Authoritative parent feeding style is associated with better child dietary quality at dinner among low-income minority families


Authoritative parent feeding style is associated with better child dietary
quality at dinner among low-income minority families

Katherine R Arlinghaus,1 Kirstin Vollrath,3 Daphne C Hernandez,1,2 Shabnam R Momin,3 Teresia M O’Connor,3

Thomas G Power,4 and Sheryl O Hughes3

1Department of Health and Human Performance, and 2HEALTH Research Institute, University of Houston, Houston, TX; 3USDA–Agricultural Research
Service, Children’s Nutrition Research Center at Baylor College of Medicine, Houston, TX; and 4Department of Human Development, Washington State
University, Pullman, WA

ABSTRACT
Background: Parent feeding styles have been linked to child weight
status across multiple studies. However, to our knowledge, the
link between feeding styles and children’s dietary quality, a more
proximal outcome, has not been investigated.
Objective: The purpose of this study was to examine the relation
between parent feeding styles and dietary quality of Head Start
preschoolers’ dinner meals.
Design: The amount of food served and consumed by children was
measured by using a standardized digital photography method during
3 in-home dinner observations of low-income minority families in
Houston, Texas. Trained dietitians entered food served and consumed
into the Nutrient Data System for Research 2009 for nutrient
analysis. Overall dietary quality of the food served and consumed
at dinner was evaluated by using the Healthy Eating Index 2010
(HEI-2010). Parent feeding style was assessed with the use of the
Caregiver’s Feeding Style Questionnaire (CFSQ). On the basis of
a parent’s level of demandingness and responsiveness to his or her
child during feeding, the CFSQ categorizes parent feeding into 4
styles: authoritative (high demandingness and high responsiveness),
authoritarian (high demandingness and low responsiveness), indul-
gent (low demandingness and high responsiveness), or uninvolved
(low demandingness and low responsiveness).
Results: For the overall sample, the mean ± SD HEI score for
dinner served was 44.2 ± 8.4, and the mean ± SD HEI score
for dinner consumed was 43.4 ± 7.0. In the fully adjusted model,
ANCOVA indicated that the authoritative parent feeding style was
associated with significantly higher child dietary quality compared
with the authoritarian feeding style (mean ± SEE HEI consumed—
authoritative 45.5 ± 0.9; authoritarian: 41.9 ± 0.7; P = 0.001).
Conclusions: Parent feeding style contributes to the overall dietary
quality of children, and among low-income minority preschoolers an
authoritative feeding style was associated with the highest dietary
quality of the 4 feeding styles. Interventions to promote feeding
practices that contribute to authoritative feeding are needed to
improve the dietary quality of preschool children at dinner. This trial
was registered at https://clinicaltrials.gov as NCT02696278. Am
J Clin Nutr 2018;108:730–736.

Keywords: child dietary quality, direct observation, parent feeding
styles, preschoolers, Healthy Eating Index

INTRODUCTION

Parental feeding styles have consistently been linked to child
weight status (1–6) and some child eating behaviors (7–10) across
studies in low-income families. However, to our knowledge,
no study has linked styles of feeding to the overall quality of
the child’s diet on the basis of a series of dinner meals. Poor
dietary quality in young children can lead to adverse health
consequences as children age (11). Preschool age is an important
developmental period for adopting healthy eating habits because
eating behaviors and preferences established during this time are
likely to persist through childhood (12) and into adulthood (13).

Parents are direct drivers of children’s dietary quality, and
consequently have a unique role in the establishment of children’s
eating environments (14). Originally developed by Baumrind
(15) and extended by Maccoby and Martin (16), general parenting
styles categorize overall patterns of parenting behavior on
the basis of 2 underlying dimensions of demandingness (the

Supported by funds from the USDA, grant 2006-55215-16695. This work
is a publication of the United States Department of Agriculture [USDA–
Agricultural Research Service (-ARS)] Children’s Nutrition Research Center,
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, and
has been funded in part with federal funds from the USDA-ARS under
cooperative agreement 58-6250-0-008, and in part by Kraft Foods, Inc.
The contents of this publication do not necessarily reflect the views or

policies of the USDA, nor does mention of trade names, commercial products,
or organizations imply endorsement from the US government.
Supplemental Figure 1 is available from the “Supplementary data” link in

the online posting of the article and from the same link in the online table of
contents at https://academic.oup.com/ajcn/.
Address correspondence to SOH (e-mail: shughes@bcm.edu).
Received January 9, 2018. Accepted for publication May 30, 2018.
First published online August 30, 2018; doi: https://doi.org/10.1093/ajcn/

nqy142.

