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      Picky eating in Swedish preschoolers of different weight status: application of two new screening cut-offs

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          Abstract

          Background

          Characteristics of picky eaters of different weight status have not been sufficiently investigated. We used two newly developed screening cut-offs for picky eating in the Food fussiness (FF) subscale of the Child Eating Behavior Questionnaire (CEBQ) to investigate the prevalence and characteristics of picky eaters in preschool-aged children with thinness, normal weight, overweight or obesity.

          Methods

          Data for 1272 preschoolers (mean age 4.9 years) were analyzed. The parent-reported FF subscale ranges from 1 to 5, and two screening cut-offs were applied to classify children as picky eaters (3.0 and 3.33). Structural Equation Modeling was used to study associations with other factors in the CEBQ, the Child Feeding Questionnaire (CFQ) and the Lifestyle Behavior Checklist (LBC). Scores were compared separately for each weight status group.

          Results

          Nearly half of the children were classified as moderate or severe picky eaters (cut-off 3.0) and 30% as severe (cut-off 3.33). For both cut-offs, prevalence was significantly lower in the obesity group. Still, one-third of children with obesity met the cut-off of 3.0 and 17% met the cut-off of 3.33. While picky eaters displayed similar patterns across weight status groups, some differences emerged. Food responsiveness was lower for picky eaters, but the difference was significant only among children with obesity. Slowness in eating was not as pronounced among picky eaters in the obesity group. In the overweight and obesity groups, parents of picky eaters did not report as high pressure to eat, as compared to the thinness or normal weight groups; in the obesity group, parents of picky eaters also perceived their children’s weight as lower. In all weight status groups, parents of picky eaters were more likely to report their children had too much screen time, complained about physical activity, and expressed negative affect toward food.

          Conclusions

          Picky eating was less common but still prevalent among children with obesity. Future studies should investigate the potential influence of picky eating on childhood overweight and obesity. Moreover, as children with picky eating display higher emotional sensitivity, further research is needed to understand how to create positive eating environments particularly for children with picky eating and obesity.

          Electronic supplementary material

          The online version of this article (10.1186/s12966-018-0706-0) contains supplementary material, which is available to authorized users.

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          Most cited references26

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          Confirmatory factor analysis of the Child Feeding Questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness.

          The Child Feeding Questionnaire (CFQ) is a self-report measure to assess parental beliefs, attitudes, and practices regarding child feeding, with a focus on obesity proneness in children. Confirmatory factor analysis tested a 7-factor model, which included four factors measuring parental beliefs related to child's obesity proneness, and three factors measuring parental control practices and attitudes regarding child feeding. Using a sample of 394 mothers and fathers, three models were tested, and the third model confirmed an acceptable fit, including correlated factors. Internal consistencies for the seven factors were above 0.70. With minor changes, this same 7-factor model was also confirmed in a second sample of 148 mothers and fathers, and a third sample of 126 Hispanic mothers and fathers. As predicted, four of the seven factors were related to an independent measure of children's weight status, providing initial support for the validity of the instrument. The CFQ can be used to assess aspects of child-feeding perceptions, attitudes, and practices and their relationships to children's developing food acceptance patterns, the controls of food intake, and obesity. The CFQ is designed for use with parents of children ranging in age from about 2 to 11 years of age. Copyright 2000 Academic Press.
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            'Finish your soup': counterproductive effects of pressuring children to eat on intake and affect.

            The authors examined whether pressuring preschoolers to eat would affect food intake and preferences, using a repeated-measures experimental design. In the experimental condition, children were pressured to eat by a request to finish their food. We collected intake data, heights and weights, child-feeding practices data, and children's comments about the food. Children consumed significantly more food when they were not pressured to eat and they made overwhelmingly fewer negative comments. Children who were pressured to eat at home had lower body mass index percentile scores and were less affected by the pressure in the lab setting than children who were not pressured at home. These data provide experimental evidence supporting previous correlational research indicating that pressure can have negative effects on children's affective responses to and intake of healthy foods.
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              A practical approach to classifying and managing feeding difficulties.

              Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The objective is to allow the physician to efficiently sort out the wide variety of conditions, categorize them for therapy, and where necessary refer to specialists in the field.
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                Author and article information

                Contributors
                pernilla.sandvik@ikv.uu.se
                anna.ek@ki.se
                maria.somaraki@ikv.uu.se
                ulf.hammar@ki.se
                karin.eli@anthro.ox.ac.uk
                paulina.nowicka@ki.se
                Journal
                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                1479-5868
                9 August 2018
                9 August 2018
                2018
                : 15
                : 74
                Affiliations
                [1 ]ISNI 0000 0004 1936 9457, GRID grid.8993.b, Department of Food Studies, Nutrition and Dietetics, , Uppsala University, ; Uppsala, Sweden
                [2 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, ; Stockholm, Sweden
                [3 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Institute of Environmental Medicine, Biostatistics, Karolinska Institutet, ; Stockholm, Sweden
                [4 ]ISNI 0000 0004 1936 8948, GRID grid.4991.5, Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, , University of Oxford, ; Oxford, UK
                Author information
                http://orcid.org/0000-0002-3203-792X
                Article
                706
                10.1186/s12966-018-0706-0
                6085619
                30092802
                60937e96-c9b1-4c58-ad61-0d74859adab3
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 April 2018
                : 23 July 2018
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                Nutrition & Dietetics
                appetite traits,eating behavior,obesity,parents,parenting practices,preschoolers,screening,sensory hypersensitivity

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