The impact of child care providers' feeding on children's food consumption

BACKGROUND: In young children, the eating environment is an important social context within which eating behaviors develop. Among many low-income young children, the responsibility for feeding may have shifted from family members to child care providers because these children spend the majority of their day in child care settings. METHODS: To examine the influence of feeding among low-income children in child care settings, feeding behaviors of child care providers in Head Start were observed and food consumption was assessed. Head Start, a comprehensive child development program that serves children from ages 3 to 5, was chosen because of the large percentage of minorities, the low-income status of the families, and the age of the children. Fifty child care providers (25 African-American; 25 Hispanic) randomly selected from Head Start centers in a large, urban southwestern city were observed on three mealtime occasions and self-reported feeding styles were assessed. Observed feeding behaviors were categorized into four feeding patterns based on their conceptual similarity to a general parenting typology (i.e., authoritarian, authoritative, indulgent, and uninvolved). Measures of food consumption were assessed on 549 children sitting with the child care providers during lunch at the Head Start centers. RESULTS: Indulgent feeding behaviors were positively related to children's consumption of vegetables, dairy, entrée, and starch; authoritative feeding behaviors were positively related to dairy consumption. CONCLUSION: This research highlights the important influence that child care providers have in the development of healthy and unhealthy eating behaviors in minority children. Implications for intervention training for child care providers to promote healthy eating among Head Start children are discussed.     

Body size preferences and food choice among mothers and children in Malawi

Overweight in mothers and children in sub‐Saharan Africa is rapidly increasing and may be related to body size perceptions and preferences. We enrolled 268 mother–child (6–59 months) pairs in central Malawi; 71% of mothers and 56% of children were overweight/obese, and the remainder were normal weight. Interviewers used seven body silhouette drawings and a questionnaire with open‐ and closed‐ended questions to measure mothers' perceptions of current, preferred and healthy maternal and child body sizes and their relation to food choices. Overweight/obese and normal weight mothers' correct identification of their current weight status (72% vs. 64%), preference for overweight/obese body size (68% both) and selection of an overweight/obese silhouette as healthy (94% vs. 96%) did not differ by weight status. Fewer overweight/obese than normal weight mothers' preferred body silhouette was larger than their current silhouette (74% vs. 29%, p < .001). More mothers of overweight than normal weight children correctly identified the child's current weight status (55% vs. 42%, p < .05) and preferred an overweight/obese body size for the child (70% vs. 58%, p < .01), and both groups selected overweight/obese silhouettes as healthy for children. More than half of mothers in both groups wanted their child to be larger than the current size. Mothers said that increasing consumption of fruits, vegetables, meat, milk, grains, fizzy drinks and fatty foods could facilitate weight gain, but many cannot afford to purchase some of these foods. Their desired strategies for increasing weight indicate that body size preferences may drive food choice but could be limited by affordability.     

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.     

How children affect the mother/victim's process in intimate partner violence

BACKGROUND: Witnessing intimate partner violence (IPV) causes physical and mental health problems for children. Children are one of multiple factors that a victim weighs as she manages the abusive relationship. Little has been written about how children affect the mother's decisions about the abuse or what assistance a mother wants from the children's physician in creating a nonabusive home. OBJECTIVE: To consider the role children play in their mothers' management of abusive partners. METHODS: Thirty-two mothers living in midwestern IPV shelters or participating in support groups were interviewed about their abuse stories, perceptions about the effects of the abuse on their children, and desires about IPV management in the health care setting. The interviews were audiotaped, transcribed, and analyzed by a team of researchers using thematic analysis. RESULTS: Children were an integral factor in the mothers' management of their abusive relationships. For more than half of the participants, something the children did or said catalyzed their seeking help. For some, the children's attachment to the abuser was a reason to delay seeking assistance. Based on these findings, we explored what mothers wanted from their children's physicians regarding their abusive relationships. Mothers talked about the delicate balance between education and blame, between offering help and becoming too intrusive, and between wanting the best for their children and fearing the involvement of child protective services. CONCLUSIONS: Children play an important role in mothers' management of their abusive relationships. From their children's physicians, participants wanted IPV screening and IPV resources. Some wanted the physician to educate them about how the IPV affected the children in a nonblaming manner.     

