(299) Parental Stress, Feeding Style, and Mealtime Behaviors of Children with Cystic Fibrosis

Background: Nutrition and adequate weight gain significantly contribute to overall health outcomes in children with cystic fibrosis (CF). Therefore, strong clinical emphasis is placed on these entities by the CF team, which can cause stress for parents. There are a number of known psychosocial factors that play a role in feeding and weight gain including parental feeding style and behavioral feeding problems. These can in turn impact parent stress levels. While overall parental stress in the CF population is well studied, there is minimal research investigating the impact of child mealtime behaviors and parental feeding style on parents’ stress, and how these impact nutritional outcomes. The current study seeks to address this gap by examining these constructs in a sample of children with CF.

Methods: Parents of a child with CF between the ages of 2-10 years were recruited during a CF clinic appointment. They completed surveys assessing child mealtime behaviors (Behavioral Pediatrics Feeding Assessment Scale; BPFAS), parental feeding style (Caregiver Feeding Style Questionnaire, CFSQ) and parental stress (Pediatric Inventory for Parents, PIP). Medical data including body mass index (BMI) and other co-variates were collected from the medical record. One-way analysis of variance tests were conducted with parental feeding style as the independent variable and BMI z-score, parenting stress, and feeding behaviors as the dependent variables. Pearson’s correlation coefficients were used to assess relationships between continuous variables.

Results: Children (n=45) had an average age of 6.75 (SD=2.67) years. Generally, parents were evenly split with regard to parental feeding style (Authoritative = 12, Authoritarian = 13, Permissive = 12, Uninvolved = 8). There was no significant difference in the children’s BMI z-score according to parental feeding style. There was a significant difference in behavioral feeding scores (BPFAS) based on feeding style (F_3,41=14.50, p< .001), with authoritarian parents reporting significantly greater mealtime behavior problems than all other parents. There was also a significant difference in parent stress based on parental feeding style (F_3,41 = 5.58, p< .01), with authoritarian parents showing more stress than authoritative (M_diff = 0.65, p< .01) and uninvolved parents (M_diff = 0.66, p< .05). Pearson correlation showed increased behavioral feeding problems were associated with increased parent stress, r(45)=0.337; p< .05.

Conclusions: Data assessing parental feeding style and behavioral feeding problems in the pediatric CF population is limited. We investigated how these variables impact parental stress. Data suggest parents who use a more demanding, authoritarian feeding style experience more stress and more child feeding problems than other parents. Increased feeding problems were also associated with more stress. Parental feeding style was not related to the child’s BMI in our sample. It is possible that our limited sample size and lack of variability in BMI resulted in insufficient power to yield significant results. Future goals will be to determine how healthcare providers can intervene to support positive parenting behaviors that reduce children’s mealtime behavior problems and parental stress and ultimately improve health outcomes in this vulnerable population.

Acknowledgements: This work was supported by the Child Health Research Institute Pilot Grant.

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