Parental feeding practices (hereafter referred to as feeding practices) influence child weight outcomes, but few studies have identified which obesogenic risk factors shape their feeding practices using an ecological approach, especially among families with low-income. The goals of the current study were to examine the unique contribution of A) child appetitive traits, B) parent psychosocial factors, and C) home environment factors on parental use of structure- and control-based feeding practices. Parents of Head Start preschoolers (N = 253) completed measures of feeding practices, child appetitive traits, and parent psychosocial and home environment factors. Hierarchical regressions were used to test the ecological levels that contribute to feeding practices explained by child appetitive traits, and the additional variance contributed by parent psychosocial and home environment factors. Results indicate that 10% of the variance was explained for the structure super-factor, with the home environment explaining 3% over and above child appetitive traits and psychosocial factors. For control-based feeding, the total model accounted for 18% of the variance. Child appetitive traits explained most of the variance (14%) whereas the home environment did not predict any variance over and above appetitive traits and psychosocial factors. These findings underscore the need to consider multiple ecological levels to better understand the complex factors that shape how parents engage with their children during feeding opportunities and the potential impact on child growth and development.

Lower executive functioning is associated with more reactive, coercive general parenting practices. Parents who experience poverty, a chronic stressor, may have compromised executive functioning that impacts parenting practices, but less is known about the impact on parent feeding practices. This study examined associations between maternal executive functioning and feeding practices among families living in low-income contexts. Participants included 137 mothers of children enrolled in Head Start who completed the Behavior Rating Inventory of Executive Function-Adult version, Child Feeding Questionnaire, Feeding to Manage Child Behavior Questionnaire, and the USDA Food Security Module. Hierarchical linear regression examined the effect of maternal executive function on maternal feeding practices (monitoring of child food intake, food to soothe, and food as a reward) after adjusting for covariates. The moderating effect of food security on this association was also explored. Mothers were white (90%), non-Hispanic (96%), about half had a high school diploma or less (55%), and a third of households experienced food insecurity (35%). Maternal executive functioning explained 9% of the variance for monitoring of child food intake (β = 0.03, p = 0.0006) and 17% of the variance for food to soothe (β = -0.03, p < 0.0001), over and above the variance explained by food security status, employment status, and child BMI z-score. Lower maternal executive functioning was associated with lower odds of household food security (OR: 0.95, CI: 0.92, 0.99). Targeting maternal executive functioning or its environmental supports may be an effective intervention strategy to promote monitoring and less food to soothe, especially among families who experience stressors related to poverty. Longitudinal research is needed to replicate these findings, and to understand the relationship between parent executive function and child weight outcomes.

BACKGROUND:Food insecurity affects up to 30 % of pregnancies and is associated with worse maternal and infant health. Healthcare systems are implementing interventions to assist patients with food insecurity, but rather than providing a single intervention, adaptively providing interventions could be a more effective strategy. The objective of this study is to determine the feasibility of adaptively providing interventions to assist pregnant patients who report being food-insecure. METHODS/DESIGN:We will conduct a pilot sequential multiple assignment randomized trial at obstetrics clinics from one health system. Adults (N = 60) who are pregnant and food-insecure will be randomized at their initial prenatal visit to one of two first-stage interventions for 3 months: 1) electronic health record (EHR) referral to WIC or 2) EHR-referral to WIC + care navigation. Participants who do not have ≥2-point improvement in food insecurity after 3 months will be re-randomized to one of two second-stage interventions for an additional 3 months: weekly delivery of 1) produce or 2) medically-tailored meals. In Aim 1, we will determine the feasibility of recruitment, and in Aim 2, we will evaluate the feasibility of re-randomization, retention, and data collection. In Aim 3, we will advance our understanding of how, why, and under what circumstances participants achieved improvements through semi-structured interviews. CONCLUSIONS:This will be the first study to test an adaptive intervention to assist pregnant patients with food insecurity and will inform a future fully-powered trial. Given the growing interest among health systems, an efficacious, adaptive food insecurity intervention could be broadly disseminated. TRIAL REGISTRATION:The study was registered with ClinicalTrials.gov (NCT06942598) on April 23, 2025.

