Mother- and father-infant feeding interactions in families with parents with BED
Several studies demonstrated that the quality of dyadic interactions during feeding has an impact on offspring’s psychopathological problems in families where parents have a psychiatric diagnosis. Although literature addressed the trans-generational transmission of psychopathology from parents with eating disorders to their offspring, the specific quality of parent-infant interactions during feeding has not been assessed. The purpose of the study was to assess possible differences in the quality of mothers-children and fathers-children feeding interactions at 36 months of age of the child in families with parents diagnosed with binge eating disorders (BED). The sample was composed by 30 Italian couples of parents and children (Ntot =90), divided into three groups based on the presence of BED diagnosis. Group A: diagnosis in both parents; Group B: diagnosis only in the mothers; Group C: diagnosis only in the fathers. For the evaluation of feeding dyadic exchanges SVIA Italian adaptation of the Feeding Scale was applied. Parent-infant interactions in families with parents diagnosed with BED show maladaptive features. Mothers and fathers relate to children in a not overlapping fashion, with mothers showing various maladaptive symptoms and fathers showing severe conflicts with the children during the meal. Primarily reducing parental symptoms is relevant in term of mental health prevention programs.
Keywords: Binge eating disorderFeeding interactionsChild psychopathology
The relational processes represent a core aspect for the evaluation and prevention of vulnerabilities
and psychological distress in infants and in their parents during childhood. Among the various typical
issues of the family relationship during developmental age, infant feeding is a key activity in the mother-
child dyad. Indeed, as known, nutrition represents a very important social behaviour as it characterizes
one of the first forms of interaction activities (Beebe & Lachmann, 2001; Stern, 1985).
There is a general consensus that adult-child interactions, such as during feeding, play a crucial
role in shaping offspring’s mental health. Indeed, in general, the relevance of caregivers-infant daily
interaction on children psychological well-being has been acknowledged and empirically supported in
international literature (Beebe & Lachmann, 2001; Chatoor, 1997; Cohn & Tronick, 1989; Kaye, 1982).
Various clinical guidelines and evidence from observational studies have indicated that nursing is
characterized by specific and rhythmic pattern, namely "turn-taking" (alternating turns), that especially
refers to a broader complex context of social interaction (Kaye, 1982; Stern, 1985). Moreover, as
highlighted by some international authors, these forms of affective and social interactions (real “social
dialogues”) could hampers the development of the rhythms of verbal dialogue and social interaction
(Ammaniti, Ambruzzi, Lucarelli, Cimino, & D'Olimpio, 2004; Kaye, 1982; Stern, 1985).
In accordance with the theoretical and empirical framework of Infant Research (Cohn & Tronick,
1989; Stern, 2010), the infant engages in bidirectional communication, showing an innate competence in
daily interactional exchanges with primary caregivers, particularly in feeding contexts. Still within this
framework, Stern (2010) consistently showed that dyads instinctively regulate their bidirectional
communications differently. Furthermore, other authors highlighted how repetitive “mismatch” between
parents and their children, that is failure in sharing empathic and sensitive interactions, could lead to
infant’s maladaptive emotional and behavioural symptoms over time (Beebe & Lachmann, 2001; Cohn &
Regarding to parental contribution, both mother and fathers in their shared experience of co-
parenting, are often indicated as having a key role in facilitating the involvement of the children in the
communicative exchange, identifying themselves in empathic way with offspring’s moods, and offering
communication strategies adapted with rhythmic and prosodic variations (Stern, 1985).
Due to the complexity of the phenomenon of nutrition during childhood, transitional feeding
difficulties can be frequently observed: they often seem to be temporary problems, quickly resolvable, but
just as often, feeding serious problems raise, consisting in an inadequate food intake, with a failure to
thrive (failure to thrive), or stunted (growth stunting) (Chatoor, 1997; Sameroff, 1983).
