The impact of maternal negative affectivity on dietary patterns of 18‐month‐old children in the Norwegian Mother and Child Cohort Study

Early dietary habits are formative for dietary habits later in life. Maternal personality might be an important factor in unhealthy feeding of children. The current study aims to assess the degree to which the personality trait of negative affectivity in mothers predicts their child's diet at age 18 months. This study is a part of the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health. A total of 27 763 mothers completed 3 repeated assessments of negative affectivity before and after childbirth and of the child's diet when the child was 18 months old. Exploratory factor analysis was used to identify the dietary patterns, and structural equation modeling was used to investigate the relationship with negative affectivity adjusted for socio‐demographical variables. Exploratory factor analysis of a foods frequency questionnaire revealed two dietary patterns in the child, labeled unhealthy diet and wholesome diet. The unhealthy diet comprised foods rich in sugar and fat; the wholesome diet comprised foods rich in fibre, vitamins and minerals. Mothers high in negative affectivity were more inclined to feed their child an unhealthy diet. The results were adjusted for maternal age, years of education, relative income, marital status, number of children, having the child in daycare, maternal smoking, maternal body mass index, and child gender. This study shows that a maternal personality trait, negative affectivity, is related to feeding the child an unhealthy diet after controlling for key socio‐demographic variables.     

Social and health behavioural determinants of maternal child‐feeding patterns in preschool‐aged children

Parental child‐feeding attitudes and practices may compromise the development of healthy eating habits and adequate weight status in children. This study aimed to identify maternal child‐feeding patterns in preschool‐aged children and to evaluate their association with maternal social and health behavioural characteristics. Trained interviewers evaluated 4724 dyads of mothers and their 4–5‐year‐old child from the Generation XXI cohort. Maternal child‐feeding attitudes and practices were assessed through the Child Feeding Questionnaire and the Overt/Covert Control scale. Associations were estimated using linear regression [adjusted for maternal education, body mass index (BMI), fruit and vegetables (F&V) intake and child's BMI z‐score]. Principal component analysis defined a three‐factor structure explaining 58% of the total variance of maternal child‐feeding patterns: perceived monitoring – representing mothers with higher levels of monitoring, perceived responsibility and overt control; restriction – characterizing mothers with higher covert control, restriction and concerns about child's weight; pressure to eat – identifying mothers with higher levels of pressure to eat and overt control. Lower socioeconomic status, better health perception, higher F&V intake and offspring cohabitation were associated with more ‘perceived monitoring’ mothers. Higher maternal F&V intake and depression were associated with more ‘restrictive’ mothers. Younger mothers, less educated, with poorer health perception and offspring cohabiting, were associated with higher use of ‘pressure to eat’. Maternal socioeconomic indicators and family environment were more associated with perceived monitoring and pressure to eat, whereas maternal health behavioural characteristics were mainly associated with restriction. These findings will be helpful in future research and public health programmes on child‐feeding patterns.     

Association of maternal characteristics and behaviours with 4‐year‐old children's dietary patterns

This study examined the association of family and maternal characteristics with preschool children's dietary patterns. Trained interviewers evaluated subsample 3422 mothers and children enrolled in the population‐based birth cohort Generation XXI (Porto, Portugal, 2005–2006). Maternal characteristics and behaviours (exercise, smoking habits, diet and child‐feeding practices) and family characteristics were evaluated. Maternal diet was classified by a dietary score, and children's dietary patterns were identified by latent class analysis. Odds ratios (OR) and confidence intervals (95% CI) were estimated by multinomial regression models. The analysis was based on a framework with four conceptual levels: maternal socio‐economic position (SEP) at 12 years, maternal socio‐economic and demographic characteristics at child's delivery, family characteristics and maternal behaviours at child's 4 years. Three dietary patterns were identified in children: high in energy‐dense foods (EDF); low in foods typically consumed at main meals and intermediate in snacks (Snacking); higher in healthy foods; and lower in unhealthy ones (Healthier, reference). Lower maternal SEP had an overall effect on children's diet (low vs. high SEP; EDF, OR = 1.76, 95% CI: 1.42–2.18; Snacking, OR = 1.73, 95% CI: 1.27–2.35), while maternal education was directly associated with it (≤9 vs. >12 schooling years, EDF, OR = 2.19, 95% CI: 1.70–2.81; Snacking, OR = 2.22, 95% CI: 1.82–3.55). Children whose mothers had worse dietary score were significantly more likely to follow unhealthier patterns (first vs. fourth quartile; EDF, OR = 9.94, 95% CI: 7.35–13.44, P‐trend < 0.001; Snacking, OR = 4.21, 95% CI: 2.94–6.05, P‐trend < 0.001). Maternal diet was the key factor associated with children's diet, above and beyond socio‐economic and demographic characteristics, accounting for one‐third of the determination coefficient of the fully adjusted model. At preschool age, interventions should give a particular focus on maternal diet and low SEP groups.     