Early childhood care and education: effects on ethnic and racial gaps in school readiness

The authors examine black, white, and Hispanic children's differing experiences in early childhood care and education and explore links between these experiences and racial and ethnic gaps in school readiness. Children who attend center care or preschool programs enter school more ready to learn, but both the share of children enrolled in these programs and the quality of care they receive differ by race and ethnicity. Black children are more likely to attend preschool than white children, but may experience lower-quality care. Hispanic children are much less likely than white children to attend preschool. The types of preschool that children attend also differ. Both black and Hispanic children are more likely than white children to attend Head Start. Public funding of early childhood care and education, particularly Head Start, is already reducing ethnic and racial gaps in preschool attendance. The authors consider whether further increases in enrollment and improvements in quality would reduce school readiness gaps. They conclude that incremental changes in enrollment or quality will do little to narrow gaps. But substantial increases in Hispanic and black children's enrollment in preschool, alone or in combination with increases in preschool quality, have the potential to decrease school readiness gaps. Boosting enrollment of Hispanic children may be especially beneficial given their current low rates of enrollment. Policies that target low-income families (who are more likely to be black or Hispanic) also look promising. For example, making preschool enrollment universal for three- and four- year-old children in poverty and increasing the quality of care could close up to 20 percent of the black-white school readiness gap and up to 36 percent of the Hispanic-white gap.     

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.     

Preschoolers of Dysphoric Mothers

Dysphoric mothers rated their preschool children as having more internalizing and externalizing behavior problems than children of nondysphoric mothers. Observers rated the dysphoric mothers as having more negative affect during play interactions, although their children's affect was not rated more negatively. The dysphoric mother-infant dyads were also rated as having a poorer quality interaction. These data suggest that mothers' chronic dysphoria (75% were chronically dysphoric) has a negative impact on the mothers' perceptions of their children as well as the mothers' and children's interaction behavior.     

The role of child care settings in obesity prevention

Mary Story, Karen Kaphingst, and Simone French argue that researchers and policymakers focused on childhood obesity have paid insufficient attention to child care. Although child care settings can be a major force in shaping children's dietary intake, physical activity, and energy balance-and thus in combating the childhood obesity epidemic-researchers know relatively little about either the nutrition or the physical activity environment in the nation's child care facilities. What research exists suggests that the nutritional quality of meals and snacks may be poor and activity levels may be inadequate. Few uniform standards apply to nutrition or physical activity offerings in the nation's child care centers. With the exception of the federal Head Start program, child care facilities are regulated by states, and state rules vary widely. The authors argue that weak state standards governing physical activity and nutrition represent a missed opportunity to combat obesity. A relatively simple measure, such as specifying how much time children in day care should spend being physically active, could help promote healthful habits among young children. The authors note that several federal programs provide for the needs of low-income children in child care. The Child and Adult Care Food Program, administered by the Department of Agriculture, provides funds for meals and snacks for almost 3 million children in child care each day. Providers who receive funds must serve meals and snacks that meet certain minimal standards, but the authors argue for toughening those regulations so that meals and snacks meet specific nutrient-based standards. The authors cite Head Start, a federal preschool program serving some 900,000 low-income infants and children up to age five, as a model for other child care programs as it has federal performance standards for nutrition. Although many child care settings fall short in their nutritional and physical activity offerings, they offer untapped opportunities for developing and evaluating effective obesity-prevention strategies to reach both children and their parents.     

Maternal perceptions of lead poisoning in children with normal and elevated lead levels.

INTRODUCTION: The purpose of this study was to examine mothers' perceptions of the severity and susceptibility of their children to lead poisoning and to determine if a correlation existed between mothers' knowledge of lead poisoning and their children's blood lead levels. It was thought that mothers of children with lead poisoning (lead levels > or = 10 micrograms/dL) would score lower on a test of their perceptions and knowledge of lead poisoning than would mothers of children with normal lead levels (lead levels < or = 9 micrograms/dL). METHOD: A cross-sectional study comparing scores of a questionnaire completed by mothers whose children had elevated blood lead levels and mothers whose children had normal blood lead levels was conducted. RESULTS: No difference was found in the median test score between the 2 groups. For the correct responses on a question-by-question comparison, significant difference existed between groups; however, the percentage of correct responses was not always greater for the mothers of children with normal blood lead levels. DISCUSSION: Mothers' perceptions and knowledge of lead poisoning were not associated with their children's blood lead levels.     

