How and how much to feed a child? Exploring parental decision-making and impact on child satiety responsiveness and adiposity

Abstract

In the early years, children experience significant dietary transitions, moving from a milk-only diet, to being introduced to solid food, and ultimately consuming family meals. While children become independent eaters, parents are responsible for making decisions about how (infant feeding and weaning style), how much, when and what their child is fed. Across four empirical studies and a systematic review, this mixed-methods thesis investigates parental decision-making about how and how much to feed a child during infancy, weaning and preschool, and the impact of those decisions on a child’s subsequent satiety responsiveness and body adiposity.

The first empirical chapter (Chapter 2) is a cross-cultural mixed-methods study exploring parental decisions about how and how much to feed a child during the three dietary transitions. Reflexive thematic analysis revealed similar themes in parental decision-making across cultures (UK and Romania). Although, Romanian parents were more likely to feed on a schedule during infancy, and were less likely to adopt a baby-led weaning approach, possibly due to fears of child choking.

In Chapter 2 parents also identified using their own portion size as a key driver of how much to feed their child. To test this, a series of studies were conducted in the laboratory (Chapter 3, Study 1), childcare settings (Chapter 3, Study 2) and online (Chapter 4). The amount of food a parent served for themselves was a strong positive predictor of the amount of food their child typically served and consumed. Additionally, the associations between how and how much children are fed and consume, and a child’s satiety responsiveness were explored. Formula-fed children consumed larger portions of food and displayed greater plate-clearing tendencies when compared to breastfed and mixed-fed (alternative milk and breastmilk) children.

In Chapter 5, a systematic literature review identified studies which investigated the association (n = 12) or causal influence (n = 2) of portion size on indexes of adiposity in children (< 19 years). Whilst most studies reported positive associations between a measure of portion size and an index of adiposity, very few intervention studies were identified, meaning that the direction and causality of the effect could not be established.

In conclusion, this thesis highlights the key role of parents in determining how and how much children are fed during the early years. Directions for future research and policy are discussed, including; a. conducting research on the causal influence of portion size on body adiposity in children, b. investigating the influence of infant feeding style on subsequent energy intake and satiety responsiveness in a prospective study.

Date of Award	6 Dec 2022
Original language	English
Awarding Institution	University of Bristol
Supervisor	Peter J Rogers (Supervisor) & Danielle Ferriday (Supervisor)