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. Author manuscript; available in PMC: 2022 Nov 1.
Published in final edited form as: Appetite. 2021 Jun 22;166:105480. doi: 10.1016/j.appet.2021.105480

Observed Behavioral Indicators of Child Satiation at Mealtime: Associations with Child Characteristics and Parent-Reported Child Eating Behaviors

Cin Cin Tan a, Hurley O Riley b, Julie Sturza c, Julie C Lumeng c,d, Alison L Miller b
PMCID: PMC8355155  NIHMSID: NIHMS1721052  PMID: 34171410

Abstract

The notion of promoting parents’ recognition of child satiation to reduce overfeeding and overeating in children is prevalent. To do so, it is important to identify common behaviors that may indicate satiation and can be easily recognized by parents. Relatively little work has focused on identifying behaviors that may indicate child satiation as they occur during naturalistic mealtimes, which is an important context for parents to observe their children’s eating behavior. Hence, the goal of the current study is to examine whether observed behavioral indicators of child satiation at mealtimes are associated with child characteristics (i.e., sex, age, and BMIz) and parent-reported child appetitive traits. We coded observed behaviors thought to indicate satiation, specifically mealtime disengagement and mealtime negativity, in a cohort of 240 families with children between 4- and 8-years old (53% boys). First, we documented the occurrence of child disengagement and negativity during naturalistic mealtimes. Second, we found that lower child BMIz and being a boy were associated with greater mealtime disengagement, but child age was not associated with mealtime disengagement. No associations were found between child characteristics and mealtime negativity. Third, we found that mealtime disengagement and mealtime negativity were associated with mother-reported satiety responsiveness on the Child Eating Behavior Questionnaire. Taken together, our findings suggest observed mealtime disengagement and mealtime negativity behaviors could be helpful indicators of child satiation in a naturalistic mealtime context.

Keywords: Satiation, mealtime, parent, child, weight

1. Introduction

The prevalence of childhood obesity in the US has more than tripled in the past thirty years (Anderson et al., 2019), with children from low-income families at especially high-risk (Hemmingsson, 2018). Although not conclusive, research suggests that infants’ satiation cues (i.e., signals of being full or done with the meal), such as crying or lateral head shakes during feeding (Shloim et al., 2018), and their caregivers’ recognition of and response to those cues during feeding may shape obesity risk (DiSantis et al., 2011). Parents who perceive that their infant is full and respond to those cues by not overfeeding may over time be able to prevent their young child from eating beyond satiation/satiety by promoting development of their infant’s ability to attend to internal sensations of fullness (DiSantis et al., 2011; McNally et al., 2016). The idea of promoting satiety responsiveness (i.e., the ability to attend to sensations of satiation and regulate food intake based on such sensations) to reduce overeating in young children is also prevalent. Several interventions with preschoolers and/or their parents embrace the goal of identifying and promoting satiation cues to prevent obesity (Eneli et al., 2015; Horodynski & Stommel, 2005; Johnson, 2000). Despite numerous interventions targeting satiety responsiveness, behaviorally assessing satiation remains challenging, particularly among older children who exhibit a variety of cues to signal satiation (Pérez-Escamilla et al., 2017) and are more responsive to learned cues from the environment than younger children (e.g., eating everything on the plate regardless of the portion size; Wardle et al., 2001).

Satiation is a dynamic concept that is difficult to measure behaviorally. Research in infancy suggests that satiation cues include indicators of disengagement with eating such as fussing, head shakes, and pulling away during meals (Shloim et al., 2018). These behaviors have not been examined as indicators of satiation later in childhood, however. Instead, many studies with children have assessed satiety responsiveness using laboratory-based tasks such as the eating in the absence of hunger protocol (Lansigan et al., 2015) and caloric compensation protocols (e.g., Kral et al., 2012). Previous research suggests that lower satiety responsiveness, as measured by lab protocols (Asta et al., 2016; Fisher et al., 2007; Kral et al., 2012) and parent-reported measures (Carnell & Wardle, 2007; Mallan et al., 2014; van Jaarsveld et al., 2011), predicts greater obesity risk. While laboratory tasks allow researchers to control for potential confounding variables, eating within the laboratory poses many limitations (Meiselman, 1992). First, these methods cannot be easily used by parents to evaluate child satiation, as they involve specialized and sometimes extensive protocols. Second, the satiety response measured using these protocols may not necessarily reflect naturalistic satiation behaviors that children exhibit during day-to-day interactions, such as mealtimes. Despite the need to understand and evaluate satiation in real-world settings, assessments of satiation in naturalistic contexts such as mealtimes are less frequent (McNally et al., 2016). Thus, it is important to investigate whether child behaviors that occur during naturalistic mealtimes could indicate satiation and evaluate how such behaviors relate to other measures of child appetitive traits as well as obesity risk.

