Alternatives to restrictive feeding practices to promote self-regulation in childhood: a developmental perspective

Intake of energy-dense snack foods is high among US children. Although the use of restrictive feeding practices has been shown to be counterproductive, there is very limited evidence for effective alternatives to restriction that help children moderate their intake of these foods and that facilitate the development of self-regulation in childhood. The developmental literature on parenting and child outcomes may provide insights into alternatives to restrictive feeding practices. This review paper uses a model of parental control from the child development and parenting literatures to (i) operationally define restrictive feeding practices; (ii) summarize current evidence for antecedents and effects of parental restriction use on children's eating behaviours and weight status, and (iii) highlight alternative feeding practices that may facilitate the development of children's self-regulation and moderate children's intake of palatable snack foods. We also discuss recent empirical evidence highlighting the role of child temperament and food motivation related behaviours as factors that prompt parents to use restrictive feeding practices and, yet, may increase children's dysregulated intake of forbidden foods.

External influences on children's self-served portions at meals

OBJECTIVE

Large portions promote intake among children, but little is known about the external influences of the eating environment on children's self-selected portion sizes. This research experimentally tested effects of the amount of entree available and serving spoon size on children's self-served entree portions and intakes at dinner meals. A secondary objective was to identify child and family predictors of self-served entree portion sizes.

DESIGN

A 2 × 2 within-subjects design was used, in which the amount of a pasta entree available for self-serving (275 vs 550 g) and the serving spoon size (teaspoon vs tablespoon) were systematically varied. The serving bowl size and portion sizes of all other foods offered were held constant across conditions. Conditions were spaced 1 week apart and randomly assigned. Weighed self-served entree portions and food intakes as well as demographics, maternal feeding styles and child/maternal anthropometrics were measured.

SUBJECTS

Participants were 60 ethnically diverse children aged 4-6 years and their mothers.

RESULTS

Mixed models revealed that children served themselves 40% more entree when the amount available was doubled (P<0.0001) and 13% more when the serving spoon size was tripled (P<0.05). Serving spoon size and the amount of entree available indirectly influenced children's intake, with larger self-served portion sizes related to greater entree intakes (P<0.0001). Greater self-served portions and energy intakes at the meal were seen among those children whose mothers reported indulgent or authoritarian feeding styles (P<0.001).

CONCLUSION

Children's self-served portion sizes at meals are influenced by size-related facets of the eating environment and reflect maternal feeding styles.

Does maternal feeding restriction lead to childhood obesity in a prospective cohort study?

BACKGROUND

Some studies show that greater parental control over children's eating habits predicts later obesity, but it is unclear whether parents are reacting to infants who are already overweight.

OBJECTIVE

To examine the longitudinal association between maternal feeding restriction at age 1 and body mass index (BMI) at age 3 and the extent to which the association is explained by weight for length (WFL) at age 1.

METHODS

We studied 837 mother-infant pairs from a prospective cohort study. The main exposure was maternal feeding restriction at age 1, defined as agreeing or strongly agreeing with the following question: "I have to be careful not to feed my child too much." We ran multivariable linear regression models before and after adjusting for WFL at age 1. All models were adjusted for parental and child sociodemographic characteristics.

RESULTS

100 (12.0%) mothers reported feeding restriction at age 1. Mean (SD) WFL z-score at age 1 was 0.32 (1.01), and BMI z-score at age 3 was 0.43 (1.01). Maternal feeding restriction at age 1 was associated with higher BMI z-score at age 3 before (β 0.26 (95% CI 0.05 to 0.48)) but not after (β 0.00 (95% CI -0.17 to 0.18)) adjusting for WFL z-score at age 1. Each unit of WFL z-score at age 1 was associated with an increment of 0.57 BMI z-score units at age 3 (95% CI 0.51 to 0.62).

CONCLUSIONS

We found that maternal feeding restriction was associated with children having a higher BMI at age 3 before, but not after, adjusting for WFL at age 1. One potential reason may be that parents restrict the food intake of infants who are already overweight.

Preventing childhood obesity: what works?

Rates of overweight in North American children and adolescents have increased dramatically since the 1970s. Childhood obesity has reached epidemic proportions and calls for prevention and treatment programs to reverse this trend have been made. However, the evidence base needed for effective action is still incomplete, especially for childhood obesity prevention programs. This paper focuses on primary prevention of childhood obesity and has three aims: (1) to briefly describe current primary prevention approaches for childhood obesity and the evidence for their impact; (2) to elucidate promising, but untested intervention strategies using an ecological framework and evidence from experimental and epidemiological research on factors influencing children's eating and weight status; and (3) to introduce a multiphase strategy for screening intervention components and building and evaluating potent interventions for childhood obesity. Most childhood obesity prevention programs have focused on school-aged children and have had little success. We suggest that, given these findings, prevention efforts should be expanded to explore other contexts in which children live as possible settings for intervention efforts, including the family and childcare settings. Given that 25% of preschool children are already overweight, intervening with children before school entry should be a priority. A review of experimental research on the developing controls of food intake in infancy and childhood suggests possible intervention strategies, focusing on parenting and aspects of the feeding environment. Epidemiological findings point to even earlier modifiable risk factors, including gestational weight gain, maternal prepregnancy weight, and formula feeding. However, the potential impact of altering these risk factors remains to be evaluated. In response to this problem, we suggest a new, multiphase method for accomplishing this, including screening intervention components, refining intervention designs and confirming component efficacy to build and evaluate potent, optimized interventions.

Maternal weight status modulates the effects of restriction on daughters' eating and weight

OBJECTIVE

To examine the effects of overweight and normal-weight mothers' restriction in child feeding on daughters' eating in the absence of hunger (EAH) and body mass index (BMI) change from age 5 to age 9 y.

DESIGN

Longitudinal study of the health and development of young girls.

SUBJECTS

A total of 91 overweight and 80 normal-weight mothers and their daughters, assessed when daughters were ages 5, 7, and 9 y.

MEASUREMENTS

Measures included maternal restriction of daughters' intake at age 5 y, and daughters' EAH and BMI change from age 5 to 9 y.

RESULTS

There were no overall differences in the level of restriction that overweight and normal-weight mothers used. However, overweight mothers' restrictive feeding practices when daughters were age 5 y predicted daughters' EAH over time, and higher EAH scores were associated with greater BMI change from age 5 to 9 y. These relationships did not hold for daughters of normal-weight mothers.

CONCLUSION

More adverse effects of restriction on daughters' EAH, and links between EAH and BMI change were only noted among daughters of overweight mothers. These findings highlight the need for a better understanding of factors that contribute to within-group variation in eating behavior and weight status.

Diet quality, nutrient intake, weight status, and feeding environments of girls meeting or exceeding the American Academy of Pediatrics recommendations for total dietary fat

The American Academy of Pediatrics (AAP) recommends that children consume no more than 30% but no less than 20% of energy as dietary fat intake, and this recommendation is accompanied by suggestions that fat calories should be replaced by eating more grain products, fruits, vegetables, low fat dairy products, beans, lean meat, poultry, fish, and other protein rich foods. In comparing diets of girls meeting this AAP recommendation with girls who consumed diets higher in fat, we noted that girls meeting recommendations had diets that came closer to meeting other dietary recommendations for several food groups and had higher intake of several key micronutrients. Dietary fat was also associated with body fat and weight status. Children's fat intake was also related to mothers' dietary fat intake, and nutrient intake patterns were similar for mothers and daughters. Finally, mothers of girls consuming higher fat diets reported using more restriction and pressure to eat in feeding their daughters. These findings provide additional support for the AAP recommendation to limit total dietary fat. Findings reveal that mothers' use of controlling feeding practices are not effective in fostering healthier diets among children, and that mothers' own eating may be more influential than their attempts to control children's intake.

