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. Author manuscript; available in PMC: 2021 Jul 1.
Published in final edited form as: Food Qual Prefer. 2020 Feb 1;83:103898. doi: 10.1016/j.foodqual.2020.103898

A laboratory-based assessment of mother-child snack food selections and child snack food consumption: Associations with observed and maternal self-report of child feeding practices

Allison D Hepworth a,*, Kameron J Moding b, Cynthia A Stifter c
PMCID: PMC7263474  NIHMSID: NIHMS1579673  PMID: 32483400

Abstract

This study explored how mothers’ observed and self-reported child feeding practices (child control over food choices, encouragement of balance and variety, and teaching about nutrition) were associated with mother-child snack food selections and child snack food consumption in a laboratory setting. Mothers (N = 107) and their 4.5-year-old children (52% female) selected up to 5 snack foods (out of 9 snack foods: 6 higher-energy-density [ED] and 3 lower-ED) for optional child consumption throughout a one-hour laboratory visit. Mothers’ in-the-moment child feeding practices during the snack food selection task were coded using observational coding schemes, and mothers’ global child feeding practices (i.e., across meals and snacking occasions) were self-reported using the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub, 2007). Results of multiple linear regression analyses with covariates showed that higher-ED snack food selections were positively associated with observed child control over food choices (B = 0.35, SE = 0.12, p = .006) and self-reported teaching about nutrition (B = 0.49, SE = 0.19, p = .010), and negatively associated with self-reported encouragement of balance and variety (B = −0.66, SE = 0.24, p = .007). Lower-ED snack food selections were positively associated with self-reported encouragement of balance and variety (B = 0.53, SE = 0.20, p = .008). Child consumption of higher-ED or lower-ED snack foods were not significantly associated with mothers’ child feeding practices (observed or self-reported). We discuss the implications of these findings for future research on children’s snack food selection and consumption.

Keywords: Snacking, Snack foods, Child feeding practices, Food parenting, Food choice, Behavioral coding

1. Introduction

Accumulating evidence suggests that snacking behaviors are associated with total dietary energy intake (Deming et al., 2017; Shriver et al., 2018), overall dietary quality (Kachurak, Bailey, Davey, Dabritz, & Fisher, 2019), and obesity risk (Kachurak, Davey, Bailey, & Fisher, 2018) among preschool-aged children (aged 2–5 years) in the United States. Therefore, it is important to identify factors that are associated with preschoolers’ snacking behaviors, including their selection and consumption of snack foods. Snacking is broadly defined as consuming foods or beverages between meals, and items consumed between these occasions are labeled, “snack foods” (Blaine, Kachurak, Davison, Klabunde, & Fisher, 2017; Hess, Jonnalagadda, & Slavin, 2016). Although snack foods are sometimes defined by their nutritional value (e.g., low-nutrient, high-energy-density foods/beverages; Hess et al., 2016), our definition includes all foods/beverages in order to identify factors associated with variations in the energy density of preschoolers’ snack food selections and consumption.

Over the past four decades, the average number of snacking occasions among preschoolers’ in the United States has increased from one to three snacking occasions per day (Dunford & Popkin, 2018). Preschoolers currently consume over 25% of their average daily calories during snacking occasions (Shriver et al., 2018), primarily from high-energy-density foods, such as cookies, potato chips and sugar-sweetened beverages (Deming et al., 2017; Shriver et al., 2018; Welker, Jacquier, Catellier, Anater, & Story, 2018). Developmental research suggests that preschoolers naturally prefer foods that are high in fat and sugar, which tend to be higher in energy density, and dislike foods with strong bitter flavors, which tend to be lower in energy density, such as green vegetables (Anzman-Frasca, Ventura, Ehrenberg, & Myers, 2018; Birch, 1999). Problematically, consuming high-energy-density snack foods has been linked to lower overall dietary quality among preschoolers (Kachurak et al., 2019). Higher overall dietary energy density (i.e. across meals and snacking occasions) has in turn been associated with greater obesity risk among children aged 2–8 years (Vernarelli, Mitchell, Hartman, & Rolls, 2011), which highlights the importance of research to identify factors associated with the energy density of preschoolers’ snack food selections and consumption (Rolls & Leahy, 2010). Such research stands to inform strategies to improve preschoolers’ dietary quality and reduce their obesity risk, and is critical in light of evidence demonstrating poor dietary quality (Hamner & Moore, 2020) and recent increases in the prevalence of severe obesity (Skinner, Ravanbakht, Skelton, Perrin, & Armstrong, 2018) among preschoolers in the United States.

Mothers and other primary caregivers influence the development of preschoolers’ eating behavior through their child feeding practices (Savage, Fisher, & Birch, 2007; Scaglioni et al., 2018; Vaughn et al., 2016). In the context of snacking, child feeding practices (also known as food parenting practices) include parenting behaviors such as determining the level of child control over snack food choices, encouraging balance and variety in children’s snack food choices, and teaching children about nutritional proprieties of different snack foods (Davison et al., 2015; Gevers, Kremers, de Vries, & van Assema, 2014). Numerous studies have investigated mothers’ child feeding practices during meals, while relatively fewer have examined mothers’ child feeding practices during snacking occasions (see Blaine et al., 2017 for a review). This is an important gap in the literature because associations between child feeding practices and children’s eating behavior may differ in the context of snacking occasions compared to meals. Indeed, results of two qualitative studies suggest that mothers perceive snacking occasions as distinct from meals, and that parents vary both what and how they feed their children depending on the context (Fisher et al., 2015; Loth, Nogueira de Brito, Neumark-Sztainer, Fisher, & Berge, 2018). For example, parents reported giving preschoolers more control over what and when they ate during snacking occasions compared to during meals (Loth, Nogueira de Brito, et al., 2018). These findings highlight the need for additional research on associations between mothers’ child feeding practices and preschoolers’ snacking behavior.

