Promoting toddlers' self-regulation and healthy eating habits among families living in poverty: A randomized controlled trial of Recipe 4 Success.

The Recipe 4 Success preventive intervention targeted multiple factors critical to the health and well-being of toddlers living in poverty. This randomized controlled trial, which was embedded within Early Head Start home visits for 12 weeks, included 242 racially and ethnically diverse families (51% girls; toddler mean age = 2.58 years; data collected 2016-2019). Compared to parents in usual practice home visits, parents in Recipe 4 Success displayed greater sensitive scaffolding of toddlers' learning and more responsive food parenting practices (Cohen's d = .21-.30). Toddlers in Recipe 4 Success exhibited greater self-regulation and had healthier eating habits (Cohen's d = |.16-.35|). Results highlight the value of Recipe 4 Success in promoting parent and toddler behavior change that could have life-long benefits.

A laboratory-based assessment of mother-child snack food selections and child snack food consumption: Associations with observed and maternal self-report of child feeding practices.

This study explored how mothers' observed and self-reported child feeding practices (child control over food choices, encouragement of balance and variety, and teaching about nutrition) were associated with mother-child snack food selections and child snack food consumption in a laboratory setting. Mothers (N = 107) and their 4.5-year-old children (52% female) selected up to 5 snack foods (out of 9 snack foods: 6 higher-energy-density [ED] and 3 lower-ED) for optional child consumption throughout a one-hour laboratory visit. Mothers' in-the-moment child feeding practices during the snack food selection task were coded using observational coding schemes, and mothers' global child feeding practices (i.e., across meals and snacking occasions) were self-reported using the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub, 2007). Results of multiple linear regression analyses with covariates showed that higher-ED snack food selections were positively associated with observed child control over food choices (B = 0.35, SE = 0.12, p = .006) and self-reported teaching about nutrition (B = 0.49, SE = 0.19, p = .010), and negatively associated with self-reported encouragement of balance and variety (B = -0.66, SE = 0.24, p = .007). Lower-ED snack food selections were positively associated with self-reported encouragement of balance and variety (B = 0.53, SE = 0.20, p = .008). Child consumption of higher-ED or lower-ED snack foods were not significantly associated with mothers' child feeding practices (observed or self-reported). We discuss the implications of these findings for future research on children's snack food selection and consumption.

Interactive effects of parenting behavior and regulatory skills in toddlerhood on child weight outcomes.

OBJECTIVES: There is limited research investigating whether maternal behaviors exhibited during non-feeding contexts play a role in the development of obesity, and whether this association varies based on children's emerging regulatory skills. The objective of this study was to investigate interactions between maternal behaviors and toddler regulation predicting child BMI z-scores (BMIZ) at 4.5 years. SUBJECTS/METHODS: Infant-mother dyads (n = 108) participated in laboratory visits when the child was 18 months and 4.5 years of age. Maternal interactive behaviors (i.e., positive responsiveness, gentle control) were coded from recordings of free play and clean-up tasks with their toddlers. Toddler regulation was assessed via an observational task, experimenter ratings, and parent ratings. Child and mother length/height and weight measurements were recorded and used to calculate child BMIZ and maternal BMI, respectively. RESULTS: After controlling for covariates, two significant interactions emerged between maternal behaviors and toddler regulation predicting BMIZ at 4.5 years. First, an interaction of positive responsiveness during free play and toddler regulation demonstrated that greater positive responsiveness significantly related to lower child BMIZ for toddlers with poor regulation. Second, an interaction of gentle control during clean-up and toddler regulation indicated that greater gentle control was associated with lower BMIZ for toddlers with lesser regulatory abilities, but higher BMIZ for well-regulated toddlers. No significant main effects emerged for maternal interactive behaviors or toddler regulation. CONCLUSIONS: These results suggest that associations between maternal behaviors and child BMIZ may depend on toddlers' emerging regulatory abilities. Maternal responsiveness during free play and gentle control during clean-up appear to protect against weight gain, especially for toddlers with lower regulatory abilities. However, greater levels of gentle control may have adverse effects on BMIZ for well-regulated toddlers. These results suggest that both parenting and toddler regulation, examined outside feeding contexts, may have important implications for child obesity.

Temperament in obesity-related research: Concepts, challenges, and considerations for future research.