Among the causes of feeding difficulties in children, parental psychopathology (e.g., depression,
anxiety, and eating disorders) is often reported. Indeed, consistent research data showed that children’s
eating difficulties were associated with anxiety and worry in parents, and that some dysfunctional aspects
of the parent-infant relationship can seriously affect the child’s self-regulation of affections and his/her
nutritional capacity (Ammaniti et al., 2004; Ammaniti, Lucarelli, Cimino, D'Olimpio, & Chatoor, 2010;
Chatoor et al., 1997).
The clinical and empirical literature in the field of infants’ eating disorder has especially examined
the link between parental psychopathology and offspring’s maladaptive emotional and behavioural
symptoms, demonstrating that parents’ (especially maternal) non-responsiveness, due to their own
psychopathological problems, interacting with infants’ characteristics (e.g., a difficult temperament),
could make difficult in offspring’s psychological balance (Ainsworth, Bell, & Stayton, 1991; Sroufe
1985). Depending on the different form of difficulties, the outcomes may include both internalizing and
externalizing symptoms (Field, 2000). Furthermore, recent research indicated that parental severe and/or
chronic psychiatric diagnosis might be a predictor of their children’s psychopathology (Dietz, Jennings,
Kelley, & Marshal, 2009).
Taking into account the above-mentioned considerations, we acknowledge that the quality of
dyadic interactions during feeding, representing the characteristics of the entire parent-infant relationship,
has a crucial role in the transmission of psychopathological risk between parents and their children
(Chatoor, 1997), especially in families where parents have a psychiatric diagnosis. Hence, the necessity of
increasingly examine the emotional and environmental experiences of children during nutrition, to
address psychological dynamics within the child-caregiver relationship.
Furthermore, to the best of our knowledge, although literature addressed the trans-generational
transmission of psychopathology from parents with eating disorders to their offspring, the specific quality
of parent-infant (mother – and father) interactions during feeding has not been assessed.
In this regard, the role of fathers appears still too little estimated. Indeed, to our knowledge, only
few study investigated the role of father’s psychopathological profiles on onset and maintenance of
emotional behavioural problems in offspring, focusing on parent-infant daily interactions (Cerniglia,
Cimino, & Ballarotto, 2014; Cimino et al., 2016a; Cimino, Cerniglia, & Paciello, 2015).
Purpose of the Study
The current study aimed at investigating parent-child relationship dynamics in families with
parents diagnosed with binge eating disorders (BED). More specifically, the purpose of this work was to
explore the link between mother and father psychopathological profiles and their children emotional-
adaptive functioning, examining mother-child and father-child relational dyadic patterns at 36 months of
age of the child.
According to Infant Research theory and consistent with a large amount of empirical work, we
hypothesized that maladaptive caregiver-infant interactive patterns, which characterize a parental style
during daily feeding interactions, occur in families with parents diagnosed with binge eating disorders
(BED), probably related to severe emotional-behavioural functioning’s impairment in children. Thus, we
generally suppose a children’s maladaptive psychopathological functioning in presence of BED parental
psychiatric diagnosis, considering the parental interactive patterns.
In other words, we expected that parental diagnosis of BED would act as risk factor that relates to
the children’s likelihood of experiencing psychopathological problems overtime. In this regard, we also
expected that offspring of parents who were both diagnosed with BED exhibit psychological problems
than children with only one parent with BED.
Our first specific objective in this study was to explore the emotional and behavioural functioning
in children of parent diagnosed with BED. The second specific goal was to assess the quality of mothers-
children and fathers-children feeding interactions, focusing on possible differences between parents in
conducting interactive exchanges with their children. More specifically, in the supposed maladaptive
quality of parent-child interactions, due to their own parental psychopathology, we intend to point out
some differences in mother-child and parent-child interactions.
Subjects and procedure
We conducted a cross-sectional study on the quality of parent-infant interactions during feeding in
families with parents diagnosed with binge eating disorders (BED). 30 Italian couples of parents, aged
between 25-45 years, and their children 36 months old (Ntot =90) were enrolled. The subjects were
recruited from an Italian program for prevention of psychopathological problems in offspring of parents
with psychiatric diagnoses. The majority of them were Caucasian. Moreover, all participants came from
families with middle or high socioeconomic status. An informed consent form was distributed to parents.
