Abstract Parents' feeding practices have been associated with children's dietary quality and food acceptance, but previous studies have largely relied exclusively on questionnaires to assess both ...parent and child behavior. The current study explored the relationships between parents' reported and observed feeding practices and toddlers' food refusals. Sixty families with toddlers (12–36 months-old) video recorded their children's dinners at home as well as a separate meal in which they offered the child a novel fruit or vegetable. Parents completed questionnaires about their feeding practices and children's picky eating and food neophobia. Videos were coded for parents' observed feeding practices at mealtimes and children's food refusals. Parents' feeding practices and children's food refusals were compared in families with children reported to be more picky and less picky eaters. The relationships between reported and observed feeding practices with observed food refusals were also assessed. It was hypothesized that parents' use of controlling and coercive prompts to eat would be associated with children's food refusals. Parent-reported picky eating was not associated with an increase in children's total food refusals, although reported neophobia was associated with more uses of crying, pushing food away, or verbally refusing a new food. More prompts to eat of any kind were associated with more food refusals. In regression models, more observed coercive-controlling prompts used by parents were associated with more food refusals by children. Parents of pickier eaters tended to use a lower proportion of autonomy-supportive prompts to eat, and these families also showed a stronger association between the use of controlling prompts and food refusals. These families may benefit the most from interventions aiming to reduce the use of controlling practices. Models using observed feeding practices were more strongly associated with children's food refusals than were parents' reported feeding practices. This highlights the importance of behavioral observation in this field.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK, ZRSKP
The World Health Organization recommends that women exclusively breastfeed until their babies are 6 months old and continue to breastfeed while introducing complementary foods. A meta‐aggregation ...methodology was used to systematically review and synthesise the qualitative studies on factors influencing breastfeeding practices of healthy Chinese women in Greater China. English and Chinese databases were searched to identify peer‐reviewed qualitative studies (published 2008–2019). Relevant data were extracted, and key themes related to factors influencing breastfeeding practices were identified. Of 7587 articles identified, 22 qualitative studies met inclusion criteria for the review, 10 of which were published in Chinese. A total of 87 themes were extracted from all included studies and classified into 9 subcategories: government enactment of policies, implementation of policies in workplaces, social expectations, social support, medical and health services, services with Chinese characteristics, breastfeeding and pumping facilities, maternal perceptions of breastfeeding and self‐efficacy to breastfeed. The nine subcategories were then grouped into four categories. Potential effect associations among these influence factors of breastfeeding practices emerged from categories and subcategories. Family members' influence on breastfeeding motivation and self‐efficacy suggest a potential benefit of breastfeeding promotion interventions targeting the whole family. The role of primary care should be fully exploited in breastfeeding promotion, including both prenatal education and post‐partum visits. Standardising the training and qualifications of maternity matrons (yuesao) and folk breastfeeding specialists (cuirushi) can promote evidence‐based approaches to facilitating breastfeeding during the confinement period. Increased availability of breastfeeding and pumping facilities in the workplace would facilitate continuing breastfeeding after returning to work.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Research has shown that people consume more food when offered larger portions, and that reducing exposure to large food portions and packages could decrease the average daily energy consumed. In this ...context, our aim is to develop strategies to promote healthier eating behaviors by reducing portion selection and intake. The present research investigates the impact of different visual attributes of foods on quantity perception and portion selection. In the first study, we tested whether modifying the shape of a familiar food influenced the ideal portion size in adults. In the second study, we assessed the impact of shape, number of units, size, and color variety on a perceived quantity for a familiar multiunit product in children. Participants (
= 70 adults,
= 62 children) completed different picture-based computer tasks. As hypothesized: (1) adults selected a smaller ideal portion size for an elongated product than for wider and thicker shapes, and (2) children's perception of food quantity was primarily driven by number of pieces, with smaller effects of size and elongation. Perceived quantity was not influenced by color variety. These findings suggest that it may be possible to reduce the size of food portions without negatively impacting perceived quantity, and to provide opportunities to nudge consumers towards smaller portions while maintaining satisfaction.