730 Am J Clin Nutr 2018;108:730–736. Printed in USA. © 2018 American Society for Nutrition.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which
permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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PARENTING FEEDING STYLE AND CHILD DIETARY QUALITY 731

extent to which parents show control, maturity demands, and
supervision) and responsiveness (the extent to which parents
show affective warmth, acceptance, and involvement). On the
basis of this work, parent feeding styles were developed to
assess an overall attitude and emotional climate specifically
with regard to child feeding (2–5). Parent feeding styles are an
optimal way to measure feeding because they encompass the
behavioral, social, and nutritional aspects of the parent-child
feeding dynamic, including the entirety of family eating from
meal conceptualization to consumption (2–5). Feeding styles are
conceptualized differently from goal-oriented feeding practices.
As with general parenting styles, feeding styles are measured
along the dimensions of demandingness and responsiveness.
Differences in the dimensions of demandingness (persistence
during eating episodes) and responsiveness (sensitivity to the
child’s individual needs during feeding) result in 4 feeding
categories: authoritative (high demand and high response),
defined as reasonable nutritional demands in conjunction with
sensitivity toward the child; authoritarian (high demand and low
response), defined as high control with little sensitivity during
feeding; indulgent (low demand and high response), defined
as high responsivity with little structure around feeding; and
uninvolved (low demand and low response), defined as a lack of
involvement during feeding (2–5).

Direct comparison of previous studies regarding feeding styles
and diet is difficult due to varying child age groups and eating
behaviors targeted as outcomes in the study designs (7–10).
Importantly, most of these studies relied on parent dietary recall
of child consumption instead of direct observation (17), did not
assess the dietary quality of the food served compared with what
was consumed, and assessed the quality of specific food groups
(i.e., fruit, vegetables, whole grains) instead of overall dinner
consumption patterns (8–10). It is important to assess the quality
of the overall meal because dietary patterns are more indicative
of disease risk than individual foods or nutrients alone (18). For
example, findings from experimental and longitudinal studies
examining the relation between specific foods, such as fruit and
vegetables, and child weight status have not been consistent
(19). Although investigation into specific food groups would
be expected to relate to overall dietary quality, a more com-
prehensive assessment of dietary quality is likely necessitated
to better understand the relation between dietary consumption
and health outcomes. Because parent feeding style is a construct
used to better understand the relation between parental feeding
and child health outcomes, the potential association between
overall dietary quality and parent feeding style is important to
examine.

The purpose of this study was to compare the overall dietary
quality using the Healthy Eating Index (HEI) of Head Start
preschoolers’ dinner meals by parent feeding styles. In the
general parenting literature, the authoritative parenting style
(high demandingness and high responsiveness) has repeatedly
been associated with positive child outcomes, including higher
academic achievement, fewer high-risk adolescent behaviors,
and greater child maturity (20). Specific to health, the general
authoritative parenting style has been associated with improved
weight status (21) and may serve as a moderator of the
relation between feeding practices and child fruit and vegetable
consumption (22, 23). Because feeding styles focus on general
parenting dimensions in a specific eating context, it is likely that

they are more importantly linked to child dietary quality than
parenting style.

Therefore, it was hypothesized that the authoritative feeding
style (high demandingness and high responsiveness) would be
associated with a higher dinner dietary quality than the other 3
parent feeding styles. This study also had an exploratory aim to
compare the dietary quality of the dinner meal served with that of
the meal consumed overall and within each of the parent feeding
styles. It was hypothesized that the dietary quality of the dinner
served would be higher than that consumed within all 4 feeding
styles.

METHODS

Subjects

Caregivers and their preschool children, who were enrolled
in 33 Head Start centers in 3 districts in Houston, Texas, were
recruited during 2007 and 2008. Approximately 2500 families
were approached during recruitment. Of these, 275 families
returned the flyer that was handed out to indicate their interest
in participating. All caregivers self-identified their ethnicity as
either African American or Hispanic. A caregiver was defined
as the individual most responsible for food intake of the child
outside of the Head Start day. The caregiver was designated as
the target parent in this study. Most caregivers were parents, with
a small number of grandparents. Subsequently, throughout the
article, caregivers will be referred to as parents. Subjects in this
study were part of a larger project that examined parent-child
interactions at the dinner meal. Details of the primary analysis
of this study have previously been published (4), as have details
of initial dietary intake analysis (24). The flow of participants is
depicted in a diagram in Supplemental Figure 1.

