Investigating the role of parent and child characteristics in healthy eating intervention outcomes

While numerous studies have investigated the efficacy of interventions at increasing children's vegetable consumption, little research has examined the effect of individual characteristics on intervention outcomes. In previous research, interventions consisting of modelling and rewards have been shown to increase children's vegetable intake, but differences were identified in terms of how much children respond to such interventions. With this in mind, the current study investigated the role of parental feeding practices, child temperament, and child eating behaviours as predictors of intervention success. Parents (N = 90) of children aged 2-4 years were recruited from toddler groups across Leicestershire, UK. Parents completed measures of feeding practices, child eating behaviours and child temperament, before participating in one of four conditions of a home-based, parent led 14 day intervention aimed at increasing their child's consumption of a disliked vegetable. Correlations and logistic regressions were performed to investigate the role of these factors in predicting intervention success. Parental feeding practices were not significantly associated with intervention success. However, child sociability and food fussiness significantly predicted intervention success, producing a regression model which could predict intervention success in 61% of cases. These findings suggest that future interventions could benefit from being tailored according to child temperament. Furthermore, interventions for children high in food fussiness may be better targeted at reducing fussiness in addition to increasing vegetable consumption

If at first you don't succeed:Assessing influences associated with mothers' reoffering of vegetables to preschool age children

Repeatedly offering vegetables has been shown to be one of the most effective methods for increasing acceptance and subsequent intake in young children. In order to increase successful offerings of vegetables and resultant consumption amongst young children, it is necessary to consider the influences on maternal reoffering of vegetables. This study aimed to investigate the relationships between mothers' tendency to reoffer vegetables and a range of demographic factors and psychological variables. A cross-sectional design was used, where mothers completed questionnaires assessing how often they reoffer rejected vegetables, concerns for economic factors, and a range of possible child and maternal influences. Mothers of preschool children were recruited from toddler groups across Leicestershire, UK, as well as online. Spearman's correlations were run to look for associations between demographic and psychological factors with maternal reoffering of vegetables. Significantly associated factors were then entered into a stepwise regression to predict maternal reoffering of vegetables. Mothers were significantly less likely to reoffer rejected vegetables if they were concerned about time, money, and waste, were influenced by their child's mood, or were concerned about their child having tantrums. Moreover, mothers who consumed more vegetables themselves reoffered vegetables more frequently. Regression analyses revealed that mothers' concern about food waste and tantrums, as well as maternal vegetable consumption, all significantly predicted mothers' reoffering of vegetables. With these findings in mind, mothers should be educated and supported with how to tackle and minimise children's tantrums during feeding, as well as being made aware of effective methods for avoiding food waste. Moreover, given that mothers' own vegetable consumption is associated with lower reoffering of vegetables to their child, interventions which seek to increase familial vegetable consumption should be pursued

The Child Feeding Guide:A digital health intervention for reducing controlling child feeding practices and maternal anxiety over time

Fussy eating and food refusal are common in young children. These behaviours can contribute to anxiety or concern in parents and caregivers, who have called for credible support to help them navigate the challenges of feeding young children. Given recent increases in technology, and use of the Internet as a trusted source of parenting support, the Child Feeding Guide digital health intervention was created to provide evidence-based support to parents and caregivers to help them to feed children and establish healthy eating habits from the early years. An evaluation was conducted with 25 mothers (with a child aged 6 months to 4 years) who used the Child Feeding Guide website/app over 4 weeks. Mothers provided information about their feeding practices and anxiety levels at baseline, and again 4 weeks later, and answered questions regarding the acceptability and use of the digital support resource. Significant decreases were seen in maternal anxiety and in maternal use of pressure to eat and restriction of food from children for weight reasons. Mothers reported that the Child Feeding Guide was easy to use, that they valued its credibility and reassurances, and that its content helped them to better understand their child’s eating behaviour. These promising findings suggest that naturalistic use of a digital health intervention could contribute to reductions in mothers’ use of controlling feeding practices and levels of anxiety. Such findings are important for supporting the development of healthy eating habits in young children and are likely to be relevant to health and childcare professionals

Teaching our children when to eat:how parental feeding practices inform the development of emotional eating-a longitudinal experimental design

