When a child gets the idea that she wants to eat a certain food like peanut butter sandwiches or mac and cheese it is referred to as an ?

Appetite. Author manuscript; available in PMC 2019 Nov 1.

Published in final edited form as:

PMCID: PMC6472478

NIHMSID: NIHMS1019586

Katie A. Loth, PhD, MPH, RD, Marc Uy, MPH, Dianne Neumark-Sztainer, PhD, MPH, RD, Jennifer Orlet Fisher, PhD, and Jerica M. Berge, PhD, MPH, LMFT, CFLE

Abstract

Food parenting practices have been identified as a potentially significant correlate of weight status and weight-related behaviors in children. The extent to which food parenting practices fluctuate across time and context is not well known. In particular, situational factors are thought to shape the types of food parenting practices used in the moment, but the nature of those factors remain unclear. In this paper data from interviews with parents (n=40) of preschoolers was used to: 1) describe parents’ day-to-day lived experiences of food parenting within the broad theoretical domains of coercive control, structure and autonomy support; 2) identify salient momentary factors that influence use of these food parenting practices; and 3) understand how these momentary factors impact the use of different types of food parenting practices. The feeding practices described by parents align well with the three overarching themes described within the literature: coercive control, autonomy support, and structure. Parents described using a combination of practices from within each of these domains; they also indicated that their feeding practices were easily influenced by momentary factors that impacted their food parenting within and across eating occasions. For the most part, parents described momentary factors (e.g. schedule changes, parental stress, child behavior) that shifted them away from structure and autonomy support feeding practices, towards indulgent and coercive feeding practices. Researchers should be aware of the likely interplay between different types of feeding practices as well as the potential that momentary factors may shift parents from one type of practice towards another. The use of novel data collection methods, such as ecological momentary assessment, that allow for exploration of food parenting practices as dynamic, rather than static, behaviors should be explored.

Keywords: Food parenting practices, Child feeding, Qualitative, Dietary intake, Weight status, Momentary

Introduction

There is a growing body of evidence that the family environment plays an integral role in child dietary intake and weight status.1–10 Specifically, food parenting practices have been identified as a potentially significant correlate of weight status and weight-related behaviors in young people.10–15 Although experts generally agree that food parenting practices are goal-directed behaviors sensitive to circumstance,11,12,16 the extent to which food parenting practices are static or fluctuate across time or context is not well characterized. Current theory, based on the extant literature,11,12 recently outlined in a content map developed by Vaughn and colleagues,11 posits that food parenting practices fall under the broad dimensions of coercive behaviors, such as food restriction and pressure-to-eat, structural behaviors, such as limit setting, rules and routines, and support behaviors, such as encouragement and nutrition education, and are associated with child weight and weight-related behaviors. 1–7 While specific feeding practices reflecting each dimension have been proposed, the extent to which these concepts are salient in parents’ day-to-day experience of feeding children is unclear. Vaughn and colleagues11 called for researchers to test and refine the components within their proposed content map, acknowledging that only some of the parenting practices described in the map have been adequately researched (e.g. food restriction, food availability) while many proposed constructs are largely theoretical and have limited empirical support (e.g. food preparation, child involvement).11,17 Further, Vaughn and colleagues indicate that while their content map was designed to represent conceptually distinct constructs that, some of the finer distinctions may or may not be useful in the design of clinical recommendations or public health interventions (e.g. availability and accessibility or reasoning and nutrition education).

Further, to date, most survey-based studies have focused primarily on parents’ “usual” use of specific food parenting practices that fall under these dimensions,11,16 failing to account for potentially important differences across shorter time frames (within- or between- day) or across contexts. For example, a parent might report via survey their “usual use” of coercive food parenting practices is low or infrequent, but there might be specific circumstances in which they might engage in coercive food parenting practices with much greater frequency or at a much higher level. Reliance on a parent’s report of “usual use” of food parenting practices is the norm within the literature to date, but overlooks the working theory that use of specific food parenting practices is context specific.

