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. Author manuscript; available in PMC: 2024 Jul 1.
Published in final edited form as: Appetite. 2023 Apr 5;186:106551. doi: 10.1016/j.appet.2023.106551

Caregiver feeding decisions and sociodemographic characteristics are associated with snack food intake during infancy and toddlerhood

Amy M Moore a, Jennifer Orlet Fisher b, Brenda Burgess c, Katherine S Morris c, Christina M Croce b, Kai Ling Kong d,e,f
PMCID: PMC10213156  NIHMSID: NIHMS1894843  PMID: 37024055

Abstract

Snacking starts early in childhood, yet little is known about child versus family influences on snacking during infancy and toddlerhood. This secondary analysis of baseline data examined associations of child characteristics (e.g., appetitive traits, temperament), caregiver feeding decisions, and sociodemographic characteristics with the mean frequency of (times/day) and mean energy from (kcal/day) child snack food intake. Caregivers and their children (ages 9 to 15 months) were recruited in Buffalo, NY from 2017 to 2019. Caregivers reported on sociodemographics, child appetitive traits (Baby Eating Behaviour Questionnaire), and child temperament (Infant Behavior Questionnaire-Revised). Three 24-hour dietary recalls were collected, and USDA food categories were used to categorize snack foods (e.g., cookies, chips, and puffs). Hierarchical multiple linear regression models examined associations of child characteristics (Step 1: age, sex, baseline weight-for-length z-score, appetitive traits, and temperament), caregiver feeding decisions (Step 2: breastfeeding duration and age of solid food introduction), and caregiver sociodemographic characteristics (Step 3: caregiver age, prepregnancy BMI, education, and household size) with mean child snack food intake. Caregivers (n = 141) were on average 32.6 years of age, predominantly white (89.1%), and college-educated (84.2%). Age of solid food introduction (B = −0.21, p = 0.03), prepregnancy BMI (B = 0.03, p = 0.04), and household size (B = 0.23, p = 0.02) were significantly associated with the mean frequency of (times/day) snack food intake, over and above other variables of interest. Child age (B = 15.96, p = 0.002) was significantly associated with mean energy from (kcal/day) snack food intake. Household size (B = 28.51, p = 0.006) was significantly associated with mean energy from (kcal/day) snack food intake, over and above other variables of interest. There were no significant associations of other child characteristics with snack food intake. Findings show that child snack food intake is more closely associated with caregiver feeding decisions and sociodemographic characteristics than child characteristics.

Keywords: infants, toddlers, snack foods, appetitive traits, temperament

1. Introduction

The introduction of nutrient-dense solid foods during the complementary feeding period is important for optimal growth and development (American Academy of Pediatrics Committee on Nutrition, 2019; Young & Krebs, 2013). Infants and toddlers have little room for discretionary energy (i.e., energy over and above nutrient needs) from high energy-dense, nutrient-poor foods (Dewey et al., 2021). As such, current dietary guidelines recommend offering nutrient-dense foods and limiting energy-dense foods containing added sugars, higher sodium, and saturated fats (AAP, 2019; US Department of Agriculture, 2020; Vos et al., 2016). Although current dietary guidelines provide recommendations related to the timing and types of solid foods to offer during complementary feeding (AAP, 2019; Pérez-Escamilla, Segura-Pérez, & Lott, 2017; US Department of Agriculture, 2020; Vos et al., 2016), data from nationally representative samples suggest that energy-dense snack food intake (e.g., cookies, cakes, and chips) starts during infancy (Deming et al., 2017; Miles & Siega-Riz, 2017). This is concerning given that there is evidence that taste exposures during infancy are associated with later taste and food preferences (Blossfeld et al., 2007; Bouhlal, Issanchou, Chabanet, & Nicklaus, 2014) and these early preferences influence subsequent dietary patterns and health outcomes (Anzman-Frasca, Ventura, Ehrenberg, & Myers, 2018; Abraham, Godwin, Sherriff, & Armstrong, 2012; Birch, Arbor, Savage, & Ventura, 2009; Birch & Doub, 2014; Savage, Fisher, & Birch, 2007). Thus, it is critical to understand the potential drivers of snack food intake during early childhood.

