Capacity for Regulation of Energy Intake in Infancy.

Importance: The capacity for regulation of energy intake (REI) to match energy needs is thought to contribute to differences in weight gain, and preventing excess infant weight gain is a priority. Objective: To determine capacity for REI across infancy. Design, Setting, and Participants: For this cohort study, a convenience sample of mother-infant dyads was recruited from the community in Michigan between 2015 and 2019. Inclusion criteria were healthy, full-term infants with weight appropriate for gestational age; biological mothers who were 18 years or older, English speaking, and a legal and custodial guardian; and infant having had consumed 2 oz or more in 1 feeding from an artificial nipple at least once per week. Infants were followed in the home setting with staff support for up to 12 months. Interventions: Mother-infant dyads participated at infant age 1, 2.5, 5, 7, 10, and 12 months. In the intervention condition, mothers offered a feeding every hour for 6 hours. In the control condition, mothers fed infants as they typically would for 6 hours. Intake was recorded and kilocalories calculated. Main Outcomes and Measures: Capacity for REI was indexed as the difference in intake in kilocalories per kilogram of body weight (intervention minus control condition); a value of 0 indicated perfect REI. Maternal and infant characteristics were obtained by questionnaire, and anthropometry was measured. Using multiple imputation, the intercept and slope for difference in kilocalories per kilogram across the 6 age points were estimated using mixed models accounting for repeated measures within participants. Statistical analyses were conducted between September 2021 and February 2023. Results: The sample included 175 infants (87 [49.71%] female, 88 [50.29%] male; 494 pairs of intervention and control conditions and 4630 feedings). The mean (SD) 12-month weight-for-age z score was 0.1 (0.8). Mean (SD) gestational age as 39.55 (1.05) weeks, and mean (SD) birth weight was 3.43 (0.41) kg. Mean (SD) breastfeeding duration for those who reported stopping by 12 months was 17.83 (12.03) weeks. As designed, the intervention (compared with control) condition included more feedings at shorter intervals. After collapsing the data across age points in a mixed model accounting for repeated measures within participants, the REI estimate at 1 month differed from 0. On average, infants ate 5.21 kcal/kg (95% CI, 2.89-7.54 kcal/kg) more in the frequent feeding intervention condition than in the ad lib feeding control condition. This difference did not significantly change over 12 months of infancy (REI slope = -0.01 kcal/kg per month; 95% CI, -0.02 to 0.03 kcal/kg per month). Conclusions and Relevance: The study's findings suggested that, on average, when offered more frequent feedings, healthy, full-term infants may overeat. The results provide support for responsive feeding as a strategy for preventing excess infant weight gain.

Associations of maternal food addiction, dietary restraint, and pre-pregnancy BMI with infant eating behaviors and risk for overweight.

Maternal food addiction, dietary restraint, and pre-pregnancy body mass index (BMI) are associated with high-risk eating behaviors and weight characteristics in children and adolescents. However, little is known about how these maternal factors are associated with individual differences in eating behaviors and risk for overweight in infancy. In a sample of 204 infant-mother dyads, maternal food addiction, dietary restraint and pre-pregnancy BMI were assessed using maternal self-report measures. Infant eating behaviors (as measured by maternal report), objectively measured hedonic response to sucrose, and anthropometry were measured at 4 months of age. Separate linear regression analyses were used to test for associations between maternal risk factors and infant eating behaviors and risk for overweight. Maternal food addiction was associated with increased risk for infant overweight based on World Health Organization criteria. Maternal dietary restraint was negatively associated with maternal report of infant appetite, but positively associated with objectively measured infant hedonic response to sucrose. Maternal pre-pregnancy BMI was positively associated with maternal report of infant appetite. Maternal food addiction, dietary restraint, and pre-pregnancy BMI are each associated with distinct eating behaviors and risk for overweight in early infancy. Additional research is needed to identify the mechanistic pathways driving these distinct associations between maternal factors and infant eating behaviors and risk for overweight. Further, it will be important to investigate whether these infant characteristics predict the development of future high-risk eating behaviors or excessive weight gain later in life.