Temperament, defined as individual differences in reactivity and regulation, has important implications for the development of childhood obesity. Indeed, numerous studies have demonstrated associations between temperament and children's eating behavior, parent feeding practices, and children's weight outcomes. Together, these findings have significantly improved our understanding of the developmental pathways to obesity-related outcomes. However, to better our understanding of the role of temperament in children's health, greater attention to how temperament is conceptualized and measured is needed. The purpose of this paper is to review the concept and principles of temperament, describe challenges in the measurement of temperament, and provide considerations for future research aimed at understanding the relationship between temperament, food intake, and childhood obesity. Moving forward, a fuller appreciation of the complexity of the temperament concept and thoughtful selection of temperament measures may help improve predictions and identify targets for interventions aimed at decreasing the risk for obesity in childhood.

Infant temperament and parent use of food to soothe predict change in weight-for-length across infancy: early risk factors for childhood obesity.

OBJECTIVES: Greater weight gain in infancy is a risk factor for childhood obesity. The present study examined the interaction between infant temperament and parent use of food to soothe infant distress (FTS) as predictors of weight gain across the first 2 years of life. SUBJECTS/METHODS: A total of 160 mother-infant dyads were recruited into a longitudinal study. Infant temperament was assessed by parents through a questionnaire (surgency, negativity) and by observer ratings (surgency, irritability) during a laboratory visit when infants were 6 months old. Parents also completed a 3-day infant cry diary when their children were 6 months of age to assess when they used food in response to infant cry/fuss bouts. Infant weight/length was measured in the lab at 6 and 18 months. Multiple regressions were run to test the moderating effect of FTS on weight gain. RESULTS: Significant interactions were revealed for both measures of surgency and parent FTS in predicting weight gain. Surgent infants whose parents had a greater tendency to use FTS had greater weight-for-length gain in 1 year than if their parents tended to use less FTS. The interaction between observer ratings of irritability and parent FTS was also significant but in an unexpected direction. CONCLUSIONS: The findings point to the role of temperament, specifically surgency, in weight gain during infancy, but only if their parents used FTS. Surgency may have evoked this feeding practice that increased their health risk.

Does Temperament Underlie Infant Novel Food Responses?: Continuity of Approach-Withdrawal From 6 to 18 Months.

This study investigated whether temperamental approach-withdrawal underlies infants' responses to novel foods. Data were drawn from a longitudinal study of mother-infant dyads (n = 136). Approach-withdrawal responses to novel foods and novel toys were coded when infants were 6 and 12 months of age. When infants were 18 months of age, approach-withdrawal behaviors, positive affect, and negative affect were used in a latent profile analysis to identify groups of toddlers who exhibited similar responses to novelty. As predicted, novel food and novel toy responses were concurrently associated at 12 months and followed a similar developmental pattern across the 1st year. Furthermore, novel food acceptance at 12 months of age, but not 6 months, predicted greater toddler approach.

Observed temperament from ages 6 to 36 months predicts parent- and teacher-reported attention-deficit/hyperactivity disorder symptoms in first grade.

This study tested the prospective association between observational indicators of temperament, which were obtained across multiple assessments when children were 6-36 months of age, and parent and teacher reports of children's attention-deficit/hyperactivity disorder (ADHD) behaviors, when children were in first grade. Data were drawn from the Family Life Project and included 1,074 children for whom temperament and either parent- or teacher-reported ADHD behavioral data were available. The results of variable-centered regression models indicated that individual differences in temperament regulation, but not temperamental reactivity, was uniquely predictive of parent- and teacher-reported ADHD behaviors. Latent profile analyses were used to characterize configurations of temperamental reactivity and regulation. Person-centered regression models were subsequently estimated in which temperamental profile membership replaced continuous indicators of temperamental reactivity and regulation as predictors. The results of person-centered regression models indicated that temperamental reactivity and regulation both contributed (both alone and in combination) to the prediction of subsequent ADHD behaviors. In general, the predictive associations from early temperament to later ADHD were of modest magnitude (R 2 = .10-.17). Results are discussed with respect to interest in the early identification of children who are at elevated risk for later ADHD.

Temperamental approach/withdrawal and food neophobia in early childhood: Concurrent and longitudinal associations.