Food preferences and subsequent dietary patterns are shaped by a complex interplay of biological, social, and environmental factors starting during early childhood (Birch et al., 2009; Ventura & Worobey, 2013). Two biologically driven child characteristics – appetitive traits and temperament – have received much attention in the literature. Appetitive traits, defined as biological predispositions towards food approach (e.g., responsiveness to food) and food avoidance (e.g., responsiveness to signals of fullness), are differentially associated with dietary intake and weight status during early childhood (Wood et al., 2020). For example, higher food responsiveness (i.e., eating in response to external stimuli when not hungry) and lower satiety responsiveness (i.e., the extent to which eating is avoided after satiation) have been associated with higher weight and rapid weight gain during infancy (Quah et al., 2015; Van Jaarsveld, Llewellyn, Johnson, & Wardle, 2011). In contrast, slowness in eating (i.e., taking a longer time to eat) has been associated with lower infant weight (Van Jaarsveld et al., 2011), and less sweet snack food intake at age 1 year (Sanjeevi, Lipsky, Siega-Riz, & Nansel, 2022). Child temperament, defined as biologically driven individual differences in behavior characterized by reactivity and self-regulation (Rothbart & Bates, 2007), has also emerged as an important influence on dietary intake and weight status during early childhood. Three broad dimensions of temperament have been described including regulation (characterized by the ability to self-regulate emotions and focus attention), surgency (characterized by high activity and approach to novel situations), and negative affectivity (characterized by easily distressed and low soothability) (Rothbart & Bates, 2007). Previous findings show that infants perceived by their caregivers as “fussy” are more likely to be introduced to solid foods before age 4 months (Wasser et al., 2011), and infants perceived as internalizing (e.g., fearful or anxious) and externalizing (e.g., becomes upset or cries easily) were more likely to be given sweet foods and beverages by their caregivers (Vollrath, Tonstad, Rothbart, & Hampson, 2011). This suggests that caregivers may offer foods and beverages in an attempt to soothe or calm their child’s distress, which may contribute to suboptimal dietary intake and higher infant weight (Bergmeier, Skouteris, Horwood, Hooley, & Richardson, 2014). Previous findings suggest that energy-dense snack food intake is associated with higher weight during infancy (Moore et al., 2019) and toddlerhood (Mennella et al., 2021). However, little is known about how these biologically driven characteristics influence snack food intake during early childhood. Understanding how these characteristics influence snack food intake has important implications for improving children’s diet quality and promoting healthy growth.

Young children rely on their caregiver’s food choices and feeding decisions to meet their nutritional needs (Anzman-Frasca et al., 2018; Birch et al., 2009; Birch & Doub, 2014; Savage et al., 2007). Previous findings related to caregiver feeding decisions show that early introduction of solid foods (before 4 months of age) is associated with shorter breastfeeding duration (Lessa et al., 2020) and higher intakes of both healthy (e.g., fruits and vegetables) and unhealthy (e.g., french fries, sweets, and baby snacks) foods (Vadiveloo, Tovar, Østbye, & Benjamin-Neelon, 2019) during early infancy. There is also evidence of associations between caregiver weight status and their child feeding decisions. For example, caregivers with overweight are less likely to breastfeed (Kitsantas & Pawloski, 2010) and more likely to offer energy-dense snack foods during toddlerhood (Hudson, Emmett, & Taylor, 2021) compared to caregivers with normal weight status. In addition, younger and multiparous caregivers are more likely to offer infants commercially prepared foods marketed for adults (e.g., fruit juice and biscuits/cookies; Betoko et al., 2013) and discretionary energy-dense nutrient-poor foods (e.g., sweet biscuits and cakes; Coxon et al., 2019) in French and Australian cohorts, respectively. Younger maternal age and lower education level is also associated with offering infants sweet beverages and snack foods once or more/day in the Netherlands (Wang et al., 2019). However, little is known about how caregiver feeding decisions and sociodemographic characteristics among US caregivers with young children, in addition to biologically driven child individual characteristics, are associated with snack food intake during early childhood.

