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Bottle‐fed infants are at higher risk for rapid weight gain compared with breastfed infants. Few studies have attempted to disentangle effects of feeding mode, milk composition and relevant covariates on feeding interactions and outcomes. The objective of the present study was to compare effects of breastfeeding directly at the breast versus bottle‐feeding expressed breast milk on feeding interactions. Mothers with <6‐month‐old infants (n = 47) participated in two counterbalanced, feeding observations. Mothers breastfed their infants directly from the breast during one visit (breast condition) and bottle‐fed their infants expressed breast milk during the other (bottle condition). Masked raters later coded videos using the Nursing Child Assessment Parent–Child Interaction Feeding Scale. Infant intake was assessed. Mothers self‐reported sociodemographic characteristics, infant feeding patterns (i.e. percentage of daily feedings from bottles) and level of pressuring feeding style. Mother and infant behaviours were similar during breast and bottle conditions. Percent bottle‐feeding moderated effects of condition on intake (P = 0.032): greater percent bottle‐feeding predicted greater intake during the bottle compared with breast condition. Effects of feeding mode were not moderated by parity or pressuring feeding style, but, regardless of condition, multiparous mothers fed their infants more than primiparous mothers (P = 0.028), and pressuring feeding style was positively associated with infant intake (P = 0.045). Findings from the present study do not support the hypothesis that feeding mode directly impacts dyadic interaction for predominantly breastfeeding mothers and infants, but rather suggest between‐subject differences in feeding experiences and styles predict feeding outcomes for this population.

Parental feeding style (PFS) remarkably influences fruit and vegetable (F&V) consumption in preschoolers. This study aimed to determine the association between PFS and preschoolers’ F&V consumption, as influenced by socioeconomic factors. A nationwide cross-sectional study was conducted among 1418 mothers of children aged 3–5 years in Saudi Arabia. Multinomial logistic regression model analysis was performed to assess the association between PFS and children’s daily F&V intake using the Parental Feeding Style Questionnaire. The influence of socioeconomic factors on this association was also evaluated. For mothers with university degrees, encouragement, emotional, and instrumental feeding enhanced their children’s intake of F&Vs, fruits, and vegetables, respectively. Children from families earning SAR >10,000 monthly had increased F&V intake with encouragement feeding and increased fruit intake with emotional feeding. However, F&V intake was reduced in children of working mothers with controlling feeding styles. Breastfeeding for <6 months was associated with increased F&V intake through emotional feeding. The most prevalent feeding style was encouragement, followed by emotional, with control and instrumental styles being less common. This study provides strong evidence on the association between PFS and daily F&V intake in Saudi preschoolers. Interventional and longitudinal studies on PFS are required to confirm these findings.

Purpose Despite being widely used, there has not yet been a confirmatory factor analysis (CFA) on the English version of the Parental Feeding Style Questionnaire (PFSQ). Preschool is a critical time to assess parental feeding styles, and the PFSQ is one of the few measures that can be used with young children. As such, the current study conducted the first CFA on the PFSQ in an English-speaking sample in the United States to establish preliminary evidence of its factor structure. Methods Parents of preschoolers aged 3–5 years ( N  = 297; M  = 33.47 years; 85.2% mothers) presenting to a pediatric dentistry office in the Midwest of the United States were recruited to participate in this cross-sectional study. Parents completed the PFSQ in the waiting room of the dental office. Robust maximum likelihood factor analyses were conducted on the PFSQ. Results The original four-factor model was not confirmed, but rather, results provided preliminary support for a five-factor solution: Control over Eating, Instrumental Feeding, Emotional Feeding, Encouragement of Variety, and Prompting of Eating, CFI = 0.91, SRMR = 0.06, RMSEA = 0.05. Conclusions The PFSQ is a widely used measure for assessing parental feeding styles in young children. However, the CFA indicated that the originally proposed four-factor structure did not fit well. Certain modifications to the measure were necessary to improve model fit. A five-factor model fit better, and six items were removed, reducing the original 27-item scale to 21 items. Level of evidence Level V, cross-sectional descriptive study.

