Maternal Behavior and Infant Weight Gain in the First Year

ObjectiveTo examine the relative contributions of maternal characteristics and behaviors in predicting infant weight gain over the first year of postpartum life.DesignLongitudinal study of maternal feeding style throughout infancy.SettingA Special Supplemental Nutrition Program for Women, Infants, and Children center.ParticipantsNinety-six low-income, minority mother-infant dyads.Main Outcome MeasuresInfant weight gain at 3, 6, and 12 months.AnalysisMultiple linear and backward regressions.ResultsNone of the mother-infant perinatal measures predicted infant weight gain from birth to 3 months, nor did measures from birth to 3 months predict weight gain from 3 to 6 months. However, the number of feedings and lessened maternal sensitivity to infant cues predicted weight gain from 6 to 12 months.Conclusions and ImplicationsThese results suggest that feeding plays an important role in promoting rapid weight gain in infants, since the maternal reports of feeding frequency, as well as their lessened sensitivity to the infants' cues, indicate that the infants in this study may have been regularly overfed. Nutrition educators who work with low-income populations should provide guidance to mothers in feeding their infants by helping them to recognize hunger signals and respond to satiety cues.     

Exploring Correlates of Infant Clarity of Cues During Early Feeding Interactions

BackgroundRecommendations aimed at reducing infants’ risk for rapid weight gain primarily focus on promoting caregivers’ use of responsive feeding practices and styles. These recommendations are grounded in the belief that infants will effectively signal hunger and satiation to their caregivers. To date, few studies have explored how variability in infants’ communication of hunger and satiation may contribute to feeding interactions.ObjectiveOur aim was to explore variability in, and correlates of, infant clarity of cues during feeding interactions.DesignThis was a cross-sectional study.Participants/settingMother–infant dyads (n=86) were video-recorded during a typical feeding interaction within laboratory-based settings in Philadelphia, PA and San Luis Obispo, CA between June 2013 and June 2017.Main outcome measuresTrained raters later coded videos using the Nursing Child Assessment Parent–Child Interaction Feeding Scale’s Infant Clarity of Cues and Maternal Sensitivity to Cues subscales. Infant weight was assessed and standardized to sex- and age-specific z scores. Mothers completed questionnaires related to family demographics, infant feeding history, feeding styles, and infant temperament and eating behaviors.Statistical analyses performedLinear models were used to test for associations between clarity of cues and breastfeeding vs formula-feeding, maternal sensitivity and responsiveness, and feeding and weight outcomes.ResultsInfants were approximately 15.5 weeks of age and 53% were female. Clarity of cues was not associated with infant sex, age, temperament, or eating behaviors. Breastfed and formula-fed infants exhibited similar clarity of cues (P=0.0636). Greater clarity of cues for infants was associated with greater maternal sensitivity to cues (P=0.0011) and responsive feeding style (P=0.0464) for mothers. Lower clarity of cues was associated with greater weight-for-age z score change for formula-fed infants, but not breastfed infants.ConclusionsEfforts to promote responsive feeding may need to also consider infant clarity of cues. Further research is needed to understand the implications of associations between infant communication and responsive feeding.     

Promoting Responsive Bottle-Feeding Within WIC: Evaluation of a Policy,Systems, and Environmental Change Approach

BackgroundBottle-fed infants are at greater risk for overfeeding and rapid weight gain (RWG); evidence-based strategies for promoting healthy bottle-feeding practices are needed.ObjectiveOur aim was to assess whether policy, systems, and environmental (PSE) strategies for promoting responsive bottle-feeding practices within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were associated with lower risk for RWG.DesignWe conducted a matched-pair cluster randomized trial. PSE strategies were implemented at 3 WIC clinics in Los Angeles County. PSE clinics were compared with 3 matched control clinics. Mothers and infants were assessed when infants were newborn and 3 months and 6 months of age.Participants/settingParticipants were mothers (n = 246) who enrolled their newborn infants (younger than 60 days) into WIC between May and August 2019.Main outcome measuresInfant weight was assessed and standardized to sex- and age-specific z scores. RWG was defined as weight-for-age z score change > 0.67. Mothers completed questionnaires assessing responsive and pressuring feeding styles, breast- and bottle-feeding patterns, and perceptions of WIC experiences.Statistical analyses performedLogistic regression with estimation via generalized estimating equations and linear mixed models with repeated measures assessed effects of PSE strategies on categorical and continuous outcomes, respectively.ResultsInfants in PSE clinics had significantly lower likelihood of exhibiting RWG (P = .014) than infants in control clinics. Mothers in PSE and control clinics reported similar levels of responsive and pressuring feeding style and similar prevalence of breastfeeding and bottle-feeding. Mothers in PSE clinics trended toward feeling better supported with respect to their decision to bottle-feed (P = .098) and had more stable intentions to stay in the WIC program (P = .002) compared with mothers in control clinics.ConclusionsPSE strategies focused on promoting more inclusive assessment of infant feeding, tailored bottle-feeding counseling, and increased education and support for responsive bottle-feeding were associated with lower risk for RWG among WIC infants.     

