www.jped.com.br
REVIEW
ARTICLE
Infant
feeding:
beyond
the
nutritional
aspects
夽
Giselia
A.P.
Silva
a,∗,
Karla
A.O.
Costa
a,
Elsa
R.J.
Giugliani
baPostgraduatePrograminChildandAdolescentHealth,UniversidadeFederaldePernambuco(UFPE),Recife,PE,Brazil bDepartmentofPediatrics,UniversidadeFederaldoRioGrandedoSul(UFRGS),PortoAlegre,RS,Brazil
Received15January2016;accepted27January2016 Availableonline18March2016
KEYWORDS
Responsivefeeding; Parentalfeedings practices; Parentingstyles; Infantfeeding
Abstract
Objective: Todrawattentionto theimportanceofinteractionbetweencaregiverandchild duringfeedingandtheinfluenceofparentingstyleondietaryhabitformation.
Sourceofdata: A search was performed in the PubMed and Scopus databases for articles addressing responsive feeding; the articles considered most relevant by the authors were selected.
Synthesisofdata: Thewaychildrenarefedisdecisivefortheformationoftheireatinghabits, especially the strategies thatparents/caregivers use tostimulate feeding. In this context, responsivefeedinghasbeenemphasized,withthekeyprinciples:feedtheinfantdirectlyand assist olderchildren when they already eaton their own; feedthem slowly and patiently, andencouragechildrentoeatbutdonotforcethem;ifthechildrefusesmanytypesoffoods, experimentwithdifferentfoodcombinations,tastes,textures,andmethodsofencouragement; minimizedistractionsduringmeals;andmakethemealsanopportunityforlearningandlove, talkingtothechildduringfeedingandmaintainingeyecontact.Itisthecaregiver’s responsibil-itytobesensitivetothechild’ssignsandalleviatetensionsduringfeeding,andmakefeeding timepleasurable;whereasitisthechild’sroletoclearlyexpresssignsofhungerandsatiety andbereceptivetothecaregiver.
Conclusion: Responsivefeeding isvery importantindietary habit formation andshould be encouragedbyhealthprofessionalsintheiradvicetofamilies.
©2016PublishedbyElsevierEditoraLtda.onbehalfofSociedadeBrasileiradePediatria.
PALAVRAS-CHAVE
Alimentac¸ão responsiva;
Práticasalimentares parentais;
Alimentac¸ãoinfantil:alémdosaspectosnutricionais
Resumo
Objetivo: Chamaraatenc¸ãoparaaimportânciadainterac¸ãoentrecuidadorecrianc¸adurante aalimentac¸ãoeainfluênciadoestilodeparentalidadenaformac¸ãodohábitoalimentar.
夽
Pleasecitethisarticleas:SilvaGA,CostaKA,GiuglianiER.Infantfeeding: beyondthenutritionalaspects.JPediatr(RioJ).2016; 92(3Suppl1):S2---7.
∗Correspondingauthor.
E-mail:giseliaalves@gmail.com(G.A.P.Silva).
http://dx.doi.org/10.1016/j.jped.2016.02.006
Estilosparentais; Alimentac¸ãoinfantil
Fontesdosdados: Foi realizada busca na basede dados PubMed e Scopus de artigos abor-dandoaalimentac¸ãoresponsiva,tendosidoselecionadosaquelesjulgadosmaisrelevantespelos autores.
