Child feeding practices and perceptions of childhood overweight and childhood obesity risk among mothers of preschool children

Aim: The present study assessed the relationship between maternal attitudes, beliefs and child feeding practices. It was hypothesised that: (i) maternal control over feeding would increase when mothers perceived their children as over‐ or underweight and were concerned about the weight status of their children; and (ii) mothers would express more concern about their daughters' weight, and report higher levels of control over feeding as a result. Methods: Participants included 112 mothers and their children aged 2–6 years who were attending swim lessons at a Central Coast swim school. Mothers completed the Child Feeding Questionnaire to assess maternal attitudes, beliefs and control over child feeding. Child and maternal body mass indexes were measured. Correlational analyses, t‐tests and multiple regression analyses were performed. Results: Mothers reported a high overall level of control in child feeding, and a low level of concern for child weight. Child overweight and obesity were marginally lower than reported in previous studies. Mothers reported more concern for their daughters' weight, but did not report increased control over feeding based on child gender. Pressure to eat was negatively associated with maternal education, suggesting a link between socioeconomic status and child feeding practices. Mothers displayed higher levels of parental control over obese than normal‐weight children, suggesting that they accurately assessed the weight status at the obese level. Conclusion: Mothers may be able to detect obesity in their children, but not overweight. Mothers may also be unconcerned about their sons' weight, and this discrepancy should be investigated in clinical and educational settings. Nutrition education and child obesity prevention and treatment programs should take maternal attitudes, perceptions and child feeding practices into account when planning interventions.     

Maternal feeding practices predict fruit and vegetable consumption in young children. Results of a 12-month longitudinal study

This study aimed to explore the prospective relationship between maternal feeding practices and young children's frequency of consumption of fruits, vegetables and sweets, and also child weight-for-height z-scores. Participants were 60 mothers who completed questionnaires when their children were 1 year old and again when their children were 2 years old. Regression analyses were performed. After controlling for availability and prior child consumption of the target food, maternal use of pressure to eat at 1 year predicted lower child frequency of fruit consumption at 2 years and approached significance for lower vegetable consumption. Maternal modelling of healthy eating at 1 year predicted higher child frequency of vegetable consumption at 2 years. Restriction did not significantly predict child frequency of consumption of fruits, vegetables or sweets over time. Child weight-for-height scores at 2 years were predicted by weight-for-height at 1 year but not by feeding practices. The findings suggest that maternal feeding practices can influence child eating at a very young age. Interventions should focus on encouraging parents to model healthy eating to promote healthy eating in children.     

Feeding practices of mothers from varied income and racial/ethnic groups

Objective: Relatively few investigators have explored the role of maternal control in describing the feeding behaviour of nonwhite parents of preschool-age children. The present study was conducted to examine if controlling feeding behaviours (i.e. restriction and pressuring) varied by income (middle vs. low) and race/ethnicity (white vs. Hispanic), and if they were associated with the body mass index (BMI) of their four-year-old offspring. Methods: Responses to the ‘restriction’ and ‘pressure to eat’ variables of the Child Feeding Questionnaire were compared between 51 white middle-income mothers and 49 Hispanic low-income mothers. Results: Mothers from both groups gave predominantly ‘neutral’ ratings in their self-reports of feeding practices. However, relative to the Hispanic mothers, white mothers indicated significantly less restriction and pressure to eat. Higher child BMI was predicted by male gender and being Hispanic. Conclusions: The utility of maternal feeding practices in predicting child overweight is discussed, and the significant association between the conceptually different constructs of restriction and pressure to eat is examined.     

Maternal and paternal controlling feeding practices with male and female children

This study aimed to compare maternal and paternal feeding practices with male and female children and examine the influence of the gender of both the parent and child on the relationship between parental unhealthy eating attitudes and controlling feeding practices. One hundred and eighty-eight participants (94 co-habiting mother-father dyads, mean age 36.4 years, SD=4.9), who were the parents of 46 male and 48 female children (mean age 37.7 months, SD=12.7) completed measures of unhealthy eating attitudes and feeding practices. Mothers and fathers differed significantly in their reports of unhealthy eating attitudes but not in their restrictive or pressurising feeding practices. Mothers reported greater perceived feeding responsibility and greater monitoring of their children's food intake than fathers. Bulimia scores were correlated with controlling feeding practices in mothers of girls but not boys. Fathers' body dissatisfaction was correlated with monitoring of sons' but not daughters' food intake. These findings suggest that parental extrapolation of weight concerns may be more likely to occur within mother-daughter and father-son relationships.     