Dietary guidelines for children under 2 years of age in the context of nurturing care

Dietary guidelines provide advice on what to eat to different subsets of the population but often do not take into account the “how” to eat. Responsive feeding is a key dimension of responsive parenting involving reciprocity between the child and caregiver during the feeding process and is characterized by caregiver guidance and recognition of the child's cues of hunger and satiety. Evidence indicates that providing responsive feeding guidance to mothers on how to recognize and respond appropriately to children's hunger and satiety cues can lead to improved feeding practices and weight status and developmental outcomes among infants and young children. In addition, early and nurturing exposures to foods with different tastes and textures and positive role modelling help children to learn to eat healthy foods. The importance of improving caregiver's responsive feeding behaviours to ensure the adequate introduction of complementary foods is becoming increasing recognized, but responsive feeding principles have not been taken into account in a comprehensive way in the development of dietary guidelines. The incorporation of all responsive feeding principles into dietary guidelines has a strong potential to enhance their impact on early childhood development outcomes for infants and young children but will require adaptation to the different contexts across countries to ensure that they are culturally sensitive and grounded in a deep understanding of the types of foods and other resources available to diverse communities.     

Value conflicts in mothers' snack choice for their 2‐ to 7‐year‐old children

Value conflicts appear when people experience struggles, doubts, and feelings of guilt when making food choices. This study aims to provide insight into value conflicts, which mothers may experience while providing snacks to their young children. Mothers are mainly responsible for providing the snacks their young children eat, making it a big responsibility for them as children's dietary behaviour tracks into adulthood. Possible value conflicts Dutch mothers (n = 136) experience while providing snacks to their 2‐ to 7‐year‐old children were investigated using food and motivation diaries and semi‐structured interviews. Differences between mothers' educational level, first versus not‐first child, and the differences in age of the children were taken into account. Results showed that the younger the children, the more value conflicts the mothers experienced. Mothers experienced most value conflicts when they provided snacks perceived as unhealthy. Six main value conflicts are elicited by this study, namely, conflicts between healthy and unhealthy snacks; conflicts between healthy and convenient snacks; conflicts related to providing snacks just before dinner; conflicts related to influence of others; conflicts when the child asks but the mother says “no”; and conflicts related to many unhealthy snacks at parties or visits. The insights gained in this study can be used for interventions to promote a healthier lifestyle, support the design of new snack products, and can give guidance for marketing challenges in global snack markets.     

A longitudinal investigation of the role of parental responses in predicting children's post‐traumatic distress

Background

While parental post‐trauma support is considered theoretically important for child adjustment, empirical evidence concerning the specific aspects of parental responding that influence child post‐traumatic distress, or the processes via which any such impacts occur, is extremely limited. We conducted a longitudinal examination of whether parental post‐trauma appraisals, trauma‐specific support style and general parenting style predicted child post‐traumatic stress symptom severity (PTSS) following trauma; and whether such influences operated via the child's own appraisals and coping style.

Method

We recruited 132 parent–child pairs following children's experience of acute trauma. We examined whether parental responses assessed at 1‐month post‐trauma, predicted child PTSS at 6‐month follow‐up. Parental trauma‐specific appraisals and responses, and general parenting style, were assessed via both self‐report and direct observations. Child‐report questionnaires were used to assess PTSS and potential mediators.