Although there are numerous child feeding practices that warrant further investigation (see Davison et al., 2015; Vaughn et al., 2016) child control over food choices, encouragement of balance and variety, and teaching about nutrition are especially relevant to studies of preschoolers’ snacking behavior; these child feeding practices can be observed during snack food selections and have corresponding self-report measures of global child feeding practices. Assessing child feeding practices using both observational and self-report measures can allow for more nuanced insights into associations between mothers’ child feeding practices and preschoolers’ snacking behavior (Fries, van der Horst, Moding, Hughes, & Johnson, 2019; Pesch & Lumeng, 2017). For example, observational measures during snacking occasions can capture “in-the-moment” child feeding practices, while global self-report measures can capture parents’ perceptions of their child feeding practices across meals and snacking occasions. Importantly, associations between mothers’ child feeding practices and children’s eating behavior may differ by measurement approach due to the strengths and limitations that are unique to observational and self-report measures (Pesch & Lumeng, 2017). A number of studies conducted during meals have shown inconsistencies between observational and self-report measures of child feeding practices (e.g., Bergmeier, Skouteris, Haycraft, Haines, & Hooley, 2015; Farrow, Blissett, & Haycraft, 2011; Fries et al., 2019). The extent to which observational and self-report measures of mothers’ child feeding practices differentially predict preschoolers’ snacking behavior is currently unknown, which limits the development of nutrition education programming that aims to improve preschoolers’ dietary quality and reduce obesity risk through modifying mothers’ child feeding practices during snacking occasions.

A few studies have examined why parents offer snacks to children (e.g., Blaine et al., 2015; Damen, Luning, Fogliano, & Steenbekkers, 2019, 2020), while much remains to be explored regarding how parents affect preschoolers’ snacking behavior through their child feeding practices. A few studies have linked variations in parents’ self-reported child feeding practices to the energy density of children’s snack food preferences and consumption. Regarding high-energy-density (ED) snack foods, children’s liking (Boots, Tiggemann, & Corsini, 2019) and consumption (Boots, Tiggemann, & Corsini, 2018; Corsini, Kettler, Danthiir, & Wilson, 2018; Fisher & Birch, 1999) of high-ED snack foods have been linked to higher self-reported global coercive parental control over preschoolers’ eating behavior (e.g., restriction). However, similar associations with self-reported global restriction have not been found in some other studies (e.g., Bauer et al., 2017; Harris, Mallan, Nambiar, & Daniels, 2014). On the other end of the spectrum, parental self-reports of granting children higher control over their own eating behavior have been positively associated with preschoolers’ selection (Wellard et al., 2014) and consumption (Chaidez, McNiven, Vosti, & Kaiser, 2014) of high-ED foods, although these associations were not specific to snacking occasions. Lastly, parents of 4- to 12-year-olds who reported lower child consumption of high-ED snack foods also highly endorsed globally encouraging healthy food and teaching children about food (Gevers, Kremers, de Vries, & van Assema, 2015).

Few studies have examined how parents’ child feeding practices are associated with children’s selection and consumption of low-ED foods, both generally and specific to snacking (see Yee, Lwin, & Ho, 2017 for a review). There are two notable exceptions: In one study, parents of 3- to 7-year-olds reported lower child liking of fruits when they also reported higher global child control over food choices (Vollmer & Baietto, 2017). Another study found that parents of 2- to 5-year-olds reported higher child fruit and vegetable consumption when they reported higher global encouragement of balance and variety and teaching about nutrition (Shim, Kim, Lee, Kids, & Team, 2016). Additional research is needed to clarify associations between mothers’ child feeding practices and preschoolers’ selection and consumption of snack foods that vary in energy density.

In the current study, we pursued two related aims on associations between mothers’ child feeding practices and preschoolers’ snacking behavior. This study adds uniquely to the literature through our use of both observational and self-report measures of mothers’ child feeding practices (specifically, child control over food choices, encouragement of balance and variety, and teaching about nutrition). First, we explored the correspondence between mothers’ observed feeding practices in the context of a mother-child snack food selection task, and mothers’ self-report of global child feeding practices (i.e., across meals and snacking occasions). Next, we explored how mothers’ child feeding practices (observed and self-reported) were associated with mother-child selections, and child consumption, of higher-energy-density and lower-energy-density snack foods in a laboratory setting. Given the mixed and/or limited findings on these associations in the literature, all analyses were exploratory.

2. Method

2.1. Participants

Mother-child dyads were recruited through birth announcements and a local community hospital in central Pennsylvania to participate in a longitudinal study that began when children were 4–6 months of age. Mothers were told that the longitudinal study focused on children’s basic needs (e.g., eating, crying, sleeping, soothing) and children’s emotional and physical development. The inclusion criteria for participation in the longitudinal study were: Maternal age ≥18 years, full-term pregnancy (≥37 weeks) without complications (e.g., low birth weight), and plans to remain in the geographic area for at least two years. As part of their on-going participation in the longitudinal study, a subset of the sample participated in a follow-up study between 2014 and 2017 when the children were 4.5 years of age, including a laboratory visit and questionnaire measures. The analytic sample for the current study included only those participants with complete data for the laboratory visit and questionnaire measures collected at age 4.5 years (N = 107). Few dyads were excluded due to missing either the laboratory visit (n = 4), or questionnaire measures (n = 1), having only a male primary caregiver (n = 2), or child food allergies that could not be accommodated in the mother-child snack food selections task (n = 1).

2.2. Procedures and measures

Mother-child dyads came to the laboratory to complete a battery of behavioral tasks that assessed parenting behaviors and children’s cognitive and emotional development within two weeks of being 4.5 years of age. Anthropometric data (i.e., height and weight) were collected at the end of the laboratory visit. Mother-child dyads were continuously video-recorded throughout the laboratory visit, which lasted approximately 1.5 h. Mothers completed questionnaire measures within approximately one month of completing the laboratory visit. All study procedures were reviewed and approved by the university Institutional Review Board. Mothers provided written consent for their own and their child’s study participation.