Procedures

Parents were recruited during parent meetings, when their
children were dropped off or picked up at Head Start, and through
sign-up sheets posted at the centers. Written consent for the
parent and his or her preschooler’s participation in the study
was obtained. Researchers completed 3 in-home observations of
participants’ dinner meals. Parents were instructed to proceed as
they normally would at a dinner meal. Eighty-five percent of
the meals were eaten at dinner tables. In half of the families,
the parent and child ate together. In 43% of the observations,
other family members were present during the meals. Researchers
provided standardized plates, bowls, and cups, and the food
served was documented using a digital photography method.
Additional helpings were observed and recorded. It was also
noted whether the child was served by the parent or if the child
served him- or herself. After the meal was completed, researchers
measured plate waste to the nearest 0.1 g on a digital scale (Ohaus
Model Pro Scout SP601 scale). Details of this procedure have
been described elsewhere (22). At the end of each observed meal,
parents were financially compensated (totaling $125 over the
3 observations). This study was approved by the Institutional
Review Board at Baylor College of Medicine, and was registered
at https://clinicaltrials.gov as NCT02696278.

https://clinicaltrials.gov


732 ARLINGHAUS ET AL.

Measures

Meal representativeness and dietary quality

To assess meal representativeness, parents were asked whether
the meal was a typical dinner eaten by their family. Detailed
dinner menu information, including recipes, preparation, and
brand names of foods, was collected from the parent at each
observation, and caregivers reported whether or not the meal
they ate was a usual meal for them. The amount of food served
was estimated by 2 registered dietitians trained in the digital
photography method (24). This information was compiled and
entered into the Nutrient Data System for Research 2009 (NDSR)
for nutrient analysis. Foods were broken down into the food
groups and components utilized in the 2010 Dietary Guidelines
for Americans (25).

The dietary quality of the child’s dinner meal was evaluated
using the HEI-2010 (26, 27). The HEI-2010 evaluates adherence
to the 2010 Dietary Guidelines for Americans (25) on a scale from
0 to 100, with a score of 100 being the highest score possible.
The HEI is a validated measure of dietary quality because it
has been shown to be associated with improved health outcomes
(28, 29). At the time of this study, the HEI had not yet been
updated for the 2015 Dietary Guidelines for Americans. Because
there are minimal differences between how the HEI-2010 and
HEI-2015 are calculated (30), it is unlikely that HEI-2015 scores
would meaningfully differ from the HEI-2010 scores. The food-
group breakdown from the NDSR nutrient analysis was used
to calculate HEI-2010 component scores, which were summed
to calculate a total HEI-2010 score (26). Adequacy components
include total fruit, whole fruit, total vegetables, greens and beans,
whole grains, dairy, protein foods, seafood and plant protein,
and fatty acids. Moderation components, for which higher scores
indicate lower consumption, include refined grains, sodium, and
empty calories. The HEI-2010 has been designed so that no one
food is required to achieve a perfect score. This enables the HEI-
2010 to evaluate a variety of meal patterns (vegetarian, vegan,
omnivore) and is inclusive of diets typically consumed by a wide
range of ethnic and cultural groups (26). Although the HEI-2010
is typically used to evaluate a person’s daily intake, because the
index considers food relative to its energy content (27) the index
can be used to evaluate the dietary quality of a single meal (31).

Parent feeding styles

Parent feeding style was assessed using the Caregiver’s
Feeding Styles Questionnaire (3). This questionnaire measures
feeding styles within a general parenting style framework. With
the use of a 5-point scale (from 1 = never to 5 = always), parents
report on how often they use 12 parent-centered compared with
7 child-centered feeding directives. Parents are then classified
into 4 feeding styles on the basis of high and low scores of 2
dimensions of parents’ demandingness of and responsiveness to
their child. Scoring procedures are described elsewhere (3–5).
Reliability and validity of the measure have been established
across multiple studies (3–5), including an observational study
of similar design and study population as the present study (4).

