Appetite 54 (2010) 30–36

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Appetite
journal homepage: www.elsevier.com/locate/appet

Research report

Relationship between parental feeding styles and eating behaviours of

Dutch children aged 6–7
Ester F.C. Sleddens a,*, Stef P.J. Kremers a, Nanne K. De Vries a,b, Carel Thijs c
a
Maastricht University, Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+,
PO Box 616, 6200 MD, Maastricht, The Netherlands
b
Maastricht University, Department of Health Promotion, School of Public Health and Primary Care (CAPHRI), PO Box 616, 6200 MD, Maastricht, The Netherlands
c
Maastricht University, Department of Epidemiology, NUTRIM School for Nutrition, Toxicology and Metabolism & School of Public Health and Primary Care (CAPHRI),
Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, The Netherlands

A R T I C L E I N F O A B S T R A C T

Article history: The present study assessed the relationship between parental feeding styles and dietary intake
Received 8 June 2009 behaviours of Dutch children aged 6–7. Associations between feeding styles and dietary behaviours of
Received in revised form 27 August 2009 the parents were also examined. We translated the validated ‘Parental Feeding Style Questionnaire’ and
Accepted 4 September 2009
evaluated its factor structure. A cross-sectional survey was completed by one of the parents of 135
children. Results indicated considerable similarity of factor structure, internal reliability and between-
Keywords: subscale correlations with the original instrument. The parental feeding dimensions of ‘instrumental
Children
feeding’ (i.e. using food as a reward) and ‘emotional feeding’ (i.e. feeding in response to children’s
Parental feeding styles
Factorial validity
emotional distress) were positively related to children’s snacking behaviour. The feeding style
Snacking ‘encouragement to eat’ was negatively associated with children’s snacking behaviour. Various feeding
Soft drink intake styles were found to be related to parental dietary behaviours. Findings indicate the importance of
Fruit consumption acknowledging parental feeding styles in future research efforts as well as in the development of family-
Breakfast consumption based interventions promoting healthy eating habits among children.
ß 2009 Elsevier Ltd. All rights reserved.

Introduction prevention of weight gain at early age as a priority. These

institutions call for research into the influence of specific parenting
The key role that parents play in the development of obesity- practices on children’s health behaviours.
inducing eating habits in their offspring is a topic of increasing Wardle, Sanderson, Guthrie, Rapoport and Plomin (2002)
interest worldwide (Golan & Crow, 2004). Several dietary designed an instrument, the Parental Feeding Style Questionnaire
behaviours have been shown to contribute to excessive weight (PFSQ), to assess four aspects of feeding style (i.e. instrumental
gain in children. Obesity-inducing behaviours include the con- feeding, control, encouragement to eat, and emotional feeding).
sumption of sugar-rich and energy-dense snacks (e.g., Jebb, 2005), The PFSQ is one of the few psychometrically sound tools available
and sugar-sweetened drinks (e.g., James & Kerr, 2005; Ludwig, to assess parental feeding styles (Wardle et al., 2002). The
Peterson, & Gortmaker, 2001; Vartanian, Schwartz, & Brownell, instrument was developed and validated in the United Kingdom,
2007). On the contrary, fruit consumption (Lock, Pomerleau, and has proved to possess adequate to good internal consistency
Causer, Altmann, & McKee, 2005; Tohill, Seymour, Serdula, Kettel- (Cronbach’s alpha ranging from 0.67 to 0.83) and excellent 2-week
Khan, & Rolls, 2004) and daily breakfast consumption (Dubois, test–retest reliability (r = 0.76–0.83) (Wardle et al., 2002).
Girard, Potvin Kent, Farmer, & Tatone-Tokuda, 2008; Ortega et al., To date, each of the four aspects of parental feeding styles
1998; Rampersaud, Pereira, Girard, Adams, & Metzl, 2005; Ruxton applying various instruments have been examined in relation to
& Kirk, 1997) have been found to be associated with having a variations in children’s eating behaviours and weight status. For
healthy body weight. Given the persistence of obesity and related instance, an experimental study demonstrated that parents’ use of
comorbidities in later life, leading international institutions such the instrumental feeding style (i.e. using food as a reward) has an
as the World Health Organization (2000) and the International impact on children’s food preferences; using a particular food as a
Obesity Task Force (Lobstein, Baur, & Uauy, 2004) have set the means to get the reward (in this case another snack product) leads
to a devaluation of the means food relative to the reward snack,
implying that a child’s preference for healthy snacks could
* Corresponding author. decrease (Newman & Taylor, 1992). Moreover, other studies also
E-mail address: [email protected] (Ester F.C. Sleddens). reported that requiring children to eat a food in order to get a