Síntesedosdados: Omododealimentarascrianc¸asédecisivonaformac¸ãodohábitoalimentar, sobretudoasestratégiasqueospais/cuidadoresutilizamparaestimularaalimentac¸ão.Nesse contexto,aalimentac¸ãoresponsivatemmerecidodestaque,tendocomoprincípios-chave: ali-mentaracrianc¸apequenadiretamenteeassistirasmaisvelhasquandoelasjácomemsozinhas; alimentarlentaepacientemente,eencorajaracrianc¸aacomer,masnãoforc¸á-la;seacrianc¸a recusarmuitosalimentos,experimentardiferentescombinac¸õesdealimentos,degostos, tex-turas emétodos de encorajamento;minimizardistrac¸ões duranteas refeic¸ões;e fazerdas refeic¸õesoportunidadesdeaprendizadoeamor,falandocomacrianc¸aduranteaalimentac¸ãoe mantendocontatoolhoaolho.Cabeaocuidadoraresponsabilidadedesersensívelaossinaisda crianc¸aealiviartensõesduranteaalimentac¸ão,alémdetorná-laprazerosa;enquantoépapel dacrianc¸aexpressarossinaisdefomeesaciedadecomclarezaeserreceptivaaocuidador. Conclusão: Aalimentac¸ãoresponsivaémuitoimportantenaformac¸ãodoshábitosalimentares edeveserincentivadapelosprofissionaisdesaúde,orientandoasfamíliascomopraticá-la. ©2016PublicadoporElsevierEditoraLtda.emnomedeSociedadeBrasileiradePediatria.
Introduction
Infantfeedingisa subjectthathasaroused greatinterest inrecentyearsinseveralfieldsofknowledge,asitinvolves differentaspectsbeyondnutrition.Knowledgeofthe imme-diateandlong-termimpactofpoornutritionhascontributed tothesearchforbetterunderstandingofhoweatinghabits areformedanddrawnattentiontotheimportanceofeating habitsearlyinlife.1,2
Eatinghabitsareinfluencedbynumerousgenetic, socio-economic, cultural, ethnic, and religious factors, among others.Startingasearly asthepregnancyperiod,through contactofthefetuswiththeamnioticfluid,3theformation of eating habitscontinues during childhood, especiallyin thefirst2---3yearsoflife,andwillbeinfluencedby differ-entfactorsthroughoutlife,suchasfamily,friends,school, andmedia.4---7
Infants, due to their biological immaturity, are totally dependentonotherstofeedthem.Theseindividuals, espe-ciallymothers becausetheyarethe primarycaregiversof children,playafundamentalroleintheconstructionof chil-dren’seatinghabits.Inadditiontodecidingwhatthechild willeat,theydeterminehowthechildwillbefed.4,6
Theinteractionbetweenthemother/caregiverandchild duringtheactof feeding/beingfedhasbeenthe focusof researchinterest in recentyears, becausethecaregiver’s characteristics and howhe/she relatestothe child has a directimpactonthewayachildwillapproachfood.From thisperspective, theparents’ life habits, parentingstyle, andhowtheyinteractwiththeirchildrenareimportantfor theformationofchildren’seatinghabits.4,8,9
Inthe contextofinfantfeeding,interactionduringthe mealcanshowtwoaspects:positiveandnegative.The pos-itive one corresponds to the responsive feeding type, in which,forBlack&Aboud,10 ‘‘theremustbeattentionand interest in the child’sfeeding; attention totheir internal signs of hunger and satiety; their ability to communicate their needsthroughdistinct andsignificant signs,and the successfulprogressiontoindependentfeeding.’’The nega-tiveaspect,inturn,canbecallednon-responsivefeeding, characterizedbyalackofreciprocitybetweenthecaregiver
andthechild,becauseduringeachinstance,oneofthetwo actorsinvolvedbecomesdominantinthefeedingsituation,
i.e.,sometimesthecaregivercommandsanddominatesand sometimesthechildcontrolsthesituation;or,thecaregiver ignoresthechild.
The aim of this review is to showhow the interaction betweencaregiverandchild duringfeedingtimeand par-entingstyleinfluencetheformationofdietaryhabits.