Controlling Maternal Feeding Practices Associated with Decreased Dieting Behavior in Sixth-Grade Children

Controlling maternal feeding practices have been linked to increased caloric intake, disinhibited eating, and obesity in children. Its relationship to child dieting behavior, however, is unknown. Using the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, this study examined whether controlling feeding practices are associated with increased or decreased dieting behavior in children. Controlling maternal feeding practices were assessed in third grade with the question, “Do you let your child eat what he/she feels like eating?” Answers ranged from 1 to 4; higher scores were reverse-coded to indicate greater control. Child dieting behavior was assessed in sixth grade and dichotomized into “any dieting behaviors” vs “none.” Multiple logistic regression was used to investigate the relationship between controlling maternal feeding practices and dieting behavior and included the covariates of sex, race, maternal education, maternal weight status, child weight status in third grade, and change in body mass index z score between third and sixth grade. In sixth grade (n=776), 41.5% of children engaged in dieting behavior. In the multivariate analysis, greater maternal control over child eating predicted lower odds of child dieting in sixth grade (odds ratio=0.79; 95% confidence interval: 0.64 to 0.97). There was no interaction between controlling maternal feeding practices and child's sex or baseline obesity status. Exerting more control over what a child eats in third grade may protect against future dieting behavior in children, independent of child's weight status or rate of weight gain. Further work is needed to better define which controlling feeding practices are beneficial for the child.     

Effects of maternal HIV on children's psychosocial adjustment with peers and with their mother

A longitudinal assessment of young adolescents' psychosocial outcomes affected by maternal HIV/AIDS was undertaken, focusing on both parent–child psychosocial ties and peer relationships. Data were taken from the Parents and Children Coping Together (PACT) study, a 15-year study assessing mothers with HIV/AIDS and their well children every six months. Families (N?=?118) who participated in PACT II and PACT III are included in the current analyses, who were assessed every six months for 36 months in PACT II, and every six months for 18 months in PACT III (providing 11 time points of data across eight years). Growth curve modeling was applied to assess the associations of maternal health on adolescent's psychosocial outcomes. In terms of their relationship with their mothers living with HIV (MLH), adolescents' psychosocial functioning was negatively impacted by maternal illness, specifically viral load count and vitality levels, whereas several indicators of increased maternal illness (including viral load, vitality, illness symptoms, and health-related anxiety) predicted less attachment with peers. In addition, MLH increased illness was associated with more adolescent autonomy.     

Maternal psychological distress and appraisal of parenting experience predict social-emotional development of Kenyan infants

This study investigated whether higher maternal psychological distress, lower provision of psychosocial stimulation and a negative appraisal of parenting experience were associated with lower cognitive, motor, social-emotional and adaptive behaviour development in children under 3 years of age in Kenya. A cross-sectional design was used, with 81 caregiver–child dyads recruited through convenience sampling. The mean age of these infants was 8.5 months (SD?=?5.6 months, range 23 days to 25.5 months). Higher maternal psychological distress was associated with lower social-emotional development, but not cognitive, motor and adaptive development of a child. Psychosocial stimulation provided by mothers was not related to any developmental outcomes. Maternal psychological distress and appraisal of parenting experience were significant, unique predictors of child social-emotional development. Findings suggest that interventions designed to promote social-emotional development of young children in Kenya should target maternal mental health and enhance confidence and experience of parenting.     

