Restrictive, but not instrumental feeding, is associated with Eating in the Absence of Hunger in toddlers: A cross-sectional lab-based study

Understanding the early origins of Eating in the Absence of Hunger (EAH) is crucial, as maladaptive appetite regulation contributes to excessive weight gain in childhood. This cross-sectional study primarily investigated in toddlers the associations between EAH and parental feeding practices (PFP), focusing on instrumental feeding. It also explored the associations with children's temperament or food accessibility, and their potential moderating effects on the relationship between EAH and PFP. Sixty-six parents and toddlers aged 24-36 months participated. EAH (kcal) was assessed using Fisher and Birch's (1999) lab-based paradigm. PFP, children's general temperament and appetitive traits, and food accessibility were parent-reported. Children's weight and height were measured to calculate their BMI z-score. Linear regressions analyzed associations between EAH and PFP, adjusted or not for children's or parents' characteristics. Interactions assessed the moderating effects of temperament or food accessibility. Toddlers' EAH (43 ± 41 kcal) was unrelated to instrumental feeding, namely using food as a reward (r = -0.08, p = 0.76) and to regulate emotions (r = 0.04, p = 0.76), which were rarely applied by parents. EAH was not associated with children's temperament or food accessibility, but exploratory analyses revealed a positive association with parental restriction for health reasons (RFH, r = 0.30, p = 0.01), especially at high and moderate levels of Ease of access to food (RFH x Ease of access interaction: β = 12.2, p = 0.01). Soothability did not moderate the relationship between EAH and PFP. In conclusion, toddler's EAH was not associated with instrumental feeding but correlated positively with health-related restriction. This was moderated by food accessibility, suggesting that limiting food accessibility in early childhood may mitigate this adverse relationship. This study was preregistered (https://osf.io/6r5m8) and received ethical approbation (CEEI, registration number 23-1001).