Complementaryfeeding:beyondthenutritional aspects
Dietary habits early in life will have different effects throughout the life of individuals. In the first 6 months of life, it is recommended that the child be exclusively breastfed,as breast milk is the only food that can meet allnutritionalandemotionalneedsoftheinfantduringthis periodandprovideanintensemother---childbond. Addition-ally,theexistenceofapositiveassociationbetweenduration ofexclusivebreastfeedingandhealthierdietinlater child-hoodhasbeenpostulated.11
After6monthsofage,theexclusiveuse ofbreastmilk isnotenough,consideringthatthenutritionalneedsofthe childare nolongermet,thus requiring the gradual intro-ductionofotherfoodsources,bymeansofcomplementary foods.11,12 The durationof breastfeeding,which is recom-mended for two years or more, also seems to influence futureeatinghabits.11
preparation and storage of food; adding simple carbohy-dratestomilk;andsupplyofprocessedfoodshighinsimple carbohydrates, lipids, and salt, often consumed by the family.
There is nodoubt thata healthy dietis vital for child health promotion. Thus, there is a need to analyze the different aspects involved in infant feeding, which will determinetheeatinghabits,whichinturnareareflection ofsocialandculturalpractices.7,15
Infant feeding practice, characterized primarily by breastfeeding and the introduction of new foods, suffers strong influence fromthe familybackground. In this con-text,themotherhasapredominantrole,representingthe main caregiver of the child. The manner in which she cares for her child is crucial for the child’s health, and isrelatedtoher educationallevel,the informationabout healthreceivedfromhealthprofessionalsand/orthemedia, social support, and her availability to fulfill the role of caregiver.2,15---18
Anotherfactortobeconsideredistheadequacyoffood --- variety, consistency,texture,and the use of a cup and spoon,respectingthechild’sdevelopment.Itisimportant tostimulatethechild,afteracertainage,tofeedwiththeir ownhands.19
Fromthepointofviewofthenutritionalcomposition,the introductionoffoodwithhighlevelsofsaltandrefinedsugar andexcesssaturatedfatsisnotrecommended,inaddition toindustrializedfood,especiallyultra-processedfood,and thoseconsideredsuperfluous,includingcandiesandsweets. Itisaconsensusthattheintroductionoffruitandvegetables inthefirstyearoflifecontributestotheimplementationof healthyeatinghabits.20,21
Aschildrengrow,theirfoodpreferenceswillbedefined; hencetheimportanceofencouragingthemfrombeginning toeata variedandadequate diet,onethatreflects their regionalfoodculture.7,19,20
The family plays a decisive role in how the child will learn tofeed, especially throughthe strategies that par-ents/caregiversuse tostimulate feeding. Recognizingthe signs of hunger and satiety and understanding the self-capacity of the small child in relation to food intake contributetotheformationofadequateeatingbehavior.2,15 Thisprocess,asmentioned,startsearlyandisestablished duringthefirstyearsoflife.
TheWorldHealthOrganization(WHO)22hasadoptedthe followingprinciplesfor healthycomplementaryfeedingof breastfedchildren:
1. Practiceexclusivebreastfeedingfrombirthto6months of age; after that, introduce complementary foods whilemaintainingbreastfeeding.
2. Continuebreastfeedingondemand,oftenuntil2years ofageorolder.
3. Practice responsive feeding,applying theprinciple of psychosocialcare.
4. Practicegoodhygieneandadequatefoodhandling. 5. Start at 6 monthsof age withsmall amountsof food
andincreasetheamountasthechildgetsolder,while maintainingfrequentbreastfeeding.
6. Graduallyincreasefoodconsistencyandvarietyasthe child getsolder, adapting tothe child’srequirements andabilities.
7. Increasethenumberoftimesthechildisfed comple-mentaryfoodsastheygrow.
8. Feed thechild avariety ofnutritious foods toensure thatallnutritionalneedsaremet.
9. Usefortifiedcomplementaryfoodsandvitamin supple-mentsforthechild,ifnecessary.
10. Increasefluidintakeduringillness,includingmore fre-quentbreastfeedingandencouragechildrentoeattheir favoritesoftfoods.Afterillness,offerfoodmoreoften thanusualandencouragethechildtoeatmore.
Itcanbeobservedthatthethirdprincipleisdedicatedto howtofeedthechild,suchistheimportanceattributedto thisaspect.Theinteractionbetweenthemother/caregiver andthechildwilldeterminewhetheror notthefeedingis responsive andwillinfluencethechild’seatinghabitsand relationshipwithfood.