Anthropometric measures

Trained research staff measured the height (Seca 213) and
weight (Befour PS6600) of children and parents in light clothing
without shoes to the nearest 0.1 cm and 0.1 kg, respectively.

Children’s age- and sex-specific BMI percentile and standardized
BMI (zBMI) were computed from the revised 2000 growth charts
and classified according to the weight categories proposed by the
CDC (32).

Child and parent characteristics

Parents and their children were classified as African American
or Hispanic on the basis of self-identification. Parents also
identified their educational attainment and their marital status, as
well as their own and, if applicable, their spouse’s employment
status.

Data analysis

Data analysis was conducted with the use of SPSS version
25. Missing data were handled using list-wise deletion. Parents
were categorized into 4 feeding style groups by conducting a
cross-classification of high and low median scores on the parent
dimensions of demandingness and responsiveness from the
Caregiver’s Feeding Styles Questionnaire. The child HEI scores
were derived from averaging across the dietary data derived from
3 meal observations. Three meals were observed for 89% of the
families, 2 meals for 10% of the families, and 1 meal for 1%
of the families. Chi-square tests and ANOVAs were conducted
to assess differences in child, parent, and meal characteristics
by feeding style. Differences in child HEI consumed scores
between child, parent, and meal characteristics were examined
using t tests and ANOVAs. Pearson’s correlation was conducted
to determine the correlation between HEI served and consumed
scores, and exploratory paired-samples t tests were used to
compare HEI served and consumed scores among child, parent,
and meal characteristics. Three ANOVA models were conducted
to compare differences in child HEI consumed score across
feeding styles. The first was unadjusted, the second adjusted for
HEI served score, and the third adjusted for child zBMI, parent
ethnicity, parent education, parent employment, parent marital
status, the number of people at the meal, the person serving the
child, meal representativeness, and child HEI served score. A post
hoc least-significant difference test was completed to determine
which feeding styles differed from one another.

RESULTS

Of the 275 families who consented to participate in this study,
dietary information from observed dinner meals was available
for 145 parent-child dyads. Only 131 dyads were included in
this analysis due to incomplete feeding style (n = 6), and
demographic (n = 8) data. Half of the preschoolers were male
and 62% were Hispanic, and they had a mean ± SD age of 4.5 ±
0.6 y. Further descriptive characteristics of the sample are
reported in Table 1. Chi-square and ANOVA testing indicated
no significant differences in characteristics by feeding style.
Independent t tests analyzing child HEI consumed scores by
child, parent, and meal characteristics indicated a significantly
higher mean HEI score consumed among Hispanic than among
African-American families [t = 3.2, P = 0.002]. No other
significant differences were found in HEI consumed scores
within any of the child, parent, or meal characteristics.

Table 2 shows the results of paired-samples t tests between
mean child HEI scores served and consumed. Overall, the HEI



PARENTING FEEDING STYLE AND CHILD DIETARY QUALITY 733

TABLE 1
Characteristics of the study population: full analytic sample and by caregiver feeding style1

Overall Authoritative Authoritarian Indulgent Uninvolved

Overall sample, n (%) 131 (100) 27 (21) 41 (31) 37 (28) 26 (20)
Child characteristics
Age, y 4.5 ± 0.62 4.6 ± 0.625 4.5 ± 0.6 4.5 ± 0.7 4.4 ± 0.7
Sex, n (%)

Female 66 (50) 15 (56) 23 (56) 18 (49) 10 (38)
Male 65 (50) 12 (44) 18 (44) 19 (51) 16 (62)

zBMI 0.8 ± 1.1 0.6 ± 1.2 0.7 ± 1.0 0.9 ± 1.2 1.2 ± 1.1
Weight category, n (%)

Underweight 3 (2) 1 (4) 0 (0) 2 (5) 0 (0)
Normal weight 74 (56) 16 (59) 29 (71) 15 (41) 14 (54)
Overweight 27 (21) 5 (19) 5 (12) 12 (32) 5 (19)
Obese 27 (21) 5 (19) 7 (17) 8 (22) 7 (27)

Parent characteristics, n (%)
Race/ethnicity

Hispanic 81 (62) 22 (81) 26 (63) 18 (49) 15 (58)
African American 50 (38) 5 (19) 15 (37) 19 (51) 11 (42)

Education
Some college or more 57 (44) 13 (48) 16 (39) 17 (46) 11 (42)
High school diploma/GED 34 (26) 5 (19) 13 (32) 10 (27) 6 (23)
Some high school or less 40 (31) 9 (33) 12 (29) 10 (27) 9 (35)

