(OR17-03-23) Responsive Feeding and Diet Quality Among Low-Income Families With Toddlers: A Mixed Method Study

Objectives: Young children from low-income families have the greatest risk of poor diet quality and obesity. Responsive feeding (RF), characterized by reciprocity between child and caregiver during feeding, promotes healthy food preferences yet is understudied among low-income caregivers. Thus, we aimed to assess RF practices and their relationship to diet quality among low-income caregivers.

Methods: Caregivers of young children (1-3 years old) from one low-income community completed an online survey and were invited to attend focus groups. The survey queried on: RF strategies and attitudes; toddler’s food group intake frequency in the past week; and diversity in the food groups. In exploratory factor analysis, the RF questions (n=28) loaded onto 2 factors: internal cues (child self-regulation and food acceptance) and external cues (meal environment, caregiver modeling, and parent beliefs). Spearman correlations tested associations between the factors and diet variables. The focus groups explored responsive feeding concepts and toddler feeding. Focus group themes were identified via thematic analysis.

Results: 134 caregivers (93% female, ~66% from underrepresented racial/ethnic groups) completed the survey, and 24 participated in a focus group. The external cues factor was associated with less frequent intake of fast food and sugar sweetened beverages (p < .05), but more frequent intake of fruit and vegetables, and less diversity in types of sweet and salty snacks (p’s <.01). The internal cues factor was associated with more frequent intake of vegetables (p < .05) and greater diversity of fruit and vegetables (p <.01). We identified four focus group themes, including two that aligned with RF practices (trust in child cues, positive strategies to encourage children to eat non-preferred foods) and two that presented barriers (lack of trust in child cues, use of force and bribery).

Conclusions: RF is relevant to low-income families and their toddler’s intake: caregivers had concerns about child self-regulation of intake and used various strategies to encourage their child to eat healthier. Continued research and effective messages are needed to support RF among low-income families with young children.

Funding Sources: Child Health and Development Institute and the Robert Wood Johnson Foundation