Megan H. Pesch

Maternal styles of talking about child feeding across sociodemographic groups.

This study sought to identify maternal styles of talking about child feeding from a semistructured interview and to evaluate associated maternal and child characteristics. Mothers of preschool-aged children (n=133) of diverse race/ethnicity and socioeconomic status (SES) (45 lower SES black, 29 lower SES white, 32 lower SES Hispanic, 15 middle to upper SES white, and 12 middle to upper SES Asian) participated in a semistructured interview about feeding. Interviews were audiotaped and transcribed. Themes were identified, and individual interviews were coded within these themes: authority (high/low), confidence (confident/conflicted/unopinionated), and investment (deep/mild/removed). Demographic characteristics were collected and a subset of children had measured weights and heights. Cluster analysis was used to identify narrative styles. Participant characteristics were compared across clusters using Fishers exact test and analysis of variance. Six narrative styles were identified: Easy-Going, Practical No-Nonsense, Disengaged, Effortful No-Nonsense, Indulgent Worry, and Conflicted Control. Cluster membership differed significantly based on maternal demographic group (P<0.001) and child weight status (P<0.05). More than half (60%) of children of mothers in the Conflicted Control cluster were obese. Maternal styles of talking about feeding are associated with maternal and child characteristics.

Overweight Adolescents and Life Events in Childhood

OBJECTIVES: To test the association of life events in childhood with overweight risk in adolescence; to examine the effects of chronicity, timing, intensity, valence, and type of life events; and to test potential moderators. METHODS: Mothers of children enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development responded to the Life Experiences Survey at ages 4, 9, and 11 years. Using logistic regression analysis, we tested the association of experiencing many negative life events with being overweight at age 15 years, controlling for child gender, race/ethnicity, maternal education, and maternal obesity. Child gender, maternal education, maternal obesity, child’s ability to delay gratification for food, and maternal sensitivity were tested as moderators. RESULTS: Among the 848 study children (82% non-Hispanic white), experiencing many negative life events was associated with a higher risk of overweight (odds ratio: 1.47 [95% confidence interval: 1.04–2.10]). Greater chronicity and negative valence of the event were associated with greater overweight risk; timing of exposure and maternal reported impact of the event were not. The association was more robust for events related to family physical or mental health and among children of obese mothers and children who waited longer for food. CONCLUSIONS: Children who experience many negative life events are at higher risk of being overweight by age 15 years. Future work should investigate mechanisms involved in this association, particularly those connected to appetitive drive and self-regulation; these mechanisms may hold promise for obesity prevention strategies.

Maternal encouragement and discouragement: Differences by food type and child weight status

Childhood obesity prevention practice guidelines recommend that parents encourage the intake of certain types of foods and discourage the intake of others. It is unknown if parents of children of different weight statuses encourage or discourage their childs intake differently based on food type. The objective of this study was to determine the association of child weight status with maternal encouragement and discouragement of for four different types of food. A total of 222 mother-child dyads were video-taped during the standardized, sequential presentation of four foods to both participants: cupcakes (familiar dessert), green beans (familiar vegetable), halva (unfamiliar dessert) and artichoke (unfamiliar vegetable). Mothers encouragements and discouragements of child intake were reliably coded for each food type. Poisson regression models were used to test the independent association of child weight status (normal weight, overweight and obese) with encouragement and discouragement for each food type. Mothers of an obese, vs. normal or overweight child, had lower rates of encouragement for a familiar dessert (p = 0.02), and a higher rates of discouragements for a familiar dessert (p = 0.001), a familiar vegetable (p = 0.01), and an unfamiliar vegetable (p = 0.001). There were no differences in encouragements or discouragements between mothers of an overweight, vs. obese child, for any of the 4 food types. Mothers of obese children may alter their feeding behavior differentially based on food type. Future work should examine how interventions promoting maternal encouragement or discouragement of different food types impact child weight status.

Mothers of Obese Children Use More Direct Imperatives to Restrict Eating

Objective: To examine the association of mother and child characteristics with use of direct imperatives to restrict eating. Methods: A total of 237 mother–child dyads (mean child age, 70.9 months) participated in a video‐recorded, laboratory‐standardized eating protocol with 2 large portions of cupcakes. Videos were reliably coded for counts of maternal direct imperatives to restrict childrens eating. Anthropometrics were measured. Regression models tested the association of participant characteristics with counts of direct imperatives. Results: Child obese weight status and maternal white non‐Hispanic race/ethnicity were associated with greater levels of direct imperatives to restrict eating (p = .0001 and .0004, respectively). Conclusions and Implications: Mothers of obese children may be using more direct imperatives to restrict eating so as to achieve behavioral compliance to decrease their childs food intake. Future work should consider the effects direct imperatives have on childrens short‐ and long‐term eating behaviors and weight gain trajectories.