Childhood obesity remains a significant public health crisis. Despite growing evidence that a) self-regulation and appetitive traits impact childhood obesity-related risk, and b) obesity-related risk is determined by the interplay between biological, psychological, and home environment factors, research has occurred largely within disciplines, hindering the interpretability and application of findings. We describe the rationale and methods of the Infant Growth and Development (iGrowUp) Study which tests two aims: (1) Determine the extent to which child self-regulatory and appetite constructs are distinct versus overlapping in the preschool period, and (2) Test a comprehensive model of biopsychosocial predictors (age 3.5 years) of childhood obesity-related risk (age 5 years) to determine the extent to which self-regulation in food and non-food contexts buffers children from child and home environment risk factors. iGrowUp is an interdisciplinary, longitudinal study that leverages the iGrow study, consisting of 299 diverse mother-infant dyads, followed from the prenatal period until children were 2 years old. We aim to recruit these children into the iGrowUp study and re-assess them at ages 3.5 and 5 years old, in addition to recruiting an additional 67 children. Key measures include (a) children’s self-regulation (i.e., observed emotion regulation, attentional regulation, physiological regulation, inhibitory control, executive function in response to food and non-food stimuli in comparable situations; maternal report of effortful control, emotional over-eating, satiety responsiveness), (b) food cue reactivity (i.e., motivation to eat, food responsiveness, enjoyment of food, eating in the absence of hunger), (c) parenting behaviors (i.e., maternal sensitivity, non-supportive emotion socialization, negative parenting practices, parent–child relationship quality), (d) child negative emotionality, (e) child hormonal risk from urine assays, (f) maternal reports of demographics, obesogenic food environment, and health, and (g) anthropometric measures of children. Demographic and other potential covariates will be included in structural equation models. This study has critical implications for prevention since it aims to identify the most influential mechanisms in infancy and preschool that may mitigate obesity-related risk. By combining the approaches of developmental and nutritional sciences, this project enhances the rigor applicable to basic and applied research that assesses food and non-food reactivity and regulation.

Objectives: Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has numerous benefits, yet many eligible children remain unenrolled. This qualitative study sought to explore perceptions of a novel electronic health record (EHR) intervention to facilitate referrals to WIC and improve communication/coordination between WIC staff and healthcare professionals. Methods: WIC staff in three counties were provided EHR access and recruited to participate. An automated, EHR-embedded WIC participation screening and referral tool was implemented within 8 healthcare clinics; healthcare professionals within these clinics were eligible to participate. The interview guide was developed using the Consolidated Framework for Implementation Research to elicit perceptions of this novel EHR-based intervention. Semi-structured interviews were conducted via telephone. Interviews were recorded, transcribed, coded, and analyzed using thematic analysis. Results: Twenty semi-structured interviews were conducted with eight WIC staff, seven pediatricians, four medical assistants, and one registered nurse. Most participants self-identified as female (95%) and White (55%). We identified four primary themes: (1) healthcare professionals had a positive view of WIC but communication and coordination between WIC and healthcare professionals was limited prior to WIC having EHR access; (2) healthcare professionals favored WIC screening using the EHR but workflow challenges existed; (3) EHR connections between WIC and the healthcare system can streamline referrals to and enrollment in WIC; and (4) WIC staff and healthcare professionals recommended that WIC have EHR access. Conclusions: A novel EHR-based intervention has potential to facilitate healthcare referrals to WIC and improve communication/coordination between WIC and healthcare systems.

Upon completion, participants will be able to describe how eating behaviors, such as dietary restraint, and food security status may influence dietary intake of selected food groups/nutrients during pregnancy.