Child and parent characteristics as predictors of change in girls' body mass index

OBJECTIVE

This study assessed predictors of change in girls' body mass index (BMI) between ages 5 and 7 y and familial aggregation of risk factors associated with childhood overweight.

METHOD

Participants included 197 5-y-old girls and their parents, of whom 192 were reassessed when girls were 7-y-old. Three classes of predictors of girls' change in BMI were assessed including girls' and parents' weight status, dietary intake and physical activity. Girls' and parents' BMI and change in BMI were calculated based on height and weight measurements. Girls' dietary intake was assessed using three 24 h recalls; parents' intake was assessed using a food frequency questionnaire. Girls and mothers provided reports of girls' physical activity; parents' frequency and enjoyment of activity were assessed using a self-administered questionnaire.

RESULTS

The most effective model predicting girls' change in BMI between ages 5 and 7 included both child and parent characteristics, specifically girls' BMI at age 5, mothers' change in BMI, fathers' energy intake, fathers' enjoyment of activity, and girls' percentage of energy from fat. In addition, results showed substantial intra-familial associations in weight status and dietary intake and to a lesser extent physical activity, and the presence of multiple risk factors within families. Associations were also noted between girls' and parents' change in BMI.

CONCLUSIONS

Results from this study highlight the centrality of the family in the etiology of childhood overweight and the necessity of incorporating parents in the treatment of childhood overweight.

Predictors of maternal child-feeding style: maternal and child characteristics

We investigated relationships among maternal and child characteristics, and two aspects of maternal child-feeding styles that may place daughters at risk for developing problems with energy balance. Participants included 104 overweight (BMI> or =25) and 92 non-overweight (BMI<25) mothers and their 5-year-old, non-Hispanic, White daughters. Child-feeding styles included (a) restriction of daughters' intake of energy-dense snack food, and (b) pressure to eat more food. Predictors of child-feeding styles included measures of (1) maternal investment in weight and eating issues, including dietary restraint and weight concern, (2) child adiposity, (3) maternal perceptions of the child as underweight or overweight, and (4) maternal concern for child weight. Mothers reported using more restrictive feeding practices when they were invested in weight and eating issues, when they perceived daughters as overweight, when they were concerned about daughters' weight, and when daughters were heavier. Mothers reported using more pressure in child feeding when daughters were thinner, and when mothers perceived daughters as underweight. Further analyses examined whether relationships among child-feeding styles were different for overweight and non-overweight mothers. Overweight mothers' child-feeding styles appeared to be influenced by observable child weight characteristics, concerns for the child's weight status, and mothers' own history of overweight. Non-overweight mothers' child-feeding styles appeared to be influenced by distorted perceptions of and concerns for children, as well as distorted self-perceptions.

Interpersonal predictors of dieting practices among married couples

The relations between couples' marital quality and dieting behavior were examined. One-hundred eighty-seven married couples' dieting behaviors, marital quality, body mass index, weight concerns, depression, and self-esteem were assessed. Results indicate that the relation between healthy dieting behaviors and marital quality is similar for both husbands and wives. However, among wives, marital discord predicted unhealthy dieting behaviors, even after wives' body mass index, weight concerns, self-esteem, and depression were controlled for. Furthermore, wives' self-esteem interacted with marital quality when predicting unhealthy dieting. These findings suggest gender differences in the relations between marital quality and dieting behaviors and are consistent with previous research suggesting that men and women have differential response patterns to marital disharmony, with women tending to internalize negative affect experienced in their marriage.

Gender and weight concerns in early and middle adolescence: links with well-being and family characteristics

Studied sex and developmental differences in weight concerns in early and middle adolescence and links between concerns and adolescent well-being and family experiences. Participants were mothers, fathers, and older and younger siblings (Ms = 15 and 12.5 years, respectively) from 197, Caucasian, working-middle class, 2-parent families. Parents rated their gender role attitudes and adolescents rated their weight concerns, well-being, gender role orientations, and physical development. Girls reported more concerns than boys; body mass index (BMI) correlated with weight concerns for all youth. Controlling for BMI and pubertal status, weight concerns were linked to older girls' well-being; with physical characteristics controlled, mothers' gender attitudes explained older girls' weight concerns, and siblings' weight concerns explained those of older and younger girls and boys.

Childhood overweight: a contextual model and recommendations for future research

The prevalence of overweight among children has doubled within the past two decades. Increases in the rate of childhood overweight are of particular concern due to the negative health and psychological effects noted among overweight children. As shown by previous research, the development of childhood overweight involves a complex set of factors from multiple contexts that interact with each other to place a child at risk of overweight. This multifaceted system can be conceptualized using Ecological Systems Theory (EST). EST highlights the importance of considering the context(s), or ecological niche, in which a person is located in order to understand the emergence of a particular characteristic. In the case of a child, the ecological niche includes the family and the school, which are in turn embedded in larger social contexts including the community and society at large. In this review, EST is used as a framework with which to summarize research assessing predictors of childhood overweight. Specifically, child characteristics that place children at risk of the development of overweight (including dietary intake, physical activity, and sedentary behaviour) will be reviewed while taking into consideration the influence of the familial environment, the school environment, and the community and larger social environments. It is concluded that future research needs to adopt a broader contextual approach in order to understand and intervene against the processes leading to the development of overweight among children and that the use of theories or paradigms such as EST will facilitate developing and testing models of causal processes.

Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight

Although a large body of research has assessed direct genetic links between parent and child weight status, relatively little research has assessed the extent to which parents (particularly parents who are overweight) select environments that promote overweight among their children. Parents provide food environments for their children's early experiences with food and eating. These family eating environments include parents' own eating behaviors and child-feeding practices. Results of the limited research on behavioral mediators of familial patterns of overweight indicate that parents' own eating behaviors and their parenting practices influence the development of children's eating behaviors, mediating familial patterns of overweight. In particular, parents who are overweight, who have problems controlling their own food intake, or who are concerned about their children's risk for overweight may adopt controlling child-feeding practices in an attempt to prevent overweight in their children. Unfortunately, research reveals that these parental control attempts may interact with genetic predispositions to promote the development of problematic eating styles and childhood overweight. Although the authors have argued that behavioral mediators of family resemblances in weight status, such as parents' disinhibited or binge eating and parenting practices are shaped largely by environmental factors, individual differences in these behaviors also have genetic bases. A primary public health goal should be the development of family-based prevention programs for childhood overweight. The findings reviewed here suggest that effective prevention programs must focus on providing anticipatory guidance on parenting to foster patterns of preference and food selection in children more consistent with healthy diets and promote children's ability to self-regulate intake. Guidance for parents should include information on how children develop patterns of food intake in the family context. Practical advice for parents includes how to foster children's preferences for healthy foods and how to promote acceptance of new foods by children. Parents need to understand the costs of coercive feeding practices and be given alternatives to restricting food and pressuring children to eat. Providing parents with easy-to-use information regarding appropriate portion sizes for children is also essential as are suggestions on the timing and frequency of meals and snacks. Especially during early and middle childhood, family environments are the key contents for the development of food preferences, patterns of food intake, eating styles, and the development of activity preferences and patterns that shape children's developing weight status. Designing effective prevention programs will, however, require more complete knowledge than currently available regarding behavioral intermediaries that foster overweight, including the family factors that shape activity patterns, meals taken away from home, the impact of stress on family members' eating styles, food intake, activity patterns, and weight gain. The research presented here provides an example of how ideas regarding the effects of environmental factors and behavioral mediators on childhood overweight can be investigated. Such research requires the development of reliable and valid measures of environmental variables and behaviors. Because childhood overweight is a multifactorial problem, additional research is needed to develop and test theoretic models describing how a wide range of environmental factors and behavioral intermediaries can work in concert with genetic predispositions to promote the development of childhood overweight. The crucial test of these theoretic models will be in preventive interventions.

