Caregiver Influences on Eating Behaviors in Young Children

Abstract

A substantial body of research suggests that efforts to prevent pediatric obesity may benefit from targeting not just what a child eats, but how they eat. Specifically, child obesity prevention should include a component that addresses reasons why children have differing abilities to start and stop eating in response to internal cues of hunger and satiety, a construct known as eating self‐regulation . This review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self‐regulation during early childhood. First, we discuss the evidence supporting an association between caregiver feeding and child eating self‐regulation. Second, we discuss what implications the current evidence has for actions caregivers may be able to take to support children's eating self‐regulation. Finally, we consider the broader social, economic, and cultural context around the feeding environment relationship and how this intersects with the implementation of any actions. As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children. It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community‐based care providers.

Parent Feeding Practices in the Context of Food Insecurity

“…Controlling feeding practices such as restriction (limiting child access to “unhealthy” foods) and pressure to eat (“clean your plate”) are thought to disrupt children’s innate ability to self-regulate how much they eat and are generally associated with problematic eating behaviors and obesity [ 55 ]. Although restriction and pressure to eat have primarily been studied in relation to child weight and obesity risk [ 56 ], parents may engage in restrictive feeding if the family is experiencing food insecurity as a way to conserve resources [ 57 ]. Similarly, parents may pressure their children to eat available food because they are unsure of when they will have food again and/or so that food is not wasted.…”

An Overview of Research Opportunities to Increase the Impact of Nutrition Intervention Research in Early Childhood and Education Care Settings According to the RE-AIM Framework

“…De-implementation has been described as stopping, reducing or replacing the use or delivery of practices or services that are unproven, harmful, ineffective or inappropriate [ 70 ]. Certain educator mealtime nutrition practices used within the ECEC setting have been associated with negative impacts on child eating behaviours, such as the impaired ability to self-regulate food intake [ 71 ] and poor child dietary outcomes [ 72 ]. Such practices include the use of controlling, non-responsive feeding behaviours, including pressuring children to eat [ 72 ], withholding of palatable foods [ 73 ] and using certain foods as a reward for eating or to encourage other desirable behaviours [ 72 ].…”

Table Talk: revision of an observational tool to characterize the feeding environment in early care and education settings

“…Prior research has attributed variability in childcare settings to the inconsistent associations between childcare exposure and overweight and obesity [ 32 ]. Yet, a majority of interventions directed toward addressing childhood obesity focus on dietary intake of children rather than environmental factors [ 33 ]. In particular, the role of the caregiver in “shaping child eating behaviors associated with healthy body weight outcomes (p 2),” such as eating self-regulation based on recognizing internal hunger and fullness cues in infrequently a focus of intervention or policy [ 33 ].…”

“…Yet, a majority of interventions directed toward addressing childhood obesity focus on dietary intake of children rather than environmental factors [ 33 ]. In particular, the role of the caregiver in “shaping child eating behaviors associated with healthy body weight outcomes (p 2),” such as eating self-regulation based on recognizing internal hunger and fullness cues in infrequently a focus of intervention or policy [ 33 ]. A shift toward improving ECET feeding behaviors may help to fill the need to understand, “how childcare environments can be optimized to mitigate the risk of childhood obesity (p 10).” [ 32 ] The TT-R has potential to contribute to that line of research (and/or internal assessment) within childcare environments by identifying unsupportive practices to eliminate and supportive practices to amplify across different ECE meal occasions.…”