Caregiver Feeding Practices and Eating Behaviors in Infants and Toddlers in Singapore

Phaik Ling Quah ^1,2* Daniel Wei Keong Chan ^2,3,4 See Ling Loy ^2,5 Chengsi Ong ^2,6 Chua Mei Chien ^2,4,7 Fabian Yap ^2,3,4 Chai-Hoon Nowel TAN ⁸ Michael Chia ⁹ Terence Buan Kiong CHUA ⁹ Kok Hian Tan ^10,2

• ¹ KK Women's and Children's Hospital, Singapore, Singapore
• ² Duke-NUS Medical School, Singapore, Singapore
• ³ Endocrinology Service, KK Women’s and Children’s Hospital, Singapore, Singapore, Singapore
• ⁴ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
• ⁵ Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore, Singapore
• ⁶ Department of Nutrition and Dietetics, KK Women’s and Children’s Hospital, Singapore, Singapore, Singapore
• ⁷ Department of Neonatology, KK Human Milk Bank, KK Women’s and Children’s Hospital, Singapore, Singapore
• ⁸ Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore, Singapore
• ⁹ Physical Education & Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore, Singapore
• ¹⁰ Division of Obstetrics & Gynecology, KK Women's and Children's Hospital, Singapore, Singapore, Singapore

Introduction: Research on early childhood caregiver feeding practices and eating behaviors is limited, especially within Asian populations. This study examined these practices across key feeding domains of variety, autonomy, and mealtime setting and timing, stratified by three age groups: 0 to <7 months, 7 to <13 months, and 13 to <36 months. Methods: A cross-sectional survey of 1,307 caregivers from a multi-ethnic population in Singapore captured demographic data, feeding practices, child eating behaviors, and caregivers' knowledge, attitudes, and practices. One-way analysis of variance (ANOVA), independent T-tests and the chi-square test were used to assess feeding practices and eating behaviors across age groups.Results: Regarding dietary variety, 14.8% and 6.1% of infants aged 7 to <13 months were offered three or fewer food groups frequently and daily, respectively. Additionally, 11.9% of infants were receiving processed foods often. At this age, only 1.0% of infants were consuming sugar-sweetened beverages (SSBs) often, while 2.0% consumed them daily.Among older children (aged 13 to <36 months), 8.1% were offered a limited variety of three food groups, while 4.5% were offered fewer than three. In contrast, a significantly higher proportion frequently consumed processed foods (24.0%) and sugar-sweetened beverages (25.2%) (p < 0.05). In terms of autonomy, only 75.4% of infants (7-<13 months) and 89.5% of older children (13-<36 months) were able to self-feed. Caregivers of older children (13-<36 months) were less likely to recognize hunger and satiety cues compared to those of infants (0-< 13 months) (p<0.05). Older children (13-<36 months) also more frequently required special mealtime settings (36.6%), viewed screens during meals (29.9%), and were less likely to be offered post-midnight meals nightly (22.6% compared to infants (70.3%) (0-<13 months) (p<0.05).Conclusion: These findings underscore the need for culturally tailored educational interventions to improve suboptimal feeding practices in children under three in Singapore's multiethnic population.