Interactionbetweenparents(caregivers)and children:theactoffeedingandbeingfed
The interaction between parents/caregivers and children early in lifehas apositive or negativeeffectonnutrition and growth,aswell asonthechild’s cognitiveand social development.1,4,10,23,24
Thebehaviorandinteractionthatoccursduringmealtime betweenmother---child/caregiver---childhasbeen character-izedasresponsive,authoritarian, orpassive. Thelasttwo characterizethenon-responsivefeedingtype.The respon-sive style is more often associated withthe formation of adequatefeedingpractices,aswellasthedevelopmentof appetiteself-regulationbythechild.25,26
The current literature on sensitive and respon-sive care differentiates responsiveness, in which the mother/caregiverinterpretsandrespondstosignsfromthe child, andactivebehavior, inwhich themother/caregiver focuses on,stimulates,andencouragesthechild toact.26 In the context of feeding, when the caregiver has the capacity for responsivenessand activebehavior, it is said that feeding constitutes the responsive or sensitive type, defined by Black & Aboud10 as ‘‘reciprocity between the childandthecaregiver.’’Inthistypeoffeeding,thechild signals through movements, facialexpressions, and voca-lizations; the caregiver recognizesthe signsand responds promptlyintheformofsupport;thechildrealizesthatthis wasaresponsetotheirsigns,establishingacommunication mediatedbyverbalandnon-verballanguage.
Someofthecomponentsofresponsivefeedingthatare effective and stimulate food intake include: responding positively tochildren by smiling, makingeye contactand usingwordsofencouragement;feedingthechildslowlyand patiently,withgooddisposition;waitingforthechildtostop eatingandwatchingcarefullyifthechildexpressessignsof satiety;providingfoodsothechildcanfeedthemselves.27
comfortable;nodistractions;mealservedinanappropriate place; caregiver fullyinvolved in theact and, preferably, face-to-facewiththechild;healthyfoodandgood presen-tation,toallowthechild todistinguishbetween different flavorsand textures; healthyfood for everyone when the mealisshared.28
Therefore,thefeedinginteractioniscompletewhenthe individuals involved can express theirsigns andthe other recognizesthem.Forcaregivers, itoccurswhenthey suc-cessfully perform the task of feeding the child; for the child, when they are able to demonstrate feeding inde-pendencebymakingsignsthatreflecttheirwishesclearly, allowingthemtoregulatethecaretheyreceive,thus con-stitutingahighlyinteractiverelationship.29 Mentroetal.30 described the essential attributes of an optimal respon-sive feeding from the child. They are: eye contact with the caregiver, as indicated by eye opening and watching thecaregiver;pleasantexpressionofaffectiontoward the caregiver,asdemonstratedby smiles;expressionof pleas-antvocalizationsdirectedtothecaregiver,asdemonstrated by the absence of crying or irritation; motor response to attempted feeding, as demonstratedby relaxed position, calm movements, and molding into the caregiver’s body. These characteristics contribute to a positive interaction betweenmother/caregiverandchildduringfeeding.
Anotheraspectthatshouldbeconsideredisthesharing ofmeals.Currently,itisachallengetoencouragechildren sothat,attheendoftheirfirstyearoflife,theywillhave theirmealstogetherwithotherfamilymembersandshare thefamilyfood,whenthisisappropriate.Thefamilymealis ahabitthathasbecomerareintoday’sworld.Anotherfact ofconcernisthatchildrenandadultsfrequentlyhavetheir attention diverted during mealtime, eating while watch-ingtelevisionor usingelectronicdevices.Thiscontributes toneglectofthe child’ssatietysignaling.Furthermore,it is known thatstimulation fromadvertisements relatedto unhealthyfoodshasgreaterimpactwhenexperienced dur-ingmeals.2,20,31,32
TheWHO22producedfourkeypointstocharacterizethe principles of responsive feeding and emphasize that the child’sfoodshouldbeservedinaseparatedish,sothatthe mother/caregivercanobservehowmuchfood thechildis eating.Theyare:
1. Feedtheinfantdirectlyandassistolderchildren when they already eat on the own; feed them slowly and patientlyandencouragechildrentoeat,butdonotforce them.
