Eating habits and attitudes of mothers of children with non-organic failure to thrive.

The eating habits and attitudes concerning body shape and weight among 26 mothers of children with non-organic failure to thrive (the index group) were studied using the eating disorder examination. They were compared with equivalent data on 26 individually matched women who participated in a large community survey. The index mothers' views of their child's weight and shape were also studied. The principal findings were, firstly, that when compared with the comparison group, mothers of children with non-organic failure to thrive had higher levels of dietary restraint. Secondly, despite their child's low weight, 50% of the index mothers were restricting their child's intake of 'sweet' foods, and a further 30% were restricting foods they considered 'fattening' or 'unhealthy'. These results raise the question of whether maternal eating habits and attitudes have a causal role in the genesis of non-organic failure to thrive. They suggest that careful inquiry about the mothers' eating habits and attitudes is needed when assessing children with non-organic failure to thrive.     

Child abuse and non-organic failure to thrive: similarities and differences in the parents

A group of 39 mothers who had a physically abused child at an average of 6 years previously and a group of 14 mothers who had a child with non-organic failure to thrive (NOFTT) 13 years ago were reviewed. Each child was compared with a child matched for age and sex and for ethnic group, residential area and social class of the parents. The mothers from the NOFTT group knew less than their comparison mothers about their child's education and on a personality test were less able at intellectual and abstract concepts. The abuse group mothers were more mobile and more isolated than their comparison group. They were less likely to have been brought up by their own parents and had more negative feelings towards their fathers. They had lower self-esteem and higher expectations for their children than the comparison mothers On a personality assessment they were more assertive, demanding and suspicious than the comparison mothers, Although child abuse and non-organic failure to thrive have been described as part of the same spectrum, the characteristics of the parents on follow-up are different. As some of the adverse characteristics of the parents persist long after the presenting incident, the need for a long term treatment programme aimed at supporting children who remain in these families is recommended.     

Association between school children's overweight and maternal obesity and perception of their children's weight status

AIM: To determine the association between overweight children and a) other components of the mothers' metabolic syndrome, such as body mass index (BMI), waist circumference (WC), HDL-cholesterol, triglycerides, glucose, HOMA-IR, blood pressure (BP), and age; and b) the mothers' perception of their children's overweight. METHODS: Six hundred and twenty children (297 M) aged 9 +/- 2 years and their mothers aged 37.7 +/- 7 years were examined between April and August 2006. BMI, BP, fasting glucose and lipids and children's Tanner stage were determined. Questionnaires were filled in about the mothers' perceptions of their children's eating habits and of their children's shape. RESULTS: Ninety-five (17.4%) of the children were obese (> 95th percentile), 108 (15.3%) overweight (> 85th percentile) and 418 (67.3%) normal. One hundred and twelve (18%) of the mothers were obese and 183 (29.5%) overweight. Mean values for measures in mothers differed between normal vs overweight/obese children: z-BMI (-0.19 vs 0.42), triglycerides (84 vs 105 mg/dl), cholesterol (147 vs 157 mg/dl), glucose (78 vs 82 mg/dl) and insulin resistance (HOMA-IR 1.34 vs 1.72). There were significant differences in the proportion with distorted perception of shape (2.2% vs 47.5%) and eating habits (11.2% vs 37%) between mothers of normal versus overweight/ obese children. Logistic regression analysis using BMI > or = 85th percentile as the dependent variable showed that the mothers' perceptions of their children's shape (OR: 18.84; 95% CI: 5.0-69.6), eating habits (OR: 3.82; 95% CI: 1.5-9.5) and mothers' BMI (OR: 2.1; 95% CI: 1.3-3.4) were associated with children's overweight. CONCLUSIONS: There was an association between mothers' distorted perception of their children's shape and eating habits and mothers' obesity and their children's overweight. This observation provides clues for obesity prevention programs.     

Do mothers of overweight Argentinean preschool children perceive them as such?