2.2.1. Mother-child snack food selections

Mother-child snack food selections were assessed approximately 20-minutes into the laboratory visit using a standardized protocol: A research assistant entered the observation room to present a small, three-tiered shelf lined with nine snack food options (described below) and an empty tray to the mother and child. The research assistant told the dyad to select up to five snack foods for the child to have available throughout the remainder of the laboratory visit (approximately one hour). The research assistant exited the room while the mother and child selected snack foods and placed them on the tray. Dyads took a mean of 2.48 min (SD = 0.81) to make their selections. After the dyad made their selections, the research assistant re-entered the observation room, removed snack foods that were not selected, and placed the snack tray on a table within the child’s reach. The research assistant reminded the dyad that the selected snack foods would remain available throughout the remainder of the laboratory visit and began the next task.

The snack food options included in this task were consistent with common options in food retail settings in the United States (e.g., gas stations, convenience stores; Tester et al., 2011), and with qualitative definitions of snack foods provided by mothers of preschoolers, such as relatively small portions of food (Blake et al., 2015). The energy density values of the snack food options were calculated from the Nutrition Facts label information and categorized according to typical energy density standards (Rolls & Leahy, 2010, p. 545). The snack food options were unevenly divided by energy density category to reflect the current unbalanced food environment in the United States (Krebs-Smith, Reedy, & Bosire, 2010) and included 6 higher-energy-density snack foods (≥1.5 kcal/g) and 3 lower-ED snack foods (<1.5 kcal/g). The higher-ED snack foods were: chocolate candy (0.6 oz Milky Way, 4.40 kcal/g; or 0.6 oz Twix, 4.71 kcal/g); pastry (1.8 oz Little Debbie honeybun, 4.31 kcal/g); chocolate chip cookies (1.1 oz Chips Ahoy mini, 4.84 kcal/g; or 1.2 oz Famous Amos bite size; 5.00 kcal/g); Fruit Roll-up (0.5 oz Betty Crocker, flavor varied, 3.57 kcal/g); popcorn (1 oz SmartFood, white cheddar, 5.71 kcal/g); and potato chips (1 oz Lays, regular, 5.71 kcal/g; or 1 oz Utz, regular, 5.36 kcal/g). The lower-ED snack foods were: small, whole apple (Macintosh, 0.47 kcal/g); applesauce (4 oz Mott’s, original, 0.79 kcal/g); and baby carrots (2 oz, 0.44 kcal/g). Snack foods were presented in the same order on the shelf for each mother-child dyad. In rare cases, select snack foods were substituted (n = 5) with snack foods that were comparable in energy density to accommodate child food sensitivities or allergies.

Trained research assistants recorded which snack foods were selected for the snack tray in real time (i.e., live-coded) during the task. For descriptive purposes, we calculated the number of children who selected each snack food, and the total number of snack foods selected (any energy density). For our principal analyses, we calculated the total number of higher-ED and lower-ED snack foods selected.

2.2.2. Child snack food consumption

Trained research assistants coded video recordings of the laboratory visit to indicate which snack foods, if any, the child consumed. If the child consumed any amount of a snack food, ranging from a single bite to the full portion, the snack food was coded as consumed. Video recordings did not allow for more precise estimates of snack food consumption due to limited camera angles. For descriptive purposes, the proportion of snacking occasions initiated by the child (as compared to snacking occasions initiated by the mother) was calculated. For our principal analyses, we calculated the total number of higher-ED and lower-ED snack foods consumed.

2.2.3. Observed maternal child feeding practices

Trained research assistants coded mothers’ child feeding practices during the snack food selections task. Observational coding schemes for child control over food choices (i.e., “child control”), encouragement of balance and variety (i.e., “encourage balance”), and teaching about nutrition (i.e., “teach nutrition”) were developed based on corresponding parental self-report measures of the same child feeding practices (Musher-Eizenman & Holub, 2007). These child feeding practices were chosen because they could be observed during snack food selection, and few studies have observed these child feeding practices, particularly in the context of snacking (Blaine et al., 2017; Yee et al., 2017). Observed child control indicated the degree to which the mother allowed the child to control snack food selections. Coded values ranged from 0 to 4, with higher scores indicating greater child control over snack food selections. Observed encouragement of balance and variety indicated the degree to which the mother promoted varied and nutritious (according to the mother’s perception) snack food selections. Coded values ranged from 0 to 2, with higher scores indicating greater encouragement of balance and variety. Observed teaching about nutrition indicated the degree to which the mother used didactic (i.e., instructional, informational) techniques to encourage the selection of nutritious (according to the mothers’ perception) snack foods. Coded values ranged from 0 to 2, with higher scores indicating greater maternal teaching about nutrition. Research assistants trained on the coding schemes until they reached reliability, defined as a single measures intra-class correlation coefficient (ICC) of 0.85 or higher (Hallgren, 2012). Approximately 20% of video-recordings (n = 25) were double-coded for reliability during the final coding stage. Coders demonstrated strong reliability for all constructs (ICC ≥ 0.95). We used the coded values for each observed child feeding practice in our principal analyses.