Patterns of growth in weight and length among American Samoan infants

Well baby clinic records on 1, 186 infants born in 1975 to 1976 on the island of Tutuila, American Samoa, form the basis for this study of the growth in weight and length from birth to 12 months. Semi‐longitudinal curves of weight and length indicate that these infants have median weights near the NCHS 75th percentile (boys) and 90th percentile (girls) up to 6 months, falling to just below the 75th percentile by 12 months. Median lengths are between the NCHS 50th and 25th percentile. Weight gain from birth to six months was found to be higher than for any other reported population (4.92 kg, sexes combined). The infant feeding pattern was found to exert a significant influence on rate of weight gain for boys between birth and 1–4 months, with the breast‐fed boys gaining more rapidly than artificial‐fed infants.     

肉块模型辅助农村离乳期儿童膳食定量评估和喂养指导的效果研究

目的 评价肉块模型用于婴幼儿喂养指导的短期效果,探索农村离乳期儿童喂养干预的新方法。方法 采用方便抽样,对河北省赵县两个乡镇263名6~11月龄儿童的家长进行6个月喂养干预指导,使用10 g熟猪瘦肉模型辅助评估食肉量。结果 儿童食肉量随年龄推进而增加,1周食肉量与血红蛋白水平的上升趋势基本一致。相对于基础调查,干预组和对照组儿童1周食肉量的自身前后增加值在中期调查时分别为30.54(23.09,37.98)g和6.24(2.56,9.93)g(P=0.000 1);终末调查时分别为36.33(23.77,48.89)g和19.74(7.57,31.91)g(P=0.073)。4.7%的干预组儿童和1.8%的对照组儿童24 h食肉量达到项目推荐最小量(P=0.190),终末调查时为4.7%和1.8%(P=0.060)。结论 肉块模型方法得到婴幼儿家长的接受和配合,初步实现儿童食肉量的定量计算,膳食改善效果显现。     

Addition of Supplementary Foods and Infant Growth (2 to 24 Months)

Objective: To determine the effect of adding supplementary foods on infant growth 2 to 8 and 12 to 24 months.

Methods: Length (cm/month) and weight (kg/month) of white infants (n = 94) were measured five to nine times from 2 to 24 months of age. Mothers reported birth weights, infants’ ages at first introduction of supplementary food, illnesses and information sources about infant feeding. Simple linear regression equations were used to compute slopes for each child (unit changes in length and in weight by age). Stepwise linear regression was used to determine the effect on weight and length slopes by the introduction of supplementary foods (e.g., an infant’s age when cereal, fruit, juice, vegetables and a meat cluster were first added) to the diet. Breast feeding (months duration or ever fed), illness scores and gender were covariates in the regression models.

Results: A significant model (F = 10.09, p = .002) for weight gain (2 to 8 months) showed that gender explained 10% of the variance; for length slope, the model was non-significant and gender explained 3% of the variance. Females had a slower weight gain compared to that of males. None of the covariates or supplementary foods were retained in the models. Weight prior to 12 months was the best predictor (p = .0001, 54% of the variance) of weight gain 12 to 24 months.

Conclusions: Unit changes in weight or length for an infant’s age were not statistically associated with the timing of when supplementary foods were first added to the diet 2 to 8 or 12 to 24 months. Weight prior to 12 months was a significant predictor of weight gain 12 to 24 months.     