2. Ifthechildrefusesmanytypesoffoods,experimentwith differentfoodcombinations,tastes,textures,and meth-odsofencouragement.
3. Minimize distractions during meals if the child quickly losesinterestinfood.
4. Rememberthatmealtime shouldbean opportunityfor learningandlove,talkingtothechildduringfeedingand maintainingeyecontact.
Some studieshaveaddressed theconsequencesof non-responsivefeeding,inwhichcaregiversarelesssensitiveand responsivetothechild’ssignals,generating lackof stimu-lusforfeeding.Thisoccurswhencaregiverstakecontrolof feeding,notrecognizingorappreciatingthesignalsemitted
bythechildinrelationtohungerandsatiety.Conversely,the caregivermaybecomecarelessorallowthechildto domi-natethesituation,duetonotunderstandingorappreciating thechild’sexpectations.4,8,15,33
Whenthechild’srefusaltoeatisunderstoodasa rejec-tionandsheis forcedtoconsumethefood,theremaybe tensionandfrustration,bothforthemother/caregiverand thechild. Inthissituation,each expressesadesirethatis notunderstoodbytheother;thechildloseshis/her auton-omy and parents are frustrated by not finishing the task of feeding their child. As a result, the child may fail to appreciatetheirinternalsatietysignalsandloseinterestin communicatingwiththeparents.This mayalsocontribute totheoften-observedbehaviorcharacterizedbyanegative reactionwhentryingnewflavors,calledneophobia.7,15
Anotheraspectworthmentioningisthatnon-responsive feedingcontributes both torapid weightgain andhence, overweight,eitherinchildhoodoradulthood,aswellasto nutritionaldeficits,ifthecaregiveris notattentive tothe signsofhungerandsatietyissuedbythechild.Ithasbeen reportedthatcaregiversofchildrenyoungerthan2yearsare moreresponsivetosignsofhungerthanofsatiety.5,8,26,29,30
A critical moment in relation to feeding behavior in thefirstyearoflifeis associatedwiththeintroductionof foodsofgreaterconsistency,especiallysolidfoods.Often, children initially refuse the food and parents/caregivers interpret the signs asan expression of ‘‘they donot like thefood.’’Thiskindofinterpretationcaninducethe care-giver to offer the type of food the child prefers, not always adequate froma nutritional point of view.1 Thus, thehealthprofessional’ssupportisimportanttoclarifyand informofthereactionsexpectedatthistimeandhelp par-ents/caregivers toovercome difficulties.34 On average, it takesat leasteightexposurestoaninitiallyrejectedfood forittobeacceptedbythechild.35
Parentingstylesonchildcareandnutrition
Parentingis understood asa set of behaviorsthat aim to ensure the child’s survival and full development, provid-ingthemgreatersafetyandautonomy.Itdoesnotdepend onlyonindividualfactors,asitisdirectlyinfluencedbythe socioculturalenvironment.10,29,36
Becominga parent canbe oneof the mostdemanding andchallengingsocialrolesthatindividualsfaceduringtheir lives, a fact that leads toa set of behavioral, cognitive, andemotionalresponses,whichrequireadaptationtoanew standardofliving.36
The need to understand the parents’ behavior issues in relation to children, whether regarding feeding or in general, has stimulated new approaches to this matter.6,9,10,17,31,36
The concept of parenting styles wasintroduced in the literature decades ago.4 From this perspective, Gomide39 describesparentingstylesasa‘‘setofeducationalattitudes thatcaregiverswillusewiththechildinordertoeducate, socialize,andcontrolthem.’’Seven educationalpractices comprise the parenting style: five are related to antiso-cialbehavior(neglect,physicalandpsychologicalviolence, laxdiscipline,inconsistentpunishment,andnegative mon-itoring)andtwotothedevelopmentofprosocialbehavior (positivemonitoringandmoralbehavior).