Understanding the extent to which child versus family characteristics influence child snack food intake are important questions that would help inform interventions to promote healthy snacking behaviors during early childhood. Therefore, this study examined the extent to which child characteristics (e.g., weight, appetitive traits, temperament) versus caregiver feeding decisions (i.e., breastfeeding duration, age of solid food introduction) and sociodemographic characteristics (e.g., caregiver age, number in household) contribute to the mean frequency of (times/day) and mean energy from (kcal/day) child snack food intake. Given known associations between child individual characteristics and dietary intake, as well as caregiver feeding decisions and sociodemographic characteristics and dietary intake, we considered a range of characteristics and explored their associations with snack food intake during early childhood.

2. Method

2.1. Study Design and Participants

This study involved a cross-sectional, secondary analysis of baseline data from a longitudinal intervention designed to explore motivation to eat in children (NCT02936284) that included caregivers who self-identified as mothers with children from 9 to 15 months of age (n = 141). Recruitment occurred in Buffalo, NY from 2017 to 2019, and families were screened for eligibility using an online survey or over the phone. Caregivers were eligible if they were ≥ 18 years of age and had a singleton pregnancy. Caregivers were excluded if they had a high-risk pregnancy (e.g., gestational diabetes mellitus, pre-eclampsia), used tobacco, alcohol, and/or illicit drugs during pregnancy, or if their child was born preterm (< 37 weeks’ gestation), had a low birth weight (< 2500 g), or known medical condition (e.g., dietary restrictions, developmental delays). Eligible caregivers were enrolled and asked to provide written informed consent and parental permission for their children. The University at Buffalo’s Institutional Review Board approved the study.

2.2. Measures

Enrolled caregivers and their children were scheduled for a 1-hour baseline laboratory visit and completed online baseline questionnaires prior to their visit. At the baseline laboratory visit, caregivers were given an informational packet regarding child dietary data collection procedures such as estimating portion sizes.

2.2.1. Sociodemographic Characteristics

Caregivers self-reported their age (in years), sex (female/male), prepregnancy weight (in pounds), race (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White) and ethnicity (Hispanic/non-Hispanic), highest level of education (in years), household size (total number in household), and infant sex (female/male) and age (in months) at baseline.

2.2.2. Anthropometrics

Caregiver height (Proscale Stadiometer, Fletcher, NC) was collected in duplicate by trained researchers during the baseline laboratory visit. The mean of the height measurements and self-reported prepregnancy weight were used to calculate prepregnancy body mass index (BMI). Child recumbent length (Seca 416 Infantometer, Hanover, MD) and weight (Seca 374 Digital Baby Scale, Hanover, MD) were collected in duplicate by trained researchers during the baseline laboratory visit. The mean of the two measurements was used to calculate age- and sex-specific weight-for-length z-scores (WFLz) at baseline using World Health Organization reference standards (de Onis et al., 2004).

2.2.3. Child Appetitive Traits – Baby Eating Behaviour Questionnaire

The Baby Eating Behaviour Questionnaire (BEBQ) is a validated 18-item parent-report measure that assesses infant appetitive traits during the exclusive milk-feeding period (Llewellyn, van Jaarsveld, Johnson, Carnell, & Wardle, 2011). Given that the children in this sample were older than the recommended exclusive milk-feeding period (i.e., approximately 6 months of age; AAP, 2019; US Department of Agriculture, 2020) at baseline, caregivers retrospectively described their infant’s feeding behaviors during the exclusive milk-feeding period on a typical daytime feeding, using a 5-point scale from Never (1) to Always (5), with higher scores indicating greater expression of that appetitive trait. Subscales included in this analysis were food responsiveness (6 items, e.g., “My baby frequently wants more milk than I provide.”; α = 0.80) and slowness in eating (4 items, e.g., “My baby takes more than 30 minutes to finish feeding.”; α = 0.61), and a single item measuring general appetite (“My baby has a big appetite.”). In this study, other BEBQ subscales (enjoyment of food and satiety responsiveness) had α < 0.60 and were not included in the analysis.