An examination of factors believed to be associated with infantile obesity.

Forty-two normal (25th to 75th percentiles of weight for age) and 47 "obese" (above the 90th percentile) infants, 4 to 9 months of age, were compared with regard to energy and macronutrient intake, breast-feeding history, age of introduction of solids, and maternal reliance on external feeding cues. The study failed to reveal characteristic group differences. The current stereotype of the obese infant as one who is overfed, is given solids very young, is not breast fed, and whose mother is not responsive to his satiety signals is challenged. As a result, the nature of current group counseling for the prevention of infantile obesity is questioned.     

Effect of a Multi-Site Trial using Short Message Service (SMS) on Infant Feeding Practices and Weight Gain in Low-Income Minorities

Objective: To test the effects of weekly SMS for improving infant feeding practices and infant weight.

Methods: This was a multi-site randomized clinical trial in a convenience sample of 202 caregivers of healthy term infants 0–2 months participating in the WIC program in Puerto Rico and Hawaii. Participants were randomized to receive SMS about infant's general health issues (control) or SMS for improving feeding practices (intervention) for four months. Weight, length and infant feeding practices were assessed at baseline and four months later.

Results: A total of 170 participants completed the study (n = 86 control and n = 84 intervention). Baseline characteristics were similar between groups. At the end, exclusive breastfeeding rates were similar between groups (67.4% control and 59.1% intervention). Introduction of other foods and beverages, addition of foods to the bottle, placing infants to sleep with milk bottles, caregiver's method and response to feeding infants and distractions while feeding infants were similar between groups. Also, weight status or rate of weight gain was similar between groups.

Conclusion: There were no significant improvements in feeding practices or in weight with the intervention. The timeline of the messages in relation to the targeted behavior may have affected the effectiveness of the intervention. Earlier dissemination of messages, higher level of intensity, longer intervention, additional contacts and inclusion of other caregivers may be needed to achieve the desired effects.     

Infant blood pressure and heart rate: relation to ethnic group (black or white), nutrition and electrolyte intake.

Blood pressure (BP) and heart rate were measured during non-rapid-eye-movement sleep in 392 full-term newborns and in 318 of these infants at age six months. Two-day records of food intake were collected at age six months for 150 infants. Black babies did not differ substantially in BP from white babies either at birth or at six months. The earliest BP tracking was from age six to 15 months (systolic (SBP): r = .29, p less than .001; diastolic:r = .45, p less than .001). No relationship was found between BP at six months and breast- or bottle-feeding, infant weight or weight change, or nutrient intake. The relationship between parental BP, on the one hand, and infant electrolyte intake and BP on the other, suggested that electrolyte intake was related to BP in the six-month-old infant, and that the relationship was different in white babies than in black babies. Among 56 white infants whose mother's mean BP was above the median for this population, infant sodium intake correlated with infant SBP (r = .31, p less than .009). Among 32 black infants, regardless of parents' BP, sodium intake was negatively correlated with SBP (r = -.36, p less than .021).     

First Steps for Mommy and Me: A Pilot Intervention to Improve Nutrition and Physical Activity Behaviors of Postpartum Mothers and Their Infants

To assess the feasibility of a pediatric primary care based intervention to promote healthful behaviors among 0–6 month old infants and their mothers. We enrolled two intervention practices (60 mother-infant pairs) and one usual care control practice (24 pairs) in a non-randomized controlled trial. We completed visits and interviews with 80 (95%) pairs at birth and 6 months. The intervention included (1) brief focused negotiation by pediatricians, (2) motivational counseling by a health educator, and (3) group parenting workshops. We evaluated the intervention effects on infant feeding, sleep duration, TV viewing, and mothers’ responsiveness to satiety cues. Maternal behavioral targets included postpartum diet, physical activity, TV and sleep. At 6 months, fewer intervention than control infants had been introduced to solid foods (57% vs. 82%; P = 0.04), and intervention infants viewed less TV (mean 1.2 vs. 1.5 h/d; P = 0.07). Compared to control infants, intervention infants had larger increases in their nocturnal sleep duration from baseline to follow up (mean increase 1.9 vs. 1.3 h/d; P = 0.05); larger reductions in settling time (mean reduction −0.70 vs. −0.10 h/d; P = 0.02); and larger reductions in hours/day of nighttime wakefulness (mean reduction −2.9 vs. −1.5 h/d; P = 0.08). There were no differences in breastfeeding, response to satiety cues, or maternal health behaviors. A program of brief focused negotiation by pediatricians, individual coaching by health educators using motivational interviewing, and group parenting workshops tended to improve infant feeding, sleep and media exposure, but had less impact on mothers’ own health-related behaviors.     