Characterization of a Vigorous sucking style in early infancy and its predictive value for weight gain and eating behaviors at 12 months.

This study sought to identify sucking profiles among healthy, full-term infants and assess their predictive value for future weight gain and eating behaviors. Pressure waves of infant sucking were captured during a typical feeding at age 4 months and quantified via 14 metrics. Anthropometry was measured at 4 and 12 months, and eating behaviors were measured by parent report via the Children's Eating Behavior Questionnaire-Toddler (CEBQ-T) at 12 months. Sucking profiles were created using a clustering approach on the pressure wave metrics, and utility of these profiles was assessed for predicting which infants will have weight-for-age (WFA) percentile changes from ages 4-12 months that exceed thresholds of 5, 10, and 15 percentiles, and for estimating each CEBQ-T subscale score. Among 114 infants, three sucking profiles were identified: Vigorous (51%), Capable (28%), and Leisurely (21%). Sucking profiles were found to improve estimation of change in WFA from 4 to 12 months and 12-month maternal-reported eating behaviors above infant sex, race/ethnicity, birthweight, gestational age, and pre-pregnancy body mass index alone. Infants with a Vigorous sucking profile gained significantly more weight during the study period than infants with a Leisurely profile. Infant sucking characteristics may aid in predicting which infants may be at greater risk of obesity, and therefore sucking profiles deserve more investigation.

Characteristics of eating behavior profiles among preschoolers with low-income backgrounds: a person-centered analysis.

BACKGROUND: Individual differences in eating behaviors among young children are well-established, but the extent to which behaviors aggregate within individuals to form distinct eating behavior profiles remains unknown. Our objectives were to identify eating behavior profiles among preschool-aged children and evaluate associations with temperament and weight. METHODS: A secondary, cross-sectional analysis of baseline data from 2 cohort studies was conducted involving 1004 children aged 3-4 years and their parents with low-income backgrounds. Children's eating behaviors and temperament were assessed by parental report. Body mass index z-scores and weight status were calculated using measured heights and weights. Latent profile analysis (LPA) was used to generate profiles and bivariate analyses were used to evaluate associations with temperament and weight status. RESULTS: LPA revealed the presence of 3 eating behavior profiles among children. Children with High Food Approach profiles (21.2%) had lower temperamental inhibitory control and the highest percent of children with obesity relative to the other profiles. Children with High Food Avoidant profiles (35.6%) had lower temperamental impulsivity and lower BMI z-scores relative to the other profiles, whereas children with Moderate Eating profiles (intermediary levels of all behaviors; 43.2%) had higher temperamental inhibitory control and lower anger/frustration, than other profiles. CONCLUSIONS: Young children's eating behaviors appear to aggregate within individuals to form empirically distinct profiles reflecting food approach, food avoidance, and moderate approaches to eating that are differentiated by aspects of temperament and weight. Future work should seek to understand the extent to which health promotion and obesity prevention approaches should be tailored to take into account children's fundamental dispositions towards eating.

Emerging Ideas Brief Report. How Do Low-Income Mothers Talk to Children About Weight and Body Shape?

OBJECTIVE: Identify mothers' perceptions of how they talk about weight and body shape with their children and examine how approaches vary by mother and child characteristics. BACKGROUND: Youth who report that their parents talk with them about their weight experience poor health. However, very little is known about the content of these conversations. METHOD: Mothers and their 6- to 11-year-old children (N = 188 dyads) participated in a mixed-methods study. Themes in mothers' responses to the interview question "How do you talk to your child about weight or body shape?" were identified, and latent class analysis was used to characterize patterns of weight and shape talk. RESULTS: Seven themes of weight and shape talk were identified, including talking about "Healthy Habits" (39.9%), "Avoids Weight and Body Talk" (21.8%), and tells "Cautionary Tales" (18.6%). Three patterns emerged from themes: talk to promote health, avoid talking about weight and shape, and talk to build children's self-esteem. Mothers of children with obesity were more likely to talk to promote health versus other patterns. CONCLUSION: The content of family conversations about weight and shape is diverse. IMPLICATIONS FOR EMERGING IDEAS: Future research is needed to understand the impacts of specific ways parents talk about weight and shape.

