Instruments assessing parental responsive feeding in children ages birth to 5 years: A systematic review

Responsive feeding of young children has been identified as a protective factor against the development of childhood obesity. Instruments developed to assess responsive feeding by parents of children birth to 5 years of age over the past 17 years were reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Four electronic databases (PubMed, CINAHL, PsycINFO, and Scopus) were used to search for relevant articles to include at least one parental responsive feeding category (Food Rewards, Pressure to Eat, Parental Control of Intake, Emotional Feeding, or Responsiveness to Cues/Child Autonomy), development, validation, or reliability of the instrument, and evaluated in at least one child between ages birth to 5 years old. The final review included 33 individual responsive feeding related instruments. Risk of bias for each article was assessed using the Risk of Bias in Non-randomized Studies (ROBINS-I) assessment tool. Of the 15 instruments intended for birth to 2-year-olds and the 28 intended for 3- to 5-year-olds, only three instruments showed rigorous validation and reliability testing (Feeding Practices and Structure Questionnaire, Comprehensive Feeding Practices Questionnaire, and Family Food Behavior Survey). The most commonly reported psychometric testing was construct validity and internal reliability. There were limited instruments intended for young children (birth to 2 years), low-income, diverse racial and ethnic groups (Hispanic and non-Hispanic black), and fathers or other caregivers. The most frequently assessed feeding practices included Pressure to Eat, Parental Control, and Food Rewards, but none of the instruments assessed all aspects of responsive feeding. This review identified the need for more comprehensive instruments that measure all aspects of responsive feeding, the need for further testing in diverse populations, and further validity and reliability testing.