Primary Health Care Intervention Reduces Added Sugars Consumption During Childhood

ObjectiveTo investigate the effectiveness of a training program for health workers regarding infant feeding practices to reduce sugar consumption in children.DesignA cluster randomized trial was conducted at 20 health centers in southern Brazil randomly assigned to an intervention (n = 9) or control (n = 11) group.ParticipantsThe 715 pregnant women enrolled were assessed when their children were aged 6 months, 3 years, and 6 years.InterventionA training session for primary care workers based on the Brazilian National Guidelines for Children.Main Outcome MeasureMothers were asked when sugar was first offered to children. Added sugars intake was obtained from dietary recalls.AnalysisThe effectiveness of the intervention was modeled using generalized estimation equations and Poisson regression with robust variance.ResultsChildren attending intervention health centers had a 27% reduced risk of sugar introduction before 4 months of age (relative risk, 0.73; 95% confidence interval [CI], 0.61-0.87) as well as lower added sugars consumption (difference, −6.36 g/d; 95% CI, −11.49 to −1.23) and total daily energy intake (difference, −116.90 kcal/d; 95% CI, −222.41 to −11.40) at 3 years of age.Conclusions and ImplicationsHealth care worker training in infant feeding guidelines may be an effective intervention to delay the introduction of added sugars and lower the subsequent intake of added sugars in infants and toddlers.     

Development and validation of the Infant Feeding Style Questionnaire

This study describes and validates the Infant Feeding Style Questionnaire (IFSQ), a self-report instrument designed to measure feeding beliefs and behaviors among mothers of infants and young children. Categorical confirmatory factor analysis was used to estimate latent factors for five feeding styles, laissez-faire, restrictive, pressuring, responsive and indulgent, and to validate that items hypothesized a priori as measures of each style yielded well-fitting models. Models were tested and iteratively modified to determine the best fitting model for each of 13 feeding style sub-constructs, using a sample of 154 low-income African-American mothers of infants aged 3–20 months in North Carolina. With minor changes, models were confirmed in an independent sample of 150 African-American first-time mothers, yielding a final instrument with 39 questions on maternal beliefs, 24 questions on behaviors and an additional 20 behavioral items pertaining to solid feeding for infants over 6 months of age. Internal reliability measures for the sub-constructs ranged from 0.75 to 0.95. Several sub-constructs, responsive to satiety cues, pressuring with cereal, indulgent pampering and indulgent soothing, were inversely related to infant weight-for-length z-score, providing initial support for the validity of this instrument for assessing maternal feeding beliefs and behaviors that may influence infant weight outcomes.     

2002年北京市2岁以内婴幼儿营养与喂养状况调查

目的了解北京市2岁以内婴幼儿出生时营养、母乳喂养与辅食添加状况,为政府制定儿童营养政策提供依据。方法采取分层整群随机抽样方法,于2002年8至11月在北京市18个区县进行抽样调查。在取得知情同意的情况下,对422名2岁以内婴幼儿的家长进行面对面询问调查。结果北京市平均婴儿出生体重为3325g,低体重出生率和巨大儿出生率分别为2．8％和13．0％;4月龄内婴儿母乳喂养率、混合喂养率和人工喂养率分别为56．6％、33．9％和9．5％,城区混合喂养率明显高于郊区;婴幼儿平均断奶月龄为7．4个月;6月龄及以上婴幼儿的辅食添加率为99．4％,城区和郊区婴幼儿各类辅食的添加顺序一致,但郊区婴幼儿的辅食添加时间晚于城区,且蔬菜水果、水产品、食用油的添加频率低于城区。结论北京地区新生儿体格发育良好,应在社区加强婴幼儿喂养的健康教育,提高母乳喂养率,适当延长母乳喂养时间,并适时添加各类辅食。     

