Feeding under fire: Relations between parental stress hormones and controlling feeding behaviors.

Under stress, parents tend to use more controlling feeding behaviors toward their children (Berge et al., 2017; Doan et al., 2022; Loth et al., 2016). However, the majority of prior work focuses on subjective reports of stress, and there is a dearth of research examining parental physiological stress and its impact on feeding behaviors. In the current study, we examined how parental physiological stress reactivity would influence their feeding behaviors under mild stress in a lab-based setting. Parents (n = 83, 50 % females) and their children (59% female, Mage = 42 months, SD = 4.48) participated. Stress was induced using the Trier Social Stress Test in the laboratory (Kirshbaum et al., 1993). Salivary samples were collected at 4 time points during the visit to index stress reactivity and later assayed for cortisol and DHEA. Parent-child interactions during the anticipatory period of the stress test were observationally coded for parent use of controlling feeding behaviors. To examine whether parent stress physiology predicts their feeding behaviors, we ran a Poisson regression using income, parent ethnicity, parent sex (mom/dad), time of day, and DHEA/cortisol ratio as predictors of controlling feeding behavior. Latinx parents used less controlling feeding behaviors, b = -0.323, p = 0.041 than non-Latinx parents. Parents with a higher DHEA/Cortisol ratio were less likely to use controlling feeding behaviors, b = -0.231, p = 0.008. To our knowledge, this is the first study to show that for both mothers and fathers, DHEA relative to cortisol has a protective role in controlling feeding practices, and lends support to the role of acute stress reactivity in predicting behavioral outcomes.

Associations between parent and child latent eating profiles and the role of parental feeding practices.

Previous research employing the person-centred approach of Latent Profile Analysis (LPA) with parent-reported data of their child's eating behaviour identified four distinct eating profiles in 3-6-year-old children: typical, avid, happy, and avoidant eating (Pickard et al., 2023). In this follow-up study, the same parents were asked to self-report their own eating behaviour (N = 785) and LPA was conducted to determine the latent eating profiles of the parents/caregivers. The LPA showed that a four-profile solution best represented the sample of parents, termed: typical eating (n = 325, 41.4%), avid eating (n = 293, 37.3%), emotional eating (n = 123, 15.7%) and avoidant eating (n = 44, 5.6%). Multiple mediation analysis was then conducted to examine both the direct associations between parents' eating profiles and the child's probability of eating profile membership, as well as the indirect associations through the mediatory role of specific parental feeding practices. The results suggested direct links between parent and child eating profiles, with the 'avid eating' and 'avoidant eating' profiles in parents predicting similar profiles in their children. Feeding practices, such as using food for emotional regulation, providing balanced and varied food, and promoting a healthy home food environment, mediated associations between parent and child eating profiles. This research provides novel evidence to reinforce the need for interventions to be specifically tailored to both the parent's and child's eating profiles. The work also provides an interesting avenue for future longitudinal examination of whether the parents' provision of a healthy home food environment could protect against intergenerational transmission of less favourable eating behaviours.

Parental perceptions of body weight and appetite in infants and toddlers with cystic fibrosis.

Nutritional status has clinical relevance and is a target of guidance to parents of children with cystic fibrosis (CF). Growth is routinely monitored in CF clinics but there is no standardized way of assessing appetitive behaviors or parents' perceptions of their children's appetite. Greater understanding of these factors could improve clinical guidance regarding parent feeding behaviors. We therefore aimed to assess parent perceptions of child weight, and parent reports of child appetite using the Baby Eating Behavior Questionnaire (BEBQ), in a sample of infants and toddlers with CF, compared with a community sample. We additionally assessed relationships of parent perceptions of child weight with parent feeding behaviors in the sample with CF. Anthropometric and questionnaire data were collected for 32 infants and toddlers with CF, as well as 193 infants and toddlers drawn from RESONANCE, a community cohort study. Parents perceived children with CF to be lower in weight than their actual weight, to a greater extent than was evident in the community sample. Parents who perceived their children with CF to be underweight vs. right weight reported greater slowness in eating on the BEBQ. Parents perceived children with CF to have greater slowness in eating and lower enjoyment of food, compared to parents of children in the community sample, independent of sample differences in child weight, age, and sex. Our results demonstrate the potential utility of the BEBQ in a clinical sample and suggest it may be helpful for clinicians to assess parents' perceptions of their child's weight and appetite to promote a fuller understanding of the child's nutritional status, facilitate appropriate feeding behaviors and alleviate unnecessary concerns.