The aims of the current study were to compare feeding practices and the eating environment (other people present, other people eating, and screen use) observed in families of toddlers across ...breakfast, lunch, dinner, and snacks. 60 families with toddlers (12–36 months; M = 24.7 months) video recorded all occasions over the course of a day when the toddler ate or drank. Videos were coded for a variety of feeding practices (e.g., prompts to eat, restriction), other people present and eating, and screen use. Prompts to eat were grouped into autonomy-supportive prompts (ASP) and coercive-controlling prompts (CCP). Results of the study showed different patterns of consistency between meals and snacks depending on the feeding practice examined. CCP were correlated across all eating occasions, including meals and snacks, but ASP, interference, and instruction were only correlated across the primary meals (all p-values < .05). ASP and praise were also more frequently demonstrated during the primary meals compared to snacks (p-values < .05). Parents also used more interference at dinner compared to both breakfast and snacks. Furthermore, mothers and siblings commonly ate with the toddler, especially during lunch and dinner, but family members infrequently ate with the child during snacks. The percentage of families using a screen was similar for breakfast (38%), lunch (39%), and dinner (33%), but slightly higher for snacks (47%). Together, the results of this study demonstrate notable differences in feeding practices and environmental factors during meals compared to snacks.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Water is recommended as the main beverage for daily fluid intake. Previous systematic reviews have studied the consumption of sugar-sweetened beverages (SSBs) among children, but none have focused on ...water consumption. Insight into factors that are associated with children's water intake is needed to inform the development of interventions aimed at the promotion of water consumption. The objective of this review was therefore to summarize the current evidence on factors associated with water consumption among children aged 2 to 12 years.
A systematic literature search in seven electronic databases was conducted in May, 2018 and retrieved 17,850 unique records. Two additional studies were identified by hand-searching references of included articles. Studies were selected if they had a cross-sectional or longitudinal study design, focused on children aged 2-12 years and published in an English language peer-reviewed journal. Participants from clinical populations, studies that included data of < 10 participants and non-human studies were excluded.
A total of 63 articles met inclusion criteria and were included in the analysis. We identified 76 factors that were investigated in these studies; 17/76 were investigated in a longitudinal study. There was evidence of positive associations between water consumption and child's self-efficacy, parental education level, parental self-efficacy, use of feeding practices such as restriction or encouraging healthy eating and study year. Evidence was inconsistent (< 60% of studies reported an association) for child's age, sex, BMI, consumption of SSBs and ethnic background of the parent. There was no evidence (≤33% of studies reported an association) of associations between consumption of milk or juice, parental emotional-, modelling- or instrumental feeding practices, eating school lunch or outside temperature and water consumption. The remaining 54 factors were investigated in fewer than three studies.
There is some evidence for an association between potentially modifiable parental and child-related factors and water consumption. However, most factors identified in this review were only studied by one or two studies and most studies were cross-sectional. More longitudinal research is necessary to investigate environmental, parental and child-related factors associated with water consumption that are currently under-studied and could further inform intervention strategies.
PROSPERO ID# CRD42018093362 , registered May 22, 2018.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
It is critical to develop ecologically valid experimental methods to assess consumers' food-related behaviors. Ad libitum approaches are often used but may not be appropriate for studies with ...children or with products that are not typically consumed until the individual feels full. The current study presents novel methods to assess children's size perception and portion preference for gummy candies. In the first study, 62 children (30 boys, 32 girls) aged 6 to 9 years completed two matching tasks: one using pictures on a computer screen, and a similar task where the products were physically manipulated. Results of the two matching tasks were correlated, demonstrating that a computer-based approach could be used to predict the factors influencing children's perception of food amount: the number, size, and shape of pieces. In the second study, a portioning measure was developed to investigate whether the factors identified in the matching tasks were confirmed in a task that more closely represented portion selection in the real world. The effects observed in the matching tasks could not be replicated in the portioning task. The size of each item had no significant impact on the portion selection, suggesting that it may be possible to reduce the size of pieces in snacks where multiple pieces are typically consumed without negatively impacting perceived quantity in children, thus offering a promising strategy to nudge children toward choosing smaller portions.
In Asia, little is known about how maternal feeding practices are associated with dietary intakes and body mass index (BMI) in preschoolers.
To assess the relationships between maternal feeding ...practices with dietary intakes and BMI in preschoolers in Asia using cross-sectional analysis in the GUSTO (Growing Up in Singapore Towards healthy Outcomes) cohort.
Mothers (n = 511) who completed the Comprehensive Feeding Practices Questionnaire (CFPQ) and a semi-quantitative Food Frequency Questionnaire (FFQ) when children were 5 years old.