Assessing an Infant Feeding Web Site as a Nutrition Education Tool for Child Care Providers

ObjectiveDetermine child care providers' infant feeding knowledge, attitude and behavior changes after viewing the infant feeding Web site and determine the effectiveness of the Web site and bilingual educational materials.DesignIntervention and control groups completed an on-line pretest survey, viewed a Web site for 3 months, and completed an on-line posttest survey; follow-up data were also assessed.SettingColorado child care centers.ParticipantsThirty-eight child care providers.InterventionSocial learning theory-based website was evaluated by child care providers in the treatment group and providers in the control group viewed a comparable website.Main Outcome MeasuresKnowledge, attitude, and behavior changes on feeding infants breast milk, formula, and solid food; desired changes to Web site.AnalysisIndependent samples t tests, chi-square, and repeated measures.ResultsChanges in attitudes and behaviors from pre- to posttest occurred primarily in the intervention group (P < .05). At follow-up, no significant differences were found among the 3 time periods. Providers desired no changes to Web site or materials.Conclusions and ImplicationsChild care providers appeared to have adequate knowledge on feeding infants formula and breast milk, but not on hunger cues. Providers would continue to use this Web site in the future. Further research should determine if changes in knowledge, attitudes, and behaviors are sustained over time and how infant feeding cues are read and determined in child care centers.     

Impact of Maternal Infant Weight Perception on Infant Feeding and Dietary Intake

Introduction Obesity is a global problem that is challenging to prevent and expensive to treat. Early childhood interventions show promise in establishing lifelong healthy eating patterns, however a better understanding of how parental feeding practices develop is needed. The study aimed to investigate maternal perception of infant weight and its relationship to feeding practices and infant dietary intake. Methods A questionnaire was completed by 263 Queensland mothers of infants aged between 5 and 13 months. Logistic regression was used to describe the association between maternal feeding practices (restriction, pressure-to-eat, monitoring), parenting style (warmth, hostility), infant weight concern and infant dietary intake. Correlation and linear regression were used to identify relationships between maternal feeding practices, parenting style, infant weight concern and infant weight. Results Mothers were found to be more concerned about underweight than overweight, misjudge infants as being underweight and failed to recognise overweight infants. Underweight concern was associated with infant weight (r?=??0.27, p?<?0.01), early introduction of solids (OR 0.24, CI 0.11–0.51) and pressure-to-eat (r?=?0.19, p?<?0.01). Pressure-to-eat was associated to maternal perception of infant weight (r?=???0.21, p?<?0.01), infant weight (r?=???0.17, p?<?0.05) and lower fruit and vegetable intake (OR 0.50, CI 0.27–0.92). Restrictive feeding practices were correlated to overweight concern (r?=?0.08, p?<?0.05). Discussion Maternal infant weight perception and concerns are related to control feeding practices which can be detrimental to infant dietary intake. Inability to recognise healthy weight may ignite these concerns or fail to address infant feeding risk factors. Discussing healthy growth should be a fundamental component of strategies to support healthy infant feeding and eating.     

Breast feeding during the first few days after birth: sometimes insufficient

Two newborn infants that were receiving breast-feeding were admitted to hospital for drowsiness and jaundice on the 6th and 4th day of life, respectively; these were a male infant that had been yellow since the very first day and a female infant that did not grasp the breast properly. Both recovered thanks to phototherapy and the administration of extra fluids. Seven days after discharge, the female infant was readmitted for the same symptoms, after which the breast-feeding was found to be insufficient and the infant was put on bottle-feeding. In infants that are being breast-fed, insufficient intake can result in dehydration with all of its consequences. Such insufficient intake may be difficult to recognise. Weight loss greater than 5% implies that more frequent feeding is necessary and a loss of more than 10% may mean that supplementary feeding is necessary, albeit temporarily.     

