Skip to main content

Bidirectional associations between parental feeding practices, infant appetitive traits and infant BMIz: a longitudinal cohort study



Little is known about the pathways linking parent feeding practices with appetitive traits and BMIz throughout infancy. This study examined bidirectional associations between parental feeding practices, infant appetitive traits, and infant BMIz.


Parents (n = 380) of infants aged less than 6 months at baseline reported their feeding practices (using the Feeding Practices and Structure Questionnaire (FPSQ) for infants and toddlers), infant appetitive traits (using the Baby Eating Behaviour Questionnaire) and infant BMIz (parent-reported) at three timepoints (< 6 months, ~ 9 months, ~ 12 months) up to 12 months of age. Cross-lagged models examined bidirectional associations between parent feeding practices, infant appetitive traits and infant BMIz.


There was strong continuity across the three timepoints for maternal feeding practices, infant appetitive traits, and infant BMIz. Infant food avoidance was prospectively associated with higher parental persuasive feeding. Infant BMIz was prospectively associated with higher parent-led feeding. Parent use of food to calm was prospectively associated with lower infant BMIz, and infant BMIz was prospectively associated with higher infant food approach. Feeding on demand was prospectively associated with lower infant food approach.


This study highlights the complex associations between parental feeding practices, infant appetitive traits and infant BMIz. The study demonstrated that both child and parent effects are important, suggesting a need for tailored programs beginning in infancy to promote and support infant appetitive traits and parent feeding practices that support healthy development.


Excess or rapid weight gain in infancy is associated with increased risk of overweight or obesity in early childhood [1], adolescence and adulthood [2]. While a number of risk factors has been identified (e.g. food approach appetitive traits) [3, 4], the processes (e.g. a change in parent behaviour in reaction to the child’s appetitive traits) that link these risk factors with excessive energy intake, and in turn overweight and obesity, are complex. We need to understand how identified risk factors casually explain overweight and obesity. There is recognition that a range of psychosocial and biological characteristics of parents and children and a number of different bidirectional and transactional processes are relevant to understanding the complex pathways to childhood overweight and obesity [5, 6]. Psychosocial processes can involve parent feeding practices and cognitions. Biological characteristics affecting such processes include infant/child temperament, neurocognitive functioning and genetics [5]. These psychosocial and biological processes, among others, have been linked to infant/child appetitive traits (defined as individual differences in patterns of behaviours and attitudes related to food and eating) [7,8,9] and weight, as well as to parent cognitions and feeding practices [5]. The current literature examining such processes has focussed largely on children older than two years [5]. Therefore, knowledge of the bidirectional and transactional processes affecting infant eating and weight will provide insights into the aetiology of overweight and obesity early in life, yet these processes may begin earlier, in infancy. The biopsychosocial model of the development of eating and weight in childhood proposes that an infant’s characteristics, appetitive traits and weight affect and are affected by parent feeding practices over time in complex pathways [5]. However, no studies have examined these processes in infancy to understand the origins of pathways linking early life risk factors to excess weight gain. Understanding these complex influences will inform programs aimed at preventing overweight and obesity early in infancy.

Presently, there is evidence from both cross-sectional and longitudinal studies on the relationships between parent feeding practices (defined as strategies that a parent engages in to influence their infant/child’s dietary intake [10]) and child/infant eating and weight outcomes. In these previous cross-sectional and longitudinal studies, there is evidence of relationships between parent feeding, child eating and child weight. Studies in children ranging from 2 to 9 years of age have shown that controlling and non-responsive feeding practices such as persuasive feeding are associated with higher child BMIz [11,12,13]. Parental feeding practices, such as pressure to eat and restriction, have also been shown to be associated with child appetitive traits (i.e., satiety responsiveness, food fussiness, emotional undereating, eating in the absence of hunger, food responsiveness and slowness in eating) [11, 14,15,16,17,18]. While, infant appetitive traits have also been shown to be associated with parental feeding practices [7] and weight outcomes [19]. However, the majority of these studies were conducted beyond the first year of life (2–9 years of age) [11,12,13,14,15,16,17,18], which does not allow for the examination of the early origins of these processes. Additionally, these studies were not designed to enable bidirectional and transactional effects to be examined and so the complex nature of these associations remains unclear. To establish the direction of association, it is necessary to use study designs with multiple waves of measurement of the same constructs, as child development theories suggest that parents adapt their parenting strategies to the child’s behaviour and weight [20]. Such studies will allow for the bidirectional and transactional associations to be examined.

