Author: Gloria Koh
Koh, Gloria, 2017 Maternal feeding self-efficacy and fruit and vegetable consumption in infants and toddlers., Flinders University, School of Health Sciences
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Fruits and vegetables (FV) are cornerstones of a healthy diet but adequate consumption remains a challenge in nutrition interventions. In young children, poor exposure and consumption of FV can potentially affect development of preference for FV and lifelong eating habits that may influence health outcomes. Current and future interventions can benefit from identifying the reasons children are not consuming adequate FV. Research in this area is confounded by the scarcity of dietary evidence for young children and limited investigation into the cognitive-behavioural impetus for mothers to offer FV to young children. This thesis examined the multi-directional relationships between maternal feeding self-efficacy, child exposure to new food, feeding behaviour and FV intake in participants in the South Australian Infants Dietary Intake study when aged 4 to 9 months (T1) (n=277) and again when aged 11 to 18 months (T2) (n= 218).
Mothers with healthy infants weighing >2500g and >37 weeks gestation were recruited post-natally from 11 South Australian hospitals. At 6 months and 13 months postnatal, infants were weighed and measured, and mothers completed a questionnaire exploring their perceptions of child feeding behavior and exposure to new foods. The questionnaires also included the Short Temperament Scale for Infants (T1), Short Temperament Scale for Toddlers (T2), Kessler 10 to measure maternal psychological distress, and five (T1) and eight (T2) items measuring maternal feeding self-efficacy. The frequency (number of occasions) and variety of FV (number of subgroups in each food category) consumed by children were estimated from a 24-hour dietary recall and 2 days food record at T1 and T2. Structural equation modeling (SEM) was performed using MPlus version 6.11 to assess the relationships between observed and latent variables.
Median (IQR) variety scores were 2(1-3) for fruit (possible score 18) and 3(2-5) for vegetable (possible score 28) at T1, and 3(1-4) for fruit and 4(1-6) for vegetable at T2. The most popular FV consumed were apple (n=108, 45.0%) and pumpkin (n=143, 56.3%) at T1 and banana (n=142, 76.8%) and potato (n=117, 62.2%) at T2. SEM at T1 and T2 revealed that parenting confidence, child exposure to novel food and positive perception of child feeding behaviour predicted maternal feeding self-efficacy which then directly (T1) and indirectly (T2) predicted the variety of vegetables children consume. Furthermore, maternal psychological status indirectly predicted child vegetable variety at T1 through parenting confidence and child exposure to new foods. Despite explaining 14% and 25% variance in child vegetable variety at T1 and T2 respectively, the conceptual model did not predict the variety of fruit intake in children at both time points. This provides evidence that FV intakes are influenced by different behavioural factors and should be examined separately. In conclusion, the direct and indirect roles of maternal feeding self-efficacy in predicting child vegetable variety highlight the importance of targeting maternal feeding self-efficacy as a key strategy towards development of healthy eating in children.
Keywords: Infant, Toddler, Child, Fruit, Vegetable, Self-efficacy
Subject: Health Sciences thesis
Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Health Sciences
Supervisor: Anthea Magarey