The purpose of the present study was to investigate whether temperamental approach/withdrawal processes were concurrently and longitudinally associated with parent ratings and behavioral observations of food neophobia at 4.5 years of age. Additionally, maternal feeding practices were examined as potential moderators of the association between toddler temperament and food neophobia. Data were drawn from a longitudinal study following individuals (n = 82) from infancy through early childhood. At 18 months of age, toddlers were observed in an unfamiliar laboratory setting with an experimenter and their reactions were coded. At 4.5 years of age, the children were again observed in an unfamiliar setting and were also offered three novel foods (lychee, nori, and haw jelly). The number of foods they refused to taste was used as a measure of behavioral neophobia. Finally, mothers reported on their child's food neophobia and temperament, as well as their own feeding practices. As expected, temperament was associated with concurrent measures of food neophobia at 4.5 years of age. Also, low approach children who exhibited high negative affect and low positive affect in response to novelty at 18 months of age had higher levels of food neophobia at 4.5 years of age compared to their peers. Furthermore, evidence emerged to show that these neophobic tendencies in low approach children were strengthened by a maternal pressuring feeding style. Collectively, the results of this study emphasize that children who have low levels of temperamental approach are at a heightened risk for developing food neophobia during childhood.

Stability of food neophobia from infancy through early childhood.

The purpose of the present study was to examine whether rejection of novel foods during infancy predicted child behavioral and parent-reported neophobia at 4.5 years of age. Data for the present study were drawn from a longitudinal study following individuals (n = 82) from infancy through early childhood. At 6 and 12 months of age, the infants tasted a novel food (green beans, hummus, or cottage cheese) and their reactions were coded for rejection of the food (i.e. crying, force outs, or refusals). The children returned to the laboratory at 4.5 years of age and participated in a behavioral neophobia task where they were offered three novel foods (lychee, nori, and haw jelly) and the number of novel foods they tasted was recorded. Mothers also reported their own and their children's levels of food neophobia. Regression analyses revealed that rejection of novel foods at 6 months interacted with maternal neophobia to predict parent-rated child neophobia. Infants who exhibited low levels of rejection at 6 months showed higher levels of parent-rated neophobia when their mothers also showed high compared to low levels of neophobia. At 12 months of age, however, infants who exhibited high levels of rejection tended to have high levels of parent-rated neophobia regardless of their mothers' levels of neophobia. These results provide preliminary evidence that rejection of novel foods during infancy does predict neophobia during early childhood, but the results vary depending on when rejection of new foods is measured.

Understanding and measuring parent use of food to soothe infant and toddler distress: A longitudinal study from 6 to 18 months of age.

The present study examined the development of parent use of food to soothe infant distress by examining this feeding practice longitudinally when infants were 6, 12 and 18 months of age. Two measures of feeding to soothe were obtained: parent self-report and observations of food to soothe during each laboratory visit. Demographic and maternal predictors of food to soothe were examined as well as the outcome, infant weight gain. The findings showed that the two measures of food to soothe were unrelated but did reveal similar and unique relations with predictor variables such as parent feeding style and maternal self-efficacy. Only observations of the use of food to soothe were related to infant weight gain. The findings indicate that the two measures of food to soothe may be complementary and that observations of this feeding practice may capture certain relations that are not obtained through the use of self-report.

Infant and maternal predictors of early life feeding decisions. The timing of solid food introduction.

There is limited research on the maternal and infant characteristics associated with the timing of solid food introduction. The current study examined how maternal feeding style and infant temperament independently and interactively predicted the age at which infants were introduced to solid food. Data from 115 predominately white, middle-class mothers were collected when infants were 4 and 6 months of age. The timing of solid food introduction was positively correlated with mothers' age, education, breastfeeding at 4 months, self-reported responsiveness to infants' hunger and satiety cues, and negatively correlated with mothers' pre-pregnancy body mass index (BMI), beliefs about feeding infants solid food prior to 6 months of age, and infants' temperamental motor reactivity. When controlling for maternal age, education, pre-pregnancy BMI, and milk feeding method at 4 months, the timing of solid food introduction was negatively predicted by mothers' beliefs about feeding solid food prior to 6 months of age. Exploratory interaction analyses suggested that infant temperament marginally moderated maternal feeding style in predicting the timing of solid food introduction.

Longitudinal associations between temperament and socioemotional outcomes in young children: the moderating role of RSA and gender.

Temperament is an important predictor of socioemotional adjustment, such as externalizing and internalizing symptoms. However, there is not a one-to-one correspondence between temperamental predispositions and these outcomes, implying that other factors also contribute to the development of internalizing and externalizing problems. Self-regulation is believed to interact with temperament, and has been studied as a predictor for later socioemotional outcomes. Respiratory sinus arrhythmia (RSA) is a psychophysiological measure of self-regulation that has been studied as a moderator of risk. The primary aim of the present study was to test if RSA baseline and RSA reactivity would moderate the link between temperament and socioemotional outcomes. Mothers reported the temperament of their infants (20 months; N = 154), RSA was collected at 24- and 42-months, and mothers reported externalizing and internalizing behaviors at kindergarten entry. RSA baseline and RSA reactivity moderated the relation between exuberant temperament and externalizing behaviors. However, these results were only significant for girls, such that high RSA baseline and greater RSA suppression predicted more externalizing behaviors when exuberance was high. Fearful temperament predicted later internalizing behaviors, but no moderation was present. These results are discussed in light of recent evidence regarding gender differences in the role of RSA as a protective factor for risk.