Emerging research in paediatric obesity has demonstrated that parental involvement in the weight management process can improve weight outcomes in children. Recent guidelines by the American Academy of Pediatrics note the importance of parent and family involvement in treatment. However, it is currently unknown if including the entire family in obesity treatment can supersede outcomes associated with participation of only one parent. Family Systems Theory (FST) provides the theoretical foundation for examining one's healthy behaviours as they exist within the context of their family, defined by family dynamics. This narrative review aims to reconsider prior definitions of paediatric family-based management using the FST framework to be inclusive of family and household diversity and in doing so, inform research not only within weight management but also other domains of clinical care requiring family support or change. Applying FST to paediatric weight management highlights the link between family dynamics and paediatric obesity, demonstrating the association of dysfunctional family dynamics with more severe obesity. While family-based weight management remains the gold standard for treatment of paediatric obesity, more investigation is needed in expanding family-based interventions to impact entire families and potentially improve outcomes more broadly for overall family health and wellbeing.

Dietary intake of certain food groups and/or nutrients during pregnancy has been associated with maternal and infant pregnancy-related outcomes. Few studies have examined how behavioral and environmental factors interact to influence prenatal diet. We examined associations between eating behaviors (dietary restraint, emotional eating, external eating) and food security status regarding dietary intake of selected nutrients/food groups during pregnancy. Participants (N = 299; 29% Non-Hispanic Black; 16% <= high school education; 21% food insecure) completed validated questionnaires to assess estimated daily intake of food groups/nutrients during pregnancy [e.g., added sugars from sugar-sweetened beverages (SSBs), % of energy from fat, fruit and vegetable (FV) intake] via National Cancer Institute Dietary Screener Questionnaires); eating behaviors (Dutch Eating Behavior Questionnaire); and food security status (6-item USDA Food security Module). Separate hierarchical multiple regressions for each dietary outcome were conducted controlling for maternal age, education, income-to-needs, race/ethnicity, pre-pregnancy BMI, and gestational diabetes. A significant interaction was found between dietary restraint and food security status on added sugar intake from SSBs (beta = -0.15, p = 0.02). The negative association between restraint and added sugar from SSBs was stronger among food insecure participants (beta = -0.47, p < 0.001 vs. 13 = -0.15, p = 0.03). Higher external eating (beta = 0.21, p < 0.01) and lower restraint (beta = -0.13, p = 0.03) were associated with higher % of energy from fat and living in a food insecure household (beta = -0.15, p = 0.01) was associated with lower FV intake. Understanding dietary intake during pregnancy requires consideration of the broader context in which eating behaviors occur.

Eating in the absence of hunger (EAH), a measure of children's propensity to eat beyond satiety in the presence of highly palatable food, has been associated with childhood obesity and later binge eating behavior. The EAH task is typically conducted in a research laboratory setting, which is resource intensive and lacks ecological validity. Assessing EAH in a group classroom setting is feasible and may be a more efficient alternative, but the validity of the classroom assessment against the traditional individually-administered paradigm has not been tested. The objective of this study was to compare EAH measured in a classroom setting to the one-on-one version of the paradigm in a sample of Head Start preschoolers. Children (n = 35) from three classrooms completed both classroom and individual EAH tasks in a random, counterbalanced order. In the group condition, children sat with peers at their classroom lunch tables; in the individual condition, children met individually with a researcher in a separate area near their classroom. In both conditions, following a meal, children were provided free access to generous portions of six snack foods (~750 kcal) and a selection of toys for 7 min. Snacks were pre- and post-weighed to calculate intake. Parents completed a survey of their child's eating behaviors, and child height and weight were measured. Paired t-tests and intraclass correlation coefficients were used to compare energy intake between conditions, and correlations between EAH intake and child BMI, eating behaviors, and parent feeding practices were examined to evaluate concurrent validity. Average intake was 63.0 ± 50.4 kcal in the classroom setting and 53.7 ± 44.6 in the individual setting, with no significant difference between settings. The intraclass correlation coefficient was 0.57, indicating moderate agreement between conditions. Overall, the EAH protocol appears to perform similarly in classroom and individual settings, suggesting the classroom protocol is a valid alternative. Future studies should further examine the role of age, sex, and weight status on eating behavior measurement paradigms.

