Influence of parental attitudes in the development of children eating behaviour

doi:10.1017/S00071145082471

Influenceofparentalattitudesinthedevelopmentofchildreneatingbehaviour

SilviaScaglioni*,MichelaSalvioniandCinziaGalimberti

PediatricClinicS.PaoloHospitalUniversityofMilan,Milan,Italy

BritishJournalofNutritionThepresentpaperisareviewofavailabledataoneffectsofparentalfeedingattitudesandstylesonchildnutritionalbehaviour.Foodpreferencesdevelopfromgeneticallydeterminedpredispositionstolikesweetandsaltyflavoursandtodislikebitterandsourtastes.Thereisevidenceforexistenceofsomeinnate,automaticmechanismthatregulateappetite.However,frombirthgeneticpredispositionsaremodifiedbyexperience.Therearemechanismsoftastedevelopment:mereexposure,medicineeffect,flavourlearning,flavournutrientlearning.Parentsplayapivotalroleinthedevelopmentoftheirchild’sfoodpreferencesandenergyintake,withresearchindicatingthatcertainchildfeedingpractices,suchasexertingexcessivecontroloverwhatandhowmuchchildreneat,maycontributetochildhoodoverweight.Mothersareofparticularinterestonchildren’seatingbehaviour,astheyhavebeenshowntospendsignificantlymoretimethanfathersindirectinteractionswiththeirchildrenacrossseveralfamilialsituations.

Arecentpaperdescribestwoprimaryaspectsofcontrol:restriction,whichinvolvesrestrictingchildren’saccesstojunkfoodsandrestrictingthetotalamountoffood,andpressure,whichinvolvespressuringchildrentoeathealthyfoods(usuallyfruitsandvegetables)andpressuringtoeatmoreingeneral.

Theresultsshowedsignificantcorrelationsbetweenparentandchildforreportednutritionalbehaviourlikefoodintake,eatingmotivations,andbodydis-andsatisfaction.Parentscreateenvironmentsforchildrenthatmayfosterthedevelopmentofhealthyeatingbehavioursandweight,orthatmaypromoteoverweightandaspectsofdisorderedeating.Inconclusionpositiveparentalrolemodelmaybeabettermethodforimprovingachild’sdietthanattemptsatdietarycontrol.

Understandingchildren’seatingattitudesandbehaviourisimportantintermsofchildren’shealth.Evidencealsoindi-catesthatdietaryhabitsacquiredinchildhoodpersistthroughtoadulthood(1).Inaddition,researchalsoindicatesaroleforchildhoodnutritiononadulthealth(2).

Parentsprovidefoodenvironmentsfortheirchildren’searlyexperienceswithfoodandeating.Severalstudieshaveshownthatachild’seatingbehaviourisstronglyinfluencedbythefamilyenvironment.Thefamilyeatingenvironmentsincludeparents’owneatingbehavioursandchild-feedingpractices.Resultsofresearchonbehaviouralmediatorsoffamilialpat-ternsindicatethatparents’owneatingbehavioursandtheirparentingpracticesinfluencethedevelopmentofchildren’seatingbehaviours.

Parentscreateenvironmentsforchildrenthatmayfosterthedevelopmentofhealthyeatingbehavioursandweight,orthatmaypromoteoverweightandaspectsofdisorderedeating.Characteristicsoftheseenvironmentsincludesocio-demo-graphicfactors,parentalactivity,parentaleatingstyles(3)andparents’child-feedingstyles.Parentsshapethedevelop-mentofchildren’seatingbehaviours,notonlybythefoodstheymakeaccessibletochildren,butalsobytheirowneatingstyles(4),behaviouratmealtimesandchildfeedingpractices(7).Parent’schild-feedingpracticesareassociatedwithchildren’seatingbehaviours,includingspecificeatingstyles,foodselectionandpreferences(5),andtheregulationofenergyintake(6).

Innate

Foodpreferences

Children’sfoodpreferencesstronglyinfluenceintakeanditisthereforevitaltounderstandhowthesepreferencesarise.Psychologicalresearchisbeginningtorevealthecomplexinter-playofinnate,learnedandenvironmentalfactorswhichshapeschildren’seatingpatterns.Foodpreferencesdevelopfromgeneticallydeterminedpredispositionstolikesweetandsaltyflavoursandtodislikebitterandsourtastes.Thereisevidencefortheexistenceofsomeinnate,automaticmechanismthatregulateappetite.In1–3yearsinfantsenergyintakeregulationiseffectiveifthereisawideofferofplainfoods.

Withplainfoods,childrenchoosetheirdietandhavearegulargrowth,withoutinstructionsfromadults.Besidethetheoryofself-regulationthereisevidencethateatingbeha-viourcanbelearntanditispossibletomodifyenergyintakebyarepeatedoffer.Tasteacquisitionforspecificfoodsisaconsequenceoflearning.