None of the parents refused to participate in the study. All of them completed the relative informed
consent form. Only children without developmental disorders were included in the study.
Based on the presence of BED diagnosis in parents the whole sample was divided into three
groups. Group A, included 20 couples and their children (children’s average mean 18.99; s.d. 2.43) -
diagnosis in both parents; Group B, included 20 couples and their children (children’s average mean
19.63; s.d. 1.40) - diagnosis only in the mothers; Group C, included 20 couples and their children
(children’s average mean 19.96; s.d. 2.38) - diagnosis only in the fathers. The children’s gender was
balanced between males and females in each group.
To address our research goals, we acknowledge that an observational measure of dyadic
behavioural and emotional exchanges in the first years of life it’s very relevant to understand the
interactive patterns (Chatoor et al., 1997). Thus, for the evaluation of feeding dyadic exchanges in the
current study we adopted the SVIA Italian adaptation of the Feeding Scale, which was developed by
Lucarelli et. al. (2002). Moreover, to verify the children’s emotional-behavioural characteristics a report-
form instrument was used.
The parent-child feeding interactions were video-recorded during a main meal in the home. The
dyadic exchanges were secondly coded using the SVIA Italian adaptation of the Feeding Scale. Parents
were also independently administered a questionnaire on their children’s behaviour.
Prior permission was obtained from the Ethical Committee of the Medicine and Psychology
Faculty at Sapienza, University of Rome, in accordance with the Declaration of Helsinki.
The following tools were administered by trained psychologists.
Evaluation of feeding dyadic exchanges
Scala di Valutazione Interazioni Alimentari (SVIA)
The S.V.I.A. - Scala di Valutazione dell’Interazione Alimentare Madre-Bambino (Lucarelli et. al.,
2002), is an Italian adaptation of the Feeding Scale-Observational Scale for Mother-Infant Interaction
during Feeding, developed by Chatoor et al. (1997). The SVIA is a scale designed to evaluate the dyadic
exchanges between mother and infant in a feeding context, with children 1–36 months old. Although this
measure originally aimed to assess mother-child interactions, currently it can also be used for the
evaluation of father-child feeding interactions (Grava, Lucarelli, & Ammaniti, 2014).
The SVIA comes in the form of check lists to be applied to the video-recorded adult-infant
interactions (lasting 20 minutes). It investigates interactive behaviours, allowing the identification of
normal, risky interactive patterns or feeding disorders in early childhood. The instruments consists of 41
items included in four subscales: 1) parent’s affective state; 2) interactive conflict; 3) food refusal
behaviour; 4) dyad’s affective state.
The scale has good internal consistency (Cronbach’s α, 0.79–0.96).
Evaluation of emotional-behavioural functioning
Child Behaviour Checklist (CBCL 1 ½–5)
The Child Behaviour Checklist (CBCL 1 ½–5; Achenbach & Rescorla, 2001; Italian version by
Frigerio & Montirosso, 2002) is a report form scale used to evaluate children psychopathological
problems. It contains 100 items to assess the child emotional and behavioural functioning in different
areas of daily functioning (age range: 18–36 months). The items are scored on a three-point scale (three
alternative answer: not true, somewhat or sometimes true, very true or often true).
The instruments measures three different symptomatic scales: Internalizing scale, Externalizing
scale, and Neither Internalizing Nor Externalizing scale. The Internalizing scale includes various
psychopathological problems, such as Anxious/Depressed, Withdrawn, Somatic Complaints, while the
Externalizing scale measures Attention Problems and Aggressive Behaviour.
The instrument shows a good internal consistency (Cronbach’s α, 0.65 to 0.96).
To assess the presence of psychopathological problems in offspring of parents with BED we
carried out multivariate analyses of variance (MANOVA) on the data in the CBCL DSM-oriented scales
in all three groups, considering the effects of age and gender (to respond to first objective). The variable
group consisted in the between-subjects factor (GA vs. GB vs. GC). To examine the quality of the
interactional patterns between mothers and children and fathers and children during feeding we carried
out multivariate analyses of variances (MANOVAs) on the SVIA dimensions (to respond to second
objective). To evaluate the correlations between the BED diagnosis in parents, child psychopathology and
quality of feeding interactions, the Pearson’s product-moment correlation coefficient was used. In all the
analyses we conducted, the child’s gender showed no significant effect on the variables. All data were
performed with IBM SPSS software (version 23.0).
