Maternal core beliefs and children's feeding problems

Child and Maternal Factors Associated with Feeding Practices in Children with Poor Growth

The development of adequate growth and healthy eating behaviors depends on nutritious food and responsive feeding practices. Our study examined (1) the relationship between maternal concern about child weight or perceived feeding difficulties and their feeding practices, and (2) the moderating role of child temperament and maternal mental health on their feeding practices. A cross-sessional study included mother-child dyads (n = 98) from a tertiary growth and feeding clinic. Children had a mean age of 12.7 ± 5.0 months and a mean weight-for-age z-score of -2.0 ± 1.3. Responsive and controlling feeding practices were measured with the Infant Feeding Styles Questionnaire. Spearman correlation and moderation analysis were performed. Maternal concern about child weight and perceived feeding difficulties were negatively correlated with responsive feeding (r = -0.40, -0.48, p < 0.001). A greater concern about child weight or perceived feeding difficulties was associated with greater use of pressure feeding practices when effortful control was low (B = 0.49, t = 2.47, p = 0.01; B = -0.27, p = 0.008). Maternal anxiety had a significant moderation effect on the relationship between feeding difficulty and pressure feeding (B = -0.04, p = 0.009). Higher maternal concern about child weight and perceived feeding difficulties were associated with less responsive satiety feeding beliefs and behaviors. Both child effortful control and maternal anxiety influenced the relationship between weight and feeding concerns and the use of pressure feeding practices.

Parental Cognitions About Sleep Problems in Infants: A Systematic Review

Introduction: Parental cognitions may directly and indirectly contribute to infant sleep outcomes. This review provides a systematic up-to-date overview of the associations between parental cognitions and infant sleep problems with special emphasis on temporal relationships and the content of parental cognitions. Methods: A systematic literature research in PubMed and Web of Science Core Collection sensu Liberati and PRISMA guidelines was carried out in March 2020 using the search terms (parent^* AND infant^* AND sleep^* problem^*), including studies with correlational or control group designs investigating associations between parental cognitions and sleep problems in children aged 1-6 years. Results: Twenty-three studies (published from 1985 to 2016) met inclusion criteria, of which 14 reported group differences or associations between parental sleep-related cognitions and child sleep outcomes. Nine papers additionally reported on the role of general parental child-related cognitions not directly pertaining to sleep. Findings from longitudinal studies suggest that parental cognitions often preceded child sleep problems. Cognitions pertaining to difficulties with limit-setting were especially prevalent in parents of poor sleepers and were positively associated with both subjective and objective measures of child sleep outcomes. Conclusions: Parental cognitions appear to play a pivotal role for the development and maintenance of sleep problems in young children, arguing that parents' attitudes and beliefs regarding child sleep inadvertently prompts parental behavior toward adverse sleep in offspring. Associations are however based on maternal reports and small to moderate effect sizes. Thus, additional parental factors such as mental health or self-efficacy, as well as additional offspring factors including temperamental dispositions and regulatory abilities, require consideration in further studies.

Early maladaptive schemas as predictors of maternal bonding to the unborn child

Background

The quality of an expectant mother’s bonding to the fetus has been shown to be associated with important developmental outcomes. Previous studies suggest that bonding quality is predicted by, for example, social support, psychological well-being, and depression. However, little is known regarding the role of maternal cognition in maternal-fetal bonding. Early maladaptive schemas (EMSs) are negative and stable assumptions about oneself and one’s relationships with others that are developed during childhood and adolescence. In the present study, we examined the associations between EMSs and the quality of the bonding to the fetus in expectant mothers.

Methods

The present investigation is part of a larger study in which 220 pregnant women (approximately 12% of the pregnant women in the region) and 130 of their partners were recruited from October 2015 until December 2017. The sample for the current study comprised 165 pregnant women (mean age 30.8 years, SD 4.1 years). The participants completed the Young Schema Questionnaire Short Form 3 (YSQ-S3) between gestational weeks 24 and 37 and the Maternal Antenatal Attachment Scale (MAAS) and the Edinburgh Postnatal Depression Scale (EPDS) between gestational weeks 31 and 41.

