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.

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.

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.

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.

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.

Maternal restrictive feeding and eating in the absence of hunger among toddlers: a cohort study.

BACKGROUND: Restrictive feeding by parents has been associated with greater eating in the absence of hunger (EAH) among children, a risk factor for obesity. However, few studies have examined the association between restrictive feeding and EAH longitudinally, raising questions regarding the direction of associations between restrictive feeding and child EAH. Our objective was to examine the bidirectional prospective associations between restrictive feeding and EAH among toddlers. METHODS: Low-income mother-child dyads (n = 229) participated when children were 21, 27, and 33 months old. Restriction with regard to food amount and food quality were measured with the Infant Feeding Styles Questionnaire. EAH was measured as kilocalories of food children consumed after a satiating meal. A cross-lagged analysis adjusting for child sex and weight-for-length z-score was used to simultaneously test cross-sectional and bidirectional prospective associations between each type of restriction and children's EAH. RESULTS: At 21 months, mothers of children with greater EAH reported higher restriction with regard to food amount (b = 0.17, p < .05). Restriction with regard to food amount at age 21 months was inversely associated with EAH at 27 months (b = -0.20, p < .05). Restriction with regard to food amount at 27 months was not associated with EAH at 33 months and restriction with regard to food quality was not associated with EAH. EAH did not prospectively predict maternal restriction. CONCLUSIONS: Neither restriction with regard to food amount nor food quality increased risk for EAH among toddlers. Current US clinical practice recommendations for parents to avoid restrictive feeding, and the potential utility of restrictive feeding with regard to food amount in early toddlerhood, deserve further consideration.

Feeding and Mealtime Correlates of Maternal Concern About Children's Weight.

OBJECTIVE: To examine associations between maternal concern regarding their children becoming overweight and two domains of weight-related parenting; child feeding practices and family meal characteristics. DESIGN: Cross-sectional study. PARTICIPANTS: Low-income mothers (n = 264; 67% non-Hispanic white) and their children (51.5% male, aged 4.02-8.06 years). VARIABLES MEASURED: Maternal concern and feeding practices, using the Child Feeding Questionnaire. Meal characteristics were assessed using video-recorded meals and meal information collected from mothers. ANALYSIS: The authors used MANOVA and logistic regression to identify differences in maternal feeding practices and family meal characteristics across levels of maternal concern (none, some, and high). RESULTS: Approximately half of mothers were not concerned about their child becoming overweight, 28.4% reported some concern, and 19.0% had high concern. Mothers reporting no concern described lower restrictive feeding compared with mothers who reported some or high concern (mean [SE], none = 3.1 [0.1]; some = 3.5 [0.1]; and high = 3.6 [0.1]; P = .004). No differences in other feeding practices or family meal characteristics were observed by level of concern. CONCLUSIONS AND IMPLICATIONS: Concern regarding children becoming overweight was common. However, concern rarely translated into healthier feeding practices or family meal characteristics. Maternal concern alone may not be sufficient to motivate action to reduce children's risk of obesity.

Maternal Concern for Child Undereating.

OBJECTIVE: To describe features of maternal concern for her child undereating; examine maternal and child correlates of maternal concern for undereating; and determine whether maternal concern for undereating is associated with feeding practices. METHODS: This was a cross-sectional analysis of an observational study with 286 mother-child dyads (mean child age, 71 months). Maternal concern for undereating was assessed using a semistructured interview. Mothers completed questionnaires to assess picky eating, food neophobia, and feeding practices. Feeding practices were further assessed using videotaped mealtime observations. Logistic regression was used to assess the association of maternal and child characteristics with maternal concern for undereating. Regression was used to assess the association of maternal concern for undereating with feeding practices, controlling for covariates. RESULTS: Over a third of mothers (36.5%) expressed concern that their child does not eat enough. Correlates of concern for undereating included child body mass index z-score (BMIz; odds ratio [OR] = 0.58; 95% confidence interval [CI], 0.43-0.77) and picky eating (OR = 2.41; 95% CI, 1.26-4.59). Maternal concern for undereating was associated with greater reported pressure to eat (relative risk [RR] = 1.97; 95% CI, 1.55-2.50), greater observed bribery (OR = 2.63; 95% CI, 1.50-4.60), and higher observed pressure (OR = 1.90; 95% CI, 1.08-3.36) during mealtimes. CONCLUSIONS: Mothers of children who are picky eaters and have a lower BMIz are more likely to be concerned that their children do not eat enough, and maternal concern for undereating is associated with pressuring and bribing children to eat. Pediatricians might address maternal concern for undereating by advising feeding practices that do not involve pressure and bribery, particularly among healthy weight children.

Affective tone of mothers' statements to restrict their children's eating.

Maternal restrictive feeding behaviors have been associated with child weight status. The affective tone of mothers' statements intended to restrict their children's eating has not been examined. The objectives of this study were to describe the affective tone of mothers' restrictive feeding behaviors (positive or negative), and to test the association of child and mother characteristics with rates of Restriction with Positive Affect, Restriction with Negative Affect and Total Restriction. A total of 237 low-income child-mother dyads (mean child age 5.9 years) participated in a videotaped standardized laboratory eating protocol, during which mothers and children were both presented with large servings of cupcakes. A coding scheme was developed to count each restrictive statement with a positive affective tone and each restrictive statement with a negative affective tone. To establish reliability, 20% of videos were double-coded. Demographics and anthropometrics were obtained. Poisson regression models were used to test the association between characteristics of the child and mother with counts of Restriction with Positive Affect, Restriction with Negative Affect, and Total Restriction. Higher rates of Restriction with Positive Affect and Total Restriction were predicted by child obese weight status, and mother non-Hispanic white race/ethnicity. Higher rates of Restriction with Negative Affect were predicted by older child age, child obese weight status, mother non-Hispanic white race/ethnicity, and lower mother education level. In conclusion, in this study mothers of obese (vs. non-obese) children had higher rates of restriction in general, but particularly higher rates of Restriction with Negative Affect. Rather than being told not to restrict, mothers may need guidance on how to sensitively restrict their child's intake. Future studies should consider the contributions of maternal affect to children's responses to maternal restriction.