2.2.4. Maternal self-reported child feeding practices

Mothers completed the Comprehensive Feeding Practices Questionnaire (CFPQ; Musher-Eizenman & Holub, 2007). The CFPQ is a validated self-report assessment of twelve global child feeding practices (i.e., across all meals and snacks). Relevant to the current study, the CFPQ was developed with parents of preschool-aged children (Musher-Eizenman & Holub, 2007), and has demonstrated associations with parent-reported food preferences among 3- to 7-year olds (Vollmer & Baietto, 2017). Three of the CFPQ scales corresponded to the observed child feeding practices measured during the snack food selections task and were included in the current study: child control over food choices (5-items, α = 0.66), encourage balance and variety (4-items, α = 0.69), and teaching about nutrition (3-items, α = 0.56). All items were assessed on a 5-point Likert scale, with higher scores indicating greater endorsement of the child feeding practice. We calculated the mean scores of the items corresponding to each self-reported child feeding practice for our principal analyses.

2.2.5. Study covariates

Since the time elapsed since a child last ate may be associated with snack food selections and consumption, it was tested as a potential study covariate. In addition, prior research suggests that associations between mothers’ child feeding practices and children’s eating behavior may be explained in part by maternal and child sociodemographic and weight status characteristics (Bergmeier et al., 2020; McPhie, Skouteris, Daniels, & Jansen, 2014; Patel, Karasouli, Shuttlewood, & Meyer, 2018). Therefore, we tested the following variables as covariates: maternal age, maternal education level, maternal BMI, household income, child sex, and child BMI-for-age z-score. Variables that had statistically significant (p < .05) bivariate associations with mothers’ child feeding practices (observed and/or self-reported), mother-child snack food selections, and/or children’s snack food consumption were retained in multiple linear regression analyses predicting mother-child snack food selections and children’s snack food consumption; this allowed us to estimate the amount of variance explained by mothers’ child feeding practices above and beyond maternal and child sociodemographic and weight status characteristics.

2.2.5.1. Time elapsed since the child last ate.

Mothers reported the time of their child’s last meal or snack prior to the laboratory visit. The number of minutes elapsed between the meal or snack and the start time of the laboratory visit was calculated. Values that exceeded the 95th percentile (n = 5) were Winsorized to (i.e., replaced with) the 95th percentile value. Two missing values were assigned the Winsorized mean, resulting in a sample mean of 111.78 min (SD = 62.86, min = 20.00, max = 267.00). The number of minutes elapsed since the child last ate (i.e., “child last ate”) was treated as a continuous variable in the analyses.

2.2.5.2. Maternal BMI.

Trained research assistants measured mothers’ height (measured at child age 6 months) and weight (measured at child age 4.5 years) using a standard stadiometer (Seca 213) and scale (Tanita UM-080). Maternal BMI was calculated from height and weight (kg/m2) and treated as a continuous variable in the analyses. Mothers who were pregnant (n = 5) were excluded from the analytic sample in all analyses including maternal BMI.

2.2.5.3. Child BMI-for-age z-score.

Trained research assistants measured child height and weight at child age 4.5 years using a standard stadiometer (Seca 213) and scale (Tanita UM-080). Child weight, height, sex, and age on the date of measurement were entered into the U.S. Centers for Disease Control and Prevention (CDC) SAS program (2016) to calculate child BMI-for-age z-scores (BMIz) according to the 2000 growth charts (Kuczmarski et al., 2002). Child BMIz was treated as a continuous variable in the analyses.

2.3. Analyses

As preliminary analyses, we calculated descriptive statistics (e.g., means, standard deviations (SD), frequencies) for participant sociodemographic and weight characteristics and all study variables. We also conducted Pearson correlations to explore bivariate associations among all potential covariates and study variables. For our principal analyses, we first conducted Pearson correlations to explore the correspondence between observed and self-reported measures of mothers’ child feeding practices. Next, we conducted multiple linear regression analyses to explore how mothers’ child feeding practices (observed and self-reported) were associated with mother-child selections, and child consumption, of higher-ED and lower-ED snack foods. There was no evidence of multicollinearity (all variance inflation factors ≤2) in the regression analyses. Analyses were conducted using SPSS version 24 (IBM Corporation, 2016). Results were considered statistically significant at p < .05.

3. Results

3.1. Preliminary analyses

Participant characteristics are presented in Table 1. The majority of mothers identified as non-Hispanic, White and were married. Children were evenly represented by sex and were primarily non-Hispanic, White. The prevalence of obesity among mothers (n = 30, 28%) and children (n = 11, 10%) was consistent with national averages in the United States (Flegal, Kruszon-Moran, Carroll, Fryar, & Ogden, 2016; Skinner et al., 2018).

Table 1.

Participant sociodemographic and weight status characteristics (N = 107).

n (%) M (SD)
Maternal characteristics
 Non-Hispanic, White 101 (94%)
 Married 95 (89%)
 Age, years 34.70 (4.64)
 Education
  Less than high school-level (<12 years) 0 (0%)
  High school-level (12 years) 19 (18%)
  Some college-level (≤13 < 16 years) 24 (22%)
  College-level (16 years) 21 (20%)
  Graduate-level (>16 years) 43 (40%)
 Annual household income
  $10,000–$39,999 16 (15%)
  $40,000–$59,999 25 (23%)
  $60,000–$79,999 19 (18%)
  $80,000–$99,999 18 (17%)
  $100,000 + 29 (27%)
 BMIa 28.88 (7.07)
  Underweight (BMI <18) 0 (0%)
  Normal weight (BMI < 18 < 25) 35 (33%)
  Overweight (BMI ≤ 25 <30) 37 (35%)
  Obese (BMI ≥ 30) 30 (28%)
Child characteristics
 Female 56 (52%)
 Non-Hispanic, White 96 (90%)
 First-born 31 (29%)
 Age, years 4.53 (0.09)
 BMI-for-age z-score 0.37 (1.06)
  Underweight (<5th percentile) 4 (4%)
  Normal weight (≤5th < 85th percentile) 76 (71%)
  Overweight (≤85th < 95th percentile) 16 (15%)
  Obese (≥95th percentile) 11 (10%)
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Note. BMI = Body mass index.

a

Maternal BMI calculations excluded pregnant mothers (n = 5).