Longitudinal Study Depicting Differences in Complementary Feeding and Anthropometric Parameters in Late Preterm Infants up to 2 Years of Age

Ensuring the nutritional demands of preterm (PT) infants during complementary feeding could contribute significantly to the infants’ long-term health and development. However, the dietary guidelines for complementary feeding in PT are scarce. Thus, describing dietary intake and identifying nutritional targets for these infants could be of great interest. The aim of this study is to assess the food intake and anthropometric parameters in a Mediterranean infant cohort from 6 to 24 months and to identify nutritional targets especially focused on late preterm infants. This is a longitudinal prospective study analyzing information from administered questionnaires about general characteristics and food frequency consumption in 115 infants (20 PT (32 to 36 gestational weeks), 95 full-term (FT)) at 6, 12 and 24 months of age. Results show that the differences in the prevalence of underweight observed in PT infants vs. FT infants are maintained for up to 6 months of age but disappear at 12 and 24 months. The age of inclusion of new foods and the average intake of the main food groups was not different from that of FTs. Although protein intake at 6 months was directly correlated with weight gain and growth in FT, these associations were not observed in PT. At the nutritional level, the low intake of vitamin D in preterm infants is noteworthy. These findings may be useful when designing new intervention strategies for this population group.     

A survey of feeding practices in infants with phenylketonuria

Background: Although the management of phenylketonuria (PKU) in infancy and early childhood is a critical part of the overall care of the disorder, there are few guidelines on infant feeding in this condition. This survey was undertaken to establish the practices of dietitians from major PKU centres in Australia and the UK. Methods: A postal questionnaire examining infant feeding practices was sent to dietitians at nine major PKU centres in the UK and four in Australia, with each dietitian describing the infant feeding process in their last five infants. A total of 63 infants were investigated. Results: A lower than expected incidence of infants with PKU were breast fed at the time of diagnosis: 28% of infants in the UK and 41% from Australia. Amino acid intake varied between 2.0 g kg^?1 day^?1 to 3.5 g kg^?1 day^?1 with 86% of dietitians calculating total amino acid intake derived from both protein substitute intake and normal infant formula. Amino acid intake was not calculated in breast-fed infants. In breast-fed infants, phenylalanine-free protein substitute was always given before breast feeds. In bottle-fed infants, normal infant formula was given before phenylalanine-free protein substitute in 75% of infants. Solids were usually introduced between 3 and 6 months and phenylalanine-free solids were given initially to the majority of infants. Most problems were seen when introducing a more concentrated phenylalanine-free protein substitute to maintain the required amino acid intake in older infants. Age of introduction varied between 4 and 12 months and type of approach included concentrating infant protein substitutes, use of L -amino acid protein substitutes only, or L -amino acid protein substitutes with added carbohydrate, vitamins and minerals. Conclusions: There appeared to be no uniform policy of infant feeding in PKU and more work is needed correlating practices to develop national and even international protocols for management.     

新疆部分地区0～18月龄HIV暴露婴幼儿的贫血现状分析

目的 分析新疆部分地区0~18个月龄人类免疫缺陷病毒(HIV)暴露婴幼儿贫血现状,为防治HIV暴露婴幼儿贫血提供依据.方法 采用回顾性调查与现况调查相结合的研究方法 ,对研究现场0~18个月龄HIV暴露婴幼儿及其看护人进行血红蛋白含量测定和问卷调查,并对数据进行分析.结果 本次研究共调查155名0~18个月龄HIV暴露婴幼儿及其看护人,其中婴幼儿总贫血患病率为16.77%,0~6月龄、7~12月龄、13~18月龄婴幼儿贫血患病率分别为6.12%、22.00%、21.43%,7~18月龄婴幼儿患病率明显高于6月龄内婴儿,差异有统计学意义(χ2=5.82,P=0.016).Logistic回归分析结果 显示:婴幼儿月龄大、家庭经济状况差、低出生体重是HIV暴露婴幼儿的患贫血危险因素.结论 HIV暴露婴幼儿6月龄后贫血患病率明显升高,与婴幼儿家庭经济状况、出生体重、辅食添加不合理等因素有关,建议加强对婴幼儿家长的喂养咨询指导,提高家长科学喂养技能,教会其科学合理的辅食添加方式,另外提供一些铁强化食品、营养包等营养补充剂,增加铁摄入量,从而防止贫血的发生.