Objective: This pilot study tested whether maternal feeding attitudes and styles towards children are part of the 'shared' or 'non-shared' home environment. A secondary aim was to test whether within-family differences in maternal feeding attitudes and styles relate to within-family differences in child weight status. Methods: Mothers of 3- to 7-year-old sibling pairs (N=15 pairs) completed the Child Feeding Questionnaire (CFQ), which assessed feeding attitudes (perceived responsibility, perceived child overweight and child weight concern) and feeding styles (monitoring, restriction and pressure to eat) towards children. Mothers rated each sibling separately. Child weight and height were measured and converted to body mass index (BMI) z-scores. Intraclass correlations tested the familial associations for each CFQ subscale. Pearson's correlations tested whether within-family differences in CFQ subscales were related to within-family differences in child BMI z-scores. Results: Perceived responsibility (p=0.77, P=0.0004), perceived child overweight (p=0.99, P<0.0001) and monitoring (p=0.57, P=0.01) showed significant familial correlations. Mothers reported significantly greater weight concern (r=0.85, P=0.02) and reduced pressure to eat (r=-0.80, P=0.03) towards heavier than thinner children within families. Conclusion: Whether or not maternal feeding practices are shared or non-shared components of the home environment depends on the specific feeding domain being measured. Restrictive feeding practices and encouragements to eat by mothers might be tested as non-shared environmental variables in genetics studies of childhood obesity.

Against the background of rising rates of obesity in children and adults in the USA, and modest effect sizes for obesity interventions, the aim of the present narrative review paper is to extend the UNICEF care model to focus on childhood obesity and its associated risks with an emphasis on the emotional climate of the parent–child relationship within the family. Specifically, we extended the UNICEF model by applying the systems approach to childhood obesity and by combining previously unintegrated sets of literature across multiple disciplines including developmental psychology, clinical psychology and nutrition. Specifically, we modified the extended care model by explicitly integrating new linkages (i.e. parental feeding styles, stress, depression and mother's own eating behaviour) that have been found to be associated with the development of children's eating behaviours and risk of childhood obesity. These new linkages are based on studies that were not incorporated into the original UNICEF model, but suggest important implications for childhood obesity. In all, this narrative review offers important advancements to the scientific understanding of familial influences on children's eating behaviours and childhood obesity.

Background/Objective: Problems associated with eating and weight in childhood are complex and have a multifactorial etiology. In recent years, childhood obesity has become a global public health problem with short- and long-term physical, psychological, and social health consequences. This is a cross-sectional study that evaluates the relationship between parenting styles, eating styles, and parents’ body mass index (BMI) and their children’s body mass index (BMI) and disordered eating behaviors (DEBs). Method: A sample of 372 dyads of mothers or fathers (mean age = 38 (SD = 8.8)) and boys or girls (mean age = 8.9 years (SD = 0.31)) was used. Results: Path analysis found that an authoritarian parenting style had a significant positive relationship with food approach (β = 0.36, p < 0.001) and food avoidance factors (β = 0.23, p < 0.001). Parental depression was positively associated with food approach (β = 0.20, p < 0.001) and food avoidance factors (β = 0.19, p < 0.001). Food approach factors significantly predicted compensatory behaviors (β = 0.14, p < 0.001). Lastly, both binge eating (β = 0.10, p < 0.05) and compensatory behaviors (β = 0.31, p < 0.001) showed significant positive relationships with children’s BMI. Conclusions: A clearer understanding of the relationships among these factors could facilitate earlier and more effective interventions targeting nutrition- and weight-related issues.

To examine cross-sectional and longitudinal (one-year follow-up) associations of parental feeding styles with child snacking behaviour and weight in the context of general parenting, taking into account the multidimensionality of the controlling feeding style. Linear regression analyses were performed. Parents completed a questionnaire to measure five feeding style dimensions (Instrumental Feeding, Emotional Feeding, Encouragement, Overt Control and Covert Control) and children's fruit, energy-dense snack and sugar-sweetened beverage (SSB) intakes. Children's height and weight were measured to calculate their BMI Z-scores. Moderation by parenting style was tested by adding interaction terms to the regression analyses. Observational study in the Netherlands. Parent-child dyads (n 1275) participating in the INPACT (IVO Nutrition and Physical Activity Child cohorT) study; children were (on average) 9 years of age. Instrumental Feeding and Emotional Feeding were negatively related to child fruit intake one year later and positively to (changes in) child energy-dense snack intake. Encouragement was negatively related to child energy-dense snacking and SSB intake one year later. Overt Control was cross-sectionally and prospectively related to (changes in) child energy-dense snacking and SSB intake in a negative direction. Covert Control showed similar associations with child energy-dense snacking and SSB intake as Overt Control. Although Covert Control was also positively related to child fruit intake and (changes in) child BMI Z-score, bootstrapping analyses revealed only a differential effect of Overt Control and Covert Control on child BMI Z-score one year later, with Covert Control displaying a stronger, positive association. Moderation analyses showed that some significant associations between parental feeding styles and outcome measures were dependent on the degree of psychological control and behavioural control. Instrumental Feeding and Emotional Feeding may have a detrimental impact on children's snacking behaviour, while Encouragement, Overt Control and Covert Control may lead to less energy-dense snacking and less SSB intake. Overt Control and Covert Control have differential effects on child BMI Z-score one year later, which supports the idea that they should be treated as separate constructs. Prospective studies with a longer follow-up may elucidate the causal pathways between the various feeding styles and children's snacking behaviour and weight, as well as the moderating influences of psychological and behavioural control.

