SmartFeeding4Kids, an online self-guided parenting intervention to promote positive feeding practices and healthy diet in young children: study protocol for a randomized controlled trial

Background Caregivers’ influence on young children’s eating behaviors is widely recognized. Nutritional interventions that focus on the promotion of children’s healthy diet should actively involve parents, focusing on their feeding behaviors and practices. Methods This work aims to describe the development and study protocol of the SmartFeeding4Kids (SF4K) program, an online self-guided 7-session intervention for parents of young (2–6 years old) children. The program is informed by social cognitive, self-regulation, and habit formation theoretical models and uses self-regulatory techniques as self-monitoring, goal setting, and feedback to promote behavior change. We propose to examine the intervention efficacy on children’s intake of fruit, vegetables, and added sugars, and parental feeding practices with a two-arm randomized controlled with four times repeated measures design (baseline, immediately, 3 and 6 months after intervention). Parental perceived barriers about food and feeding, food parenting self-efficacy, and motivation to change will be analyzed as secondary outcomes. The study of the predictors of parents’ dropout rates and the trajectories of parents’ and children’s outcomes are also objectives of this work. Discussion The SmartFeeding4Kids program relies on technological resources to deliver parents’ self-regulation techniques that proved effective in promoting health behaviors. The study design can enhance the knowledge about the most effective methodologies to change parental feeding practices and children’s food intake. As a self-guided online program, SmartFeeding4Kids might overcome parents’ attrition more effectively, besides being easy to disseminate and cost-effective. Trial registration The study was registered in ClinicalTrials.gov (NCT04591496) on October 19, 2020.

Efeito de Intervenções Focadas nas Práticas Alimentares Parentais Sobre o Comportamento Alimentar e o Status de Peso de Pré-Escolares

Os pais desempenham papel fundamental na instalação e manutenção dos hábitos alimentares das crianças, sendo responsáveis desde a compra até a oferta dos alimentos, contexto dentro do qual estão inseridas as práticas alimentares parentais. Utilizadas com maior frequência em crianças pré-escolares, estratégias como a pressão para comer e alimentos como recompensa podem contribuir para o desenvolvimento de sobrepeso e obesidade infantil. Diante disso, têm sido desenvolvidos diferentes programas de intervenção para modificar tal situação. Nesse sentido, o presente estudo teve como objetivo avaliar o efeito de intervenções focadas nas práticas alimentares parentais sobre o comportamento alimentar e o status de peso de pré-escolares. Foi realizada uma busca, entre março e maio de 2020, nas bases de dados Scielo, PubMed e Lilacs, utilizando o termo “parental feeding practices”. O total de artigos encontrados foi filtrado por ano de publicação (2016-2020), tipo de estudo, forma de acesso gratuita e faixa etária do público estudado, e posteriormente foram lidos os títulos, resumos e o texto completo dos estudos para finalizar a seleção. Ainda foram adicionados estudos de outras bases de dados, cujos anos foram anteriores ao intervalo considerado na pesquisa. A maioria das publicações encontradas mostraram redução no uso de práticas alimentares parentais inadequadas; redução no consumo de alimentos não saudáveis e aumento da ingestão de alimentos saudáveis no grupo intervenção; mas não mostraram mudanças significativas no IMC/Idade em qualquer grupo, nem diferenças significativas entre os grupos para os parâmetros referidos após as intervenções. As intervenções focadas nas práticas alimentares parentais podem reduzir o uso de estratégias inadequadas pelos pais e melhorar o comportamento alimentar de crianças pré-escolares, mas não foram capazes de provocar mudanças significativas no status de peso deste público, o que mostra a necessidade de realização de mais estudos para observar efeitos neste parâmetro a longo prazo.

Parent Gender Affects the Influence of Parent Emotional Eating and Feeding Practices on Child Emotional Eating

Extant research supports a direct association between parent’s own emotional eating and their child’s emotional eating, and demonstrates correlations among parent emotional eating, feeding practices, and child emotional eating. However, the majority of this work focuses on the separate influences of these factors. The current study aims to add to the literature by simultaneously examining the indirect effects of three major parental feeding practices (i.e., emotion regulation, instrumental, and restrictive feeding) in the association between parent emotional eating and child emotional eating, and exploring how these indirect effects vary based on parent gender. Parents (86 fathers, 324 mothers) of an elementary school-age child (M = 8.35, SD = 2.29, range = 5–13) completed an online survey through Qualtrics Panels. Results suggested that restrictive feeding partially accounted for the association between parent and child emotional eating in the combined sample of mothers and fathers. Exploratory analyses revealed that the indirect effects of parental feeding practices in the association between parent emotional eating and child emotional eating varied based on parent gender. Among mothers, restrictive feeding was the only feeding practice that partially accounted for the association between maternal and child emotional eating, whereas all three feeding practices fully accounted for the association between father and child emotional eating. As the bulk of the literature on parent emotional eating and feeding has solely focused on mothers, these findings offer insight into how feeding practices may differentially function in the relation between parent emotional eating and child emotional eating for mothers versus fathers.

Factors Associated with Feeding Problems in Young Children with Gastrointestinal Diseases

Feeding problems are associated with the consumption of a limited amount or restricted variety of foods and often occur in children with gastrointestinal diseases. The majority of studies to date do not use valid and reliable measurements to detect feeding problems. The aim of this cross-sectional study was to assess behavioral and skill-based feeding problems in young children with gastrointestinal diseases by using a well-established parent-reported feeding measure and identify demographic, anthropometric, and environmental factors associated with maladaptive feeding behaviors in this pediatric population. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and self-reported questionnaires assessing mealtime environment and parental feeding practices. It was found that 18.6% of the sample had abnormal Total Frequency Score (TFS) (frequency of problematic feeding behaviors) and 39.5% had abnormal Total Problem Score (TPS) (number of behaviors perceived as problematic by parents). Younger children, with lower body mass index, lower birth weight, and only children were more likely to have feeding problems. The study showed that parent-reported feeding problems are increased in young children with gastrointestinal diseases and are associated with specific aspects of mealtime environment and parental feeding practices.

Moderating Effects of Parental Feeding Practices and Emotional Eating on Dietary Intake among Overweight African American Adolescents

This study examined the effects of parental feeding practices and adolescent emotional eating (EE) on dietary outcomes among overweight African American adolescents. Based on Family Systems Theory, it was hypothesized that parental feeding practices, such as parental monitoring and responsibility, would buffer the effects of EE on poor dietary quality, whereas practices such as concern about a child’s weight, restriction, and pressure-to-eat would exacerbate this relationship. Adolescents (N = 127; Mage = 12.83 ± 1.74; MBMI% = 96.61 ± 4.14) provided baseline data from the Families Improving Together (FIT) for Weight Loss trial and an ancillary study. Dietary outcomes (fruit and vegetables (F&Vs), energy intake, sweetened beverage, total fat, and saturated fat) were assessed using random 24-h dietary recalls. Validated surveys were used to assess adolescent-reported EE and parental feeding practices. Results demonstrated a significant interaction between EE and parental monitoring (adjusted analyses; B = 0.524, SE = 0.176, p = 0.004), restriction (B = −0.331, SE = 0.162, p = 0.043), and concern (B = −0.602, SE = 0.171, p = 0.001) on F&V intake; under high monitoring, low restriction, and low concern, EE was positively associated with F&V intake. There were no significant effects for the other dietary outcomes. These findings indicate that parental feeding practices and EE may be important factors to consider for dietary interventions, specifically for F&V intake, among overweight African American adolescents.