Association between Parents’ Perceptions of Preschool Children’s Weight, Feeding Practices and Children’s Dietary Patterns: A Cross-Sectional Study in China

Abstract

Parental perception of children’s weight may influence parents’ feeding practices, and in turn, child dietary intake and weight status; however, there is limited evidence generated for preschoolers. The aim of this cross-sectional study was to investigate associations between Chinese parents’ perceptions of child weight, feeding practices and preschoolers’ dietary patterns. Participants (1616 parent-child pairs) were recruited from six kindergartens in Hunan, China. Parents’ misperception, concern, and dissatisfaction on child weight were collected through a self-administered caregiver questionnaire. Parental feeding practices and children’s dietary intake were, respectively, assessed using the Child Feeding Questionnaire and a Food Frequency Questionnaire. Linear regression models were applied to analyze associations between parental weight perceptions, feeding practices, and preschooler’s dietary patterns. Associations between parents’ weight perceptions and dietary patterns were significant only among underweight children. Regardless of child weight status, parental weight underestimation and preference for a heavier child were positively associated with pressure-to-eat. Parental weight concern was positively associated with restriction in normal weight child, but this was not found in other weight groups. In conclusion, Parents’ misperception, concern, and dissatisfaction about child weight are associated with parents’ feeding practices and may influence preschoolers’ dietary quality, but the relationships vary by children’s actual weight status.

The Relationships between Caregivers’ Concern about Child Weight and Their Non-Responsive Feeding Practices: A Systematic Review and Meta-Analysis

“…Characteristics of the included studies are shown in Table 1 . The studies were published between 2001 and 2022, conducted in the US ( n = 12) [ 21 , 24 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ], Australia ( n = 6) [ 26 , 27 , 75 , 76 , 77 , 78 ], Brazil ( n = 4) [ 28 , 30 , 50 , 79 ], Sweden ( n = 4) [ 22 , 80 , 81 , 82 ], China ( n = 2) [ 83 , 84 ], the Netherlands ( n = 1) [ 85 ], Ethiopia ( n = 1) [ 29 ], the UK ( n = 1) [ 86 ], Mexico ( n = 1) [ 87 ], South Korea ( n = 1) [ 88 ], Portugal ( n = 1) [ 23 ], India ( n = 1) [ 25 ], and France ( n = 1) [ 74 ]. The study designs were a cross-sectional study ( n = 32) and a cohort study ( n = 3) [ 23 , 26 , 85 ].…”

“…The caregivers were typically mothers ( n = 19). Only four studies used a random sampling method [ 27 , 29 , 67 , 83 ].…”

“…Thirty studies used the subscale of concern about child weight in CFQ to assess caregivers’ concern about children at risk of being overweight [ 19 ], and two studies [ 29 , 77 ] used the Preschooler Feeding Questionnaire (PFQ) [ 89 ] to assess caregivers’ concern about child underweight. CFQ ( n = 21) and the Chinese Child Feeding Questionnaire (C-CFQ) [ 90 ] ( n = 2) [ 83 , 84 ] was used to assess the domains of non-responsive feeding practices, including restriction, pressure to eat, and use of food as a reward. The Comprehensive Feeding Practices Questionnaire (CFPQ) [ 64 ] was also adopted in ten studies to assess caregivers’ restrictions for weight and health, pressure to eat, use of food as a reward, and emotional feeding.…”

“…Consistently, the results of this meta-analysis indicated that caregivers’ concern about child overweight was associated with more restriction of food. When caregivers are concerned about child overweight, they may realize the consequences of child overweight or obesity [ 2 , 3 , 4 ], such as adulthood obesity and chronic disease, which may make them adopt controlled feeding practices (e.g., the restriction of unhealthy food) [ 83 ]. Furthermore, society places great importance on weight and body shape [ 91 ]; thus, caregivers may be more likely to restrict their children’s eating if they were concerned about their child becoming overweight.…”

“…When they are concerned about child overweight, they may not consider applying responsive feeding practices (e.g., rules and limits, modeling, and the encouragement of healthy eating). Instead, they may prefer to use restrictive feeding as a straightforward method [ 83 ]. Second, although the subscale of concern about child weight in the CFQ has been commonly used [ 19 ], it has been criticized that it is not possible to know whether the concern was about either current or future overweight or a combination of both [ 70 , 86 ].…”