Purpose: The purpose of this research is to systematically adapt and pilot an observational measure, called the Mealtime Emotional Climate in Child Care Observational Scales (MECCOS), to assess MEC in family childcare homes (FCCHs). MEC—defined as the quality of emotional interactions between the child and caregiver—has a relationship with children’s diet in family homes, but there is no validated tool to measure MEC in childcare settings.

Methods: This cross-sectional study utilized data from 55 video-recorded lunchtime observations of Nebraska FCCH providers. To create MECCOS, FCCH mealtime videos were first coded using the Iowa Family Interaction Rating Scales (IFIRS). The IFIRS was chosen because it has been widely utilized with children aged 3-5 years and has been previously adapted to measure MEC in the home with clear definitions of constructs and a detailed codebook. After coding each video individually with the adapted tool, the team met to discuss and adapt the MECCOS tool based on the video coding. After the iterative process, adaptations were made to the IFIRS tool in 4 themes: purpose and definitions of the scales, relevance for use in an FCCH setting including examples of interactions during mealtimes between the provider and children, refining the scoring scheme, and including additional items from previously validated measures. The final measure included 21 items. To understand the underlying structure for the items in the adapted MECCOS tool, an exploratory factor analysis with an oblimin rotation was conducted using SPSS v.29

Results/findings: EFA analyses indicated that two factors accounted for 56.4% of the total variance in responses to the MECCOS. Factor 1 appeared to capture ‘Positive Mealtime Emotional Climate’ and emerged with five items (i.e. relationship quality, communication, positive emotion expression, positive reinforcement, explanations/reasoning) and loadings ranging from .5 to .9. Factor 2 appeared to capture ‘Negative/Hostile Emotional Climate’ and included three items (i.e. hostile, negative emotion expression, intrusive/controlling) with factor loadings ranging from .3 to .7.

Conclusion: This study advances the field by adapting a measure to assess MEC in childcare settings for fostering a pleasant mealtime environment that is beneficial for children’s development and healthy eating behavior.

Purpose: The Satter Division of Responsibility in Feeding (sDOR) model is an approach to establish trusting feeding relationships for enjoyable mealtimes with young children. Adherence to sDOR has not been studied in relation to children’s dietary intake. The study purpose was to evaluate the association between caregiver sDOR adherence and children’s dietary intake.
Methods: A cross-sectional asymmetric survey with measured child weights/heights was used. Caregivers and children ages 3 to < 6 years were recruited from early childhood education centers. A survey was completed by 91 dyads from August–November 2019;. The association between sDOR adherence (sDOR.2-6y™) and dietary intake (Block Kids Food Screener) was tested by Spearman rho correlation coefficient.
Results/findings: Children’s energy intake (n=86) was 916.0 ± 46.5 kcals (mean ± standard deviation (SD)). Food group consumption in cup equivalents was: Fruit/Fruit Juice: 1.4 ± 0.7, Vegetables (no potatoes/legumes): 0.5 ± 0.3, Potatoes (including French fries): 0.1 ± 0.1, Dairy: 1.7 ± 0.8; and ounce equivalents of Whole Grains 0.4 ± 0.3, and Meat, Poultry, Fish: 1.5 ± 0.8. Complete sDOR and dietary data was provided by n=65 caregivers. Greater sDOR adherence to child autonomy was associated with lower intake of potatoes and French fries among children (overall child autonomy domain rho= -0.28; n=65; P=0.03), but no significant correlations were found among other dietary components.
Conclusions: sDOR.2-6y™ is a tool to measure caregiver feeding practices rather than the foods or nutrient quality of meals, yet sDOR adherence was inversely correlated with children’s consumption of potatoes and French fries. Given this association, continued investigation of dietary intake with more robust methods of dietary quality and a larger sample is warranted.