Maternal prepregnancy body mass index in relation to Hispanic preschooler overweight/obesity

The aim of the current study was to examine the role of maternal prepregnancy body mass index (BMI) on overweight/obesity among US Hispanic children ages 2 and 4 years old. We used US nationally representative data from preschoolers enrolled in the Early Childhood Longitudinal Study-Birth Cohort study. The findings revealed that a significantly higher percent (41.6%) of Hispanic mothers were overweight/obese prior to pregnancy compared to white mothers (34.8%). At 2 years of age, 38.3% of the children born to Hispanic mothers were overweight/obese compared to 29.4% of children born to white mothers. By the age of 4, overweight/obesity increased significantly for both racial/ethnic groups with preschoolers whose mothers were Hispanic being more likely to be overweight/obese (44.6%) compared to children whose mothers were white (34.2%). Further, preschoolers born to overweight/obese Hispanic mothers were more than twice as likely [odds ratio = 2.74 (95% confidence interval (CI) 1.60, 4.69)] to be overweight/obese than those born to Hispanic mothers of normal prepregnancy BMI. Preschoolers born to overweight/obese white mothers were approximately 1.4 (95% CI 1.05, 1.93) times more likely to be overweight/obese in comparison to those born to mothers with a normal prepregnancy BMI. Maternal prepregnancy weight is potentially a modifiable risk factor for preschooler overweight/obesity. Study findings support the design of early and targeted interventions to reduce this risk to the long-term health of Hispanic maternal and child dyads.     

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.     

Maternal feeding practices and beliefs and their relationships to overweight in early childhood.

To better explore possible factors that may lead to childhood obesity, we developed and analyzed two new instruments that assess maternal feeding practices and beliefs. The Infant Feeding Questionnaire (IFQ) assesses feeding during the entire first year of life and was administered to 453 mothers of children 11 to 23 months old. The Preschooler Feeding Questionnaire (PFQ) assesses feeding of young children between the ages of 2 to 5 years and was administered to 634 mothers of children this age. Each questionnaire was factor analyzed and mean factor scores were calculated and linked with the children's measured and mothers' self-reported weight and height. Mean factor scores from the IFQ and PFQ were compared between mothers who were obese (body mass index > or = 30 kg/m2) and those who were nonobese, between those who did and those who did not have an overweight child (weight-for-height > or = 90th percentile), and between those who had a low income (< or = 185% of the poverty level) and those who had a high income. To control for confounding variables and to detect interaction among variables, hierarchical linear regression was used. Results from this study did not suggest that there is a particular "feeding style" that is associated with overweight in young children; however, there were differences found in feeding behaviors between high and low income mothers.     

Mothers' perceptions of anxiety of their diabetic children

Within the theoretical framework of family dynamics, the anxiety levels expressed by 20 diabetic children, the level of anxiety ascribed to them by their mothers, and the anxiety levels of 20 healthy children were studied. The diabetic children did not form an emotionally deviant group in terms of their expressed anxiety, although their mothers viewed them as significantly more anxious than they judged themselves. The mothers' own anxiety was the best predictor of their perceptions of their children's anxiety. The results are discussed in terms of their effects on communication and coping in the families.     

Developmental and Health Services in Head Start Preschools: A Tiered Approach to Early Intervention