Results

Initial parent negative appraisals and encouragement of avoidant coping were associated with higher child‐reported PTSS at 6‐month follow‐up. Predictive effects were maintained even when controlling for initial child symptom levels. Observational assessments broadly supported conclusions from self‐report. There was evidence that parental influences may operate, in part, by influencing the child's own appraisals and coping responses. In contrast, there was no evidence for an influence of more “adaptive” support or general parenting style on child PTSS.

Conclusions

Findings provide important insight into how elements of social support may influence child post‐trauma outcomes.     

Mealtime interactions in families of pre-schoolers with type 1 diabetes

OBJECTIVES: Parents of pre-schoolers with type 1 diabetes report more behavioral feeding problems and concerns about the management of mealtime behavior than parents of age-matched healthy control children. We compared mealtime interactions of 26 families of pre-schoolers with type 1 diabetes (13 boys; mean age = 4.4 yr) and those of 26 families of age-matched control children by using direct observation of meals. METHODS: Families had three meals videotaped in their home. Trained coders independently scored each meal for parent, child, and child eating behaviors by using the Dyadic Interaction Nomenclature for Eating (DINE). RESULTS: The frequency of parent and child behaviors at mealtimes (such as instructions to eat, coaxing, feeding, refusing food, leaving the table, and non-compliance with instructions to eat) was similar for both groups. Children ate less and engaged in more behaviors incompatible with eating during the second half of meals than during the first half. Children, who took over 19 min to eat at meals (average duration for controls) played more and ate less than children, who ate more quickly. CONCLUSIONS: Despite increased parental concern, pre-schoolers with type 1 diabetes do not have more challenging mealtime behaviors than age-matched healthy controls. Interventions to inform parents of pre-schoolers with type 1 diabetes about typical child mealtime behaviors and teach effective strategies for managing problematic behaviors are needed to reduce parental concerns and may be critical for improving adherence to diet if a relation between child behavior, adherence, and metabolic control is demonstrated. Further research is required to investigate whether these mealtime interactions adversely impact dietary adherence and blood glucose excursion.     

‘I know it's wrong,but . . .’: a qualitative investigation of low‐income parents' feelings of guilt about their child‐feeding practices

In the developed world, child overweight and obesity rates are highest among the disadvantaged. This has resulted in calls for more research with low socio‐economic families to better understand their experiences with disadvantage and how they might lead to poorer weight outcomes. The present study, conducted in Australia, adopted a qualitative approach to investigate the factors affecting low socio‐economic parents' child‐feeding practices. Methods used to collect data were introspections, interviews and focus groups. In total, 37 parents of overweight or obese children aged between 5 and 9 years took part in the 6‐month study. Guilt emerged as an emotion that parents regularly experienced when allowing their children to consume too much food or foods high in fat, salt and/or sugar. Parents attributed their guilt‐inducing child‐feeding practices to both external and internal factors. Time scarcity and cost were factors that were primarily characterized by an external locus of control. The factors characterized by an internal locus of control were fear of their children experiencing hunger, the perceived need to secure their children's affection through the provision of treat foods, perceptions of their ability to balance their children's diets across eating situations and perceived laziness. Recommendations are provided for addressing guilt‐inducing child‐feeding practices.     

Dissimilarities across age groups in the associations between complementary feeding practices and child growth: Evidence from rural Togo