Purpose: Early life food exposures may influence food preferences and receptivity, thereby impacting long-term diet quality. Infant exposure to discretionary foods may be more detrimental for infants with high food approach traits; conversely, early exposure to fruits and vegetables may be more important for those with high food avoidance traits. This study investigated associations of infant food exposures with early childhood diet quality and whether these associations are modified by infant appetitive traits.
Methods: Data are from the Pregnancy Eating Attributes Study (PEAS) and Sprouts follow-up study, a prospective cohort assessed from the first trimester of pregnancy through early childhood. Birthing parents completed the Baby Eating Behavior Questionnaire assessing food-approach and food-avoidance appetitive traits at 6 months and food frequency questionnaires assessing infant age at introduction to and frequency of consuming food groups at ages 6, 12, and 24 months. At child ages 3.5 and 5 years, parents provided three 24-hour dietary recalls, from which the Healthy Eating Index-2020, a measure of conformance to U.S. dietary guidelines, was calculated. Structural equation models examined associations of age at introduction to, and intake frequency of, fruit/vegetables and discretionary foods, and their interactions with food-approach and food-avoidant appetitive traits, on child diet quality at age 3.5 & 5 years, controlling for income, education, and breastfeeding duration.
Results: Higher childhood diet quality was associated with later infant age at introduction to discretionary foods (β=0.26±0.07, p<0.001), lower intake of discretionary foods at ages 12 (β=-0.24±0.09, p=0.006) and 24 (β=-0.47±0.14, p<0.001) months, and greater intake of fruits and vegetables at age 24 months (β=0.46±0.11, p<0.001). Childhood diet quality was not associated with infant age at introduction to fruits and vegetables or their intake at age 12 months. Infant appetitive traits were not associated with childhood diet quality and did not modify associations of infant food exposures with childhood diet quality.
Conclusions: Exposure to discretionary food in the first two years of life was consistently associated with lower diet quality in early childhood regardless of the strength of appetitive traits. Findings suggest the public health importance of efforts to reduce infant intake of discretionary foods.

Purpose: Dietary intake during infancy shapes later food preferences and is important for short- and long-term health and wellbeing. Although caregivers are thought to influence the developing food preferences of infants, children less than two years old have been notably absent in existing meta-analyses on the topic. We conducted a scoping review to fill this gap by using a systematic process to identify and summarize the published literature on the resemblance of caregiver and infant diet during the period of complementary feeding (ages 6-23 months).
Methods: Articles were included if they assessed intake of foods or beverages other than human milk or commercial milk formula and reported a test of association between the intake of caregivers and infants. Four electronic databases (PubMed, EMBASE, Scopus, and Global Health) were systematically searched for articles published since 2000. Thirty-three articles, representing 32 studies, were identified.
Results: Most studies examined infant intake of food groups or items (n=20), seven studies examined infant dietary patterns, and six studies examined dietary diversity. Studies predominantly reported associations between diets of mothers and infants (n=31); three studies reported associations for fathers. Most studies assessed infant diet at one timepoint (n=26), with 12 studies combining the intakes of younger (0-11 months) and older infants (12-23 months). Food groups examined, in order of frequency, included ‘non-core’ foods and beverages (n=14), vegetables (n=13), fruits (n=12), protein foods (n=6), grains (n=5), and dairy (n=4). Definitions of variables for food groups and dietary patterns were highly heterogeneous, but consistent for dietary diversity. Nearly all studies (n=31) reported significant associations between dietary intakes of caregivers and infants.
Conclusions: Across the various aspects of diet examined, studies consistently reported significant associations between the dietary intakes of caregivers and their infants, suggesting caregiver diet may be a promising focus for interventions aiming to shape the food preferences and dietary intakes of infants. Future studies should include assessments of other caregivers who may be responsible for feeding, such as fathers and grandmothers.