2.2.4. Child Temperament – Infant Behavior Questionnaire-Revised

The Infant Behavior Questionnaire-Revised is a widely used 191-item validated parent-report measure that assesses infant temperament between ages 3 and 12 months (Gartstein & Rothbart, 2003). Three broad dimensions of infant temperament were included in this analysis: regulation (60 items, e.g., “When having to wait for food or liquids during the last week, how often did the baby seem not to be bothered?”; α = 0.90), surgency (72 items, e.g., “During feeding, how often did the baby wave arms?”; α = 0.87), and negative affect (59 items, e.g., “During feeding, how often did the baby fuss or cry when given a disliked food?”; α = 0.83). Mothers rated the frequency of specific infant behaviors during the past 2 weeks, using a 7-point scale from Never (1) to Always (7), with higher scores indicating higher levels of that temperament dimension.

2.2.5. Child Dietary Assessment

Breastfeeding duration (in months) and infant age (in months) at solid food introduction were assessed at baseline using an adapted version of the feeding questionnaire used in the Infant Feeding Practices Study II (Fein et al., 2008). Caregivers were contacted by phone on three separate occasions (2 weekdays and 1 weekend day) to obtain three 24-hour dietary recalls for their child. Trained researchers followed modified procedures from the Feeding Infants and Toddlers Study 2008 (Briefel et al., 2010). Caregivers were asked about foods and beverages provided by all caregivers including childcare providers. At the start of each call, researchers asked if the previous 24 hours were a typical eating day for the child. If not, the recall was rescheduled. Trained researchers collected child dietary recalls from caregivers (as proxies) using the USDA Automated Multiple-Pass Method, a computer-assisted dietary interview that includes standardized probes to collect dietary information on all foods and beverages consumed during the previous 24 hours (Raper, Perloff, Ingwersen, Steinfeldt, & Anand, 2004). Trained researchers entered dietary recalls into the Nutrition Data System for Research dietary analysis program (Nutrition Data System for Research, 2019). All children in this analysis had three days of dietary recalls and children who exceeded ±2 SDs of their estimated energy requirements (n = 3) were excluded (Institute of Medicine, 2011), leaving a final analytic sample of 141.

2.2.6. Child Snack Food Intake

The USDA’s What We Eat in America food group classifications ‘snacks and sweets’ (e.g., cakes, cookies, chips, and crackers) and ‘baby food: snacks and sweets’ (e.g., puffs, melts, and baby cookies) were used to categorize foods consumed by children as ‘snack foods’ (US Department of Agriculture, 2017). Two researchers with nutrition training (AMM and CMC) assigned foods consumed to the ‘snack food’ category and a third researcher with nutrition training (KSM) reviewed assignments for accuracy and to resolve discrepancies. Mean frequency of (times/day) and mean energy from (kcal/day) child snack food intake was calculated and used as outcome variables.

2.3. Statistical Analysis

Descriptive statistics for main variables are presented as means (standard deviations) for continuous variables and frequencies (percentages) for categorical variables. Descriptive statistics for snack food intake are reported separately for infants (9 to 11 months, n = 71) and toddlers (12 to 15 months, n = 70) since feeding recommendations (AAP, 2019; US Department of Agriculture, 2020) and energy requirements differ between the first and second years of life (Institute of Medicine, 2011). Bivariate correlation coefficients examined associations between main variables (see Supplement 1). Hierarchical multiple linear regression models examined associations of the mean frequency of (times/day) and mean energy from (kcal/day) child snack food intake in separate models. For each model (mean frequency and energy), Step 1 modeled child characteristics including age (in months), sex (female/male), baseline WFLz, appetitive traits (food responsiveness, slowness in eating, general appetite), and temperament (regulation, surgency, negative affect). Step 2 modeled caregiver feeding decisions including breastfeeding duration (in months) and age of solid food introduction (in months). Step 3 modeled sociodemographic characteristics including caregiver age (in years), pregnancy BMI, highest education level (in years), and household size (total number in household). Between each step, an F-test was performed comparing improvement in model fit (R2) to determine if there was a statistically significant improvement. Results are reported as beta coefficients, which can be negative (for every 1-unit increase in the independent variable, the dependent variable will decrease by the beta coefficient value) or positive (for every 1-unit increase in the independent variable, the dependent variable will increase by the beta coefficient value). Residual probability plots for regression models were examined to ensure residuals were normally distributed. Data were analyzed using SAS 9.4 (SAS Institute Inc., 2015) and P < 0.05 was considered significant.