A mixed methods analysis of maternal response to children's consumption of a palatable food: differences by child weight status: Maternal response to children's consumption

Little is known about how mothers respond to their child eating palatable foods.

Early Feeding Practices and Development of Childhood Obesity

Early child feeding practices, defined as the ways in which caregivers interact with their children around food and eating, have been implicated in children’s risk of obesity. Early child feeding practices can be conceptualized as beginning with the choices parents make about breastfeeding in early infancy and extending to choices about how mealtimes are structured and which foods are made available in the home environment. Parent feeding practices across these contexts and developmental periods have also been conceptualized as differing with respect to pressure, monitoring, and restriction, as well as with regard to sensitivity to the child’s hunger and satiety cues. Emerging work has increased the understanding of individual differences in appetitive traits, such as a child’s propensity to eat in the absence of hunger, eat in response to stress or emotion, or eat in response to food cues in the environment. These child behavioral predispositions likely require individualized parenting approaches. In this chapter, we review current best evidence regarding the associations between child feeding practices and obesity, starting from infancy through early childhood. Overall, evidence for a causal role of different parenting approaches in conferring child obesity risk is modest at best.

Selective eating behaviors in children: An observational validation of parental report measures

Selective eating in children is commonly measured by parental report questionnaires, yet it is unknown if parents accurately estimate their childs selective eating behavior. The objectives of this study were to test the validity and stability of two measures of selective eating using observed child behavior. Low-income mother-child dyads participated in a videotaped laboratory eating protocol at two time points (baseline: mean child age = 5.9 years; follow-up: mean child age = 8.6 years), during which they were presented with a familiar and an unfamiliar vegetable. Videos were reliably coded for child selective eating behaviors: amount consumed, child hedonic rating of vegetables, child compliance with maternal prompts to eat, latency to first bite, number of bites, and negative utterances. Mothers completed the Child Eating Behavior Questionnaire Food Fussiness (CEBQ FF) scale and the Food Neophobia Scale (FNS) at both time points. Questionnaire validity, stability of measured behaviors, and discriminant validity of questionnaires were examined in the full sample. CEBQ FF scores and FNS scores were both inversely correlated with the quantity consumed, child hedonic rating, and compliance with prompts to eat for both familiar and unfamiliar vegetables at baseline and at follow up. CEBQ FF and FNS scores were inversely correlated with number of bites (for both foods), positively correlated with latency to first bite (for both foods), and inversely correlated with child negative utterances (for the familiar food only). Notably, FNS scores correlated with observed behavior for both familiar and unfamiliar foods, rather than demonstrating a specific association with unfamiliar foods only. This study supports the validity of the CEBQ FF and FNS in low-income early school-aged children.

Maternal beliefs about television and parental mediation in a low-income United States sample

Abstract Low-income children are at greater risk for excess screen time and negative correlates associated with screen media use. The goal of this study is to increase our understanding of low-income mothers’ beliefs and practices around their children’s television (TV) use (parental mediation). We administered semi-structured interviews to 296 low-income mothers of children ages four–eight years old in the United States. Five themes emerged from the qualitative analysis: (1) mothers are confident in restriction of TV content; (2) time limits are not as important as TV content and are only necessary in extreme situations; (3) mothers make meaning of child learning from TV content; (4) mothers identified individual differences in child TV overuse; and (5) mothers’ policy on TV during mealtime depends on how they believe TV to affect child mealtime behaviors and mothers’ mealtime goals. We discuss the implications of these themes for promoting parental mediation in low-income families.

The case of the missing testicle: blunt scrotal trauma in the pediatric emergency department.

Abstract Serious blunt scrotal trauma in the pediatric population is rare and can pose significant danger to the viability of the testes. The following case describes an adolescent boy who presented with a single testis in his scrotum after low-impact perineal trauma, consistent with testicular dislocation. The literature regarding scrotal trauma includes few cases of testicular dislocation from low-impact perineal trauma. Included is a brief review of the most recent data including epidemiology, differential diagnosis, acute management, and complications pertinent to the pediatric emergency clinician.