Maternal distress, child behaviour, and disclosure of psychosocial concerns to a paediatrician

BACKGROUND: Despite the availability of effective screening measures, primary care providers continue to fail to identify and manage many children with psychosocial problems. One of the best predictors of identification by a primary care physician is whether mothers disclose concerns about their child's psychosocial functioning to their child's physician. This study examined if maternal distress and child behaviour predicted whether mothers had and discussed concerns about their child's behaviour and emotions with paediatricians. METHODS: Participants were 138 mothers who accompanied their 4-12-year-old children to a health supervision visit at an urban teaching hospital. Mothers completed a demographic questionnaire, the Pediatric Symptom Checklist, the Beck Depression Inventory, and an exit questionnaire. Results Logistic regression correctly classified 97.3% of mothers who did not disclose child problems. Only 34.5% of mothers who did disclose were correctly classified. CONCLUSIONS: The results supported the hypothesis that mothers' psychosocial functioning is significantly related to concern about child behaviour and disclosure of concerns to the paediatrician. The inability of child behaviour and maternal functioning to predict which mothers were concerned and disclosed concerns supports the hypothesis that disclosure and identification of psychosocial problems in primary care is complex and requires a multifactor model.     

The association between maternal serious psychological distress and child obesity at 3 years: a cross-sectional analysis of the UK Millennium Cohort Data

Background The prevalence of child obesity is increasing rapidly worldwide. Early childhood has been identified as a critical time period for the development of obesity. Maternal mental health and early life environment are crucial factors and have been linked to adverse child outcomes. The objective of the study was to examine the relationship between maternal serious psychological distress and obesity in early childhood. Methods A cross‐sectional analysis of data from the Millennium Cohort Study was conducted. Subjects consisted of all natural mothers (n= 10 465) who had complete and plausible data for Kessler‐6 scores, socio‐demographic and anthropometric variables, and their children for whom anthropometric measurements were completed at age 3. Maternal serious psychological distress was defined as a score of 13 or more on the Kessler‐6 scale. Obesity was defined as body mass index ≥95th centile of the 1990 reference chart for age and sex in children. The data were analysed using spss 16. Maternal socio‐demographic factors that are known to influence maternal mental health and child obesity were identified and adjusted using multivariate logistic regression. Results Of the 10 465 mother–child dyads, 3.5% of mothers had serious psychological distress and 5.5% of children were obese at 3 years of age. Logistic regression analysis showed that maternal serious psychological distress was associated with early childhood obesity (P= 0.01; OR 1.62, 95% CI 1.11, 2.37). After adjusting for potential confounding factors using multivariate logistic regression, maternal serious psychological distress remained significantly associated with early childhood obesity (P= 0.01; OR 1.59, 95% CI 1.08, 2.34). Conclusions The results show that maternal serious psychological distress is independently associated with early childhood obesity.     

Effects of Combining Public Assistance and Employment on Mothers and Their Young Children

SUMMARY

One goal of recent welfare reform legislation is to move welfare-dependent mothers with young children into the paid labor force. However, prior to the new legislation, many welfare-dependent women were already engaged in employment activities. In this paper we examine whether child or maternal well-being is influenced by a mother's strategy of combining work and public assistance receipt in the late 1980s. Measures of well-being include children's cognitive test scores and behavior problems, parenting behavior, and maternal mental health, social support, and coping strategies collected when children were 2 ½ to 3 years of age. Data from the Infant Health and Development Program (a sample of low birthweight, premature infants born in 8 sites in 1985) were used to identify low-income families (incomes under 200% of the poverty threshold; N = 525). Comparisons were made among mothers in the following groups: (a) Work Only, (b) Some Work-Some Welfare, (c) Some Work-No Welfare, (d) No Work-No Welfare, and (e) Welfare Only. Mothers in the Some Work-Some Welfare group had children with cognitive and behavioral scores similar to children whose mothers were in the Work Only group; these two groups also had similar mental health, social support, and coping scores. However, not working and receiving welfare (Welfare Only) was associated with negative cognitive and behavioral outcomes for children, with less stimulating home learning environments, lower maternal mental health, less social support, and more avoidant coping strategies. We discuss the proposition that welfare and work may be complementary rather than opposing strategies, in terms of putting together a family income package.     