Adequate complementary feeding (CF) practices are essential for achieving optimal growth but challenging to measure comprehensively. This paper describes CF practices in 2,034 children aged 6–23 months and investigates their relationships with length‐for‐age z‐score (LAZ) and stunting, using cross‐sectional data collected from May to July 2014 in rural Northern Togo. The World Health Organization infant and young child feeding indicators were computed, along with ancillary indicators on feeding style and timing of introduction of complementary foods. The associations between those indicators and children's LAZ and stunting were assessed using linear and logistic regressions after stratification by age group and adjustment for children, maternal, and household characteristics. CF practices were suboptimal, and their associations with child's growth varied across indicators and age groups. In children aged 6–11 months, reaching the minimum dietary diversity and the minimum acceptable diet was associated with higher LAZ (p < .05). In 18‐ to 23‐month‐old children, only the consumption of iron‐rich food was associated with both LAZ (p = .02) and stunting (p = .05). The late introduction of family foods was associated with higher odds of being stunted and lower LAZ in children aged 12–17 months (p < .001). The untimely introduction of porridge was associated with higher odds of stunting in children aged 9–23 months (p < .05). Unexpectedly, helping the child to eat was negatively associated with linear growth in all age groups. These findings nurture the ongoing process of review of the World Health Organization infant and young child feeding indicators showing that, in their current version, they hardly capture the links between CF and child's growth at different ages.     

Maternal diets matter for children's dietary quality: Seasonal dietary diversity and animal‐source foods consumption in rural Timor‐Leste

Improving the dietary quality of women and children is essential to reduce all forms of malnutrition. In this study, we assessed seasonal child and maternal dietary diversity and consumption of animal‐source foods (ASF), using 1,236 observations from combined data collected among 167 mother–child dyads in rural Timor‐Leste. We used generalized linear and logistic mixed‐effects models to examine the dietary differentials of mothers and children in two agricultural livelihood zones and across the seasons, as well as to identify household and agroecological characteristics associated with children's dietary quality in relation to their mothers'. We found dietary quality to be marginally better in coastal than in mid‐altitude zones. However, women's diets were strikingly poor, and their intake of ASF was lower than among children. Mothers exhibited preferential allocation patterns of specific ASF, dairy products and eggs, to children. The intake of ASF was predicted by seasonality. Flesh foods and red meat were much more likely to be consumed during the dry season, when cultural ceremonies are often performed. We found a positive and strongly significant association between children's dietary indicators—dietary diversity score, minimum dietary diversity and ASF consumption, and those of their mothers'. Maternal dietary quality and educational attainment, more so than agroecological characteristics, were explanatory factors of children's diet. Our study highlights that addressing the dietary quality of children in Timor‐Leste would benefit from improving women's diets through better access to nutritious foods and to secondary education.     

Maternal and child dietary patterns and their determinants in Nigeria

Understanding the overall dietary patterns of a population is a key step in initiating appropriate nutritional interventions and policies. Studies characterising the dietary patterns of Nigerian mothers and children are lacking. Complete dietary data for 13 566 mothers and their 13 506 children were analysed from the 2008 Nigerian Demographic and Health Surveys (NDHS), a nationally representative sample, to identify the overall maternal and child dietary patterns and to study the potential determinants of such dietary patterns. The 2008 NDHS included questions that inquired about the food items mothers and their children had consumed during the 24 h preceding the day of the interview. Factor analysis with the principal component procedure was used to construct the dietary patterns, and multiple multilevel logistic regression was used to investigate the determinants of the dietary patterns. Four (‘mixed’, ‘traditional’, ‘staple foods and milk products’ and ‘beverages’) and five (‘mixed’, ‘selective’, ‘beverages and candies’, ‘gruels, grains and semi‐solids’ and ‘infant formula and cereals’) distinct dietary patterns were obtained for the mothers and children, respectively. The key determinants of both maternal and child dietary patterns were month of interview, religion, region of residence, maternal education, maternal occupation, wealth index and maternal body mass index. Marital status additionally predicted maternal patterns, while sex of the child, number of siblings, child's age, maternal age and place of residence additionally determined the child's patterns. This study has identified four and five different dietary patterns to characterise the dietary habits of Nigerian mothers and their children, respectively, and has shown the important socio‐economic/demographic factors influencing the dietary patterns, which can guide appropriate nutritional interventions among Nigerian mothers and children.     

