Sample characteristics of Samples 1 and 2 with relevant feeding practices data are presented in Table 2. Characteristics are presented for the four subsamples that were used for the different analysis steps. Notably, 266 participants of Sample 1 were currently milk and solid feeding their child and therefore completed both sets of questions. Consequently, 294 participants from Sample 1 and 437 from Sample 2 (T1 assessment) contributed to the milk feeding version (N = 731), while 463 participants from Sample 1 and 148 from Sample 2 (T3 assessment) contributed to the solids feeding version (N = 611).
[Insert Table 2 here]
Development and validation of the FPSQ milk feeding version – FPSQ-M
CFA – factor specification and structural validation ( N = 731)
Initially 26 items were developed for the milk-feeding version of the FPSQ. Six items were excluded based on serious issues with item distribution (all from the Parent-led feeding construct; see Additional file 1for table with excluded items). The remaining 20 items for which less severe issues with item distribution were flagged were included in the CFA. The proposed model, based on the theoretical development of the FPSQ milk-feeding version, consisted of four factors: ‘Feeding on demand’ (4 items), ‘Using food to calm’ (5 items), ‘Persuasive feeding’ (5 items) and ‘Parent-led feeding’ (6 items). This initial model showed poor fit (RMSEA = 0.110, CFI = 0.90 and TLI = 0.89) and two items loaded < 0.4 onto the Persuasive Feeding factor (PERS 3 + 4).
Modification indices indicated that PERS3 (“I offer the breast/bottle to check if my baby is hungry”) might better load with the factor ‘Using food to calm’. While model fit improved (RMSEA = 0.075, CFI = 0.96 and TLI = 0.95), PERS4 still loaded below < 0.4 and was removed in the next step. Goodness-of-fit indices indicated that this model showed acceptable fit to the data (RMSEA = 0.080, CFI = 0.95 and TLI = 0.95), however, after examination of all items on the factor it was decided that this item did not fully fit with the remaining items. Removal of PERS3 led to a model of mostly acceptable fit (RMSEA = 0.082, CFI = 0.96 and TLI = 0.95) while the normed chi-square of 5.9 was outside the desirable range. All items were significant, had standardised factor loadings > 0.5 and SMC values ≥ 0.2. Cronbach’s alphas, Coefficient H, mean scores and factor-factor correlations are presented in Table 4, reflecting good internal reliabilities with all Cronbach’s alphas being above 0.7 and all Coefficient Hs being above 0.8.
Table 4
Internal reliability, means, standard deviation and factor-factor correlations of 4 milk-feeding practices (based on 19 items, FPSQ-M) – N = 731
| Demand 4 items | Food to calm 5 items | Persuasive feeding 3 items | Parent-led feeding 6 items |
Cronbach’s alpha | .868 | .874 | .713 | .789 |
Coefficient H | .927 | .917 | .814 | .911 |
Mean ± SD | 3.77 ± 1.01 2 missing | 2.57 ± 0.93 16 missing | 1.91 ± 0.80 16 missing | 1.67 ± 0.75 0 missing |
Food to calm | 0.490 (< .001) | 1 | | |
Persuasive feeding | -0.259 (< .001) | 0.277 (< .001) | 1 | |
Parent-led feeding | -0.646 (< .001) | -0.309 (< .001) | 0.426 (< .001) | 1 |
[Insert Table 3 and Table 4 here]
Development and validation of the solid feeding version – FPSQ-S
CFA – factor specification and structural validation ( N = 611)
Initially 35 items were developed for the solid-feeding version of the FPSQ. The same six items as above were excluded based on serious issues with item distribution (all from the Parent-led feeding construct; see Additional file 1 for table with excluded items). The remaining 29 items for which less severe issues with item distribution were flagged were included in the CFA. The proposed model, based on the theoretical development of the FPSQ solid-feeding version and the established factors of the milk-feeding version, consisted of four factors: ‘Feeding on demand’ (5 items), ‘Using food to calm’ (6 items), ‘Persuasive feeding’ (11 items) and ‘Parent-led feeding’ (7 items). This initial model showed poor fit (RMSEA = 0.076, CFI = 0.89 and TLI = 0.88) and four items had factor loadings < 0.4 (PARENT2, PERS 5 + 6 + 11). Additionally, modification indices revealed that several items might better load onto a different factor than currently placed. Consequently several changes were made to the model in subsequent iterations. These included: 1) moving PERS5 to the Parent-led feeding factor but then removing it in the next step because of a standardised factor loading < 0.4; 2) moving PERS11 to the Parent-led feeding factor but then removing it in the next step because of a standardised factor loading < 0.4; deleting 3) PARENT2 and 4) PERS6 because of standardised factor loadings < 0.4, 5) PARENT1 because of content-overlap with PERS9 and cross-loading with the Persuasive feeding factor, and finally 6) DEM1, PARENT3 and PERS3 because of parsimony (i.e. better model fit was achieved with fewer items making them redundant; see Additional file 1 for model fit). The final model included 21 items, loading onto 4 factors. Goodness-of-fit indices indicated that this model showed acceptable fit to the data: RMSEA = 0.065, CFI = 0.95 and TLI = 0.94, while the normed chi-square of 3.6 was outside the desirable range. All items were significant, had standardised factor loadings > 0.5 (see Table 5) and SMC values > 0.2.
