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Hohman EE, Savage JS, Stansfield BK, Lavner JA. Sleep SAAF Responsive Parenting Intervention for Black Mothers Impacts Response to Infant Crying: A Randomized Clinical Trial. Acad Pediatr 2024; 24:97-104. [PMID: 37148966 PMCID: PMC10625644 DOI: 10.1016/j.acap.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Many parents use food to soothe their infant, regardless of infant hunger, which can increase risk for rapid weight gain. Interventions promoting alternative soothing strategies may help parents respond more appropriately to crying. This secondary analysis aimed to examine effects of the Sleep SAAF (Strong African American Families) responsive parenting (RP) intervention on maternal responses to infant crying and to explore moderating effects of infant negativity. METHODS Primiparous Black mothers (n = 212) were randomized to an RP or safety control intervention, delivered during home visits at 3 and 8 weeks postpartum. Parents were empowered to first use non-food soothing strategies (eg, white noise, swaddling) when responding to crying. Mothers completed the Babies Need Soothing questionnaire at 8 and 16 weeks, and the Infant Behavior Questionnaire at 16 weeks. Data were analyzed using linear or logistic regression. RESULTS RP mothers were significantly more likely than controls to use shushing/white noise to soothe their infant at 8 (OR = 4.9, 95% CI: 2.2-10.6) and 16 weeks (OR = 4.8, 95% CI: 2.2-10.5), to go for a walk in stroller/ride in car at 8 weeks (OR = 2.3, 95% CI: 1.2-4.6), and to swing/rock/bounce their infant at 16 weeks (OR = 5.5, 95% CI: 1.2-25.7). RP mothers also reported significantly more frequent use of deep breathing, exercising, and bathing/showering than controls when frustrated with crying. Infant negativity moderated some intervention effects such that the RP intervention was more effective at increasing use of some soothing practices among mothers with less negative infants. CONCLUSIONS An RP intervention positively impacted first-time Black mothers' responses to infant crying.
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Affiliation(s)
- Emily E Hohman
- Center for Childhood Obesity Research (EE Hohman and JS Savage), 129 Noll Laboratory, Pennsylvania State University, University Park.
| | - Jennifer S Savage
- Center for Childhood Obesity Research (EE Hohman and JS Savage), 129 Noll Laboratory, Pennsylvania State University, University Park; Department of Nutritional Sciences (JS Savage), 129 Noll Laboratory, Pennsylvania State University, University Park.
| | - Brian K Stansfield
- Department of Pediatrics (BK Stansfield), Medical College of Georgia, Augusta.
| | - Justin A Lavner
- Department of Psychology (JA Lavner), University of Georgia, Athens.
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Tauriello S, Moding K, Aronoff N, Kubiniec E, Anzman-Frasca S. Examining links between child temperament and feeding, eating, and weight outcomes: An updated systematic review of the literature. Eat Behav 2023; 49:101739. [PMID: 37209569 DOI: 10.1016/j.eatbeh.2023.101739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Weight outcomes have been associated with child temperament, defined as individual differences in reactivity and self-regulation. The current systematic review aims to provide an updated summary of the evidence linking temperamental negative reactivity, surgency, and regulation superfactors to early childhood feeding, eating, and weight outcomes. METHODS PubMed, PsycINFO and Embase databases, as well as scientific meeting programs, were searched using keywords and subject headings. Publication dates were limited to 2012-2019 as prior reviews were published in 2012 and 2014. Identified studies were eligible if they included children ages 0-5 years, a measure of child temperament, and a measure of parent/caregiver feeding, child eating, or child weight. 7113 studies were identified and 121 met inclusion criteria. RESULTS Feeding, eating, and weight outcomes were largely unrelated to overarching negative reactivity, surgency, and effortful control superfactors. Examination of individual temperament dimensions suggested difficult temperament was frequently linked to non-responsive feeding practices, whereas elevated emotionality and decreased self-regulation were linked to maladaptive eating behaviors, and lower inhibitory control to adiposity. Analyses with infants reported greater percentages of significant associations compared to children, and cross-sectional studies generally reported fewer significant associations than other study designs. CONCLUSIONS Difficult temperament, greater emotionality and lower self-regulation and inhibitory control were the aspects of temperament most consistently related to poorer early childhood feeding, eating, and weight outcomes. Associations tended to be stronger in infancy, and when examined within a non-cross-sectional study design. Findings can inform the development of tailored efforts to promote healthy eating and growth throughout childhood.
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Affiliation(s)
- Sara Tauriello
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Kameron Moding
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States of America
| | - Nell Aronoff
- University Libraries, University at Buffalo, Buffalo, NY, United States of America
| | - Elizabeth Kubiniec
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America; Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, United States of America.