Maternal depression is associated with child undernutrition: A cross‐sectional study in Ethiopia

Child undernutrition is widespread in low‐ and middle‐income countries (LMIC) and is associated with health and economic losses. Undernutrition is estimated to contribute to 3.1 million deaths per year in children less than 5 years of age. A complex causal and contextual factors contributing to child undernutrition have been assessed, but maternal depression, which could contribute to child undernutrition by interfering with the mother's child caring practice and ability, has been received little attention. The objective of this study was to assess the association between maternal postpartum depression symptoms and infant (5–10 months of age) stunting in northern Ethiopia. A community‐based cross‐sectional study was conducted among mother–infant pairs (n = 232) between March and April 2018. Through interviewer‐administrated questionnaire, information on sociodemographic variables were collected, and maternal depression symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS≥13). Infants' length and weight were measured and converted to length and weight for age Z scores using the WHO growth standards. Breastfeeding was a norm, but the adequacy of complementary feeding practice was sub‐optimal. Only 25% of the infants met the minimum meal frequency (MMF), less than 10% met the minimum dietary diversity (MMD; 9%) or minimum acceptable diet (7%). Maternal depression was prevalent (22.8%) and was significantly associated with inappropriate complementary feeding and stunting (P < .05). Improving complementary feeding practices is central to preventing stunting in this and other settings. However, such efforts should integrate interventions that address maternal depression to improve child feeding and caring practices to effectively prevent stunting.     

Do maternal perceptions of child eating and feeding help to explain the disconnect between reported and observed feeding practices?: A follow‐up study

Research demonstrates a mismatch between reported and observed maternal feeding practices. This mismatch may be explained by maternal cognitions, attitudes, and motivations relating to dyadic parent–child feeding interactions. These complex constructs may not be apparent during observations nor evidenced in self‐report questionnaire. Therefore, the aim of this study was to use a qualitative approach to gain a more nuanced and contextualized understanding of (a) maternal perceptions of children's food intake control; (b) how parent–child mealtime interactions influence maternal feeding practices; and (c) ways in which mothers may promote healthy child eating and weight outcomes. Semistructured telephone interviews were conducted with 23 mothers (M = 38.4 ± 3.7 years of age) of preschool‐aged children (M = 3.8 ± 0.6 years of age, 19 were normal weight, 14 were girls), who had previously completed child feeding questionnaire and participated in two home‐based mealtime observations, 12 months apart. Interviews were recorded, transcribed, and themes extracted to create the database. Four major themes emerged: (a) Maternal confidence in children's ability to regulate food intake is variable; (b) Implementing strategies for nurturing healthy relationships with food beyond the dining table; (c) Fostering positive mealtime interactions is valued above the content of what children eat; and (d) Situation‐specific practices and inconsistencies. Findings indicate that maternal feeding practices are shaped by both parent and child influences, and child feeding is mostly guided by controlling the family food environment, rather than by directly pressuring or restricting their child's eating. Results also highlighted the need for research to consider both parent and child influences on child feeding.     

Child feeding in rural northern Ghana: Carer's perceptions of food and their children's diets

A child''s diet should be composed of appropriate nutrients to achieve optimal nutritional status, and though there is a substantial evidence base for child feeding recommendations, developing countries continue to face challenges regarding optimal child feeding. This paper describes an ethnographic study undertaken in rural northern Ghana to explore community perceptions of what ‘counts’ as food for children and the impact this had on the nutrients they received. Fifteen households with children under 5 years were purposively selected. In‐depth interviews were held with 25 mothers, 7 fathers and 8 grandparents within these households as well as 2 diviners. Participant observations were also undertaken. Findings show that satiety rather than nutrition was the key consideration in adult choices about a child''s diet. The community regarded carbohydrate‐based meals as food, but considered protein, vitamins and mineral‐based foods as nonessential elements of a child''s diet, and important sources of these nutrients were regarded as treats.     