Confirmatory factor analysis of the Child Feeding Questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness

The Child Feeding Questionnaire (CFQ) is a self-report measure to assess parental beliefs, attitudes, and practices regarding child feeding, with a focus on obesity proneness in children. Confirmatory factor analysis tested a 7-factor model, which included four factors measuring parental beliefs related to child's obesity proneness, and three factors measuring parental control practices and attitudes regarding child feeding. Using a sample of 394 mothers and fathers, three models were tested, and the third model confirmed an acceptable fit, including correlated factors. Internal consistencies for the seven factors were above 0.70. With minor changes, this same 7-factor model was also confirmed in a second sample of 148 mothers and fathers, and a third sample of 126 Hispanic mothers and fathers. As predicted, four of the seven factors were related to an independent measure of children's weight status, providing initial support for the validity of the instrument. The CFQ can be used to assess aspects of child-feeding perceptions, attitudes, and practices and their relationships to children's developing food acceptance patterns, the controls of food intake, and obesity. The CFQ is designed for use with parents of children ranging in age from about 2 to 11 years of age.

Diet quality, nutrient intake, weight status, and feeding environments of girls meeting or exceeding recommendations for total dietary fat of the American Academy of Pediatrics

OBJECTIVES

To compare the diet quality and weight status of girls consuming diets meeting the recommendation of the American Academy of Pediatrics for dietary fat with those of girls consuming >30% of energy from fat and to examine relationships between girls' dietary fat intake, mothers' nutrient intakes, and mothers' child-feeding practices.

DESIGN

Participants were 192 white girls and their mothers, who were divided into 2 groups: >30% of energy from fat (high fat [HF]) or </=30% of energy from fat (low fat [LF]), based on girls' 3-day dietary recalls. Girls' food group and nutrient intakes, Healthy Eating Index, body mass index, and mothers' nutrient intakes and child-feeding practices were compared.

RESULTS

Girls with HF diets consumed fewer fruits, more meat, and more fats and sweets and had lower Healthy Eating Index scores than did the girls in the LF group. Mothers of girls in the HF group had higher fat intakes than did those in the LF group. Girls and mothers in the HF group had lower intakes of fiber and vitamins A, C, B6, folate, and riboflavin. Mothers in the HF group reported using more restriction and pressure to eat in feeding their daughters. Girls in the HF group showed greater increase in body mass index and skinfold thickness from age 5 to 7 years.

CONCLUSION

These findings provide additional support for the recommendation of the American Academy of Pediatrics to limit total dietary fat. Findings reveal that mothers' use of controlling feeding practices are not effective in fostering healthier diets among girls and that mothers' own eating may be more influential than their attempts to control the intake of their daughters. dietary fat, dietary quality, nutrient intake, overweight, feeding practices, children.

Weight status, parent reaction, and self-concept in five-year-old girls

OBJECTIVE

This study examined the relationship between weight status and self-concept in a sample of preschool-aged girls and whether parental concern about child overweight or restriction of access to food are associated with negative self-evaluations among girls.

METHOD

Participants were 197 5-year-old girls and their parents. Girls' weight status (weight for height percentile) was calculated based on height and weight measurements. Girls' self-concept was assessed using an individually administered questionnaire. Parents' concern about their child's weight status and restriction of their child's access to food were assessed using a self-report questionnaire.

RESULTS

Girls with higher weight status reported lower body esteem and lower perceived cognitive ability than did girls with lower weight status. Independent of girl's weight status, higher paternal concern about child overweight was associated with lower perceived physical ability among girls; higher maternal concern about child overweight was associated with lower perceived physical and cognitive ability among girls. Finally, higher maternal restriction of girls' access to foods was associated with lower perceived physical and cognitive ability among girls with higher weight status but not among girls with lower weight status.

CONCLUSIONS

At least as early as age 5 years, lower self-concept is noted among girls with higher weight status. In addition, parents' concern about their child's weight status and restriction of access to food are associated with negative self-evaluations among girls. Public health programs that raise parental awareness of childhood overweight without also providing constructive and blame-free alternatives for addressing child weight problems may be detrimental to children's mental health.

Behavioral science research in diabetes: lifestyle changes related to obesity, eating behavior, and physical activity

Lifestyle factors related to obesity, eating behavior, and physical activity play a major role in the prevention and treatment of type 2 diabetes. In recent years, there has been progress in the development of behavioral strategies to modify these lifestyle behaviors. Further research, however, is clearly needed, because the rates of obesity in our country are escalating, and changing behavior for the long term has proven to be very difficult. This review article, which grew out of a National Institute of Diabetes and Digestive and Kidney Diseases conference on behavioral science research in diabetes, identifies four key topics related to obesity and physical activity that should be given high priority in future research efforts: 1) environmental factors related to obesity, eating, and physical activity; 2) adoption and maintenance of healthful eating, physical activity, and weight; 3) etiology of eating and physical activity; and 4) multiple behavior changes. This review article discusses the significance of each of these four topics, briefly reviews prior research in each area, identifies barriers to progress, and makes specific research recommendations.

Parents' restrictive feeding practices are associated with young girls' negative self-evaluation of eating

OBJECTIVE

This study was conducted to determine whether parents' restriction of young girls' access to palatable foods promotes the consumption of those foods while evoking negative self-evaluation.

DESIGN

Girls' intake of 10 snack foods was measured immediately following a standard lunch, in a setting with free access to palatable snack foods. Girls' self-evaluation about their eating was assessed following the free access snack session. In addition, reports of parental restriction were obtained from mothers, fathers, and girls.

PARTICIPANTS

Participants were 197 girls aged 4.6 to 6.4 years and their parents.

STATISTICAL ANALYSIS

Structural equation modeling was used to test models describing relationships between parents' restriction and girls' eating.

RESULTS

Following the standard lunch, girls' snack food intake during the 10-minute free access session ranged from 0 to 436 kcal, with a mean of 123 +/- 7 kcal. Approximately half of the girls reported negative self-evaluation about eating 1 or more of the 10 foods provided. The revised path model indicated that parents' restriction predicted both girls' snack food intake and girls' negative self-evaluation of eating. Girls' negative self-evaluation of eating was not associated with the amount of food that they consumed when not hungry, but was linked to their perceptions of being restricted from those foods.

APPLICATIONS/CONCLUSIONS

These findings indicate that restricting young girls' access to palatable foods may promote the intake of restricted foods and may also generate negative feelings about eating restricted foods.

Influence of body composition on the accuracy of reported energy intake in children

OBJECTIVE

Mis-reporting dietary intake is a substantial barrier to understanding the role of dietary behavior in disease. Work with adults indicates that heavier individuals under-report dietary intake and that under-reporting may be macronutrient-specific. Whether weight status and macronutrient intake influence the accuracy of dietary reports among children, however, is less clear. This research evaluated children's dietary reporting accuracy as a function of their relative weight, body composition, and macronutrient intake.

RESEARCH METHODS AND PROCEDURES

Participants included 146 4- to 11-year-old children. Reported energy intake was determined by interviewing children in the presence of parents, using three multiple pass, 24-hour recalls. Children were classified as having had an under-reported, accurately reported, or over-reported dietary intake relative to total energy expenditure, as measured by doubly labeled water. Reporting accuracy was examined as a function of children's body weight, body composition (using dual energy x-ray absorptiometry), and macronutrient intake.