Background: Emotional eating in children has been related to the consumption of energy-dense foods and obesity, but the development of emotional eating in young children is poorly understood. Objectives: We evaluated whether emotional eating can be induced in 5-7-y-old children in the laboratory and assessed whether parental use of overly controlling feeding practices at 3-5 y of age predicts a greater subsequent tendency for children to eat under conditions of mild stress at ages 5-7 y. Design: Forty-one parent-child dyads were recruited to participate in this longitudinal study, which involved parents and children being observed consuming a standard lunch, completing questionnaire measures of parental feeding practices, participating in a research procedure to induce child emotion (or a control procedure), and observing children's consumption of snack foods. Results: Children at ages 5-7 y who were exposed to a mild emotional stressor consumed significantly more calories from snack foods in the absence of hunger than did children in a control group. Parents who reported the use of more food as a reward and restriction of food for health reasons with their children at ages 3-5 y were more likely to have children who ate more under conditions of negative emotion at ages 5-7 y. Conclusions: Parents who overly control children's food intake may unintentionally teach children to rely on palatable foods to cope with negative emotions. Additional research is needed to evaluate the implications of these findings for children's food intake and weight outside of the laboratory setting. This trial was registered at clinicaltrials.gov as NCT01122290

Clustering and correlates of screen-time and eating behaviours among young children

Background: Screen-time and unhealthy dietary behaviours are highly pervasive in young children and evidence suggests that these behaviours often co-occur and are associated. Identifying clusters of unhealthy behaviours, and their influences early in childhood, can assist in the development of targeted preventive interventions. The purpose of this study was to examine the sociodemographic, behavioural, and home physical environmental correlates of co-occurring screen-time and unhealthy eating behaviours and to assess the clustering of screen-time and unhealthy dietary behaviours in young children. Methods: Parents of 126 children, from the UK, aged 5–6 years (49% boys) completed a questionnaire which assessed their child’s screen-time (ST), fruit and vegetable (FV), and energy-dense (ED) snack consumption. Categories of health behaviours were created based on frequencies of children meeting recommendations for FV and ST and median splits of frequencies for ED snacks. Parents reported on their own behaviours (ST, FV, and ED snack consumption), how often they ate meals and watched TV with their child, and on the availability and accessibility of foods within the home. An observed over expected ratio (O/E) was used to assess behavioural clustering. Multivariable multinomial logistic regression was used to examine correlates of behaviour patterns. Results: Approximately 25% of children had two or three health risk behaviours. Correlates consistently associated with clusters included parental income, eating meals at the TV, parental ST and ED snack food consumption, and home availability of ED snack foods. Observed over expected ratios were close to 1 and ranged from 0.78 to 1.43. The three-risk behaviour combination of insufficient FV consumption, high ED snack consumption, and excessive ST occurred more frequently than expected (1.23 (95% CI 0.89, 1.58)). Conclusions: ST and unhealthy dietary behaviours cluster in children as young as 5 years of age and parents’ own behaviours appear to be important influencing factors. Further research into the development of behavioural clustering in young children to identify and further understand the mechanisms underlying the synergy among health behaviours is needed. Feasibility interventions promoting reductions in both screen-time and unhealthy dietary behaviours reciprocally, while simultaneously focusing on changing parental behaviours, are warranted

Role-model, reoffer, reward: A thematic analysis and TDF mapping of influences on families’ use of evidence-based vegetable feeding practices

Children's vegetable intake is low, despite benefits for immediate and long-term health. Repeatedly reoffering vegetables, role-modelling consumption, and offering non-food rewards effectively increase children's vegetable acceptance and intake. However, a number of barriers prevent families from reoffering previously-rejected vegetables. This study used the Theoretical Domains Framework (TDF) and the COM-B model of behaviour to explore barriers and enablers to reoffering, role-modelling and offering non-food rewards among parents of 2-4-year-old children. Twenty-five semi-structured interviews were conducted, from which eleven core inductive themes were generated: ‘Child factors’, ‘Eating beliefs’, ‘Effectiveness beliefs’, ‘Past experience’, ‘Current family behaviours’, ‘Harms’, ‘Knowledge’, ‘Need for change’, ‘Parent effort’, ‘Parent values’ and ‘Practical issues’. The codes underpinning these themes were inductively mapped to 11 of the 14 TDF domains, and five of the six COM-B components. Previously-reported influences on families' vegetable feeding practices were confirmed, including concerns about child rejection of foods/meals, cost of vegetables, and food waste. Novel findings included some parents' perceptions that these practices are pressurising, and that certain beliefs/knowledge about children's eating behaviour can provide a “protective mindset” that supports families' perseverance with reoffering over time. Future interventions should be tailored to better reflect the diversity of needs and previous experiences of feeding that families have, with some families likely to find that troubleshooting and further signposting is appropriate for their needs while others might benefit from more persuasive and educational approaches. The mapping of codes to the TDF and COM-B will facilitate the identification of appropriate intervention functions and behaviour change techniques when designing new interventions to support families with increasing their children's vegetable intake

