Research report Parent feeding interactions and practices during childhood cancer treatment. A qualitative investigation Catharine A.K. Fleming a, *, Jennifer Cohen b,c,d , Alexia Murphy e , Claire E. Wakefield b,d , Richard J. Cohn b,d , Fiona L. Naumann a a School of Medical Science, UNSW Medicine, University of NSW Australia, High St Kensington, Sydney, NSW 2052, Australia b Kids Cancer Centre, Sydney Children’s Hospital, High Street, Randwick, Sydney, NSW 2031, Australia c School of Medicine, University of Wollongong, Wollongong, NSW, Australia d School of Women’s and Children’s Health, UNSW Medicine, University of NSW Australia, Sydney, NSW, Australia e Children’s Nutrition Research Centre, Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, Australia ARTICLE INFO Article history: Received 11 March 2014 Received in revised form 18 December 2014 Accepted 24 December 2014 Available online Keywords: Feeding practices Nutrition Nutritional support Paediatric oncology A B ST R AC T In the general population it is evident that parent feeding practices can directly shape a child’s life long dietary intake. Young children undergoing childhood cancer treatment may experience feeding difficul- ties and limited food intake, due to the inherent side effects of their anti-cancer treatment. What is not clear is how these treatment side effects are influencing the parent–child feeding relationship during anti-cancer treatment. This retrospective qualitative study collected telephone based interview data from 38 parents of childhood cancer patients who had recently completed cancer treatment (child’s mean age: 6.98 years). Parents described a range of treatment side effects that impacted on their child’s ability to eat, often resulting in weight loss. Sixty-one percent of parents (n = 23) reported high levels of stress in regard to their child’s eating and weight loss during treatment. Parents reported stress, feelings of help- lessness, and conflict and/or tension between parent and the child during feeding/eating interactions. Parents described using both positive and negative feeding practices, such as: pressuring their child to eat, threatening the insertion of a nasogastric feeding tube, encouraging the child to eat and providing home cooked meals in hospital. Results indicated that parent stress may lead to the use of coping strat- egies such as positive or negative feeding practices to entice their child to eat during cancer treatment. Future research is recommended to determine the implication of parent feeding practice on the long term diet quality and food preferences of childhood cancer survivors. © 2014 Published by Elsevier Ltd. Introduction It is well established that parent feeding practices and interac- tions with their child during mealtimes can directly shape a child’s life long dietary intake (Birch, 1998, 1999; Birch & Fisher, 1998; Brunstrom, Mitchell, & Baguley, 2005). From the parents’ initial choice of an infant-feeding method through to subsequent child feeding practices, parents influence a child’s feeding development and learned food experiences (Birch, 1998). The child’s feeding envi- ronment is also an important component in which the child’s food preferences and food acceptance patterns are shaped (Birch & Fisher, 1998). When a child receives a diagnosis of cancer, there is the po- tential for healthy feeding development to be negatively influenced (Green, Horn, & Erickson, 2010). The impact of a cancer diagnosis and the associated treatment during a child’s feeding development may affect parental feeding practices and parent–children interaction at mealtimes. Aggres- sive treatment protocols, periods of enteral nutrition, and long- term hospitalization can significantly impact on a child’s feeding development, food intake, and parent–child mealtime interaction (Green et al., 2010; Skolin, Hursti, & Wahlin, 2001). Anti-cancer treat- ment regimens often involve intense chemotherapy and radiation which may cause appetite suppression, nausea, vomiting, mucosi- tis, pain, or changes in taste and smell (Mosby, Barr, & Pencharz, 2009; Robinson, Loman, Balakas, & Flowers, 2012; Skolin et al., 2006). This cluster of toxic treatment side effects can result in child be- coming reluctant to eat, possibly due to negative experiences associated with food during this time (Green et al., 2010; Hanigan & Walter, 1992). To overcome this reluctance to eat, nutrition in- terventions such as enteral nutrition (EN) which provide nutrition to a child though the use of a nasogastric feeding tube (NGT), are Dr Wakefield is supported by an Early Career Development Award from the Cancer Institute of NSW (ID 11/ECF/3-43) and a Career Development Fellowship from the National Health and Medical Research Council (ID APP1067501). The Behavioural Sciences Unit at SCH is supported by the Kids with Cancer Foundation. This study was supported financially by a PhD Scholarship to Ms Catharine Fleming by the Anthony Rothe Memorial Fund. * Corresponding author. E-mail address: c.a.fleming@student.unsw.edu.au (C.A.K. Fleming). http://dx.doi.org/10.1016/j.appet.2014.12.225 0195-6663/© 2014 Published by Elsevier Ltd. Appetite ■■ (2015) ■■–■■ ARTICLE IN PRESS Please cite this article in press as: Catharine A.K. Fleming, et al., Parent feeding interactions and practices during childhood cancer treatment. A qualitative investigation, Appetite (2015), doi: 10.1016/j.appet.2014.12.225 Contents lists available at ScienceDirect Appetite journal homepage: www.elsevier.com/locate/appet Q2 Q1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87