Purpose: This pre-registered systematic review synthesizes qualitative studies examining infant feeding attitudes and beliefs among mothers who immigrated to the United States. It aims to consolidate existing knowledge and enhance culturally competent care among healthcare providers engaging with immigrant mothers about infant feeding.
Methods: Utilizing the SPIDER framework, inclusion and exclusion criteria were established. Eligible studies: (1) focused on mothers who immigrated to the United States; (2) provided a comprehensive review of infant feeding attitudes and beliefs; and (3) were qualitative in nature. Searches were conducted across PubMed, Web of Science, SCOPUS, and PsycInfo, restricting date (2000 to present) and language (English). A narrative synthesis followed.
Findings: Out of 153 identified outputs, 93 titles and abstracts, and 39 full-texts were screened. Ultimately, twelve studies met inclusion criteria. The studies involved immigrant mothers from diverse origins (Marshall Islands, Vietnam, the Dominican Republic, the Democratic Republic of Congo, Burundi, China, Mexico, El Salvador, Bangladesh, Korea, Brazil, Cambodia, and Somalia) and revealed factors influencing infant feeding attitudes and beliefs across the social ecological model. Nine themes emerged including: (1) truly individual attitudes and beliefs; (2) familial influence on mother's infant feeding attitudes and beliefs (e.g., a Hispanic mother shared “my mother told me [breastfeeding] was healthier"); (3) relationship with child's effect on maternal feeding attitudes and beliefs; (4) struggle between family and healthcare provider advice; (5) healthcare system and provider influence on infant feeding attitudes and beliefs; (6) home country culture (with subthemes: breast is best, first foods, and postpartum practices); (7) cultural disconnects (e.g., Marshallese mothers shared “in the Islands you can [breastfeed] freely. But here you got to cover your breasts with blankets"); (8) necessity of employment in the United States; and (9) WIC's influence on infant feeding attitudes and beliefs.
Conclusions: This review emphasizes the multifaceted impact of intrapersonal factors, interpersonal processes, organizational processes, community factors, and public policy on immigrant mothers’ attitudes and beliefs towards infant feeding. Healthcare providers must navigate and respect these influences to provide culturally sensitive care. The findings emphasize the need for tailored approaches in healthcare practices concerning infant feeding among immigrant mothers.

Purpose: The first two years of life are an important period in which to begin infant feeding practices that will promote healthy growth and development. Dietary intake during early infancy influences lifelong flavor preferences and dietary behaviors that can impact long-term health.

Methods: Mothers & Others was a family-based, multi-component randomized controlled obesity prevention intervention with a goal of introducing appropriate and timely complementary foods during infancy. We aimed to determine the efficacy of this intervention to impact diet quality in the obesity prevention group versus the infant safety attention control group. We used a two-part binary choice model that included the type and amount of fruits, vegetables, juice, french fries, sweet drinks, sweet foods, and salty foods consumed at infant ages 6, 9, 12, and 15 months. The model first estimated the probability of any consumption using logistic regression, followed by a regression model conditional on consumption. We used logistic regression to assess the treatment effects on introduction of complementary foods before 4 months.

Results: At 9 months, among consumers, infants in the obesity prevention group consumed sweet foods 0.59 times more per day (p=.05) compared to those in the attention control group. At 12 months, infants in the obesity prevention group were more likely to consume french fries [OR 1.94 (1.07, 3.50), p=.03], sweet foods [OR 1.95 (1.06, 3.61), p=.03], sugar sweetened beverages [OR 2.15 (1.05, 4.37), p=.04], and salty snacks [OR 2.26 (1.18, 4.34), p=.01] compared to infants in the attention control group.

Conclusion: Our results suggest parents need increased behavioral support, beyond knowledge acquisition, to minimize introduction of foods high in added sugars, fat, and sodium. Future interventions may benefit from providing guidance earlier, beginning during pregnancy; including an increased dose and array of behavior change strategies (frequent goal setting, weekly tailored feedback) adapted to the period of complementary feeding; and targeting other household or environmental influences during this critical period of dietary behavior development.