Examining parents' experiences and challenges of feeding preschool children with avid eating behaviour

Daily manifestations of Children's avid eating behaviour and associations with temperament, parental feeding practices and wellbeing

Recent evidence has identified four distinct eating profiles in 3-5-year-old children in the UK: avid, happy, typical, and avoidant. Among these profiles, children with avid eating behaviour exhibit high responsiveness to food cues, emotional eating, fast eating speed, and low responsiveness to fullness, posing risks for overeating and higher adiposity. Despite the implications, there is limited research on how avid eating manifests and impacts parents' behaviour and wellbeing. This study aimed to report the frequency of children's avid eating behaviour and explore its associations with child demographics, child temperament, home environment, parental feeding practices, and parental wellbeing. This study collected data via Ecological Momentary Assessment from 109 parents of a 3-5-year-old child identified as having an avid eating profile through a latent profile analysis of parents' reports of their children's eating behaviour. Using baseline and momentary data, the novel findings revealed that children with avid eating frequently requested food, especially snacks, with higher occurrences during weekends. Older children and boys showed higher probabilities of avid eating. High surgency in children correlated with more frequent food requests, while greater effortful control in children related to fewer eating occasions. Parents of children with higher probability of avid eating reported higher stress, depression, and anxiety, as well as frequent food requests from their child. Additionally, food insecurity was linked to increased food requests, suggesting a complex interplay between food availability and eating behaviour. The study underscores the need for targeted interventions to support parents in managing children's avid eating behaviour and improving overall family wellbeing.

Parental use of structure-based and autonomy support feeding practices with children with avid eating behaviour: an Ecological Momentary Assessment study

BACKGROUND

Avid eating is an eating profile which confers greater risk for childhood obesity and can be challenging for parents to manage. Using Ecological Momentary Assessment (EMA), we have previously shown that parental mood, feeding goals, and eating context determine parents' use of coercive and indulgent feeding practices. Parents have also reported using specific noncoercive practices which provide structure (e.g., modelling) or autonomy support (e.g., nutrition education) when feeding children with avid eating behaviour more effectively. However, research is yet to examine the momentary predictors of these adaptive feeding practices.

METHOD

This EMA study aimed to examine parental mood, goals, and context as momentary predictors of parents' use of noncoercive feeding practices during daily feeding interactions with preschool children (3-5-years-old) with an avid eating profile. Parents (N = 109; females n = 85) completed a 10-day EMA period which assessed momentary mood, feeding goals, feeding practices, and contextual factors.

RESULTS

Parents were more likely to use structure-based feeding practices when feeding goals were health-related, the atmosphere was positive or neutral, or when parents initiated eating occasions. Parents were also more likely to use autonomy support feeding practices when their feeding goals were health-related or when parents initiated eating occasions. Encouraging children to eat or negotiating with children about how much or what food to eat was significantly associated with a negative atmosphere during eating occasions.

CONCLUSIONS

Together, our findings show that parental mood, feeding goals and context are momentary predictors of parents' use of noncoercive feeding practices to manage children's avid eating behaviour. Further work is needed to examine whether supporting parents to prioritise health-related goals at mealtimes increases the use of adaptive, noncoercive feeding practices.

Capturing Everyday Parental Feeding Practices and Eating Behaviors of 3- to 5-Year-Old Children With Avid Eating Behavior: Ecological Momentary Assessment Feasibility and Acceptability Study

Background

The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as ecological momentary assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents' feeding practices and feeding goals, particularly when feeding children with high food approaches.

Objective

The main objectives of this study were to (1) assess parents/caregivers' compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children's eating occasions and parents' feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions.

Methods

Parents in the United Kingdom with a child aged 3 to 5 years who exhibit avid eating behavior were invited to participate in a 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey.

Results

Of those parents who completed the EMA study, 104 (87.4%) parents provided at least 7 "full" days of data (2 signal surveys and 1 event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), 3 daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the 10 days. Over the EMA period, a total of 2524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD 0.18; min=1.7, max=2.3). The majority of parents felt that the surveys made them more aware of their feelings (105/118, 89%) and activities (93/118, 79%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r=0.483, P<.001). However, the number of daily food requests per day estimated at baseline (mean 4.5, SD 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean 3.7, SD 1.1), (t116=18.8, P<.001).

Conclusions

This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents' involvement to ensure successful data collection.

Parents' use of coercive and indulgent feeding practices for children with avid eating behaviour: an Ecological Momentary Assessment study

BACKGROUND

Children with avid eating behaviour display high food responsiveness, high emotional overeating and low sensitivity to fullness; behaviours which may increase the risk of obesity and are challenging for parents to manage. This study explores the situational predictors of coercive or indulgent feeding practices among parents of children with avid eating behaviours using Ecological Momentary Assessment (EMA).

METHODS

The study involved 109 parents of 3-5-year-old children exhibiting avid eating behaviour. Over 10 days, participants completed EMA surveys via a mobile app to report on their mood, stress, feeding goals, and feeding practices during eating occasions. Multilevel modelling was used to assess how parental mood, goals, and the eating context (e.g., meal versus snack, public versus private setting) influenced feeding practices.

RESULTS

Parents were more likely to use specific coercive or indulgent feeding practices when experiencing higher stress, when aiming to avoid mealtime conflict, and during meals versus snacks. A negative meal atmosphere and a public setting also increased the likelihood of certain indulgent practices. Notably, parents were more likely to report giving their child food to calm them down or help manage their behaviour when the meal atmosphere was perceived as negative and if they aimed to reduce conflict at the meal. The findings highlight that the context of feeding occasions significantly drives the use of coercive or indulgent feeding practices.

CONCLUSIONS

Parental stress, goals, and the eating context are key determinants of coercive or indulgent feeding practices with children exhibiting avid eating behaviours. Interventions to support parents should consider these dynamic factors, promoting healthier feeding strategies tailored to real-life contexts.

Differences in parental behaviour, emotions, and cognitions between children's eating profiles

A variety of parent psychological characteristics (e.g., wellbeing) have been related to children's eating behaviour. However, parent-child feeding interactions are reciprocal and complex, including relationships between parental cognitions, emotions, as well as the influence of children's varying appetitive traits. Using a person-centred approach, children's appetitive traits can be clustered into meaningful eating profiles. To date, no research has examined whether parental behaviours, emotions, and cognitions differ depending on a child's eating profile. Hence, this study recruited parents/primary caregivers from the APPETItE project, whose child had previously been identified as having an avoidant, typical, happy, or avid eating profile. Parents/primary caregivers of children (3-6 years; N = 632) completed online questionnaires examining broader parenting behaviour (parenting styles), parental emotions (stress, wellbeing), and parental cognitions (goals, self-efficacy, time and energy for meal planning and preparation, and perceptions about children's body size). Findings showed significant differences in parent responses to the questionnaires based on children's eating profiles. Parents of children with a happy eating profile reported better psychological wellbeing and greater parenting time and energy for meal planning and preparation, as well as being less likely to report goals of avoiding mealtime stress and conflict. In contrast, parents of children with an avoidant eating profile reported poorer psychological wellbeing. Children with an avid eating profile were perceived by parents as having a higher body weight, whereas children with an avoidant eating profile were perceived as having a lower body weight. Overall, these findings demonstrate that differences in parental characteristics and perceptions exist between children's eating profiles and thus should be considered in the development of tailored interventions to support children's healthy eating.