Modeling dyadic processes using Hidden Markov Models: A time series approach to mother-infant interactions during infant immunization.

The focus of the present longitudinal study, to examine mother-infant interaction during the administration of immunizations at two and six months of age, used hidden Markov modeling, a time series approach that produces latent states to describe how mothers and infants work together to bring the infant to a soothed state. Results revealed a 4-state model for the dyadic responses to a two-month inoculation whereas a 6-state model best described the dyadic process at six months. Two of the states at two months and three of the states at six months suggested a progression from high intensity crying to no crying with parents using vestibular and auditory soothing methods. The use of feeding and/or pacifying to soothe the infant characterized one two-month state and two six-month states. These data indicate that with maturation and experience, the mother-infant dyad is becoming more organized around the soothing interaction. Using hidden Markov modeling to describe individual differences, as well as normative processes, is also presented and discussed.

Infant temperament and feeding history predict infants' responses to novel foods.

The purpose of the present study was to investigate whether infant temperament and previous feeding history were associated with infants' acceptance and rejection of a novel food at 12 months of age. Mother-infant dyads (n = 89) were video-recorded during a novel food (hummus, cottage cheese) feeding task. Infants' reactions (acceptance and rejection behaviors) and maternal responsiveness and affect during the interaction were coded from the recordings by teams of coders. Mothers reported on their infants' temperamental approach via the Infant Behavior Questionnaire-Revised (IBQ-R) and their infants' feeding history (previous exposure to solid foods and exclusive breastfeeding). Regression analyses revealed that infants rated lower on approach showed less acceptance of the first offer of novel food than infants rated higher on approach. Additionally, low approach infants who were previously exposed to a greater number of solid foods showed fewer rejection behaviors in response to the later offers of food. Exclusive breastfeeding for 4 months did not appear to have an effect on acceptance or rejection. Finally, greater maternal responsiveness was related to the infants' acceptance of the new food whereas lower maternal responsiveness was associated with rejection of the novel food. These results suggest that the acceptance and rejection of new foods by infants is dependent upon their temperament and previous exposure to solid foods, as well as the manner in which mothers present the novel food.

Negative temperament as a moderator of intervention effects in infancy: testing a differential susceptibility model.

A consideration of potential moderators can highlight intervention effects that are attenuated when investigating aggregate results. Differential susceptibility is one type of interaction, where susceptible individuals have poorer outcomes in negative environments and better outcomes in positive environments, compared to less susceptible individuals, who have moderate outcomes regardless of environment. In the current study, we provide rationale for investigating this type of interaction in the context of a behavioral childhood obesity preventive intervention and test whether infant negativity moderated intervention effects on infant self-regulation and weight gain and on two aspects of mothers' parenting competence: parenting self-efficacy and parenting satisfaction. Results showed that infants' negative temperament at 3 weeks moderated intervention effects on some, but not all, outcomes. The intervention led to greater parenting satisfaction in mothers with highly negative infants but did not affect parenting satisfaction in mothers with less negative infants, consistent with a model of differential susceptibility. There was also a trend toward less weight gain in highly negative intervention group infants. In contrast, there was a main effect of the intervention on infant self-regulation at 1 year, such that the intervention group had higher observed self-regulation, across levels of infant negativity. Results support the importance of incorporating tests of moderation into evaluations of obesity interventions and also illustrate that individuals may be differentially susceptible to environmental effects on some outcomes but not others.

Heterogeneity in Maltreated and Non-maltreated Preschool Children's Inhibitory Control: The Interplay Between Parenting Quality and Child Temperament.

This study examined the contribution of child temperament, parenting, and their interaction on inhibitory control development in a sample of maltreated and non-maltreated preschool children. One hundred and eighteen mother-child dyads were drawn from predominantly low-income, rural communities. Dyads participated in a laboratory session in which maternal warm autonomy support, warm guidance, and strict/hostile control were observationally coded during a joint teaching task. Independent assessments of children's inhibitory control were obtained, and observers rated children's temperament. After relevant covariates, including income, maternal education, and child age and IQ were controlled for, there were no differences between the maltreatment and non-maltreatment groups in either children's inhibitory control or mothers' behaviours in the laboratory session. Even after much of the variance in children's inhibitory control was accounted for from the covariates, children's temperamental negativity moderated the effects of warm autonomy support on inhibitory control in both maltreatment and non-maltreatment groups. Temperamentally negative children whose mothers displayed more warm autonomy support showed greater inhibitory control, at levels on par with low-negative children. Findings suggest that heterogeneity in children's self-regulation may be due in part to individual differences in sensitivity to caregiver support for children's independence, even among those exposed to maltreatment.

