Research reviewParental influences on children’s eating behaviour and characteristics of successful parent-focussed interventions☆
Highlights
► Review of literature on contributing factors to the development of feeding and eating problems in childhood. ► Themes cover exposure, role-modelling, parental feeding practices and parental feeding style. ► Review of parent-focussed interventions. ► Discussion on the use of technology to deliver interventions.
Introduction
Approximately 25–40% of infants and toddlers experience feeding problems, as reported by their caregivers (Reau, Senturia, Lebailly, & Christoffel, 1996). Based on this, it is estimated that up to 289,266 of the children born in England and Wales in 2010 (Office for National Statistics, 2011) and 1,600,112 of the children born in the USA in the same year (Hamilton, Martin, & Ventura, 2011), will experience some feeding-related problem. Taken across the EU as a whole, this equates to around 3,160,320 of the children born in 2010 (United Nations, 2011). This is concerning, since a poor diet in childhood often predicts poor diet in adulthood (e.g., Craigie, Lake, Kelly, Adamson, & Mathers, 2011) and the development of a range of otherwise preventable diseases, such as obesity, cancer, and heart disease (e.g., Nicklas & Hayes, 2008). This is costly, with recent figures reporting that the British healthcare system spent £5.8 billion in 2006–2007 treating illnesses related to inadequate nutrition and poor diet (Scarborough et al., 2011). In addition, child feeding problems are often associated with decreased parental emotional and psychological wellbeing (e.g., Blissett, Meyer, & Haycraft, 2007). However, since many families experiencing non-clinical feeding problems do not receive professional help, parental mental health and wellbeing issues are less likely to be identified and treated. Thus, common feeding problems can leave both the parent and the child vulnerable to further negative health-related outcomes.
The definition of a non-clinical feeding-related problem is somewhat ambiguous due to the plethora of different terms that are used within the literature to describe problematic feeding and eating behaviours. Most child eating problems involve food refusal to a greater or lesser degree (Dovey, Farrow, Martin, Isherwood, & Halford, 2009). However, ‘food refusal’ is an umbrella term which incorporates labels such as picky or fussy eating, poor appetite, food avoidance, neophobia, and infantile anorexia, to name a few. Eating problems may present a risk to nutritional health (Galloway, Fiorito, Lee, & Birch, 2005), but may not necessarily be associated with underweight (March & Cohen, 1990), Importantly, as acknowledged by Bryant-Waugh, Markham, Kreipe, and Walsh (2010), child eating difficulties affect more than just the child, and have a wider impact on the family. Indeed, the relationships and interactions around feeding are important factors that play a role in the development and maintenance of eating difficulties.
This review focuses on the role of parental feeding practices in the development of non-clinical feeding problems; those aspects of children’s eating behaviour that are not conducive to the development of a varied and nutritionally-balanced diet or a healthy relationship with food. It will begin by reviewing the literature related to parental feeding practices, before discussing the nature of the support that is currently available for parents and identifying the characteristics of successful interventions. Finally, new approaches to more interactive interventions which may prove fruitful are described.
Section snippets
Parental influences on children’s eating behaviour
In general, parents tend to control what and when their young children eat. Frequently, they also attempt to control how much is eaten. As a result, a parent’s influence is significant – often well before their child can even walk or talk. This influence is reflected both by what is on the plate and the context in which it is offered. The following section reviews the ways in which the home mealtime environment and parental feeding practices influence children’s eating behaviour and the impact
Parent-focussed interventions for non-clinical feeding difficulties
What, when, and how much food is offered to a child at mealtimes is the responsibility of a child’s parents/caregivers, most often the mother (e.g., Blissett et al., 2006, Robinson, 2000, Savage et al., 2007). However, what and how much is eaten is determined by the child. Maladaptive feeding practices often derive from a parent’s anxiety about the health and wellbeing of their child; the belief that their child is unable to self-regulate (Tan & Holub, 2011), is perceived to be underweight (
Discussion
Non-clinical feeding problems are extremely common, yet they can have serious adverse psychological and nutritional consequences. At present, parents are poorly supported in understanding why feeding problems in childhood can arise and what they can do to encourage the development of a healthy, varied, and balanced diet. As such, there is a real need to try to address the underlying causes of common feeding problems and equip parents with the knowledge and skills to tackle these when they
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Acknowledgements: Dr. Gemma Mitchell was employed on a grant funded by the Garfield Weston Foundation. There was no other funding for this work.