Behavioral Responses to Sucrose as an Indicator of Positive Hedonic Response Across the First Six Months of Infancy.

Behavioral responses to sucrose provide an index of positive hedonic response in newborns. In 118 infants, the current study used repeated assessments to explore behavioral responses to sucrose solutions (24%/50% sucrose) compared to water across the first six months of infancy. Lip smacking and bringing fingers to mouth are more likely to occur in response to 24% sucrose relative to water. Tongue protrusions are also more likely to occur for 50% sucrose relative to water. Behavioral responses to sucrose may provide an index of positive hedonic response and could be used to investigate individual differences in the first six months of infancy.

Phenotypes of controlling feeding behaviours in mothers of toddlers: A mixed methods study.

BACKGROUND: Maternal feeding behaviours, in particular controlling behaviours, are associated with risk of childhood obesity. OBJECTIVES: To qualitatively examine patterns of mothers' beliefs and behaviours around controlling feeding through a semi-structured interview and to examine associations of those patterns with participant demographic characteristics and classical child feeding instruments. METHODS: A convenience sample of mothers (N = 35) of toddlers (mean age 25 months) participated in a semi-structured interview about their child feeding beliefs and behaviours. Anthropometrics were measured. Transcripts were analyzed using narrative analysis for patterns from which two emerged, known as phenotypes. A coding scheme was created and reliably applied. Bivariate correlates of the phenotypes with participant child characteristics and mother self-reported feeding behaviours were examined. RESULTS: The phenotypes were High Covert Control (n = 12) and Shared Control (n = 23). High Covert Control phenotype membership was correlated with higher child and mother BMI (body mass index) and child female sex. Shared Control phenotype membership was correlated with lower child and mother BMI and greater pressure to eat. CONCLUSIONS: Two controlling feeding phenotypes emerged among mothers of toddlers, which were associated with participant characteristics including BMI, but did not map onto classical child feeding instruments.

Feeding styles among mothers of low-income children identified using a person-centered multi-method approach.

BACKGROUND: Maternal feeding styles have been associated with children's eating behaviors and obesity risk. Few works have identified maternal feeding styles using a multi-method person-centered approach. OBJECTIVES: (1) To identify maternal feeding styles using a person-centered multi-method approach, and (2) to examine the association of child weight status with maternal feeding styles. METHODS: Participants were low-income mother-child dyads (N = 255) (mean child age 5.9 years) from the United States. Mothers completed questionnaires and participated in a semi-structured interview. Interview transcripts were reliably coded for constructs of child feeding including beliefs, goals, and concerns. Family mealtime video recordings were reliably coded for feeding behaviors. Child anthropometrics were measured. Latent class analysis (LCA) was used to determine empirically-driven typologies of maternal feeding styles. Chi-square analyses tested the association of maternal feeding styles with child overweight or obese (vs. not) weight status. RESULTS: Two maternal feeding styles were identified by LCA which we term "High Coercive Control" (27% child overweight/obese) and "Low Coercive Control" (55% child overweight/obese). High Coercive Control mothers were more likely to believe their child was too thin, self-reported being more demanding in feeding and pressuring the child to eat, worried more about their child not eating enough and were observed to use more bribery. Low Coercive Control mothers were concerned about their child eating too much, and were less likely to self-report engaging in pressuring or restricting feeding behaviors. CONCLUSIONS: The findings suggest that although there is a "feeding style" characterized by substantial control, this style was most common among mothers of thinner children. The mothers of children with overweight/obesity were primarily characterized by engaging in the "recommended" feeding behaviors and being appropriately concerned about their child's risk for excess weight.

Maternal prompting types and child vegetable intake: Exploring the moderating role of picky eating.