Maternal overreliance on feeding to soothe to relieve infants' distress has been associated with higher rates of childhood obesity. Limited research has examined infant and maternal characteristics that predict maternal feeding to soothe. The goal of the present study was to examine the role of infant (temperament) and maternal (depression, sleep problems) characteristics as predictors of maternal feeding to soothe. Mothers (N = 176) completed the Food to Soothe Scale, the Infant Behavior Questionnaire-Revised Very Short Form, the Center for Epidemiological Studies Depression Scale, and the Pittsburgh Sleep Questionnaire when their infants were 6 months old. Hierarchical multiple regression was used. Maternal depression only predicted feeding to soothe among mothers receiving WIC benefits, and this association was no longer significant when maternal sleep problems were added to the model. Maternal sleep problems predicted higher feeding to soothe as a main effect and in interaction with infant negative emotionality, maternal depression, and to a lesser extent WIC status. Specifically, infant negative emotionality was only associated with greater feeding to soothe among mothers with higher sleep problems, and sleep problems were only associated with greater feeding to soothe among depressed mothers and mothers receiving WIC benefits. The findings suggest that addressing multiple stressors, including maternal sleep, in the early postnatal period may strengthen the effectiveness of early child obesity interventions that target maternal feeding behaviors.

Excessive infant weight gain is a strong predictor of later obesity. While controlling feeding has been linked to negative weight outcomes, research has not considered associations between infant appetite and maternal feeding simultaneously in relation to infant weight. This longitudinal study examined infant food responsiveness and slowness in eating as predictors of infant weight outcomes and tested controlling feeding styles (restrictive and pressuring) as moderators. Data came from a diverse sample of mothers and their infants participating in an ongoing longitudinal study. Mothers (n = 159) reported infant appetite and feeding styles at 2 postnatal time-points (2-month visits and 6-month visits). The infant weight outcomes included change in weight-for-age z-scores (WAZ-change) and rapid weight gain (RIWG; WAZ-change >= 0.67 SD) from birth to the second postnatal visit. Data were analyzed using hierarchical multiple and logistic regressions, controlling for birthweight, gestational age, maternal race/ethnicity, feeding mode, and residing with an intimate partner. Over 25% of infants exhibited RIWG. Greater infant food responsiveness predicted both greater infant weight gain and RIWG status. Infant food responsiveness and slowness in eating interacted with controlling feeding styles in a unique way. Infants with higher food responsiveness whose mothers were less restrictive had greater weight gain (b = 0.61, p < 0.001) and increased probability of RIWG (b = 2.71, p < 0.01) than infants with more restrictive mothers. Higher slowness in eating was associated with a lower RIWG probability among infants of mothers with lower pressuring feeding (b = -1.86, p < 0.05). For infants with a large appetite, some level of restrictive feeding may be beneficial for preventing excessive weight gain while pressuring may exacerbate the positive association between faster eating and RIWG.