Childhood overweight is rapidly on the rise and underlies the younger presentation of diabetes. The aim of this study was to determine the association between overweight and age, sex, and the perception of the overweight children by their mothers. Three hundred and twenty-one (160 males) children (mean age 4.39 +/- SD 0.83 yr) [body mass index (BMI) 16.6 +/- 2.11] from schools at the kindergarten level were evaluated. Data on age, sex, weight, and height were recorded. At risk for overweight and overweight were defined as a BMI of > or = 85th or > or = 95th percentile, respectively. Written questionnaires for mothers' perceptions about their children's eating habits (a lot, right, little, or very little) and shape (very fat, fat, normal, and thin) were performed. The prevalence of at risk of overweight and overweight was 19 and 18.4%, respectively. There was a significant difference in the proportion of distorted perception of shape between mothers of normal-weight children vs. those of at risk of overweight and overweight children (17 vs. 87.5%, p < 0.001). Seventy-six and 98% of mothers of overweight and at risk of overweight children, respectively, rated them as normal or thin. Mothers exhibited poor overall ability to estimate the way at risk of overweight and overweight children ate. There was a significant difference in the proportion of distorted perception of eating habits between mothers of normal-weight children vs. those of at risk of overweight and overweight children (36.3 vs. 90.8%, p < 0.001). Eighty-four and 96% of mothers of obese and overweight children, respectively, thought that their children ate right or little. A multiple regression analysis using BMI > 95th percentile as the dependent variable showed that the mothers' perceptions of shape and eating habits [odds ratio 4.5; 95% confidence interval (CI) 2.5-7.8; p < 0.0001] were both significant independent risk factors for overweight, adjusted for age and sex. The agreement between the perception of shape and eating habits vs. the medical records BMI > 95th percentile was poor; for shape: kappa 0.31 + 0.07; 95% CI 0.17-0.44, and for nutrition: 0.14 + 0.06; 95% CI 0.02-0.27. This suggests that the mothers' perceptions of shape and eating behavior is a predictor of obesity and could be used in clinical practice as a simple tool to identify children at high risk for overweight.     

Connections between parental eating attitudes and children's meagre eating: questionnaire findings

This study investigated whether young children's problematic, meagre eating is associated with the eating habits and attitudes of the parents. The subjects, 397 children, their mothers (n = 397) and fathers (n = 375) participated in a prospective atherosclerosis risk-factor intervention trial. The parents evaluated their own eating behaviour in questionnaires when their child was 13 mo old. The children's eating problems were recorded by the mothers when the child was 13 mo old, and by both parents when the child was 5 y old. At both ages, the weight and height of the children were measured. Problematic or maladaptive eating habits of the children were found to be connected to those of their parents. The mother's poor ability to enjoy eating, high tendency to snack and low tendency to eat only when hungry, as well as the father's difficulty in maintaining ideal weight significantly predicted persistent problems of meagre eating in their children. CONCLUSION: The study suggests that the eating habits and attitudes of parents may be reflected in the eating behaviour of young children.     

Prevalence of obesity, binge eating, and night eating in a cross-sectional field survey of 6-year-old children and their parents in a German urban population

BACKGROUND: To assess the prevalence of obesity, obesity-related binge eating, non-obesity-related binge eating, and night eating in five- to six-year-old children and to examine the impact of parental eating disturbances. METHODS: When 2020 children attended their obligatory health exam prior to school entry in the city of Aachen, Germany, 1979 parents (97.9%) filled out a questionnaire on their child's eating habits and weight development in a cross-sectional survey. Anthropometric measurements were collected for all children in a standardized form. RESULTS: Episodes of binge eating were found in 2.0% of the children surveyed and night eating in 1.1%. There was a significant relationship between binge eating and obesity but not between night eating and the child's weight. Children's binge eating and night eating were strongly associated with eating disturbances on the part of their mothers (adjusted odds ratios [95% confidence intervals]: 6.1 [2.7-13.5] and 7.8 [2.1-29.4], respectively) and with a non-German native language (adjusted odds ratios [95% confidence intervals]: 2.6 [1.2-5.5] and 11.6 [3.5-38.7], respectively). CONCLUSIONS: In concurrence with studies on adulthood, binge eating is linked to obesity already in early childhood. Children of mothers with eating disorders and children of mothers with a non-German native language are at increased risk of developing eating disorders themselves. Future studies should focus on obesity and eating disorders in early childhood; prevention programs should seek to target young children at risk as early as possible.     

Long-term effects of nonorganic failure to thrive

Fourteen children admitted to the hospital at an average age of 12.5 years previously were reviewed in comparison with a group of children matched for age, sex, social class, and ethnic group. The children in the study group were smaller in height and weight, than children in the comparison group. They had lower scores on the verbal intelligence scale of the Wechsler Intelligence Scale for Children--Revised, poorer language development, and less well-developed reading skills. They had lower social maturity and a higher incidence of behavioral disturbances. There were no differences between the study and comparison groups in family size, maternal age, family health, social isolation, and mothers' childhood experiences. The study group mothers had less knowledge about their children's education, were more anxious, and had a tendency toward concrete thinking. To prevent the long-term adverse effects of nonorganic failure to thrive, a more active, practical, and long-term program, begun at the time of presentation, is recommended.     

