Mother–child feeding interactions in children with and without weight faltering; nested case control study

Aims: To explore whether the Mellow Parenting assessment system can detect any difference in parent–child meal time interaction between children with weight faltering (failure to thrive) and normally growing children. Subjects and methods: Thirty mother–infant dyads with weight faltering and 29 healthy controls nested within the Gateshead Millennium prospective cohort study were assessed at mean age 15.6 months (range 13–20). Video-tapes of two standardized meals per child by a researcher blind to infant health status were analysed using a simplified version of the Mellow Parenting Coding System (MPCS), an all events measure of maternal–child interactivity. These were linked to questionnaire data on eating behaviour and growth held on the children. Results: The MPCS had good inter-rater reliability (0.82) and coherent inter-relationships between coding domains. During case meals there were significantly fewer positive interactions overall: cases median 81.5 (IQR 4–496); controls 169.5 (40–372) and within all the commonly observed domains (Anticipation (p = 0.013), autonomy (p = 0.003), responsiveness (p = 0.005) and cooperation (p = 0.016)). There were only low levels of distress and control or negative behaviours and no significant differences were found in these between the groups. The case infants had significantly lower reported appetite by the age of 4 months and higher reported avoidance of feeding at the age of 8 months than controls. Conclusions: Mothers of weight faltering infants generally showed fewer interactions with their infants at mealtimes. It is not clear whether this is causal or simply a maternal adaptive response to their childʹs eating behaviour.