Parental controlling feeding styles and practices have been associated with greater food-approaching appetitive behaviors (i.e., food responsiveness) linked to childhood obesity. Recent longitudinal research suggests that this relationship may be reciprocal such that controlling feeding predicts child appetite and vice versa. However, to date no studies have considered these associations during infancy. The current study investigates prospective bidirectional associations between controlling feeding (restriction, pressure, and food to soothe) and infant food responsiveness. Mothers (N = 176) reported their controlling feeding and their infant's food responsiveness at infant age 2, 6, and 14 months. A 3-wave cross-lagged panel model was used to test the effect of controlling feeding at an earlier time point on infant food responsiveness at a later time point, and vice versa. Maternal controlling feeding and infant food responsiveness showed moderate stability across infancy. Net of covariates, we observed parent-driven prospective relations between pressuring feeding styles and food to soothe with infant food responsiveness. Pressuring to finish was a significant predictor of increases in food responsiveness from 2 to 6 months (p = 0.004) and pressuring with cereal was a significant predictor of increases in food responsiveness from 6 to 14 months (p = 0.02). Greater use of situational food to soothe was marginally associated with higher food responsiveness from 2 to 6 months (p = 0.07) and 6 to 14 months (p = 0.06). Prospective associations between restrictive feeding styles and infant food responsiveness were not observed. Findings point to pressuring feeding styles and food to soothe as potential early life intervention targets to prevent increases in food responsiveness in infancy. Longitudinal research with follow-up in the toddler and preschool years are needed to understand how these associations unfold over time and whether child-driven effects of food responsiveness become apparent as children get older.

Background Research is needed to identify pathways by which household food insecurity (FI) contributes to parental controlling feeding styles and infant food responsiveness, 2 factors that play a role in shaping obesity risk across infancy and early childhood. Objectives This longitudinal study tested the hypothesis that prenatal FI would be positively associated with higher infant food responsiveness via greater parental mental health symptomatology and controlling feeding styles (pressuring, restrictive). Methods Participants included a community sample of 170 birth parents and their infants participating in an ongoing longitudinal study. Parents self-reported household FI and mental health symptoms (depression and anxiety) during pregnancy. Postnatally, parents reported their mental health symptoms, their use of controlling feeding styles, and infant food responsiveness. Path analyses with bias-corrected 95% bootstrapped CIs tested direct and indirect associations between prenatal FI and infant food responsiveness. Results Prenatal FI was indirectly associated with higher infant food responsiveness via greater parental mental health symptomatology and pressuring to finish (b = 0.01; 95% CI: 0.001, 0.025). Prenatal FI was associated with greater parental mental health symptomatology across the peripartum period (beta = 0.54; P < 0.001), which in turn was associated with more pressuring to finish at 2 months pospartum (beta = 0.29; P = 0.01) and higher infant food responsiveness at 6 months (beta = 0.17; P = 0.04). There were no direct effects of prenatal FI on controlling feedings styles or infant food responsiveness. Conclusions Our findings point to parental mental health as a potential pathway by which FI may be associated with obesity-promoting parental feeding styles and infant appetitive behaviors. In addition to ensuring reliable access to enough quality food during pregnancy, multipronged assistance that promotes emotional well-being during the peripartum period and clinical guidance on noncontrolling feeding styles could benefit parent and infant health and well-being.

The relative reinforcing value (RRV) of food measures how hard someone will work for a high-energy-dense (HED) food when an alternative reward is concurrently available. Higher RRV for HED food has been linked to obesity, yet this association has not been examined in low-income preschool-age children. Further, the development of individual differences in the RRV of food in early childhood is poorly understood. This cross-sectional study tested the hypothesis that the RRV of HED (cookies) to low-energy-dense (LED; fruit) food would be greater in children with obesity compared to children without obesity in a sample of 130 low-income 3- to 5-year-olds enrolled in Head Start classrooms in Central Pennsylvania. In addition, we examined individual differences in the RRV of food by child characteristics (i.e., age, sex, and reward sensitivity) and food security status. The RRV of food was measured on concurrent progressive-ratio schedules of reinforcement. RRV outcomes included the last schedule reached (breakpoint) for cookies (cookie Pmax) and fruit (fruit Pmax), the breakpoint for cookies in proportion to the total breakpoint for cookies and fruit combined (RRV cookie), and response rates (responses per minute). Parents completed the 18-item food security module to assess household food security status and the Behavioral Activation System scale to assess reward sensitivity. Pearson's correlations and mixed models assessed associations between continuous and discrete child characteristics with RRV outcomes, respectively. Two-way mixed effects interaction models examined age and sex as moderators of the association between RRV and Body Mass Index z-scores (BMIZ). Statistical significance was defined as p < 0.05. Children with obesity (17%) had a greater cookie Pmax [F (1, 121) = 4.95, p = 0.03], higher RRV cookie [F (1, 121) = 4.28, p = 0.04], and responded at a faster rate for cookies [F (1, 121) = 17.27, p < 0.001] compared to children without obesity. Children with higher cookie response rates had higher BMIZ (r = 0.26, p < 0.01); and RRV cookie was positively associated with BMIZ for older children (5-year-olds: t = 2.40, p = 0.02) and boys (t = 2.55, p = 0.01), but not younger children or girls. The RRV of food did not differ by household food security status. Low-income children with obesity showed greater motivation to work for cookies than fruit compared to their peers without obesity. The RRV of HED food may be an important contributor to increased weight status in boys and future research is needed to better understand developmental trajectories of the RRV of food across childhood.