Researchers have suggested that parents can help promote eating self-regulation among children by accurately recognizing and responding to child states of hunger and satiation (DiSantis et al., 2011). In order to promote parents’ recognition of child satiation, it is important to identify behavioral indicators of satiation during mealtimes. Family mealtimes are an essential context to study satiation in older children because family mealtimes provide children with ample opportunities to display behaviors that may signal satiation. Parents also tend to prompt their children to eat during mealtimes (Orrell-Valente et al., 2007). If parents repeatedly fail to recognize child satiation cues, over time they may override child internal satiation signaling and promote overeating. Similar to infant studies (Shloim et al., 2018), indicators of satiation in young children during mealtimes could include attempts to disengage from the meal or negative responses to food at mealtimes. For example, child behaviors that may indicate satiation during mealtimes could include attempts to terminate the meal, for example playing with their food, pushing the meal away, or explicitly attempting to remove themselves from the table. Children may also display negative emotionality, for example verbalizing disappointment or “yuck” in response to food as a sign of not wanting to eat. To our knowledge, these behavioral indicators of mealtime disengagement and mealtime negativity have not been examined in association with parent-reported child eating behaviors. Further, it is unknown how such observed behavioral indicators of satiation may relate to characteristics such as child age, sex, and body mass index z-score (BMIz). Identifying behaviors that indicate satiation as they unfold in a naturalistic mealtime environment may inform the development and evaluation of interventions to teach parents how to recognize mealtime behaviors that may indicate satiation in their children to prevent overfeeding them and ultimately, child overeating.

Individual differences based on child age, sex, and adiposity indicators have been found for lab-based measures of satiety responsiveness in prior work, though associations are inconsistent. Some studies have found that younger children are more responsive to satiety than older children. For example, early childhood studies using a caloric compensation (COMPx) protocol have found that younger children can more effectively adjust their energy intake after receiving a snack (Cecil et al., 2005; Hetherington et al., 2000). In contrast, a separate study with 3-6 year old children did not find age differences in either COMPx or EAH protocols (Remy et al., 2015). Sex and adiposity differences in satiety responsiveness are also unclear, as several studies have found inconsistent results. For instance, early childhood studies have found that girls consume less in EAH protocols than boys (Hill et al., 2008; Remy et al., 2015), while no sex differences were found in other studies using the EAH protocol (Fisher et al., 2007) or parent-reported satiety responsiveness (Carnell & Wardle, 2007; Mallan et al., 2014; Sleddens et al., 2008). Some studies have found BMIz to be negatively associated with parent-reported satiety responsiveness (Mallan et al., 2014; Sleddens et al., 2008), while other studies found no significant associations between adiposity and lab-based measures of satiety responsiveness (Fogel et al., 2018; Remy et al., 2015). Prior work has also found some, though not always consistent, associations between lab-based behavioral satiation measures such as EAH and COMPx and parent-reported appetitive traits using the Child Eating Behavior Questionnaire (CEBQ) during early childhood. Carnell and Wardle’s (2007) study found that higher satiety responsiveness was associated with lower energy intake in the EAH protocol and better caloric compensation during the COMPx protocol (Carnell & Wardle, 2007). In contrast, parent-reported appetitive traits were not associated with EAH in a sample of Australian toddlers (Mallan et al., 2014). Thus, investigating observed behavioral indicators of satiation will be helpful in elucidating how well observed child behaviors during a naturalistic mealtime context relate to parent reports on a well-known measure such as the CEBQ.