Intimate Partner Violence,Maternal Gatekeeping,and Child Conduct Problems

We examined the mediating role of parenting behavior on the relationship between intimate partner violence and child conduct problems, as well as the moderating role of maternal gatekeeping to these associations. The sample (N = 395) is from a longitudinal study of rural poverty in the eastern United States exploring the ways in which child, family, and contextual factors shape child development over time. Study findings indicate that a father's harsh–intrusive parenting behavior may be a key mediating pathway linking intimate partner violence and child conduct problems. Study findings further provide evidence for problematic outcomes for children when mothers encourage fathers with high levels of harsh–intrusive parenting to interact with their children.     

Breastfeeding mothers consume more vegetables and a greater variety of fruits and vegetables than non‐breastfeeding peers: The influence of socioeconomic position

Aim: This study compared the diets of breastfeeding and non‐breastfeeding mothers from socioeconomically diverse regions of Melbourne to determine whether breastfeeding is a marker for healthier maternal dietary intakes. Methods: This cross‐sectional study obtained information via self‐reported questionnaire from 529 first‐time Melbourne mothers. Breastfeeding status was determined when the children were 3.9 months. Diet information was obtained using a validated Food Frequency Questionnaire. Maternal diet was assessed by seven indicators: average daily intake of fruit, vegetables, non‐core drinks, non‐core sweet snacks, non‐core savoury snacks, variety of fruit and variety of vegetables eaten in the preceding 12 months. Associations between breastfeeding status and each dietary variable were assessed using linear regression analyses. Socioeconomic position, maternal body mass index and the cluster‐based sampling design were controlled for. Results: Of the 529 subjects, 70% were breastfeeding their child. Compared with non‐breastfeeding mothers, breastfeeding mothers were found to consume more serves of vegetables (P= 0.001), a greater variety of fruit and vegetables (P= 0.001 and P≤ 0.001 respectively), and sweet snacks were consumed more frequently (P= 0.006). Differences were observed between low and high socioeconomic position mothers for fruit serves (P= 0.003), vegetable serves (P= 0.010) and fruit variety (P= 0.006). These associations persisted after controlling for socioeconomic position and maternal body mass index. Conclusions: The association between infant feeding (breastfeeding) and some aspects of maternal diet provides further evidence suggesting a link between maternal and child diets from a younger age than previously examined.     

A controlled trial of early interventions to promote maternal adjustment and development in infants born with severe congenital heart disease

Background Congenital heart disease can have a negative impact on both infant development and maternal adjustment. This study considered the impact of a new programme of early psychosocial interventions on such outcomes, following the birth of a child with severe congenital heart disease. Methods Seventy infants and their mothers were assigned to an intervention or control group based on order of presentation to the unit. Interventions aimed at bolstering mother–infant transactions, through psychoeducation, parent skills training and narrative therapy techniques were implemented. Results Clinically and statistically significant gains were observed at 6‐month follow‐up on the mental (but not the psychomotor) scale of the Bayleys‐II. Positive gains were also manifested on feeding practices, maternal anxiety, worry and appraisal of their situation. Conclusions A programme of generalizable psychosocial interventions is shown to have a positive impact on the infant with severe congenital heart disease and the mother.     

Breast feeding and later psychosocial adjustment

The relationship between the duration of breast feeding and psychosocial outcomes measured between the ages of 15 and 18 years was examined in a birth cohort of 999 New Zealand children. During the period from birth to 1 year, information was collected on maternal breast-feeding practices. Between the ages of 15 and 18 years, sample members were assessed using a range of psychosocial measures, including measures of the quality of parent-child relationships, juvenile delinquency, substance abuse and mental health. Children who were breast fed for a longer duration were more likely to report higher levels of parental attachment and tended to perceive their mothers as being more caring and less overprotective towards them compared with bottle-fed children. No association was found between the extent of breast feeding and subsequent rates of juvenile offending, substance use and mental health in later life. Mothers who elected to breast feed were also more likely to be older, better educated, living with a partner, less likely to smoke during pregnancy, and to come from advantaged socio-economic backgrounds characterised by better living standards and a higher family income. Rates of breast feeding were also greater among mothers who gave birth to a first-born child of higher birthweight. After adjustment for these maternal and perinatal factors, the duration of breast feeding remained significantly associated with adolescent perceptions of maternal care, with increasing duration of breast feeding being associated with higher levels of perceived maternal care during childhood. It is concluded that: (a) it is unlikely that breast feeding is associated with reduced risks of psychiatric disorder in later life; (b) breast feeding may lead to closer parent-child relationships; and (c) it is unlikely that the association between breast feeding and cognitive development is mediated by intervening processes relating to improved psychosocial adjustment in breast-fed children.     