RESULTS

Average reported intake was, on average, 14% greater than children's estimated expenditure (p < 0.01). Reporting accuracy varied as a function of children's relative weight and body composition; under-reporting tended to occur among heavier children, having the highest body fat content (p < 0.0001) and relative weight (p < 0.0001).

DISCUSSION

These findings suggest that weight status influences the accuracy of dietary reports made by children and their parents. More research is needed to address possible psychological and social factors that introduce bias in reporting children's dietary data.

Young girls' emerging dietary restraint and disinhibition are related to parental control in child feeding

This research investigated the origins of dietary restraint and disinhibition in young girls by considering how parents' control in child feeding and their daughters' perceptions of these practices relate to girls' dietary restraint and disinhibition. Participants were 197 5-year-old girls (4.6-6.4 years) and their parents. Parental pressure and restriction were measured using the Child Feeding Questionnaire. Girls' perceptions of parental pressure and restriction were measured using the Kid's Child Feeding Questionnaire, and their restraint and emotional and external disinhibition were measured using an age-appropriate version of the Dutch Eating Behavior Questionnaire. Logistic regression was used to determine associations among parental control in feeding, daughters' perceptions of control, and daughters' dietary restraint and disinhibition. The results indicated that one-third of 5-year-olds reported moderate levels of dietary restraint, about 25% of the sample showed evidence of emotional disinhibition, and nearly 75% reported externally disinhibited eating in the presence of palatable foods. Daughters' dietary restraint and emotional disinhibition were related to their perceptions of parental pressure to eat more, while their external disinhibition was related to their perceptions of having restrictions placed on their eating. This research reveals that pressure in child feeding is associated with the emergence of dietary restraint and disinhibition among young girls, eating styles characterized by a lack of responsiveness to internal hunger and satiety cues.

Five-year-old girls' ideas about dieting are predicted by their mothers' dieting

OBJECTIVE

To explore 5-year-old girls' ideas, concepts, and beliefs about dieting.

DESIGN

Girls were asked to define dieting, to describe the behaviors dieting comprised, and were queried about links between dieting, weight control, and body shape. Parents completed questionnaires addressing family health history, demographics, and issues related to food, dieting, and weight control.

SUBJECTS/SETTING

Participants were 197 girls aged 5 years and their parents. All girls lived with both biological parents, and were without food allergies or chronic medical problems.

STATISTICAL ANALYSES PERFORMED

For 5 open-ended questions related to dieting, girls were categorized as either having or not having ideas about dieting. These ideas, concepts, and beliefs were categorized, and logistic regression examined predictors of girls' ideas about dieting.

RESULTS

Depending on the question, from 34% to 65% of girls aged 5 years had ideas about dieting. Compared to girls whose mothers did not diet, girls whose mothers reported current or recent dieting were more than twice as likely to have ideas about dieting, suggesting that mothers' dieting behavior is a source of young girls' ideas, concepts, and beliefs about dieting. Among mothers, more than 90% reported recent dieting, and most reported use of both health-promoting and health-compromising dieting behaviors.

APPLICATIONS

Women should be informed that weight control attempts may influence their young daughters' emerging ideas, concepts, and beliefs about dieting. Mothers should be encouraged to use health-promoting rather than health-compromising weight control strategies, not only for their own well being, but to reduce the likelihood that daughters will incorporate health-compromising dieting behaviors into their concepts, ideas, and beliefs about dieting.

Etiology of body dissatisfaction and weight concerns among 5-year-old girls

Among adolescent girls and women, higher weight status is associated with greater body dissatisfaction and weight concerns. This study investigated the etiology of body dissatisfaction and weight concerns among 5-year-old girls by assessing associations among girls' and parents' weight status, body dissatisfaction, and weight concerns. Weight status, body dissatisfaction, and weight concerns were assessed for 197 5-year-old girls and their parents, and relationships among these variables were investigated using multiple regression in the form of path analysis. For girls and parents, higher weight status was associated with greater body dissatisfaction, which in turn was associated with higher weight concerns. No direct relationship was found between girls' weight status and girls' weight concerns. Girls' body dissatisfaction and mothers' weight concerns, however, were independently and positively associated with higher weight concerns among girls. In conclusion, relationships among weight status, body dissatisfaction, and weight concerns for 5-year-old girls parallel those reported among adults. In addition, results suggest that the etiology of weight concerns in young girls may be linked to girls' subjective evaluations of their weight status (body dissatisfaction) in combination with weight concerns expressed by their mothers.

Nutritional guidance is needed during dietary transition in early childhood

OBJECTIVE

To assess dietary nutritional quality during dietary transition to a modified adult-style diet in the second year of life.

DESIGN

A total of 55 children from 12 to 18 months old and their parents were studied. Dietary intake and indices of growth were measured monthly. Dietary data were collected monthly and tabulated using the Minnesota Nutrient Data System. Data were evaluated using repeated-measures analysis of variance, time trend, and correlational analyses.

RESULTS

Mean energy intake increased from 12 to 18 months of age (926+/-24 kcal to 1062+/-33 kcal) with contributions from energy-yielding macronutrients remaining relatively constant. Throughout the study, fat intakes were below 30% of energy for 22% to 33% of the sample. Micronutrient intake patterns were diverse with intake for some nutrients (vitamins A, C, B(6), B(12), and D and calcium) remaining above recommended levels despite changes over the course of the study. Folate intakes increased from 79% of the recommended value at 12 months old to approximately 100% at 18 months old. Zinc and vitamin E intakes were well below recommended levels throughout the study, and iron decreased markedly from 96% of the recommended level at 12 months old to 76% at 18 months old.

APPLICATIONS/CONCLUSIONS

These data show that intakes of some key nutrients are low during the period of dietary transition in early childhood, and intakes for some nutrients actually decrease despite increases in energy intake. Furthermore, because a considerable portion of children studied were consuming low-fat diets, it is clear that many parents are not following the only pediatric nutrition recommendations that currently exist. These findings argue strongly for the development of dietary guidance that not only addresses fat restriction, but also assists parents in selecting diets that support optimum growth and development in young children.nutrient intake, infants, dietary density.

Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes

OBJECTIVE

Current recommendations for infant feeding encourage breast-feeding through the first year. This research was conducted to evaluate associations among breast-feeding, maternal control of child feeding, and the dietary intake of toddlers during the second year of life. In particular, we sought to determine whether breast-feeding through the first year and subsequent toddler intake was mediated via maternal control of child feeding.

DESIGN/SUBJECTS

Fifty-five white infants and their mothers were monitored longitudinally from age 12 or 13 months to age 18 months.

MAIN OUTCOME MEASURES

Breast-feeding through the first year and maternal control in infant feeding were evaluated as predictors of energy intake at age 18 months.

STATISTICAL ANALYSES PERFORMED

Regression analysis was used to evaluate predictors of toddler energy intake at age 18 months. A mediation model tested if the relationship between breast-feeding and infant intake was mediated by maternal control in feeding.

RESULTS

Breast-feeding through the first year was associated with higher toddler energy intakes at age 18 months through its influence on maternal control in feeding. Mothers who breast-fed their infants for at least 12 months used lower levels of control in feeding. Lower levels of maternal control in feeding were associated with higher toddler energy intakes. The highest energy intakes among children aged 18 months were observed among taller and leaner toddlers.