3. Results

3.1. Sociodemographic Characteristics

Table 1 presents the baseline characteristics of caregivers and their children. Caregivers self-identified as female (100%) and were on average aged 32.6 (SD = 4.4) years, predominantly white (89.1%), and college-educated (84.2%). Children were on average aged 11.9 (SD = 1.9) months and over half were identified by their caregiver as female (55.3%), with birth WFLz (M = −0.79, SD = 1.5) and baseline WFLz (M = 0.57, SD = 0.86) within the normal range. Most children were breastfed for 6 months or more (68.1%) and were introduced to solid foods after 4 months (96.5%).

Table 1.

Demographics of 141 caregivers and their children.

Caregiver n mean ± SD or n (%)
Age (years) 141 32.6 ± 4.4
Sex (female) 141 141 (100)
Prepregnancy BMI (kg/m2) 140 28.3 ± 7.2
Race and ethnicity 137
 American Indian 2 (1.4)
 Asian 2 (1.4)
 Black 5 (3.7)
 White 122 (89.1)
 Multiracial 6 (4.4)
Education 139
 High school diploma or some college 22 (15.8)
 College graduate 117 (84.2)
Parity 1.6 ± 0.98
Household size 135 3.7 ± 0.95
Breastfeeding duration (months) 141 7.7 ± 4.6
Age solid food introduction (months) 141 5.3 ± 1.0
Child
Baseline age (months) 141 11.9 ± 1.9
Sex (female) 141 78 (55.3)
Birth WFLza 141 −0.79 ± 1.5
Baseline WFLza 141 0.57 ± 0.86
Appetitive traitsb 141
 Food responsiveness 2.3 ± 0.62
 Slowness in eating 2.5 ± 0.63
 General appetite 3.9 ± 0.81
Temperamentc 140
 Regulation 4.7 ± 0.54
 Surgency 5.1 ± 0.46
 Negative affect 3.1 ± 0.57
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a

Calculated using WHO reference standards (de Onis et al., 2004).

b

Baby Eating Behaviour Questionnaire scored Never (1) to Always (5) (Llewellyn, van Jaarsveld, Johnson, Carnell, & Wardle, 2011).

c

Infant Behavior Questionnaire-Revised scored Never (1) to Always (7) (Gartstein & Rothbart, 2003).

Note: BMI, body mass index; WFLz, weight-for-length z-score

3.2. Child Snack Food Intake

Most children (92.9%) consumed snack foods on any given day and the mean frequency of snack food intake was 1.3 times/day (SD = 1.0; range = 0 – 7). More specifically, infants (9 to 11 months) consumed snack foods 1.2 (SD = 0.92) times/day, and toddlers (12 to 15 months) consumed snack foods 1.4 (SD = 1.1) times/day. Mean energy from snack food intake for all children was 67 (SD = 88) kcal/day. More specifically, infants (9 to 11 months) consumed 47 (SD = 65) kcal/day and toddlers (12 to 15 months) consumed 88 (SD = 102) kcal/day.

3.3. Mean Frequency of Child Snack Food Intake

Table 2 presents the results for hierarchical multivariable linear regression models for associations between child characteristics, caregiver feeding decisions, and sociodemographic characteristics with the mean frequency of (times/day) child snack food intake. In Step 1, child characteristics were not significantly associated with the mean frequency of snack food intake. These characteristics accounted for 4.6% of the total variance in snack food intake. In Step 2, caregiver feeding decisions revealed that age of solid food introduction (B = −0.21, SE = 0.10, p = 0.03) was negatively and significantly associated with the mean frequency of snack food intake, over and above child characteristics. These characteristics account for 4.7% of the total variance in snack food intake. In Step 3, caregiver sociodemographic characteristics revealed that caregiver prepregnancy BMI (B = 0.03, SE = 0.01, p = 0.04) and household size (B = 0.23, SE = 0.10, p = 0.02) were positively and significantly associated with the mean frequency of snack food intake, over and above other variables of interest. These characteristics account for 7.6% of the total variance in snack food intake. Taken together the results indicate that for each unit increase in age of solid food introduction (in months), the mean frequency of snack food intake decreased 0.21 times/day. For each unit increase in caregiver BMI and household size (an increase of one person), the mean frequency of snack food intake increased by 0.03 times/day and 0.23 times/day, respectively.

Table 2.

