Parental nutrition knowledge, feeding practices, and dietary behaviors among preschool children in the West Bank, Palestine: a cross-sectional study

Early childhood is a critical period for the development of dietary behaviors, and parents and caregivers play an important role in shaping children’s food environments, feeding routines, and eating practices. Evidence from the West Bank remains limited regarding the combined relationships among parental nutrition knowledge, multidimensional feeding practices, and preschool children’s dietary behaviors. This study assessed parental nutrition knowledge and feeding practices and examined their associations with selected dietary behaviors among preschool children in the West Bank, Palestine. This analytical cross-sectional study was conducted between March and May 2026 among 350 parents and primary caregivers of children aged 2–5 years residing in selected governorates of the northern West Bank. Participants completed a structured self-administered questionnaire assessing sociodemographic and child-related characteristics, parental nutrition knowledge, nine Feeding Practices and Structure Questionnaire-28 (FPSQ-28) domains, and five child dietary behaviors. Descriptive statistics, non-parametric bivariate analyses, multiple linear regression, and ordinal logistic regression were performed. Benjamini–Hochberg false discovery rate (FDR) correction was applied to the principal substantive exposure–outcome comparisons. Sensitivity analyses addressed the bounded parental knowledge score, ordinal coding of screen time, and violations of the proportional-odds assumption. Mean parental nutrition knowledge was 5.09 ± 0.83 out of 6, indicating generally high knowledge. Only 49.7% correctly identified that natural juice is not a healthy substitute for whole fruit. The FPSQ-28 demonstrated high internal consistency (Cronbach’s α = 0.918). In adjusted linear regression, higher child screen time was associated with a lower parental knowledge score (B = − 0.116, 95% CI: −0.210 to − 0.023, p = .015), and this association remained consistent in sensitivity analyses. After FDR correction in the dietary-behavior models, higher screen time remained associated with less frequent breakfast consumption and fruit and vegetable intake and with more frequent unhealthy snack and sweetened drink consumption. Higher healthy food availability and positive reinforcement were associated with more frequent fruit and vegetable intake, whereas pressure to eat was associated with less frequent fruit and vegetable intake. Food as reward was associated with more frequent sweetened drink consumption, restriction with less frequent unhealthy snack consumption, and variety encouragement with more frequent unhealthy snack consumption and lower reported food refusal. Associations between parental nutrition knowledge and the dietary outcomes did not remain statistically supported after FDR correction. Parental nutrition knowledge was generally high, but feeding practices and child dietary behaviors varied. Child screen time was the most consistent correlate of dietary behaviors, while selected feeding-practice domains showed behavior-specific associations. The findings suggest that family-centered nutrition approaches may benefit from combining nutrition information with practical feeding guidance, supportive home food environments, structured eating routines, attention to screen-related behaviors, and involvement of caregivers in early childhood nutrition. Because of the cross-sectional design, causal or directional relationships cannot be inferred.