Parent feeding practices in infants and toddlers referred to a hospital-based feeding program in the United States.

While considerable research exists on parent feeding practices for infants and toddlers, past research has not focused on children with feeding problems. The goal of this study was to identify parent feeding practices in a sample of infants (n = 178) and toddlers (n = 221) referred to a hospital-based feeding clinic and then examine how these parent feeding practices were correlated with specific feeding problems. Parents completed surveys to report child demographics, feeding problems, and use of 54 feeding practices. Forty-eight (88.8%) of 54 practices were utilized more often for toddlers than for infants. Exploratory factor analysis with the 54 practices and the full sample (n = 399) produced the 16-item Baby Parent Mealtime Action Scale (BPMAS) with three dimensions: Multiple Food Offers, Use of Cereal/Pureed Foods, Use of Toys/TV. Controlling for demographics, hierarchical regression examined how each BPMAS dimension was associated with five feeding problems (underweight, tube feeding, texture problems, limited diet, mealtime disruption). Multiple Food Offers (e.g., daily offering of vegetables, offering foods from the family meal) was the dimension most correlated with fewer feeding problems such as tube feeding (ß = -0.220, p < 0.001), texture rejection (ß = -0.361, p < 0.001), and limited diet variety (ß = -0.175, p < 0.001), but also with more mealtime disruption (ß = 0.231, p < 0.001). Use of Toys/TV was correlated with more mealtime disruption (ß = 0.260, p < 0.001). In addition to demonstrating a correlation between parent feeding practices and feeding problems, this study also found adding cereal/pureed foods to be common and while the dimension, Use of Cereal/Pureed Foods, was not significantly correlated with any specific feeding problem, this dimension provides an expanded understanding of cereal usage.

A qualitative inquiry of parents of extremely picky eaters: Experiences, strategies and future directions.

BACKGROUND/AIM: Picky eating is a common childhood phenomenon in younger children, impacting family relationships and mealtimes. Limited qualitative studies have explored parents' experiences of parenting an extremely picky eater. This study aimed to address this gap. METHODS: This exploratory qualitative research design included participants who were Australian-based parents (n = 10) of children aged 2-6 years with a minimum picky eating score of 3.33, indicating extreme picky eating, on the Food Fussiness subscale of the Child Eating Behavior Questionnaire (CEBQ). Parents were interviewed online via Zoom using semi-structured interviews focused on their experiences of having a child who is a picky eater. Reflexive thematic analysis was used to analyze the data. RESULTS: Five themes were identified: 1: The picky eating journey for parents. 2: Picky eating impacts families and mealtimes. 3: Parents have attempted multiple strategies to manage picky eating. 4: Emotions associated with parenting an extremely picky eater. 5: Parents of extremely picky eaters have a positive outlook for the future. CONCLUSION: This qualitative study demonstrates that parents' experiences of parenting an extremely picky eater are varied. Parents desire health professionals who listen to their concerns and provide evidence-based knowledge around parent feeding practices to positively impact picky eating.

Examining food parenting practices in military families.

Food parenting practices impact child eating and weight outcomes. While there are currently no data examining food parenting practices among military families, research on general parenting has shown that military families are more likely to engage in authoritarian parenting practices. In addition, psychological well-being affects food parenting, and the military lifestyle is defined by how frequently they experience stressful demands such as deployment and relocation. The study objectives were to describe food parenting practices among military families by: (1) comparing food parenting practices between military families and civilian families; and (2) exploring associations between military (total military years, deployments, relocation) and psychological (stress, anxiety, depression) factors and food parenting practices. Participants includes 358 parents (103 military, 255 civilian) of children between the ages of five and 13 years. There were no significant differences in food parenting practices between military and civilian families. However, within military families, both total number of military parent and having more than one military parent were associated with increased structure-based food parenting practices. Having more than one military relocation was associated with more frequent pressure to eat and coercive control. While stress was associated with more frequent restriction, there were no associations between anxiety or depression and food parenting practices. These findings suggest that although food parenting practices of military families are similar to those of their civilian counterparts, there are specific psychological and military life factors that impact food parenting practices in this population.