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van der Stouwe T, Leijten P, Asscher JJ, Deković M, van der Put CE. Adding Structured Components to Home Visitation to Reduce Mothers' Risk for Child Maltreatment: a Randomized Controlled Trial. JOURNAL OF FAMILY VIOLENCE 2023:1-14. [PMID: 36817847 PMCID: PMC9924864 DOI: 10.1007/s10896-023-00509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Purpose Home visitation program effects are generally small, which may be caused by flexible intervention content leading to inconsistent outcomes. In this study we therefore examined whether the effectiveness of a Dutch home visitation program (i.e., Supportive Parenting) can be improved by adding structured intervention components targeting key risk factors for child maltreatment: parental sense of competence, perceived stress, parental anger, and PTSD symptoms. Method Participants were randomly assigned to an experimental group (n = 74) that received four additional intervention components in two home visits, or a control group (n = 60) that received regular Supportive Parenting. Outcomes were assessed before (T1) and after (T2) the first, and before (T3) and after (T4) the second home visit. Effects were examined using ANCOVA for primary outcomes: parental sense of competence, perceived stress, parental anger, and PTSD symptoms, and secondary outcomes: risk of child maltreatment, parental warmth, and negative parenting. Moderation effects were examined for T1 scores, child temperament and life events. Results Mothers who received the intervention components showed less stress compared to the control group at T3 and T4. There were no differences between groups on other outcomes and no moderation effects, although parental sense of competence reduced and anger increased within the experimental group specifically. Conclusion The structured components may enhance the effectiveness of Supportive Parenting to reduce parenting stress. Future research into how other outcomes can be improved is needed. Supplementary Information The online version contains supplementary material available at 10.1007/s10896-023-00509-7.
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Affiliation(s)
- Trudy van der Stouwe
- Research Institute of Child Development and Education, University of Amsterdam, Post Box 15776, 1001 NG Amsterdam, The Netherlands
| | - Patty Leijten
- Research Institute of Child Development and Education, University of Amsterdam, Post Box 15776, 1001 NG Amsterdam, The Netherlands
| | - Jessica J. Asscher
- Clinical Child and Family Studies, Utrecht University, Post Box 80140, 3508 TC Utrecht, The Netherlands
| | - Maja Deković
- Clinical Child and Family Studies, Utrecht University, Post Box 80140, 3508 TC Utrecht, The Netherlands
| | - Claudia E. van der Put
- Research Institute of Child Development and Education, University of Amsterdam, Post Box 15776, 1001 NG Amsterdam, The Netherlands
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Filippetti ML. Being in Tune With Your Body: The Emergence of Interoceptive Processing Through Caregiver–Infant Feeding Interactions. CHILD DEVELOPMENT PERSPECTIVES 2021. [DOI: 10.1111/cdep.12420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hyczko AV, Ruggiero CF, Hohman EE, Anzman-Frasca S, Savage JS, Birch LL, Paul IM. Sex Differences in Maternal Restrictive Feeding Practices in the Intervention Nurses Start Infants Growing on Healthy Trajectories Study. Acad Pediatr 2021; 21:1070-1076. [PMID: 34020105 PMCID: PMC8349795 DOI: 10.1016/j.acap.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intervention Nurses Start Infants Growing on Healthy Trajectories tested an early life responsive parenting (RP) intervention designed for obesity prevention. Body mass index z-score at age 3 years was lower for the RP group versus controls with a larger effect for girls than boys. We sought to determine if child sex was associated with differing maternal feeding practices and whether sex moderated intervention effects on feeding. DESIGN/METHODS Mothers (N = 279) completed the Infant Feeding Styles Questionnaire (IFSQ) at 28 weeks, the Structure and Control in Parent Feeding (SCPF) at 1, 2, and 3 years, and the Child Feeding Questionnaire (CFQ) at 3 years. Study aims were tested using 2-way analysis of variance and repeated measures. RESULTS Mothers reported greater restriction (limiting food quantity) for boys at 28 weeks (IFSQ: 3.0 ± 1.1 vs 2.8 ± 1.0, P = .07) and across annual measurements from age 1 to 3 years (SCPF: P = .04). At age 3, the intervention group effect on restriction differed by sex (CFQ: P = .047) such that higher restriction was reported by RP group mothers of boys versus girls (3.4 ± 0.7 vs 3.0 ± 0.9, P = .002) with no control group sex difference (3.4 ± 0.8 vs 3.3 ± 0.9, P = .79). There were no sex differences or sex by intervention group interactions in other reported feeding practices at any assessment (ie, structure-based feeding, pressure). CONCLUSIONS Mothers of boys used more restrictive feeding through age 3. These findings may be partially explained by previously reported better self-soothing and self-regulation abilities of participating girls.
