Help Me Feed Me: A Mixed Methods Study of Factors Associated with Infant and Toddler Child Care Teachers' Responsive Feeding Style

The first 1,000 days of life are a critical window of development, yet 8.1% of US children ages two years or under are at risk for obesity and adverse health outcomes. Children have a greater need for multiple nutrients relative to body weight compared to adults, but attaining adequate nutrition can be a challenge due to caregiver feeding styles and cultural traditions. During this period, it is imperative that children be allowed to develop appropriate self-feeding skills and be provided with nutrient-rich diets to help them establish healthy eating habits and achieve healthy growth. Child care centers are a logical setting to target obesity prevention and healthy eating intervention efforts. In the US, almost one in four children under the age receive care in some form of an organized child care arrangement. This three paper dissertation used a mixed methods analytic approach to answer two research questions: (1) what are the factors associated with infant and toddler child care teachers’ responsive feeding style in child care centers and (2) what are the attitudes and beliefs among infant and toddler child care center teachers surrounding a responsive feeding style? Study 1 validated the Infant Feeding Styles Questionnaire (IFSQ) among US infant and toddler child care teachers and results showed that the IFSQ demonstrated good overall performance for the laissez-faire, pressuring, and responsive constructs and the restrictive-diet quality sub-construct, but a poor model fit for the indulgence construct. In Study 2, two multilevel multiple regression models, accounting for clustering in centers and applying full information maximum likelihood (FIML) to address missing data, were fit using mean teacher IFSQ feeding attention and satiety sub-construct scores as dependent variables, respectively. Results showed that teachers’ motivation to encourage children’s healthy eating - effort/importance and confidence in feeding vegetables to children were positively associated with responsive attention. Study 3 findings indicated that teachers have positive attitudes about their role in supporting child self-feeding but there is a need for more training on child nutrition, responsive feeding, and nutrition policies and expectations in centers. This dissertation adds to the research literature on child care teacher responsive feeding style.