Previous studies of children aged 1 to 9 years that have applied cross-lagged modelling (a technique used to examine two or more variables across different time points) to examine the bidirectional associations between feeding practices, child appetitive traits and/or BMIz have included children aged 1 to 9 years. These studies found both parent- [21,22,23,24,25,26] and child- [22, 24, 26,27,28] driven associations. With regard to the child-driven associations, studies found that parents use non-responsive feeding practices such as restriction, pressure to eat, and control in response to their child’s weight status [26,27,28]. Eating large amounts of food, slow eating, food refusal, and satiety responsiveness can evoke parent feeding practices such as structured meal timing, monitoring, pressure to eat, covert restriction, and overt restriction [22, 24]. With regard to the parent-driven associations, studies found that feeding practices such as pressure to eat, overt control and restriction of food predict higher child weight status at the next assessment point [22, 26]. Additionally, feeding practices such as using food as a reward for behaviour, covert restriction and family meal setting influence child appetitive traits including emotional overeating, food responsiveness and satiety responsiveness [21, 24, 25]. Finally, parental encouragement to eat has been shown to predict increased child enjoyment of food [25] and prompts to eat different food predicted eating in the absence of hunger [23]. However, all of these studies were conducted beyond the first year of life [21,22,23,24,25,26,27,28], which does not allow for examining these associations in early life when many processes originate.

Overall, while there is evidence that parents and children influence each other in relation to parent feeding, child eating and child weight, there are a number of limitations with the current evidence base. Previous cross-lagged studies (mentioned above) have only examined the associations between parental feeding practices and BMIz [26,27,28] or feeding practices and child appetitive traits [21, 22, 24, 25], while none has examine these simultaneously. There are no cross-lagged studies examining parent feeding, infant eating and infant weight during infancy to allow for the examination of early origins of these pathways [21,22,23,24,25,26,27,28]. However developmental literature stresses the importance of examining processes in infancy to understand their early origins [5]. Additionally, the time between waves of previous studies is between 1 and 4 years, in early years (0 to 2 years) it is important to assess infants and children more frequently as the stages of development are short. Examining these processes in infancy will enable us to further our understanding regarding the pathways to overweight and obesity that may begin during infancy [5]. It is important to explore the pathways that may link risk factors to child overweight and obesity to inform tailored early interventions including both the child and parents, rather than corrective interventions later in life.

Therefore, the aims of this exploratory study are to examine the directionality of associations between parental feeding practices (feeding on demand, food to calm, parent-led feeding and persuasive feeding), infant appetitive traits (food avoidance and food approach), and infant BMIz, and to examine the auto-regressive paths for each variable across timepoints. It is hypothesised, based on previous research in older children [21,22,23,24,25,26,27,28] and developmental literature [5], that persuasive and parent-led feeding practices will increase infant food approach appetitive traits, which will increase infant BMIz and the use of more restrictive feeding practices at later time points. Additionally, it is hypothesised that feeding practices, infant appetitive traits, and infant BMIz will increase at each time point.


Study design

This is a longitudinal cohort study of parents and their infant children. Participants completed three self-report surveys approximately three months apart, beginning when their infant was aged less than 6 months.


Parents of infants aged less than 6 months were recruited between February 2016 and September 2016 via an early parenting support service in New South Wales, Australia: Tresillian Family Care Centres ( Flyers and posters were displayed around the centres and nurses handed them to parents at appointments. If interested in the study, parents were provided with a Plain Language Statement (PLS) outlining details of the study and a hard copy of the survey or a link to an online survey. The completed survey was returned by parents to a sealed box at their Tresillian Centre and collected by research staff. Parents were also recruited via advertisements on the Tresillian Facebook group. If parents responded to the advertisement, they were linked to an electronic version of the PLS and survey (using the online platform SurveyGizmo). Participants were asked if they were willing to be contacted for a follow up survey; if they indicted yes, they were contacted via email 3 months after the first survey and again after a further 3 months. Eligible participants were parents of an infant less than 6 months of age, aged 18 years and over, and able to read and write in English. Participants were excluded from analysis if their infant was > 6 months of age at baseline, born at < 35 weeks gestation, < 2500 g birthweight, living outside Australia, or had a health condition that affected feeding. In appreciation of parents’ time, participants were able to enter a random draw for one of two iPads. No identifiable data were collected, thus removing any potential source of bias. Ethical approval was granted from the University of Technology Sydney Human Research Ethics Committee (REF NO. 2,015,000,528) and the Sydney Local Health District Human Research Ethics Committee (Protocol No X15-0233).