Further, while research suggests that sociodemographic (e.g., food insecurity, limited economic resources)18–25 and personal (e.g., health/weight concerns)3,26–33 characteristics are associated with the use of specific food-related parenting practices, it is largely unknown how factors that fluctuate across time or context (herein referred to as momentary factors) might contribute to within- or between- day differences in use of food parenting practices. Examples of momentary factors that might impact the way a parent interacts with a child around food include parent or child mood, physical location, or competing priorities (e.g. other children, job requirements); it is easy to imagine how a parent might shift their approach to feeding day-to-day or moment-to-moment, based on changes to these momentary factors. In fact, two recent publications by Berge and colleagues utilizing ecological momentary assessment (EMA) methods, found that momentary parental stress and mood, played a salient role in the use of coercive food-related parenting practices; 34,35 higher parental stress and greater depressed mood earlier in the day were found to predict greater use of pressure-to-eat feeding behaviors later the same evening. Long term, developing an understanding of momentary factors that influence a parent’s use of particular food-related parenting practices across multiple contexts will facilitate the development of improved measures of the use and impact of food-related parenting practices, as well as effective interventions aimed at promoting the use of appropriate food-related parenting practices. For example, if parental stress level is consistently identified as a salient momentary factor in the use of coercive food-related parenting practices, stress management could be addressed as part of an obesity intervention aimed at reducing the use of coercive practices. Filling this critical gap in the body of research on food-related parenting practices is a necessary next step toward developing comprehensive recommendations for clinicians and parents to promote a healthy weight among pre-school aged children. Qualitative research lends itself well to understanding more comprehensively parents’ experiences of momentary factors that may influence the food parenting environment.

Thus, the research described in the current paper used in-depth qualitative interviews with parents of preschool aged children to achieve the following three aims: 1) to describe parents’ day-to-day lived experiences of food parenting within broad theoretical domains outlined by Vaughn: coercive control, structure and autonomy support, 2) to identify salient momentary factors that influence the use of these food-related parenting practices, 3) and to understand how momentary factors impact the use of different types of food parenting practices. This work advances the theoretical work of Vaughn and colleagues by providing empirical evidence of the extent to which food-parenting constructs outlined in their conceptual model are useful in practice and present in the descriptions of parents’ day-to-day experiences of feeding. Further, findings will lead to hypothesis generation about food parenting as a context specific construct and help us to recognize the salient momentary factors that impact parents’ use of particular food parenting practices. The current qualitative exploration was conducted with parents of pre-school aged children as children this age spend considerable time with their parents and food-parenting practices are known to have a significant impact on the food preferences and dietary intake of children at this young age.36–39

Methods

Study Design and Population

The current qualitative research is an ancillary study to Project EAT (Eating and Activity in Adolescents and Young Adults) a large, population-based cohort study on eating and weight-related health.40,41 Survey data collected from 1,830 young adults [Mean age 31.3 years (SD:1.5)] as a part of EAT-IV were utilized to identify potential qualitative interview participants that met the inclusion criteria; young adults who indicated on the EAT-IV survey that they had at least one child aged 2–5 years who lived with them at least 50% of the time were invited by email to participate in qualitative interviews in batches of 20. Sample extensiveness42 was judged to be adequate when the recruitment of new participants provided few additional insights and theoretical saturation was reached.43 Recruitment emails indicated that the study goal was to learn more about parents’ experiences feeding their pre-school aged child and the factors influencing choices made about feeding. Recruitment was primarily conducted by email with some follow-up phone calls. Interested participants were scheduled to complete a semi-structured interview in-person or via phone if the participant did not live locally or had another reason that meeting in person would be challenging (e.g. primarily childcare issues).

Project EAT study participants self-reported their age and ethnicity/race on the original school-based survey. On the EAT-IV survey participants self-reported their sex, income, employment status, and educational attainment, in addition to the number of children, their ages and their current custodial arrangement. Interview participants were more likely to be female, white, and have greater access to economic resources (e.g., education, income) than the full Project EAT-IV study cohort (Additional details are in Table 1).

Table 1.

Demographic characteristics of study participants: EAT IV Parent Sample and Qualitative Interview Sample

Data collection

For the current study, researchers trained in standardized interview protocols44 conducted semi-structured interviews with parents (n=40) with the goals to 1) describe parents’ day-to-day lived experiences of food parenting, 2) identify salient momentary factors that influence use of these food parenting practices, and 3) understand how momentary factors impacted parents’ use of particular food parenting practices. Interview questions were informed by the food-related parenting practice literature and designed to inquire broadly about the home food environment [e.g., food-related patterns, routines, and rules; home food availability/accessibility], as well as about what influenced the home food environment in the homes of the families interviewed [e.g., (Overall: parents goals/aspirations, cooking skills, financial limitations) (Momentary: time, stress, mood)]. Semi-structured interview questions relevant to the current analysis are included in Table 2; this interview guide included broad, open-ended questions with optional prompts to assist with engaging participants as needed.

