April 2011 Issue

Parent-Child Interaction During Feeding — How It May Influence Kids’ Weight and Relationship With Food
By Christin L. Seher, MS, RD, LD
Today’s Dietitian
Vol. 13 No. 4 P. 32

With many social, environmental, cultural, and nutritional factors contributing to childhood obesity, parenting may not be the first one that comes to mind. When parenting does enter the discussion, parents’ food choices, whether they provide sufficient opportunity for physical activity, and their modeling of healthful behaviors tend to draw the most attention.

The 2008 Feeding Infants and Toddlers Study (FITS), however, highlights the importance of the way in which parents and caregivers interact with children during mealtimes in setting the stage for children’s relationship with food, which not only influences nutritional choices throughout the lifespan but also impacts food preferences, eating habits, and self-regulation of caloric intake. And, as recent research suggests, the way in which parents interact with children during feeding can also impact children’s weight, even at a very early age.

Different Parenting and Feeding Styles
First described by developmental psychologist Diana Baumrind during the 1970s and later expanded on by Maccoby and Martin in 1984, “parenting style” is a well-recognized term for describing how parents interact with their children in daily life. By characterizing behavior along two dimensions—control/demandingness and warmth/responsiveness—four general parenting styles emerge: authoritative (high control, high responsiveness), authoritarian (high control, low responsiveness), indulgent/permissive (low control, high responsiveness), and neglectful/uninvolved (low control, low responsiveness).

Authoritarian parents are described as being “too hard,” overbearing, and controlling and constantly telling children what to do without giving consideration to children’s perspectives or providing a rationale for their own decisions. Indulgent/permissive parents are viewed as being “too soft,” letting children do what they please and not setting limits or providing boundaries for behavior. Neglectful/uninvolved parents provide basic care for their children but take a “hands-off” approach to parenting, often emotionally disengaging from their children. Authoritative parenting, however, is considered to strike a “just-right” balance between setting appropriate limits for children while expecting maturity and allowing children to experiment with their own decision-making skills.1 This democratic, responsive style of parenting has been consistently associated with optimal child development.1

A person’s overall parenting style can also determine his or her attitude toward feeding a child. As early as the 1980s, researchers were examining how parent-child interactions in the context of feeding influence a child’s nutritional status. Much of this early research on the influence of parenting came from Leann Birch’s work at Penn State University. Birch and colleagues conducted many of the seminal studies in this area and were the first to adapt and apply Baumrind’s taxonomy of parenting to explain different ways of feeding. In this regard, they identified several feeding styles to describe the way in which parents interact with their children.

An authoritarian feeding style manifests as maintaining a high level of control over a child by restricting access to specific foods (often unhealthful foods), pressuring a child to eat, and forcing a child to consume food with little regard for his or her preferences.2 Parents with an indulgent/permissive feeding style allow their children total freedom with their food choices and the amount of food they consume, leading some to equate this type of feeding with “nutritional neglect.”2 Parents with an authoritative feeding style operate democratically, allowing children to exert some control in the process. For example, authoritative parents might control food choices (and their healthfulness) through the meals they offer and prepare but allow children to choose which foods from these meals they would like to consume and in what amount.2

One of the current questions up for debate is whether an individual’s general parenting style aligns with his or her feeding style. According to Katie Kavanagh, PhD, RD, LD, an assistant professor of nutrition at the University of Tennessee, Knoxville, “It is certainly intuitive that an authoritative parenting style—the ideal—would be likely to manifest as an authoritative feeding style—[researchers] think the ideal.” Yet Kavanagh emphasizes caution in assuming this is always the case because “this connection has not yet been solidly explored [enough to] definitively say that a certain parenting style manifests as a certain feeding style … though the probability is great.”

Most studies to date have supported the association between caregivers’ general parenting style and their feeding style, with several studies showing a strong correlation.1,3,4 Additionally, research indicates that parents’ feeding style remains relatively stable over time and does not change as their children age.5

Effect on Children’s Weight
Most of the research examining the effect of parent-child interactions during feeding looks at preschool-aged to adolescent children, but parenting likely starts to influence a child’s weight during infancy. As a study published in the October 2010 issue of the Journal of the American Dietetic Association suggests, Kavanagh and colleagues theorized that the infant-oriented feeding practices characteristic of authoritative parents may offer some protective health benefits, while feeding practices that are caregiver oriented may predispose a child to infant obesity. Such infant-oriented feeding practices they described include managing infant behaviors (eg, fussiness, gas, spitting up, sleeping habits) through physical and emotional means (eg, rocking, talking, changing a diaper, swaddling) before offering breast, bottle, or solids as a solution. Caregiver-oriented feeding practices use food as a primary coping strategy. Parents are quick to offer food as comfort (often to get the baby to adhere to their idea of a routine) and may misinterpret infant cues, both of which could lead to overfeeding. Feeding in this manner is concerning, as recent research has demonstrated infant weight at 6 months of age to be highly predictive of future weight.6

However, Kavanagh cautions that while “much of our current education—eg, ‘feeding on demand’ for breast-feeding mothers and educating formula-feeding mothers on infant satiety cues—is targeting the authoritative behavior of high responsiveness, we don’t have enough data to say that this can positively impact both over[feeding] and underfeeding.” However, she notes, “One would hypothesize that, were a mother to feed with high responsiveness—and [be] accurately responsive—then the infant should, in most cases, be able to self-regulate intake, which could allow for appropriate weight gain.”