Table 5
Standardised factor loadings for items of the FPSQ-S according to CFA (4 factors, 21 items and for the extended version – 6 factors 34 items)
Factor | Label | Item | Loading N = 611 | Loading extended version N = 463 |
Feeding on demand (lower score indicates feeding on demand) | DEM2 | My child eats at set times | .850 | .825 |
DEM3 | I decide when it is time for my child to eat | .632 | .648 |
DEM4 | I let my child decide when she/he would like to eat* | .628 | .630 |
DEM5 | My child has a set mealtime routine | .786 | .789 |
Using food to calm | FC1 | I give my child food to settle him/her even if he/she is not hungry | .698 | .731 |
FC2 | I offer my child something to eat to make her/him feel better when she/he is unsettled or crying | .882 | .872 |
FC3 | I offer my child something to eat to make her/him feel better when she/he is hurt | .863 | .934 |
FC4 | When my child gets unsettled or is crying, one of the first things I do is give her/him food | .776 | .793 |
FC5 | I give my child food to make sure that they do not get unsettled or cry | .716 | .704 |
FC6 | I use food to distract my child or keep him/her busy | .641 | .650 |
Persuasive feeding | PERS1 | I encourage my child to eat all of the food in front of him/her | .795 | .803 |
PERS2 | When my child turns away, I try to get her/him to eat a little bit more | .800 | .774 |
PERS4 | If my child indicates she/he is not hungry I try to get her/him to eat anyway | .719 | .737 |
PERS7 | I say or do something to show my disapproval of my child for not eating | .682 | .761 |
PERS8 | I praise my child after each bit to encourage finishing the food | .682 | .710 |
PERS9 | When my child refuses food they usually eat, I encourage her/him to eat it | .708 | .714 |
PERS10 | I play games to make sure my child eats enough | .645 | .681 |
Parent-led feeding | PARENT6 | I carefully control how much my child eats | .800 | .808 |
PARENT 7 | I have a rule about how much my child should eat | .851 | .853 |
PARENT 8 | I let my child decide how much she/he eats* | .756 | .793 |
PARENT 9 | I decide how much my child eats | .767 | .811 |
Family Meal Environment | FM3 | My child eats together with other family members. | X | .816 |
FM4 | My child is given the same foods as the rest of the family (pureed, mashed, chopped). | X | .788 |
FM5 | Whether my child is eating or not, my child sits with the rest of the family when they are having a meal. | X | .611 |
FM6 | I eat my meals while my child eats. | X | .864 |
Using (non-) food rewards | REW1 | I offer foods to my child as a reward for good behaviour. | X | .859 |
REW2 | I offer my child their favourite foods in exchange for good behaviour. | X | .913 |
REW5 | I promise my child something other than food if they eat (for example: “If you eat your beans, we can go to the park”). | X | .861 |
REW6 | When my child refuses food they usually eat, I encourage eating by offering a non-food reward (for example: favourite toy or sticker). | X | .884 |
REW7 | I encourage my child to eat something by using food as a reward (for example: “If you finish your vegetables, you will get some dessert"). | X | .960 |
REW8 | When my child refuses food they usually eat, I encourage eating by offering a food reward (for example: dessert). | X | .918 |
REW9 | I use desserts as an encouragement to get my child to eat the main course. | X | .960 |
REW10 | I make my child finish the main course before having a dessert. | X | .703 |
REW11 | I warn my child that I will take a favourite food away if my child does not eat a food they do not like (for example: “If you don’t finish your vegetables, you won’t get dessert”). | X | .870 |
*Item is reverse coded |
X item was not tested in this version |
Response options: 1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = always |
[Insert Table 5 here]
As shown in Table 1, three additional feeding constructs were included in the solid-feeding version of the FPSQ compared to the milk-feeding version [i.e. (1) “Feeding location – sit down meal”, (2) “Family meal environment” and (3) “Using (non-)food rewards”]. Due to the younger age and thus different developmental stage of the children in Sample 2, these three feeding aspects were only investigated in Sample 1 (n = 463). Initially 10 and 11 items were developed to assess mealtime structure (constructs 1 and 2) and using (non-)food rewards (construct 3). Four items were excluded based on serious issues with item distribution (2 from constructs 1 and 3 respectively; see Additional file 1 for table with excluded items). Issues with item distribution were flagged for the remaining 17 items.
