Effect of Parental Feeding Practices (i.e., Responsive Feeding) on Children’s Eating Behavior

Kimberley Mallan and Narissa Miller

Healthy eating habits formed in childhood track into later life [1]. Whilst some eating behaviors appear to have a genetic basis[2], the early feeding environment is considered critical to the development of healthy eating behaviors that will ensure children to effectively self-regulate energy intake through the ability to recognize and respond appropriately to internal cues of satiety and hunger, and ultimately achieve and maintain a healthy weight status [1, 3]. 

Parental feeding practices have been of interest to researchers and clinicians alike because they constitute modifiable risk factors for problematic child diet-related outcomes and appear to be amenable to intervention [3]. The purpose of this review is to examine current evidence for a causal relationship between feeding practices and child eating behaviors related to obesity risk. 

Feeding practices are defined as content-specific, goal-directed strategies or behaviors used by parents in an attempt to control or modify their child’s diet and eating behaviors. DiSantis et al. [4] proposed that nonresponsive feeding practices that are controlling, coercive, or encourage children to eat for reasons other than hunger may interfere with a child’s ability to self-regulate their energy intake, i.e., to adjust their eating in response to internal feelings of fullness or satiety. It is proposed that when parents fail to recognize or respond appropriately to children’s internal cues of hunger or fullness, the child’s ability to self-regulate may be disrupted [4]. Therefore, the way in which feeding is responsive is an important element of the caregiver-child interaction. 

Responsive feeding is defined as developmentally appropriate (not intrusive or controlling), prompt, and contingent responses to infant and child hunger and satiety. Also integral to responsive feeding are: establishing routines around mealtimes (eating at the same place and times), modeling appropriate behavior (making healthy choices), and ensuring children are seated [5].  

Research in this field has predominantly focused on nonresponsive feeding practices including pressure to eat, instrumental, and emotional feeding (i.e., using food as a reward or to soothe the child), and restriction. In summary, current evidence generally suggests that nonresponsive feeding practices may be detrimental to the development of healthy eating behaviors in children. Pressure to eat appears to be associated with higher consumption of discretionary/snack foods but may be a practice that is used in response to child (low) weight concerns or food-avoidant eating behaviors such as food fussiness. Instrumental and emotional feeding have consistently been associated with emotional eating, food responsiveness, and higher snack food intake. Restricting children’s access to unhealthy snack foods appears to lead to greater interest in the restricted food and higher intake if the child is granted access in experimental settings. Finally, although a relatively new construct in the feeding literature, structure-related feeding practices appear to have protective effects on children’s eating behaviors. 

Future research in this field that utilizes a longitudinal design assesses feeding practices and child eating concurrently, and attempts to ensure the validity of such measures is needed. Observational data that can complement self-report measures of both feeding practices and child eating behavior are one option for ensuring the validity of study findings. It is anticipated that greater understanding of the complex associations between these eating and feeding constructs can assist in improving our knowledge of the modifiable factors that contribute to the development of childhood obesity. These findings may be used in the design of future obesity prevention interventions targeting parental feeding practices.

References

  1. Savage JS, Fisher JO, Birch LL: Parental influence on eating behavior: conception to adolescence. J Law Med Ethics 2007;35:22–34.
  2. Llewellyn CH, Trzaskowski M, van Jaarsveld CH, et al: Satiety mechanisms in genetic risk of obesity. JAMA Pediatr 2014;168:338–344.
  3. Daniels LA, Mallan KM, Nicholson JM, et al: Outcomes of an early feeding practices intervention to prevent childhood obesity. Pediatrics 2013;132:e109–e118.
  4. DiSantis K, Hodges E, Johnson S, Fisher J: The role of responsive feeding in overweight during infancy and toddlerhood: a systematic review. Int J Obes (Lond) 2011;35:480–492.
  5. Black MM, Aboud FE: Responsive feeding is embedded in a theoretical framework of responsive parenting. J Nutr 2011;141:490–494.