Significant differences in maternal child‐feeding style between ethnic groups in the UK: the role of deprivation and parenting styles

Background

Nonresponsive maternal child‐feeding interactions, such as restricting, pressurising and emotional feeding, can affect the ability of a child to self‐regulate intake and increase the risk of becoming overweight. However, despite findings that South Asian and Black children living in the UK are more likely to be overweight, UK research has not considered how maternal child‐feeding style might differ between ethnic groups. The present study aimed to explore variations in maternal child‐feeding style between ethnic groups in the UK , taking into account associated factors such as deprivation and parenting style.

Methods

Six hundred and fifty‐nine UK mothers with a child who was aged 5–11 years old completed a questionnaire. Items included ethnicity and demographic data, as well as copies of the Child Feeding Questionnaire, Parental Feeding Styles Questionnaire and Parenting Styles and Dimensions Questionnaire.

Results

Significant differences in perceived responsibility (P = 0.002), restriction (P = 0.026), pressure to eat (P = 0.045), instrumental feeding (P = 0.000) and emotional feeding (P = 0.000) were found between the groups. Mothers from South Asian backgrounds reported higher levels of pressure to eat, emotional feeding and indulgent feeding styles, whereas mothers from Chinese backgrounds reported greater perceived responsibility and restriction. Mothers from Black and White British backgrounds were not significantly higher with respect to any behaviour. Maternal child‐feeding style was also associated with deprivation and parenting style, although these did not fully explain the data.

Conclusions

Understanding cultural factors behind maternal child‐feeding style, particularly around pressurising and indulgent feeding behaviours, may play an important part in reducing levels of children who are overweight and obese in the UK .

     

Which adaptive maternal eating behaviors predict child feeding practices? An examination with mothers of 2- to 5-year-old children

Researchers have started to explore the detrimental impact of maladaptive maternal eating behaviors on child feeding practices. However, identifying which adaptive maternal eating behaviors contribute to lower use of negative and higher use of positive child feeding practices remains unexamined. The present study explored this link with 180 mothers of 2- to 5-year-old children. Hierarchical regression analyses (controlling for recruitment venue and maternal demographic characteristics, i.e., age, education, ethnicity, and body mass index) examined mothers' intuitive eating and eating competence as predictors of four feeding practices (restriction, monitoring, pressure to eat, and dividing feeding responsibilities with their child). Mothers who gave themselves unconditional permission to eat were less likely to restrict their child's food intake. Mothers who ate for physical (rather than emotional) reasons and had eating-related contextual skills (e.g., mindfulness when eating, planning regular and nutritious eating opportunities for themselves) were more likely to monitor their child's food intake. Mothers who had eating-related contextual skills were more likely to divide feeding responsibilities with their child. No maternal eating behavior predicted pressure to eat. Interventions to help mothers develop their eating-related contextual skills and eat intuitively, in particular, may translate into a more positive feeding environment for their young children.     

The determinants of negative maternal parenting behaviours: maternal,child, and paternal characteristics and their interaction

This study tested Belsky's determinants of parenting, namely maternal characteristics, child characteristics, and contextual issues, namely the mother's perception of the husband as a father, husband, and person. Three hundred and seventy-nine mothers first investigated by Sears, Maccoby, and Levin completed a standardised interview to assess their parenting attitudes and behaviours, as well as their five-year-old child's (202 boys, 177 girls) behaviours. Rejecting mothers had lower maternal self-esteem and higher academic expectations of their children, who showed less conscience and less similarity to the mother, and perceived their husbands as being colder towards the child. Furthermore, mothers with low self-esteem were more rejecting of girls with a difficult temperament, but less rejecting of boys with a difficult temperament. Controlling mothers were more educated and had higher academic expectations for their children, while their children were less likely to dominate their relationship, but only in mothers with low maternal self-esteem. Results partially support Belsky's model of the determinants of parenting.     