Hierarchical multiple linear regression models for child characteristics, caregiver feeding decisions, and sociodemographic characteristics with the mean frequency (times/day) of child snack food intakea (n = 141).

Characteristic R2 ΔR2 B SE t P value
Step 1: Child
Age (months) 0.03 0.05 0.69 0.49
Sex 0.18 0.18 1.04 0.30
Baseline WFLzb 0.12 0.11 1.15 0.25
Food responsivenessc −0.27 0.16 −1.64 0.10
Slowness in eatingc 0.09 0.14 0.65 0.52
General appetitec 0.005 0.12 0.01 0.99
Regulationd −0.16 0.19 −0.83 0.41
Surgencyd 0.11 0.22 0.48 0.63
Negative affectd −0.08 0.16 −0.47 0.64
F (9, 130) = 0.70, p = 0.71 0.046 0.046
Step 2: Caregiver feeding decisions
Breastfeeding duration (months) −0.01 0.02 −0.64 0.52
Age solid food introduction (months) −0.21 0.10 −2.15 0.03
F (2, 128) = 3.34, p = 0.04 0.093 0.047
Step 3: Sociodemographic
Caregiver age (years) −0.03 0.02 −1.33 0.19
Prepregnancy BMI 0.03 0.01 2.03 0.04
Education (years) −0.03 0.05 −0.68 0.50
Household size 0.23 0.10 2.27 0.02
F (4, 118) = 2.62, p = 0.04 0.169 0.076
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a

USDA’s What We Eat in America food group classifications ‘snacks and sweets’ (e.g., chips, crackers, cakes, cookies) and ‘baby food: snacks and sweets’ were used to categorize foods consumed by children as ‘snack foods’ (US Department of Agriculture, 2017).

b

Calculated using WHO reference standards (de Onis et al., 2004).

c

Baby Eating Behaviour Questionnaire scored Never (1) to Always (5) (Llewellyn, van Jaarsveld, Johnson, Carnell, & Wardle, 2011).

d

Infant Behavior Questionnaire-Revised scored Never (1) to Always (7) (Gartstein & Rothbart, 2003).

Note: B, unstandardized beta coefficient; SE, standard error; WFLz, weight-for-length z-score; BMI, body mass index

3.4. Energy from Child Snack Food Intake

Table 3 presents the results for hierarchical multivariable linear regression models for associations between child characteristics, caregiver feeding decisions, and sociodemographic characteristics with mean energy from (kcal/day) child snack food intake. In Step 1, child age (B = 15.96, SE = 4.17, p = 0.002) was positively and significantly associated with mean energy from snack food intake. No other child characteristics were significantly associated with mean energy from snack food intake. These characteristics accounted for 12.6% of the total variance in snack food intake. In Step 2, caregiver feeding decisions revealed that age of solid food introduction (B = −16.47, SE = 8.01, p = 0.04) was negatively and significantly associated with mean energy from snack food intake, although not significantly over and above child characteristics. These characteristics account for 3.9% of the total variance in snack food intake. In Step 3, caregiver sociodemographic characteristics revealed that household size (B = 28.51, SE = 8.14, p = 0.0006) was positively and significantly associated with mean energy from snack food intake, over and above other variables of interest. These characteristics account for 12.0% of the total variance in snack food intake. Taken together the results indicate that for each unit increase in child age (in months), mean energy from snack food intake increased by 15.96 kcal/day and for each unit increase in household size (one person), mean energy from snack food intake increased 28.51 kcal/day.

Table 3.

Hierarchical multiple linear regression models for child characteristics, caregiver feeding decisions, and sociodemographic characteristics with mean energy from (kcal/day) child snack food intakea (n = 141).