Parent feeding practices

Parent feeding practices were measured using the Feeding Practices and Structure Questionnaire (FPSQ) for infants and toddlers [29]. This questionnaire can be used with parents who currently milk-feed their infant/child (18 items) or solid-feed their infant/child (34 items). At timepoints 1 and 2 the FPSQ milk feeding (FPSQ-M) version was administered. At timepoint 3 the parents were offered the FPSQ solid feeding (FPSQ-S) version if they were predominantly solid feeding (3 + meals or snacks per day). If they were feeding solids foods < 3 times per day, they were offered the FPSQ-M. These questionnaires measures four (FPSQ-M) or six (FPSQ-S) feeding practices: feeding on demand vs. feeding routine (e.g. “I let my baby decide when she/he would like to have a feed”), using food to calm (e.g., “I feed my baby to make sure that she/he does not get unsettled or cry”), persuasive feeding (e.g., “If my baby indicates she/he is not hungry, I try to get him to feed anyway”), parent-led feeding (e.g., “I feed my baby for a set time”), family meal environment, and using (non-) food rewards. The family meal environment and using (non-) food rewards are only included in the FPSQ-S and therefore not included in the current study. Each feeding practice consists of 4–7 items, which are rated on a five-point Likert scale ranging from 1 to 5 (never to always). The scores were averaged to obtain a single continuous score for each feeding practice. Both questionnaire versions were developed and validated in the current study sample and showed good internal reliability (Cronbach’s alphas: feeding on demand 0.87, food to calm 0.87, persuasive feeding 0.71, and parent-led feeding 0.79) [29].

Infant appetitive traits

Infant appetitive traits were measured using the Baby Eating Behaviour Questionnaire (BEBQ), which originally asked parents to retrospectively rate their perceptions of their infant’s appetitive traits [30]. However, in the present study parents were asked about their infant’s current appetitive traits, therefore wording was changed to present tense (e.g., “my baby loved milk” was changed to “my baby loves milk”). The questionnaire contains questions on five appetitive traits: satiety responsiveness, slowness in eating, food responsiveness, enjoyment of food, and general appetite. Each appetitive trait consists of 3–6 items, with the exception of general appetite which only consists of one item. Responses were recorded on a five-point Likert scale ranging from 1 to 5 (never to always). The scores were averaged to obtain a continuous score for each appetitive trait. As conducted in previous research [19], the appetitive traits were combined into two categories: food approach (food responsiveness, enjoyment of food, general appetite) or food avoidance (satiety responsiveness and slowness in eating), resulting in a single continuous score for each category. The Cronbach’s alphas ranged between 0.75 and 0.77 at timepoint 1, 0.71 and 0.73 at timepoint 2, and 0.65 and 0.74 at timepoint 3 for slowness in eating, food responsiveness, and enjoyment of food, indicating moderate to good internal reliability for these appetitive traits. The Cronbach’s alphas were 0.62, 0.57, and 0.63 for satiety responsiveness at the three timepoints respectively.

Infant body mass index z-score

At each timepoint, parents were asked to self-report their infant’s most recent weight, length and date of measurement based on their infant’s health record. Infant weight and length measurements are taken at regular health check-ups by a health professional (e.g., nurses, general practitioners) and recorded in their health record. To calculate the body mass index (BMI) z-scores, the World Health Organization’s age- and sex-specific growth charts were used [31]. BMI z-scores were used as a continuous variable.

Statistical analysis

It was not possible to simultaneously include all variables in one model due to low statistical power. Therefore, as per Schreiber et al. [32] who recommend a ratio of ten participants to one parameter, four separate models (one model per feeding practice) were used to examine the longitudinal associations between parent feeding practices, infant appetitive traits and infant BMIz. Structural equation modelling was used to simultaneously estimate the cross-lagged associations between parental feeding practices (feeding on demand vs. feeding routine, using food to calm, persuasive feeding, and parent-led feeding), infant appetitive traits (food avoidance/food approach), and infant BMIz at each time point (Fig. 1). Auto-regressive paths for each variable were also examined across timepoints between parent feeding practices, infant appetitive traits, and infant BMIz at timepoint 1. This resulted in 32 pathways being estimated per model. Missing data were handled by estimating the parameters using the method of maximum likelihood which are iterative in nature [33]. All statistical analyses were conducted using Stata 16 [34]. The study was performed and reported following the strengthening the reporting of the observational studies in epidemiology (STROBE) guidelines [35].

Fig. 1
figure 1

Cross-lagged model of parental feeding practices, infant appetitive traits, and infant BMIz


In total, 445 parents provided some data; 65 participants were excluded, leaving 380 participants at T1, 178 at time 2, and 154 at time 3. The time between waves was a mean of 99 days (range 72–152) between T1 and T2, and 100 days (range = 54–182) between T2 and T3. Table 1 shows the descriptive characteristics of the participants. Just over half of the infants were male (54.2%), and the mean age was 3.22 months at T1, 6.51 months at T2 and 9.96 months at T3. Most parents were aged under 35 years of age (77.6%) and over half were university educated (57.6%).

Table 1 Sample characteristics

Table 2 presents the means and standard deviations for parent feeding practices, infant appetitive traits, and infant BMIz at each timepoint. Of the 74 paths (14 auto-regressive and 60 cross-lagged) across four models, 19 (14 auto-regressive and 5 cross-lagged) were found to be significant. The results of all pathways tested are presented in Supplementary Tables 14. Figures 2, 3, 4 and 5 illustrates the significant associations between parent feeding practices, infant appetitive traits and infant BMIz at different time points.