Children’s emotional-behavioural profiles
With regard to the assessment of children’s psychological symptoms, a MANOVA was conducted
on three groups on CBCL scales to verify whether children of parents diagnosed with BED showed
maladaptive emotional-behavioural functioning. Analyses showed a Group effect (λ= .229; F= 25.450, p
=.000). The analysis revealed a statistically significant effect on all the CBCL DSM-oriented scales
administered. According to our hypothesis, children of parents both diagnosed with BED reported high
levels of psychopathology, especially regarding to affective problems (F= 60.50, p =.000), anxiety
problems (F= 86.22, p =.000) and oppositional defiant problems (F= 45.88, p =.000).
Quality of mother–child and father–child interactions during feeding
With respect to the assessment of the mother–child and father–child interactions during feeding,
MANOVA analysis of the observational scale during feeding showed general maladaptive interactional
patterns that are established between parents and child during their daily interaction.
More particularly, mothers diagnosed with BED showed high scores on the Mother’s Affective
State and Interactive Conflict dimension. Fathers with BED tended to have more interactive conflict with
their children compared with mothers with BED. Moreover, mothers’ and fathers’ scores were
significantly higher than those showed by only one parent diagnosed with BED, in all dimensions (p <
.01). Indeed, both mothers and fathers diagnosed with BED showed poor quality in feeding interactions
with their child. In this regard, differences between mother- and father-infant feeding interactions were
relevant. Mothers with BED reported difficulties in showing positive affects and a higher frequency of
negative affects such as sadness or distress. Fathers with BED showed intensity of conflictual exchanges
within the dyad, expressing severe distress and discomfort when facing feeding routines with their
GA = both parents diagnosed with BED; GB = mother diagnosed with BED; GC = father diagnosed with BED Table
GA = both parents diagnosed with BED; GB = mother diagnosed with BED; GC = father diagnosed with BED
In order to explore the association between parental BED diagnosis, child psychopathology, and
quality of feeding exchanges the Pearson’s product-moment correlation coefficient was performed. An
interaction effect between both parental diagnosis of BED, the CBCL scales and SVIA scores was
evidenced (p <.01).
The main aim of the present study was to verify how parent-infant interactions during feeding
might be linked to children’s well-being impairment, in families with parents diagnosed with BED,
considering both mother-infant and father-infant exchanges. To our knowledge, no study on this topic
took place yet.
Since having parent with a psychiatric diagnosis represents a risk factor for early developmental
emotional/behavioural problems (Cimino et al., 2015; Murray, Halligan, & Cooper, 2010), we expected
that maladaptive parent-infant interactions during feeding in families with parents diagnosed with BED
would be linked to low levels of emotional and behavioural functioning in children; as well as we
expected that some difference in the quality of mothers-children and fathers-children feeding interactions
should be present.
Our findings generally support these predictions. The results of the current study show also within
our sample a high prevalence of children’s emotional-behavioural problems and of maladaptive
interactive exchange between parents and offspring. Overall, our findings are consistent with previous
research in showing high rates of psychopathological symptoms in children of parents with psychiatric
diagnosis, suggesting a negative effect of parental eating disorders on their offspring’s mental health
(Cerniglia et al., 2014; Cimino et al., 2015; Cimino et al., 2016a). Moreover, parent-infant interactions in
families with parents diagnosed with BED show maladaptive features. Mothers and fathers relate to
children in a not overlapping fashion, with mothers showing various maladaptive symptoms and fathers
showing severe conflicts with the children during the meal. A possible explanation is that fathers show
serious problems in relating to their children owing to their own difficulties in regulating hunger, satiety
and eating pace.