The goal of the current study is to examine whether observed behaviors that could indicate child satiation (i.e., mealtime disengagement and mealtime negativity) are associated with child characteristics (i.e., sex, age, and BMIz) and parent-reported child appetitive traits. First, since BMIz is negatively associated with satiety responsiveness in several studies (e.g., Mallan et al., 2014; Sleddens et al., 2008), we hypothesized that higher child BMIz would be associated with lower mealtime disengagement and lower negativity. No specific directions were hypothesized for the associations between child age, sex and observed behavioral indicators of child satiation, as these associations are inconsistent in the literature. Second, we hypothesized that greater observed child mealtime disengagement would be associated with less parent-reported child food approach behavior (i.e., food responsiveness, enjoyment of food, emotional overeating, and desire to drink), but associated with more parent-reported child food avoidance behavior (i.e., satiety responsiveness, slowness in eating, emotional undereating, and food fussiness) on the CEBQ. Third, we hypothesized that greater observed child mealtime negativity would be associated with less parent-reported child food approach behavior (i.e., food responsiveness, enjoyment of food, emotional overeating, and desire to drink), but associated with more parent-reported child food avoidance behavior (i.e., satiety responsiveness, slowness in eating, emotional undereating, and food fussiness) on the CEBQ.

2. Methods

All mother-child dyads were initially recruited from Head Start, the federal preschool program serving children living in poverty, in the Midwest United States to participate in a study of eating behavior (Lumeng et al., 2014). At the time of recruitment, all children were between ages 3-4 years and their families were considered low-income according to the Federal Poverty Guidelines (mean income-to-needs ratio at enrollment = 0.88). After completing the initial study, families were re-contacted by phone and invited to participate in a follow up study, from which these data were gathered. Inclusion criteria for all studies were that child was born at >35 weeks gestation, with no significant medical complications, developmental delays or history of food allergies; primary caregiver had <4-year college degree and was fluent in English; and child was not a foster child. Male primary caregivers were excluded from the current study analyses. Of the female primary caregivers, 95% were biological mothers (others were adoptive mothers, stepmothers, and grandmothers); henceforth we refer to the entire group as “mothers”.

The sample included in the current analysis was limited to those dyads who completed the questionnaires and at least one home mealtime observation video, resulting in a final sample size of 240. There were no significant differences between this sample of 240 and those who were excluded (n=42) with regard to child sex, child age, child body mass index (BMI) z-score, and child race/ethnicity, maternal age, and maternal BMI. In the current study’s sample, children (53% Boys) were between ages 4-8 years (M=5.9 years old; SD = 0.70). The cohort was 57% white, non-Hispanic, 16% black, non-Hispanic, 17% biracial, non-Hispanic; 10% of the overall sample was Hispanic. All mothers provided written informed consent for themselves and their children and were compensated at $150 for participating in all study procedures. All children assented to the mealtime video recording. The University of Michigan Institutional Review Board approved this study.

Child weight and height were measured during an in-home visit by research assistants trained in standardized measurement technique. A Detecto DR-550C scale, which was calibrated weekly, was used to measure weight. A Seca 213/217 stadiometer was used to measure height. Each measurement was collected twice at the same time during the home visit and averaged. If the two measurements differed by >0.1 kg for weight or >0.5 cm for height, two additional measurements were collected and averaged. The 2000 U.S. Centers for Disease Control Growth Charts was used to determine child body mass index z-score (BMIz). Mean child BMIz was 0.87 (SD = 1.02; Range = −2.58 to 3.26).

2.1. Procedures

Three naturalistic mealtimes were videotaped. Mothers were asked to record typical evening meals in their home on three weeknights over the course of one week. Specifically, mothers were told to “please video record only what is typical for your family. Do not do anything special for us.” Research assistants provided the family with a simple camera kit and instructions on how to record mealtimes, and instructed the mothers that the video must capture the child’s upper torso, plate, and drink. Mothers were asked to record the entire meal or record for 30 minutes, whichever is shorter. Reminders were provided prior to each mealtime, and several follow-up questions were obtained after each meal such as the typicality and content of the meal (i.e., foods and beverages served). We reviewed meals that were rated as “not typical” by mothers on a case-by-case basis and only dropped the data with “extreme” atypicality such as another family being present during mealtime. Once the recordings were completed, research assistants collected the camera and the video data. We coded the data from one video per index child, with the second observation chosen preferentially on the premise that families may be more acclimated to the camera than for the first video. All 240 families with an observed mealtime included in the current study had a second mealtime observation. Other siblings were present in 70% of the meals and at least one other individual was present in 91% of the meals. Three undergraduate research assistants who were not involved in fieldwork were trained to achieve interrater reliability (κ > 0.7) on a subset of mealtime observations prior to coding. Approximately 40% of mealtime observations were double-coded to ensure ongoing reliability.