Bidirectional associations between parental feeding practices, infant appetitive traits and infant BMIz: a longitudinal cohort study.

BACKGROUND: Little is known about the pathways linking parent feeding practices with appetitive traits and BMIz throughout infancy. This study examined bidirectional associations between parental feeding practices, infant appetitive traits, and infant BMIz. METHODS: Parents (n = 380) of infants aged less than 6 months at baseline reported their feeding practices (using the Feeding Practices and Structure Questionnaire (FPSQ) for infants and toddlers), infant appetitive traits (using the Baby Eating Behaviour Questionnaire) and infant BMIz (parent-reported) at three timepoints (< 6 months, ~ 9 months, ~ 12 months) up to 12 months of age. Cross-lagged models examined bidirectional associations between parent feeding practices, infant appetitive traits and infant BMIz. RESULTS: There was strong continuity across the three timepoints for maternal feeding practices, infant appetitive traits, and infant BMIz. Infant food avoidance was prospectively associated with higher parental persuasive feeding. Infant BMIz was prospectively associated with higher parent-led feeding. Parent use of food to calm was prospectively associated with lower infant BMIz, and infant BMIz was prospectively associated with higher infant food approach. Feeding on demand was prospectively associated with lower infant food approach. CONCLUSION: This study highlights the complex associations between parental feeding practices, infant appetitive traits and infant BMIz. The study demonstrated that both child and parent effects are important, suggesting a need for tailored programs beginning in infancy to promote and support infant appetitive traits and parent feeding practices that support healthy development.

Like parent, like child? Intuitive eating among emerging adults and their parents.

Intuitive eating (IE) emphasizes relying on hunger and satiety cues to guide eating, and is associated with positive mental health and health-promoting behaviors. Although parents' own eating patterns often shape those of their children, no known research has explored familial associations of IE. The purpose of this cross-sectional, population-based study was to examine IE concordance between emerging adults and their parents, and whether concordance differed across sociodemographic characteristics and weight perceptions. The analytic sample included 891 emerging adults (M age = 22.0) and their primary parent (M age = 50.4) who participated in the population-based, longitudinal EAT and F-EAT 2010-2018 studies. Parents and emerging adults were grouped into dyads based on IE concordance: (1) neither are intuitive eaters; (2) only the emerging adult is an intuitive eater; (3) only the parent is an intuitive eater; (4) both are intuitive eaters. Dyads differed across socioeconomic status (SES), race/ethnicity, and weight perceptions. Concordant dyads who ate intuitively were more likely to be at higher SES and perceive their weight as "about right" than concordant dyads who did not eat intuitively. Asian emerging adults were most likely to belong to concordant non-intuitive eater dyads. Emerging adults who shared their parent's perception their weight was "overweight" were less likely to be intuitive eaters (even if their parents were). In this sample, sociodemographic characteristics and weight perceptions were related to IE concordance among emerging adults and their parents. Lower SES might be an intergenerational barrier to IE disproportionately impacting communities of color, though longitudinal data are needed. Results also suggest rather than motivating healthful eating, perceiving one's weight as "overweight" could hinder IE. Differences across sociodemographic variables likely intersect in meaningful ways, which is an important future research direction.

Changes to the home food environment and parent feeding practices during the COVID-19 pandemic: A qualitative exploration.

The COVID-19 pandemic brought about many changes that potentially altered the home food environment, which has been associated with child eating patterns and dietary intake. There is also some evidence that changes due to the COVID-19 pandemic are associated with health behaviors in children, such as an increased intake of high-calorie snack food. The current study aimed to more deeply understand how the COVID-19 pandemic affected the home food environment of meal and snack time routines and parent feeding practices within families of young children. Data for this study are taken from the Kids EAT! Study, a racially/ethnically diverse cohort of families with 2-5 year old children. Qualitative interviews were conducted by phone and video conference with mothers (n = 25) during August/September 2020 and were coded using a hybrid deductive/inductive analysis approach. This allowed coders to identify themes using the interview questions as an organizational template (deductive) while also allowing unique themes to emerge from the qualitative data (inductive). Three overarching themes emerged with multiple sub-themes: 1) Mothers were more directive in the types of food and amounts of food eaten by children; 2) Mothers had less rules around mealtimes; 3) Mothers had increased meal responsibilities. When faced with a change in a structured schedule and increased stress-such as occurred with the COVID-19 pandemic, parents may benefit from advice on how to manage parent feeding practices, including tips on appropriate limit setting, establishing a schedule and routines, and improving accessibility of healthful snacks. Lessons learned during the COVID-19 pandemic may have relevance to other time periods when families face disruptions to routine and during other times of transition.