A clinical description of children with solid organ transplants who present with feeding disorder

Pediatric solid organ transplant recipients have long‐standing malnutrition concerns related to their pretransplant medical status. The targeted nutrition therapy utilized pre‐, peri‐, and post‐transplantation may have the adverse effect of impeding normally developing feeding skills, particularly in very young children. Little is known about the relationship between transplantation and feeding disorders of childhood. The purpose of this study was to describe severity of feeding disorder and parental stress in patients with transplant compared to children followed in a specialty feeding clinic and the general community. Sixty‐four children, comprised of 32 children with solid organ transplant ages 2 months to 12 years and 32 matched control patients diagnosed with a feeding disorder without history of solid organ transplant, were reviewed. All children were from the Feeding, Swallowing, and Nutrition Clinic at a single children's hospital. Findings indicate that patients who received a transplant and presented with a feeding problem had worse symptoms of feeding disorder than are typically found in the general community. These feeding problems disrupt mealtime behavior, caregiver and child relationship within a mealtime context, and may result in maladaptive feeding strategies used by families. When transplanted children present with feeding disorders, they are severe and have multiple effects on both the child and the feeding dynamic between the child and the child's caregivers. Further investigation may help us to better understand the relationship between transplantation and symptoms of feeding disorder.     

Determinants of age‐appropriate breastfeeding,dietary diversity,and consumption of animal source foods among Indonesian children

Global child feeding practices remain suboptimal. In this study, we assess the determinants of age‐inappropriate breastfeeding, dietary diversity, and consumption of 3+ types of animal source foods (ASFs) using 11,687 observations from combined data from the Indonesian Demographic Health Survey of 2012 and 2017. We used linear and logistic regression after adjusting for the complex sampling design. Child's age and quality of antenatal care (ANC) were associated with all outcomes. Socio‐economic status and labour force participation were positively associated with higher dietary diversity score, ASF consumption, and age‐inappropriate breastfeeding. More ANC visits and having consultation at ANC were associated with more dietary diversity. Higher women's knowledge level was associated with more dietary diversity and consuming more ASF. Compared with western Indonesia, more children in eastern Indonesia were age‐inappropriately breastfed and had lower dietary diversity. The Indonesian government needs to develop programmes to improve child feeding particularly in eastern Indonesia, focusing on improving dietary diversity and ASF consumption in poorer households and on prolonging breastfeeding in richer households. Women's labour force participation should be encouraged, but programmes for working mothers are also needed to support continued breastfeeding and to express breast milk. ANC and postnatal programmes need improved consultation sessions for child feeding.     

The relationship between parental perceptions of diabetes and glycaemic control

Aim

To measure the relationship between perceived child competence, parental self‐efficacy, and children''s glycaemic control.

Methods

Cross‐sectional outpatient based questionnaire survey of 78 parents of children aged 6–12 years with insulin dependent diabetes mellitus, diagnosed for at least one year. Parental perceptions of their child''s competence were assessed, together with parental perceptions of their own self‐efficacy in managing their child''s diabetes. Glycaemic control was assessed by the average annual HbA_1C level.

Results

The response rate was 64.5% (51 parents); 82% were mothers and the socioeconomic class and ethnicity spread was representative of the general population. The mean age of the children was 10 years and duration of diabetes 4.4 years. Poorer glycaemic control was associated with higher perceived child competence, together with lower perceived age of responsibility, lower perceived seriousness, and less frequent blood tests. Higher parental self‐efficacy and higher perceived child competence predicted a higher level of normalisation, as did lower perceived seriousness, a lower perceived parental responsibility for management, and a less protective style of parenting.

Conclusion

Parents'' perceptions of their children''s diabetes are significantly related to glycaemic control; however, those who appear more competent at managing diabetes may overestimate their child''s capabilities, leading to poorer glycaemic control.     

Role of dietary patterns,sedentary behaviour and overweight on the longitudinal development of childhood constipation: the Generation R study