Employment status
Both caregiver and spouse employed 33 (25) 8 (30) 13 (32) 9 (24) 3 (12)
Either caregiver or spouse employed 72 (55) 15 (56) 19 (46) 19 (51) 19 (73)
Neither caregiver nor spouse employed 26 (20) 4 (15) 9 (22) 9 (24) 4 (15)

Marital status
Married/cohabitating 64 (49) 14 (52) 24 (59) 14 (38) 14 (54)
Single 67 (51) 13 (48) 17 (41) 23 (62) 12 (46)

Meal characteristics
Number of people at the meal 2.1 ± 1.1 2.0 ± 1.2 2.0 ± 1.0 2.5 ± 1.1 2.1 ± 1.3
Person serving child, n (%)

Parent serves child 116 (89) 23 (85) 36 (88) 33 (89) 24 (92)
Child serves him/herself 15 (11) 4 (15) 5 (12) 4 (11) 2 (8)

Meal representativeness, n (%)
Usual dinner 92 (70) 20 (74) 25 (61) 26 (70) 21 (81)
Not a usual dinner 39 (30) 7 (26) 16 (39) 11 (30) 5 (19)

1No significant differences in characteristics by feeding styles were indicated by ANOVA or chi-square test. GED, general equivalency diploma; zBMI,
standardized BMI.

2Mean ± SD (all such values).

score of what children were served and what they consumed
was highly correlated (r = 0.8, P < 0.001). However, significant
differences between served and consumed scores existed among
children whose parents had authoritarian or indulgent feeding
styles compared with the authoritative feeding style (P = 0.008
and 0.044, respectively).

Table 3 shows the unadjusted and adjusted means of child HEI
consumed scores. All 3 ANOVA models showed a significant
difference in child HEI consumed score across feeding styles
[unadjusted F(3, 116) = 5.1, P = 0.002, η2 = 0.1; partially
adjusted F(3, 116) = 3.9, P = 0.011, η2 = 0.1; fully adjusted
F(3, 116) = 3.7, P = 0.015, η2 = 0.1]. Post hoc tests using
least-significant differences showed a significantly higher HEI
consumed score among the authoritative feeding style compared
with the authoritarian, indulgent, and uninvolved feeding styles
in the unadjusted model (P < 0.001, P = 0.021, and P = 0.002,
respectively). The higher HEI-consumed score among the
authoritative compared with the uninvolved feeding style was no
longer significant in the model adjusting for HEI-served score

(P = 0.118), and only the difference between authoritative and
authoritarian feeding styles remained significant in the fully
adjusted model (P = 0.001).

DISCUSSION

This study examined the relation between parent feeding style
and overall preschooler dietary quality at dinner among a sample
of low-income Hispanic and African-American families. Con-
sistent with our hypothesis, the authoritative feeding style (high
demandingness and high responsiveness) was associated with
significantly higher child dietary quality than the authoritarian
feeding style (high demandingness and low responsiveness).
The superior dietary quality found here for the authoritative
compared with the authoritarian feeding style is consistent with
child dietary outcomes from research with general parenting
styles, which found fruit and vegetable consumption to be better
among children with parents engaging in an authoritative feeding
style (23). In contrast to our hypothesis, in the adjusted model,



734 ARLINGHAUS ET AL.

TABLE 2
Child HEI score of dinner meal served and consumed by characteristics1

HEI dinner score

Served Consumed

Overall 44.2 ± 8.4 43.4 ± 7.0
Parental feeding style

Authoritative 47.5 ± 9.9 47.6 ± 6.8
Authoritarian 43.6 ± 8.1 41.5 ± 6.22
Indulgent 44.7 ± 7.0 43.6 ± 6.43
Uninvolved 41.2 ± 8.1 41.7 ± 7.8

Child characteristics
Sex
Female 43.0 ± 8.2 42.8 ± 6.5
Male 45.5 ± 8.5 43.9 ± 7.62

Weight category
Underweight 45.0 ± 5.0 45.9 ± 3.7
Normal weight 44.3 ± 1.0 43.3 ± 0.9
Overweight 43.0 ± 1.6 43.8 ± 1.3
Obese 45.3 ± 1.5 42.9 ± 1.43