Supporting Kavanagh’s comments is a recent study examining the feeding relationship among almost 100 mother-infant pairs participating in the Supplemental Nutrition Program for WIC. The results of this study, published in the Journal of Nutrition Education and Behavior in 2009, indicated that the level of maternal sensitivity to infant feeding and satiety cues impacts children’s weight status at the age of 1. Those mothers who are less responsive to infants’ cues have children who are more likely to be overweight by this point.

Published in 2006 in Pediatrics, a study by Rhee and colleagues examining data from almost 900 toddlers enrolled in the National Institutes of Child Health and Human Development Study of Early Childcare and Youth Development demonstrates the impact that parenting has on children’s weight status. In this study, children whose parents were categorized as authoritarian (in general parenting style) were more likely to be overweight (at the time of the study, BMI was considered greater than the 95th percentile) than those who had authoritative parents. Even more dramatic, children of indulgent/permissive and neglectful/uninvolved parents were twice as likely to be overweight than their peers with authoritative parents. Research using a different sample of 718 children enrolled in Head Start confirmed these results, with the indulgent/permissive parenting style being associated with children with a significantly higher BMI.7

Prospective studies have indicated that in addition to overall parenting style, caregivers’ feeding style may influence children’s weight over time, especially in children considered at high risk of obesity. A 2004 study found that for children predisposed to obesity, having parents who exhibited authoritarian feeding practices (eg, food restriction) resulted in additional weight gain (over the two-year study period); those parents who reported higher concern for their child’s weight were more likely to engage in these authoritarian feeding practices.5 In this sample, authoritative feeding behaviors were associated with more positive weight outcomes.

Despite these results, a review by Wardle et al examining the relationship between parenting and children’s adiposity cautioned that not all studies conducted thus far have been conclusive enough to warrant immediate action.8 The authors note that methodological inconsistencies are abundant in the literature; the samples studied have been relatively homogeneous; and more longitudinal studies are needed to address causality before evidence-based guidelines can be adopted.

Impact on Food Preference, and Beyond
In 1985, Costanzo and Woody first began studying the impact of parenting on children’s weight. They proposed that parents who were overly concerned or preoccupied with children’s weight status, believed children were at risk of health or weight issues, or did not feel children were capable of self-control over feeding exerted more control in the feeding relationship.9 They hypothesized that these behaviors could possibly impede children’s ability to recognize hunger and satiety cues, leading to overweight or obesity.10 Subsequent research has confirmed this hypothesis, indicating that behaviors associated with an authoritarian feeding style (eg, restricting access to foods, pressuring a child to eat certain foods) are associated with negative outcomes, such as the ability to self-regulate intake.10,11

In fact, one study conducted in the United Kingdom demonstrated that children of mothers who restricted access to unhealthful foods would actually increase the amount they would consume when offered these foods.12 These results support several other studies that show restricting access to unhealthful foods in an attempt to mitigate negative health outcomes or influence children’s weight can actually increase their preference for the restricted foods (even in the absence of hunger), diminish self-control in eating, and refocus their attention away from internal satiety cues to the external eating environment.10 Additionally, the U.K. study found that pressuring children to eat results in decreased enjoyment of food, fussiness, slowness, and early satiety. This finding also confirms previous research that pressure to eat particular foods has negative effects on feeding behavior.10,12

Parenting may also impact weight by influencing children’s consumption of nutrient-rich foods. A 2009 study published in the International Journal of Behavioral Nutrition and Physical Activity by Hoerr and colleagues demonstrated that children of parents who exhibited indulgent/permissive or neglectful/uninvolved feeding styles consumed less fruit and 100% fruit juice, fewer vegetables, and fewer dairy products. This study, which was conducted with more than 700 racially diverse, low-income Head Start participants, expands on previous research indicating that general parenting style can influence the consumption of nutrient-rich foods, particularly fruits, vegetables, and dairy products.2,13 These results indicate that a child’s intake can be influenced not only by general parenting style but also through more specific parent feeding practices.

Interpreting the literature regarding the effect of parenting on the consumption of specific foods is complicated by the fact that researchers are not uniformly assessing parent-child interactions using the same terminology. For example, one study of more than 750 preschool students in Belgium found no association between fruit and vegetable consumption and general parenting style.3 However, the study did demonstrate that parents who utilized child-centered feeding practices, such as allowing children to choose appropriate foods, helping children eat, and saying something positive about food—which equate to an authoritative feeding style—had children who consumed more fruits and vegetables than those who used parent-centered feeding practices such as showing disapproval for not eating, using food as a reward, and physically struggling with or spoon feeding the child (characteristic of authoritarian feeding).