ObjectiveTo describe a tiered approach to identifying and addressing developmental and health concerns among low-income preschool children in Head Start.MethodsAnalytic sample consisted of 3- to 5-year-old Head Start students (n = 1171) from 14 centers in Los Angeles County serving predominantly Latino families during 2008−2009. All Head Start students were screened for developmental and health concerns and assigned to 1 of 3 tiers of intervention need: Tier 1 children needed only the usual Head Start curriculum, Tier 2 children needed targeted interventions (excluding special education), and Tier 3 students received special education services. Logistic regressions were used to analyze predictors of each tier, with screening results and sociodemographic variables as covariates.ResultsSixty-nine percent of children were in Tier 1, 25% in Tier 2, and 6% in Tier 3. Tier 2 children most commonly needed mental health services and were less likely than those in Tier 1 to be from primarily English-speaking homes (odds ratio = 0.6, P < .01). Tier 3 children were significantly less likely to be female than Tier 2 children (odds ratio = 0.4, P < .05).ConclusionsMore than one-quarter of low-income children not in special education may need targeted interventions, particularly mental health services. Although Head Start agencies are required to identify and address these needs, many other early education and clinical settings do not. Establishing screening and intervention guidelines for this intermediate-risk group represents a key policy gap for the child health and education systems.     

Violence exposure and traumatic stress symptoms as additional predictors of health problems in high-risk children

OBJECTIVE: To test the hypotheses that both violence and traumatic stress symptoms are associated with negative health status among poor preschool children. STUDY DESIGN: This cross-sectional analysis of a Head Start preschool age cohort (n = 160) studied health outcomes parallel to those assessed in the 2001 National Health Interview Survey of child health (asthma, allergy, attention deficit hyperactivity disorder, global appraisal) as well as two stress-related somatic complaints, gastrointestinal problems and headache. Risk factors include sociodemographics, mothers' health factors, extent of exposure to violence and maltreatment, and mother- and teacher-reported traumatic stress symptoms. RESULTS: Compared with poor children in the National Health Interview Survey and their Head Start peers, children exposed to violence and those with high levels of traumatic stress had significantly worse outcomes, in a dose-response relation. Being abused, exposed to domestic violence, and having a mother using substances were associated with a higher number of health problems. The hierarchical model established the mother's own poor physical health and the child's level of traumatic stress as the strongest predictors of poor child health. CONCLUSIONS: These two risk factors are amenable to intervention by health care providers who treat children.     

Screen Time at Home and School among Low-Income Children Attending Head Start

Objective

To describe the patterns of screen viewing at home and school among low-income preschool-aged children attending Head Start and identify factors associated with high home screen time in this population. Few studies have examined both home and classroom screen time, or included computer use as a component of screen viewing.

Methods

Participants were 2221 low-income preschool-aged children in the United States studied in the Head Start Family and Child Experiences Survey (FACES) in spring 2007. For 5 categories of screen viewing (television, video/DVD, video games, computer games, other computer use), we assessed children’s typical weekday home (parent-reported) and classroom (teacher-reported) screen viewing in relation to having a television in the child’s bedroom and sociodemographic factors.

Results

Over half of children (55.7 %) had a television in their bedroom, and 12.5 % had high home screen time (>4 h/weekday). Television was the most common category of home screen time, but 56.6 % of children had access to a computer at home and 37.5 % had used it on the last typical weekday. After adjusting for sociodemographic characteristics, children with a television in their bedroom were more likely to have high home screen time [odds ratio?=?2.57 (95 % confidence interval: 1.80–3.68)]. Classroom screen time consisted almost entirely of computer use; 49.4 % of children used a classroom computer for ≥1 h/week, and 14.2 % played computer games at school ≥5 h/week.

Conclusions

In 2007, one in eight low-income children attending Head Start had >4 h/weekday of home screen time, which was associated with having a television in the bedroom. In the Head Start classroom, television and video viewing were uncommon but computer use was common.     

Recurrent otitis media and parenting stress in mothers of two-year-old children.

This study examined the impact of recurrent otitis media on mothers' perceptions of themselves and of their 2-year-old children. Fifty-two mothers of children with and without histories of recurrent otitis media completed measures that rated the level of stress in the mother-child relationship at two points in time. The mothers of children who experienced six or more episodes of otitis media in the first 2 years of life rated their children as significantly more demanding at age two and at follow-up 6 months later than did the mothers of children who experienced no more than one episode of the illness. At the first point in time, these mothers also rated themselves as significantly more depressed and less competent than did control mothers, a pattern that was maintained at the follow-up. Findings of the study suggest that recurrent otitis media early in life may contribute to adverse perceptions of child and self that may persist for some time after the child has been relatively disease free and further suggest that parental perceptions may mediate relationships between early recurrent otitis media and later developmental outcomes.