Table 2 Means and standard deviations of the feeding practices, appetitive traits, and BMIz at timepoints 1, 2 and 3 (n = 380)
Fig. 2
figure 2

Statistically significant pathways in cross-lagged model examining longitudinal associations between parental feeding on demand, infant appetitive traits and infant BMIz

Fig. 3
figure 3

Statistically significant pathways in cross-lagged model examining longitudinal associations between parental food to calm, infant appetitive traits and infant BMIz

Fig. 4
figure 4

Statistically significant pathways in cross-lagged model examining longitudinal associations between parental persuasive feeding, infant appetitive traits and infant BMIz

Fig. 5
figure 5

Statistically significant pathways in cross-lagged model examining longitudinal associations between parent-led feeding, infant appetitive traits and infant BMIz

There were significant autoregressive paths (relationship between repeated measures over time) across timepoints for each maternal feeding practices, child appetitive traits, and BMIz with an increase from timepoint 1 to timepoint 2 (range 0.42–0.64) and from timepoint 2 to timepoint 3 (range 0.23–0.62), while food to calm and feeding on demand plateaued between the last two timepoints.

The cross-lagged paths suggest the associations were both child (appetitive traits or BMIz) driven (n = 3), and parent (parental feeding practices) driven (n = 2). Of the child-driven associations, two were associated with parent related outcomes, and one was associated with a child related outcome. That is, food avoidance at timepoint 1 was positively associated with persuasive feeding at timepoint 2. BMIz at timepoint 1 was positively associated with parent-led feeding at timepoint 2, and BMIz at timepoint 2 was positively associated with food approach at timepoint 3. Of the parent-driven associations, both were associated with child related outcomes. Feeding on demand at timepoint 1 was negatively associated with food approach at timepoint 2 and food to calm at timepoint 1 was negatively associated with BMIz at timepoint 2.


Findings from this novel longitudinal study of infant eating and parent feeding suggest that infants and parents influence each other in a range of complex ways. As expected, infant BMIz, infant appetitive traits and parent feeding practices were all significant components of the tested models. Firstly, the longitudinal findings show that in infancy, parents react to their infant’s appetitive traits and BMIz. Secondly, the findings suggest that parent feeding practices influence infant appetitive traits and BMIz. Thirdly, the findings showed that infant BMIz was associated with later infant appetitive traits. Finally, this study found there was continuity in maternal feeding practices, child appetitive traits, and infant BMIz across the three timepoints. However, there were also a number of non-significant relationships.

As hypothesised, the present study identified that infant food avoidant appetitive traits and higher infant BMIz predicted the use of non-responsive feeding practices at a later timepoint, such as persuasive feeding and parent-led feeding (i.e., the reliance, or lack thereof, on infant cues in regard to initiation and termination of feeding). Traditionally, the dominant perspective on infant eating and weight was a “parent-driven” perspective, with infants or children seen as passive recipients of parent feeding practices [36]. However, it is becoming recognised that parents and infants influence each other in contemporaneous, bidirectional and transactional ways [6, 21,22,23,24,25,26,27,28]. The findings of this study are supportive of this newer perspective, with parental feeding practices at times responding to their infant’s appetitive traits or BMIz, and these responses seen within the first 6 months of life. Previous research has also provided evidence for child effects on parent feeding practices: Costa et al. found that infant food refusal was associated with parental pressure to eat at a later timepoint [22], Jansen et al. found that satiety responsiveness was associated with structured meal timing, covert and overt restriction at a later timepoint [24], and several studies have shown that a higher child BMIz predicted controlling and restrictive feeding practices [26,27,28]. However, to our knowledge, this is the first study to show evidence of these associations in infancy. This study, together with previous research, shows that parents are sensitive to their infant or child’s BMIz across childhood and use particular feeding practices in response to this [28, 37]. However, previous research has found that these feeding practices may affect child weight and appetitive traits in unintended ways [38, 39], for instance diminishing the child’s responsiveness to internal satiety cues, which could then lead to the parent using further non-responsive feeding practices. Further longitudinal studies are needed to examine these associations over a longer period to understand how they evolve with development and affect child BMIz.

The present study also found that parental feeding practices can predict infant BMIz and appetitive traits. In line with our hypotheses, the present study found that parent feeding on demand (rather than by routine) was associated with lower infant food approach appetitive traits at a later timepoint, and that using food to calm at timepoint 1 predicted a lower BMIz at timepoint 2. This is inconsistent with previous literature in older children which shows that using food to calm or as a reward leads to unhealthy food intake and a higher weight status [40, 41]. At the age of the infants in wave 1 (average of 3 months), the food used to calm was likely either breastmilk or formula which may be associated with different patterns of weight development than using (non-core) foods to calm in older children. Food to calm may therefore be positively associated with weight status in children over one year of age and future research is needed to examine these associations in older infants and toddlers. Nevertheless, the findings are supportive of the idea that infants and parents influence each other in reciprocal ways, and this has relevance to appetitive traits and BMIz. Additionally, a transactional process was shown with food to calm at timepoint 1 being associated with lower BMIz at timepoint 2 which in turn was associated with higher infant food approach appetitive traits at timepoint 3. This is supportive of previous research in pre-school children which has found that if feeding is parent driven/led (such as covert restriction, encouragement to eat and using food as a reward) rather than child led, it predicts higher food approach appetitive traits in children (such as food responsiveness and enjoyment of food) [21, 24, 25]. The present study expands on previous work by demonstrating that these associations begin earlier than childhood; they can already be seen in infancy. To our knowledge, this is the first study to demonstrate a transactional process in infancy. However, while the findings were broadly supportive of the biopsychosocial transactional framework [6], it is important to note that this exploratory study tested a large number of pathways and not all pathways were significant. Therefore, further research is required, with a larger sample size, to confirm these findings.