0195-6663/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.appet.2009.09.002
 E.F.C. Sleddens et al. / Appetite 54 (2010) 30–36 31

reward has been shown to reduce a child’s liking for that food (e.g., De Lauzon-Guillain, Musher-Eizenman, Leporc, Holub, & Charles,
Birch, Birch, Marlin, & Kramer, 1982; Birch, Marlin, & Rotter, 1984). 2009; Fisher & Birch, 1999a, 1999b; Francis, Hofer, & Birch, 2001;
Using foods as rewards for regulating a child’s behaviour have been Tiggemann & Lowes, 2002; Ventura & Birch, 2008). Results of those
shown to increase children’s preferences for these products (Birch, studies showed that restrained eating among parents is linked to
Zimmerman, & Hind, 1980). However, a few studies found parental use of restriction as a feeding style (Birch & Fisher, 2000;
contradictory results regarding the effects of instrumental feeding De Lauzon-Guillain et al., 2009; Fisher & Birch, 1999a, 1999b;
on child’s preferences and behaviour (Horne et al., 2004; Lowe, Francis et al., 2001; Tiggemann & Lowes, 2002). Other studies have
Horne, Tapper, Bowdery, & Egerton, 2004; Moore, Tappen, & found that using food for non-nutritive purposes, including
Murphy, 2007). Regarding the influence of the instrumental emotional feeding (Wardle et al., 2002) and using food as a
feeding scale of the PFSQ on children’s weight status, Carnell reward (De Lauzon-Guillain et al., 2009), were positively asso-
and Wardle (2007) failed to find an association with children’s ciated with parental emotional eating. Additionally, external
adiposity at the ages of three to six. Musher-Eizenman and eating among mothers was characterised by higher levels on the
colleagues (Musher-Eizenman, De Lauzon-Guillain, Holub, Leporc, instrumental feeding scale in the study of Wardle and colleagues
& Charles, 2009) reported that using food as a reward for child (2002). Studies regarding the relationship between feeding styles
behaviour was positively related to child Body Mass Index (BMI) in and specific dietary behaviours of parents (e.g., snacking, soft drink
the United States, but was inversely related to child BMI in France. consumption, fruit consumption and breakfast consumption) are
Mixed results regarding the impact of feeding styles on currently lacking.
children’s dietary behaviours and ultimately weight status were Whereas many studies measuring parental feeding styles have
also reported for parental use of controlling feeding styles. mainly focused on examining the association with children’s BMI
Following parental restriction, a child’s preferences for the (e.g., Carnell & Wardle, 2007; Haycraft & Blissett, 2008; Mon-
forbidden foods have been shown to increase (Fisher & Birch, tgomery et al., 2006; Wardle et al., 2002), the current study aimed
1999a, 1999b; Jansen, Mulkens, & A. Jansen, 2007; Liem, Mars, & De to assess a comprehensive set of dietary behaviours as more
Graaf, 2004), even in the absence of hunger. This may clarify the proximal predictors of children’s adiposity. The aim of the present
finding that parental restriction of highly palatable snack foods has study was 3-fold. First, we translated the PFSQ and evaluated its
been found to be related to higher levels of eating (e.g., Birch, factorial validity and psychometric characteristics in a Dutch
Fisher, & Davison, 2003; Faith, Scanlon, Birch, Francis, & Sherry, sample of 6- and 7-year olds. Second, we assessed associations of
2004; Fisher & Birch, 1999a, 1999b; Musher-Eizenman & Holub, parental feeding styles with eating behaviours of children aged 6 to
2006), and excessive weight gain among children (e.g., Faith, 7. Third, we examined associations of parental feeding styles with
Berkowitz, et al., 2004; Faith, Scanlon, et al., 2004). In contrast, actual parental dietary behaviours.
other studies found that controlling feeding styles were not linked
to children’s intake of energy-dense foods (e.g., Montgomery, Methods
Jackson, Kelly, & Reilly, 2006), children’s BMI (e.g., Brann & Skinner,
