Parenting Style, Caregiver Stress, and Energy-Dense Feeding Episodes in Low-Income Preschoolers: A Pilot Ecological Momentary Assessment Study.

Background/Objectives: Excess consumption of energy-dense foods (EDF; ultra-processed snacks, sweets, and sugar-sweetened beverages) among preschool-aged children is a public health concern, particularly in low-income families. Caregiver parenting style, psychological stress, and food-parenting practices (FPP) may shape children's EDF consumption, yet little is known about how these factors operate in real time. This exploratory pilot study examined (1) associations between baseline characteristics and EDF feeding episodes across 1 week and (2) whether caregivers' momentary stress during EDF episodes related to FPP used. Methods: In total, 22 caregivers of Head Start children (ages 3-5) completed baseline measures and 7 days of ecological momentary assessment (up to seven prompts/day). At each prompt, caregivers reported child EDF consumption in the past hour; if confirmed, they reported FPP used and rated momentary stress. Aim 1 used Poisson regression to model caregiver-level EDF episode counts. Aim 2 tested momentary stress-practice associations during EDF episodes using GEE, with within-person and between-person stress modeled separately. Results: Authoritarian parenting was associated with a higher weekly rate of EDF episodes (RR = 1.43, 95% CI 1.23-1.66, p < 0.001); authoritative parenting trended lower (RR = 0.90, p = 0.065). Higher baseline stress was associated with more EDF episodes (RR = 1.25, p = 0.001). Momentarily, elevated stress above a caregiver's own average increased odds of using food as a reward (OR = 1.08 per +10 points, p = 0.011), while higher average momentary stress was associated with co-eating (OR = 1.59, p = 0.042). Domain-level FPP composites showed no association with momentary stress. Conclusions: Authoritarian parenting and higher caregiver stress were associated with increased EDF feeding, and momentary stress was linked to reward-based feeding during those episodes. These hypothesis-generating findings suggest potential behavioral targets for just-in-time adaptive intervention, pending replication in adequately powered studies.