Characteristic R2 ΔR2 B SE t P value
Step 1: Child
Age (months) 15.96 4.17 3.83 0.002
Sex 5.93 14.62 0.41 0.69
Baseline WFLzb 12.58 8.93 1.41 0.16
Food responsivenessc −15.46 13.34 −1.16 0.25
Slowness in eatingc −9.25 11.60 −0.80 0.43
General appetitec −8.04 10.00 −0.80 0.42
Regulationd −1.28 15.74 −0.08 0.94
Surgencyd −11.67 18.90 −0.62 0.54
Negative affectd 8.05 13.45 0.60 0.55
F (9, 130) = 2.09 p = 0.03 0.126 0.126
Step 2: Caregiver feeding decisions
Breastfeeding duration (months) −0.89 1.70 −0.52 0.60
Age solid food introduction (months) −16.47 8.01 −2.06 0.04
F (2, 128) = 2.93, p = 0.05 0.165 0.039
Step 3: Sociodemographics
Caregiver age (years) −2.55 1.89 −1.01 0.18
Prepregnancy BMI 1.10 1.08 1.02 0.31
Education (years) −6.10 −1.65 −1.65 0.10
Household size 28.51 8.14 3.50 0.0006
F (4, 118) = 4.67, p = 0.002 0.285 0.120
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a

USDA’s What We Eat in America food group classifications ‘snacks and sweets’ (e.g., chips, crackers, cakes, cookies) and ‘baby food: snacks and sweets’ were used to categorize foods consumed by children as ‘snack foods’(US Department of Agriculture, 2017).

b

Calculated using WHO reference standards (de Onis et al., 2004).

c

Baby Eating Behaviour Questionnaire scored Never (1) to Always (5) (Llewellyn, van Jaarsveld, Johnson, Carnell, & Wardle, 2011).

d

Infant Behavior Questionnaire-Revised scored Never (1) to Always (7) (Gartstein & Rothbart, 2003).

Note: B, unstandardized beta coefficient; SE, standard error; WFLz, weight-for-length z-score; BMI, body mass index

4. Discussion

This analysis described associations between child characteristics, caregiver feeding decisions, and caregiver sociodemographic characteristics with the mean frequency of and mean energy from snack food intake among young children 9 to 15 months of age. In this study, infants and toddlers consumed energy-dense snack foods more than once per day. Mean frequency of snack food intake was more closely associated with caregiver feeding decisions (i.e., age of solid food introduction) and sociodemographic characteristics (i.e., caregiver BMI and household size) versus child characteristics. Mean energy from snack food intake was more closely associated with child characteristics (i.e., age) and sociodemographic characteristics (i.e., household size) versus caregiver feeding decisions. Understanding what characteristics exert greater influence on snack food intake could be used to tailor interventions targeting healthy snacking behaviors during early childhood.

The current findings are consistent with existing literature showing that child feeding decisions and caregiver/household characteristics are associated with dietary intake during early childhood (Betoko et al., 2013; Vadiveloo et al., 2019). In line with nationally representative samples (Deming et al., 2017; Miles & Siega-Riz, 2017; Roess et al., 2018), in this sample of predominantly white, college-educated caregivers and their young children, most children (92.9%) consumed a snack food on a given day. Findings also show that later age of solid food introduction was associated with lower mean frequency of and energy from child snack food intake, whereas greater household size was associated with higher mean frequency of and energy from child snack food intake, above and beyond other variables of interest. Findings related to later age of solid food introduction may be partially explained by research suggesting that infants introduced to solids foods early versus infants who were not, had both higher healthy and unhealthy food scores (Vadiveloo et al., 2019), suggesting that these infants may have more eating occasions. In addition, it is also possible that caregivers who adhere to dietary guidelines for the timing of solid food introduction may also follow guidelines for the introduction of nutrient-dense foods and offer energy-dense snack foods less often. Findings related to greater household size may be partially explained by an increased need for convenient, ready-to-eat foods among large and/or busy families (Horning, Fulkerson, Friend, & Story, 2017). Given that young children rely on their caregiver’s food choices and feeding decisions to meet their nutritional needs, reinforcing existing guidelines related to the timing and types of foods introduced during complementary feeding may help improve snacking behaviors during early childhood.