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Affiliation(s)
- Alexis V. Hyczko
- Penn State College of Medicine, 500 University Dr., Hershey, PA, USA 17033
| | - Cara F. Ruggiero
- Penn State University, Center for Childhood Obesity Research, 129 Noll Laboratory, University Park, PA, USA 16802
| | - Emily E. Hohman
- Penn State University, Center for Childhood Obesity Research, 129 Noll Laboratory, University Park, PA, USA 16802
| | - Stephanie Anzman-Frasca
- University at Buffalo, Department of Pediatrics, G56 Farber Hall, South Campus, Buffalo, NY, USA 14214-8001
| | - Jennifer S. Savage
- Penn State University, Center for Childhood Obesity Research, 129 Noll Laboratory, University Park, PA, USA 16802
| | - Leann L. Birch
- University of Georgia, Department of Foods and Nutrition, 176 Dawson Hall, Athens, GA, USA 30602-3632
| | - Ian M. Paul
- Penn State College of Medicine, 500 University Dr., Hershey, PA, USA 17033,Departments of Pediatrics & Public Health Sciences, 500 University Dr., Hershey, PA, USA 17033
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Supporting Infant Emotion Regulation Through Attachment-Based Intervention: a Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:702-713. [PMID: 32388694 DOI: 10.1007/s11121-020-01127-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Infant emotion regulation has long-term implications for human development, highlighting the need for preventive interventions that support emotion regulation early in life. Such interventions may be especially important for infants higher in emotional reactivity who need to regulate their emotions more frequently and intensely than infants lower in emotional reactivity. The current randomized trial examined main and moderated effects of an attachment-based intervention on (a) infants' use of mother-oriented and self-soothing emotion regulation strategies and (b) infant emotion dysregulation in 186 low-income, predominantly Latino infants. We tested the brief (10-session) Attachment and Biobehavioral Catch-up (ABC) intervention in the context of home-based federal Early Head Start (EHS) services. Control participants received home-based EHS plus 10 weekly books. Intent-to-treat analyses with covariates revealed main effects of the intervention on infants' use of mother-oriented emotion regulation strategies during a brief (40-s) novel and potentially fear-inducing procedure (d = 0.31). Infant emotional reactivity moderated intervention impacts on mother-oriented emotion regulation strategies and on infant emotion dysregulation: We found stronger effects of the intervention for infants relatively higher in emotional reactivity. Findings are discussed in terms of the preventive value of attachment-based interventions for supporting early emotion regulation.
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Harris HA, Anzman-Frasca S, Marini ME, Paul IM, Birch LL, Savage JS. Effect of a responsive parenting intervention on child emotional overeating is mediated by reduced maternal use of food to soothe: The INSIGHT RCT. Pediatr Obes 2020; 15:e12645. [PMID: 32372570 PMCID: PMC7729434 DOI: 10.1111/ijpo.12645] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Child emotional overeating is a risk factor for obesity that is learned in the home environment. Parents' use of food to soothe child distress may contribute to the development of children's emotional overeating. OBJECTIVES To examine the effect of a responsive parenting (RP) intervention on mother-reported child emotional overeating, and explore whether effects are mediated by mother-reported use of food to soothe child distress. METHODS The sample included primiparous mother-infant dyads randomized to a RP intervention (n = 105) or home safety control group (n = 102). Nurses delivered RP guidance in four behavioral domains: sleeping, fussy, alert/calm, and drowsy. Mothers reported their use of food to soothe at age 18 months and child emotional overeating at age 30 months. Mediation was analyzed using the SAS PROCESS macro. RESULTS RP intervention mothers reported less frequent use of food to soothe and perceived their child's emotional overeating as lower compared to the control group. Food to soothe mediated the RP intervention effect on child emotional overeating (mediation model: R2 = 0.13, P < .0001). CONCLUSIONS Children's emotional overeating may be modified through an early life RP intervention. Teaching parents alternative techniques to soothe child distress rather than feeding may curb emotional overeating development to reduce future obesity risk.
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Affiliation(s)
- Holly A. Harris
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Michele E. Marini
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania
| | - Ian M. Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Leann L. Birch
- Department of Foods and Nutrition, University of Georgia, Athens, Georgia
| | - Jennifer S. Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, Pennsylvania
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Lipsanen J, Elovainio M, Hakulinen C, Tremblay MS, Rovio S, Lagström H, Jaakkola JM, Jula A, Rönnemaa T, Viikari J, Niinikoski H, Simell O, Raitakari OT, Pahkala K, Pulkki-Råback L. Temperament profiles are associated with dietary behavior from childhood to adulthood. Appetite 2020; 151:104681. [PMID: 32251766 DOI: 10.1016/j.appet.2020.104681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 03/01/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Temperament may be associated with eating behaviors over the lifespan. This study examined the association of toddlerhood temperament with dietary behavior and dietary intervention outcomes across 18 years. METHODS The study comprised 660 children (52% boys) from The Special Turku Intervention Project (STRIP), which is a longitudinal randomized controlled trial from the age of 7 months until the age of 20 years (1990-2010). Temperament was assessed using Carey temperament scales when the participants were 2 years of age. Latent profile analysis yielded three temperament groups, which were called negative/low regulation (19% of the children), neutral/average regulation (52%) and positive/high regulation (28%). Dietary behavior was examined from 2 to 20 years of age using food records, which were converted into a diet score (mean = 15.7, SD 4.6). Mixed random-intercept growth curve analysis was the main analytic method. RESULTS Dietary behavior showed a significant quadratic U-shaped curve over time (B for quadratic association = 0.39, P<.001; B for linear association = 0.09, P = 0.58). Children in the negative/low regulation temperament group had a lower diet score (less healthy diet) across the 18 years compared to children in the neutral/average or in the positive/high regulation group. Temperament was not associated with the rate of change in diet over time. Temperament did not have any interactive effects with the intervention (F [2, 627], P = 0.72). CONCLUSION Children with a temperament profile characterized by high negative mood, high irregularity and high intensity in emotion expression constitute a risk group for less healthy eating over the lifespan.
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Affiliation(s)
- Jari Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Marko Elovainio
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland; National Institute for Health and Welfare, Finland
| | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, Canada
| | - Suvi Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland
| | - Johanna M Jaakkola
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Finland
| | - Tapani Rönnemaa
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Finland
| | - Jorma Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Finland
| | - Harri Niinikoski
- Institute of Biomedicine, University of Turku, Department of Pediatrics and AdolescentMedicine, Turku University Hospital, Turku, Finland
| | - Olli Simell
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland; Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland; Research Centre for Child Psychiatry, Faculty of Medicine, University of Turku, Finland.