Associations between parenting stress, parent feeding practices, and perceptions of child eating behaviors during the COVID-19 pandemic.

The aim of this study was to explore associations between parenting stress, feeding practices, and perceptions of children's eating behaviors during the COVID-19 pandemic. Parents (n = 284) of children ages 4-6 years completed a cross-sectional online survey during the onset of pandemic-related stay-at-home mandates in the U.S. Parents reported current levels of parenting stress, feeding practices, and child eating behaviors. Parents also reported whether parenting stress had increased, stayed the same, or decreased since prior to the onset of pandemic-related stay-at-home mandates. Greater levels of parenting stress were associated with less desirable feeding practices, including greater odds of high use of food for emotional regulation (OR = 1.05, 95% CI = 1.03-1.08), food as a reward (OR = 1.05, 95% CI = 1.02-1.08), and pressure to eat (OR = 1.03, 95% CI = 1.01-1.06), and low use of encouraging a balanced diet (OR = 1.03, 95% CI = 1.01-1.06). Greater levels of parenting stress were also associated with greater perceptions that children exhibited problematic eating behaviors, including greater odds of high food fussiness (OR = 1.05, 95% CI = 1.02-1.08) and low enjoyment of food (OR = 1.05, 95% CI = 1.02-1.07). For parents who reported their parenting stress had increased, greater parenting stress was associated with more frequent use of pressure to eat (p = .009) and less frequent monitoring their child's diet (p = .028). In conclusion, parenting stress during the pandemic was associated with use of food for emotional and behavioral regulation and perceptions that children exhibited problematic eating behaviors. Further research is needed to understand how to mitigate parenting stress and promote healthy feeding practices during times of crisis.

Maternal sleep problems, depression, and infant negative emotionality are associated with maternal feeding to soothe in early infancy.

Maternal overreliance on feeding to soothe to relieve infants' distress has been associated with higher rates of childhood obesity. Limited research has examined infant and maternal characteristics that predict maternal feeding to soothe. The goal of the present study was to examine the role of infant (temperament) and maternal (depression, sleep problems) characteristics as predictors of maternal feeding to soothe. Mothers (N = 176) completed the Food to Soothe Scale, the Infant Behavior Questionnaire-Revised Very Short Form, the Center for Epidemiological Studies Depression Scale, and the Pittsburgh Sleep Questionnaire when their infants were 6 months old. Hierarchical multiple regression was used. Maternal depression only predicted feeding to soothe among mothers receiving WIC benefits, and this association was no longer significant when maternal sleep problems were added to the model. Maternal sleep problems predicted higher feeding to soothe as a main effect and in interaction with infant negative emotionality, maternal depression, and to a lesser extent WIC status. Specifically, infant negative emotionality was only associated with greater feeding to soothe among mothers with higher sleep problems, and sleep problems were only associated with greater feeding to soothe among depressed mothers and mothers receiving WIC benefits. The findings suggest that addressing multiple stressors, including maternal sleep, in the early postnatal period may strengthen the effectiveness of early child obesity interventions that target maternal feeding behaviors.

Associations between parental perception of- and concern about-child weight and use of specific food-related parenting practices.

Little is known about the association between parental perception of their child's weight as well as parent's current and future concerns regarding their child's weight and a broad range of food-related parenting practices. This study used the first wave of cross-sectional data from the longitudinal Family Matters study to examine the relationships between parental perception of child weight status, parent concern for child's current and future weight and parent use of different types of food-related practices. Parent/child dyads (n = 150) were recruited from primary care clinics. Multiple regression models were fit to examine cross-sectional relationships between parental perception and concern for their child's weight and food-related parenting practices (food restriction, pressure-to-eat, food control, food monitoring, nutrition education, and parent modeling). Parents who perceived their child to be underweight had lower scores for food restriction than parents who perceived their child to be overweight. Parents who reported concern about their child's current weight reported higher scores for food restriction and monitoring than parents who were not currently concerned. Parents who reported concern about their child's future weight status reported higher scores for pressure-to-eat and monitoring than parents who were not at all concerned about their child's future weight status. The relationship between parental perception of child's current weight status and parent use of food restriction, pressure-to-eat, and overall food control was modified by child sex. Overall, results suggest that parent's perceptions of and concerns about their child's current and future weight status were correlated with their feeding approaches. Health care providers may want to consider providing anticipatory guidance for parents that have concerns about their child's weight by teaching them about positive, evidence-based ways they can engage in healthy food-related parenting practices.

