Background: Fussy eating is common in young children, often raising concerns among parents. The use of pressuring feeding practices may provoke or worsen child fussiness, but these practices could equally be a parent's response to child fussy eating.
Objective: In longitudinal analyses, we assessed directionality in the relation between fussy eating and parent's pressure to eat across childhood.
Methods: Study participants were 4845 mother-child dyads from the population-based Generation R cohort in the Netherlands. The Child Behavior Checklist was used to assess fussy eating (2 items) at child ages 11/2, 3 and 6. years. Parents' pressure to eat was assessed with the Child Feeding Questionnaire (4 items) when children were 4. years old. All scale scores were standardized.
Results: Linear regression analyses indicated that preschoolers' fussy eating prospectively predicted higher levels of parents' pressure to eat at child age 4. years, independently of confounders (adjusted B = 0.24, 95% CI: 0.21, 0.27). Pressure to eat at 4. years also predicted more fussiness in children at age 6. years, independently of confounders and of fussy eating at baseline (adjusted B = 0.14, 95% CI: 0.11, 0.17). Path analyses indicated that the relation from fussy eating at 3. years to parenting one year later was stronger than from pressure at 4. years to fussy eating two years later (p. <. 0.001).
Conclusions: Our findings suggest bi-directional associations with parental pressuring feeding strategies being developed in response to children's food avoidant behaviors, but also seemingly having a counterproductive effect on fussiness. Thus, the use of pressure to eat should be reconsidered, while providing parents alternative techniques to deal with their child's fussy eating.

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Keywords Children, Controlling feeding, Fussy eating, Longitudinal, Pickiness, Pressure to eat
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Journal Physiology and Behavior
Jansen, P.W, de Barse, L.M, Jaddoe, V.W.V, Verhulst, F.C, Franco, O.H, & Tiemeier, H.W. (2017). Bi-directional associations between child fussy eating and parents' pressure to eat: Who influences whom?. Physiology and Behavior. doi:10.1016/j.physbeh.2017.02.015