APPLICATIONS/CONCLUSIONS

Our findings suggest that breast-feeding through the first year may have an effect on children's energy intake by shaping mothers' child-feeding practices. These findings may be used by clinicians to assist parents in making informed decisions about choice of infant-feeding method and to provide anticipatory guidance regarding infant-feeding style when initiating dietary diversity.

Mothers' child-feeding practices influence daughters' eating and weight

BACKGROUND

Childhood overweight has increased dramatically, particularly among young girls. Genetic and environmental factors produce the overweight phenotype. Nonshared environments appear to account for a substantial proportion of the population variance in overweight but remain largely unspecified and unmeasured.

OBJECTIVE

Our goal was to evaluate the influence of maternal control in feeding, an aspect of nonshared family environment, on daughters' eating and relative weight.

DESIGN

Structural equation modeling was used to test models that describe maternal influences on daughters' eating and relative weight. The participants were 197 white, non-Hispanic families with 5-y-old daughters. The mothers' own dietary restraint and their perceptions of their daughters' risk of overweight were used to predict maternal control in feeding, which was used to predict the daughters' eating and weight outcomes.

RESULTS

Maternal body mass index was a modest predictor of daughters' relative weight. The addition of the family-environment pathway provided a good fit and showed additional, independent prediction of daughters' relative weight. Mothers' dietary restraint and perceptions of their daughters' risk of overweight predicted maternal child-feeding practices, which in turn predicted daughters' eating and relative weight.

CONCLUSIONS

Child-specific aspects of the family environment, including mothers' child-feeding practices and perceptions of their daughters' risk of overweight, may represent important, nonshared, environmental influences on daughters' eating and relative weight. The environmental effects noted were modest but comparable in magnitude to the direct association between maternal and child weight, which indicates that measuring family environmental factors can enhance our understanding of the etiology of childhood overweight.

Development of food preferences

Using a developmental systems perspective, this review focuses on how genetic predispositions interact with aspects of the eating environment to produce phenotypic food preferences. Predispositions include the unlearned, reflexive reactions to basic tastes: the preference for sweet and salty tastes, and the rejection of sour and bitter tastes. Other predispositions are (a) the neophobic reaction to new foods and (b) the ability to learn food preferences based on associations with the contexts and consequences of eating various foods. Whether genetic predispositions are manifested in food preferences that foster healthy diets depends on the eating environment, including food availability and child-feeding practices of the adults. Unfortunately, in the United States today, the ready availability of energy-dense foods, high in sugar, fat, and salt, provides an eating environment that fosters food preferences inconsistent with dietary guidelines, which can promote excess weight gain and obesity.

Restricting access to foods and children's eating

This study evaluated maternal restriction of children's access to snack foods as a predictor of children's intake of those foods when they were made freely available. In addition, child and parent eating-related "risk" factors were used to predict maternal reports of restricting access. Participants were 71, 3-to-5-year-old children (36 boys, 35 girls) and their parents. Children's snack food intake was measured immediately following a meal, in a setting offering free access to palatable snack foods. Child and maternal reports of restricting children's access to those snack foods were obtained. In addition, information on child and parent adiposity as well as parents' restrained and disinhibited eating was used to examine "risk" factors for restricting access. For girls only, child and maternal reports of restricting access predicted girls' snack food intake, with higher levels of restriction predicting higher levels of snack food intake. Maternal restriction, in turn, was predicted by children's adiposity. Additionally, parents' own restrained eating style predicted maternal restriction of girls' access to snack foods.

Restricting access to palatable foods affects children's behavioral response, food selection, and intake

BACKGROUND

Restricting children's access to palatable foods may appeal to parents as a straightforward means of promoting moderate intakes of foods high in fat and sugar; however, restricting access to palatable foods may have unintended effects on children's eating. The efficacy of restricting children's access to palatable foods as a means of promoting patterns of moderate intake of those foods is unknown.

OBJECTIVE

Two experiments were conducted to test the hypothesis that restricting access to a palatable food enhances children's subsequent behavioral responses to, selection of, and intake of that restricted food.

DESIGN

Both experiments used a within-subjects design to examine the effects of restricting access to a palatable food on children's subsequent behavior, food selection, and food intake. The first experiment examined the effects of restriction within and outside the restricted context and the second experiment focused on the effects within the restricted context.

RESULTS

In both experiments, restricting access to a palatable food increased children's behavioral response to that food. Experiment 2 showed that restricting access increased children's subsequent selection and intake of that food within the restricted context.

CONCLUSIONS

Restricting access focuses children's attention on restricted foods, while increasing their desire to obtain and consume those foods. Restricting children's access to palatable foods is not an effective means of promoting moderate intake of palatable foods and may encourage the intake of foods that should be limited in the diet.

Restricting access to foods and children's eating

This study evaluated maternal restriction of children's access to snack foods as a predictor of children's intake of those foods when they were made freely available. In addition, child and parent eating-related "risk" factors were used to predict maternal reports of restricting access. Participants were 71, 3-to-5-year-old children (36 boys, 35 girls) and their parents. Children's snack food intake was measured immediately following a meal, in a setting offering free access to palatable snack foods. Child and maternal reports of restricting children's access to those snack foods were obtained. In addition, information on child and parent adiposity as well as parents' restrained and disinhibited eating was used to examine "risk" factors for restricting access. For girls only, child and maternal reports of restricting access predicted girls' snack food intake, with higher levels of restriction predicting higher levels of snack food intake. Maternal restriction, in turn, was predicted by children's adiposity. Additionally, parents' own restrained eating style predicted maternal restriction of girls' access to snack foods.

Like mother, like daughter: familial patterns of overweight are mediated by mothers' dietary disinhibition

BACKGROUND

Obese parents are more likely to have obese children. Parents provide both the genes and eating environment for their children and familial patterns of adiposity are the result of gene-environment interactions. Environmental factors are implicated in the rapid increases in prevalence of childhood overweight that have occurred in the past 2 decades. Examination of aspects of the family environment may provide insight into increases in childhood overweight over time.

OBJECTIVE

We examined parental characteristics associated with overweight and eating behaviors in preschool children.

DESIGN

Seventy-five preschool children and their parents were recruited from local daycare centers. Information was obtained on parents' body mass indexes (BMIs), dietary restraint, and dietary disinhibition. A behavioral index of disinhibited eating in children was used to measure children's eating when given free access to palatable snack foods in the absence of hunger. Children's weight-for-height values were also calculated.

RESULTS

Maternal dietary disinhibition (R2 = 0.35, P < 0.01) and maternal BMI (R2 = 0.19, P < 0.05) positively predicted daughters' overweight. Maternal disinhibition (R2 = 0.35, P < 0.05) mediated the relation between mothers' BMI and daughters' overweight when both maternal disinhibition and maternal BMI were used to predict daughters' overweight. Furthermore, when both mothers' disinhibition and daughters' free access intakes were used to predict daughters' overweight, mothers' disinhibition (P < 0.05) showed independent prediction.

CONCLUSIONS

These findings suggest that familial influences on child overweight differ according to parent and child sex. Also, these results suggest that mothers' dietary disinhibition mediates familial similarities in degree of overweight for mothers and daughters.