Results

All EMS domains correlated significantly and negatively with scores for quality of maternal-fetal bonding on the MAAS. Only the Disconnection and Rejection domain correlated significantly and negatively with MAAS scores for intensity of preoccupation with the fetus. The Disconnection and Rejection domain was a significant independent predictor of the quality of maternal-fetal bonding. Symptoms of depression mediated the effect of the EMS domains on the quality of maternal-fetal bonding. The EMS domains Disconnection and Rejection, Impaired Autonomy and Performance, and Impaired Limits showed significant direct effects on bonding quality.

Conclusions

EMSs are related to expectant mothers’ self-reported bonding to their fetuses. This association was mediated by the mothers’ symptoms of depression. The results may have implications for the early identification of pregnant women at risk of bonding difficulties and encourage more studies on cognitive schemas and mechanisms for maternal-fetal bonding.

Are parents' anxiety and depression related to child fussy eating?

OBJECTIVE

To examine the association between parental anxiety and depression with child fussy eating-that is, consistent rejection of particular food items.

DESIGN

This study was embedded in Generation R, a prospective cohort from fetal life onwards in the Netherlands.

SETTING

Population-based.

PARTICIPANTS

4746 4-year-old children and their parents.

EXPOSURE

Parental internalising problems (ie, symptoms of anxiety and depression) were assessed with the Brief Symptoms Inventory during pregnancy and the preschool period (child age 3 years).

MAIN OUTCOME MEASURE

The food fussiness scale of the Children's Eating Behaviour Questionnaire.

RESULTS

Maternal anxiety during pregnancy and during the child's preschool period was related to higher food fussiness sum-scores in children. For instance, per point on the anxiety scale in pregnancy, children had on average a 1.02 higher sum-score (95% CI 0.59 to 1.46) on the food fussiness scale, after adjustment for confounders. Likewise, mothers' depressive symptoms at both time points were associated with fussy eating behaviour in their children (eg, in the antenatal period: per point on the depression scale, children had a 0.91 point higher sum-score on the food fussiness scale, 95% CI 0.49 to 1.33). We found largely similar associations between fathers' internalising problems and children's fussy eating. However, fathers' anxiety during the antenatal period was not related to child fussy eating.

CONCLUSIONS

Maternal and paternal internalising problems were prospectively associated with fussy eating in preschoolers. Healthcare practitioners should be aware that non-clinical symptoms of anxiety and depression in parents are risk factors for child fussy eating.

Picky eating: the current state of research

PURPOSE OF REVIEW

In this review, an overview of literature on picky eating is given, with the focus on recently published studies.

RECENT FINDINGS

Papers on picky eating published over the past 2 years broadly covered three themes: characterization of picky eating; factors contributing to the development of picky eating in children; and management of picky eating. Findings suggest that picky eating is a reasonably robust concept, comprising food neophobia, eating a limited variety of food, and other specific features related to food and eating (e.g. low enjoyment of food, slowness in eating, and higher satiety responsiveness). Picky eating has a higher prevalence in preschool children and seems to decrease thereafter. Studies investigating factors influencing the development of picky eating in childhood have examined a range of child factors, parent factors, and parent-child interactions. Only very limited guidance has emerged regarding the management of picky eating.

SUMMARY

Picky eating is a descriptive term with greater emerging clarity about its core characteristics and associations. Research remains limited with ongoing difficulties related to lack of standardized assessment measures, and poor ability to differentiate between normal and clinically significant picky eating.

Mealtime Observations and Parent-Report: Correspondence Across Measurement and Implications for Intervention

This study explored the relationship between self-reported and observed mealtime behaviour and examined concurrent predictors of observed child and parent mealtime behaviour. The sample consisted of 67 parents of 1.5- to 6-year-old children experiencing difficulties with their child's mealtime, and 33 parents who were not concerned with their child's mealtime behaviour. Parent-reported and observed mealtime data, and parent-reported mealtime cognitions were collected. Regression analyses indicated that consistent with hypotheses, observed and parent-reported mealtime behaviour were related. Observed child behaviour was predicted by self-reported parenting behaviour and observed positive parent behaviour, as well as parental cognitions. Observed parent behaviour was predicted only by self-reported parenting mealtime behaviour.