Using the RE-AIM framework to identify and describe nutritional feeding styles and intervention model best practices for primary caregivers in Africa: A narrative review.

BACKGROUND: Current research shows that across the world people are eating poorly. This is leading to increased incidences of nutrition-related health problems. AIM: This paper aims to provide a synthesis of research on the nutritional feeding programs and nutritional models used by primary caregivers in Africa, in order to identify best practice models, programs, and processes from the field of nutritional and feeding intervention development. METHODS: The research used a narrative review methodology. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used to disseminate results to allow for cross-comparison of core components inherent in health promotion interventions. We chose the RE-AIM framework as it facilitates the development, delivery, and evaluation of health interventions. RESULTS: After screening a total of 8220 articles, four studies were deemed relevant for the purposes of this review. The selected studies were the only ones that discussed nutrition interventions or programs with a very clear aim and purpose, even though they did not include any information on implementation, review or evaluation of these interventions/program. No studies focusing on the African context were deemed relevant as none of them focused on best practice models for nutrition education interventions or programs. CONCLUSIONS: Of a review of over 8220 articles, four studies were found that discuss nutritional feeding programs and nutritional models used by primary caregivers. Of these four, only one focused on enablers, barriers, and resources, all of which are essential for engaging in health behavior change. And only one focused on sustainability of the interventions.

Feeding Practices and Parenting: A Pathway to Child Health and Family Happiness.

Feeding and parenting are inextricably linked. The complex bidirectional interactions between parent feeding practices and child eating behaviour shape the early feeding environment which in turn interacts with genetic predispositions to lay the foundation for life-long eating habits and health outcomes. Parent feeding and child (and parent) eating are central to the fabric of family life and are strongly rooted in culture and tradition. Yet, many parents experience stress and anxiety related to this ubiquitous parenting task and perceive their child as a "fussy eater" or a "difficult feeder." Parents commonly misinterpret heritable and developmentally "normal" child eating behaviour, such as food refusal, as cause for concern. In an effort to get their child to "eat well" they respond with coercive feeding practices, such as pressure, reward and restriction. Emotional feeding that uses food to comfort, distract, calm or shape behaviour is also common. Although well intentioned, these non-responsive, parent- rather than child-centred feeding practices are ineffective, even counterproductive. They teach children to eat for reasons unrelated to appetite and, hence, more than they need and fail to support development of healthy food preferences and appetite regulation. Early feeding interventions are needed that assist parents to understand normal child eating behaviour and promote responsive feeding practices and effective food parenting. The aim of this chapter is to review (1) "normal" eating behaviour of young children, (2) the range of feeding practices and strategies that parents use to respond to and try to shape these behaviours, (3) evidence for approaches to feeding young children that have potential to reduce conflict related to child feeding and promote life-long healthy eating patterns that are a key determinant of long-term health and well-being and (4) to provide an overview of an early feeding intervention, NOURISH, which demonstrated a positive impact on maternal feeding practices and potentially reduced parent anxiety and stress related to feeding.

Exploratory factor analysis of The Comprehensive Feeding Practices Questionnaire (CFPQ) in a low-income hispanic sample of preschool aged children.