Descriptive statistics on mother-child snack food selections and child snack food consumption are presented in Table 2. The majority of dyads (n = 85, 79%) selected the maximum of 5 snack foods (min = 1, max = 5). Chocolate chip cookies were the most commonly selected snack food (n = 73, 68%), followed by applesauce (n = 68, 64%), apple (n = 59, 55%), chocolate candy (n = 57, 53%), fruit roll-up (n = 57, 53%), popcorn (n = 52, 49%), carrots (n = 48, 45%), potato chips (n = 42, 39%), and honeybun (n = 37, 35%).

Table 2.

Descriptive statistics for mother-child snack food selections and child snack food consumption (N = 107).

Snack food Selected for snack tray Child consumed
M (SD) Selected n (%) M (SD) Consumed n (%)
All snack foods 4.61 (0.87) 1.25 (1.28)
Higher-ED snack foodsa 2.97 (0.99) 0.82 (0.91)
 Chocolate candy 57 (53%) 13 (12%)
 Chocolate chip cookies 73 (68%) 21 (20%)
 Fruit Roll-up 57 (53%) 25 (23%)
 Honeybun 37 (35%) 8 (8%)
 Popcorn 52 (49%) 14 (13%)
 Potato chips 42 (39%) 7 (7%)
Lower-ED snack foodsb 1.64 (0.79) 0.44 (0.63)
 Apple 59 (55%) 22 (21%)
 Applesauce 68 (64%) 18 (17%)
 Carrots 48 (45%) 7 (7%)
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Note. ED = energy density.

a

Higher-ED snack foods contained ≥1.5 kcal/g.

b

Lower-ED snack foods contained <1.5 kcal/g.

Approximately two-thirds of children (n = 67, 63%) consumed at least one snack food (any amount) during the one-hour observation period following snack food selections. The fruit roll-up was the most commonly consumed snack food (n = 25, 23%), followed by apple (n = 22, 21%), chocolate chip cookies (n = 21, 20%), applesauce (n = 18, 17%), popcorn (n = 14, 13%), chocolate candy (n = 13, 12%), honeybun (n = 8, 8%), carrots (n = 7, 7%), and potato chips (n = 7, 7%). Among children who consumed any snack foods, children initiated the vast majority of snacking occasions (Mproportion = 0.88, SD = 0.31, min = 0.00, max = 1.00); children were the sole initiators of snacking occasions in most dyads (82%).

3.1.1. Covariate associations

There were several small, statistically significant bivariate associations involving potential covariate variables (see Table 3). There were no statistically significant associations involving household income, child sex, or child BMI-for-age z-score (p > .05; data not shown). Therefore, we retained the time elapsed since the child last ate, maternal age, maternal education, and maternal BMI as covariates in the multiple regression analyses predicting mother-child snack food selections and children’s snack food consumption. In addition, these preliminary analyses revealed that the number of higher-ED and lower-ED density snack foods selected had small correlations with the number of these snacks foods that children consumed (see Table 3). Therefore, we also included the number of higher-ED and lower-ED snack foods selected as a covariate in the multiple linear regression analysis predicting children’s consumption of snacks foods corresponding in energy density.

Table 3.

Pearson correlation results for study variables (N = 107).

M (SD) 1 2 3 4 5 6 7 8 9 10 11 12 13
1. Child last ate (min) 111.78 (62.86)
2. Maternal age (years) 34.70 (4.64) 0.06
3. Maternal education (years) 15.33 (2.23) −0.17† 0.17†
4. Maternal BMIa 28.88 (7.07) 0.20* 0.09 −0.22*
5. OB: Child controlb 3.21 (0.89) 0.06 −0.21* −0.11 0.16
6. OB: Encourage balancec 0.86 (0.73) −0.17 0.18 −0.01 −0.20* −0.49***
7. OB: Teach nutritiond 0.98 (0.46) 0.07 0.05 0.15 −0.24* −0.25* 0.25*
8. SR: Child controle 2.53 (0.61) −0.05 0.17† −0.19 0.27** 0.02 −0.08 −0.02
9. SR: Encourage balance 4.21 (0.53) −0.12 0.09 0.27** −0.28** −0.19* 0.21* 0.12 −0.07
10. SR: Teach nutrition 3.84 (0.66) −0.11 0.16 0.22* −0.12 −0.24* 0.18† 0.24* −0.07 0.63**
11. Higher-ED selectedf 2.97 (0.99) −0.06 −0.13 −0.10 −0.01 0.32** −0.16† −0.19* 0.00 −0.21* −0.01
12. Higher-ED consumedg 0.82 (0.91) 0.03 0.11 0.01 −0.06 0.01 −0.08 −0.05 −0.10 0.07 0.22* 0.23*
13. Lower-ED selectedh 1.64 (0.79) 0.19* −0.01 0.02 0.07 −0.12 0.11 0.14 −0.15 0.18† 0.01 −0.54*** −0.20*
14. Lower-ED consumedi 0.44 (0.63) 0.10 0.03 −0.07 −0.04 −0.05 0.05 −0.04 −0.15 0.14 0.11 −0.10 0.35*** 0.30**
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Note. BMI = body mass index; ED = energy density; OB = observed; SR = self-reported.

a

Correlations with maternal BMI excluded pregnant mothers (n = 5).

b

Measured on a 0 to 4 scale.

c

Measured on a 0 to 2 scale.

d

Measured on a 0 to 2 scale.

e

All self-reported child feeding practices were measured on a 1 to 5 scale.

f

Total number of high-ED snack food selected.

g

Total number of higher-ED snack foods consumed.

h

Total number of lower-ED snack foods selected.

i

Total number of lower-ED snack foods consumed.

†

p < .10.

*

p < .05.

**

p < .01.

***

p < .001.