Defined in this way, the relational context in families with parents diagnosed with BED has been
found to be severely compromised. Consequently, parent-infant interactions in risk environment need to
be study with more special attention. In this regard primarily reducing parental symptoms is relevant in
term of mental health prevention programs. Indeed, verifying that maladaptive pattern characterizes the
relationship between parents diagnosed with BED and their children at 36 months, our data are consistent
with those of previous studies that argued that psychiatric disease in parents lead to offspring’s
uneasiness, which could crystalize into early psychopathological symptoms (Cimino et al., 2015; Cimino
et al., 2016a). Even more so, findings in the current study turn out to be very important in relation to child
mental health, since early children’s emotional and behavioural difficulties in the first years of life tend to
increase overtime (Ammaniti, Lucarelli, Cimino, D'Olimpio & Chatoor, 2012; Cimino et al., 2016b;
Cimino et al., 2015).
Our results should be viewed in the light of several methodological limitations.
The findings should be confirmed in a future research including a larger sample. Indeed, our
sample size limits the generalizability of the study. In addition, although we used an observational
measure of dyadic behavioural and emotional exchanges together with a report-form instrument, future
longitudinal studies to test the offspring’s difficulties overtime would be advisable.
Despite the abovementioned limitations, our study nevertheless confirmed that feeding interaction
during early childhood is an important source of psychological dynamics within the child-caregiver
relationship. Moreover, the use of video recording instrument such as SVIA allowed us to specifically
observe the daily interactions between child and parents in a psychopathological risk environment.
Actually, our results evidenced that once we take into account contexts of feeding, assessing the
quality of mother–child and father–child interactions, we gather crucial information about the parent-
infant relationship and its implications for children mental health. Our results have also demonstrated that
fathers engage in interactions with their children in a specific way. Thus, in our opinion, these findings
would seem to suggest that the contribution of maternal and paternal parent figures must be further
investigated. A productive focus for future research could better explore the weight of father’s
psychological profiles on offspring’s early negative outcomes. To date we have no much data about this.
In finally conclusion, the result of the study might be the starting point for developing more
systematic investigations in the field of relational dyadic pattern and for planning useful psychological
- Ammaniti, M., Ambruzzi, A.M., Lucarelli, L., Cimino, S., & D'Olimpio, F. (2004). Malnutrition and dysfunctional mother-child feeding interactions: Clinical assessment and research implications. Journal of the American College of Nutrition, 23, 3, 259-271.
- Ammaniti, M., Lucarelli, L., Cimino, S., D'Olimpio, F., & Chatoor, I. (2010). Maternal psychopathology and child risk factors in infantile anorexia. International Journal of Eating Disorders, 43, 3, 233-240. doi: 10.1002/eat.20688 Ammaniti, M., Lucarelli, L., Cimino, S., D'Olimpio, F., & Chatoor, I. (2012). Feeding disorders of infancy: a longitudinal study to middle childhood. International Journal of Eating Disorders, 45, 2, 272-280. doi: 10.1002/eat.20925 Ainsworth, M. D. S., Bell, S. M., & Stayton, D. J. (1991). Infant-mother attachment and social development: 'Socialisation' as a product of reciprocal responsiveness to signals. Woodhead, Martin (Ed.); Carr, Ronnie (Ed.); Light, Paul (Ed.), Becoming a person (pp. 30-55). Florence, KY, US: Taylor & Frances/Routledge.
- Beebe, B., & Lachmann, F. M. (2001). Infant research and adult treatment: A dyadic systems approach. Hillsdale, NJ: Analytic Press.
- Cerniglia L., Cimino S., & Ballarotto, G. (2014), Mother-child and father-child interaction with their 24 months old children during feeding, considering paternal involvement and child’s temperament in a community sample. Infant Mental Health Journal, 35, 5, 473-481. doi: 10.1002/imhj Chatoor, I. (1997). Feeding disorders of infants and toddlers. In J.D. Noshpitz (Ed.), Handbook of Child and Adolescent Psychiatry (pp. 367-386). New York: Wiley and Sons.
- Chatoor, I., Getson, P., Menvielle, E., Brasseaux, C., O’Donnel, E., Rivera, Y., & Mrazek, D. A. (1997).