As excepted, this study found the mean scores of feeding practices, some child appetitive traits and BMIz increase with age, which is consistent with previous studies [7, 9, 24, 42,43,44]. Two of the feeding practices (food to calm and feeding on demand) plateaued between the last two timepoints. However, this may be related to parents switching from milk feeding to solid feeding. Parents may be more inclined to follow a routine rather than feeding on demand or feeding to calm as infants get older and transition to solid foods. While only a small proportion of parents chose to fill out the solid feeding version, it is assumed that most children would be introduced to solids at this age (6 months) in line with typical Australian feeding practices [45]. Further research with a longer duration is needed to see if these feeding practices continue to plateau or increase again in the pre-school years. Food approach and BMIz had the strongest autoregressive pathways from timepoint 2 to timepoint 3, compared to the increase from timepoint 1 to timepoint 2.

These findings suggest that it could be important to develop tailored programs for parents during infancy directed at the pathways that lead to overweight and obesity (such as appetitive traits and parent feeding practices) rather than corrective interventions later in life. Such anticipatory programs have been undertaken in the past, these could be adopted and adapted with emerging insights into infancy [46]. However, further knowledge is needed before developing such programs. This study will aid in building the knowledge needed to develop intervention programs by establishing the relationships between appetitive traits, parent feeding practices and child BMIz status. Further longitudinal research should be conducted with a larger sample size to confirm these findings and allow the inclusion of more variables to explore additional pathways (such as parental cognitions and infant/child temperament) to further inform intervention programs [6].

This is the first study that we are aware of to incorporate appetitive traits, BMIz and feeding practices (appropriately measured for this age range) in one cross-lagged model in infancy, which has allowed for the novel examination of complex pathways to infant weight gain. However, as previously mentioned, there is a need for a larger cohort study tracking these behaviours from infancy into childhood and adolescence, to allow for the inclusion of additional variables, as per biopsychosocial models of eating and weight [6, 47,48,49]. Tracking these behaviours across the pre-school years, when we know food avoidance increases [50,51,52], and appetite self-regulation declines [53], will allow the examination of the possible multiple pathways and individual variations that predict BMIz status. Further, a larger sample size would also increase the generalisability of the findings and allow for the inclusion of time-invariant confounders. A limitation of this study includes the reliance on a single informant, which may lead to common method variance [54] and social desirability bias. Future studies would be strengthened with the use of multiple informants and multiple methods (including objective measures) to temper some of these measurement limitations. Additionally, the study also used the BEBQ to examine the child appetitive traits, which has limited data on validity and was originally developed for retrospective use with exclusively milk fed infants [30]; however, many studies have used the BEBQ in the same way as the current study [7, 55,56,57]. Lastly, there was a time difference between the date the parents completed the survey and the date of the last weight and length measurements by primary care providers (a mean of 18 days at T1, 24 days at T2 and 34 days at T3), and a different time length between each wave. Future cohort studies should measure all of the participants and all of the variables at the same time and reduce each timepoint to a smaller age range. It should also be noted that loss to follow-up over the 3 timepoints was high. However, the statistical approach used permits for and handles missing data, which reduces the risk of drop out bias.


This study explored how infant appetitive traits, parent feeding practices and infant BMIz influence each other over time. Results suggested that effects appear to be both infant- and parent- driven, but also that there is continuity in appetitive traits, feeding practices, and infant BMIz over time. However, many of the expected pathways were not significantly associated, highlighting the need to better understand when and how infants and parents influence each other in feeding and eating.

Therefore, while these findings are broadly supportive of a transactional framework that suggests pathways in infant feeding, eating and BMIz emerge early in life, further research with more sophisticated measures and that follow infants into toddlerhood and beyond will provide greater insights into the pathways explaining the development of eating behaviours and BMIz that can form the basis of early, targeted intervention programs.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.



Body mass index


Body mass index z-score


Baby Eating Behaviour Questionnaire


  1. Smego A, Woo JG, Klein J, Suh C, Bansal D, Bliss S, et al. High body mass index in infancy may predict severe obesity in early childhood. J Pediatr. 2017;183:87–93. e1.