3.2. Principal analyses

Results of the Pearson correlation analyses testing associations between the observational and self-report assessments of mothers’ child feeding practices are presented in Table 3. Notably, observed child control over food choices was not correlated with self-reported child control (r = 0.02, p = .842). On the other hand, observed encouragement of balance and variety and observed teaching about nutrition had small, positive correlations with their corresponding self-report measures (r = 0.21, p = .030, and r = 0.24, p = .013, respectively).

Results of the multiple linear regression analyses for mother-child snack food selections and child snack food consumption are presented in Tables 4 and 5, respectively. Only the models predicting higher-ED snack food selections (R2 = 0.22, F = 2.56, p = .009) and lower-ED snack food selections (R2 = 0.19, F = 2.13, p = .030) were statistically significant. Regarding higher-ED snack food selections, mother-child dyads tended to select more higher-ED snack foods when mothers were observed to give children higher levels of control over food choices, and when mothers reported higher levels of teaching about nutrition. Specifically, each one-unit in increase observed child control (measured on a 0 to 4 scale) was associated with selecting 0.35 more higher-ED snack foods (SE = 0.12, p = .006). Each one-unit increase in self-reported teaching about nutrition (measured on a 1 to 5 scale) was associated with selecting 0.49 more higher-ED snack foods (SE = 0.19, p = .010). Dyads tended to select fewer higher-ED snack foods when mothers self-reported higher encouragement of balance and variety: Each one-unit increase in self-reported encouragement of balance and variety (measured on a 1 to 5 scale) was associated with selecting 0.66 fewer higher-ED snack foods (SE = 0.24, p = .007). Regarding lower-ED snack food selections, dyads tended to select more lower-ED snack foods when mothers self-reported higher encouragement of balance and variety. Specifically, each one unit increased in self-reported encouragement of balance and variety was associated with selecting 0.53 more lower-ED snack foods (SE = 0.20, p = .008).

Table 4.

Multiple linear regression results for mother-child snack food selections (n = 102).a

Variable Number of higher-ED snack foods selected Number of lower-ED snack foods selected
B SE β R2 F p B SE β R2 F p
0.22 2.56 0.009 0.19 2.13 0.030
Covariates
 Child last ate (min) 0.00 0.00 −0.03 0.754 0.00† 0.00 0.18 0.097
 Maternal age (years) −0.02 0.02 −0.08 0.411 0.00 0.02 0.00 0.975
 Maternal education (years) −0.02 0.05 −0.04 0.692 0.00 0.04 0.01 0.925
 Maternal BMI −0.02 0.02 −0.16 0.127 0.02* 0.01 0.22 0.048
Observed maternal child feeding practices
 Child control 0.35** 0.12 0.32 0.006 −0.11 0.10 −0.12 0.293
 Encourage balance 0.05 0.15 0.03 0.768 0.05 0.13 0.05 0.685
 Teach nutrition −0.39† 0.22 −0.18 0.082 0.25 0.18 0.15 0.176
Self-reported maternal child feeding practices
 Child control 0.08 0.17 0.05 0.645 −0.25† 0.14 −0.19 0.068
 Encourage balance −0.66** 0.24 −0.35 0.007 0.53** 0.20 0.35 0.008
 Teach nutrition 0.49* 0.19 0.33 0.010 −0.29† 0.15 −0.24 0.064
Open in a new tab

Note. ED = energy density; BMI = body mass index.

a

Analytic sample reduced due to missing BMI data for pregnant mothers (n = 5).

†

p < .10.

*

p < .05.

**

p < .01.

Table 5.

Multiple linear regression results for child snack food consumption (n = 102).a

Variable Number of higher-ED snack foods consumed Number of lower-ED snack foods consumed
B SE β R2 F p B SE β R2 F p
0.17† 1.72 0.082 0.15 1.45 0.165
Covariates
 Child last ate (minutes) 0.00 0.00 0.01 0.924 0.00 0.00 0.05 0.658
 Higher-ED selectedb 0.22* 0.10 0.24 0.030
 Lower-ED selectedc 0.24** 0.09 0.30 0.006
 Maternal age (years) 0.04† 0.02 0.19 0.070 0.01 0.02 0.05 0.656
 Maternal education (years) −0.03 0.04 −0.07 0.494 −0.04 0.03 −0.15 0.185
Maternal BMI −0.01 0.02 −0.07 0.513 −0.01 0.01 −0.08 0.470
 Observed maternal child feeding practices
 Child control −0.10 0.12 −0.10 0.430 0.00 0.08 0.00 0.973
 Encourage balance −0.21 0.15 −0.17 0.155 −0.01 0.10 −0.01 0.937
 Teach nutrition −0.13 0.22 −0.06 0.563 −0.16 0.15 −0.11 0.308
Self-reported maternal child feeding practices
 Child control −0.24 0.16 −0.16 0.137 −0.08 0.11 −0.08 0.468
 Encourage balance −0.10 0.24 −0.06 0.677 0.08 0.17 0.07 0.645
 Teach nutrition 0.35† 0.19 0.25 0.067 0.09 0.13 0.09 0.488
Open in a new tab

Note. ED = energy density; BMI = body mass index.

a

Analytic sample reduced due to missing BMI data for pregnant mothers (n = 5).

b

Total number of high-ED snack food selected.

c

Total number of lower-ED snack foods selected.

†

p < .10.

*

p < .05.

**

p < .01.

4. Discussion

Preschool-aged children the United States tend to consume high-energy-density foods during snacking occasions (Deming et al., 2017; Shriver et al., 2018; Welker et al., 2018). Given concerning evidence linking children’s consumption of high-energy-density foods to lower dietary quality (Kachurak et al., 2019) and higher childhood obesity risk (Vernarelli et al., 2011), it is critical to identify factors that reduce preschoolers’ selection and consumption of higher-energy-density foods, and promote their selection and consumption of lower-energy density foods during snacking occasions. Considering parents’ proximal influence on preschoolers’ eating behaviors (Savage et al., 2007; Scaglioni et al., 2018), the current study explored associations among mothers’ child feeding practices (observed and self-reported), mother-child snack food selections, and children’s snack food consumption in a laboratory setting.