BACKGROUND: It is unknown if using different maternal prompting types is associated with vegetable intake in children perceived to be picky versus non-picky. OBJECTIVES: 1) To test the correlation of counts of maternal prompting types with child vegetable intake, and picky eating, 2) to examine the interaction of prompting types and picky eating status on vegetable intake. DESIGN/METHODS: Low-income mother-child dyads (N = 199, mean child age 6.0 years) participated in a videotaped laboratory eating protocol with green beans, a familiar vegetable. A coding scheme was developed and reliably applied to categorize mothers' prompting types. The prompting types were: Coercive Control (Sub-Categories: Reward and Pressure-to-Eat), Autonomy Promotion (Sub-Categories: Modeling, Reasoning, Praise, and Question), and Total Prompts (sum of all prompts). Mothers completed questionnaires. Bivariate analyses tested the association between counts of maternal prompting types with amount of green beans eaten, and picky eating. Regression analyses examined the interaction of picky eating status with counts of maternal prompting type on amount of green beans eaten. RESULTS: Mothers used on average 1.66 prompts. Greater use of Coercive Control, Autonomy Promotion-Modeling, and Total Prompts were all inversely correlated with amount of green beans eaten. Greater use of Autonomy Promotion-Praise was directly correlated with amount of green beans eaten. In stratified models, greater use of Coercive Control prompts was negatively associated with amount of green beans eaten by the child in non-picky eaters, but not in picky eaters. There was no interaction between other prompting types and child picky eating status in predicting amount eaten. All p-values <0.05. CONCLUSIONS: Mothers use different prompting types to encourage their children to eat vegetables depending on their picky eating status, most of which may be correlated with reduced intake.

Donuts on our daughters: Gender differences in food categories on children's apparel.

OBJECTIVE: Recent trends in children's fashion have featured food-graphics on children's apparel. Little attention has been paid to the food-graphic content of children's apparel. The objectives of this study were to describe and quantify food-graphics appearing on children's apparel, to examine characteristics of children's apparel items associated with the presence versus absence of food-graphics, and to examine gender differences in food-graphics. METHODS: A content analysis of food-graphics on children's apparel from major apparel retailer websites was performed. Images of food-graphic apparel were reliably coded for food-graphic categories. Multivariable analyses examined the association of apparel item characteristics with food-graphic presence. Bivariate analyses tested the association of presence or absence of each food category with gender of apparel item. RESULTS: Of the 3870 apparel items coded, 8.2% (318) had food-graphics. In multivariable analysis, food-graphics were more likely to be present on girls' (versus boys') apparel (RR = 1.73, 95% CI 1.34-2.12). Content analysis of food-graphic items revealed categories including "pastries", "frozen desserts", "pizza", "fast food", "fruit", and "love of food". Girls' (versus boys') food-graphic apparel was more likely to have categories of "pastries" (33% versus 12%), "frozen desserts" (20% versus 9%), and "fruit" (30% versus 11%) and less likely to have categories of "pizza" (9% versus 30%), and "fast food" (3% versus 23%). The "love of food" category did not differ by gender. All p-values ≤.01. CONCLUSIONS: Food-graphics on children's apparel are fairly common, especially on apparel marketed for girls. Children's apparel may represent a novel cultural influence on children's eating and food perceptions.

Deconstructing the Family Meal: Are Characteristics of the Mealtime Environment Associated with the Healthfulness of Meals Served?