Thefirstpositivepracticeisrelatedtotheattentionto wherethechildisandwhatactivitiestheyareperforming, aswellasthesupportandaffectiongivenbyparents.The secondincludestheattitudesofparentsthattransmit jus-tice,responsibility,andculturallyacceptedvaluesthathelp indiscerningrightfromwrong.
Thenegativepracticeofneglectinvolveslackof atten-tionandaffection,aswellaslackofparentalattentionto theneedsofchildren,thusexemptingthemselvesfromthe responsibility.Violenceincludes theuse ofthreats, black-mail,andpunishment,whetherphysicalormoral.Thethird antisocialpractice(laxdiscipline) implies non-compliance withpre-establishedrules.Parentsthreaten,butatthetime ofenforcementoftherules,theygiveintotheirchildren. Thefourthpracticeoccurswhentheparents’moodaffects theirbehaviorwhenpunishingorreinforcingtheattitudesof children;thus,itistheparents’emotionalstatethat deter-minestheeducationalactions,andnotthechild’sactions. Thepracticeofnegativemonitoring,inturn,comprisesan excessofrulesandsupervisionbyparents,andtheir disre-gardbythechildren,creatingaclimateofhostilityandlack ofdialog.
Thus, it can be observed that the responsive or non-responsive typeof feeding adopted by parents is directly relatedtothetypeofparentalcare.Itisobservedthatthe parentingstylesthatappeartobemoreassociatedwith chil-dren’sfeeding difficultiesare thoserelatedtocontrolling and/orneglectfulstyles.Ontheotherhand,thesupportive parentingstyleappearstobepositive,asitaimsto under-standthechild’sinternalsignsandwishes,andencourages theirintegrationwiththesocialenvironmentinwhichthe childlives.7,31,36,40---43
Analyzing together the socialization practices, mater-nalresponsiveness,andeducationallevelandincome,itis clearthateducationandthegeneralmaternal health sta-tusareessentialforthecareprocess.Studiesshowthatthe highertheireducationallevel,thegreatertheirperception ofchilddevelopmentandthelessconflictualrelationswith theirchildren,whichleadstofewerpunitive,coercive,and neglectpractices.Lowincome,loweducationallevel,and domesticviolenceexplaintheincreasedfamilyvulnerability tothelackofmoreresponsiveandattentivecare.6,8,18,41,42
Finalconsiderations
Not only what children eats is important, but also how, when, where, and who feeds them. Due importance has
been increasingly given to the interaction between the mother/caregiverandthechildwhoisbeingfed.This inter-actionshouldresultintheso-calledresponsivefeeding,and it is the caregiver’s responsibility to be sensitive to the child’ssigns andease tensions duringfeeding, inaddition tomakingthemealapleasantmoment;whileitistherole ofthechildtoexpressthesignsofhungerandsatietyclearly andtoberesponsivetofeedingattempts.
Responsivefeedingshouldbemoreappreciatedby fam-ilies,healthprofessionals,andhealthpolicymakers.Health professionals should advise families on how to practice it, which requires them to go beyond the more general issues in relation to food consumption and try to under-standthe social andcultural integrationof the family,as wellasthepsychosocialaspectsofthecaregiver,inorderto provide individualized guidance. Policymakers shouldgive moreimportancetotheissueofhowtofeedchildren.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
References
1.HartCN,RaynorHA,JelalianE,DrotarD.Theassociationof maternalfoodintake and infants’andtoddlers’ foodintake. ChildCareHealthDev.2010;36:396---403.
2.ThompsonAL,BentleyME.Thecriticalperiodofinfantfeeding forthedevelopmentofearlydisparitiesinobesity.SocSciMed. 2013;97:288---96.
3.Beauchamp GK, Mennella JA. Flavor perception in human infants: development and functional significance. Digestion. 2011;83:1---6.
4.Chaidez V, Townsend M, Kaiser LL. Toddler-feeding prac-tices amongMexican American mothers.A qualitativestudy. Appetite.2011;56:629---32.