Table 2:

Semi structured Interview Guide

The semi-structured interview guide was first piloted with two content area experts, three graduate students, and four parents of children aged 2–5 to make sure questions were clear, elicited in-depth discussion, and were acceptable to participants; feedback from pilot testing was used to modify the wording, content and order of interview questions. Interviews were conducted by one of four trained female research staff members,44 including the study PI (first author). All four interviewers were trained by the study PI according to the protocols of Kreuger;45 none had a prior relationship with the study participants. Interviews ranged in length from 30 to 60 minutes. To reduce burden, participants were allowed to complete the interviews in person or over the phone. The majority of interviews (n=30) took place in a private room on the University campus, while 10 interviews took place over the telephone; both interview formats (phone and in person) lasted similar lengths and yielded similarly descriptive responses from study participants. Interviews were audio-recorded and written consent was obtained before commencing the interview. All study protocols were approved by the University of Minnesota’s Institutional Review Board Human Subjects Committee and participants provided informed consent.

Data Analysis

Audio-recorded interviews (n=40) were transcribed verbatim and coded using a hybrid deductive and inductive content analysis approach46,47 using NVivo10 software (NVivo 10, QSR International Pty Ltd, Burlington, MA 2014). Specifically, when exploring the types of food parenting practices utilized we first allowed specific themes to naturally emerge from the data (inductive analysis), but then sought to organize these themes based on the broad dimensions of structure, autonomy support, and coercive control outlined in the Vaughn’s content map11 (deductive analysis). When inquiring about momentary factors that influenced food parenting and aiming to understand the role that these factors played in the parenting practices utilized, we relied solely on inductive content analysis. Using open coding, the researchers first read through each transcript in full to gain a broad sense of the full story being told by the participant as well as to allow for any unexpected linkages between participant responses to various questions to reveal themselves to the research team.48 Following this initial read-through, the researchers then read each interview line-by-line to establish initial codes and capture key thoughts and concepts. Next, coding to reduce broad categories into subcategories was conducted and major concepts were identified. The major concepts were further defined, developed and refined into overarching constructs and sub-themes.

All parent transcripts were read and coded by the principal investigator (first author of this paper) to ensure that saturation of themes had occurred. To improve trustworthiness49–52 of the data and reduce bias, 32 (80%) randomly selected transcripts were double-coded (first and second author of this paper). After initial coding, agreement was reached between the two coders on themes and placement of quotes within themes 94.7% of the time (initial interrater reliability). Then, both coders came together in person to discuss questions and discrepancies regarding quotes or placement of quotes in theme categories until 100% agreement was reached. To confirm interpretation of the information generated from the interviews, preliminary study results underwent member checking with ten (25%) of the original parent participants. In qualitative research, member checking is considered best-practice and is one type of validation method that offers study participants the opportunity to provide informant feedback or respondent validation of the study results.50,52,53 For this study, a subsample of the original participants reviewed the preliminary study findings and provided feedback via a second individual interview with the principal investigator to enhance data credibility and authenticity 50,52,53; adaptations to the final themes (names and descriptions) were made based on feedback that occurred during member checking interviews.

Results

What food parenting practices do parents use?

Specific food parenting practices utilized day-to-day by parents (subthemes) were operationalized from the rich descriptions provided within the one-on-one interviews; identified practices were then conceptually organized within the broad theoretical domains (overarching themes: coercive control, structure, autonomy support) outlined in Vaughn’s concept map.11 Specific food parenting practices identified are described in detail below, organized under broad overarching themes; additional example quotes from participants related to themes are available in Table 3.

Table 3:

Food parenting constructs and associated quotes

Coercive Control.

Parenting practices subthemes consistent with the broad overarching theme of coercive control11 were discussed within individual parent interviews. Specifically, many parents (47.5%) discussed using bribes, threats or tricks as well as employing pressure-to-eat (35.0%) and food restriction (32.5%) techniques at some eating occasions. For example, one parent said, “I’ll set an actual timer and say, ‘You have five minutes to eat your food, and if you don’t finish it, then you don’t get a treat.’”