For our first aim, we explored the correspondence between mothers’ child feeding practices observed during a mother-child snack food selection task in the laboratory, and mothers’ self-reported global child feeding practices (i.e., across meals and snacks). We found a small degree of positive correspondence in the observed and self-reported measures of encouragement of balance and variety and teaching about nutrition, and no correspondence in the observed and self-reported measures of child control over food choices. These results add to existing literature demonstrating inconsistencies between observational and self-report measures of child feeding practices during meals (Bergmeier et al., 2015; Farrow et al., 2011; Fries et al., 2019). To our knowledge, the current study is among the first to compare observational and self-report measures of encouragement of balance and variety and teaching about nutrition. Our results demonstrated that mothers were somewhat consistent in their use of encouragement of balance and variety and teaching about nutrition during snack food selections (observed) and globally across meals and snacking occasions (self-reported). These findings highlight the need for additional research on how parents develop these child feeding practices, as their consistent use (or non-use) across meals and snacking occasions may compound their effects on children’s dietary quality and obesity risk over time (Yee et al., 2017).

The null association between observed and self-reported child control over food choices is consistent with a prior study conducted with parents of 1-to-3-year olds, which found that observed and self-reported measures of allowing children to choose foods during meals had among the lowest consistency of the child feeding practices they assessed (Fries et al., 2019). There are a few possible explanations for the lack of an association between observed and self-reported measures of child control over food choices in the current study. This finding may reflect differences in the context of measurement: Mothers may exert different levels of control over snack food selection compared to globally across all meals and snacks, as suggested by a qualitative study of parents of preschool-aged children (Loth, Uy, Neumark-Sztainer, Fisher, & Berge, 2018). Alternatively, it may be that mothers underestimate the extent to which they grant their children control over food choices when asked in a questionnaire. However, this explanation is limited by the differences in the context of measurement. As a third explanation, it may be that in observed assessments, mothers are responding to their children’s desires in-the-moment, allowing children more control while also giving them information about their choices in a more covert effort to guide food selection (Stifter & Moding, 2019). Future studies should continue to explore reasons for agreement or disagreement between observed in-the-moment and global maternal self-report assessments of child control, including agreement between observed and self-report assessments that are both specific to snacking.

For our second aim, we explored how mothers’ child feeding practices (observed and self-reported) were associated with mother-child snack food selections and children’s snack food consumption. We found that mothers’ child feeding practices explained a small amount of variance of selections of both higher-energy-density and lower-energy-density foods, above and beyond covariates. However, mothers’ child feeding practices did not explain a statistically significant amount of variance in children’s consumption of higher-energy-density or lower-energy-density foods during the one-hour observation period following snack food selections. The relatively small amount of variance explained by our multiple linear regression models is consistent with nutrition research examining complex health outcomes, such as child feeding practices, and suggest that unmeasured factors affected snack food selection and consumption (Pounis, 2019).

With regard to snack food selections, mother-child dyads selected more higher-energy-density snack foods when mothers were observed to give children greater control over the snack food choices. This finding is consistent with a previous study of parents of 3- to 12-year-olds, which found that the mean energy content of a hypothetically selected fast food meal was higher when parents self-reported greater child control over food choices (Wellard et al., 2014). The positive association between observed child control over food choices and higher-energy-density snack food selection may be explained by children’s natural preferences for foods that are higher in energy density (Anzman-Frasca et al., 2018; Birch, 1999). Recent evidence for this preference has come from a hypothetical food choice study in which children aged 3 to 14 years rated higher-energy-density foods as more preferred than lower-energy-density foods (Potter, Griggs, Ferriday, Rogers, & Brunstrom, 2017). Mothers’ self-reported global child control over food choices, however, was not associated with the energy density of mother-child snack food selections. This inconsistency suggests that children’s in-the-moment control over food choices was more salient to snack food selections than the amount of control children generally have over their food selections across meals and snacks. This may be explained by differences in the level of child control mothers’ grant children during snacking occasions versus their more global practices across meals and snacks, as suggested by the null bivariate association we found between these two measures. Alternatively, this finding may reflect differences in the timescale of measurement; observed child control and mother-child snack food selections were assessed simultaneously, whereas mothers self-reported global child control was assessed within one-month of the laboratory visit.

Mother’s self-reported encouragement of balance and variety had favorable associations with the energy density of dyads’ snack food selections. These findings are among the first to show an association between mother’s encouragement of balance and variety and mother-child snack food selections of lower-energy-density snack foods, and complement existing research demonstrating similar associations between higher global encouragement and balance and variety and children’s lower consumption of higher-energy-density snacks foods (Gevers et al., 2015), and children’s higher consumption of fruits and vegetables (Shim et al., 2016). The null associations between observed encouragement of balance and variety and snack food selections may suggest that mothers’ global use of this practice was more salient to dyads’ snack food selections than their in-the-moment use of this practice. The favorable associations between mothers’ self-reported global encouragement of balance and variety, and the energy density of dyads’ snack food selections may be explained by social influences on children’s eating behavior over time, as parental encouragement can influence children’s food choices despite children’s preferences for high-energy-density foods (see Scaglioni et al., 2018 for a review).