Youngchildrenarealsopredisposedtobeneophobicaboutfood.Particularlytowardsthesecondyearoflife,coincidingwithanimportantperiodoftransitiontoanadultdiet,thereisatendencytoavoidnovelfoods(neophobia).Neophobia(literally‘fearofthenew’)manifestsitselfasarejectionofunfa-miliarfoodsinfavouroffamiliarones.Inasurveyofalmost6002–6-year-oldchildren,neophobiawassignificantlynegativelyassociatedwithfruit,vegetableandmeatintake(8)THOUGH

*Correspondingauthor:DrSilviaScaglioni,emailsilviascaglioni@unimi.it

InfluenceofparentalattitudesS23

NOTWITH

consumption(9)ofdairyfoods,starchystaplesorcakes

andbiscuits.

Foodaversionscanbelearntinonetrialifconsumptionisfollowedbydiscomfort.However,frombirthgeneticpredis-positionsaremodifiedbyexperience.Therearemechanismsoftastedevelopmentandpositivelyassociatedwith:

Mereexposure:themoreexposurewehavetoastimulus,themorewewilltendtolikeit;foodswhichhavebeeneatenmoreoftentendtobelikedmore;thisisthewaythatspecificpreferencesgrowindifferentcultures.Severalstudiessuggestthatanexposurebasedapproachhaspromiseforimprovingthequalityofchildren’sdiets.Particularstrengthsofthetechniqueareitssimplicityandrelativelylowdemandsofbothparentsandchildren.

Medicineeffect:welikebetterafoodthatweeatwhenwearehealthyinsteadofafoodproposedwhenweareill.

Flavourlearning:between2foodsofdifferenttaste,admi-nisteredoneaddedwithsugarandonewithout,thereisprefer-enceforthefirstfoodalsowhenproposedwithoutsugar.noFlavournutrientlearning:themoreafoodisenergy-richitthemoreisappreciated,thisisaprimordialmodel.Man(10)canirrecognizethemostcaloricfoodsindispensabletolife.tuNFamilyenvironment

fIntheexperiencecontext,duringtheearlyyears,parentsplayaoparticularlyimportantrole.Therearemanyvariableswithinthelafamilysettingthatcanaffectchildren’seatingbehaviourand,ulti-nmately,theirweightoutcome.Includedamongtheseareparents’rueatingbehaviours,foodsmadeavailabletochildren,andchildfeedingstrategiesutilized.Parentsplayapivotalroleinthedevel-Joopmentoftheirchild’sfoodpreferencesandenergyintake,withhsresearchindicatingthatcertainchildfeedingpractices,suchasitexertingexcessivecontroloverwhatandhowmuchchildrenireat,maycontributetochildhoodoverweight(22)(Table1).

BThechildrenbehaviours(dietaryintakes-eatingstyle,weight,physicalactivity)areinfluencedfromparentcharac-teristics.Thefamilyenvironmentinfluence:

1.thechildrenintakebyeatingstyles,dietcomposition,foodpreferences,child-feedingpractices,availabilityofenergy-densefoodsinthehome,restauranteatingv.mealspreparedathome,familymealsv.eatingawayfromthetable

Table1.FamilyfactorsthatinfluencebidirectionallyparentsandchildParentcharacteristics

ChildcharacteristicsParents’weightstatus

DietaryintakesPerceivedresponsabilityforchildfeedingEatingstyleParent’sdietaryintakeWeight

FoodpreferencesPhysicalactivity

FeedingpracticePortionsize

FoodavailableathomeFoodaccessibility

Eatinglocationsambienttemperaturesandlighting

Timeofconsumption,ambientsoundsTemperatureandsmelloffoods

Familymealsv.eatingawayfromtableFamilyincomePhysicalactivity

FromDavison&Bearch2001ObesityReviews.

2.thechildrenenergyexpenditurebyphysicalactivitypat-terns,physicalactivitypreference,metabolicrate,enjoy-mentofphysicalactivity,encouragingchildrentobeactive,providingopportunitiestobeactiveTheparentscaninfluencethedevelopmentofchildreneatingbehaviourthroughasetofregulatoryactsaimedathelpingchildrenadapttotheirenvironments:

.

Sustenance:providingfood,protectionfromenvironmentthreats

.Stimulation.Support

.Structure:organizingeatingenvironments

.