Some parents (12.5%) also discussed using food to control a child’s behavior. For example, one parent said, “If they get in the car after school and ask for something right away, like, ‘Do you have any cookies?’ then I know that they’re hungry, and that half an hour between getting home and dinnertime, they’re going to get upset, or it’s going to be a meltdown, so I’ll give them a little something. Like, ‘Here’s a couple pretzels,’ or ‘Here’s a cheese stick’ or ‘Here’s a glass of milk.’”

Autonomy support.

Many parents described engaging behaviors (subthemes) that fell under the overarching theme of autonomy support.11 These parenting practices stood apart from coercive control in that they did not stem from a primary goal of having the child behave in a very specific way. For example, many parents (75%) discussed engaging in reasoning, or using logic to persuade their child to make certain choices about food or to adopt a particular eating behavior; in many cases there was some amount of nutrition education occurring within the context of parental reasoning. For example, one parent said, “I try and communicate to him like, ‘It is really important to drink water. Like, you can have that [particular food], but that’s full of sugar or that’s really like fattening or that’s not a healthy snack. You can make that choice, but then you should really try hard to make a healthy choice later.’ you know.”

Encouragement was used by many parents (45.0%); they described attempts to embolden their child to take on new healthy eating habits, try new or different foods, or select a healthier option. Parents (57.5%) also discussed the frequent use of negotiation, or back-and-forth discussion, in determining the amount or type of food consumed by their child. For example, one parent said, “I usually say, ‘Finish what you have first, and then you can have more,’ because oftentimes they’ll like finish one thing and they won’t have touched another thing on their plate, so I’m like, ‘Well, you have to have a few bites of this before you can have more of that.’ So, lots of that kind of negotiation.”

Finally, parents (30.0%) talked about efforts to increase child involvement in the planning and preparation of meals as a means of passing on family norms and traditions and to provide an opportunity for their child to develop important meal planning and food preparation skills.

Structure.

Many parents discussed using food parenting practices (subthemes) that fell under the overarching theme of structure.11 For example, most parents (87.5%) discussed having well-established rules and limits around food and eating; specific rules and limits differed widely between families, but overall parents utilized rules and limits to set expectations for their child regarding what, when, where, and how much food their child was allowed to eat. Some parents also discussed having rules or limits related to the atmosphere of the family meal; for example, many families limited the use of devices (e.g., television, iPad) at meals. Parents (85.0%) discussed following a schedule or routine with a specific focus on the importance of consistent timing of meals and snacks throughout the day to ward off frequent requests for snacks as well as grazing throughout the day at the expense of eating more traditional meals. For example, one parent said: “So usually we do have a pretty strict schedule for snacks and dinners, just because like she’s usually pretty picky. She would snack all day if she could. So we set up a snacking schedule, which I think they have a good amount of snacks, like three snacks a day is, you know, a pretty good amount. And we have set up at the certain times just so they don’t get full before they eat their meals.”

Parents (60.0%) engaged in monitoring behaviors, noting that they would keep track of the types of foods offered and eaten with the goal of providing a balanced variety over the course of a day; for example, if a child did not eat any vegetables at lunch time, a parent might intentionally offer two vegetables at dinner to promote consumption. The use of guided choices or allowing a child the freedom to choose between a limited number of pre-selected options (e.g., spaghetti or tacos), was also very common among parents interviewed, with 67.5% of parents endorsing the use of this food parenting practice. Parents (52.5%) also discussed making intentional choices about food accessibility and availability with the goal of limiting their child’s intake of certain foods and promoting their intake of others. Specifically, many parents indicated that they had specific places within their home (a fridge or kitchen drawer, countertop) where they placed snacks that they allowed their child to freely choose from, whereas other foods and snacks were kept out of reach or out of sight. One participant said, “In the refrigerator, the cheese sticks and other snacks are at his level, and the unhealthy stuff is up top, so he can’t just kind of reach in and grab it.” Many participants also talked about being careful to only buy certain foods or certain amounts of less healthful foods at the store to limit their child’s access to these foods at home.

