Parental feeding practices and associations with child weight status: Swedish validation of the Child Feeding Questionnaire finds parents of 4-year-olds less restrictive.

The Child Feeding Questionnaire (CFQ) assesses parental feeding attitudes, beliefs and practices concerned with child feeding and obesity proneness. While the questionnaire has been developed and primarily used in the U.S., validation studies in other countries are limited. The aim of this study was to examine the psychometric properties of the CFQ among mothers with preschoolers in Sweden and the associations between parenting practices and children's weight status, adjusting for potential confounders. Based on records from the Swedish population register, all mothers of 4-year-olds (n=3 007) from the third largest city in Sweden, Malmö, were contacted by mail. Those who returned the completed CFQ together with a background questionnaire (n=876) received the CFQ again to enable test-retest evaluation. In total, 564 mothers returned the completed CFQ for the second time. We used confirmatory factor analysis to test whether the original 7-factor model was supported. Good fit (CFI= 0.94, TLI =0.95, RMSEA=0.04, SRMR= 0.05) was obtained after minor modifications such as dropping 2 items on restriction and adding 3 error covariances. The internal reliability was good for the majority of the factors, as well as for the 2-week test-retest reliability. As hypothesized, the scores on Restriction were among the lowest ever reported. We also examined the influence of parenting practices on child BMI (dependent variable) in a structural equation model (SEM) and found that child BMI had a positive association with restriction and a negative association with pressure to eat. Restriction, in turn, was positively influenced by concern about child weight. The second SEM treated parenting practices as dependent variables. In sum, the results of the study support the validity and reliability of the CFQ in Sweden and show that an independent relationship exists among parental feeding practices, especially restriction, and child BMI, early in life,. Parental foreign origin and child BMI had direct effects on parental restrictive practices, while pressure to eat was also influenced by parental education. Longitudinal studies are needed to further understand the direction of the relationship and to assess to what extent parental feeding practices are modifiable through family-based interventions. Moreover, carefully designed cross-cultural comparisons could perhaps explain why the levels of restrictive feeding behaviors in Swedish families are the lowest reported