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Landsem IP, Handegård BH, Ulvund SE. Temperamental Development among Preterm Born Children. An RCT Follow-Up Study. CHILDREN-BASEL 2020; 7:children7040036. [PMID: 32340334 PMCID: PMC7230507 DOI: 10.3390/children7040036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/27/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022]
Abstract
A randomized controlled trial study recruited 146 preterm born children, either to participate in a modified version of the Mother–Infant Transaction Program (MITP-m) or to receive the usual follow-up services, before and after discharge from a neonatal intensive care unit. This follow-up study investigates whether MITP participation is associated with parental perceptions of child temperament from two to seven years. Children’s temperament was reported by mothers and fathers separately at children’s ages of 2, 3, 5, and 7 years. Parents in the MITP-m group reported lower levels of negative emotionality in their children compared to the control group. In maternal reports, a group effect (F(1, 121) = 9.7, p = 0.002) revealed a stable difference in children’s negative emotionality from two to seven years, while a group-by-time interaction related to an increasing difference was detected in reports from fathers (F(1, 94) = 4.8, p = 0.03). Another group difference appeared in fathers’ reports of children’s soothability (F(1, 100) = 14.2, p < 0.0005). MITP-m fathers seemed to perceive their children as easier to soothe at all ages as no interaction with time appeared. Parental reports on children’s sociality, shyness, and activity did not differ between the groups.
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Affiliation(s)
- Inger Pauline Landsem
- Child & Adolescent Department, University Hospital of North Norway, 9019 Tromsø, Norway
- Health Research Faculty, UIT the Arctic University of Norway, 9019 Tromsø, Norway;
- Correspondence:
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de Wit M, Leijten P, van der Put C, Asscher J, Bouwmeester-Landweer M, Deković M. Study protocol: randomized controlled trial of manualized components in home visitation to reduce mothers' risk for child maltreatment. BMC Public Health 2020; 20:136. [PMID: 32000744 PMCID: PMC6993430 DOI: 10.1186/s12889-020-8237-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/17/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND This study tests whether home visitation to prevent child maltreatment can be improved by adding manualized program components, targeting four key risk factors for child maltreatment: low parental self-efficacy, high levels of perceived stress, parental anger, and post-traumatic stress symptoms. Home visitation is widely implemented, but effects on child maltreatment risk tend to be modest at best. Home visitation tends to be rather flexible (i.e., professionals decide how to support each family). We will test whether adding manualized program components increases program effectiveness, by ensuring that key risk factors are addressed, while maintaining flexibility. In addition, we will test whether any component effects on reduced child maltreatment risk can be explained (i.e., is mediated) by ameliorated risk factors. Lastly, we will test whether the components are more effective for some mothers (e.g., those at highest child maltreatment risk) than for others. METHODS We will conduct a randomized controlled trial among 398 mothers enrolled in a Dutch home visiting program targeting families at risk for child maltreatment. Mothers in the experimental group will receive the manualized components in two consecutive home visits, while mothers in the control group will receive regular home visits (care as usual). Mothers will fill out questionnaires at four time points: before and after each of the two home visits. Outcome variables include the four targeted risk factors parental self-efficacy, perceived stress, parental anger, and (recognition of) post-traumatic stress symptoms, as well as parenting practices (e.g., rejection and affection), and risk for child maltreatment. DISCUSSION This study aims to determine whether adding manualized program components to a flexible home visiting program increases program effectiveness on risk for child maltreatment. In addition, our test of whether the effects of the components on risk for child maltreatment is explained (i.e., mediated) by amelioration of the targeted risk factors, may contribute to our understanding of the role of these risk factors in child maltreatment. Our tests of which mothers benefit most from adding the components may help move the field towards evidence-based personalized family support. TRIAL REGISTRATION This trial has been retrospectively registered in the Netherlands Trial Register (NL8005).
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Affiliation(s)
- Merel de Wit
- Research Institute of Child Development and Education, University of Amsterdam, PO Box 15780, 1001, NG, Amsterdam, the Netherlands.