Finally, a subtheme of anticipatory catering emerged during discussions with 57.5% of parents; this theme was not specifically described in Vaughan’s content map, but seems to be most in line with indulgent feeding practices. Anticipatory catering refers to the practice of making choices about what to buy, prepare and serve based almost exclusively on catering to known child preferences. For example, a number of parents talked about planning and preparing only a very limited number of meals that they knew were their child’s favorite. For example, “I mean, we just try to keep it simple, because she only likes certain things, and that actually affects like what we make all the time. Like we have macaroni and cheese all the time just because that’s one thing that I know she’ll eat, and chicken because she eats it, and hot dogs because she eats it. But it’s just also [because of] me working at night; it’s just easier for all of us, knowing we don’t have to like fight with her to eat anything.” While many parents choose to prepare meals they knew would be well-liked by family members, including their children, the behaviors described under the anticipatory catering theme went beyond that, as parents described avoiding trying new things and feeling very limited in the meals they could prepare.

What factors influence the use of certain food parenting practices ‘in the moment’?

Results from parent interviews suggested that food parenting practices are not static, rather they fluctuate across time and context and are readily impacted by a variety of salient momentary factors. Parents identified several subthemes that fell under this overarching theme of “salient momentary factors”, or factors that caused parents to make a shift or change to their usual food parenting practices; these subthemes are discussed below, and example quotes from participants related to momentary themes are available in Table 4.

Table 4:

Momentary factors that influence food parenting practices

Many parents (65.0%) talked about limited time changing the quality of the food they would prepare for their family. Some parents also indicated that they were more likely to prepare a child’s preferred foods or to relax the enforcement of usual mealtime rules if they were rushed for time in an attempt to avoid conflict at the meal. Some parents (25%) also discussed the role that activities or special events played in their food parenting: families were more likely to eat convenience foods or fast food, and to rush or even skip family meals, to accommodate evening activities. Further, they reported relaxing rules about candy or junk food if it was available at an evening activity or special event. Another theme that arose from interviews was the momentary impact of coordination with a partner/accommodating changing work schedules. For many families (22.5%), the evening routine was subject to change depending on who was at home during the dinner hour, which was not always predictable (e.g., shift work, traffic, late meeting, on-call). Parents described making simpler, child-centric meals or being more relaxed about the structure of the dinner hour if they were the only parent at home, whereas they had a more elaborate meal and structured routine if they knew that their partner would join them. Many also talked about being less engaged with their child during the meal if they were the only grown-up present.

The majority of parents (70.0%) talked about the impact that their own mood, energy level or physical health played in their food parenting practices; if they were feeling tired, worn out, sick or stressed that they were more likely to serve foods that they knew their child would eat without complaint, even if they were less healthful or not a balanced meal. They were also more likely to make the last minute decision to eat out or order in food. Some parents noted that if they were worn out or stressed they might choose to eat separately from their child or to rely on devices (e.g. TV, iPad) to make mealtimes less of an effort for them. Finally, parents talked about using how they were quicker to rush or pressure their child to eat or to use a bribe to make the meal go smoothly. Along similar lines, parents (47.5%) noted that their child’s mood or physical health could impact food-parenting choices; parents indicated that if their child was crabby, whiny, tired, or didn’t feel well, they typically chose foods that were quick to prepare and preferred by their child to make things easier on themselves.

Many parents talked about trying to have a plan in place for meals and snacks at the start of each week and indicated that when they did have a plan in place that there was very little that could get in the way of them executing the plan; however, parents (25.0%) discussed that if they failed to have a plan in place then the littlest thing could throw them off and result in them serving very different meals or engaging in very different mealtime rules and routines than they typically did.

How do momentary factors influence the types of food parenting practices parents utilize?

When talking with parents about how momentary factors influenced the way they engaged with their children around food parents spoke about things that shifted their parenting away from structure and autonomy support behaviors, towards less structure and support and more coercive types of behaviors. For example, one parent said, “When I’m stressed out, I just want to be alone, and so I just like go in a different room, and eat by myself, and like watch TV, or like not engage with them. Or sometimes, even at the table, I don’t engage with them at the same level that I usually do if I’m stressed out. They just get up and play and their food gets cold and stuff. So, yeah, [stress] definitely affects it.”