Although research on children’s individual characteristics and snack food intake during early childhood is limited, previous research suggests that appetitive traits, such as slowness in eating, have been associated with lower sweet snack food intake (Sanjeevi et al., 2022), whereas anxious or fussy temperaments have been associated with greater sweet food and beverage intake (Vollrath et al., 2011). In contrast to our a priori hypotheses, children’s individual characteristics, including appetitive traits and temperament, were not significantly associated with and explained little variance (4.6%) in the mean frequency of snack food intake. Infant age was the only children’s individual characteristic significantly associated with the mean energy from snack food intake. However, this is an expected finding given that energy requirements vary between infancy and toddlerhood ((Institute of Medicine, 2011). Given previous research showing that caregivers often respond to their child’s characteristics such as “fussiness” with food, often in an attempt to soothe or calm, which may contribute to suboptimal dietary intake and higher weight during infancy (Bergmeier et al., 2014), it was surprising that other children’s individual characteristics such as appetitive traits and temperament were not significantly associated with snack food intake. It is possible that during infancy and toddlerhood, children’s individual characteristics are not strong enough to influence snack food intake, and other social and environmental such as caregiver feeding decisions and sociodemographic characteristics exert a stronger influence. It is important to note that the current findings are cross-sectional, and thus it is unknown how children’s individual characteristics influence snack food intake across time and how other unmeasured factors might influence snack food intake.

Although this study has many strengths, including the use of 24-hour dietary recalls to measure child dietary intake, it is not without limitations. This sample predominantly included white caregivers with higher socioeconomic status, which limits generalizability to other groups that are more at risk for suboptimal dietary intake and overweight. Future studies should examine child snack food intake in diverse groups and across time, and examine other factors known to impact dietary intake, such as food insecurity. Another limitation of this study is that caregivers were asked to retrospectively report their infant’s feeding behaviors during the exclusive milk feeding period, which may have introduced recall bias. This study used the WWEIA food group classifications, not caregiver reported eating occasion-based snacking (or eating between meals), to categorize snack foods. Thus, it is unknown whether caregivers consider these as snack foods, and whether there are other foods that caregivers consider snack foods (e.g., sweetened yogurt, ready-to-eat cereals) that were not included. In addition, focusing on the types of foods offered as snack foods does not account for behavioral aspects of eating occasion-based snacking reflective of eating in between meals. Caregivers may have also overestimated food and beverage intake for their young children (Fisher et al., 2008). Although taken together these factors explained a larger proportion of variance in child snack food intake, other unmeasured factors, such as caregiver eating behavior, feeding practices, and timing of returning to work after delivery, that may play a role in child snack food intake are unknown. However, given the role of caregiver feeding decisions (age of solid food introduction) and sociodemographic characteristics (household size), future studies should examine these factors to better understand snacking behaviors in early childhood.

4.1. Conclusion

The consumption of energy-dense snack foods is common during infancy and toddlerhood, making snack foods important targets for improving children’s diet quality. Findings provide evidence that the mean frequency of snack food intake is more closely associated with caregiver feeding decisions and sociodemographic characteristics than child characteristics and mean energy from snack food intake is more closely associated with child and sociodemographic characteristics than caregiver feeding decisions among infants and toddlers. Additional research is needed to understand the bidirectional and broader family influences on snacking behaviors during early childhood over time. Finally, this study also suggests that reinforcing existing guidelines for the introduction of nutrient-dense food during the complementary feeding period may also be needed to help caregivers select healthy snacks for their young children.

Supplementary Material

1

Acknowledgments:

All authors would like to thank the courageous mothers with young children who participated in this study and the talented researchers who were responsible for data collection and curation. This would not have been possible without each of you, thank you.

Funding/Financial Disclosures:

This work was supported by a grant from the National Institute on Child Health and Human Development of the NIH (grant number: R01 HD087082-01). The funding agency had no role in the study design, data collection, data analysis, interpretation, or writing of this manuscript.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Trial Registration: National Institute on Child Health and Human Development, Grant/Award Number R01HD087082–01.

Institutional Review Board Statement:

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of The University at Buffalo (protocol number: STUDY00000472).

Informed Consent Statement:

Informed consent was obtained from all subjects involved in the study.

Conflict of Interest Statement:

The authors declare no conflict of interest.

Ethics Statement

This study was approved by The University at Buffalo’s Institutional Review Board (IRB), IRB protocol STUDY00000472. All research was conducted in accordance with the approved submission and according to the guidelines of the Declaration of Helsinki.

Data Availability Statement:

Data is available upon request from KLK (kkong@cmh.edu).

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Associated Data

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Supplementary Materials

1
NIHMS1894843-supplement-1.docx (24.6KB, docx)

Data Availability Statement

Data is available upon request from KLK (kkong@cmh.edu).

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