5.HodgesEA,JohnsonSL, HuguesSO, HopkinsonJM,Butte NF, FisherJO.DevelopmentoftheresponsivenesstoChildFeeding CuesScale.Appetite.2013;65:210---9.
6.McPhieS,SkouterisH,DanielsL,JansenE.Maternalcorrelates ofmaternalchildfeedingpractices:asystematicreview.Matern ChildNutr.2014;10:18---43.
7.Savage JS, Fisher JO, Birch LL. Parental influence on eat-ingbehavior: conceptionto adolescence. JLaw Med Ethics. 2007;35:22---34.
8.Bentley ME, Wasser HM, Creed-Kanashiro HM. Responsive feeding and child undernutrition in low- and middle-income countries.JNutr.2011;141:502---7.
9.Khandpur N, Blaine RE, Fisher JO, Davison KK. Fathers’ childfeeding practices: areview oftheevidence. Appetite. 2014;78:110---21.
10.Black MM, Aboud FE. Responsive feeding is embedded in a theoretical framework of responsive parenting. J Nutr. 2011;141:490---4.
11.PerrineCG,GaluskaDA,ThompsonFE,ScanlonKS. Breastfeed-ingdurationisassociatedwithchilddietat6years.Pediatrics. 2014;134:S50---6.
12.PrzyrembelH.Timingofintroductionofcomplementaryfood: short-and long-term health consequences. AnnNutr Metab. 2012;60:8---20.
13.AndrewN,HarveyK.Infantfeedingchoices:experience, self-identityandlifestyle.MaternChildNutr.2011;7:48---60.
Committeeon Nutrition. JPediatr GastroenterolNutr. 2009; 49:112---25.
15.SherryB,McdivittJ, BirchLL, CookFH, SandersS, PrishJL, etal.Attitudes,practices,and concerns aboutchild feeding andchildweightstatusamongsocioeconomicallydiversewhite, Hispanic, and African-American mothers. J Am Diet Assoc. 2004;104:215---21.
16.BroiloMC,LouzadaMLC,Drachler ML,StenzelLM,VitoloMR. Maternalperceptionandattitudesregardinghealthcare profes-sionals’guidelinesonfeedingpracticesinthechild’sfirstyear oflife.JPediatr(RioJ).2013;89:485---91.
17.KavanaghKF, HabibiM,Anderson K,SpenceM.Caregiver- vs infant-orientedfeeding:a modelofinfant-feeding strategies among special supplemental nutrition program for women, infants,andchildrenparticipantsinruraleastTennessee.JAm DietAssoc.2010;110:1485---91.
18.SaxtonJ, Carnell S, VanJaarsveld CHM, Wardle J. Maternal educationisassociated withfeedingstyle.JAm DietAssoc. 2009;109:894---8.
19.Dwyer JT, Butte NF, Deming DM, Siega-Riz AM, Rayde KC. FeedingInfantsandToddlersStudy2008:progress,continuing concerns,andimplications.JAmDietAssoc.2010;10:S60---7.
20.FoxMK,Pac S,DevaneyB,Jankowski L.FeedingInfantsand ToddlersStudy:whatfoodsareinfantsandtoddlerseating?J AmDietAssoc.2004;104:S22---30.
21.SparrenbergerK,FriedrichRR,SchiffnerMD,SchuchI,Wagner MB.Ultra-processedfoodconsumptioninchildrenfromabasic healthunit.JPediatr(RioJ.).2015;91:535---42.
22.WorldHealthOrganization.Complementaryfeeding.Infantand youngchildfeeding.Modelchapterfortextbooksformedical studentsandalliedhealthprofessionals.Geneva:WHO;2009. p.19---28.
23.Cerezo MA, Trenado RM, Pons-Salvado RG. Mother---infant interaction and quality of child’s attachment: a nonlinear dynamicalsystemsapproach.NonlinearDynamicsPsycholLife Sci.2012;16:243---67.