Also of consideration is the fact that feeding style is influenced by myriad social, cultural, and environmental factors that can be heavily rooted in normative behaviors for sex, race, ethnicity, and socioeconomic status and strongly dictated by the nutrition environment. Additionally, researchers have a difficult time accounting for the interplay between parenting or feeding style and personality characteristics of a child as temperament, adaptability, and openness to try new foods may mediate the effect that parents have in influencing children’s relationship with food.3

Keep Parenting in Mind
Researchers examining the impact of parenting on child nutrition agree that failing to address underlying parent-child dynamics in nutrition education and interventions efforts is a major mistake. While most exercise caution in citing parenting as a direct cause of negative health outcomes, it is now well recognized that the way parents and children interact during mealtimes does indeed affect feeding.

Carolyn Ievers-Landis, PhD, an associate professor of pediatrics in developmental/behavioral pediatrics and psychology at Rainbow Babies & Children’s Hospital of University Hospital’s Case Medical Center in Cleveland, Ohio, believes practitioners should share this research with the parents with whom they work, emphasizing to them that “their parenting matters.”

“Parents who establish regular mealtime routines and who engage in positive yet directive parenting practices during mealtimes have children with the best eating habits,” she says. “Feeding style is very important to consider for parents having the greatest success in supporting their children in living healthy lives, including the consumption of a nutritious diet.”

Research supports this advice, with several intervention studies demonstrating better outcomes when parents are targeted rather than those initiatives that focus exclusively on children.14

According to Ievers-Landis, practitioners working with families can incorporate strategies that take a parent’s feeding style into account by “counseling parents regarding how to provide a healthful eating environment and a positive, supportive dinnertime routine. This includes expectations for the child to sit at the table, eat with the family while discussing their day, and taking small tastes of nonpreferred foods. Lots of praise should accompany the child making healthy choices and trying new foods.”

Sarah Krieger, MPH, RD, LD/N, national spokesperson for the American Dietetic Association, agrees, saying, “Mealtime should be about connecting with our kids. … I encourage families to keep the conversation positive and avoid criticizing as well as avoiding negative comments about the food. Eating should be pleasurable, and that attitude starts with the parents.”

— Christin L. Seher, MS, RD, LD, is founder of Strategic Health Solutions, LLC, serving northeastern Ohio.

 

References
1. Hughes SO, Power TG, Fisher JO, Mueller S, Nicklas TA. Revisiting a neglected construct: Parenting styles in a child-feeding context. Appetite. 2005;44(1):83-92.

2. Patrick H, Nicklas T, Hughes SO, Morales M. The benefits of authoritative feeding style: Caregiver feeding styles and children’s food consumption patterns. Appetite. 2005;44(2):243-249.

3. Vereecken C, Rovner A, Maes L. Associations of parenting styles, parental feeding practices and child characteristics with young children’s fruit and vegetable consumption. Appetite. 2010;55(3):589-596.

4. Hubbs-Tait L, Kennedy TS, Page MC, Topham GL, Harrist AW. Parental feeding practices predict authoritative, authoritarian, and permissive parenting styles. J Am Diet Assoc. 2008;108(7):1154-1161.

5. Faith MS, Berkowitz RI, Stallings VA, Kerns J, Storey M, Stunkard AJ. Parental feeding attitudes and styles and child body mass index: Prospective analysis of a gene-environment interaction. Pediatrics. 2004;114(4):e429-e436.

6. McCormick DP, Sarpong K, Jordan L, Ray LA, Jain S. Infant obesity: Are we ready to make this diagnosis? J Pediatr. 2010;157(1):15-19.

7. Hughes SO, Shewchuk RM, Baskin ML, Nicklas TA, Qu H. Indulgent feeding style and children’s weight status in preschool. J Dev Behav Pediatr. 2008;29(5):403-410.

8. Wardle J, Carnell S. Parental feeding practices and children’s weight. Acta Paediatr Suppl. 2006;96(454):5-11.

9. Costanzo PR, Woody EZ. Domain-specific parenting styles and their impact on the child’s development of particular deviance: The example of obesity proneness. J Soc Clin Psych. 1985;3(4):425-430.

10. Birch LL, Fisher JO, Grimm-Thomas K, Markey CN, Sawyer R, Johnson SL. Confirmatory factor analysis of the Child Feeding Questionnaire: A measure of parental attitudes, beliefs, and practices about child feeding and obesity proneness. Appetite. 2001;36(3):201-210.

11. Campbell KJ, Crawford DA, Ball K. Family food environment and dietary behaviors likely to promote fatness in 5-6 year old children. Int J Obes (Lond). 2006;30(8):1272-
1280.

12. Webber L, Cooke L, Hill C, Wardle J. Associations between children’s appetitive traits and maternal feeding practices. J Am Diet Assoc. 2010;110(11):1718-1722.

13. Kremers SP, Brug J, de Vries H, Engles RC. Parenting style and adolescent fruit consumption. Appetite. 2003;41(1):43-50.

14. Golan M. Parents as agents of change in childhood obesity—from research to practice. Int J Pediatr Obes. 2006;1(2):66-76.

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