Surveillance:monitoringandcontrolovereating

Parentalcontrol

Arecentpaper(5)describestwoprimaryaspectsofcontrol:restriction,whichinvolvesrestrictingchildren’saccesstojunkfoodsandrestrictingthetotalamountoffood,andpressure,whichinvolvespressuringchildrentoeathealthyfoods(usuallyfruitsandvegetables)andpressuringtoeatmoreingeneral.Parentsmayuseacombinationofthesemethodstoobtainadesiredresult;forexample,pressuringachildtoeathealthyfoodsbyusingbribesorrewardscon-sistingofsugarysnacksthatareotherwiserestricted(19).Parentrestrictionhasshorttermandlongtermeffectonchildren’sintake.Itenhancespreference,increasesattentionandintakeatfirst,thenthiscurbincreasesintake,increaseseatingintheabsenceofhunger,doesn’tproduceabilitytoself-regulatedietbutcausesnegativeselfevaluation,greaterweightgainfrom5to11years(5).

Pressuringchildrentoeat,likewiseappearstobecounter-productive,reducingchildren’sabilitytoregulatetheirenergyintake(6).Afurtherstudy(11)haslinked‘pressuretoeat’toreducedconsumptionoffruitandvegetablesin5-year-oldgirls.Acommonassumptionrunsthroughthesestudies:thatcontrollingchildren’sintakeoffoodisacausalfactorintheirpooreatingpatterns.Itisentirelyplausible,however,thatthedirectionofcausalityrunscountertothis;that,infact,parentsuseofcontrolisaresponsetounhealthyeatinghabits.Othersresearcheshaveexploredtheimpactofcontrollingfoodintakebyrewardingtheconsumptionof‘healthyfood’asin‘ifyoueatyourvegetablesIwillbepleasedwithyou’.Forexample,Birchetal.(12)gavechildrenfoodinassociationwithpositiveadultattentioncomparedwithmoreneutralsituations.

Thiswasshowntoincreasefoodpreference;butascon-cludedbyBirch:“althoughthesepracticescaninducechildrentoeatmorevegetablesintheshortrun,evidencefromourresearchsuggeststhatinthelongrunparentalcontrolattemptsmayhavenegativeeffectsonthequalityofchildren’sdietsbyreducingtheirpreferencesforthosefoods.”(13)Initialevidenceindicatesthatimpositionofstringentpar-entalcontrolscanenhancepreferencesforhigh-fatandenergy-densefoods,limitchildren’sacceptanceofavarietyoffoodsanddisruptchildren’sregulationofenergyintakebyalteringchildren’sresponsivenesstointernalcuesofhungerandsatiety.Thiscanoccurwhenwell-intendedbutconcernedparentsassumethatchildrenneedhelpin

S24S.Scaglionietal.

determiningwhat,when,andhowmuchtoeatandwhenparentsimposechild-feedingpractices(14)thatprovidechildrenwithfewopportunitiesforself-control.Maternalinfluences

Mothersareofparticularinterestonchildren’seatingbeha-viour,astheyhavebeenshowntospendsignificantlymoretimethanfathersindirectinteractionswiththeirchildrenacrossseveralfamilialsituations,includingmealtimes(15).Motherswhoexertagreaterdegreeofcontrolovertheirchild’sfoodintakehadchildrenwhodemonstratedlessabilitytoregulateenergyintake.Externalparentalcontrolofthechild’sdietaryintakemayindirectlyfosterthedevelopmentofexcessadiposityinthechild.

Birchandcolleagues(16,17)pointoutthatmothers,whowerepreoccupiedwiththeirownweightandeating,reportedhigherlevelsofrestrictingdaughters’intake,encouragingdaughterstoloseweightovertime.Inthisstudy,mothers’encourage-nmentofdaughters’weightlosswaslinkedtodaughters’oirestrainedeatingbehaviour.Thisrelationshipwaspartiallytimediatedbydaughters’perceptionofmaternalpressuretortloseweight.Thesefindingssuggestthatmothers’preoccupa-uNtionwithweightandeating,viaattemptstoinfluencedaugh-ters’weightandeating,mayplacedaughtersatriskforfodevelopingproblematiceatingbehaviours.

Thepredictorsofmaternalchild-feedingl(5)stylearematernalandachildcharacteristics.Birchandcolleaguesaffirmthatmothersnreportedusingmorerestrictivefeedingpracticeswhentheyper-ruceiveddaughtersasoverweightandreportedusingmorepressureinchildfeedingwhentheyperceiveddaughtersasunderweight.JoMothers’child-feedingpracticeswererelatedtomothers’hsowninvestmentinweightandeatingrelatedissues,daugh-itters’observableweightstatus,mothers’perceptionsofirdaughters’weightstatus,andmothers’concernfortheirBdaughterdevelopingaweightprobleminthefuture.Thismodelheldformaternalrestriction,inthatmothersreportedgreateruseofrestrictioninchildfeedingwhentheyhadgreaterweightandeatingconcernsoftheirown,whendaughterswereoverweight,whentheyperceivedthattheirdaughterswereatriskfordevelopingaweightproblem,andwhentheyhadconcernsaboutdaughters’weight(18).RecommendationsforpracticeonnutritionalbehaviourTheparentalattitudesandbehaviourarecentraltothedevel-opmentofchildren’seatinghabits,soit’simportanttogivetotheparentssomestrategiesabouttheirchild’snutritionalbeha-viouras:

1.Guidanceforparentsshouldincludeinformationonhowchildrendeveloppatternsoffoodintakeinthefamilycontext.

