Early feeding practices and development of childhood obesity_2018_book chapter.pdf

Introduction Early feeding practices are believed to be an important contributor to obesity risk in early childhood. Feeding practices can be considered to encompass both what and how caregivers, usually parents, feed their children. In this chapter, we will review the evidence to support links between feeding practices and the development of childhood obesity. We will begin by reviewing the evidence linking infant feeding practices and obesity, including breastfeeding, formula composition, the timing of introduction of solid foods, and bottle use. Next, we will move on to consider the evidence for associations between parent feeding practices in toddlerhood and beyond with child obesity. Specifically, we will review the main constructs typically used to conceptualize parental feeding practices, including pressure, monitoring, restriction, promotion of autonomy, repeated exposure, modeling, and teaching. We will also briefly consider the beliefs about child obesity and feeding that often underlie these practices. We will consider the home feeding environment with a focus on the role of television, family mealtimes, and timing of eating in childhood obesity. We will consider the composition of food served, including dietary variety. Finally, we will consider the role of the child in shaping the parent’s feeding behavior. Children are not “blank slates”, but rather active participants in the parent-child interaction around feeding. Just as parents may shape children’s obesity risk, children’s individual traits and behavior shape parenting practices. We will consider children’s food preferences, eating in the absence of hunger, responsiveness to hunger and satiety, emotional or stress eating, and temperament as predictors of parent feeding practices. We will close by considering directions for future research. It is important to note that the vast majority of research on this topic to date has focused on mothers. Future work should include fathers and father figures, as they also play critical roles in parenting and shaping a child’s obesity risk. In addition, much of the work on early feeding practices has occurred in US or European populations of children, most of whom are white and relatively well resourced. Future work should consider whether the findings are generalizable to other populations of children. Finally, understanding feeding practices is complicated by challenges in measurement. The vast majority of studies have gathered data via maternal self-report on questionnaires, which has inherent bias. A growing body of work has employed videotaped observation, though this approach has its own limitations. Ultimately, capturing feeding practices requires a multi-method approach that can consolidate, and facilitate interpretation of, available evidence.