Getting my child to eat the right amount. Mothers' considerations when deciding how much food to offer their child at a meal

Feeding young children successfully requires parenting skills, trust that children will eat, and nutrition and child development knowledge to ensure that foods and the amounts offered are developmentally appropriate. Mothers are often responsible for determining how much food is offered to their children; however, the influences on mothers' decisions regarding how much to offer their children--their motivations, goals for feeding and child consumption--have not been investigated. Study aims included gathering qualitative data regarding mothers' decisional processes related to preparing a dinner meal plate for her preschooler. Low income mothers (n = 15 African American and n = 15 Latina mothers) were recruited from preschools in the Denver, CO metropolitan area to participate in semi-structured interviews. Mothers prepared a plate for their preschooler and were asked about influences on their decisions about portion sizes and their expectations for children's eating. Data were coded by 2 independent coders using a consensus coding process and analyzed by investigators. Three themes emerged: (1) portion sizes differ for children who are "good" eaters and "picky" eaters; (2) mothers know the "right amounts" to serve their child; and (3) mothers have emotional investments in their children's eating. Some influencing factors were child-centered (e.g. child's likes and dislikes, "picky" and "good" eaters, and foods previously eaten in the day) and some related to adult expectations and concerns (nutrient content and waste). Interventions focusing on portion size may be more effective if tailored to the mothers' perceptions regarding her child's eating characteristics.

Childhood feeding difficulties: a randomized controlled trial of a group-based parenting intervention

BACKGROUND

Difficulty with feeding is common during early childhood. Behavioral techniques have shown considerable utility for difficult feeding, although large-scale studies of behavioral parenting interventions with typically developing young children, and in group formats, are limited.

OBJECTIVE

The current study aimed to evaluate the efficacy of a group-based, behavioral family intervention for typically developing healthy children with problem eating via a fully randomized 2-group design.

METHODS

: Ninety-six families of children aged 1.5 to 6 years with feeding difficulties participated in a trial of Hassle Free Mealtimes Triple P (A. Morawska and M.R. Sanders, unpublished data, 2008) in regional and metropolitan Queensland (Australia).

RESULTS

Results support the utility of a group-based behavioral parenting program for childhood feeding issues, with significant improvements to the mealtime and general behavior of target children, the mealtime and general practices of parents, parental confidence and cognitions, compared with a waitlist control. Six-month follow-up data and clinical and reliable change indices support the intervention's utility. Parents were also highly satisfied with the program.

CONCLUSION

The current study provides evidence of the efficacy of a group-based behavioral family intervention for mealtime difficulties, including observational and more extended outcome measures. Future directions and clinical implications of this research are discussed.

Maternal and paternal controlling feeding practices: reliability and relationships with BMI

OBJECTIVE

This study aimed to examine the interrelationships between mothers' and fathers' reports on the child-feeding questionnaire (CFQ), the BMI of parents and their children, and observations of parents' controlling feeding practices at mealtimes.

METHODS AND PROCEDURES

Twenty-three mothers and twenty-three fathers of children aged between 18 and 67 months reported on their child-feeding practices, on their child's height and weight, and were observed during a normal family mealtime at home.

RESULTS

No associations were found between mothers' reported and observed feeding practices. Fathers' reported pressure to eat and restriction were associated with more controlling observed mealtime feeding practices. Mothers and fathers did not significantly differ in their reported or observed child-feeding practices. Children's BMI was not related to maternal or paternal reported or observed feeding practices. More mealtime pressure was observed in parents with a higher BMI.

DISCUSSION

Fathers' self-reports of their mealtime practices are reliable. Mothers' feeding practices may differ when fathers are present and further work should examine mothers at mealtimes with and without fathers. Although children's BMI was not related to parents' use of reported or observed control, parents with a higher BMI were more controlling, highlighting the importance of considering parents' own weight in future studies.

Maternal mental health and child feeding problems in a non-clinical group

OBJECTIVE

To compare the contribution of symptoms of anxiety, depression and eating psychopathology to reports of child feeding difficulties in a non-clinical group of mothers of male and female children.

METHOD

A community sample of 56 mothers of male children and 40 mothers of female children with a mean age of 32 months completed measures of anxiety, depression, eating psychopathology and child feeding problems.

