Please...Just One More Bite? The Influence of Parental Control Upon Food Intake

Please...Just One More Bite? The Influence of Parental Control Upon Food Intake

Claire Farrow, PhD | Lecturer in Psychology | Keele University | Keele, Staffordshire, UK 

From an early age, the majority of children will naturally self regulate their food intake: eating as much as is necessary to satiate their hunger and stopping when they're full. Infants seem to be born with this innate sense—perhaps this may be more easily observed in breastfed infants who can turn away when they've had enough. Unfortunately, as children grow and socialize, their eating habits begin to resemble those of adults, who will often consume tasty foods to excess even when they're not hungry. In today's climate of increased overweight and obesity, this unhealthy change is of major concern.

Various factors are believed to influence self-regulation. For example, the social rule of eating set meals at certain times can lead people to eat when they're not hungry. In addition, the pressure of eating with other people and the influence of mass media and television advertisements can encourage children and adults to overeat. However, for very young children, even more influential is the occurrence of parental control over the intake and selection of foods. While usually implemented with good intentions, parental control has been shown to hinder a child's own ability to self-regulate, and further, to encourage overeating or other eating imbalances. Given the detrimental effects of these practices, it's important to appreciate what makes caregivers more likely to control a child's food intake.

Misguided Control Tactics
For the concerned parent, the most obvious response to childhood overweight is to limit access to certain types of foods or to make certain foods available only at specific times. With fussy eaters or children who are underweight, the natural response is to encourage the child to eat more food and more calorie-dense foods. However, despite good intentions, these practices can actually make the feeding situation worse. A wealth of research suggests that parents who exert greater control actually interfere with their child's natural ability to regulate intake. These two coping methods—pressuring the child to eat and restricting the child's intake—are both well-documented methods of controlling children's food. 

Many of us have distasteful memories of cold peas or Brussels sprouts which our parents encouraged us to eat and which we refuse to touch even to this day. Indeed, when a parent pressures a child to eat—a common strategy used with children who dislike a particular food—the child is more likely to subsequently report heightened dislike for that food. In fact, the amount of control a caregiver exerts over a child's eating has been shown to be one of the best predictors of the child's ability to regulate energy intake, with caregivers who are the most controlling having children who are the least successful at this type of regulation.1

Unsurprisingly, the foods that have been most commonly associated with the use of pressure to eat are healthy foods such as fruit and vegetables, with mothers who pressure their children to eat more fruits and vegetables having children who are fussier about these foods.2 These findings have been demonstrated in observational studies where the use of pressure for a child to finish his/her soup has been associated with lower consumption of the soup, lower child body mass index and more negative comments about the soup.3

Moreover, the effects of using pressure can be enduring. Even in adulthood, recollections of having been forced a food during childhood actually predict a person's dislike for that food. For example, Batsell, Brown, Ansfield & Paschall4interviewed a group of 407 college students and found that over 68% of students could recollect being forced or demanded to consume a food against their will, most often by a parent or teacher, and that 72% of those students said that they would not eat the forced food in the present day. These strategies may not only predict the dislike of specific forced foods, but the use of pressure and coercion at mealtimes could actually lead a child to dislike mealtimes in general—for example, if the child is conditioned to find mealtimes an aversive experience. 

When a parent perceives a child to be overweight, gaining weight too rapidly or eating too many 'unhealthy' foods, a common strategy is to restrict the child's access to certain types of foods, or to restrict the child from eating what may be perceived as 'too much' food. This is especially the case in our obesigenic society where childhood obesity and overweight are becoming increasingly more prevalent. Again, though, this strategy has been shown to be counterproductive. The restriction of certain foods from a child's diet has been associated with a heightened preference for those foods. Indeed, in experimental settings, restricting access to palatable foods has been shown to increase a child's selection and intake of those foods,5 while children who are exposed to more restriction from their parents are more likely to have higher levels of adiposity6 and a higher fat mass.7

In one study, Fisher & Birch8 asked both children and their mothers to report how much control the mothers exerted over their children's food intake. The authors found that for female children, reports of higher levels of restriction predicted higher levels of the girls' snack food intake. Importantly, this finding was not significant for male children, and, as discussed hereafter, many studies have found that the influence of maternal control upon children's feeding is more detrimental for female compared to male children. 