Maternal perception of excess weight in children: a survey conducted by paediatricians in the province of Milan

OBJECTIVE: To establish whether maternal perception of a child's body weight (BW) and food intake is related to the level of maternal education. STUDY DESIGN: Height and BW of 569 mother/child couples were measured, and mothers received a questionnaire regarding their perception of their own weight and their child's BW and food intake. RESULTS: Twenty-nine percent of mothers and 35% of children were overweight or obese. Only 10% of the mothers underestimated their own weight, while 37% overestimated it. In contrast, 28% of mothers underestimated their child's BW, while 9% overestimated it. Higher maternal instruction level was significantly associated to a lower weight class in both mothers and children, and to a correct perception of the child's weight. Fifty-seven per cent of the mothers who perceived their child to be overweight or obese were not concerned. Forty-four per cent of the mothers with overweight or obese children believed that their child was eating correctly. CONCLUSIONS: A better understanding of how mothers perceive the problem of excess weight in their children is relevant to the success of preventive interventions in childhood obesity.     

Diet quality,nutrient intake,weight status,and feeding environments of girls meeting or exceeding the American Academy of Pediatrics recommendations for total dietary fat

The American Academy of Pediatrics (AAP) recommends that children consume no more than 30% but no less than 20% of energy as dietary fat intake, and this recommendation is accompanied by suggestions that fat calories should be replaced by eating more grain products, fruits, vegetables, low fat dairy products, beans, lean meat, poultry, fish, and other protein rich foods. In comparing diets of girls meeting this AAP recommendation with girls who consumed diets higher in fat, we noted that girls meeting recommendations had diets that came closer to meeting other dietary recommendations for several food groups and had higher intake of several key micronutrients. Dietary fat was also associated with body fat and weight status. Children's fat intake was also related to mothers' dietary fat intake, and nutrient intake patterns were similar for mothers and daughters. Finally, mothers of girls consuming higher fat diets reported using more restriction and pressure to eat in feeding their daughters. These findings provide additional support for the AAP recommendation to limit total dietary fat. Findings reveal that mothers' use of controlling feeding practices are not effective in fostering healthier diets among children, and that mothers' own eating may be more influential than their attempts to control children's intake.     

Relation of childhood malnutrition to parental education and mothers’ nutrition related KAP

Severely malnourished children (26), weight for age 55.27±3.17, were identified in a colony of predominantly Muslim urban slum dwellers of low economic status. An equal number of normally nourished children matched for age, sex and per capita income were identified. A strong relation was found between nutritional status of the subjects and educational level of their mothers (P<0.025). Father's education was unrelated to childrens' nutritional status. A thirty seven point questionnaire was administered to the mothers to record their nutritional knowledge, attitudes and practices (KAP). Analysis revealed that better KAP in relation to 16 of these 37 questions was not associated with better nutritional status. Seven questions were found to have only a weak association. The remaining 14 questions were identified as important for a nutrition education programme. Comparison of nutritional KAP score based on these 14 questions in case of mothers of normal and severely malnourished children revealed a significantly higher score in the former. Questions related to growth monitoring and breast feeding were not found to be important. No significant association was found between mothers' KAP and educational level. It is concluded that (i) Maternal education and KAP are significantly and independently associated with childrens' nutritional status. (ii) The content areas of knowledge, attitudes and practices significantly associated with nutritional status pertain to nutritional requirements of children, nutritional value of foods, immunisation, hygiene, oral rehydration and diarrhea.     

Frequent breastfeeding and food refusal associated with failure to thrive. A manifestation of the vulnerable child syndrome

This paper acquaints pediatricians and health care personnel with the triad of poor weight gain, frequent breastfeeding, and food refusal in infants during the second 6 months of life. The histories of six infants aged 8-11 months, with failure to thrive, food refusal, and frequent breastfeeding, are presented. All the mothers were facing significant stresses, which may have decreased their breast milk supply, and were leading them to use breastfeeding for their comfort and/or the comfort of their infant. The infants responded with continued frequent breastfeeding, refusal of complementary foods, and decreased weight gain. These infants fit the characteristics of the vulerable child syndrome. Treatment of these infants required evaluation and treatment of the mothers' psychosocial issues along with a behavioral feeding program. Even with this multidisciplinary approach, these infants showed very slow catch-up growth. Pediatricians and health care personnel should use and build on this information in the evaluation and treatment of infants with similar problems.     