In contrast, when mothers self-reported higher teaching about nutrition, dyads tended to select more higher-energy-density snack foods. Again, this finding is among the first to show an association between mothers’ teaching about nutrition and mother-child snack food selections of high-energy-density snack foods, and in some respects complements existing research demonstrating positive associations between restrictive child feeding and children’s consumption of high-energy-density snack foods (Boots et al., 2018; Corsini et al., 2018; Fisher & Birch, 1999). However, observed teaching about nutrition had an opposite, marginally significant negative association with higher-energy-density snack food selections. Associations between teaching about nutrition and snack food selections may depend on how mothers contextualize their nutrition education messages to children. For example, mothers may teach children about food in the context of weight loss, which has been associated with negative child eating behavior outcomes such as early dieting (Balantekin, Savage, Marini, & Birch, 2014). Or, mothers may teach children about foods in the context of supporting healthy growth and active play, which has been linked to positive effects on children’s eating behavior such as increasing children’s liking and intake of lentils (a lower-energy-density food; Ramsay, Roe, Davis, Price, & Johnson, 2017). Additional research on how mothers frame their nutrition education messages to children would help clarify associations between teaching about nutrition and children’s snacking behavior.

Regarding children’s snack food consumption, we found that the child feeding practices we assessed in this study using both observed and self-reported measures explained little variance in children’s consumption of higher- or lower-energy-density snack foods. These findings are in contrast to prior studies that have linked parent self-report measures of child control, encouragement of balance and variety, and teaching about nutrition to parent-reported child consumption of higher-energy-density and lower-energy-density foods (Chaidez et al., 2014; Gevers et al., 2015; Shim et al., 2016). Our conflicting findings may be explained by differences in assessment approaches for child feeding practices and/or children’s snack food consumption, and by differences in sample characteristics across studies. Interestingly, children’s consumption of higher- and lower-energy density snack foods had a medium bivariate association in the current study, which suggests that children who consumed snack foods were more interested in snacking generally than considering the energy density of the snack foods. Additionally, although children’s hunger levels were not measured in the current study, the amount of time elapsed since the child’s last meal or snack was not associated with child snack food consumption. This finding provides additional evidence that most preschoolers will consume at least some amount of snack foods when they are available, which is consistent with existing research showing high rates of eating in the absence of hunger among preschool-aged children (Corsini et al., 2018; Harris et al., 2014). Taken together, these findings support recent calls for additional research on associations between children’s appetitive traits and snacking behavior (see Kral et al., 2018; Porter et al., 2018), particularly given that child sex and BMI were also not associated with snack food selections or consumption in the current study.

4.1. Strengths, Limitations, and Future directions

This study has several strengths and a few notable limitations. A primary strength is our use of observational measures to assess mothers’ child feeding practices, mother-child snack food selections, and children’s snack food consumption. Observational measures overcome some limitations of self-reported measures of child feeding practices and eating behavior (e.g., social desirability and recall bias), and allowed us to compare participants under the same conditions (e.g., standardized snack food options and duration of time for consumption), which strengthens the validity of our results (Bruemmer et al., 2009; Pesch & Lumeng, 2017). At the same time, our findings are limited to behaviors that occurred in a laboratory setting, which may not generalize to behaviors in more typical contexts, such as homes or food retail locations. For example, mothers and children may have behaved atypically due to being video recorded and/or having few other competing demands for their attention during the snack food selection task. Further, we focused on child feeding practices that could be observed during the snack food selection task and had corresponding self-report measures on the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub, 2007). Additional insight could be gained in studies investigating a broader range of child feeding practices (e.g., child involvement in food preparation, maternal role modeling) in the context of snacking.

There are other unmeasured factors that may have impacted the total number of higher-energy-density and lower-energy-density snack foods selected and/or consumed in this study. We did not assess children’s liking of the snack food options, children’s perceptions of the taste or sensory properties of the snack food options, or children’s hunger levels, although we did assess the time elapsed since the child had last eaten. The snack food options were unevenly divided by energy density category to reflect the current food environment (Krebs-Smith et al., 2010) such that more higher-energy-density snack foods were available for selection than lower-energy-density snack foods; this unequal division may have increased the number of higher-ED snack foods that mother-child dyads selected by chance alone, and prevented us from comparing mother-child snack food selections and children’s consumption between energy density categories. The precise amount of each snack food consumed was not measured and could not be assessed retrospectively from video recording due to limited camera angles, which prohibited more detailed analyses of child snack food consumption such as caloric or macronutrient intake. Despite this limitation, our observational assessment overcomes some of the limitations associated with parent-reported food frequency questionnaires (e.g., recall bias), which are among the most common assessments in the existing literature on children’s snacking behavior (Blaine et al., 2017). Lastly, mothers were the only primary caregivers represented in this sample, and most participants identified as non-Hispanic, White. Additional research is needed to test the generalizability of these findings in samples that are more diverse in sociodemographic characteristics.

5. Conclusions

Snacking occasions are an area of opportunity to reduce children’s dietary energy density, which may in turn improve overall dietary quality and decrease childhood obesity risk (Dunford & Popkin, 2018). The results of this exploratory, laboratory-based study revealed that mothers’ child feeding practices were associated with mother-child selections of higher-energy-density and lower-energy-density snack foods, but not children’s consumption of these snack foods. Associations with snack food selections varied depending on whether mothers’ child feeding practices were assessed using an observational measure administered while dyads selected the snack foods, or using a self-report measure of mothers’ global child feeding practices (i.e., across all meals and snacks). Further, mothers’ child feeding practices (both observed and self-reported) explained a relatively small amount of variance in the selection of higher-energy-density and lower-energy-density snack food selections, suggesting that other factors influence snack food choices. Future studies should continue to explore how parents’ child feeding practices and other factors (e.g., child appetitive traits) influence preschool-aged children’s snacking behavior.

Acknowledgements

Funding: This work was supported by a grant from the NIDDK: National Institute of Diabetes and Digestive and Kidney Diseases (DK081512) awarded to the third author. The funding source had no role in the design, analyses, or presentation of this research. Declaration of interest: None. The authors thank the families for their time and participation in this research study.

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