The Evolution of Mothers' Beliefs About Overweight and Obesity in Their Early School-Age Children.

OBJECTIVE: To identify changes in maternal beliefs, concerns, and perspectives about overweight and obesity in their children over a 2-year period. METHODS: A total of 37 low-income English-speaking mothers of overweight or obese children participated in 2 semistructured interviews, separated by about 2 years. Mean child age was 5.9 years at baseline and 8.2 years at follow-up. Mother and child anthropometric data were obtained, and mothers completed demographic questionnaires at both time points. Mothers' interviews were analyzed using the constant comparative method for longitudinal patterns of change in their perspectives on childhood obesity across the 2 time points. RESULTS: Six longitudinal patterns of change in mothers' perspectives and beliefs were identified: 1) mothers' identification of a weight problem in their child emerges gradually, 2) mothers' level of concern about their child overeating increases, 3) mothers' concerns about consequences of obesity intensify and change over time, 4) mothers feel less control over their child's eating and weight, 5) mothers' efforts to manage eating and weight become more intentional, and 6) mothers are more likely to initiate conversations about weight as their child gets older. CONCLUSIONS: Mothers' concerns about children's weight and eating habits increased, and reported weight management strategies became more intentional over a 2-year period. Further research should consider attending to maternal perspectives on child weight and eating and their evolution in the development of family-based interventions for childhood obesity.

Maternal encouragement and discouragement: Differences by food type and child weight status.

Childhood obesity prevention practice guidelines recommend that parents encourage the intake of certain types of foods and discourage the intake of others. It is unknown if parents of children of different weight statuses encourage or discourage their child's intake differently based on food type. The objective of this study was to determine the association of child weight status with maternal encouragement and discouragement of for four different types of food. A total of 222 mother-child dyads were video-taped during the standardized, sequential presentation of four foods to both participants: cupcakes (familiar dessert), green beans (familiar vegetable), halva (unfamiliar dessert) and artichoke (unfamiliar vegetable). Mother's encouragements and discouragements of child intake were reliably coded for each food type. Poisson regression models were used to test the independent association of child weight status (normal weight, overweight and obese) with encouragement and discouragement for each food type. Mothers of an obese, vs. normal or overweight child, had lower rates of encouragement for a familiar dessert (p = 0.02), and a higher rates of discouragements for a familiar dessert (p = 0.001), a familiar vegetable (p = 0.01), and an unfamiliar vegetable (p = 0.001). There were no differences in encouragements or discouragements between mothers of an overweight, vs. obese child, for any of the 4 food types. Mothers of obese children may alter their feeding behavior differentially based on food type. Future work should examine how interventions promoting maternal encouragement or discouragement of different food types impact child weight status.

Maternal concerns about children overeating among low-income children.

Addressing overeating is essential to obesity treatment and prevention. The objectives of this study were to investigate maternal concern for child overeating, to identify associated participant characteristics and to determine if concern for child overeating is associated with maternal feeding practices. Low-income mothers (N=289) of children (mean age 70.8months) participated in a semi-structured interview. Themes of maternal concern for child overeating were identified and a coding scheme was reliably applied. Maternal feeding practices were measured by questionnaire and videotaped eating interactions. Logistic regressions were used to test the associations of participant characteristics with the presence of each theme, and bivariate analyses were used to test the associations of the presence of each theme with feeding practices. Three themes were identified: 1) mothers worry that their child does overeat, 2) mothers acknowledge that their child may overeat but indicate that it is not problematic because they manage their child's eating behavior, and 3) mothers acknowledge that their child may overeat but indicate that it is not problematic because of characteristics inherent to the child. Child obesity predicted the themes; mothers of obese and overweight children are more likely to be concerned about overeating. Themes were associated with lower levels of observed pressure to eat. Only Theme 2 was associated with greater restrictive feeding practices. Interventions that provide parents' practical, healthy ways to prevent child overeating may be helpful.

Psychological Distress Among School-Aged Children with and Without Intrauterine Cocaine Exposure: Perinatal Versus Contextual Effects.

Whether intrauterine cocaine exposure (IUCE) explains unique variance in psychiatric functioning among school age children, even after controlling for other biological and social risk factors, has not been fully delineated. As part of a longitudinal birth cohort study of children with and without IUCE, we conducted and analyzed data based on structured clinical interviews with 105 children (57% male) and their caregivers when the child was approximately 8.5 years old; 47% of the children had experienced IUCE. Interviews included past and current major psychological disorders and sub-threshold mental health symptoms. Potential covariates were ascertained by interviews of birth mothers and other caregivers from shortly after the child's birth until the 8.5-year visit. More than one-third of children met DSM-IV criteria for one or more mood, anxiety, attention deficit, or disruptive behavior disorders. IUCE was not significantly associated with children's history of psychological distress, in either bivariate or multiple logistic regressions. In contrast, birth mothers' acknowledgement of greater psychiatric distress at baseline and higher levels of alcohol consumption during pregnancy, and at 8.5 years caregivers' reports of their own psychological distress, and children's lower IQ were predictors of higher rates of psychological morbidity. Findings are consistent with prior reports suggesting that, regardless of IUCE status, children from low-income, urban backgrounds are at heightened risk for psychological distress. Results underscore the need for closer monitoring of the mental health of children living in low-income households, with or without intrauterine substance exposures, to facilitate access to appropriate services.