Development of food acceptance patterns in the first years of life

As young omnivores, children make the transition from the exclusive milk diet of infancy to consuming a variety of foods. They must learn to accept a set of the foods available in their environmental niche, and they 'come equipped' with a set of predispositions that facilitate the development of food acceptance patterns, constrained by predisposition and limited by what is offered to them. While children are predisposed to like sweet or salty foods and to avoid sour or bitter foods, their preferences for the majority of foods are shaped by repeated experience. The predispositions that shape food acceptance patterns also include neophobia and the predisposition to learn to prefer and accept new foods when they are offered repeatedly. In addition, the predisposition for associative conditioning affects children's developing food acceptance patterns, resulting in preferences for foods offered in positive contexts, while foods presented in negative contexts will become more disliked via the learning of associations with the social and environmental contexts. Children also learn to prefer energy-dense foods when consumption of those foods is followed by positive post-ingestive consequences, such as those produced when high-energy-density foods are eaten when hungry. Although children are predisposed to be responsive to the energy content of foods in controlling their intake, they are also responsive to parents' control attempts. We have seen that these parental control attempts can refocus the child away from responsiveness to internal cues of hunger and satiety and towards external factors such as the presence of palatable foods. This analysis suggests that taking a closer look at what children are learning about food and eating may provide clues regarding the formation of children's food acceptance patterns, and that this approach also suggests potential causative factors implicated in the aetiology of obesity and the emergence of weight concerns. Current data, although limited, suggest that child-feeding practices play a causal role in the development of individual difference in the controls of food intake, and perhaps in the aetiology of problems of energy balance, especially childhood obesity. These relationships should be pursued in future research.

Infants' consumption of a new food enhances acceptance of similar foods

The number of feedings needed to increase intake of a novel target food was investigated, and whether exposure effects generalized to other foods in a sample of 4 to 7-month-old infants (N=39). Other foods varied in their similarity to the target food, including the same food prepared by another manufacturer, similar foods (other fruits for infants receiving a target fruit) and a different food (e. g. vegetables for infants receiving a target fruit). Infants were fed the target food once a day for 10 days. Intake was used to indicate acceptance. Results revealed that exposure dramatically increased infants' intake of the target food, from an average of 35-72 g. Intake of the different food was unchanged. Same and similar food intake increased with target food exposure. Intake of the target, same and similar foods nearly doubled to 60 g after one exposure to the target food. These rapid increases in intake contrast the slower changes seen in young children. Results for the other foods suggest that infants may have difficulty discriminating among many foods.

Development of eating behaviors among children and adolescents

The prevalence of obesity among children is high and is increasing. We know that obesity runs in families, with children of obese parents at greater risk of developing obesity than children of thin parents. Research on genetic factors in obesity has provided us with estimates of the proportion of the variance in a population accounted for by genetic factors. However, this research does not provide information regarding individual development. To design effective preventive interventions, research is needed to delineate how genetics and environmental factors interact in the etiology of childhood obesity. Addressing this question is especially challenging because parents provide both genes and environment for children. An enormous amount of learning about food and eating occurs during the transition from the exclusive milk diet of infancy to the omnivore's diet consumed by early childhood. This early learning is constrained by children's genetic predispositions, which include the unlearned preference for sweet tastes, salty tastes, and the rejection of sour and bitter tastes. Children also are predisposed to reject new foods and to learn associations between foods' flavors and the postingestive consequences of eating. Evidence suggests that children can respond to the energy density of the diet and that although intake at individual meals is erratic, 24-hour energy intake is relatively well regulated. There are individual differences in the regulation of energy intake as early as the preschool period. These individual differences in self-regulation are associated with differences in child-feeding practices and with children's adiposity. This suggests that child-feeding practices have the potential to affect children's energy balance via altering patterns of intake. Initial evidence indicates that imposition of stringent parental controls can potentiate preferences for high-fat, energy-dense foods, limit children's acceptance of a variety of foods, and disrupt children's regulation of energy intake by altering children's responsiveness to internal cues of hunger and satiety. This can occur when well-intended but concerned parents assume that children need help in determining what, when, and how much to eat and when parents impose child-feeding practices that provide children with few opportunities for self-control. Implications of these findings for preventive interventions are discussed.

Psychological influences on the childhood diet

Psychological influences on the childhood diet are addressed. The focus is on factors that influence the formation of children's food preferences. Evidence for links among food preferences, dietary intake and children's adiposity is presented, with an emphasis on dietary fat. Few food and flavor preferences are innate; most are learned via experience with food and eating and involve associative conditioning of food cues to aspects of the child's eating environment, especially the social contexts and physiological consequences of eating. Parents' child-feeding practices are central in this early feeding environment and affect children's food preferences and their regulation of energy intake. An understanding of how children's food preferences are acquired is essential in developing strategies to improve the quality of children's dietary intake.

Food intake regulation in children. Fat and sugar substitutes and intake

A series of experiments exploring children's responsiveness to manipulations of energy density and macronutrient content of foods have been reviewed to assess the nutritional impact of macronutrient substitutes on children's intake. In these experiments, the focus is on the extent to which the energy content of foods was a salient factor influencing children's food intake, and macronutrient substitutes were used as tools to investigate this issue. Therefore, although several different macronutrient substitutes have been used in this research, we do not have a parametric set of experiments systematically assessing the impact of a variety of macronutrient substitutes. Given this, what can we conclude from the existing data? When the energy density and macronutrient content of foods is altered through the use of macronutrient substitutes that reduce the energy content of foods, children tend to adjust for the missing energy, although this adjustment may be partial and incomplete. This suggests the possibility that when macronutrient substitutes are used to reduce the energy content of foods, children's energy intake may be reduced. This adjustment, however, will most likely be less than a "calorie for calorie" reduction. In addition, even among young children, there are individual differences in the extent to which children adjust their intake in response to macronutrient and energy manipulations. The data are more extensive and particularly clear for cases in which CHO manipulations are used to alter energy density, but there is evidence for adjustments in energy intake in response to alterations of the fat content of the diet. The compensation for energy is not macronutrient specific; that is, when the fat content of food is reduced to reduce energy density of foods, children do not selectively consume fat in subsequent meals. This means that manipulations of macronutrient content of foods that reduce foods' energy content may not result in alterations of energy intake, but because these adjustments in energy intake are not macronutrient specific, changes in the overall macronutrient composition of children's diets can be obtained. There does not appear to be anything unique or special about the effects of macronutrient substitutes on children's intake; their effects are similar to those produced by other manipulations of macronutrient and energy content accomplished without macronutrient substitutes (e.g., augmenting foods with fat or carbohydrate to produce macronutrient differences). The research also indicates that under conditions that minimize adult attempts to control how much and what children eat, children can adjust their food and energy intake in response to the alterations of macronutrient and energy content of foods. Whether or not young children adjust food intake to compensate for energy-density changes depends upon their opportunity to control their own food intake as opposed to having their intake controlled by others. Young children's ability to adjust intake in response to alterations in the energy density of foods can be readily disrupted by the imposition of controlling child-feeding practices that attempt to regulate what and how much children eat. We believe that early experiences, including child-feeding practices imposed by parents, are major factors contributing to the etiology of individual differences and gender differences in the behavioral controls of food intake that can occur in response to the energy content of foods. The extent to which children respond to energy density of the diet has major implications for the effects of fat and sugar substitutes on children's intake. If children who are responsive to energy density consume substantial amounts of foods containing macronutrient substitutes, they should show some adjustments in intake to compensate for reduced energy, so that the impact of macronutrient substitutes on energy intake may be relatively small. However, changes in macronutrient com

Appetite and eating behavior in children

The authors propose that individual differences among children in the controls of food intake can be viewed in terms of differences in balance of power in feeding. They also argue that the individual differences in styles of intake control that emerge by adolescence and adulthood, including chronic dieting, eating disorders, and out-of-control eating, begin in the early balance of control in the feeding context. Limited evidence suggests that the course of development of shared control differs for intermeal interval, food selection, and meal size.

Fat preferences and fat consumption of 3- to 5-year-old children are related to parental adiposity

OBJECTIVE

To examine differences in preferences for high-fat foods, dietary fat intake, anthropometric measurements, and parental body mass index (BMI) among 3- to 5-year-old children.