Parent characteristics
Race/ethnicity
Hispanic 46.0 ± 9.24 44.9 ± 7.44
African American 41.4 ± 6.0 41.0 ± 5.8

Education
Some college or more 44.2 ± 8.0 43.6 ± 7.1
High school diploma/GED 43.0 ± 8.8 42.3 ± 6.6
Some high school or less 45.4 ± 8.7 44.03 ± 7.4

Employment status
Both caregiver and spouse employed 46.3 ± 8.31 44.7 ± 6.6
Either caregiver or spouse employed 43.4 ± 8.81 43.1 ± 7.6
Neither caregiver nor spouse employed 44.0 ± 7.1 42.5 ± 5.93

Marital status
Married/cohabitating 45.0 ± 9.3 44.3 ± 6.8
Single 43.5 ± 7.5 42.5 ± 7.33

Meal characteristics
Person serving child
Parent serves child 44.4 ± 0.8 43.6 ± 0.7
Child serves themselves 42.7 ± 1.5 41.7 ± 1.7

Meal representativeness
Usual dinner 44.2 ± 0.9 43.4 ± 0.7
Not a usual dinner 44.4 ± 1.3 43.4 ± 1.1
1Values are means ± SDs; n = 131. GED, general equivalency diploma;

HEI, Healthy Eating Index.
2, 3Different from HEI dinner score served (paired-samples t test;

differences assessed horizontally within a row): 2P < 0.01, 3P < 0.05.
4Different across levels of the characteristic, P < 0.05 (paired-samples

t test indicated the HEI dinner score to be significantly different; assessed
vertically within a column).

no significant differences in child dinner dietary quality were
seen between the authoritative feeding style and either the
indulgent or uninvolved feeding styles. This is not consistent
with previous studies on feeding style and dietary quality, which
found permissive feeding styles to be associated with higher
child consumption of low-nutrient-dense foods and poor fruit
and vegetable consumption (8, 9). This is likely due to the great
number of covariables in the main model and the overall sample
size. In the unadjusted model, the authoritative feeding style
was associated with significantly higher dietary quality compared
with all other feeding styles. Overall, the main findings of this
study indicate that in low-income minority families, a child’s
highest dietary quality is likely to be achieved when parents not

only set appropriate guidelines for eating but are also responsive
to their child’s eating preferences and behaviors.

Although most dietary studies rely on self-report, one strength
of this study was its ability to objectively measure participants’
diet through detailed menu information, digital photography, and
food-waste measurement. The dietary component in this study
was unique because it includes the objective measurement of
both food served and food consumed. Having both measurements
enabled exploratory investigation into the differences in the
quality of food eaten compared with that served to the children.
Although consumption is ultimately limited by the food available,
the child’s choice of which foods and how much to consume of
the meal served to him or her can either increase or decrease
dietary quality.

The findings of this study are consistent with our exploratory
hypothesis that the overall dietary quality of food served would be
higher than that of the food consumed. Although this difference
was not significant among the overall sample, the dietary quality
of the meal served was significantly higher than the dietary
quality of the meal consumed among children whose parents have
either an authoritarian or indulgent feeding style. These feeding
styles have both been associated with unhealthy dietary intake
(8, 9). Parents with an indulgent feeding style are likely to be
responsive to a child’s mood during the meal but are unlikely
to make demands on or offer guidance about a child’s intake
once the food is served. It is thought that this lack of guidance
contributes to poor child dietary quality (8).

Conversely, parents with an authoritarian feeding style are
likely to make demands of their child during dinner and
not be responsive to their child’s preferences, emotions, or
individual needs. However, it is possible for the high level of
demandingness exhibited by authoritarian feeders to consist of
demands unrelated to overall dietary quality. For example, a
parent could make disciplinary demands on a child during dinner
(e.g., sit up straight, use your napkin). It is also possible for
the demands made by parents with an authoritarian feeding
style to be inconsistent with healthy choices. The parent feeding
style construct does not specifically consider parents’ nutrition
knowledge or values with regard to healthful food, but only
assesses parents’ level of demandingness on and responsiveness
to their children during eating episodes. The significant difference
between the dietary quality served and consumed indicates that
parents’ influence during a meal is important and necessitates
more investigation into how specific goal-oriented parent feeding
practices during the dinner meal may relate to overall dietary
quality. This may be especially pertinent given that the dietary
quality of the meal served was significantly higher than that
consumed among children with obesity. The lack of statistical
difference in zBMI across feeding styles seen in this sample
(n = 131) could be due to insufficient power because a significant
3-way interaction between parent feeding style, ethnicity, and sex
on child zBMI was found in the full sample (n = 177) (4).