Parental health beliefs as a cause of nonorganic failure to thrive

Parental misconceptions and health beliefs concerning what constitutes a normal diet for infants is reported as a cause for failure to thrive. There were seven patients (four boys, three girls), 7 to 22 months of age, who were evaluated for poor weight gain and linear growth. They were only consuming 60% to 94% of the recommended caloric intake for age and sex. The children's caloric intake had been restricted by their parents. They were concerned that the children would become obese, develop atherosclerosis, become junk food dependent, and/or develop eating habits that the parents believed were unhealthy. The parents instituted diets consistent with health beliefs currently in vogue and recommended by the medical community for adults who are at risk for cardiovascular disease. These diets caused the infants to experience inadequate weight gain and have a decreased linear growth rate. With nutritional counseling, all food restrictions were removed, the caloric intake was increased to 94% to 147% of the recommended intake for age. The weight gain rate increased significantly (P less than .05) from 0.1 +/- 0.1 kg/mo to 0.4 +/- 0.3 kg/mo, and the linear growth rate increased significantly (P less than .05) from 0.4 +/- 0.4 cm/mo to 1.0 +/- 0.6 cm/mo within 3 months of therapy. Exaggerated concerns about excessive food intake in childhood and/or concern about the sequelae of eating an improper diet has resulted in this entity of failure to thrive due to parental health beliefs.     

Impact of delayed development in premature infants on mother-infant interaction: a prospective investigation

We examined events that precede a diagnosis of developmental delay by comparing 16 very low birth weight premature infants whose condition was diagnosed as developmental delay at 18 months corrected age with 16 matched developmentally normal infants. All infants were observed with their mothers during maternal visits to the nursery and during home visits 1, 3, 6, and 9 months after discharge. The mothers' reactions to their infants were rated at these times. All the children were followed up at a neonatal clinic, and detailed clinic records were used to document the time when a physician first suspected a delay and when this delay was first mentioned to the mother. The results indicate that parents had usually been told of their child's handicap by the time the child was 6 to 9 months old; yet mothers of the delayed children changed the interaction with their children as early as 1 month after discharge from hospital. These mothers initially touched, smiled at, and talked to their developmentally delayed infants significantly more often, but by 9 months they did so much less often than mothers of nondelayed children. The degree of change in mothers' behavior was related to their psychosocial background, with better-adjusted mothers showing the most change. We conclude that mothers' statements about their infants are usually valid and that physicians may share their potential concerns about infants more freely.     

Restrained eating in overweight children: does eating style run in families?

Overweight children show abnormalities in eating style, such as restrained eating and tendency toward overeating (comprising both emotional and external eating). Family surroundings play a major role in developing eating behaviors in children. We tested whether restrained eating and tendency toward overeating predicted the amount of food intake in 41 overweight children (23 girls and 18 boys) and their parents (40 mothers and 11 fathers) after receiving a preload. We further investigated with questionnaires whether there were associations between the parents' and their children's eating behavior and whether mothers' food intake predicted the amount of food consumed by children in an experimental trial. We found that neither children with restrained eating nor their mothers ate more after a preload, but children with a high tendency toward overeating ate somewhat more after receiving a preload. Further analyses showed that children's food intake in the preload paradigm was predicted by mothers' food intake. Our findings point to a familial transmission of eating styles: children eat as their primary caregivers do, even when the caregivers are not present in the laboratory.     

Co-morbidity associated with fabricated illness (Munchausen syndrome by proxy).

Fifty six children who had been victims of fabricated illnesses and 82 of their 103 siblings were studied. In addition to the index fabrication, 64% of index children had had other illnesses fabricated by their mothers. Twenty nine per cent of the index children had a history of failure to thrive and 29% a history of non-accidental injury, inappropriate medication, or neglect. Seventy three per cent of the index children had been affected by at least one of these additional problems. Eleven per cent of the siblings had died in early childhood, the cause of death not being identified. Thirty nine per cent of siblings themselves had had illnesses fabricated by their mothers, and 17% had been affected by either failure to thrive, non-accidental injury, inappropriate medication, or neglect.     