The influence of childhood nutrition on the development of constipation beyond the period of weaning and breastfeeding is relatively understudied. In addition, eating patterns in childhood can be highly correlated with overweight and sedentary behaviour, which may also have an influence on constipation. The aim of this study was to assess whether common dietary patterns, sedentary behaviour and childhood overweight are associated with constipation in childhood. The study was embedded in a population‐based prospective birth cohort. Information on dietary intake was obtained by a food frequency questionnaire at the child's age of 14 months (n = 2420). The adherence scores on a ‘Health conscious’ and ‘Western‐like’ diet were extracted from principal component analysis. At the age of 24, 36 and 48 months, information on constipation and sedentary behaviour, and weight and height was obtained by parental‐derived questionnaires and from the child health centres, respectively. Adherence to a ‘Western‐like’ dietary pattern was associated with a higher prevalence of constipation up to 48 months [adjusted odds ratio (aOR); 95% confidence interval (CI): 1.39; 1.02–1.87], which was not mediated by overweight or sedentary behaviour. Adherence to a ‘Health Conscious’ dietary pattern was only associated at short term, with a lower prevalence of constipation at 24 months (aOR; 95%CI: 0.65; 0.44–0.96). No association was found between overweight, sedentary behaviour and constipation. Our results suggest that specific dietary patterns in early childhood could be associated with higher or lower risks for constipation, but these effects are time‐dependent. Overweight and sedentary behaviour seem to not have a major role on constipation in childhood.     

Antenatal dietary patterns and depressive symptoms during pregnancy and early post‐partum

Perinatal depression is a debilitating disorder experienced during pregnancy and/or the first year post‐partum. Recently, maternal dietary intake during pregnancy has emerged as a possible area of intervention for the prevention of mental disorders in women and their offspring. However, the relationship between antenatal diet quality and perinatal depressive symptoms remains poorly understood. The current study explored the predictive role of antenatal diet quality for antenatal and post‐natal depressive symptoms. Pregnant women (n = 167) were recruited between February 2010 and December 2011. Women completed the Edinburgh Postnatal Depression Scale at time 1 [T1, mean weeks gestation = 16.70, standard deviation (SD) = 0.91], time 2 (T2, mean weeks gestation = 32.89, SD = 0.89) and time 3 (T3, mean weeks post‐partum = 13.51, SD = 1.97) and a food frequency questionnaire at T1 and T2. Diet quality was determined by extracting dietary patterns via principal components analysis. Two dietary patterns were identified: ‘healthy’ (including fruit, vegetables, fish and whole grains) and ‘unhealthy’ (including sweets, refined grains, high‐energy drinks and fast foods). Associations between dietary patterns and depressive symptoms were investigated by path analyses. While both ‘healthy’ and ‘unhealthy’ path models showed good fit, only one significant association consistent with study hypotheses was found, an ‘unhealthy’ diet was associated with increased depressive symptoms at 32 weeks gestation. Given that this association was cross‐sectional, it was not possible to make any firm conclusions about the predictive nature of either dietary patterns or depressive symptoms. Dietary intervention studies or larger prospective studies are therefore recommended.     

“Those who care much,understand much.” Maternal perceptions of children's appetite: Perspectives from urban and rural caregivers of diverse parenting experience in Bangladesh

Appetite in children is an important determinant of nutritional intake and growth. The information used by caregivers to understand children's appetite can help inform infant and young child feeding promotion and appetite assessment. We conducted a qualitative study to (a) explore maternal perceptions and responses to children's appetite and (b) to identify how these factors differ by type of caregiver, level of maternal experience, and urban versus rural context. We used purposive sampling to recruit mothers and alternate caregivers into 14 total focus group discussions (six to eight participants in each group; N = 95) in both urban and rural settings in Bangladesh. To understand children's appetite, caregivers monitor children's dietary patterns, emotional signs, and physical and verbal cues. Healthy appetite was observed by willingness to eat diverse foods, finish offered portions, and by acceptance of foods without excessive prompting. Child illness was cited for a cause of low appetite, which was manifested through fussiness, and avoiding commonly consumed foods. Mothers described a limited set of feeding practices (offering diverse foods, playing, and cheering children with videos) to encourage consumption when children lacked appetite. Mothers' stress related to work was noted as a barrier to identifying appetite cues. Urban mothers described a lower access to instrumental social support for child feeding but informational support than mothers in the rural setting. Understanding caregivers' perceptions of children's appetite may inform strategies to improve responsive feeding and tool development to assess changes in appetite as early indicators of change in health or nutrition status among high‐risk children.