Why Parents Control
In addition to the child's weight status or eating patterns, various other factors have been shown to predict why a caregiver is more likely to exert control when feeding his/her child. Social and demographic factors have been linked with the use of controlling and restrictive feeding practices. For example, Taveras et al.9 conducted a longitudinal study exploring the factors that predict the use of restriction at 1 year. They found that younger, multigravida women, from lower socio-economic backgrounds, were more likely to use restrictive feeding practices. In another longitudinal study in America spanning from birth to 7 years of child age, Duke et al.10 found that being born outside of America predicted the use of pressure to eat with male children and the use of restriction with female children. These findings suggest that cultural and social factors may be important in determining the kinds of parenting strategies used during child feeding. In addition, mothers who breast-feed have been shown to be less likely to exert control over their child's food intake, and this is after controlling for the influence of potentially confounding social and demographic factors. This could be a result of the fact that breast-feeding is associated with child weight, growth and obesity,11 and as such may influence the amount of control exerted during child feeding. Moreover, breast-feeding mothers have less obvious control over their infant's intake of milk and are thus better practiced at allowing their infants to assume control over their solid food intake.12,13

A mother's mental health is also important in determining her interactions with her child. The presence of symptoms of distress, depression, anxiety or concerns about her own eating has been linked with a greater prevalence of control over the child's eating. The distress of these symptoms may heighten the possibility that a mother will resort to feeding practices that demonstrate high levels of control. For example, mothers with their own concerns about their weight or shape may extrapolate their anxieties onto their child's eating and be concerned that their child may develop some form of eating disorder. Indeed, women with diagnosed eating disorders have been shown to use more strong verbal control with their children,14 and parental body dissatisfaction has been shown to predict the use of parental pressure during feeding times with children.15 Similarly, mothers who are very anxious—particularly those who are anxious about control, disorder or mess—are likely to find feeding a young child distressing and anxiety-provoking and thus may be more likely to exert control.16

Other child characteristics can also evoke greater levels of control. For example, mothers are more likely to be concerned about their daughters' rather than their sons' snack food intake.17 This relationship is thought to reflect greater societal pressure for girls to be slim. In addition, children who are temperamentally described as difficult by their caregivers tend to have more negative mealtime interactions, and children who are described as un-adaptable are reported to display greater levels of food refusal.(18) To date, research has not directly explored the relationship between controlling feeding practices and child temperament.

Observed Maternal Control
Although there has been a wealth of research indicating that controlling feeding practices are counterproductive to child eating and weight, the majority of research conducted in this field has utilized cross-sectional and self-report methods. The cross sectional nature of data collection precludes answers of cause and effect, and it may be just as likely that a mother will control her child's food intake because she is concerned about his or her weight as it is that control would exacerbate weight gain or loss. Moreover, with the use of maternal report to assess control, we cannot be sure if many mothers are under or over reporting the amount of control they use in order to be viewed more positively by the researcher. 

Given these issues, we conducted a longitudinal study from birth to one year of age to explore how observed maternal control during feeding is related to child weight gain. Children will naturally self regulate their intake and weight gain during infancy19,20 a phenomena often referred to as 'regression towards the mean' in weight. We hypothesized that observed maternal control during feeding would interfere with this natural self regulation, by exacerbating slow or rapid early infant weight gain. We also assessed infant temperament and breast-feeding in order to evaluate their relationships with controlling feeding practices. The data discussed here are published in the journal Pediatrics.21

For this study, sixty-nine women gave informed consent during pregnancy to take part in a longitudinal study. These women completed a questionnaire about their child's temperament at 6 months, reported details about their child's gender and their breast-feeding history and were observed during a feeding interaction to ascertain an independent measure of maternal control. All mother/child dyads were observed during one feeding interaction and mothers were rated by independent judges according to the amount of control they exerted during the mealtime. Some mothers were very controlling and would continuously force food and repeatedly re-offer food when it had been rejected. Other caregivers were much less controlling and would allow their infants as much autonomy as possible while supervising the mealtime interaction: for example allowing the infant to eat at his or her own pace, removing rejected or refused food, allowing the infant to play with feeding utensils and food. In addition, all children were weighed at birth, 6 and 12 months and weight scores were standardized and converted into z-scores using the Child Growth Foundation reference curves disc which standardizes weight considering child gender and exact age (1996).22

The results indicated that there were no gender or temperament differences in the amount of control used by mothers in this sample; maternal use of control was not significantly correlated with how difficult, unpredictable or unadaptable the mother perceived her child to be. However, mothers who breast-fed their babies were observed to be relatively less controlling at mealtimes. These findings have been reported elsewhere23 and as discussed previously, may be associated with specific benefits gained from breast-milk, or may result from the experience of breast-feeding promoting a balance of control and child autonomy over feeding interactions. 