2.2. Measures

2.2.1. Observed Mealtime Disengagement

Child mealtime disengagement was operationalized as behavioral and verbal indicators of mealtime disengagement during the recorded mealtime. Behavioral indicators of mealtime disengagement included active behavioral attempts to terminate a meal that could be positive/neutral, such as leaving the table or playing with food/toys, or negative, such as throwing foods or forcefully pushing the plate away. Verbal indicators of mealtime disengagement included comments indicating a desire to terminate the meal by making explicit references to being full, being done, or having had enough to eat, for example, children asking “can I leave the table?” or “I am done with my dinner.” Positive/neutral behaviors, negative behaviors, and verbal indicators of mealtime disengagement were assessed at 10-s intervals as not present (0) or present (1). The mean proportion of intervals with mealtime disengagement (i.e., mean proportion of positive/neutral behaviors, negative behaviors, and verbal indicators) was used during data analysis (κ = .78 - .85).

2.2.2. Observed Mealtime Negativity

Child mealtime negativity was operationalized as emotional displeasure in response to or in anticipation of eating food during the mealtime. Mealtime negativity included displays of disgust and/or disappointment in food served, or food in general, for instance, through verbalizations (e.g., “ew, gross” or “yuck”), facial expressions (e.g., frowning and nose wrinkling), and body movements (e.g., putting head down on arms). We did not include displays of mealtime negativity that were not related to the food (e.g., throwing tantrums about toys). Mealtime negativity was assessed at 10-s intervals as not present (0) or present (1). The proportion of intervals with mealtime negativity present was used for analysis (κ = .88).

2.2.3. Parent-Reported Child Eating

Parents completed the 35-item Child Eating Behavior Questionnaire (CEBQ; Wardle, Guthrie, Sanderson, & Rapoport, 2001) to assess aspects of their child’s eating behaviors that reflect food approach behaviors, and food avoidance behaviors, including satiety responsiveness (Ek et al., 2016; Hughes & Frazier-Wood, 2016). Food approach behaviors included food responsiveness (FR; 4 items; “If allowed to, my child would eat too much”), enjoyment of food (EF; 4 items; “my child loves food”), emotional over-eating (EOE; 4 items; “my child eats when worries”), and desire to drink (DD; 3 items; “my child is always asking for a drink”). Food avoidance behaviors included satiety responsiveness (SR; 5 items; “my child leaves food on his/her plate at the end of a meal”), slowness in eating (SLE; 4 items; “my child eats slowly”), emotional under-eating (EUE; 4 items; “my child eats less when angry”), and food fussiness (FF; 7 items; "my child refuses new foods at first"; Ek et al., 2016; Hughes & Frazier-Wood, 2016). Parents rated each statement about their child on a 5-point Likert scale ranging from never (1) to always (5). Negatively worded items were reverse scored. Higher scores indicate stronger parent endorsement of each child eating behavior (α’s ranged from .61 to .89).

3. Results

The observed child mealtime variables were found to be non-normally distributed, thus nonparametric tests were conducted. Spearman tests were conducted for correlational analyses, whereas Mann-Whitney U tests were calculated to compare groups. Spearman correlational analyses (for child age and child BMIz) and Mann-Whitney U tests (for child sex) were conducted to examine whether child characteristics were associated with observed child mealtime behaviors. Table 1 demonstrates the means, standard deviations, and correlations among all study variables (except child sex). Child age was not associated with observed mealtime disengagement or mealtime negativity (p = .09 and p = .09, respectively). Higher child BMIz was associated with lower mealtime disengagement, but child BMIz was not associated with mealtime negativity. There was a sex difference in mealtime disengagement such that boys showed higher disengagement than girls (U = 5670, z = −2.83, p = .005). There were no sex differences in mealtime negativity (U = 7139, z = −.05, p = .96).