BACKGROUND:Food insecurity (FI) may increase the odds for childhood obesity, yet little is known about the mechanism explaining this relationship. Parents experience greater psychosocial stress in the context of FI. In these environments, children from FI households may exhibit different appetitive behaviours. OBJECTIVES:To examine associations between FI and appetitive behaviours in children (3-5 years) and to explore whether social, emotional and structural properties of the home environment moderate this relationship. METHODS:In a low-income sample of 504 parent-child dyads, parents completed the household food security module and the Children's Eating Behavior Questionnaire. A subsample (n = 361) self-reported perceived stress, depressive symptoms, household chaos and family functioning. Children were categorized as food secure, household FI and child FI. RESULTS:Food responsiveness (LSmeans ± SE; child FI: 2.56 ± 0.13; food secure: 2.31 ± 0.10, p < 0.05) and emotional overeating (LSmeans ± SE; child FI: 1.69 ± 0.10; food secure: 1.48 ± 0.08, p < 0.05) were higher among children in the child FI group compared to the food secure group. Child FI was only associated with higher food responsiveness among children of parents reporting high levels of perceived stress (p = 0.04) and low levels of family functioning (p = 0.01). There were no differences in food responsiveness by food security status at mean or low levels of perceived stress or at mean or high levels of family functioning (p > 0.05). CONCLUSIONS:Child FI may contribute to obesity risk through differences in appetitive behaviours. For low-income families, stress management and improving family dynamics may be important factors for interventions designed to improve children's appetitive behaviours.

The parent feeding literature has largely focused on the use of controlling, intrusive practices to manage children's food intake (e.g., restriction, pressure). Less research has been conducted on parents' use of food as a contingency to direct or motivate child behavior. The aim of this study was to develop and validate the Feeding to Manage Child Behavior Questionnaire (FMCBQ). A mixed-methods approach was used to develop the 10-item questionnaire. Cognitive interviews informed the modification, deletion and/or replacement of items. The survey was distributed to mothers of children aged 2-5 years participating in the Women, Infants, and Children program or Head Start (n = 334). Factor analysis was conducted to test our theoretical model and construct validity was assessed. Caregivers also completed the Structure and Control in Parenting Feeding (SCPF) questionnaire and Child Behavior Questionnaire (CBQ). Exploratory factor analysis revealed a 2-factor model; 5-item Food to Soothe (FTS) and 4-item Food as Reward (FAR) subscale. Internal consistencies were good (0.84, 0.70 respectively). Both subscales were weakly and negatively associated with maternal self-reported BMI. As predicted, both subscales were positively correlated with child negative affect and other control-based feeding practices, whereas only FTS was negatively associated with structure-based feeding. The FMCBQ provides a short, reliable, and valid tool to assess use of FAR and FTS in response to a variety of contexts to better understand how mothers feed their children.