Elsevier

Academic Pediatrics

Volume 16, Issue 8, November–December 2016, Pages 777-782
Academic Pediatrics

Child Nutrition
Maternal Concern for Child Undereating

https://doi.org/10.1016/j.acap.2016.06.004Get rights and content

Abstract

Objective

To describe features of maternal concern for her child undereating; examine maternal and child correlates of maternal concern for undereating; and determine whether maternal concern for undereating is associated with feeding practices.

Methods

This was a cross-sectional analysis of an observational study with 286 mother–child dyads (mean child age, 71 months). Maternal concern for undereating was assessed using a semistructured interview. Mothers completed questionnaires to assess picky eating, food neophobia, and feeding practices. Feeding practices were further assessed using videotaped mealtime observations. Logistic regression was used to assess the association of maternal and child characteristics with maternal concern for undereating. Regression was used to assess the association of maternal concern for undereating with feeding practices, controlling for covariates.

Results

Over a third of mothers (36.5%) expressed concern that their child does not eat enough. Correlates of concern for undereating included child body mass index z-score (BMIz; odds ratio [OR] = 0.58; 95% confidence interval [CI], 0.43–0.77) and picky eating (OR = 2.41; 95% CI, 1.26–4.59). Maternal concern for undereating was associated with greater reported pressure to eat (relative risk [RR] = 1.97; 95% CI, 1.55–2.50), greater observed bribery (OR = 2.63; 95% CI, 1.50–4.60), and higher observed pressure (OR = 1.90; 95% CI, 1.08–3.36) during mealtimes.

Conclusions

Mothers of children who are picky eaters and have a lower BMIz are more likely to be concerned that their children do not eat enough, and maternal concern for undereating is associated with pressuring and bribing children to eat. Pediatricians might address maternal concern for undereating by advising feeding practices that do not involve pressure and bribery, particularly among healthy weight children.

Section snippets

Participants

Participants were a convenience sample of 286 low-income, female primary caregiver–child dyads from South-central Michigan, who were enrolled in a previous longitudinal study in 2009 to 2011. Participants from the original study were invited through their child's Head Start program (free, federally subsidized preschool programs for low-income children) to participate in a study seeking to understand how stress is associated with children's eating behaviors. Participants were followed

Results

Characteristics of the study sample (n = 286) are shown in Table 1. In the semistructured interview, more than a third of mothers (n = 105; 36.5%) expressed that they were concerned about child undereating; illustrative quotes are shown in Table 2. The presence of concern for undereating was defined as the mother expressing any worries or concern about her child not eating enough quantity of food. Some mothers expressed concerns for their children being “too skinny” or underweight, which they

Discussion

Results of this study support previous studies that showed that mothers are concerned that their children do not eat enough,1, 2, 3 and also makes several new contributions to the literature that might guide providers in responding to maternal concerns about child undereating. The first key finding was that approximately one-third of mothers of low-income 4- to 8-year old children expressed concern that their child does not or might not eat enough. Qualitative analysis of mothers' elaboration

Acknowledgments

Financial Disclosure: Dr Brown is supported by a grant from the Health Resources and Service Administration's National Research Service Award (T32 HP014001). Dr Pesch is supported by an American Heart Association Postdoctoral fellowship. Dr Lumeng is supported by R01HD061356. Dr Perrin is supported by NIH/NICHD R01HD059794. The funding sources had no role in study design, in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the

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    The authors have no conflicts of interest to disclose.

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