Table 1.

Means, standard deviations, and correlations

Variable M SD 1 2 3 4 5 6 7 8 9 10 11
1. Child Age 71.3 8.4
2. Child BMIz 0.87 1.03 −.00
3.Disengagement 0.01 0.01 −.11 −.18*
4. Negativity 0.07 0.13 −.11 .04 .21**
5. FR 2.81 0.88 .05 .29** −.06 .02
6. EOE 1.98 0.66 .09 .21** −.04 .10 .58**
7. EF 3.96 0.70 .12 .20** −.15** .11 .51** .19**
8. DD 3.54 1.11 −.20** .07 −.00 .02 .41** .27** .14*
9. SR 2.85 0.63 −.22** −.22** .19** .18** −.26** −.04 −.52** .08
10. SLE 2.82 0.79 −.15* −.16* .08 .13* −.20** −.01 −.36** .05 .52**
11. EUE 2.84 0.69 −.19** −.02 .10 .11 .14* .37** −.04 .30** .31** .18**
12. FF 2.77 0.75 −.13* −.12 .09 .09 −.01 .10 −.36** .16* .36** .28** .27**
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Note. M and SD are used to represent mean and standard deviation, respectively. Disengagement = Mealtime Disengagement; Negativity = Mealtime Negativity; FR = Food Responsiveness; EOE = Emotional Overeating; EF = Enjoyment of Food; DD = Desire to Drink; SR = Satiety Responsiveness; SLE = Slowness in Eating; EUE = Emotional Under Eating; FF = Food Fussiness.

*

indicates p < .05.

**

indicates p < .01.

Due to non-normality of the observed child mealtime variables, Spearman tests were only conducted for correlations between observed child mealtime variables and child characteristics and CEBQ. The remaining correlational analyses were conducted using Pearson test.

To examine whether observed child mealtime behaviors were associated with parent-reported child food approach and food avoidance variables, correlational analyses were conducted. Higher overall mealtime disengagement was associated with less enjoyment of food, and more satiety responsiveness (see Table 1). Overall mealtime disengagement was not associated with other food approach (i.e., FR, EOE, DD), or food avoidance (i.e., SLE, EUE, FF) variables. We conducted follow-up analyses to see whether specific mealtime disengagement indicators were associated with CEBQ ratings (see Table 2). We found that positive/neutral indicators of disengagement were positively associated with SR and EUE, whereas negative and verbal indicators were negatively associated with EF. Mealtime negativity was associated with more slowness in eating and more satiety responsiveness. However, mealtime negativity was not associated with any of the food approach (i.e., FR, EF, EOE, DD) or other food avoidance (i.e., EUE, FF) variables.

Table 2.

Correlations between Specific Mealtime Disengagement Indicators and CEBQ

Variable 1 2 3
1.Positive/Neutral Mealtime Disengagement --
2.Negative Mealtime Disengagement .02 --
3.Verbal Mealtime Disengagement .12* .27** --
4. FR −.04 −.11 −.07
5. EOE .00 −.08 −.04
6.EF −.08 −.15* −.13*
7.DD .04 −.04 −.08
8.SR .19** .11 .03
9. SLE .07 .08 .03
10. EUE .13* −.01 .03
11. FF .10 .07 .04
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Note. FR = Food Responsiveness; EOE = Emotional Overeating; EF = Enjoyment of Food; DD = Desire to Drink; SR = Satiety Responsiveness; SLE = Slowness in Eating; EUE = Emotional Under Eating; FF = Food Fussiness.

*

indicates p < .05.

**

indicates p < .01.

Due to non-normality of the observed child mealtime variables, Spearman tests were only conducted for correlations between observed child mealtime variables and child characteristics and CE

4. Discussion

The current study identified behaviors that could indicate child satiation during mealtimes, including mealtime disengagement and mealtime negativity, and found that lower child BMIz and being a boy, but not child age, were associated with greater mealtime disengagement. None of these child characteristics were associated with mealtime negativity. Furthermore, both mealtime disengagement and mealtime negativity were associated with greater mother-reported satiety responsiveness, and mealtime negativity was associated with slowness in eating, suggesting that these mealtime-context behaviors may be indicators of children’s desire to terminate a meal upon satiation.