Analysis of the data suggested that infants did appear to regulate their weight gain across the first year of life as weight gain from birth to 6 months was negatively correlated with weight gain from 6-12 months. Furthermore, observations of maternal control during mealtimes moderated this relationship. That is, although early (0-6 months) and later (6-12 months) weight gain were negatively correlated, the relationship between early and later weight gain was dependent upon the use of maternal control during feeding. Specifically, when mothers used a moderate or low amount of control, their infants appeared to regulate their weight gain across the first year of life, with those with rapid early weight gain slowing down, and those with slow early weight gain accelerating in their growth. Conversely, where mothers were very controlling during feeding at 6 months, the opposite pattern emerged: infants with slow early weight gain continued to have slow weight gain from 6-12 months and those with rapid early weight gain continued to have greater weight gain in the latter half of the first year. 

These findings replicate other research which has suggested that the use of control during feeding is counterproductive and interferes with children's self regulation of their eating or weight, but extend previous findings by utilizing observational and longitudinal methods. Moreover, these are the first findings to suggest these pathways in infants as early as 6 months of age. There are clearly limitations to this study that preclude assuming that maternal control is predictive of the child's weight regulation. Indeed, the sample size is relatively small and one observation of child feeding is not enough to gain a particularly accurate representation of control during feeding.24 Moreover, there are likely to be many other factors that influence weight gain in addition to control, breastfeeding and temperament. Despite these limitations, the results of this study suggest that where mothers are less controlling infants appear to regulate their own weight gain across the first year of life. However, where mothers use greater levels of control, infants regulate their weight gain less accurately, and rapid or slow early weight gain continue to prevail.

Conclusions
These findings clearly have implications for the advice that we give to parents who have problems with feeding and child weight, in that greater levels of control can be counterproductive. However, the sample used here is non-clinical and therefore, it is crude to generalize these findings to samples of children who are overweight or experiencing growth faltering. Further research is required to determine both the effectiveness of imposition of control over feeding in intervention for child weight problems and the long term effects of the use of such strategies. It is also premature to assume that these findings will hold true for fathers. To date, there has been relatively little research conducted about the influence of paternal feeding practices upon the child's weight and food intake, and more research is needed in this area.

For parents who are concerned that their child is not gaining as much weight as is ideal or is gaining weight more rapidly that expected, these results suggest that over-controlling the child's intake during feeding may not be a beneficial process. Indeed, more implicit rather than explicit use of control may be more functional in these situations—for overweight children, try limiting the availability of fatty foods rather than explicitly forbidding them. For underweight children, offer choices of more nutrient/calorie dense foods rather than forcing these alternatives.

Unfortunately, these practices can be very trying and their effects are likely to be more gradual, in contrast to the use of pressure or restriction which can result in instant compliance or reduced intake. While these data suggest that in non-clinical samples control can be a counterproductive response to slow or rapid weight gain, further research needs to be conducted to provide caregivers with realistic alternative strategies to manage and resolve difficulties with child feeding or child weight concerns. 

Claire Farrow, PhD, is a Lecturer in Psychology at the University of Keele in the United Kingdom, and honorary fellow of the Applied Developmental Psychology Research group at the University of Birmingham. Dr. Farrow has been involved in a series of research projects using longitudinal designs and observational procedures to study the development of child feeding and weight gain. Her interests are in the factors that predict the development of dysregulation with food intake in childhood. Dr. Farrow is a member of the British Psychological Society and the Society for Reproductive and Infant Psychology.