Estimation of nonlinear mixed-effects continuous-time models using the continuous-discrete extended Kalman filter.

Many intensive longitudinal measurements are collected at irregularly spaced time intervals, and involve complex, possibly nonlinear and heterogeneous patterns of change. Effective modelling of such change processes requires continuous-time differential equation models that may be nonlinear and include mixed effects in the parameters. One approach of fitting such models is to define random effect variables as additional latent variables in a stochastic differential equation (SDE) model of choice, and use estimation algorithms designed for fitting SDE models, such as the continuous-discrete extended Kalman filter (CDEKF) approach implemented in the dynr R package, to estimate the random effect variables as latent variables. However, this approach's efficacy and identification constraints in handling mixed-effects SDE models have not been investigated. In the current study, we analytically inspect the identification constraints of using the CDEKF approach to fit nonlinear mixed-effects SDE models; extend a published model of emotions to a nonlinear mixed-effects SDE model as an example, and fit it to a set of irregularly spaced ecological momentary assessment data; and evaluate the feasibility of the proposed approach to fit the model through a Monte Carlo simulation study. Results show that the proposed approach produces reasonable parameter and standard error estimates when some identification constraint is met. We address the effects of sample size, process noise variance, and data spacing conditions on estimation results.

Longitudinal antecedents of executive function in preschoolers.

Despite an extensive history underscoring the role of social processes and child contributions to the development of executive functions (C. Lewis & J. Carpendale, 2009; L. S. Vygotsky, 1987), research on these relations is sparse. To address this gap, 68 mother-child dyads were examined to determine whether maternal attention-directing behaviors (attention maintaining, attention redirection) and toddlers' temperament predicted executive processes during preschool (mean age = 4.5 years, SD = 0.46)-delay and conflict inhibition. Maternal attention maintaining was associated with high levels of conflict inhibition for inhibited and exuberant children, whereas attention redirection was associated with low levels of delay and conflict inhibition for inhibited children. Therefore, maternal attention-directing behaviors may enhance the development of executive functions but only for children with inhibited and exuberant temperaments.

Temperamental surgency and emotion regulation as predictors of childhood social competence.

The primary aims of the current study were to longitudinally examine the direct relationship between children's temperamental surgency and social behaviors as well as the moderating role of children's emotion regulation. A total of 90 4.5-year-old children participated in a laboratory visit where children's temperamental surgency was rated by experimenters and children's emotion regulation abilities were assessed. The summer before entry into first grade, children's social behaviors with unfamiliar peers were observed in the laboratory and mothers completed a questionnaire about children's social behaviors. Supporting our hypotheses, results revealed that children high in temperamental surgency developed more negative peer behaviors, whereas children low in temperamental surgency were more likely to develop behavioral wariness with peers. Emotion regulatory behaviors were found to moderate the relation between temperamental surgency and aggression, where high-surgent children who showed high levels of social support seeking were less likely to be rated by their mothers as high in aggression. Furthermore, results revealed that low-surgent children who showed high levels of distraction/self-soothing were more likely to show behavioral wariness around unfamiliar peers, whereas high-surgent children who used more distraction/self-soothing behaviors were rated by their mothers as lower in social competence.

Interparental aggression and infant patterns of adrenocortical and behavioral stress responses.

Drawing on emotional security theory, this study examined linkages between interparental aggression, infant self-regulatory behaviors, and patterns of physiological and behavioral stress responses in a diverse sample of 735 infants residing in predominately low-income, non-metropolitan communities. Latent profile analysis revealed four classes of adrenocortical and behavioral stress-response patterns at 7 months of age, using assessments of behavioral and cortisol reactivity to an emotion eliciting challenge, as well as global ratings of the child's negative affect and basal cortisol levels. The addition of covariates within the latent profile model suggested that children with more violence in the home and children who used less caregiver-oriented regulation strategies were more likely to exhibit a pattern of high cortisol reactivity with moderate signs of distress rather than the average stress response, suggesting possible patterns of adaptation in violent households.