| | - Patty Leijten
- Research Institute of Child Development and Education, University of Amsterdam, PO Box 15780, 1001, NG, Amsterdam, the Netherlands
| | - Claudia van der Put
- Research Institute of Child Development and Education, University of Amsterdam, PO Box 15780, 1001, NG, Amsterdam, the Netherlands
| | - Jessica Asscher
- Research Institute of Child Development and Education, University of Amsterdam, PO Box 15780, 1001, NG, Amsterdam, the Netherlands
- Clinical Child and Family Studies, Utrecht University, PO Box 80125, 3508, TC, Utrecht, the Netherlands
| | - Merian Bouwmeester-Landweer
- The Netherlands Center for Preventive Youth Health (NCJ), Churchilllaan 11, 3527, GV, Utrecht, the Netherlands
| | - Maja Deković
- Clinical Child and Family Studies, Utrecht University, PO Box 80125, 3508, TC, Utrecht, the Netherlands
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The Effects of an Infant Calming Intervention on Mothers' Parenting Self-Efficacy and Satisfaction During the Postpartum Period: A Randomized Controlled Trial. J Perinat Neonatal Nurs 2020; 34:300-310. [PMID: 33079803 DOI: 10.1097/jpn.0000000000000510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this study was to evaluate the effects of a behavioral infant calming technique to support mothers' parenting self-efficacy and parenting satisfaction. The methods of this randomized controlled trial are based on the CONSORT guidelines. Data were collected during March 1 to May 20, 2019, from 3 postpartum units in 1 university-level hospital in Finland. A total of 250 mothers agreed to participate, of which 120 were randomly allocated to the intervention group and 130 to the control group. All mothers completed a baseline questionnaire before randomization. Mothers in the intervention group were taught the 5 S's infant calming technique. The control group received standard care. Follow-up data were collected 6 to 8 weeks postpartum. The primary outcome measure was the change in parenting self-efficacy and parenting satisfaction scores over the follow-up period. The intervention group showed significantly larger improvements in parenting self-efficacy scores. There were no statistically significant differences in median improvements in parenting satisfaction. The 5 S's infant calming technique is feasible. These study findings may assist midwifery and neonatal nursing staff to support mothers and families during the postpartum period, whether the infants are fussy or not.
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Ruggiero CF, Hohman EE, Birch LL, Paul IM, Savage JS. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting intervention for firstborns impacts feeding of secondborns. Am J Clin Nutr 2020; 111:21-27. [PMID: 31782493 PMCID: PMC6944525 DOI: 10.1093/ajcn/nqz277] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/14/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The Intervention Nurses Start Infant Growing on Healthy Trajectories (INSIGHT) study's responsive parenting (RP) intervention, initiated in early infancy, prevented the use of nonresponsive, controlling feeding practices and promoted use of structure-based feeding among first-time parents compared with controls. OBJECTIVES We sought to examine the spillover effect of the RP intervention on maternal feeding practices with their secondborn (SB) infants enrolled in an observational-only study, SIBSIGHT, and to test the moderating effect of spacing of births. METHODS SB infants of mothers participating in the INSIGHT study were enrolled into the observation-only ancillary study, SIBSIGHT. SBs were healthy singleton infants ≥36 weeks of gestation. Infant feeding practices (i.e., food to soothe, structure vs. control-based practices) were assessed using validated questionnaires: Babies Need Soothing Questionnaire, Infant Feeding Styles Questionnaire, and the Structure and Control in Parent Feeding Questionnaire. RESULTS SBs (n = 117 [RP: 57, control: 60]; 43% male) were delivered 2.5 ± 0.8 y after firstborns (FBs). At age 1 y, the Structure and Control in Parent Feeding Questionnaire revealed that the mothers in the RP group used more consistent feeding routines (4.19 [0.43] compared with 3.77 [0.62], P = 0.0006, Cohen's D: 0.69) compared with control group mothers. From the Infant Feeding Styles Questionnaire, RP group mothers also used less nonresponsive, controlling feeding practices such as pressuring their SB infant to finish (1.81 [0.52] compared with 2.24 [0.68], P = 0.001, Cohen's D: 0.68) compared with controls. In contrast to our hypotheses, no differences were detected in bottle-feeding practices such as putting to bed with a bottle/sippy cup or adding cereal to the bottle, despite observing study group differences in FBs. Spacing of births did not moderate intervention effects. CONCLUSIONS RP guidance given to mothers of FBs may prevent the use of some nonresponsive, controlling feeding practices while establishing consistent feeding routines in subsequent siblings.
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Affiliation(s)
- Cara F Ruggiero
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA,Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA,Address correspondence to CFR (e-mail: )
| | - Emily E Hohman
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Leann L Birch
- Department of Foods and Nutrition, University of Georgia, Athens,GA, USA
| | - Ian M Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA,Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
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13
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Anzman-Frasca S, Paul IM, Moding KJ, Savage JS, Hohman EE, Birch LL. Effects of the INSIGHT Obesity Preventive Intervention on Reported and Observed Infant Temperament. J Dev Behav Pediatr 2018; 39:736-743. [PMID: 29927795 PMCID: PMC6261801 DOI: 10.1097/dbp.0000000000000597] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Infants higher on negative reactivity and lower on regulation, aspects of temperament, have increased obesity risk. Responsive parenting (RP) has been shown to impact the expression of temperament, including the developing ability to regulate negative emotions. The aim of this analysis was to test the effects of the INSIGHT study's RP intervention designed for the primary prevention of obesity on reported and observed infant negativity and regulation. METHODS The sample included 240 mother-infant dyads randomized 2 weeks after birth to the RP intervention or a safety control intervention. Both groups received 4 home visits during the infant's first year. In the RP group, nurses delivered RP guidance in domains of sleep, feeding, soothing, and interactive play. At 1 year, mother-reported temperament was measured by a survey, and a frustration task was used to observe temperament in the laboratory. Effects of the RP intervention were tested using general linear models. RESULTS The RP intervention reduced overall reported infant negativity, driven by lower distress to limitations (p < 0.05) and faster recovery from distress (p < 0.01) in the RP group versus controls. There were no intervention effects on reported regulation or observed negativity. The intervention did increase observed regulation, particularly the use of self-comforting strategies (p < 0.05) during the frustration task. DISCUSSION An RP intervention designed for early obesity prevention affected reported infant negativity and observed regulation, outcomes that have been linked with subsequent healthy development. Interventions grounded in an RP framework have the potential for widespread effects on child health and well-being.