2005; Carnell & Wardle, 2007; Haycraft & Blissett, 2008; Procedures and participants
Montgomery et al., 2006) or body fatness (Spruijt-Metz, Lindquist,
Birch, Fisher, & Goran, 2002). Others reported that parental control Seven primary schools in the town of Maastricht and its
was inversely related to children’s intake of snack foods and soft surrounding area (the Netherlands) agreed to take part in this
drinks (Gubbels et al., 2009) or children’s adiposity (e.g., Robinson, study. In total, 334 questionnaire packages were distributed
Kiernan, Matheson, & Haydel, 2001). among parents of 6- and 7-year-old children at these schools. This
Studies examining parental prompting to eat in relation to package included the PFSQ and items assessing children’s and
children’s eating behaviour and weight status are relatively sparse parental snacking behaviour, soft drink consumption, fruit
and have reported contradictory findings. Small positive correla- consumption and breakfast consumption. We received 140
tions between the PFSQ scale of encouragement and children’s BMI completed questionnaires (41.9%). The response rate per school
of first-borns have been found, suggesting that parents of thinner ranged from 15.0 to 60.7%. Five children were excluded, because
children reported less prompting (Wardle et al., 2002). Drucker, the parents did not have Dutch nationality. Parents could decide
Hammer, Agras, and Bryson (1999) reported that more maternal which of the parents completed the questionnaire. Most often
prompting to eat has been related to increased intake of calories mothers completed the questionnaire (N = 122). Eleven fathers
among young children. In contrast, Vereecken and colleagues filled out the questionnaire and two families reported that both
(Vereecken, Legiest, De Bourdeaudhuij, & Maes, 2009) showed that parents completed the questionnaire together. The participating
parental encouragement through negotiation had a positive children consisted of two approximately equal-sized age groups:
impact on dietary habits among sixth graders, and increased the 6-year-old children (N = 71) and 7-year-old children (N = 62). Age
likelihood of vegetable consumption. In addition, maternal was not reported in two cases. Gender was evenly divided (67 girls
encouragement to promote the intake of a variety of foods and and 68 boys). In general, parents who completed a high level of
healthy foods was found to be related to lower child BMI (Musher- education were overrepresented (44.8 and 49.2% of, respectively,
Eizenman et al., 2009). However, others found no association mothers and fathers received a college or university degree).
between prompts to eat and children’s weight status (e.g., Carnell
& Wardle, 2007; Koivisto, Fellenius, & Sjödén, 1994). Parental Feeding Style Questionnaire
Regarding the fourth, and final, dimension of parental feeding
style, emotional feeding, only few studies have been conducted to The PFSQ was translated into Dutch by a team of four experts on
examine its impact on child dietary behaviour and weight status. eating behaviour at Maastricht University (the Netherlands) who are
Two studies found no relationship between the PFSQ dimension of Dutch native speakers and fluent speakers of the English language
emotional feeding and children’s BMI (Carnell & Wardle, 2007; (the authors ES and SK, and two colleagues of the Department of
Musher-Eizenman et al., 2009). At best, the relation between Health Promotion). Translations were cross-checked by this team
parental feeding styles and eating behaviour and overweight of and in case of inconsistencies between the translations, team
children is inconsistent. meetings were held to discuss the particular item; for some issues,
Studies examining parental feeding styles in relation to eating we contacted the developer of the instrument (Prof. Wardle). All
behaviours of parents are relatively sparse (Birch & Fisher, 2000; translators approved the final translation.