Family Environment and Childhood Feeding Problems

A strong relationship exists between children’s feeding problems and eating disorders among their mothers. Several studies have noted that intrusive and inconsistent parenting, especially during mealtimes, might be important in the development of food-related disorders (Psychol Med 1996; 26:569; BMJ 1995; 299:777).

Two environmental aspects are suspect

Peter J. Cooper, PhD and co-workers at the University of Reading, Reading, UK, report that two aspects of family environment are strongly associated with the development of feeding problems among children (Br J Psychiatry 2004;184:210) The two suspected causes are chaotic, disorganized mealtimes and a disharmonious child-mother relationship, particularly when the mother is controlling. The researchers’ study included three groups: children with feeding problems (35 children), children who were shy, fearful, or had behavioral problems (58 children), and a control group with no feeding problems (23 children).

Dr. Cooper’s group used a self-report version of the Behavior Screening Questionnaire (BSQ), along with a questionnaire on child shyness. The teachers completed the Pre-school Behavior Checklist of all the children. Children with feeding problems were identified by their mothers’ responses on the BSQ. The mothers were assessed with the Eating Disorder Examination and the Anxiety Disorders Interview Schedule

Taking the study into the home

Fifty-six children were identified with feeding problems, and 43 children entered the study. The mothers and children were assessed in their own homes with a series of standardized questionnaires and also with direct observation. The in-person mealtime observations served two purposes—the first was to validate the children’s assignment to the feeding problem category and the second was to observe the mother-child relationship during a meal. The mothers were asked to give their child his or her normal midday meal and if the two normally ate together, to do that also.

The meal was recorded by video camera, with the researcher in another room to allow a normal meal. The researchers studied the tape for food refusal and fussiness, the amount eaten and any abnormal eating behavior, such as spitting. The videotape was also used to rate the mother’s overall child management style at the meal. The mothers and children were also filmed interacting in a situation not related to eating—the children were instructed to explore the contents of a dangerous-looking box and the mother was instructed to help them.

Clinical implications

According to the authors, given the high incidence of eating disorders among mothers of children with feeding problems, it is essential to look at the mother’s eating history as well as the child’s. In addition, a family meal should be evaluated. Reorganizing family meals and using measures to improve the quality of the mother-child relationship will improve the success of treating childhood eating problems, according to Dr. Cooper and his colleagues.