Associations between 12 maternal feeding practices (mean scores divided into tertiles) and children's dietary intakes of seven food groups and BMI z-scores were examined using the general linear regression model. Weight and height of the child were measured, and dietary intakes derived from the FFQ.
Compared to those in the low tertile, mothers in the high tertile of modelling healthy food intakes had children with higher intakes of vegetables+20.0g/day (95%CI:11.6,29.5) and wholegrains+ 20.9g/day (9.67,31.1) but lower intakes of sweet snacks-10.1g/day (-16.3,-4.94) and fast-foods-5.84g/day (-10.2,-1.48). Conversely, children of mothers in the high tertile for allowing child control (lack of parental control) had lower intake of vegetables-15.2g/day (-26.6,-5.21) and wholegrains-13.6g/day (-22.9,-5.27), but higher intakes of sweet snacks+13.7g/day (7.7, 19.8) and fast-foods+6.63g/day (3.55,9.72). In relation to BMI at 5 years, food restrictions for weight was associated with higher BMI z-scores 0.86SD (0.61,1.21), while use of pressure was associated with lower BMI z-scores-0.49SD(-0.78,-0.21).
Modelling healthy food intakes by mothers was the key feeding practice associated with higher intakes of healthy foods and lower intakes of discretionary foods. The converse was true for allowing child control. Only food restrictions for weight and use of pressure were associated with BMI z-scores.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A systematic review was conducted on the literature on feeding behaviors in Chinese families of children under 6 years old. Forty relevant publications were identified, of which 33 were published in ...Chinese, 7 in English. All studies were questionnaire-based and used a cross-sectional research design. Approximately half of the studies reported a score for each feeding practice/style, based on a Likert scale; the other half dichotomized these scores into a percentage of the population that reported frequent use of the behaviors. The most commonly reported feeding style of Chinese caregivers was a locally defined “active response” style that somewhat resembled authoritative parenting. The most commonly reported feeding practices were praise, encouraging trying new foods, encouragement of balanced diet and encouragement of healthy eating. Some behaviors showed a great deal of variance in prevalence between studies, which may be at least partially due to differences in methodology and how behaviors were defined. Some feeding behaviors varied in frequency depending on the child's age, although longitudinal studies are needed to better understand how these evolve over time. Child body composition was also associated with feeding behaviors use, although the direction of the association cannot be determined due to the cross-sectional nature of the research. There is still an important gap in the literature regarding the feeding behaviors of non-maternal caregivers, as grandparents often play an important role in childcare in China.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Parental behaviours influence food acceptance in young children, but few studies have measured these behaviours using observational methods, especially among children with Down syndrome (CWDS). The ...overall goal of this study was to understand parent feeding practices used during snack time with young CWDS (N = 111, aged 11-58 months). A coding scheme was developed to focus on feeding practices used by parents of CWDS from a structured home-use test involving tasting variously textured snack products. Behavioural coding was used to categorise parental feeding practices and quantify their frequencies (N = 212 video feeding sessions). A feeding prompt was coded as successful if the child ate the target food product or completed the prompt within 20 s of the prompt being given without a refusal behaviour. CWDS more frequently consumed the test foods and completed tasks in response to Autonomy-Supportive Prompts to Eat (49.3%), than to Coercive-Controlling Prompts to Eat (24.2%). By exploring the parent-CWDS relationship during feeding, we can identify potentially desirable parent practices to encourage successful feeding for CWDS. Future research should build upon the knowledge gained from this study to confirm longitudinal associations of parent practices with child behaviours during feeding.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Picky eating, which includes behaviors such as limited dietary variety, neophobia, food refusals, and sensory sensitivities, can be a source of stress for families. Parents can influence their ...children's mealtime behavior through the feeding practices they use when offering foods. Some practices are counterproductive to establishing healthy eating habits and should be avoided, but caregivers need alternative behaviors to replace them. Parents should be encouraged to keep trying after a food is refused, as children may need to be exposed to a food several times before it is accepted. Varying the preparation changes the taste, texture, and appearance of food, and children may prefer some variants to others. Some children refuse foods to express independence; thus, providing choices between two healthy options may allow children to express a preference without saying "no" altogether. Coercive feeding practices such as the use of pressure to eat or using food as rewards should be avoided, as these can create negative associations with the food or meals and lead to food refusals. Instead, caregivers can model eating and enjoying the food. Nonfood rewards, such as praise or stickers, can also be used to encourage children to taste a food without negative outcomes.
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