24.FraleyRC,RoismanGI,HaltiganJD.Thelegacyofearly expe-riencesindevelopment:formalizingalternativemodelsofhow earlyexperiencesarecarriedforwardovertime.DevPsychol. 2013;49:109---26.
25.BrownA,LeeM.Maternalchild-feedingstyleduringthe wean-ingperiod:associationwithinfantweightandmaternaleating style.EatingBehav.2011;12:108---11.
26.HodgesEA,HughesSO,HopkinsonJ,FisherJO.Maternal deci-sionsabouttheinitiation and terminationof infantfeeding. Appetite.2008;50:333---9.
27.Aboud FE, Shafique S, Akhter S. A responsive feeding intervention increases children’s self-feeding and mater-nal responsiveness but not weight gain. J Nutr. 2009;139: 1738---43.
28.EnglePL,BentleyM,PeltoG.Theroleofcareinnutrition pro-grammes:currentresearchand aresearchagenda.ProcNutr Soc.2000;59:25---35.
29.RheeKE,LumengJC,AppuglieseDP,KacirotiN,Bradley RH. Parentingstylesandoverweightstatusinfirstgrade.Pediatrics. 2006;117:2047---54.
30.MentroAM,StewardDK,GarvinBJ.Infantfeeding responsive-ness:aconceptualanalysis.JAdvNurs.2002;37:208---16.
31.PetersJ,DollmanJ,PetkovJ,ParlettaN.Associationsbetween parentingstylesandnutritionknowledgeand2---5-year-old chil-dren’sfruit,vegetableandnon-corefoodconsumption.Public HealthNutr.2013;16:1979---87.
32.Fiates GM, Amboni RD, Teixeira E. Television use and food choices of children: qualitative approach. Appetite. 2008;50:12---8.
33.GrossRS,FiermanAH,MendelshonAL,ChiassonMA,Scheinmann R,MessitoMJ.Maternalperceptionsofinfanthunger,satiety, andpressuringfeedingstylesinanurbanLatinaWICpopulation. AcadPediatr.2010;10:29---35.
34.VanDjikaM,HunninsS,vanGeertP.Variabilityineating behav-iorthroughouttheweaningperiod.Appetite.2009;52:766---70.
35.Maier A, Chabanet C, Schaal B, Leathwood P, Issanchou S. Food-relatedsensoryexperiencefrombirththroughweaning. ContractedpatternsintwonearbyEuropeanregions.Appetite. 2007;18:429---40.
36.Hubbs-TaitL, KennedyTS,Page MC,TophamGL,Harrist AW. Parentalfeedingpracticespredictauthoritative,authoritarian, andpermissiveparentings.JAmDietAssoc.2008;108:1154---61.
37.HouzelD.Asimplicac¸õesdaparentalidade.In:Solis-PontonL, SilvaMCP.(Orgs.).Serpai,sermãe.Parentalidade:umdesafio parao terceiromilênio.São Paulo:CasadoPsicólogo; 2004. p.47---52.
38.MartinsCA. Transic¸ãonoexercício daparentalidadedurante oprimeiroanodevidadacrianc¸a:umateoriaexplicativade enfermagem.Lisboa:UniversidadedeLisboa;2013[Thesis].
39.Gomide PIC. Inventários de estilos parentais (IEP): Modelo teórico, manualde aplicac¸ão,apurac¸ão einterpretac¸ão.Rio deJaneiro:Vozes;2006.
40.CarnellS,CookeL,ChengR,RobbinsA,WardleJ.Parental feed-ingbehavioursandmotivations.Aqualitativestudyinmothers ofUKpre-schoolers.Appetite.2011;57:665---73.
41.HughesSO,PowerTG,FisherJO,MuellerS,NicklasTA. Revis-itinganeglectedconstruct:parentingstylesinachild-feeding context.Appetite.2005;44:83---92.
42.MitchellS,BrennanL,HayesL,MilesCL.Maternalpsychosocial predictorsofcontrollingparentalfeedingstylesandpractices. Appetite.2009;53:384---9.