Clustering and correlates of screen-time and eating behaviours among young adolescents

Background: Screen-time and eating behaviours are associated in adolescents, but few studies have examined the clustering of these health behaviours in this age group. The identification of clustered health behaviours, and influences on adolescents’ clustered health behaviours, at the time when they are most likely to become habitual, is important for intervention design. The purpose of this study was to assess the prevalence and clustering of health behaviours in adolescents, and examine the sociodemographic, individual, behavioural, and home social and physical environmental correlates of clustered health behaviours. Methods: Adolescents aged 11–12 years (n=527, 48% boys) completed a questionnaire during class-time which assessed screen-time (ST), fruit and vegetable (FV), and energy-dense (ED) snack consumption using a Food Frequency Questionnaire. Health behaviours were categorised into high and low frequencies based on recommendations for FV and ST and median splits for ED snacks. Adolescents reported on their habits, self-efficacy, eating at the television (TV), eating and watching TV together with parents, restrictive parenting practices, and the availability and accessibility of foods within the home. Behavioural clustering was assessed using an observed over expected ratio (O/E). Correlates of clustered behaviours were examined using multivariate multinomial logistic regression. Results: Approximately 70% reported having two or three health risk behaviours. Overall, O/E ratios were close to 1, which indicates clustering. The three risk behaviour combination of low FV, high ED, and high ST occurred more frequently than expected (O/E ratio = 1.06 95% CI 1.01, 1.15. Individual, behavioural, and social and physical home environmental correlates were differentially associated with behavioural clusters. Correlates consistently associated with clusters included eating ED snacks while watching TV, eating at the TV with parents, and the availability and accessibility of ED snack foods within the home. Conclusions: There is a high prevalence of screen time and unhealthy eating, and screen time is coupled with unhealthy dietary behaviours. Strategies and policies are required that simultaneously address reductions in screen time and changes to habitual dietary patterns, such as TV snacking and snack availability and accessibility. These may require a combination of individual, social and environmental changes alongside conscious and more automatic (nudging) strategies

Unpacking the relationships between positive feeding practices and children's eating behaviours:The moderating role of child temperament

Evidence suggests that children's eating behaviours are influenced by the feeding practices which parents employ. Furthermore, parents may alter the feeding practices they use according to their child's temperament. However, there is a paucity of literature on how children's temperament moderates the relationship between parents' use of feeding practices and children's eating behaviours. One hundred and eleven mothers of 2 to 4-year-old children completed questionnaire measures of their feeding practices along with their child's eating behaviours and temperament. Two-tailed Spearman's correlations revealed that mothers' use of a range of positive (health promoting) feeding practices was associated with greater enjoyment of food and lower food fussiness among children. Moderation analyses found that relationships between mothers involving their children in food choice and preparation and children's eating behaviours were moderated by children's temperament. Involvement in food choice and preparation was no longer associated with higher enjoyment of food and lower fussiness for children who were either highly emotional or low in sociability. These findings suggest that while many previously identified positive feeding practices may be associated with more healthy eating for all children, some may be less helpful or less achievable with children who have particular temperamental traits. Future research should seek to develop interventions to promote healthy eating which are tailored towards children's individual characteristics

Authors’ Reply to Richardson and Chen: Comment on “Sport and transgender people: a systematic review of the literature relating to sport participation and competitive sport policies”

Letter to the editor. This letter refers to the article available at https://doi.org/10.1007/s40279-016-0621-y