Given that many Head Start preschool children eat breakfast,
lunch, and 2 snacks at the Head Start center, this study captured
the dietary quality of the meal most reflective of parents’
influence on their child’s dietary quality: the dinner meal.
Furthermore, the multiple-observation method used in this study
offers insight into the family’s dinner patterns. However, HEI
scores for one meal may not be reflective of the dietary quality
of an entire day’s intake. The overall mean ± SD HEI score



PARENTING FEEDING STYLE AND CHILD DIETARY QUALITY 735

TABLE 3
Adjusted and unadjusted mean child HEI scores of dinner meal consumed by feeding style1

Child HEI consumed score

Unadjusted model Partially adjusted model2 Fully adjusted model3

Caregiver feeding style Mean ± SD P Mean ± SEE P Mean ± SEE P
Authoritative 47.6 ± 6.8 – 45.5 ± 0.8 – 45.5 ± 0.9 –
Authoritarian 41.5 ± 6.2 <0.001 41.9 ± 0.7 0.001 41.9 ± 0.7 0.001
Indulgent 43.6 ± 6.4 0.021 43.3 ± 0.7 0.042 43.2 ± 0.7 0.059
Uninvolved 41.7 ± 7.8 0.002 43.6 ± 0.8 0.118 43.7 ± 0.9 0.161

1P values were determined by using least-significant differences pairwise comparison. HEI, Healthy Eating Index; zBMI, standardized BMI.
2Adjusted for child HEI served score.
3Adjusted for child zBMI, parent ethnicity, parent education, parent employment, parent marital status, the number of people at the meal, the person

serving the child, meal representativeness, and child HEI served score.

of the dinner meal consumed in the present study was lower
(43.4 ± 7.0) than in previous studies that used dietary recall data
from the 2012 NHANES, which reported an average HEI-2010
score of 52 for children aged 4–8 y (33) and 55 for children aged
2–5 y (34). Some food components are more likely to be
consumed at various times of the day than are others, and this
may differ by culture (35). For example, in a typical American
diet, fruit may be more frequently consumed in the morning
than in the evening meal. In this instance, a low fruit component
score for dinner does not necessarily indicate that fruit is lacking
from a person’s diet. Because the majority of the sample in
the present study was Hispanic (62%), it is unlikely that the
low (relative to other preschool-aged children) dietary quality
scores observed in this study were due to ethnic differences
in eating patterns. Indicators of dietary quality—for example,
vegetable intake—have consistently been found to be higher
among Hispanic individuals than African-American or White
individuals (36–38). Although a good strategy to ensure that all
food components are regularly consumed, each food component
does not need to be consumed at each meal for adequate overall
dietary quality.

Some limitations to this study are acknowledged. As men-
tioned above, only the dinner meals were observed among various
meals consumed by children during the day. Other limitations
include the use of direct observation, which may alter family
behaviors, including the food served by the parent and the food
consumed by the child. In addition, the focus on only Head Start
African-American and Hispanic families reduces the generaliz-
ability of these findings to low-income Head Start families from
2 ethnic groups. Last, due to the cross-sectional design of this
study, no inferences with regard to causation can be made.

A nutritious diet is necessary for proper growth and devel-
opment (11) and dietary consumption habits established during
childhood are likely to continue being practiced as an adult
(13). The results of this study suggest that, with regard to child
dietary quality, an authoritative feeding style may be preferable
to an authoritarian feeding style among low-income minority
families with preschool-aged children. Further research to better
understand feeding practices that contribute to authoritative
feeding, especially those occurring during the dinner meal, is
warranted to gain a better understanding for how parent feeding
styles can be shifted toward the authoritative feeding style. From
this information, parent feeding interventions can be designed

to improve the dietary quality and, consequently, the health of
children.

The authors’ responsibilities were as follows—KRA, KV, DCH, and SOH:
designed the research and analyzed the data; TGP and SOH: conducted the
research; KRA, DCH, and SOH: had primary responsibility for the final
content; and all authors: wrote the manuscript, and read and approved the
final manuscript. The authors had no financial relationships relevant to this
article to disclose.

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