References 

  1. Johnson, S. L. & Birch, L. L. (1994). Parents' and children's adiposity and eating style. Pediatrics, 94, 653-661.
  2. Galloway, A. T., Fiorito, L., Lee, Y., & Birch, L. L. (2005). Parental pressure, dietary patterns, and weight status among girls who are "picky eaters". Journal of the American Dietetic Association, 105, 541-548.
  3. Galloway, A. T., Fiorito, L. M., Francis, L. A., & Birch, L. L. (2006). "Finish your soup": counterproductive effects of pressuring children to eat on intake and affect. Appetite, 46, 318-323.
  4. Batsell, W. R., Brown, A. S., Ansfield, M. E., & Paschall, G. Y. (2002). "You Will Eat All of That!": A retrospective analysis of forced consumption episodes. Appetite, 38, 211-219.
  5. Fisher, J. O. & Birch, L. L. (1999). Restricting access to palatable foods affects children's behavioral response, food selection, and intake. American Journal of Clinical Nutrition, 69, 1264-1272.
  6. Fisher, J. O. & Birch, L. L. (1999). Restricting access to foods and children's eating. Appetite, 32, 405-419.
  7. Spruijt-Metz, D., Li, C., Cohen, E., Birch, L., & Goran, M. (2006). Longitudinal influence of mother's child-feeding practices on adiposity in children. Journal of Pediatrics, 148, 314-320. 
  8. Fisher, J. O. & Birch, L. L. (1999). Restricting access to foods and children's eating. Appetite, 32, 405-419.
  9. Taveras, E. M., Scanlon, K. S., Birch, L., Rifas-Shiman, S. L., Rich-Edwards, J. W., & Gillman, M. W. (2004). Association of breastfeeding with maternal control of infant feeding at age 1 year. Pediatrics, 114, e577-e583.
  10. Duke, R. E., Bryson, S., Hammer, L. D., & Agras, W. S. (2004). The relationship between parental factors at infancy and parent-reported control over children's eating at age 7. Appetite, 43, 247-252.
  11. Owen, C.G., Martin, R.M., Whincup, P.H., & Smith, G.D. (2005). Effect of Early Infant Feeding on the Risk of Obesity Across the Life Course: A Quantitative Review of Published Evidence, Pediatrics, 115, 1367-1377.
  12. Farrow, C. & Blissett, J. (2006). Breast-feeding, maternal feeding practices and mealtime negativity at one year. Appetite, 46, 49-56.
  13. Taveras, E. M., Scanlon, K. S., Birch, L., Rifas-Shiman, S. L., Rich-Edwards, J. W., & Gillman, M. W. (2004). Association of breastfeeding with maternal control of infant feeding at age 1 year. Pediatrics, 114, e577-e583.
  14. Stein A, Woolley H, Murray L, Cooper P, Cooper S, Noble F, Affonso N, Fairburn CG. (2001) Influence of psychiatric disorder on the controlling behaviour of mothers with 1-year-old infants. A study of women with maternal eating disorder, postnatal depression and a healthy comparison group, British Journal of Psychiatry, 179, 157-62.
  15. Duke, R. E., Bryson, S., Hammer, L. D., & Agras, W. S. (2004). The relationship between parental factors at infancy and parent-reported control over children's eating at age 7. Appetite, 43, 247-252.
  16. Farrow, C. V. & Blissett, J. M. (2005). Is maternal psychopathology related to obesigenic feeding practices at 1 year? Obesity, 13, 1999-2005.
  17. Duke, R. E., Bryson, S., Hammer, L. D., & Agras, W. S. (2004). The relationship between parental factors at infancy and parent-reported control over children's eating at age 7. Appetite, 43, 247-252.
  18. Farrow, C. & Blissett, J. (2006). Maternal cognitions, psychopathologic symptoms, and infant temperament as predictors of early infant feeding problems: A longitudinal study. International Journal of Eating Disorders, 39, 128-134.
  19. Adair L. The infant's ability to self-regulate caloric intake: a case study. (1984) Journal of the American Dietetic Association, 84: 543-546.
  20. Cohen R, Brown K, Canahuati J, Rivera L, Dewey K. Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomized intervention study in Honduras. Lancet: 1994: 344: 288-293.
  21. Farrow, C. & Blissett, J. (2006). Does maternal control during feeding moderate early infant weight gain? Pediatrics. 118(2):e293-8.
  22. Child Growth Foundation (1996). Cross sectional stature and weight reference curves for the UK. London: Child Growth Foundation.
  23. Farrow, C. & Blissett, J. (2006a). Breast-feeding, maternal feeding practices and mealtime negativity at one year. Appetite, 46, 49-56.
  24. Young, B. & Drewett, R. (2000). Eating behaviour and its variability in 1-year-old children. Appetite, 35, 171-177.
Nestle -- Good Food, Good Life

The content on this site is for educational purposes only and is intended solely for medical professionals in the United States only. If you are not a medical professional, please visit www.gerber.com.

All trademarks are owned by Société des Produits Nestlé S.A., Vevey, Switzerland or used with permission.

© 2016 Nestlé. All rights reserved.