DESIGN

Children's fat intake was measured using 30-hour weighed food intake data from a standard menu. Children's fat preferences were assessed using a subset of foods from the standard menu. We obtained parents' BMI scores and children's anthropometric measurements including weight-for-stature, triceps, and subscapular skinfolds.

SUBJECTS

Participants were children 3 to 5 years of age (n = 18, 10 girls and 8 boys; mean [+/- standard deviation] age = 52 +/- 1.9 months) who were without food allergies, food sensitivities, or chronic illness, and the children's parents (18 mothers and 16 fathers).

STATISTICAL ANALYSES PERFORMED

Correlational analyses and maximum likelihood contingency tables were used to examine children's fat preferences and fat intake, children's anthropometric measurements, and BMI scores of parents.

RESULTS

Although all children were offered the same daily menu, children's dietary fat intakes ranged from 25% to 42%. Children indicating strong preferences for high-fat foods had high total fat intakes (r = .54, P < .05; chi 2 = 3.96, df = 1, P < .05). Children's fat preferences were also related to their triceps skinfold measurements (r = .61; P < .01). Finally, those children with the strongest preferences for high-fat foods (r = .75, P < .01; chi 2 = 10.68, df = 1, P < .05) and the highest total fat intakes (r = .67, P < .01; chi 2 = 5.28, df = 1, P < .05) had heavier parents than did children with low scores.

CONCLUSIONS

Offering children a nutritionally adequate diet is necessary but may not be sufficient to ensure dietary quality; children's food preferences are influential determinants of macronutrient intake. The association of children's fat preferences and intake with parental adiposity suggests that dietary influences may mediate familial patterns of adiposity.

Infant dietary experience and acceptance of solid foods

OBJECTIVE

To examine the effects of dietary experience and milk feeding regimen on acceptance of their first vegetable by 4- to 6-month-old infants.

DESIGN

Longitudinal study, of 26-days duration, observing infants aged 4 to 6 months at the start of the study. Random assignment to treatments, within-subject control.

SETTING

General community in a medium-sized midwestern town.

SUBJECTS

Thirty-six infants and their mothers. Subjects were solicited through birth records and advertisements in local newspapers.

INTERVENTIONS

Infants were randomly assigned to be fed one vegetable on 10 occasions, either salted or unsalted peas or green beans, for a 10-day period.

OUTCOME MEASURES

Infant intake of the vegetable consumed during the 10-day exposure period; intake of salted and unsalted versions: (1) before the 10-day exposure period, (2) immediately after the exposure period; and (3) after a 1-week period of delay. Intake of a control food was also measured before and after repeated consumption of the vegetable. Adult ratings of the infants' videotaped responses during test feedings were also obtained before and after the exposure period.

RESULTS

After 10 opportunities to consume the vegetable, all infants significantly increased their intake (P < .001). Although they did not differ initially, infants fed breast milk showed greater increases in intake of the vegetable after exposure and had an overall greater level of intake than formula-fed infants. Adult ratings of the infants' nonverbal responses correlated positively with infant intake.

CONCLUSIONS

Infants increase their acceptance (reflected both in changes in intake and in behavioral response) of a novel food after repeated dietary exposure to that food. Relative to formula-feeding, breast-feeding may facilitate the acceptance of solid foods.

Effects of a nonenergy fat substitute on children's energy and macronutrient intake

To determine whether children adjusted their energy intake in response to covert manipulations in the proportion of energy from dietary fat, 24-h food intake of 29 2- to 5-y-old children was measured over four 2-d blocks. In this within-subject crossover design, in the first three meals of the first day of each block, children consumed foods containing dietary fat or a nonenergy fat substitute, which provided 10% of total daily energy intake. Children compensated for the missing energy; cumulative energy intake differed by only 100 kJ over 2 d. Substitution for dietary fat reduced the percent of energy from fat from 38.7% to 36.4%. Children's intake at individual meals was highly variable (mean CV 24.7%) relative to the variability of total daily energy intake (CV = 8.6%). To produce this pattern, children adjusted energy intake across successive meals. Use of a fat substitute at 10% of energy from dietary fat did not significantly reduce 24-h energy intake.

The postingestive consequences of fat condition preferences for flavors associated with high dietary fat

To investigate whether children acquire conditioned preferences for flavors associated with high dietary fat content, 27 3- and 4-year-old children participated in a series of 12 conditioning or mere exposure sessions. Following an overnight fast, children who participated in conditioning trials consumed fixed quantities of a flavored yogurt drink that on half the days was high in fat and energy (954 kJ, 18 g fat/150 g serving) or contained no fat (277 kJ, 0 g fat/150 g serving). Children in the conditioning group consumed 150 g servings, children in the mere exposure group tasted 16 g or less of these same stimuli. Preferences were assessed before and after conditioning when the children were hungry and also postconditioning when the children were satiated. Results provided evidence for conditioned preferences based on the postingestive consequences of dietary fat. Children in the conditioning group learned to prefer the high-density paired flavor over the low-density paired flavor, and increased their preference for the high-density paired flavor from pre- to postconditioning. Children in the mere exposure group showed positive shifts in preference for both the fat-free and the high-fat paired flavors. In the conditioning group, preferences for the high-fat flavor was depressed by satiety, whereas the preference of the mere exposure group did not vary with hunger state. Conditioned flavor preferences, based on the postingestive consequences of fat intake, may contribute to children's preferences for foods high in dietary fat.

Children's lunch intake: effects of midmorning snacks varying in energy density and fat content

To determine the effects of preloads differing in energy density and fat content on subsequent lunch intake, 24 preschool children consumed 113 g ice-cream preloads as mid-morning snacks (containing 0, 12, or 18 g of fat, and 4 g of protein), followed nearly 2 h later by an ad libitum lunch consisting of a variety of foods. A fat-free baseline preload, consisting of dry cereal and apple juice, was also included. The baseline, fat-free, medium and high-fat preloads contained 334, 740, 953, and 1150 kJ per serving. All three ice-cream preloads produced significant but equivalent suppression of ad libitum lunch intake relative to baseline; lunch intake was not related to the fat content or energy density of the ice-cream preloads. Compensation at lunch was not macronutrient specific; children did not increase their fat intake at lunch following the fat-free preload. As energy and fat content of the preloads increased, children consumed significantly fewer foods at lunch, confirming previous findings. These changes in the variety of foods consumed were related to preference: regardless of preload, children continued to consume their preferred foods, while non-preferred foods tended to be eliminated following the higher energy preloads. Because compensation for energy was incomplete, energy intake of meals plus snacks increased with the energy content of the preload. Additional research is required to determine whether manipulating the fat and energy content of snacks produces similar effects when the unit of analysis is the child's total daily diet, rather than a single meal.

