Early nutrition plays a crucial role not only in providing essential nutrients for proper child development, but may also be an important step in creating desirable eating behaviors, which can be transmitted into adulthood. The aim of this study was to assess possible links between early feeding factors, such as breastfeeding, complementary feeding (timing and method) as well as types of complementary foods and mealtime environment during the first three months of complementary feeding and eating behaviors in children aged 1–3 years old. This cross-sectional, online survey involved 467 mothers of toddlers aged 1–3 years old from the whole of Poland. The questionnaire consisted of questions about early feeding and the Children’s Eating Behavior Questionnaire (CEBQ). The adjusted linear regression model revealed that longer duration of any breastfeeding was negatively related to enjoyment of food (EF), desire to drink (DD) and positively related to satiety responsiveness (SR) and slowness in eating (SE) subscales. Moreover, offering homemade complementary foods more often than commercial may be related to higher SR. Eating meals during distraction seems to be negatively associated with EF, and positively with DD and SE subscales. Our study highlights possible links between early feeding factors and toddlers’ eating behaviors, so further investigation, also including dietary factors, is needed.
Nutrition during early life is an important factor in shaping food preferences and eating behaviors that can be transferred into childhood and beyond. Development of healthy eating habits influences later health and may prevent obesity and other non-communicable diseases which are considered as social and public health problems.
Among early nutrition factors, breastfeeding and complementary feeding play a major role. Exclusive breastfeeding for the first 6 months of life is a desirable goal in infants’ nutrition and should be continued as complementary foods are introduced, as long as mutually desired by mother and infant. Breastfeeding, besides having many health benefits both for mother and child, may also contribute to establishing food preferences and eating behaviors.
Complementary feeding is the next stage in infant’s feeding. It is possible to start introducing solids between 17 and 26 weeks; however, exclusive breastfeeding for 6 months is a gold standard in infants’ nutrition and, during this time, breast milk provides all the essential nutrients in the majority of children. However, besides timing, psychological and neurological maturation is also crucial. Complementary feeding is a gradual process of introduction foods and beverages other than breastmilk/formula and it typically continues to 24 months. Complementary feeding, besides its role in providing nutrients, is also an important period in the acquirement of an optimal eating behavior and healthy eating habits. Responsive feeding, in which the child leads the feeding interaction, in contrast to it being the parent’s responsibility over what, when and where a child is fed, seems to play an important role in the context of shaping food preferences and establishing desirable eating behaviors.
There is no concise recommendation about method of complementary feeding or type of complementary foods. Over the last year, interest in baby-led weaning method (BLW) has grown substantially, suggesting much promise in relation to possible benefits of BLW to infant eating behaviors; however, results are inconclusive. To the best of our knowledge, the number of studies focusing on types of complementary foods in relation to eating behavior is scarce. On the one hand, WHO reports suggest that the nutrition quality of commercial complementary foods may be inadequate. On the other hand, there is a possible risk of offering unsuitable family foods, with the addition of salt/sugar.
Another factor, besides timing and method of introducing complementary foods, that may be important in creating healthy eating behaviors is mealtime environment. Previous studies have suggested that frequent family mealtimes may be associated with more desirable eating behaviors, better diet quality as well as decreased risk of overweight/obesity and eating disorders. In addition, meal consumption during distraction, such as watching television, may be a risk factor for developing unhealthy food habits.
Recent studies have analyzed eating behaviors in the context of early feeding factors; however, results are inconclusive. Moreover, previous studies sometimes focused on selected early feeding factors such as breastfeeding, complementary feeding or mealtime habits only.
The aim of the present study was to assess possible links between breastfeeding, complementary feeding (timing and method) as well as types of complementary foods and mealtime environment during the first three months of complementary feeding and eating behaviors in children aged 1–3 years old.
The study followed the ethical standards recognized by the Declaration of Helsinki and was approved by the Ethics Committee of the Faculty of Human Nutrition and Consumer Science, Warsaw University of Life Sciences, Poland, on 19/07/2019 (Resolution No. 45/2019).
The study was designed as a cross-sectional study among mothers of children aged 1–3 years old from Poland. Data related to the study were collected in 2020–2022, with the use of the CAWI (Computer-Assisted Web Interview) method. Mothers were recruited through social media. The questionnaire was published in parenthood-specific discussion boards using the Google Forms web survey platform. The link to the online survey was shared through social media, such as Facebook, Instagram, and WhatsApp, and by personal contacts of the research group members. Participants received information about the anonymity of the study, the voluntary nature and the possibility to stop their participation at any study stage.
The inclusion criteria were formulated as follows:
The exclusion criteria were:
The questionnaire was completed by 603 participants and 467 (77% of initial sample) of them were included in the final analysis. Participants were excluded due to lack of or incomplete data, living abroad, child’s age (less than 12 or more than 36 months) and extreme gestational age.
The questionnaire comprised questions about early and current feeding practices, birth-related and demographic data, as well as questions regarding child and maternal anthropometry. One of the parts of the survey was the Children’s Eating Behavior Questionnaire (CEBQ).
Mothers were asked about milk feeding practices—whether they ever breastfed and for how long. Information about duration of any and exclusive breastfeeding was gathered. Due to the definition of exclusive breastfeeding, if an infant received water or any other food/drink product during the declared period of exclusive breastfeeding, the duration was adequately corrected.
Additionally, mothers were asked about the first 3 months of complementary feeding period, such as age at when they introduced particular food/drink products. On this basis, we calculated age when infants started complementary feeding. Time of introducing complementary feeding was defined as the month when children received for the first time any other than breastmilk/formula product (including water; not applying to water that was an ingredient of formula milk). Among infants who were born prematurely, we reported data expressed in corrected age. Age at complementary feeding introduction was categorized as (1) complementary feeding started before 4 months, (2) before 4 and 6 months, (3) after 6 months. Information about method of complementary foods introduction was also gathered. Baby-led weaning (BLW) was defined as solely or mostly baby feeding themselves, mixed method as about half spoon-feeding by an adult and half baby feeding themselves, and tablespoon feeding (TSF) as mostly or solely spoon-fed by an adult. Data about types (commercial baby foods and drinks, homemade adapted for infants, family foods) of complementary foods and mealtime environment (with family, during watching TV, distraction, playtime) were also examined.
We also asked about current feeding practices, such as mentioned above mealtime environment, frequency of consumption of selected food items and use of added salt and sugar in the toddlers’ diets.
Current eating behaviors were assessed using the Children’s Eating Behavior Questionnaire (CEBQ) completed by mothers. It is a 35-item tool, where respondents rate each item on a 5-point Likert scale from 1 (never) to 5 (always). Results for each subscale were calculated as the mean from all items in the given subscale.
CEBQ is a psychometric tool for assessing eating behaviors in children and was originally developed and validated by Wardle et al. Since then, CEBQ in original or modified versions has been used in multiple studies, involving wide age ranges of study subjects (from 12 months.