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Affiliation(s)
- Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Ian M. Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Kameron J. Moding
- Department of Pediatrics/Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer S. Savage
- Center for Childhood Obesity Research and Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA
| | - Emily E. Hohman
- Center for Childhood Obesity Research and Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA
| | - Leann L. Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA
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14
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Associations between bottle-feeding intensity and maternal encouragement of bottle-emptying. Public Health Nutr 2017; 20:3090-3098. [DOI: 10.1017/s1368980017002166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AbstractObjectiveTo explore longitudinal associations between bottle-feeding and maternal encouragement of infant bottle-emptying during the first 6 months of infancy.DesignMothers completed questionnaires during the third trimester of pregnancy, then monthly during the first 6 months postpartum. Questionnaires assessed family demographics, maternal and infant weight status, infant feeding patterns and maternal encouragement of infant bottle-emptying.SettingThe Infant Feeding Practices Study 2, conducted by the US Centers for Disease Control and Prevention and the Food and Drug Administration.SubjectsMothers (n 1776).ResultsRepeated-measures regression was used to explore associations between bottle-feeding intensity (BFI; defined as the percentage of daily feedings that were from a bottle) and encouragement of bottle-emptying. Mothers who reported consistently high or consistently low BFI also exhibited consistently higher or lower frequency of encouraging their infants to empty the bottle (respectively) across the first 6 months of infancy, whereas mothers who reported increases in their BFI also exhibited concomitant increases in the frequency to which they encouraged their infants to finish the bottle. More frequent encouragement of bottle-emptying was also associated with feeding expressed breast milk (P<0·001), and lower parity (P=0·01), pre-pregnancy BMI (P=0·002) and infant birth weight (P=0·001).ConclusionsMore frequent use of bottles for infant feeding was significantly associated with more frequent encouragement of bottle-emptying. Further research using causal designs is needed to better understand whether the use of bottles promotes this controlling feeding practice or whether mothers with more controlling feeding practices opt to bottle-feed.
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15
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Planalp EM, Van Hulle C, Gagne JR, Goldsmith HH. The Infant Version of the Laboratory Temperament Assessment Battery (Lab-TAB): Measurement Properties and Implications for Concepts of Temperament. Front Psychol 2017; 8:846. [PMID: 28596748 PMCID: PMC5442210 DOI: 10.3389/fpsyg.2017.00846] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/09/2017] [Indexed: 12/03/2022] Open
Abstract
We describe large-sample research using the Infant Laboratory Temperament Assessment Battery (Lab-TAB; Goldsmith and Rothbart, 1996) in 1,076 infants at 6 and 12 months of age. The Lab-TAB was designed to assess temperament dimensions through a series of episodes that mimic everyday situations. Our goal is to provide guidelines for scoring Lab-TAB episodes to derive temperament composites. We also present a set of analyses examining mean differences and stability of temperament in early infancy, gender differences in infant temperament, as well as a validation of Lab-TAB episodes and composites with parent reported Infant Behavior Questionnaire (IBQ; Rothbart, 1981) scales. In general, laboratory observed temperament was only modestly related to parent reported temperament. However, temperament measures were significantly stable across time and several gender differences that align with previous research emerged. In sum, the Lab-TAB usefully assesses individual differences in infant emotionality.
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Affiliation(s)
- Elizabeth M Planalp
- Department of Psychology, University of Wisconsin-MadisonMadison, WI, United States.,Waisman Center, University of Wisconsin-MadisonMadison, WI, United States
| | - Carol Van Hulle
- Waisman Center, University of Wisconsin-MadisonMadison, WI, United States
| | - Jeffrey R Gagne
- Department of Psychology, University of Texas at ArlingtonArlington, TX, United States
| | - H Hill Goldsmith
- Department of Psychology, University of Wisconsin-MadisonMadison, WI, United States.,Waisman Center, University of Wisconsin-MadisonMadison, WI, United States
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16
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Kim BR, Chow SM, Bray B, Teti DM. Trajectories of mothers' emotional availability: relations with infant temperament in predicting attachment security. Attach Hum Dev 2017; 19:38-57. [PMID: 27852132 PMCID: PMC5598772 DOI: 10.1080/14616734.2016.1252780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study examined observations of parenting quality (mothers' emotional availability - EA) during infant bedtimes at 4 points across the infants' first year, assessing relations between levels and trajectories of EA and infant attachment at 12 months and the role of infant temperament in moderating these associations. The sample (N = 128) was predominantly Euro-American (82.5%) and at low socioeconomic risk. Latent growth curve modeling with latent basis coefficients indicated substantial individual differences in initial levels and slopes in EA trajectories across the first year. Both levels of maternal EA and EA trajectories across the first year predicted 12-month infant attachment security. Although maternal EA tended to decrease across the first year in the full sample, EA trajectories that showed a "bounce-back" between 6 and 12 months, suggesting more successful maternal adaptation to an expanding infant developmental repertoire, predicted greater infant security at 12 months. In addition, linkages between latent EA trajectories and 12-month attachment were moderated by 3-month infant temperamental reactivity and regulation. These findings indicate that infant attachment security is sensitive to both static and dynamic aspects of parenting quality across the first year, and that infant temperament can interact with both in predicting infant attachment.