Disordered eating among preadolescent boys and girls: the relationship with child and maternal variables

Objective: (i) To analyze the eating behaviors and body satisfaction of boys and girls and to examine their mothers’ perceptions of these two domains; and (ii) to evaluate eating problem predictors using child body mass index (BMI), self-esteem, and body satisfaction as well as maternal BMI, eating problems, and satisfaction with their child’s body. The participants included 111 children (54.1% girls aged between 9 and 12 years old) and their mothers. Assessment measures included the Child Eating Attitude Test, the Self-Perception Profile for Children, the Eating Disorders Questionnaire, and the Child Eating Behavior Questionnaire. Child and maternal measures also included BMI and Collins Figure Drawings. Results: (i) No association between child and maternal BMI for either sex was found; (ii) no difference was found between boys and girls with regard to eating behavior; (iii) most children revealed a preference for an ideal body image over their actual body image; (iv) most mothers preferred thinner bodies for their children; (v) greater BMI was related to higher body dissatisfaction; and (vi) child BMI and dissatisfaction with body image predicted eating disturbances in boys, whereas self-esteem, maternal BMI, and eating behavior predicted them in girls. Discussion: Maternal eating problems and BMI were related to female eating problems only.     

The positive influence of maternal identification on body image, eating attitudes, and self-esteem of Hispanic and Anglo girls

OBJECTIVE: The role of maternal identification in the development of girls' body image, eating attitudes, and self-esteem was examined. METHOD: Hispanic and Anglo girls (n = 410) ages 8-13 were surveyed using the Body Esteem Scale (BES), the Children's Eating Attitudes Test, the Piers-Harris Children's Self-Concept Scale, and the Child Figure Drawing task. From this sample, normal-weight girls with high or low scores on the BES were selected for the main study. Ninety-two mother-daughter pairs participated in this second phase in which mothers completed similar questionnaires and girls performed a Q-sort task measuring maternal identification. RESULTS: Maternal identification was positively correlated with girls' self-esteem and negatively correlated with eating problems and body dissatisfaction. Also, mothers with high self-esteem tended to have daughters with high self-esteem. The mothers of girls with low BES scores found a significantly greater discrepancy than the mothers of girls with high BES scores when contrasting their daughters' current shape with either the ideal figure for their daughter or the figure they believed boys would find attractive. DISCUSSION: Girls who aspired to be like their mothers in terms of personality traits felt better about themselves and their bodies compared with girls with low maternal identification.     

The effect of maternal depression and marital adjustment on young children's internalizing and externalizing behaviour problems

BACKGROUND: The present study aimed to clarify the circumstances under which maternal depression is associated with adverse outcomes in pre-school-aged children, and to explore the additional impact of the marital relationship in a socio-economically low-risk sample. METHODS: Ninety-two mothers recruited into a longitudinal study were assessed for symptoms of depression when their children were 4, 12 and 15 months, and later at 4 years of age. At 4 years of age, mothers were also asked to report on marital adjustment. Mothers, fathers and pre-school teachers were asked to report on children's internalizing and externalizing behaviour problems. RESULTS: Children exposed to chronic maternal depression were rated by their parents as significantly more problematic on internalizing and externalizing behaviours. This association was not mediated or moderated by low marital satisfaction. No parent-reported effects were evident for children exposed to transient depression. Ten per cent of the children had internalizing scores in the clinical range, and 7% had externalizing scores in the clinical range. Almost all of the children with clinically elevated scores had been exposed to chronic maternal depression. Teacher reports of internalizing behaviours corroborated parent reports; however, teachers tended to report significantly lower levels of behaviour problems. Although there was a tendency for teachers to rate children exposed to any depression as more problematic on internalizing behaviours, the subgroup differences were not significant. CONCLUSIONS: Findings confirm that depression chronicity is important in determining child behavioural outcomes, and that depression effects cannot be accounted for by low marital adjustment. Results are discussed with reference to transmission of risk models, and treatment implications are considered.