Importantly, parents spoke about how momentary factors might lead to a change in food parenting practices prior to the start of a meal (e.g. “If she’s tired or cranky, or if I’m really tired or cranky, I’m much less likely to enforce us sitting down together at the table.”) or within the context of an eating exchange (e.g. “I mean, like if he starts asking for a cookie. [I’ll say] ‘No treats tonight. No treats.’ But he keeps pestering, and if I’m tired and worn out, I’ll say, ‘Okay, you can have half a cookie,’ so at least he doesn’t think he’s winning the full cookie, but at the same time, I’m just worn out and want him to stop asking a hundred times.”).

Overall, the sample of parents interviewed seemed to aspire to engage primarily in food parenting practices that fell under the domains of structure and autonomy support; but, parents identified numerous momentary factors that, at times, led their actions to differ from their initial aspirations. Parents typically described momentary factors shifting away from their goal of structure toward indulgence and away from their goal of autonomy support toward coercive control.

Discussion

This paper used data collected through one-on-one interviews with parents of preschool-aged children to empirically operationalize food parenting practices that are thought to reflect three broad dimensions of food parenting, as outlined by Vaughn’s content map: coercive control, autonomy support, and structure. Further, we aimed to qualitatively explore potentially salient momentary factors that influence the use of particular food parenting practices in order to to better understand how momentary factors influence the food parenting practices parents rely on in the moment. Results from parent interviews illuminated the diversity and variability in the types of food parenting practices utilized by parents of preschool-aged children. Parents reported utilizing food parenting practices from across the three broad domains (coercive control, autonomy support and structure); practices described by parents aligned, with few exceptions, with the practices proposed in Vaughn’s content map. Modeling, food preparation, nutrition education, and praise were four specific practices discussed within Vaughn’s paper that did not emerge as themes during our parent interviews; it might be that the parents we interviewed engage in these practices without realizing they are (e.g., praise) or without recognizing their potential impact on their child (e.g., modeling, food preparation) or it might be that some of these practices are more relevant to parents of older children (e.g., nutrition education). It is also possible that while Vaughn’s content map was designed to represent conceptually distinct constructs, that during parent interviews certain practices did not emerge as distinct from one another. In particular, it seems that while nutrition education did not emerge as a distinct practice during interviews, many participant quotes that were conceptualized under “reasoning” also seemed to hint at nutrition education. Moving forward it will be important for researchers to consider the theoretical utility versus the practical utility of narrowly defining specific food parenting practices.

Importantly, many parents indicated that the specific food parenting practices they engage in might change within the context of one eating occasion (e.g. starting with encouragement and moving on to bribery) or across the course of the day or week (e.g. guided choices one day and pressure-to-eat another day). The majority of participants felt that their use of specific food parenting practices varied across time and context. For example, most parents talked about wanting to rely primarily on structure (e.g., food availability, rules and routines) and autonomy support (e.g. guided choices, encouragement) behaviors. However, most parents were able to identify several momentary factors that would arise (e.g. stress, limited time, child’s mood), causing them to shift their approach away from an “aspirational” environment of structure and support and towards a more “situational or coping” environment of indulgence and coercive control. Findings from this study align with, the work of Berge and colleagues which explored the momentary impact of parental stress and mood, measured using ecological momentary assessment (EMA), on use of coercive food parenting practices; parental stress was found to be associated with an increase in the use of coercive food parenting practices the same evening. 34,35 Further, previous research supports the idea that parents often report engaging in multiple, sometimes even counterintuitive, feeding strategies; for example, previous work by the lead author found that many parents of adolescents reported high levels of both food restriction and pressure-to-eat.18 At the time, it was posited that parents might use different strategies for different foods and the current research broadens this potential explanation by suggesting that parents may be using multiple practices across all three domains within the context of one eating occasion. Additionally, previous research has proposed that the relationship between parent feeding practices and child outcomes is likely to be bi-directional; the emergence of child health and mood as salient momentary impacts supports this idea. Future research should employ data collection and analytic strategies that allow for further exploration of this combined use of practices; for example, instead of asking parents to simply respond with their overall, usual level of endorsement (Likert: disagree to agree) of a series of food-parenting practices (e.g., “My child should always eat all the food on her plate”),16 survey questions could be adapted to provide the opportunity for more nuanced and time and context specific responses, as well as the report of multiple behaviors at one time. Alternatively, researchers could employ novel data collection strategies, such as video-recorded interactions, that allow them to capture a wide range of behaviors at one time.54 Further, research should aim to better understand how and why parents shift between engaging in different types of food parenting practices and how the dynamic use of varied food parenting practices impacts child weight and weight-related outcomes.