Our finding that greater mealtime disengagement and mealtime negativity were associated with greater mother-reported satiety responsiveness, and mealtime negativity with slowness in eating, though not other food avoidance behaviors such as food fussiness, adds to the literature about satiation in children. These associations suggest that mealtime disengagement – particularly behavioral or verbal indicators of a desire to terminate the meal, such as leaving the table or engaging in another activity – and mealtime negativity (i.e., displeasure in response to or anticipation of eating the meal) may be reasonable indicators of satiation in young children that can be observed during a meal. Negative and verbal disengagement behaviors were associated with lower enjoyment of food, as well. Findings are consistent with infant literature, which suggests that infants also display disengagement cues and negativity during feeding such as fussing and pulling away upon satiation (Shloim et al., 2018). Observing a range of indicators of mealtime disengagement and mealtime negativity may be an effective method for assessing satiety responsiveness during early childhood.

The positive association between mealtime disengagement and lower child BMIz suggests that displaying indicators of wanting to terminate a meal could help protect against overweight and obesity during early childhood. Researchers have proposed that caregivers’ inappropriate responses to child cues of hunger and satiation (specifically overfeeding) might impair child self-regulation, ultimately accelerating child weight gain (DiSantis et al., 2011). Children who demonstrate more frequent displays of satiation might elicit more appropriate responses by caregivers. Studies have supported this notion, finding that greater parent-reported child satiety responsiveness (Mallan et al., 2014) and higher parent feeding responsiveness (Hurley et al., 2011) are associated with lower child BMIz during early childhood. As parent reports of child appetitive behaviors do not always correspond with objectively-measured satiation, such as EAH, in young children (e.g., Mallan et al., 2014), it is important to identify observable satiation indicators from naturalistic mealtimes in order to understand how these appetitive traits may mitigate or exacerbate obesity risk. Results from the current study revealed that observed mealtime disengagement behavior corresponded with parent-reported satiety responsiveness and enjoyment of food, as well as lower child BMIz, suggesting that disengagement may be a helpful behavior to address in interventions designed to enhance parent responsiveness to cues in child feeding in order to prevent or treat obesity in children (Boutelle et al., 2019).

Our finding that boys displayed greater mealtime disengagement than girls adds to the literature about sex differences in satiety responsiveness. A recent review of the literature found that studies investigating sex differences in appetitive traits, including satiety responsiveness, have not found systematic sex differences in children (Keller et al., 2019). Some studies have found no significant sex differences in satiety responsiveness during early childhood (e.g.,Carnell & Wardle, 2008; Sleddens et al., 2008), while other studies, for example, have found that girls have greater satiety responsiveness than boys in school-aged children (6-8 years) (Jalkanen et al., 2017). Sex differences in satiety responsiveness seem likely, as studies have found sex differences in neural processing of food cues and parental socialization of children’s eating tendencies (Keller et al., 2019). For instance, a study of socioeconomically diverse families of kindergarteners found that girls were praised more than twice as often as boys for eating during a naturalistic mealtime observation (Orrell-Valente et al., 2007). Contrary to our hypothesis, observed mealtime negativity was not associated with child sex, age, or BMIz. Some other studies have found no association between parent-reported satiety responsiveness and child characteristics such as sex (Carnell & Wardle, 2008; Sirirassamee & Hunchangsith, 2016), thus future research should continue to investigate potential differences in observed mealtime cues to better understand which, if any, child characteristics are associated with appetitive traits.

Follow-up analyses revealed that positive/neutral indicators of mealtime disengagement were positively associated with mother-reported satiety responsiveness and emotional undereating, whereas negative and verbal indicators of disengagement were negatively associated with enjoyment of food. These findings may suggest some specificity to mealtime disengagement cues such that satiation may be indicated by positive/neutral indicators of mealtime disengagement such as playing with food or toys during the meal. In contrast, children may utilize negative (e.g., throwing food) and verbal (e.g., “I’m done with my dinner”) disengagement cues when they want to terminate the meal because they do not enjoy the food. Taken together, our findings provided initial evidence for indicators of mealtime disengagement that may signal child satiation, particularly positive and neutral indicators. More research is needed to disentangle various mealtime disengagement cues to better inform parents regarding which behavioral and/or verbal indicators actually reflect satiation versus not enjoying the food. Further research is also needed to investigate the development of mealtime disengagement cues across ages.