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Affiliation(s)
- Bo-Ram Kim
- Dept of Human Development and Family Studies, The Pennsylvania State University, College of Health and Human Development, University Park, PA 16802
| | - Sy-Miin Chow
- Dept of Human Development and Family Studies, The Pennsylvania State University, College of Health and Human Development, University Park, PA 16802
| | - Bethany Bray
- The Methodology Center, College of Health and Human Development, The Pennsylvania State University, University Park, PA 16802
| | - Douglas M. Teti
- Dept of Human Development and Family Studies, The Pennsylvania State University, College of Health and Human Development, University Park, PA 16802
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17
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Child regulative temperament as a mediator of parenting in the development of depressive symptoms: a longitudinal study from early childhood to preadolescence. J Neural Transm (Vienna) 2017; 124:631-641. [PMID: 28124161 DOI: 10.1007/s00702-017-1682-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/16/2017] [Indexed: 01/05/2023]
Abstract
Child temperament as well as parenting behaviors have been linked to adolescent depression. Beyond their main effects, the interplay between these factors is of interest. For example, in an interactive model, a differential susceptibility of temperamental variants to parenting has been suggested. However, so far, the differential susceptibility hypothesis has mostly been studied with a focus on externalizing disorders. On the other hand, parenting may shape the child's temperament and vice versa in a transactional process. In a prospective, longitudinal at-risk sample (163 boys, 176 girls), we assessed emotional (easy-difficult) and regulative (self-control) temperament at ages 4.5, and 8 years, respectively, as well as parenting quality at age 4.5 years using the HOME inventory. Hierarchical linear regression analysis was used to investigate the prediction of depressive symptoms at age 11, measured by the Child Depression Inventory, including interaction terms between the temperament variable and parenting. We additionally tested whether parenting was mediated by child temperament. As previously reported, both self-control and parenting were longitudinally associated with preadolescent depressive symptoms. There were no interactive effects between temperament and parenting. However, the effects of parenting were partly mediated by self-control. Our data do not support a differential susceptibility of temperamental variants in the development of preadolescent depression. However, our results are in line with the assumption that parenting may shape young children's temperament, with positive parenting in the early childhood fostering the development of regulative temperament.
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18
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Thibodeau EL, August GJ, Cicchetti D, Symons FJ. Application of environmental sensitivity theories in personalized prevention for youth substance abuse: a transdisciplinary translational perspective. Transl Behav Med 2016; 6:81-9. [PMID: 27012256 DOI: 10.1007/s13142-015-0374-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Preventive interventions that target high-risk youth, via one-size-fits-all approaches, have demonstrated modest effects in reducing rates of substance use. Recently, substance use researchers have recommended personalized intervention strategies. Central to these approaches is matching preventatives to characteristics of an individual that have been shown to predict outcomes. One compelling body of literature on person × environment interactions is that of environmental sensitivity theories, including differential susceptibility theory and vantage sensitivity. Recent experimental evidence has demonstrated that environmental sensitivity (ES) factors moderate substance abuse outcomes. We propose that ES factors may augment current personalization strategies such as matching based on risk factors/severity of problem behaviors (risk severity (RS)). Specifically, individuals most sensitive to environmental influence may be those most responsive to intervention in general and thus need only a brief-type or lower-intensity program to show gains, while those least sensitive may require more comprehensive or intensive programming for optimal responsiveness. We provide an example from ongoing research to illustrate how ES factors can be incorporated into prevention trials aimed at high-risk adolescents.
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19
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Tate AD, Trofholz A, Rudasill KM, Neumark-Sztainer D, Berge JM. Does child temperament modify the overweight risk associated with parent feeding behaviors and child eating behaviors?: An exploratory study. Appetite 2016; 101:178-83. [PMID: 26916725 PMCID: PMC4837692 DOI: 10.1016/j.appet.2016.02.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Child temperament is a measure of an individual's behavioral tendencies. The primary objective of this study was to examine whether child temperament modified the overweight risk associated with parent feeding behaviors and child eating behaviors. METHODS A sample of predominantly African American, Midwest families (N = 120) recruited from four metropolitan primary care clinics participated in this cross-sectional, mixed methods study. Parents reported on feeding practices, child eating behaviors, and child temperament. RESULTS Difficult temperament was not statistically related to parent feeding practices or child eating behaviors (p > 0.05). Tests of interaction indicated that the risk of child overweight differed by difficult temperament and easy temperament for two child eating behaviors (emotional eating and food fussiness, p < 0.05). For example, the effect of food fussiness decreased the risk of overweight for difficult temperament children but increased overweight risk for easy temperament children. Further, the effect of emotional eating increased the risk of overweight for difficult temperament children but decreased overweight risk for easy temperament children. CONCLUSIONS Tailoring parent-level interventions to child temperament or promoting environments that trigger less reactive individual responses may be effective in lowering risk of child overweight.
