children aged 7 to 18 were randomized to CBT or IMC. CBT was delivered primarily by trained master's degree students in psychology; IMC was delivered by pediatricians or pediatric gastroenterologists. Assessments were performed pretreatment, posttreatment, and at 6- and 12-month follow-up. Primary outcomes were level of abdominal pain (AP) as reported on questionnaires and diaries. Secondary outcomes were other gastrointestinal complaints, functional disability, other somatic complaints, anxiety, depression, and quality of life. RESULTS: Both CBT and IMC resulted in a significant decrease in AP (P < .001), but no significant difference was found between the treatments in their effectiveness (P > .05 for all end points). According to the questionnaire-derived data, 1 year after treatment, 60% of children that received CBT had significantly improved or recovered, versus 56.4% of children receiving IMC, which did not significantly differ (P = .47). These percentages were 65.8% versus 62.8% according to the diary-derived data, which also did not significantly differ (P = .14). Additionally, nearly all secondary outcomes improved after treatment. CONCLUSIONS: CBT was equally effective as IMC in reducing AP in children with FAP. More research into the specific working mechanisms of CBT for pediatric FAP is needed.

The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression.

The objective of this study was to examine if emotion awareness in children and adolescents (age 7-18 years old) is directly related to somatic complaints, and if this relationship holds when considering symptoms of anxiety and depression as mediating factors. A number of questionnaires measuring emotion awareness, symptoms of anxiety and depression and somatic complaints were administered to Dutch schoolchildren (N = 617). A path model was constructed, with the use of structural equation modelling. The results showed that two aspects of emotion awareness (bodily awareness and differentiating between emotions) contributed to the prediction of somatic complaints. However, this was no longer the case when controlling for symptoms of anxiety and depression. Thus, in this study, no direct relation was found between emotion awareness and somatic complaints. Instead, the relation was perfectly mediated by symptoms of anxiety and depression. The results suggest that focusing only on the relation between emotion awareness and somatic complaints is an oversimplified perspective that falls short as a starting point to find therapeutic solutions for children who suffer from somatic complaints.

Do parents maintain or exacerbate pediatric functional abdominal pain? A systematic review and meta-analysis.

Parents may maintain or exacerbate functional abdominal pain (FAP) in children through modeling of physical symptoms and solicitous responses to the child's complaints. This systematic review and meta-analysis aimed to examine these relationships. Parents of children with FAP reported more physical symptoms than parents of healthy children (effect size d = .36). As all studies were cross-sectional or retrospective, the causal direction was unclear. For parental responses to child complaints, not enough studies were available to perform a meta-analysis. We conclude that the present literature is unfit to establish whether parents maintain or exacerbate pediatric FAP through the processes investigated.