Help me make it through the night: behavioral entrainment of breast-fed infants' sleep patterns

The study objective was to investigate whether exclusively breast-fed infants could be taught to sleep through the night (defined from 12:00 AM to 5:00 AM) during the first 8 weeks of life. The design was short-term longitudinal, from the last trimester of pregnancy until the eighth week after birth. Twenty-six first-time parents and their newborn were randomly assigned to treatment and control groups (13 in each group). Treatment parents were instructed to offer a "focal feed" (between 10 PM and 12 AM) to their infants every night, to gradually lengthen intervals between middle-of-the-night feeds by carrying out alternative caretaking behaviors (eg, reswaddling, diapering, walking), and to maximize environmental differences between day and nighttime. All parents kept 72-hour diaries of their infants' feeding and sleeping patterns every week from birth to 8 weeks of age and rated their infants' temperament at birth and at 8 weeks. By 3 weeks, treatment infants showed significantly longer sleep episodes at night. By 8 weeks 100% of treatment infants were sleeping through the night compared to 23% of control infants. Treatment infants were feeding less frequently at night but compensated for the relatively long nighttime interval without a feed by consuming more milk in the early morning. Milk intake for 24-hour periods did not differ between groups. Treatment infants were rated as more predictable on Bates' Infant Characteristics Questionnaire. It is concluded that parents can have a powerful influence on the development of their infants' sleep patterns. Frequent night waking in breast-fed infants often results in early termination of lactation.(ABSTRACT TRUNCATED AT 250 WORDS)

Children's preferences for high-fat foods

Many high-fat foods are highly preferred by adults, and children soon acquire these preferences. The circumstances and mechanisms that contribute to establishing children's preferences for high-fat foods are the subject of this review.

Tryptophan intake influences infants' sleep latency

Formula-fed infants have depressed plasma tryptophan concentration relative to human milk-fed infants. Because tryptophan alters sleep-waking patterns in adults, a study was designed to determine whether additional dietary tryptophan could elevate plasma tryptophan concentrations of formula-fed infants to concentrations characteristic of human milk feeding and whether differences in plasma tryptophan or the ratio of plama tryptophan to the sum of the other plasma large neutral amino acids (tryptophan:LNAA) were of behavioral significance. Infants were fed a formula (13 g protein/L; whey:casein, 34:66) containing either 0, 294, 588 or 882 mumol/L of added tryptophan. Infants fed human milk or commercial formula (15 g protein/L; whey:casein, 18:82) were included for comparison. In formula-fed groups, plasma tryptophan was directly related to tryptophan intake (r = 0.46, P less than 0.0005). Infants fed commercial formula or the formula without added tryptophan had lower (P less than 0.001) plasma tryptophan compared with infants fed human milk. Only the infants fed the highest tryptophan formula had significantly higher plasma tryptophan:LNAA ratios than the other experimental groups, and these ratios were similar to those of infants fed human milk. The plasma tryptophan:LNAA ratios, not plasma tryptophan concentrations, were predictive of differences in the infants' sleep latency; infants fed formula containing the highest tryptophan had sleep latencies of 18.7 min, significantly shorter (P less than 0.05) than those of infants fed formulas containing less added tryptophan (27.7 min). Feeding infants formulas differing in tryptophan concentration produced differences in sleep latency, which could influence neurobehavioral developments.(ABSTRACT TRUNCATED AT 250 WORDS)

Conditioned preferences: young children prefer flavors associated with high dietary fat

In two experiments, 20 2-5-year-old children participated in a series of 8 conditioning trials to investigate whether they acquired conditioned preferences based on the fat content of a food. On different days, each child consumed fixed quantities of novelly flavored yogurts that were high or low in fat and energy density (220 or 110 kcal/serving). After conditioning, patterns of ad lib consumption data provided evidence of caloric compensation in response to the energy density differences in the preloads. Children consumed more following the low- than the high-fat preloads. Preference assessments, performed pre- and postconditioning, revealed conditioned flavor preferences based on fat content: children increased their preference for the high-density paired flavor, but no change in preference was noted for the low-density paired flavor. These data suggest that such conditioned flavor preferences based on energy density may be contributing to children's preferences for foods high in dietary fat.

The variability of young children's energy intake

BACKGROUND

Research conducted in the 1930s showed that, given nutritious choices, children can select an adequate diet without adult supervision. Paradoxically, children grew well and were healthy despite patterns of intake at individual meals that were unpredictable and highly variable.

METHODS

To investigate in more detail the energy intake of young children, we measured 24-hour food intake for 15 children, from two to five years of age, on six days. For each of the six days of the study, coefficients of variation were calculated for each child for each of the six meals and snacks (breakfast, lunch, dinner, and morning, afternoon, and evening snacks) and for total daily energy intake.

RESULTS

The children's intake at individual meals was highly variable, but total daily energy intake was relatively constant for each child. The mean coefficient of variation for each child's energy intake at individual meals was 33.6 percent; in contrast, the mean coefficient of variation for each child's total daily energy intake was 10.4 percent. In most cases, high energy intake at one meal was followed by low energy intake at the next meal, or vice versa.

CONCLUSIONS

Although children's food consumption is highly variable from meal to meal, daily energy intake is relatively constant, because children adjust their energy intake at successive meals.

The scapegoat effect on food aversions after chemotherapy

The effects of consuming a novel food (halva) versus a familiar food (cookies) before gastrointestinal (GI) toxic chemotherapy on patients' preference for familiar foods consumed after chemotherapy treatment were compared. The development of aversions to the novel and familiar foods was also assessed. Patients with a history of posttreatment nausea consumed either a novel or a familiar food before chemotherapy and were asked to keep a food record through the next breakfast and to rate their preference for these foods. Patients who consumed halva before treatment were significantly more likely to increase their ratings for foods consumed after chemotherapy than patients who consumed familiar cookies. Aversions to the novel food were significantly more frequent than aversions to the familiar food. These findings provide evidence that a novel but not a familiar food consumed before chemotherapy can act as a scapegoat to prevent items in the regular diet consumed after chemotherapy from decreasing in preference. Providing patients with a novel food before chemotherapy is a useful clinical intervention to reduce the likelihood of forming aversions to familiar foods consumed after chemotherapy.

Control of intake by human-milk-fed infants: relationships between feeding size and interval

Diurnal feeding behavior of 24 exclusively breast-fed infants was examined at 2, 4, 6, 8, and 12 weeks to assess whether milk intake at a feeding was related to previous (preprandial) or subsequent (postprandial) intervals between feedings. Amount of human milk consumed per feeding and intervals between feedings were measured over a 72-hr period. Correlation analyses revealed that volume of milk ingested at a feeding (meal size) was positively related to preprandial interval at all 5 ages (r = 0.39-0.47, p less than 0.0001). Meal size was likewise related, but not as strongly, to postprandial interval at 4 of the 5 time points examined (r = 0.17-0.25, p less than 0.01). Results of the correlational analyses revealed clear, consistent preprandial correlations, providing evidence for a reactive type feeding pattern among the solely breast-fed infants. Postprandial correlations, possibly reflect an anticipatory feeding pattern, were present but remained consistently low over the 3 months examined, providing little evidence of a developmental shift. This study provides a preliminary foundation for future longitudinal studies that address the regulation of food intake among infants.

Conditioned flavor preferences in young children

In this experiment 11 children participated in a series of 8 pairs of conditioning trials in order to investigate the hypothesis that children could form conditioned flavor preferences based on caloric density. Unfamiliar drink flavors were used in these trials, and the drinks were either high in caloric density (155 kcal/150 ml) or low (less than 5 kcal/150 ml). Caloric density was altered by the addition of low glucose maltodextrin. Each child always had the same caloric density/flavor pairing throughout the conditioning trials. Each trial pair included one high and one low density preload, followed by ad lib consumption. These conditioning trials substituted for the children's regularly scheduled morning snack four days per week, one trial per day. Conditioning trials were given as a series of two-part snacks, consisting of fixed volumes of initially unfamiliar drinks, followed by the opportunity to eat a variety of foods ad lib. Two measures, obtained before and after conditioning, provided evidence for the formation of conditioned flavor preferences: 1) preference assessments, and 2) two-flavor choice tests. In addition, the ad lib consumption data indicated that the children were responsive to the caloric density manipulation, by consistently eating more following the low than the high density drink. The potential contribution of such acquired flavor preferences to the reduction of neophobia is discussed.