Early feeding practices and development of childhood obesity_2018_book chapter.pdf

IntroductionEarly feeding practices are believed to be animportant contributor to obesity risk in earlychildhood. Feeding practices can be consideredto encompass both what and how caregivers, usuallyparents, feed their children. In this chapter,we will review the evidence to support linksbetween feeding practices and the developmentof childhood obesity. We will begin by reviewingthe evidence linking infant feeding practices andobesity, including breastfeeding, formula composition,the timing of introduction of solid foods,and bottle use.Next, we will move on to consider the evidencefor associations between parent feedingpractices in toddlerhood and beyond with childobesity. Specifically, we will review the mainconstructs typically used to conceptualize parentalfeeding practices, including pressure, monitoring,restriction, promotion of autonomy,repeated exposure, modeling, and teaching. Wewill also briefly consider the beliefs about childobesity and feeding that often underlie thesepractices. We will consider the home feedingenvironment with a focus on the role of television,family mealtimes, and timing of eating inchildhood obesity. We will consider the compositionof food served, including dietary variety.Finally, we will consider the role of the child inshaping the parent’s feeding behavior. Childrenare not “blank slates”, but rather active participantsin the parent-child interaction around feeding.Just as parents may shape children’s obesityrisk, children’s individual traits and behaviorshape parenting practices. We will consider children’sfood preferences, eating in the absence ofhunger, responsiveness to hunger and satiety,emotional or stress eating, and temperament aspredictors of parent feeding practices. We willclose by considering directions for future research.It is important to note that the vast majority ofresearch on this topic to date has focused onmothers. Future work should include fathers andfather figures, as they also play critical roles inparenting and shaping a child’s obesity risk. Inaddition, much of the work on early feedingpractices has occurred in US or European populationsof children, most of whom are white andrelatively well resourced. Future work shouldconsider whether the findings are generalizableto other populations of children. Finally,understandingfeeding practices is complicated by challenges in measurement. The vast majorityof studies have gathered data via maternal self-reporton questionnaires, which has inherent bias.A growing body of work has employed videotapedobservation, though this approach has itsown limitations. Ultimately, capturing feedingpractices requires a multi-method approach thatcan consolidate, and facilitate interpretation of,available evidence.