    Article  Google Scholar 

  2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among us children and adolescents, 1999–2010. JAMA. 2012;307(5):483–90.

    Article  Google Scholar 

  3. Weng SF, Redsell SA, Swift JA, Yang M, Glazebrook CP. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Arch Dis Child. 2012;97(12):1019–26.

    Article  Google Scholar 

  4. Baidal JAW, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016;50(6):761–79.

    Article  Google Scholar 

  5. Russell CG, Russell A. Biological and psychosocial processes in the development of children’s appetitive traits: insights from developmental theory and research. Nutrients. 2018;10(6):692.

    Article  Google Scholar 

  6. Russell CG, Russell A. A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: insights from developmental theory and research. Obes Rev. 2019;20(5):725–49.

    Article  Google Scholar 

  7. Russell CG, Appleton J, Burnett AJ, Rossiter C, Fowler C, Denney-Wilson E, et al. Infant appetitive phenotypes: a Group-Based multi-trajectory analysis. Front Nutr. 2021;8:749918.

    Article  Google Scholar 

  8. Kral TV, Moore RH, Chittams J, Jones E, O’Malley L, Fisher JO. Identifying behavioral phenotypes for childhood obesity. Appetite. 2018;127:87–96.

    Article  Google Scholar 

  9. Wardle J, Guthrie CA, Sanderson S, Rapoport L. Development of the Children’s eating Behaviour Questionnaire. J Child Psychol Psychiatry. 2001;42(7):963–70.

    Article  CAS  Google Scholar 

  10. Gregory JE, Paxton SJ, Brozovic AM. Maternal feeding practices predict fruit and vegetable consumption in young children. Results of a 12-month longitudinal study. Appetite. 2011;57(1):167–72.

    Article  Google Scholar 

  11. McPhie S, Skouteris H, Fuller-Tyszkiewicz M, McCabe M, Ricciardelli LA, Milgrom J, et al. Maternal predictors of preschool child-eating behaviours, food intake and body mass index: a prospective study. Early Child Dev Care. 2012;182(8):999–1014.

    Article  Google Scholar 

  12. Webber L, Hill C, Cooke L, Carnell S, Wardle J. Associations between child weight and maternal feeding styles are mediated by maternal perceptions and concerns. Eur J Clin Nutr. 2010;64(3):259–65.

    Article  CAS  Google Scholar 

  13. Jansen PW, Roza SJ, Jaddoe VW, Mackenbach JD, Raat H, Hofman A, et al. Children’s eating behavior, feeding practices of parents and weight problems in early childhood: results from the population-based Generation R Study. Int J Behav Nutr Phys Act. 2012;9(1):1–11.

    Article  Google Scholar 

  14. Farrow C, Galloway A, Fraser K. Sibling eating behaviours and differential child feeding practices reported by parents. Appetite. 2009;52(2):307–12.

    Article  CAS  Google Scholar 

  15. Gregory JE, Paxton SJ, Brozovic AM. Pressure to eat and restriction are associated with child eating behaviours and maternal concern about child weight, but not child body mass index, in 2-to 4-year-old children. Appetite. 2010;54(3):550–6.

    Article  Google Scholar 

  16. Carnell S, Benson L, Driggin E, Kolbe L. Parent feeding behavior and child appetite: associations depend on feeding style. Int J Eat Disord. 2014;47(7):705–9.

    Article  Google Scholar 

  17. Powell FC, Farrow CV, Meyer C. Food avoidance in children. The influence of maternal feeding practices and behaviours. Appetite. 2011;57(3):683–92.

    Article  Google Scholar 

  18. Birch LL, Fisher JO, Davison KK. Learning to overeat: maternal use of restrictive feeding practices promotes girls’ eating in the absence of hunger. Am J Clin Nutr. 2003;78:215–20.

    Article  CAS  Google Scholar 

  19. Kininmonth A, Smith A, Carnell S, Steinsbekk S, Fildes A, Llewellyn C. The association between childhood adiposity and appetite assessed using the child eating Behavior Questionnaire and Baby Eating Behavior Questionnaire: a systematic review and meta-analysis. Obes Rev. 2021;22(5):e13169.

    Article  Google Scholar 

  20. Black MM, Aboud FE. Responsive feeding is embedded in a theoretical framework of responsive parenting. J Nutr. 2011;141(3):490–4.

    Article  CAS  Google Scholar 

  21. Berge JM, Miller J, Veblen-Mortenson S, Kunin-Batson A, Sherwood NE, French SA. A bidirectional analysis of feeding practices and eating behaviors in parent/child dyads from low-income and minority households. J Pediatr. 2020;221:93–8. e20.

    Article  Google Scholar 

  22. Costa A, Severo M, Oliveira A. Food parenting practices and eating behaviors in childhood: a cross-lagged approach within the Generation XXI cohort. Am J Clin Nutr. 2021;114:101–8.