BACKGROUND: Multiple studies and guidelines emphasize the benefits associated with family meals. However, family meals are not well defined and little research has been conducted to determine whether mealtime characteristics are associated with the healthfulness of foods served. OBJECTIVE: The objective of this study was to define and measure specific mealtime characteristics and examine whether these characteristics are associated with the healthfulness of meals served to young children from low-income families, as measured by the Healthy Meal Index (HMI). PARTICIPANTS/SETTING: Study participants included 272 young children from low-income families residing in southeast Michigan during 2011 to 2013. DESIGN: For this cross-sectional study, parents videorecorded 757 mealtimes that were coded for four mealtime variables and meal healthfulness using the HMI. Mealtime characteristics included Eating at a Table (vs not), Served Family-Style (vs not), TV Off (vs not), and Parent Partakes (sits and eats or drinks with child) (vs not). A Family Meal was defined as a meal that had all four measured mealtime characteristics. MAIN OUTCOME MEASURES: All meals were scored using the HMI, which has two components: the HMI Adequacy score (based on the presence of foods that are recommended for a healthy diet) and the HMI Moderation score (based on the absence of foods recommended to be consumed in moderation). The scores are summed to obtain the HMI Total score. STATISTICAL ANALYSES PERFORMED: Generalized estimating equations tested the associations of mealtime characteristics with HMI scores, controlling for child sex and age, and parent education and race/ethnicity. RESULTS: In adjusted models, Family Meals were positively associated with HMI Adequacy (P=0.02) and Total (P=0.05) scores. Eating at a Table was positively associated with HMI Moderation (P=0.01) and HMI Total (P=0.01) scores. Served Family-Style was positively associated with HMI Adequacy scores (P=0.04). TV Off was associated with higher HMI Total scores (P=0.05). Parent Partakes was not associated with HMI scores. CONCLUSIONS: Family Meals were associated with greater healthfulness of the foods served. Characteristics of mealtime that are commonly utilized to define Family Meal were differentially associated with meal healthfulness.

Approaches to restrictive feeding: Associations with child weight and eating behavior.

BACKGROUND: Identifying differences in how mothers communicate restriction of their children's eating may be important to understanding the effects of restriction on children's intake and weight status. OBJECTIVES: To characterize mothers' restrictive statements by affect and directness, and examine cross-sectional associations between restrictive statement types and children's body mass index and eating behaviors. METHODS: Mother-child dyads (N = 223, mean child age 5.9 years) participated in a structured eating task. A coding scheme reliably characterized mothers' restrictive statements. Mothers completed measures of child enjoyment of food, food responsiveness, and satiety responsiveness, and child anthropometrics were measured. Poisson regression was used to test associations between type of restrictive statements and child BMI z-score (BMIz) and eating behaviors, adjusting for covariates. RESULTS: Higher child BMIz was associated with mothers' more frequent use of negative direct restrictive statements, but not other types of statements. This association was stronger among girls (RR (95% CI) = 2.28 (1.45-3.59)) than boys (RR (95% CI) = 1.49 (1.05-2.10)). Among girls, but not boys, higher enjoyment of food and lower satiety responsiveness were associated with more frequent positive direct restrictive statements (RR (95% CI) = 1.63 (1.20-2.21) and RR (95% CI) = 1.94 (1.29-2.92), respectively). For both sexes, mothers' use of positive indirect restrictive statements was more frequent among children with higher enjoyment of food (RR (95% CI) = 1.38 (1.11-1.72). CONCLUSIONS: The statements mothers use to restrict their children's eating vary in affect and directness. Child characteristics, such as sex, BMI, and the presence of specific eating behaviors, are associated with differing approaches to restriction by mothers.

An investigation of maternal food intake and maternal food talk as predictors of child food intake.

Though parental modeling is thought to play a critical role in promoting children's healthy eating, little research has examined maternal food intake and maternal food talk as independent predictors of children's food intake. The present study examines maternal food talk during a structured eating protocol, in which mothers and their children had the opportunity to eat a series of familiar and unfamiliar vegetables and desserts. Several aspects of maternal talk during the protocol were coded, including overall food talk, directives, pronoun use, and questions. This study analyzed the predictors of maternal food talk and whether maternal food talk and maternal food intake predicted children's food intake during the protocol. Higher maternal body mass index (BMI) predicted lower amounts of food talk, pronoun use, and questions. Higher child BMI z-scores predicted more first person pronouns and more wh-questions within maternal food talk. Mothers of older children used fewer directives, fewer second person pronouns, and fewer yes/no questions. However, maternal food talk (overall and specific types of food talk) did not predict children's food intake. Instead, the most robust predictor of children's food intake during this protocol was the amount of food that mothers ate while sitting with their children. These findings emphasize the importance of modeling healthy eating through action and have implications for designing interventions to provide parents with more effective tools to promote their children's healthy eating.

