Mothers’ eating disorder history and mother and infant attention to food during infant meal times: a candidate for intergenerational transmission of eating disorder behaviours

Introduction:
There is evidence to suggest that individuals with eating disorders (EDs) show differences in attention to food compared to those without eating disorders. Children of mothers with eating disorders are at an elevated risk of developing an eating disorder themselves. One potential intergenerational pathway may be that parents, and then infants, pay more attention to food in interactions, which in turn mediates transmission of disordered eating behaviours, particularly those during feeding and mealtimes. No study has investigated whether mothers’ ED behaviour history is associated with maternal and infant attention to food during infant feeding interactions.

Methods:
Mothers and 7-month-old infants from the Avon Longitudinal Study of Parents and Children Generation-2 provided video footage of mother–infant feeding interactions filmed at home using head cameras. Feeding interactions were coded for mothers’ and infants’ visual attention using a micro-behavioural observational coding system. Outcomes were the mothers’ and infants’ proportion duration (of the entire feeding interaction) spent looking at food. Mothers’ ED behaviour history was assessed at age 25 years using the Youth Risk Behaviour Surveillance System questionnaire, from which a binary Diagnostic and Statistical Manual of Mental Disorders, fifth edition, disordered eating variable was generated. Linear regression testing associations between mothers’ ED behaviour history and mother and infant attention to food were adjusted for infants’ sex, age, and birth order, and mothers’ age, education, and employment.

Results:
In 98 mother–infant dyads, mothers’ ED behaviour history was associated with longer proportion duration of infants’ looking at food during mealtimes [estimate = 0.59 (0.19, 0.99), p = 0.004], corresponding to a 20% difference in time spent looking at food for infants of mothers with an ED behaviour history compared to those without. There was no association between ED behaviour history and mothers’ attention to food.

Conclusions:
Increased infant looking time to food during feeding may indicate a preoccupation with food. This preoccupation could be a reflection of ED behaviours being modelled to offspring by mothers or early behavioural markers of shared genetic risk for EDs. Support for mother–infant dyads with an ED history could target guiding mothers’ and infants’ attention (via video feedback, for example) to non-food-related activities to minimise any impact on the mothers’ relationship with the infant or the infants’ relationship with food.

Lay summary:
Children of mothers with EDs are at an elevated risk of developing an eating disorder themselves. One potential pathway of transmission of eating disordered behaviour from mother to offspring may be through behaviours shown during feeding and mealtimes. Existing evidence suggests that individuals with eating disorders show differences in attention to food compared to those without eating disorders, but no study had examined attention to food in mother-infant interactions. Using naturalistic observations of feeding at home, we showed that the infants of mothers with an eating disorder history showed increased attention to food during mealtimes. This provides preliminary evidence that attentional patterns during feeding interactions could be sensible targets for intervention.