The Comprehensive Feeding Practices Questionnaire (CFPQ) is an important measure to assess parent feeding practices as it encompasses a broad range of feeding behaviors, not just behaviors negatively associated with child weight outcomes. However, parent feeding practices have been shown to differ across ethnicities and the CFPQ has not been tested among low-income, Hispanic-American parents with preschool-aged children, a group at elevated risk for developing obesity. A confirmatory factor analysis was performed with the present Hispanic-American sample of Head Start mothers with preschoolers to confirm the original 12-factor, 49-item structure of the CFPQ. Because the original factor structure was not confirmed in the present Hispanic-American sample, an exploratory factor analysis was conducted to examine the psychometric properties of the CFPQ in this sample (n = 187). Among this sample, a five-factor model with 34 items was found to more appropriately assess parent feeding practices than the original 12-factor, 49-item CFPQ. This study provides preliminary validation of the CFPQ for use among low income, Hispanic-American families. Although future research is needed to replicate findings among a larger sample, this study takes an important first step toward more accurately assessing parent feeding practices among this high-risk population to inform tailored interventions that aim to reduce economic and ethnic disparities in child obesity.

A comparison of maternal feeding responses to child fussy eating in low-income food secure and food insecure households.

Children learn to like a wide variety of healthy foods through exposure in their early feeding environment. While some children may reject foods during this learning process, parents may perceive persistent refusal as 'fussy' or 'picky' eating. Low-income parents may provide fussy children with a narrow range of foods that they will like and accept to avoid food and economic waste; inadvertently limiting children's exposure to a variety of healthy foods. This 'risk aversion' to food rejection may be particularly salient in food insecure households where resources are further constrained. We aimed to examine if food insecurity modifies the relationship between child fussy eating and parents' food provision and feeding with respect to exposure to a variety of healthy foods. Australian mothers residing in a low-income community (N = 260) completed a cross-sectional survey on their preschool-aged child's 'food fussiness', household food insecurity and food exposure practices. Food exposure practices included the home availability of fruit and vegetables, and children's tasting of a variety of fruit and vegetables (food provision); and whether parents prepared alternative meals for their child (feeding). Mothers reporting food insecurity (11%) were less likely to have fruit frequently available in the home compared to mothers reporting food security. Food insecurity moderated the relationship between fussy eating and food exposure practices insofar that food secure mothers were more likely to prepare alternative meals for fussier children. Family resources and child fussy eating behaviours are identified as important contextual factors in food provision and feeding. Findings from the current study suggest that health professionals, researchers and policymakers tailor interventions to consider both the needs of families and child eating characteristics.

Examining within- and across-day relationships between transient and chronic stress and parent food-related parenting practices in a racially/ethnically diverse and immigrant population : Stress types and food-related parenting practices.

BACKGROUND: Although prior research suggests that stress may play a role in parent's use of food-related parenting practices, it is unclear whether certain types of stress (e.g., transient, chronic) result in different food-related parenting practices. Identifying whether and how transient (i.e., momentary; parent/child conflict) and chronic (i.e., long-term; unemployment >6 months) sources of stress are related to parent food-related parenting practices is important with regard to childhood obesity. This is particularly important within racially/ethnically diverse parents who may be more likely to experience both types of stress and who have higher levels of obesity and related health problems. The current study examined the association between transient and chronic stressors and food-related parenting practices in a racially/ethnically diverse and immigrant sample. METHODS: The current study is a cross-sectional, mixed-methods study using ecological momentary assessment (EMA). Parents (mean age = 35; 95% mothers) of children ages 5-7 years old (n = 61) from six racial/ethnic groups (African American, American Indian, Hispanic, Hmong, Somali, White) participated in this ten-day in-home observation with families. RESULTS: Transient stressors, specifically interpersonal conflicts, had significant within-day effects on engaging in more unhealthful food-related parenting practices the same evening with across-day effects weakening by day three. In contrast, financial transient stressors had stronger across-day effects. Chronic stressors, including stressful life events were not consistently associated with more unhealthful food-related parenting practices. CONCLUSIONS: Transient sources of stress were significantly associated with food-related parenting practices in racially/ethnically diverse and immigrant households. Chronic stressors were not consistently associated with food-related parenting practices. Future research and interventions may want to assess for transient sources of stress in parents and target these momentary factors in order to promote healthful food-related parenting practices.

Comparing parents' and overweight adolescents' reports on parent mealtime actions.

