title: Bi-directional associations between child fussy eating and parents' pressure to eat: Who influences whom?
abstract: BACKGROUND
  Fussy eating is common in young children, often raising concerns among parents. The use of pressuring feeding practices may provoke or worsen child fussiness, but these practices could equally be a parent's response to child fussy eating.
  
  
  OBJECTIVE
  In longitudinal analyses, we assessed directionality in the relation between fussy eating and parent's pressure to eat across childhood.
  
  
  METHODS
  Study participants were 4845 mother-child dyads from the population-based Generation R cohort in the Netherlands. The Child Behavior Checklist was used to assess fussy eating (2 items) at child ages 1½, 3 and 6years. Parents' pressure to eat was assessed with the Child Feeding Questionnaire (4 items) when children were 4years old. All scale scores were standardized.
  
  
  RESULTS
  Linear regression analyses indicated that preschoolers' fussy eating prospectively predicted higher levels of parents' pressure to eat at child age 4years, independently of confounders (adjusted B=0.24, 95% CI: 0.21, 0.27). Pressure to eat at 4years also predicted more fussiness in children at age 6years, independently of confounders and of fussy eating at baseline (adjusted B=0.14, 95% CI: 0.11, 0.17). Path analyses indicated that the relation from fussy eating at 3years to parenting one year later was stronger than from pressure at 4years to fussy eating two years later (p<0.001).
  
  
  CONCLUSIONS
  Our findings suggest bi-directional associations with parental pressuring feeding strategies being developed in response to children's food avoidant behaviors, but also seemingly having a counterproductive effect on fussiness. Thus, the use of pressure to eat should be reconsidered, while providing parents alternative techniques to deal with their child's fussy eating.
authors.affiliation: Institute of Psychology, Erasmus University Rotterdam, Netherlands; Department of Child and Adolescent Psychiatry, Psychology, Erasmus MC-Sophia, Netherlands. Electronic address: p.w.jansen@erasmusmc.nl.
authors.forename: Pauline W
authors.initials: PW
authors.lastname: Jansen
authors.affiliation: The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
authors.forename: Lisanne M
authors.initials: LM
authors.lastname: de Barse
authors.affiliation: The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Department of Pediatrics, Erasmus MC-Sophia, Netherlands.
authors.forename: Vincent W V
authors.initials: VWV
authors.lastname: Jaddoe
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychology, Erasmus MC-Sophia, Netherlands.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Verhulst
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychology, Erasmus MC-Sophia, Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
authors.forename: Henning
authors.initials: H
authors.lastname: Tiemeier
mesh_terms: D000367:Age Factors; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D002675:Child, Preschool; D018672:Community Health Planning; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D005518:Food Preferences; D006801:Humans; D007223:Infant; D007389:Internal-External Control; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D009034:Mother-Child Relations / Q000523:psychology*; D009426:Netherlands; D016487:Parenting / Q000523:psychology*; D012189:Retrospective Studies
keywords: Children; Controlling feeding; Fussy eating; Longitudinal; Pickiness; Pressure to eat