2.Practicaladviceforparentsincludeshowtofosterchil-dren’spreferencesforhealthyfoodsandhowtopromoteacceptanceofnewfoodsbychildren.

3.Parentsneedtounderstandthecostsofcoercivefeedingpracticesandbegivenalternativestorestrictingfoodandpressuringchildrentoeat

4.Settingagoodexample:parentalrolemodellingisimport-antinestablishingchildren’sfoodchoice.Depending

ontheirownfoodschoice,parentscanbeeitherpositiveornegativerolemodels.Forexampleinsomestudyfruitandvegetableconsumptionishigherinchildren(20)andadolescents(21)whoeatatthesametimeastheirparentsandinpre-schoolerswhoeatthesamefoodatmeal-timeswhichfurthersupportsthisview.It’sveryimportantthatparents,guardiansandcaregiversmustprovideappropriaterolemodellingthroughtheirownbehaviour,thatis,influencechildrento“doasIdo”ratherthan“doasIsay”.

5.

Respondtosatietycluesanddonotoverfeed;infantsandyoungchildrencanusuallyself-regulatetotalenergycaloricintake;donotforcechildrentofinishmealsifnothungry

6.Parentsshouldrememberthattheyareresponsibleforchoosingfoodsandwhenandwherefoodshouldbeeaten.

7.

Twonaturalparentalimpulses,pressuringchildrentoeatandrestrictingaccesstospecificfoods,arenotrec-ommendedbecausetheyoftenleadtoovereating,dislikesandparadoxicalinterestinforbiddenitems

8.

Strategiestoimprovingnutritioninyoungchildrenareforparents,notchildren:

.tochoosemealtimes;

.

provideawidevarietyofnutrient-densefoods,suchasfruitsandvegetables,insteadofhigh-energy-density/nutrient-poor“junk”foods;.age-appropriateportionsize;

.

limitingsnackinganduseofjuiceorsweetenedbeverages;

.

allowingchildrenwithnormalbodymassindextoself-regulatetotalcaloricintake;

.

havingregularfamilymealstopromotesocialinteractionandrolemodelfood-relatedbehaviour.

limitvideoandtelevisionwatchingtolessthan2hoursdaily.

Conclusions

Thedevelopmentofchildren’sfoodpreferencesinvolvesacomplexinterplayofinnate,familialandenvironmentalfac-tors,notallofwhicharelikelytopromoteahealthyandvarieddiet.Parentsemployavarietyofstrategiestoimprovetheirchildren’seatinghabitssomeofwhichhavebeenfoundtobecounter-productive.Over-control,theofferingofrewards,andtheprovisionofnutritioninformationtochil-drenappeartohavenegativeeffectsonfoodacceptancepat-terns.Parentsownfoodpreferences,ontheotherhand,areenormouslyinfluentialandeatingtogetherasafamilypro-videsavaluableopportunityforparentstomodelgoodeatinghabits.Togetherwiththeevidencethatrepeatedtasteexposurecanincreaseacceptanceofhealthyfoods,thesefindingsshouldinformtheguidancegiventoparentsduringearlychildhood.Effectivepreventionprogramsmustfocusonprovidinganticipatoryguidanceonparentingtofosterpat-ternsofpreferenceandfoodselectioninchildrenmorecon-sistentwithhealthydietsandpromotechildren’sabilitytoself-regulateintake.Guidanceforparentsshouldincludeinformationonhowchildrendeveloppatternsoffoodintakeinthefamilycontext.Practicaladviceforparents

InfluenceofparentalattitudesS25

includeshowtofosterchildren’spreferencesforhealthyfoodsandhowtopromoteacceptanceofnewfoodsbychil-dren.Parentsneedtounderstandthecostsofcoercivefeedingpracticesandbegivenalternativestorestrictingfoodandpressuringchildrentoeat.Providingparentswitheasy-to-useinformationregardingappropriateportionsizesforchildrenisalsoessentialasaresuggestionsonthetimingandfrequencyofmeals.

Conflictofintereststatement

Noneoftheauthorshasanyconflictsofinteresttoreport.

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