Recognizing indicators of satiation during early childhood has implications for obesity prevention. When parents are able to recognize their child’s satiation and hunger, they can respond appropriately to those cues (i.e., responsive feeding), which may reduce risk of overweight/obesity in children (Hurley et al., 2011). While few interventions have targeted satiety responsiveness in children (Burgess & Faith, 2018), interventions with infants suggest that satiety responsiveness and responsive feeding are potentially viable intervention targets. For instance, a randomized controlled trial with 698 first-time Australian mothers held six interactive group sessions focused on recognizing and appropriately responding to hunger/satiation cues, positive parenting, and promotion of healthy food preferences in infants. Parents of infants receiving the intervention reported that their infant had greater satiety responsiveness and food responsiveness, and less fussiness and emotional overeating at 21-27 months of age (Daniels et al., 2014). Recognizing satiation indicators during early childhood may help inform such interventions seeking to improve parental responses to satiation during mealtimes.

Limitations of this study include our single observation of children’s behaviors, which may not necessarily be representative of all of the behaviors that could indicate children’s satiation at this age or in all mealtime or eating contexts. To obtain a more comprehensive understanding of children’s satiation indicators, future work could observe children’s behavior across mealtimes (breakfast, lunch, dinner) for multiple days, as well as utilize a diary method to capture maternal reports of children’s behaviors across several days. In addition, the families were tasked with recording the mealtimes, thus there may be bias in the meal selected or changes in behaviors given the presence of a camera. We operationally defined and coded variables based on plausible behaviors that could occur during a meal and may indicate satiation. Although we found evidence that the coded child behaviors are associated with child BMIz and parent-reports of food avoidance (i.e., satiety responsiveness, slowness in eating), it is important to note that children may exhibit other behaviors that may indicate satiation which we did not code. The observed behaviors thought to indicate satiation in our study, such as mealtime negativity, may also indicate other child characteristics such as picky eating, though negativity was not associated with food fussiness as reported by mothers. Last, given that we coded videos of family mealtimes at home, we did not have access to the actual amount (kilocalories) of foods that a child consumed. We did assess child’s bite rate and found that even after controlling for bite rate, findings remained the same (data available upon request), suggesting that the observed mealtime disengagement and negativity behaviors may reflect child satiation or lack of desire to eat the foods presented rather than simply speed of eating. Finally, we conducted the study with families living in poverty, as children living in poverty are at greater risk for obesity (Hemmingsson, 2018). Although it is important to understand eating behaviors in this high-risk population, findings from the current study may not generalize to other similar-aged children who differ from the children in the current sample.

5. Conclusions

This study attempted to identify child behaviors that indicate satiation during mealtimes, and associations of these behaviors with child characteristics and parent-reported child eating behaviors to enhance our understanding of how to assess child satiation in naturalistic settings, and ultimately to better inform the development of feeding-focused interventions to curb childhood obesity. Overall, findings revealed that observed mealtime disengagement and negativity were associated with higher maternal-reported child satiety responsiveness. Furthermore, evidence suggested that children who displayed more behaviors indicating satiation during meals had lower BMIz, less food enjoyment (for mealtime disengagement), and higher slowness in eating (for mealtime negativity). These findings are important, considering that obesity prevention interventions have focused on increasing parents’ recognition of children’s satiation signaling. Based on these findings, teaching parents to view children’s mealtime disengagement and negativity behaviors as attempts to terminate a meal due to satiation may be fruitful in preventing overeating.

Acknowledgements/Funding:

All phases of this study were supported by the National Institute of Health (NIH) grant numbers R03HD084708 and R01HD061356.

Footnotes

Studies in humans. This research involving human participants have been performed in accordance with the Declaration of Helsinki. This research was reviewed and approved by the University of Michigan Institutional Review Board. All participants provided informed consent before participating.

Submission Declaration. This manuscript has not been published previously or is not under consideration for publication elsewhere.

Submission Verification. All authors have approved the manuscript’s content.

Declaration of interest. None.

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