Selective eating behaviors in children: An observational validation of parental report measures.

Selective eating in children is commonly measured by parental report questionnaires, yet it is unknown if parents accurately estimate their child's selective eating behavior. The objectives of this study were to test the validity and stability of two measures of selective eating using observed child behavior. Low-income mother-child dyads participated in a videotaped laboratory eating protocol at two time points (baseline: mean child age = 5.9 years; follow-up: mean child age = 8.6 years), during which they were presented with a familiar and an unfamiliar vegetable. Videos were reliably coded for child selective eating behaviors: amount consumed, child hedonic rating of vegetables, child compliance with maternal prompts to eat, latency to first bite, number of bites, and negative utterances. Mothers completed the Child Eating Behavior Questionnaire Food Fussiness (CEBQ FF) scale and the Food Neophobia Scale (FNS) at both time points. Questionnaire validity, stability of measured behaviors, and discriminant validity of questionnaires were examined in the full sample. CEBQ FF scores and FNS scores were both inversely correlated with the quantity consumed, child hedonic rating, and compliance with prompts to eat for both familiar and unfamiliar vegetables at baseline and at follow up. CEBQ FF and FNS scores were inversely correlated with number of bites (for both foods), positively correlated with latency to first bite (for both foods), and inversely correlated with child negative utterances (for the familiar food only). Notably, FNS scores correlated with observed behavior for both familiar and unfamiliar foods, rather than demonstrating a specific association with unfamiliar foods only. This study supports the validity of the CEBQ FF and FNS in low-income early school-aged children.

Do children with obesity have worse table manners? Associations between child table manners, weight status and weight gain.

BACKGROUND: Children with obesity experience stigma stemming from stereotypes, one such stereotype is that people with obesity are "sloppy" or have poor manners. Teaching children "proper table manners" has been proposed as an obesity prevention strategy. Little is known about the association between children's weight status and table manners. OBJECTIVES: To examine correlates of child table manners and to examine the association of child table manners with child obese weight status and prospective change in child body mass index z-score (BMIz). METHODS: Mother-child dyads (N = 228) participated in a videotaped laboratory eating task with cupcakes. Coding schemes to capture child table manners (making crumbs, chewing with mouth open, getting food on face, shoving food in mouth, slouching, and getting out of seat), and maternal attentiveness to child table manners, were reliably applied. Anthropometrics were measured at baseline and at follow-up two years later. Regression analyses examined the association of participant characteristics with child table manners, as well as the associations of child table manners with child obese weight status, and prospective change in BMIz/year. RESULTS: Predictors of poorer child table manners were younger child age, greater cupcake consumption, and greater maternal attentiveness to child table manners. Poorer child table manners were not associated with child obese (vs. not) weight status, but were associated with a prospective decrease in BMIz/year in children with overweight/obesity. CONCLUSIONS: Obesity interventions to improve table manners may be perpetuating unfavorable stereotypes and stigma. Future work investigating these associations is warranted to inform childhood obesity guidelines around table manners.

Maternal Mental Representations of the Child and Mobile Phone Use During Parent-Child Mealtimes.

OBJECTIVE: Qualities of the parent-child relationship have not been explored as predictors of parent mobile device use during parent-child activities. METHODS: In 195 mother-child dyads enrolled in an ongoing cohort study, maternal mental representations of their child (ability to reflect on their child's characteristics, emotional state, and their parenting role) were evaluated through the Working Model of the Child Interview (WMCI), a validated semistructured interview. WMCI scale scores were examined as predictors of active maternal mobile device use during parent-child eating encounters (videotaped home mealtimes and a structured laboratory-based protocol) in multivariate logistic regression models. RESULTS: Children were aged 5.9 years (SD: 0.7), mothers were aged 31.5 years (SD: 7.4), and 73.3% of mothers were of white non-Hispanic race/ethnicity. During the family mealtime, 47 (24.1%) mothers actively used a mobile device at least once, whereas during the structured eating protocol, 44 (22.6%) mothers used a device. Controlling for maternal race/ethnicity, education level, and child's sex, WMCI subscales were associated with device use during home mealtimes (higher Child Difficulty) and the eating protocol (higher Child Difficulty and lower Richness of Perceptions and Caregiving Sensitivity). CONCLUSION: Maternal mental representations of their child were significantly associated with using mobile devices during eating encounters. More research studies are needed to understand directionality and longer-term associations between mobile device use and parent-child relationship characteristics.