It is notable that the salient momentary factors that parents identified as causing them to alter their typical food parenting practices are fairly commonplace (e.g. activities, limited time, stress), indicating that it does not take something extraordinary to throw off a typical pattern or routine.55 Further, it is likely that there are certain sub-groups of parents that are impacted more frequently, or to a greater degree, by these types of momentary factors. For example, a single parent or a parent that works shift work may experience limited time, stress, or the impact of changing schedules with greater frequency than a parent with the support of a partner or a more flexible job. Disparities in exposure to the salient momentary factors identified by parents in interviews should be explored further and may serve to explain observed differences in use of particular food parenting practices across demographic characteristics.18 The potential impact of momentary factors on the use of specific food parenting practices, as well as disparities in exposure to salient momentary factors, should be considered when planning public health and clinical interventions for parents of young children. For example, future interventions might help parents identify manageable ways of maintaining structure and autonomy support in food parenting in the face of disruptions to typical routine or other external challenges. Further, for families that experiences frequent disruptions or lack routine, it might make sense for interventions to help parents find ways to establish family routines as a launch point for a future work aimed at the adoption and maintenance of structure and autonomy support food parenting practices. Previous research by Fiese and Wamboldt suggests that capitalizing on preexisting routines or establishing new routines may help families reduce the burden of adopting and maintaining new behaviors.56,57

Anticipatory catering emerged as a food parenting practice relied upon by a number of parents. This is a new finding in the literature and was not specifically outlined in Vaughn’s review article; however, using Vaughn’s concept map as a guide, this practice seems most consistent with a sub-type of unstructured, indulgent practices. It make sense that parents would consider child preferences when shopping for food and planning and preparing meals, however the behaviors described underneath the umbrella of anticipatory catering seemed to take this consideration a step further. During interviews, a number of parents described completely avoiding purchasing or serving foods that they didn’t know with certainty that their child would like, or alternatively, they would plan to prepare their child a replacement meal of favorite foods when they were going to serve a new, or potentially disliked meal. For some families, this level of anticipatory catering meant their child was only ever exposed to or offered a very small number of food items. Given that previous research has shown that preschool aged children are still developing taste preferences and that repeated exposures to new foods is needed to inform taste preferences,36–39,58 a parent’s choice to engage in high levels of anticipatory catering could have a potential impact on the development their child’s food preferences. Further research is needed to understand the prevalence of anticipatory catering type behaviors among parents of preschool-aged children and should explore the longitudinal impact of these types of behaviors on food preferences and dietary intake. Further, while we placed anticipatory catering under the umbrella of structure in this paper, future discussion is needed about the best placement for this subtheme within the proposed content map. Vaughn defines structure as “parents’ organization of children’s environment to facilitate children’s competence”. Included under the umbrella theme of structure, Vaughn describes unstructured practices, which are further delineated into neglect and indulgence; although we determined that, using the content map, the concept of anticipatory catering fits best within the unstructured practices construct, the actual behavior described by parents is not unstructured at all. In fact, parents who engaged in this behavior did so in a very structured and intentional way, and as a result many of them engaged in very few other food parenting practices. For example, if a parent plans ahead and serves a meal that only foods they know will be well received by their child, they alleviate the potential need or desire to engage in additional practices at that meal, such as pressure-to-eat, reasoning, encouragement, and negotiation. Looking beyond Vaughn’s content map for guidance to better understand this parenting practice, it seems that anticipatory catering could easily be conceptualized as behavior associated with a permissive or indulgent feeding style;59–63 overall, the behavior of anticipatory catering is both volitional and involves planning, but fundamentally indulgent in that it is overly responsive to the child and their preferences.