RESULTS

In mothers of male children, symptoms of depression and anxiety, but not eating psychopathology, were predictors of difficult feeding interactions. In contrast, in mothers of female children, symptoms of bulimia and depression, but not anxiety, were significant predictors of reported food refusal.

DISCUSSION

Different aspects of psychopathological symptomology may be risk factors for reports of feeding problems dependent on the child's gender. Further work should continue to assess the nature and motivation for the controlling of feeding behaviors exhibited by mothers of children of different genders.

Predictors of maternal control of feeding at 1 and 2 years of age

OBJECTIVE

To establish the best predictors of maternal use of controlling feeding practices at 1 and 2 years of age.

DESIGN

A longitudinal study from birth to 2 years.

PARTICIPANTS

Sixty-two mothers of 2-year-old children.

MEASURES

Infant weight at birth, 6, 12 and 24 months, breastfeeding history, infant temperament and feeding difficulties at 6 and 12 months, maternal demographics at 12 and 24 months, maternal mental health at 6 and 12 months, maternal controlling feeding practices at 12 and 24 months.

RESULTS

Controlling feeding practices at 1 year were predicted by perceptions of infant temperament at 6 months, birth weight, length of breastfeeding, mental health at 6 months, and mealtime negativity at 6 months. Parental control over feeding when their child reached 2 years was predicted by the mother's tendency to use that particular strategy at 1 year in combination with the perceptions of infant temperament and feeding problems at 1 year, weight at 1 year, length of breastfeeding in infancy, and/or maternal mental health at 1 year.

CONCLUSIONS

Breastfeeding appears to promote subsequent monitoring, and is associated with reduced use of pressurising and restrictive feeding practices. Infant characteristics are important predictors of control at both 1 and 2 years of age. The use of controlling feeding practices is relatively stable from 1 to 2 years.

The mediating role of eating psychopathology in the relationship between unhealthy core beliefs and feeding difficulties in a nonclinical group

OBJECTIVE

To determine whether maternal eating psychopathology mediates the relationship between unhealthy core beliefs and reports of child feeding difficulties.

METHOD

A community sample of 114 mothers of 65 male children and 49 female children between 4 months and 5 years completed the Eating Disorders Inventory-II, (Garner, Eating Disorder Inventory-2 Professional Manual, Odessa, 1991) the Child Feeding Assessment Questionnaire, (Harris and Booth, Monographs in Clinical Pediatrics, Vol 5, 1992) and the Young Schema Questionnaire (Short Form) (Young, Young's Schema Questionnaire: Short Form, Available in electronic form at, http://www.schematherapy.com, 1998).

RESULTS

Drive for thinness significantly mediated the relationship between maternal defectiveness/shame beliefs and food refusal in mothers of daughters, but no mediational relationships were found for mothers of sons in this nonclinical group.

CONCLUSION

Maternal drive for thinness mediates the effect of unhealthy beliefs on mothers' tendencies to report feeding difficulties in their daughters.

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.

Maternal cognitions, psychopathologic symptoms, and infant temperament as predictors of early infant feeding problems: a longitudinal study

OBJECTIVE

The current study examined the contribution of prenatal and postnatal maternal core beliefs, self-esteem, psychopathologic symptoms, and postnatal infant temperament to the prediction of infant feeding difficulties.

METHOD

Ninety-nine women completed questionnaires assessing their core beliefs, psychopathology, and self-esteem during pregnancy and at 6 months postpartum. At 6 months, mothers also rated their infant's temperament and feeding, and were ob-served feeding their infants.

RESULTS

Maternal reports of child feeding difficulties were predicted by higher levels of emotional deprivation and entitlement core beliefs and lower levels of self-sacrifice and enmeshment core beliefs during pregnancy. Postnatal social isolation core beliefs, lower maternal self-esteem, and more difficult infant temperament added significantly to the variance explained by prenatal factors. Maternal core beliefs, self-esteem, psychopathology, and infant temperament failed to significantly predict independent observations of child food refusal.

CONCLUSION

Maternal cognitions are implicated in the development of maternal reports of feeding difficulty.