Picky eating, pressuring feeding, and growth in toddlers.

Several common theoretical frameworks have posited causal pathways between picky eating, pressuring feeding, and growth in early childhood. The evidence to support these pathways is limited. This observational cohort study sought to examine the cross-lagged associations between mother-reported pressuring feeding, mother-reported child picky eating, and measured weight-for-length z-score (WLZ) across child ages 21, 27, and 33 months (n = 244). Cross-lagged analysis was used to evaluate longitudinal associations between these three constructs. The sample was 50.5% white, 52.3% male and 37.8% of mothers had a high school education or less. Mean WLZ was 0.52, 0.41, and 0.38 at each age, respectively. Pressuring feeding, picky eating, and WLZ each tracked strongly from 21 to 33 months. There were concurrent associations between pressuring feeding and picky eating. However, there were no prospective associations between pressuring feeding and future WLZ; WLZ and future pressuring feeding; pressuring feeding and future picky eating; picky eating and future pressuring feeding; or picky eating and future WLZ. Our results do not support causal relationships between picky eating, pressuring feeding, and growth in toddlerhood. Future work that examines alternative mechanisms shaping growth in early childhood is needed.

Association of Picky Eating With Weight Status and Dietary Quality Among Low-Income Preschoolers.

BACKGROUND: Picky eating is common in children. Few studies have examined predictors of picky eating, and the association of picky eating with weight status and dietary quality is inconsistent in the literature. We aimed to identify predictors of picky eating and to test the association of picky eating with child body mass index z-score (BMIz), dietary quality, and micronutrient intake. METHODS: This was a cross-sectional analysis of baseline data from a randomized controlled trial to prevent obesity among 506 preschoolers attending Head Start. Parents completed questionnaires to assess picky eating and child temperament. Three 24-hour dietary recalls were collected to assess dietary intake. Multivariate regression models assessed child, parent, and family predictors of picky eating; additional models tested adjusted associations of picky eating with child BMIz, dietary quality (measured using the Healthy Eating Index-2010), and micronutrient intake. RESULTS: Picky eating was predicted by male sex, older child age, and more difficult temperament but not race/ethnicity, maternal body mass index, maternal depressive symptoms, household food insecurity, or single parent home. Picky eating was not associated with child BMIz or micronutrient deficiencies; it was inversely associated with total Healthy Eating Index-2010 score and servings of whole fruit, total vegetables, greens and beans, and total protein foods. CONCLUSIONS: Pediatric providers should support parents in expanding the number of healthy foods the child eats to improve dietary quality, but reassure parents that picky eating is not associated with children's weight status or micronutrient deficiencies.

Mothers of Obese Children Use More Direct Imperatives to Restrict Eating.

OBJECTIVE: To examine the association of mother and child characteristics with use of direct imperatives to restrict eating. METHODS: A total of 237 mother-child dyads (mean child age, 70.9 months) participated in a video-recorded, laboratory-standardized eating protocol with 2 large portions of cupcakes. Videos were reliably coded for counts of maternal direct imperatives to restrict children's eating. Anthropometrics were measured. Regression models tested the association of participant characteristics with counts of direct imperatives. RESULTS: Child obese weight status and maternal white non-Hispanic race/ethnicity were associated with greater levels of direct imperatives to restrict eating (p = .0001 and .0004, respectively). CONCLUSIONS AND IMPLICATIONS: Mothers of obese children may be using more direct imperatives to restrict eating so as to achieve behavioral compliance to decrease their child's food intake. Future work should consider the effects direct imperatives have on children's short- and long-term eating behaviors and weight gain trajectories.