To examine associations between maternal characteristics and feeding styles in Caribbean mothers. Participants were mother-child pairs enrolled in a cluster randomised trial of a parenting intervention in three Caribbean islands. Maternal characteristics were obtained by questionnaires when infants were 6-8 weeks old. Items adapted from the Toddler Feeding Behaviour Questionnaire were used to assess infant feeding styles at the age of 1 year. Feeding styles were identified using factor analysis and associations with maternal characteristics assessed using multilevel linear regression. Health clinics in St. Lucia (n 9), Antigua (n 10) and Jamaica (n 20). A total of 405 mother-child pairs from the larger trial. Maternal depressive symptoms were associated with uninvolved (β = 0·38, 95 % CI (0·14, 0·62)), restrictive (β = 0·44, 95 % CI (0·19, 0·69)) and forceful (β = 0·31, 95 % CI (0·06, 0·57)) feeding and inversely associated with responsive feeding (β = -0·30, 95 % CI (-0·56, -0·05)). Maternal vocabulary was inversely associated with uninvolved (β = -0·31, 95 % CI (-0·57, -0·06)), restrictive (β = -0·30, 95 % CI (-0·56, -0·04)), indulgent (β = -0·47, 95 % CI (-0·73, -0·21)) and forceful (β = -0·54, 95 % CI (-0·81, -0·28)) feeding. Indulgent feeding was negatively associated with socio-economic status (β = -0·27, 95 % CI (-0·53, -0·00)) and was lower among mothers ≥35 years (β = -0·32, 95 % CI (-0·62, -0·02)). Breast-feeding at 1 year was associated with forceful feeding (β = 0·41, 95 % CI (0·21, 0·61)). No significant associations were found between maternal education, BMI, occupation and feeding styles. Services to identify and assist mothers with depressive symptoms may benefit infant feeding style. Interventions to promote responsive feeding may be important for less educated, younger and socio-economically disadvantaged mothers.

Background Parental complaints about feeding difficulties (FD) during childhood are frequent in pediatrics. Behavioral factors about children’s feeding and parental aspects are fundamental in solving these problems, but research in this area lacks information considering the joint presence of fathers and mothers. Thus, this study aimed to investigate the features of children, parents and mealtime practices related to FD reported by fathers and mothers and to identify parenting styles, mealtime actions, practices and factors associated with FD in children. Methods 323 parents (226 mothers and 97 fathers) of children aged 1 to 7 years were recruited in the emergency waiting room at Sabará Hospital Infantil, in São Paulo, Brazil, and self-completed electronic questionnaires on parenting style (Caregiver’s Feeding Styles Questionnaire), parents’ mealtime actions (Parent Mealtime Action Scale), socioeconomic information, personal and children’s health data and routine meal practices. Results The prevalence of FD in children was 26.6%. Indulgent parenting style was the most frequent (44.2%), followed by authoritarian (25.1%), authoritative (23.8%), and uninvolved (6.9%) styles. Most parents (75.8%) reported presence during meals, and 83.6% used distractions. Regression analyses after adjustments showed, as factors associated with FD, female children (OR: 2.06; 95%CI: 1.19–3.58), parents’ FD history (OR: 3.16; 95%CI: 1.77–5.64), and greater frequency of parents’ behavior of offering many food options (OR: 2.69; 95%CI: 1.18–6.14). Parents with indulgent styles had decreased chances of reporting FD in their children (OR: 0.13; 95%CI: 0.06–0.27). Furthermore, the practice of children sharing the family menu (OR: 0.43; 95%CI: 0.18–0.99) and higher frequency of parents’ behavior of setting snack limits (OR: 0.44; 95%CI: 0.23–0.85) were inversely associated with FD. Conclusions This study reinforces the multifactorial aspects involved in the feeding difficulties context. It points out the importance of expanding knowledge of the individual role of fathers and mothers to compose a scenario that can guide future studies and interventions. Trial registration CAAE #99221318.1.0000.5567 with registration number 2,961,598.

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.