Overall, findings from this qualitative study suggest that researchers studying food parenting practices should be aware of the likely interplay between types of feeding practices and the potential impact that momentary factors may have in shifting parents from one type of practice towards another. Further, developing novel measures and assessment methods that allow for exploration of food-related parenting practices as dynamic, rather than static, behaviors should be explored. Understanding the relationship between food parenting practices and child outcomes within the dynamic context of a family is a challenge that must be met, not by limiting our exploration to a few specific parenting behaviors assumed to be static over time, but by challenging ourselves to explore approaches that embrace the diversity and complexity of these dynamic behaviors. One such approach is ecological momentary assessment (EMA), a novel methodology that utilizes hand-held devices to capture information on behaviors as they unfold in their natural environment, moment-by-moment, to capture dynamic changes in behavior over time and across contexts. Use of EMA could provide an opportunity to elucidate temporal relationships between momentary variables (e.g., parental stress, child behavior) and use of food parenting practices. The influential momentary impacts identified within the current study could serve to inform the development of new measures focused on identifying momentary influences of food parenting to be measured via EMA technology.

There are both strengths and limitations to this study. This study adds significantly to the emerging literature aimed at broadening our conceptualization of food parenting practices, by being the first, to our knowledge, qualitative research study to operationalize the dimensions proposed in the content map developed by Vaughn and other leading experts in the field. Further, this study adds to the evolving conversation about food parenting practices as dynamic and context specific constructs by relying upon parents to identify the most salient factors that impact their moment-to-moment choices about what food parenting practices to use. Finally, this study proposes the idea that there might be an interplay between specific types of food parenting practices and momentary factors, whereby exposure to certain momentary factors causes parents to shift from one set of feeding practices to another. However, although study participants were drawn from a large, population-based sample, they are still not representative of the full Project EAT sample, or the population at large. For example, this sample was made up of predominately white and higher income individuals; future research should explore if salient momentary influences on the use of particular food parenting practices are different among more racially/ethnically and socioeconomically diverse populations. Further, it is important to consider the role that the questions and prompts included within the semi-structured interview guide might have played in participant responses; by asking participants to reflect on and share day-to-day factors that shifted their use of food parenting practices and providing specific prompts, it is possible that we influenced their report of particular momentary factors. Finally, although all interview participants lived with their child at least fifty percent of the time, many had arrangements in which they were not the sole (e.g. child attended daycare or school) or primary caregiver (e.g. responsibility for child’s care was shared with another parent or relative); while allowing parent participants with a range of lifestyles and living arrangements increased diversity in participant responses and generalizability of findings to other similarly diverse populations, the fact that not all interviewees were the child’s sole, primary caregiver could also be considered a study limitation.

Conclusion

Findings from this study indicate that parents of preschool-aged children utilize a broad range of food-related practices that their use of particular behaviors was dynamic (both within and between meals) and specific to the context. Researchers studying food parenting practices should consider the broad range of behaviors utilized by parents, rather than focusing in on a specific technique, when striving to best understand the role of parents in the weight and weight-related outcomes of children. For example, if a parent regularly engages in feeding practices representing all three broad domains of food parenting within the context of one eating occasion (e.g., restriction, negotiation, and food availability), the utility of exploring the impact of one particular practice on dietary intake is limited. Further, the use of novel data collection methods that allow for exploration of food parenting practices as dynamic and context specific, rather than static, should be explored. Finally, public health professionals and clinicians should consider the potential impact of momentary factors on the use of specific food parenting practices when planning interventions for parents of young children; for example, helping parents to anticipate things that might come up and disrupt their typical routine, and create a plan for ways to manage these disruptions in a healthful way, might help to minimize the use of unstructured and coercive food parenting practices.

Acknowledgements

Research is supported by grant no. K23-HD090324-01A1 from the National Institute of Child Health and Human Development (PI: Katie Loth). Content is solely the responsibility of the authors and does not necessarily represent the official views of National Institute of Child Health and Human Development or the National Institutes of Health. Additionally, it should be noted that the completion of this research would not have been possible without the hard work of student volunteers: Anne Hutchinson, Abbie Lee, and Junia Nogueira de Brito.

Footnotes

Competing Interests

The authors declare that they have no competing interests.

Contributor Information

Katie A. Loth, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN.

Marc Uy, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, ude.nmu@510xxxyu.

Dianne Neumark-Sztainer, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, ude.nmu@110amueN.

Jennifer Orlet Fisher, Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, ude.elpmet@rehsifoj.

Jerica M. Berge, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, ude.nmu@egrebj.

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