- A Feeding Scale for research and clinical practice to assess mother-infant interactions in the first three years of life. Infant Mental Health Journal, 18, 76-91.
- Cimino, S., Cerniglia L., Paciello M., & Sinesi, S. (2013), A six-year prospective study on children of mothers with eating disorders: the role of paternal psychological profiles. European Eating Disorders Review, 21, 3, 238-246.
- Cimino, S., Cerniglia L., & Paciello, M. (2015), Mothers with depression, anxiety or eating disorders and longitudinal outcomes on their children: a study on paternal psychopathological risk. Child Psychiatry and Human Development,46, 228-236. doi: 10.1007/s10578-014-0462-6.
- Cimino, S., Cerniglia L., Porreca A., Simonelli A., Ronconi L., & Ballarotto, G. (2016a), Mothers and fathers with Binge Eating Disorder and their 18-36 months old children: a longitudinal study on parent-infant interactions and offspring’s emotional-behavioural profiles. Frontiers in Psychology, 7, 580 ISSN: 1664-1078, doi: 10.3389/fpsyg.2015.01210.
- Cimino, S., Cerniglia L., Almenara C., Jezek S., Erriu M., & Tambelli, R. (2016b), Developmental trajectories of body mass index and emotional-behavioural functioning of underweight children: a longitudinal study. Scientific Reports – Nature, 6: 20211 ISSN: 2045-2322, doi: 10.1038/srep20211.
- Cohn, J. F., & Tronick, E. (1989). Specificity of Infants' Response to Mothers' Affective Behaviour.
- Journal of the American Academy of Child & Adolescent Psychiatry, 28(2), 242-248. doi:10.1097/00004583-198903000-00016.
- Dietz, L. J., Jennings, K. D., Kelley, S. A., & Marshal, M. (2009). Maternal depression, paternal psychopathology and toddlers’ behaviour problems. Journal of Clinical Child and Adolescent Psychology, 38, 48–61. doi: 10.1080/15374410802575362.
- Field, T.M. (2000). Infants of depressed mothers. In S.L. Johnson, A.M. Hayes, T.M. Field, N.
- Schneiderman, & P.M. McCabe (Eds.), Stress, coping, and depression (pp. 7-22). Mahwah, NJ: Erlbaum.
- Frigerio, A. & Montirosso, R. (2002). La valutazione su base empirica dei problemi emotivo-comportamentali in età evolutiva. Infanzia e Adolescenza, 1, 38–48.
- Grava, C., Lucarelli, L., & Ammaniti, M. (2014). Gli eventi traumatici oroalimentari nell’infanzia: interazioni alimentari madre-bambino e padre-bambino a confronto. Infanzia e Adolescenza, 13(3), 148-160.
- Kaye, K. (1982). The mental and social life of babies. Chicago, IL: University of Chicago Press. Sameroff, A. (1983). Developmental systems: Contexts and evolution. In W., Kessen. (Ed.) Handbook of child psychology: Vol. 1. History, theory, and methods (pp. 237 – 294). New York: Wiley.
- Lucarelli, L., Cimino, S., Perucchini, P., Speranza, A.M., Ammaniti, M., & Ercolani, A.P. (2002). I disturbi alimentari nella prima infanzia: validazione di uno strumento osservativo dell’interazione madre-bambino. Infanzia e Adolescenza, 2, 113-124.
- Murray, L., Halligan S. L., & Cooper, P. J. (2010). Effects of postnatal depression on mother–infant interactions, and child development. In G., Bremner & T., Wachs T. (Eds.) Handbook of infant development (2nd ed.; Vol. 2, pp. 192–220). Chichester, United Kingdom: Wiley-Blackwell.
- Sroufe, L.A. (1985). Attachment classification from the perspective of infant-caregiver relationships and infant temperament. Child Development, 56, 1-14.
- Stern, D. N. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. New York: Basic Books.
- Stern, D. N. (2010). Forms of vitality: Exploring dynamic experience in psychology, the arts, psychotherapy, and development. Oxford: Oxford University Press.
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