This study aimed to compare answers given by parents and their adolescent children to the Portuguese version of the Parent Mealtime Action Scale (PMAS) and to assess associations among the reported behaviors. To compare these answers, a cross-sectional study was conducted in a sample of 72 patients of the Obesity Clinic of the Division of Nutrology of the Pediatrics Department at the Federal University of São Paulo (Unifesp), Brazil. These patients were aged from 10 years to 19 years and 11 months, and their parents or legal guardians also participated. First, parents were interviewed and instructed to answer how often they perform each behavior measured by the PMAS (never, sometimes or always). Next, the same questions were answered by the adolescents. The general linear model (GLM) showed the effects of the interviewees and of the interaction between interviewees and sex. We also observed a triple interaction effect (sex x interviewees x categorized age). The internal reliability of the PMAS was higher for parental answers than for those given by the children. This finding is probably observed because the scale has been developed and validated to evaluate the pattern of parental responses concerning their eating practices during their children's meals. In addition, although parents believe they are engaging in certain behaviors, the effectiveness of these strategies may not be recognized by their children. Very low intraclass correlation coefficients were observed between parents' and children's answers to the original domains of the PMAS (ICC: 0.130-0.578), suggesting that the factorial structure of the PMAS may only be used to assess parental behavior, as it is not sufficiently accurate to assess the children's understanding of parent mealtime actions.

Examining variability in parent feeding practices within a low-income, racially/ethnically diverse, and immigrant population using ecological momentary assessment.

BACKGROUND: Current measures of parent feeding practices are typically survey-based and assessed as static/unchanging characteristics, failing to account for fluctuations in these behaviors across time and context. The current study uses ecological momentary assessment to examine variability of, and predictors of, parent feeding practices within a low-income, racially/ethnically diverse, and immigrant sample. METHODS: Children ages 5-7 years old and their parents (n = 150 dyads) from six racial/ethnic groups (n = 25 from each; Black/African American, Hispanic, Hmong, Native American, Somali, White) were recruited for this mixed-methods study through primary care clinics. RESULTS: Among parents who used restriction (49%) and pressure-to-eat (69%) feeding practices, these feeding practices were utilized about every other day. Contextual factors at the meal associated with parent feeding practices included: number of people at the meal, who prepared the meal, types of food served at meals (e.g., pre-prepared, homemade, fast food), meal setting (e.g., kitchen table, front room), and meal emotional atmosphere (p < 0.05). Parents tended to restrict desserts, dairy, and vegetables and pressure children to eat fruits, vegetables, meat proteins, and refined grains (p < 0.05). There were some differences by race/ethnicity across findings (p < 0.01), with Hmong parents engaging in the highest levels of pressure-to-eat feeding practices. CONCLUSIONS: Parent feeding practices varied across the week, indicating feeding practices are more likely to be context-specific, or state-like than trait-like. There were some meal characteristics more strongly associated with engaging in restriction and pressure-to-eat feeding practices. Given that parent feeding practices appear to be state-like, future interventions and health care providers who work with parents and children may want to address contextual factors associated with parent feeding practices to decrease restriction and pressure-to-eat parent feeding practices.

A qualitative investigation of how mothers from low income households perceive their role during family meals.

BACKGROUND: Having regular family meals has been shown to be protective for child dietary intake (e.g., higher intake of fruit and vegetables). Mothers appear to be most responsible for preparing family meals. Therefore, understanding how mothers perceive their roles around family meals may help identify ways in which to help more families have regular family meals. METHODS: United States mothers (n = 83) from the Twin Cities, Minnesota were interviewed during an in-home visit. Researchers trained in qualitative interviewing used a semi-structured approach and asked questions regarding the mothers' overall perception of their role during family meals. Interviews were coded using a mixed deductive and inductive content analysis approach. The majority of mothers were from minority and low-income households. RESULTS: Mothers described their roles during family meals as the follows: 1) Helping children make healthy choices at family meals; 2) Making the meal happen; 3) Monitoring children's food intake; 4) Managing behavior at the family meal; 5) Making the family meal atmosphere enjoyable; and 6) Facilitating conversation/communication. Two secondary research questions also emerged about the specifics of the mothers' perception of her role at family meals (i.e., How do mothers deal with fighting or arguing if it occurs at family meals? and What do mothers talk about with children at family meals?) CONCLUSIONS: Results show that mothers have a large and varied role during family meals. Additionally, they are willing to put effort into family meals and want them to be enjoyable. Findings also suggest that mothers can be supported by encouraging fuller family participation in family meals and by offering mothers quality nutrition and parent feeding practice information.