Parent-child feeding interactions: The Influence of Child Cognitions and Parental Feeding Behaviors on Child Healthy Eating

Background: There is a lack of validated instruments for quantifying feeding behavior among parents of older children and adolescents. The Comprehensive Feeding Practices Questionnaire (CFPQ) is a self-report measure to assess multiple parental feeding practices. The CFPQ is originally designed for use with parents of children ranging in age from about 2 to 8 years. It is previously validated with American and French parents of children within this age range. The aim of the present study was to adapt and test the validity of this measure with parents of older children (10-to-12-year-olds) in a Norwegian setting. Methods: A sample of 963 parents of 10-to-12-year-olds completed a Norwegian, slightly adapted version of the CFPQ. Scale analyses were performed to test the validity of the instrument in our sample. Results: Although a few problematic items and scales were revealed, scale analyses showed that the psychometric properties of the slightly adapted, Norwegian version of the CFPQ were surprisingly similar to those of the original CFPQ. Conclusions: Our results indicated that the CFPQ, with some small modifications, is a valid tool for measuring multiple parental feeding practices with parents of 10-to12-year-olds. Background Much of our eating behaviors are formed in early childhood and most behaviors are modeled after important caregivers of the child, primarily the parents [1]. Furthermore, parents shape children’s early experiences with food and eating [2], and can affect children’s diet and eating behaviors in numerous ways. For instance: by encouraging them to eat certain foods, by restricting certain foods, or by passively allowing certain foods in the regular diet. Other important parent-related determinants of children’s eating behaviors are the physical and emotional environment in which eating behaviors are developed [3]. Hart, Bishop, and Truby [4], have stated a need for increased knowledge about parental influence on children’s eating behavior. Also Zeinstra [5] has suggested that further research on child eating behavior should focus on the role of parental strategies in shaping children’s food preferences and consumption. A barrier to this literature has been a lack of validated instruments for quantifying parental feeding behaviors and styles [6]. Thus, comparability of studies has been a challenge. In a review of 22 studies [7], only the Child Feeding Questionnaire (CFQ) [8] was cross-validated in different parental samples and used in multiple settings. Furthermore, most previous measures of parental feeding practices have included just a few feeding practices, such as restrictive feeding and pressure to eat. These practices are aspects of control over child food intake, and are typically measured with the CFQ [8]. Although controlling feeding practices seem to be widely used by parents in an attempt to secure a well-balanced diet for their children [7], some studies have proved counterproductive effects of these strategies, as parents who exert too much control over child food intake tend to have children with an increased preference for high-fat foods and higher levels of snack-food intake [9]. * Correspondence: elisabeth.l. melbye@uis.no University of Stavanger, Norwegian School of Hotel Management, 4036 Stavanger, Norway Full list of author information is available at the end of the article Melbye et al. BMC Medical Research Methodology 2011, 11:113 http://www.biomedcentral. com/1471-2288/11/113 © 2011 Melbye et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The emphasis on parental control in previous feeding practices measures may have left other important feeding practices rather underexplored. This is especially true for feeding practices that are associated with desirable outcomes in children [10]. Parental modelling of healthy eating and exposure to healthy foods are examples of feeding practices that may be effective [11-14]. The extent to which parents try to teach their children about nutrition is another aspect not examined in the previous measures of parental feeding practices [10]. However, more recent research has suggested that additional feeding practices such as these can also be measured in parents and might impact child outcomes [15]. The Comprehensive Feeding Practices Questionnaire (CFPQ) [10] is an extension of previous feeding practices measures, and represents a more complete range of feeding practices that may be relevant to child outcomes. It consists of 49 items representing 12 dimensions (subscales), each including 3-8 items. Initial testing of the CFPQ with American parents of 2-to-8-year-olds showed reasonable validity and reliability [10]. An analysis of nine CFPQ subscales with French parents of 4-to-7-year-olds demonstrated reasonable validity and reliability in this sample as well [15]. Although the CFPQ appears to be a promising instrument for measuring multiple parental feeding practices, it’s important to note that this instrument was designed to measure feeding practices in parents of young children (about 2 to 8 years of age). Zeinstra [5] suggests that children’s cognitive development influences the strategies that parents use to shape the eating behavior of their children. Thus, feeding practices measures developed for parents of young children will not necessarily be valid for parents of older children and adolescents. As far as we know, only one previous study has validated a (pure) feeding practices measure with parents of older children and adolescents. In this study by Kaur et al [16], a modified version of Birch’s CFQ was validated in a multiethnic sample of 260 parents of 10-to-19-year-olds (mean age:15 years). The psychometric properties of the modified CFQ were found to be similar to those of the original CFQ. However, consistent with the evolving independence of adolescents, the factor scores for the controlling feeding practices measured by the CFQ decreased with increasing age of the adolescent. That is; controlling feeding strategies seemed to be less used by parents of older children and adolescents than for younger ones. Nevertheless, the fact that parents are considered to be an important social agent impacting upon children’s diets, also applies to older children and adolescents [17]. So far, most studies of parental influence on child eating behavior have focused on young children. In the present study, we have focused on feeding practices in parents of children on the onset of adolescence (10-12year-olds). Adolescence is the period from about the age of eleven to the late teen years, and represents a transitional stage from childhood to adulthood. It is characterized by the elaboration of identity, and it is a time of growing independence when individuals want to make their own decisions including what and when to eat [18,19]. This stage is typically a time of gradual shift from parental to peer influence [20]. Thus, during adolescence parental influence over food choice may be displaced by the effects of advertising and peer pressure [21], and the age at which these changes set in appears to be diminishing [22]. However, the eagerness of adolescents to take over responsibility for food choice is not necessarily matched with their ability to make healthy food decisions. Adolescents have a reputation for unhealthy food choices [23,24], and interventions directed towards this group of the population have had mixed success [25]. Furthermore, research has found that adolescents understand at an abstract level the (un)healthiness of foods, but have limited concern about future health [26]. Therefore, the influence of parents should be assessed at all stages of this “hand-over-of-control” period to assist in the development of concurrent parental and peer group intervention programs [27]. The rationale for focusing on 10-to-12-year-olds in the present study is that children this age are still highly influenced by parents. Accordingly, it might be easier to implement intervention programs involving parents among individuals within this age range than among older ones. Given the lack of validated instruments measuring feeding practices that might be relevant for parents of older children and adolescents, we aimed to test the validity of the CFPQ with Norwegian parents of 10-to-12-year-olds to check if it is a suitable tool for measuring feeding practices in this part of the population. We believe that development and validation of broad feeding practices measures such as the CFPQ is of great importance for applied research aiming to develop interventions to improve children’s and adolescents’ diets, whether it is for public health purposes or for clinical purposes.