Maternal prompts to eat, child compliance, and mother and child weight status

OBJECTIVE: To determine if there is a relationship between maternal prompting to eat, child compliance, and mother and child weight. STUDY DESIGN: Seventy-one 3- to 6-year-old children and their mothers were videotaped tasting four foods (two familiar, two novel). Maternal prompts to eat and the child's compliance with the prompts were coded. Multiple logistic regression evaluated demographic, anthropometric, and food characteristics that predicted prompting and compliance; and demographic, behavioral, and food characteristics that predicted child body mass index Z score (BMIz) in the children of obese and non-obese mothers. RESULTS: Obese mothers did not prompt more than non-obese mothers, but children of obese mothers were more compliant (70.2% +/- 19.4 v 59.6% +/- 21.2, P = .04). Low maternal education, a novel food, and younger child age predicted prompting. Maternal obesity, a familiar food, and older child age predicted compliance. In children of obese mothers, low maternal education, more prompts to eat novel foods, fewer prompts to eat familiar foods, and fewer child bites of familiar foods predicted child BMIz (R(2) = 64%). In children of non-obese mothers, none of the covariates predicted child BMIz. CONCLUSIONS: Children of obese mothers may be more responsive to environmental cues to eat.     

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.     

Minority mothers' perceptions of children's body size.

OBJECTIVE: To investigate African-American and Hispanic mothers' perceptions of their children's body size using a scale with child figure silhouettes and compare those perceptions with their children's actual body mass index. METHODS: A set of child figure silhouettes was developed depicting 4 and 5 year-old African-American and Hispanic children. Body mass index was systematically estimated for each child figure on the set of silhouettes. Minority mothers with children enrolled in ten Head Start centers (n=192) were interviewed using the silhouettes, and height and weight measurements were taken on their children. Head Start, a comprehensive child development program that serves children aged 3 to 5 years old, was chosen because of the large percentage of minorities, the low-income status of the families, and the age of the children. RESULTS: Significant differences were found between mothers' perceptions of their children's body size and the actual body size of the children. On average, mothers perceived their children to be thinner than their actual size. Furthermore, of those mothers with children at risk for overweight or overweight, two-thirds were either satisfied with their children's existing body size or wanted their children to be heavier. However, half of the mothers of children above the 95th percentile for BMI wanted their children to be thinner. CONCLUSIONS: These data suggest that minority mothers' perceptions of their children's body size may not be consistently biased in one direction. Despite the possible social norm for a larger body size among low-income minorities, some mothers of overweight minority children do perceive their children to be too heavy when they reach a certain size.     

Energy compensation in young children who fail to thrive

BACKGROUND: Failure to thrive is generally attributed to undernutrition, but little is known about the appetite or eating behaviour of children with the condition. The hypothesis that young children who fail to thrive lack a normal sensitivity to internal hunger or satiation cues was tested in this study using an energy compensation procedure. METHOD: Twenty-seven children under assessment by a community-based service for failure to thrive, with weight gain in the lowest 5% for their age, were studied at one year of age with 26 controls of the same age and sex with normal weight gain, resident in the same local geographical area. Test meals were given in the child's own home on two separate days. The test meals were preceded by either a high energy (402 kJ) drink, or by a low energy (1 kJ) drink on a control day. The order was randomised, and the study conducted double blind, without the experimenter or the mother knowing which drink was which. Energy intake at the test meal was measured. RESULTS: There was no significant difference in the birth weight of the children in the two groups but by the time of the test the cases weighed significantly less than controls, with mean (SD) weight 9.06 (1.05) kg and 11.59 (1.59) kg respectively. In relation to the British Growth Reference for weight this is a difference of 2.2 SD. Mean (SD) energy intake at the meal on the control day was significantly lower in the case children than the controls (FTT 687.5 (334.3) kJ; controls 1065.9 (431.8) kJ; p < .001). After the high energy drink, controls reduced their energy intake at the meal by a mean (SD) -257.3 (383.3) kJ while the cases showed a slight average increase of +78.1 (365.9) kJ; t = 3.26, df 51, p < .001. Per kJ of the pre-load, the average change was -1.18 kJ in controls and +0.80 kJ in cases. CONCLUSIONS: The controls compensated as expected for their high energy load at the subsequent meal, but the case children did not, showing that they lack the normal responses to internal hunger/satiation cues. High energy snacks may improve the nutritional status of children who fail to thrive.     

What is a normal rate of weight gain in infancy?

We have retrieved weights from the Child Health records of an annual cohort of 3418 full-term children, aged 18–30 months in order to define a lower limit of normality for weight gain for both clinical and research purposes. There was a strong tendency for children at the extremes of the distribution to move inwards towards the average: only 26% of those below the 3rd centile for weight at six weeks were still below it at one year. We describe a method based on conditional standards to correct for this "regression to the mean" and produce a measure of the discrepancy between a child's predicted and actual growth: the "thrive index". The value of the thrive index below which only a minority of children fell provided a lower threshold for normality. While most children below the 3rd centile for weight at 9–24 months of age also had subnormal weight gain, 41 % of those with subnormal weight gain had not fallen below the 3rd centile.