Next, the final CFA model for the solid-feeding version presented above with 4 factors (21 items) was used and 2 new factors were added – mealtime structure (8 items) and rewards (9 items). Although the goodness-of-fit indices indicated that this model showed acceptable fit to the data (RMSEA = 0.066, CFI = 0.93 and TLI = 0.93, normed chi-square = 3.0), not all items were significant and modification indices revealed that several items might better load onto a different factor than currently placed. Additionally, standardised factor loadings around 0.4 suggested that some items should possibly be deleted. Consequently six changes were made to the model in subsequent iterations. These included: First moving FME1 to the Rewards factor and then deleting it because the standardised factor loading was below 0.4; next moving FME2 to the Rewards factor and then deleting it because the standardised factor loading was below 0.4; finally deleting SIT3 and SIT2 due to standardised factor loadings below 0.4 (see Additional file 1 for model fit). The final model included 34 items, loading onto 6 factors. Goodness-of-fit indices indicated that this model showed acceptable fit to the data: RMSEA = 0.052, CFI = 0.97 and TLI = 0.96, while the normed chi-square of 2.2 was just outside the desirable range. All items were significant, had standardised factor loadings > 0.5 and SMC values ≥ 0.2. Cronbach’s alphas, Coefficient H, mean scores and factor-factor correlations are presented in Table 6, reflecting good internal reliabilities with all Cronbach’s alphas being above 0.7 and all Coefficient Hs being above 0.8.
Table 6
Internal reliability, means, standard deviation and factor-factor correlations of 6 solid-feeding practices (based on 34 items, FPSQ-S; Sample 1, n = 463)
| Demand 4 items | Food to calm 6 items | Persuasive feeding 7 items | Parent-led feeding 4 items | Family meal environment 4 items | Using (non-) food rewards 9 items |
Cronbach’s alpha | .740 | .858 | .853 | .836 | .805 | .918 |
Coefficient H | .838 | .936 | .890 | .891 | .878 | .979 |
Mean ± SD | 3.33 ± 0.77 0 missing | 1.80 ± 0.66 40 missing | 2.64 ± 0.83 40 missing | 2.06 ± 0.86 20 missing | 3.74 ± 0.82 1 missing | 1.56 ± 0.75 86 missing* |
Food to calm | -0.135 (0.011) | 1 | | | | |
Persuasive feeding | 0.359 (< .001) | 0.361 (< .001) | 1 | | | |
Parent-led feeding | 0.440 (< .001) | 0.218 (< .001) | 0.613 (< .001) | 1 | | |
Family meal setting | -0.08 (0.110) | -0.029 (0.603) | -0.107 (0.040) | -0.248 (< .001) | 1 | |
Using (non-) food rewards | 0.096 (0.112) | 0.560 (< .001) | 0.590 (< .001) | 0.396 (< .001) | 0.129 (0.051) | 1 |
*This is largely due to the “not applicable” response option, which was coded ‘missing’ for analysis. |
[Insert Table 6 here]