    Article  Google Scholar 

  23. Galindo L, Power TG, Beck AD, Fisher JO, O’Connor TM, Hughes SO. Predicting preschool children’s eating in the absence of hunger from maternal pressure to eat: a longitudinal study of low-income, Latina mothers. Appetite. 2018;120:281–6.

    Article  Google Scholar 

  24. Jansen E, Williams KE, Mallan KM, Nicholson JM, Daniels LA. Bidirectional associations between mothers’ feeding practices and child eating behaviours. Int J Behav Nutr Phys Act. 2018;15(1):3.

    Article  Google Scholar 

  25. Steinsbekk S, Belsky J, Wichstrøm L. Parental feeding and child eating: an investigation of reciprocal effects. Child Dev. 2016;87(5):1538–49.

    Article  Google Scholar 

  26. Tschann JM, Martinez SM, Penilla C, Gregorich SE, Pasch LA, De Groat CL, et al. Parental feeding practices and child weight status in mexican american families: a longitudinal analysis. Int J Behav Nutr Phys Act. 2015;12(1):1–10.

    Article  Google Scholar 

  27. Afonso L, Lopes C, Severo M, Santos S, Real H, Durao C, et al. Bidirectional association between parental child-feeding practices and body mass index at 4 and 7 y of age. Am J Clin Nutr. 2016;103(3):861–7.

    Article  CAS  Google Scholar 

  28. Jansen PW, Tharner A, van der Ende J, Wake M, Raat H, Hofman A, et al. Feeding practices and child weight: is the association bidirectional in preschool children? Am J Clin Nutr. 2014;100(5):1329–36.

    Article  CAS  Google Scholar 

  29. Jansen E, Russell CG, Appleton J, Byrne R, Daniels L, Fowler C, et al. The feeding Practices and structure questionnaire: development and validation of age appropriate versions for infants and toddlers. Int J Behav Nutr Phys Act. 2021;18(1):1–14.

    Article  Google Scholar 

  30. Llewellyn CH, van Jaarsveld CH, Johnson L, Carnell S, Wardle J. Development and factor structure of the Baby Eating Behaviour Questionnaire in the Gemini birth cohort. Appetite. 2011;57(2):388–96.

    Article  Google Scholar 

  31. World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: World Health Organization; 2006. Report No.: 924154693X.

  32. Schreiber JB, Nora A, Stage FK, Barlow EA, King J. Reporting structural equation modeling and confirmatory factor analysis results: a review. J Educational Res. 2006;99(6):323–38.

    Article  Google Scholar 

  33. Jung T, Wickrama KA. An introduction to latent class growth analysis and growth mixture modeling. Soc Personal Psychol Compass. 2008;2(1):302–17.

    Article  Google Scholar 

  34. Stata Statistical Software. College Station. TX: Stata Corp LP; 2019.

    Google Scholar 

  35. Vandenbroucke JP, Elm Ev, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147(8):W–163.

    Article  Google Scholar 

  36. Blissett J. Relationships between parenting style, feeding style and feeding practices and fruit and vegetable consumption in early childhood. Appetite. 2011;57(3):826–31.

    Article  Google Scholar 

  37. Spill MK, Callahan EH, Shapiro MJ, Spahn JM, Wong YP, Benjamin-Neelon SE, et al. Caregiver feeding practices and child weight outcomes: a systematic review. Am J Clin Nutr. 2019;109(Supplement_1):990S–1002S.

    Article  Google Scholar 

  38. Fisher JO, Birch LL. Restricting access to palatable foods affects children’s behavioral response, food selection, and intake. Am J Clin Nutr. 1999;69:1264–72.

    Article  CAS  Google Scholar 

  39. Fisher JO, Birch LL. Restricting access to foods and children’s eating. Appetite. 1999;32(3):405–19.

    Article  CAS  Google Scholar 

  40. Powell EM, Frankel LA, Hernandez DC. The mediating role of child self-regulation of eating in the relationship between parental use of food as a reward and child emotional overeating. Appetite. 2017;113:78–83.

    Article  Google Scholar 

  41. Verbeken S, Braet C, Lammertyn J, Goossens L, Moens E. How is reward sensitivity related to bodyweight in children? Appetite. 2012;58(2):478–83.

    Article  Google Scholar 

  42. Silva TA, Jordani MT, Guimarães IGdC, Alves L, Braga CBM, Luz SdAB. Assessment of eating behavior and food neophobia in children and adolescents from UBERABA-MG. Revista Paulista de Pediatria. 2020;39:e2019368.

    Article  Google Scholar 

  43. Svensson V, Lundborg L, Cao Y, Nowicka P, Marcus C, Sobko T. Obesity related eating behaviour patterns in swedish preschool children and association with age, gender, relative weight and parental weight-factorial validation of the Children’s eating Behaviour Questionnaire. Int J Behav Nutr Phys Act. 2011;8(1):1–11.