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Affiliation(s)
- Allan D Tate
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
| | - Amanda Trofholz
- Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Jerica M Berge
- Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
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20
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Ventura AK, Pollack Golen R. A pilot study comparing opaque, weighted bottles with conventional, clear bottles for infant feeding. Appetite 2014; 85:178-84. [PMID: 25445988 DOI: 10.1016/j.appet.2014.11.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
It is hypothesized that the visual and weight cues afforded by bottle-feeding may lead mothers to overfeed in response to the amount of liquid in the bottle. The aim of the present pilot study was to test this hypothesis by comparing mothers' sensitivity and responsiveness to infant cues and infants' intakes when mothers use opaque, weighted bottles (that remove visual and weight cues) compared to conventional, clear bottles to feed their infants. We also tested the hypothesis that mothers' pressuring feeding style would moderate the effect of bottle type. Formula-feeding dyads (N = 25) visited our laboratory on two separate days. Mothers fed their infants from a clear bottle one day and an opaque, weighted bottle on the other; bottle-order was counterbalanced across the two days. Infant intake was assessed by weighing each bottle before and after the feeding. Maternal sensitivity and responsiveness to infant cues was objectively assessed using the Nursing Child Assessment Feeding Scale. Mothers were significantly more responsive to infant cues when they used opaque compared to clear bottles (p = .04). There was also a trend for infants to consume significantly less formula when fed from opaque compared to clear bottles (p = .08). Mothers' pressuring feeding style moderated the effect of bottle type on maternal responsiveness to infant cues (p = .02) and infant intake (p = .03). Specifically, mothers who reported higher levels of pressuring feeding were significantly more responsive to their infants' cues (p = .02) and fed their infants significantly less formula when using opaque versus clear bottles (p = .01); no differences were seen for mothers who reported lower levels of pressuring feeding. This study highlights a simple, yet effective intervention for improving the bottle-feeding practices of mothers who have pressuring feeding styles.
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Affiliation(s)
- Alison K Ventura
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, 1505 Race Street, Mail Stop 1030, Philadelphia, PA 19102, USA; Department of Kinesiology, College of Science and Mathematics, California Polytechnic University, One Grand Avenue, San Luis Obispo, CA 93407, USA.
| | - Rebecca Pollack Golen
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, 1505 Race Street, Mail Stop 1030, Philadelphia, PA 19102, USA
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21
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Paul IM, Williams JS, Anzman-Frasca S, Beiler JS, Makova KD, Marini ME, Hess LB, Rzucidlo SE, Verdiglione N, Mindell JA, Birch LL. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study. BMC Pediatr 2014; 14:184. [PMID: 25037579 PMCID: PMC4105401 DOI: 10.1186/1471-2431-14-184] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/09/2014] [Indexed: 12/15/2022] Open
Abstract
Background Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This “parenting” intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT’s central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent–child responsibility for feeding, reducing subsequent risk for overeating and overweight. Methods/Design 316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the “parenting” or “safety” groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3–4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second-born siblings of INSIGHT participants will be enrolled in an observation-only study to explore parenting differences between siblings, their effect on weight outcomes, and carryover effects of INSIGHT interventions to subsequent siblings. Discussion With increasing evidence suggesting the importance of early life experiences on long-term health trajectories, the INSIGHT trial has the ability to inform future obesity prevention efforts in clinical settings. Trial registration NCT01167270. Registered 21 July 2010.
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Affiliation(s)
- Ian M Paul
- Department of Pediatrics, HS83, Penn State College of Medicine, 500 University Dr,, Hershey 17033, PA, USA.
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22
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Anderson SE, Lemeshow S, Whitaker RC. Maternal-infant relationship quality and risk of obesity at age 5.5 years in a national US cohort. BMC Pediatr 2014; 14:54. [PMID: 24564412 PMCID: PMC3938469 DOI: 10.1186/1471-2431-14-54] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/19/2014] [Indexed: 11/29/2022] Open
Abstract
Background Poor quality relationships between mothers and toddlers have been associated with higher risk for childhood obesity, but few prospective studies of obesity have assessed maternal-child relationship quality in infancy. In addition it is not known whether the increased risk is associated with the mother’s or the child’s contribution to the relationship quality. Methods We analyzed data (n = 5650) from the Early Childhood Longitudinal Study, Birth Cohort, a national study of U.S. children born in 2001 and followed until they entered kindergarten. At 9 months of age, the Nursing Child Assessment Teaching Scale (NCATS) was used to assess the quality of observed playtime interactions between mothers and infants, yielding separate scores for maternal and infant behaviors. Obesity (BMI ≥95th percentile) at age 5.5 years was based on measured weight and height. Results The prevalence (95% confidence interval) of obesity at 5.5 years of age was higher among children in the lowest quartile of maternal NCATS score (20.2% [95% CI: 17.2%, 23.2%]) than in the highest quartile (13.9% [11.3%, 16.5%]), but maternal NCATS score was not significantly associated with obesity after adjustment for race/ethnicity, maternal education and household income. The prevalence of obesity at 5.5 years of age was similar among children in the lowest quartile of infant NCATS score (17.4% [14.4%, 20.3%]) and in the highest quartile (17.6% 14.4%, 20.8%]), and was not changed with covariate adjustment. Conclusions Maternal-infant relationship quality, assessed by direct observation at 9 months of age in a national sample, was not associated with an increased risk of obesity at age 5.5 years after controlling for sociodemographic characteristics.
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Affiliation(s)
- Sarah E Anderson
- Division of Epidemiology, The Ohio State University College of Public Health, 336 Cunz Hall, 1841 Neil Avenue, Columbus, Ohio 43210, USA.
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