    Article  Google Scholar 

  44. Carter MA, Dubois L, Tremblay MS, Taljaard M, Jones BL. Trajectories of childhood weight gain: the relative importance of local environment versus individual social and early life factors. PLoS ONE. 2012;7(10):e47065.

    Article  CAS  Google Scholar 

  45. Australian Institute of Health Welfare. Australian national infant feeding survey: indicator results. Canberra: Australian Institute of Health and Welfare; 2010;2012.

  46. Daniels LA, Magarey A, Battistutta D, Nicholson JM, Farrell A, Davidson G, et al. The NOURISH randomised control trial: positive feeding practices and food preferences in early childhood-a primary prevention program for childhood obesity. BMC Public Health. 2009;9(1):1–10.

    Article  Google Scholar 

  47. Smith JD, Egan KN, Montaño Z, Dawson-McClure S, Jake-Schoffman DE, Larson M, et al. A developmental cascade perspective of paediatric obesity: a conceptual model and scoping review. Health Psychol Rev. 2018;12(3):271–93.

    Article  Google Scholar 

  48. Goetz D, Caron W. A biopsychosocial model for youth obesity: consideration of an ecosystemic collaboration. Int J Obes. 1999;23(2):58–64.

    Article  Google Scholar 

  49. Nguyen C, Bera K. Bio-psycho-social approach to the treatment of childhood obesity: a novel technique. J Child Obes. 2016;1(4):16.

    Article  Google Scholar 

  50. Mascola AJ, Bryson SW, Agras WS. Picky eating during childhood: a longitudinal study to age 11 years. Eat Behav. 2010;11(4):253–7.

    Article  Google Scholar 

  51. Hafstad GS, Abebe DS, Torgersen L, von Soest T. Picky eating in preschool children: the predictive role of the child’s temperament and mother’s negative affectivity. Eat Behav. 2013;14(3):274–7.

    Article  Google Scholar 

  52. Cardona Cano S, Tiemeier H, Van Hoeken D, Tharner A, Jaddoe VW, Hofman A, et al. Trajectories of picky eating during childhood: a general population study. Int J Eat Disord. 2015;48(6):570–9.

    Article  Google Scholar 

  53. Russell A, Russell CG. Appetite self-regulation declines across childhood while general self-regulation improves: a narrative review of the origins and development of appetite self-regulation. Appetite. 2021;162:105178.

    Article  Google Scholar 

  54. Podsakoff N. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. 2003;885(879):10.1037.

    Google Scholar 

  55. Mallan KM, Daniels LA, Susan J. Confirmatory factor analysis of the Baby Eating Behaviour Questionnaire and associations with infant weight, gender and feeding mode in an australian sample. Appetite. 2014;82:43–9.

    Article  Google Scholar 

  56. Kakaroukas A, Abrahamse-Berkeveld M, Berrington JE, McNally RJ, Stewart CJ, Embleton ND, et al. An Observational Cohort Study and Nested Randomized Controlled Trial on Nutrition and Growth Outcomes in Moderate and late Preterm Infants (FLAMINGO). Front Nutr. 2021;8:561419.

    Article  Google Scholar 

  57. Shepard DN, Chandler-Laney PC. Prospective associations of eating behaviors with weight gain in infants. Obesity. 2015;23(9):1881–5.

    Article  Google Scholar 

Download references


The authors would like to acknowledge the assistance of the Tresillian Family Care Centres and their staff for their work in advertising this study and recruiting participants, as well as thanks to the parents who participated in the research.


This work was supported by the Health Futures Development Grant provided by the Faculty of Health, University of Technology Sydney. The funder had no role in the design, analysis or writing of this article.

Author information

Authors and Affiliations



CGR, JA, CF, EJ, CR, and EDW designed the study. CGR, JA, CF, CR and EDW collected the data. AJB analysed the data with input from CGR, JA and EJ. AJB led the writing of the article and all authors reviewed, critiqued and approved the manuscript.

Corresponding author

Correspondence to Alissa J Burnett.

Ethics declarations

Ethics approval and consent to participate

Ethical approval was granted from the University of Technology Sydney Human Research Ethics Committee (REF NO. 2015000528) and the Sydney Local Health District Human Research Ethics Committee (Protocol No X15-0233).

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1: 

Supplementary Table 1. The associations between feeding on demand, appetitive traits and infant BMI (n=380). Supplementary Table 2. The associations between food to calm, appetitive traits and infant BMI (n=380). Supplementary Table 3. The associations between persuasive feeding, appetitive traits and infant BMI (n=380). Supplementary Table 4. The associations between parent-led feeding, appetitive traits and infant BMI (n=380).

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Burnett, A.J., Jansen, E., Appleton, J. et al. Bidirectional associations between parental feeding practices, infant appetitive traits and infant BMIz: a longitudinal cohort study. Int J Behav Nutr Phys Act 19, 153 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Appetitive traits
  • Infancy
  • Parent feeding
  • Weight
  • Cross-lagged
  • Child eating behaviours