Infant and maternal predictors of early life feeding decisions. The timing of solid food introduction

Parental Decision-Making Around Introducing Complementary Foods: An Integrative Review

A primary role in infant parenting is feeding, and this role undergoes a significant transition when introducing complementary foods (CF), with important long-term health implications. Understanding the influences on parental decision-making around timing the introduction to CF can help health care providers provide parents with effective support for feeding; however, the factors that influence parental decision-making have not been recently reviewed in the United States. To determine influences and information sources, this integrative review examined the literature from 2012 to 2022. Results indicated that parents are confused and distrustful of inconsistent and changing guidelines around CF introduction. Instead, developmental readiness signs may be a more appropriate way for practitioners and researchers to support parents in appropriate CF introduction. Future work is needed to evaluate interpersonal and societal influences on parental decision-making, as well as to develop culturally sensitive practices to support healthful parental decisions.

Early introduction of complementary foods/drinks and milk feeding type in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

Infants younger than 4 months are not ready for complementary foods/drinks (any solid or liquid other than breast milk or infant formula). Almost half of US infants participate in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which provides nutrition education and support to low-income families. We describe the prevalence of early introduction (<4 months) of complementary foods/drinks and examine the association of milk feeding type (fully breastfed, partially breastfed or fully formula fed) with early introduction of complementary foods/drinks. We used data from 3310 families in the longitudinal WIC Infant and Toddler Feeding Practices Study-2. We described the prevalence of early introduction of complementary foods/drinks and modeled the association of milk feeding type at Month 1 with early introduction of complementary foods/drinks using multi-variable logistic regression. Thirty-eight percent of infants were introduced early to complementary foods/drinks (<4 months). In adjusted models, infants who were fully formula fed or partially breastfed at Month 1 were 75% and 57%, respectively, more likely to be introduced early to complementary foods/drinks compared with fully breastfed infants. Almost two in five infants were given complementary foods/drinks early. Formula feeding at Month 1 was associated with higher odds of early introduction of complementary foods/drinks. There are opportunities to support families participating in WIC to prevent early introduction of complementary foods/drinks and promote child health.

Examining links between child temperament and feeding, eating, and weight outcomes: An updated systematic review of the literature

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.

Are Complementary Feeding Practices Aligned with Current Recommendations? A Narrative Review

The complementary feeding introduction period (introduction of solid foods alongside breastmilk or formula) is defining in children's health; however, it appears that many parents do not follow complementary feeding guidelines. Our aim was to describe current parental feeding practices during complementary feeding in relation to current recommendations and explore determinants of adherence to guidelines. We included any relevant studies published within the last decade in French or English and summarized findings by recommendation category. The timing of complementary food introduction varied widely across and within continents (earlier in North America and often delayed in Asia). The introduction of allergenic foods tended to be delayed globally. Although some parents now begin complementary feeding with solid foods (i.e., baby-led weaning), delayed introduction of lumpy textures was still prevalent in the United States and in Europe. The consumption of iron-rich foods was predominantly low in Africa. Added sugars were globally introduced early, especially in America. Evidence for the prevalence of responsive feeding practices among parents is unclear due to the small number of studies. Determinants of complementary feeding practices included parental characteristics, such as age, education, socio-economic status, and race/ethnicity. Interventions aiming to increase adherence to complementary feeding guidelines must account for parental characteristics.

Food as a key disgust elicitor in infancy and childhood: Previous research and opportunities for future study

Disliked foods may have important value in the study of the development of disgust. The current review draws from literature across disciplines, including theories of disgust and studies of the development of eating behavior and food preferences, to highlight food as an important category of disgust responses across a wide age range, including children as young as 3 years old and adults. Children's disgust responses to certain types of food are considered to be both innate and culturally constrained behaviors, and their perceptions of other people's food choices indicate potential links between foods and cultural groups. We end by discussing several ongoing and future research areas, including connections between disgust responses and food rejection in infancy and children's food rejection behaviors across cultures.

Mothers' feeding practices among infants (4-12 months) and associated factors: a cross-sectional study in Saudi Arabia

A global target of increasing exclusive breast-feeding (EBF) to at least 50 % by the year 2025 was set by the WHO for infants under 6 months. The lowest prevalence in the world was found in the Eastern Mediterranean region in 2010-18 and little is known about the status of mothers' feeding practices in Saudi Arabia. The present study aimed to assess mothers' actual feeding and weaning practices used with their infants by the mothers' different age groups. The present study was conducted among 247 mothers of infants aged 4-12 months who were attending public well-baby clinics. Quantitative data were obtained by nutritionists using an electronic semi-structured questionnaire about mothers' feeding practices. Only 5·3 % of mothers engaged in EBF, 44·9 % breast-fed their infants after an hour of birth, while 92·7 % of infants had ever been breast-fed. The average intent/plan to continue breast-feeding was 4·9(±3·1) months. Younger mothers introduced weaning food around 4 weeks earlier than older mothers (mean differences were -0·4, 95 % CI -0·71, -0·13; P = 0·031). A total of 64·3 % of infants received complementary feeding before completing 17 weeks. Maternal age group and delivery mode were the only factors associated with the early introduction of complementary feeding. A total of 69·2 % of the mothers believed that 'it is a good time' and 61·1 % felt that 'infants are hungry and need other sources of food'. Online sources and family advice were the top sources of information on mothers' feeding practices. Provision of professional advice about EBF and optimal weaning practices are significant areas for improvement in terms of compliance with recommended infant feeding practices.

An online survey of dietary quality during complementary feeding; associations with maternal feeding self-efficacy and adherence to dietary recommendations

Background

Parents are the gatekeepers of nutrition in early life and their feeding practices form children’s dietary behaviours. Although maternal characteristics have been associated with certain feeding practices, their relationship with overall quality of complementary feeding diets has not been explored. This study aimed to: assess dietary quality in complementary feeding age; explore its association with maternal and child characteristics; and evaluate the association between complementary feeding practices and child weight.

Methods

An online cross-sectional survey captured data from a self-selected sample of mothers living in the UK with a healthy full-term child in complementary feeding age. A total of 466 mothers completed a questionnaire on their complementary feeding practices, demographics, anthropometrics, rates of maternal food neophobia, feeding self-efficacy, social support, postnatal depression and infant temperament. Dietary quality was assessed using the Complementary Feeding Utility Index (CFUI). Children were classified into underweight, normal weight, overweight and obese.

Results

Majority of participants reported high levels of dietary quality as determined by a mean CFUI score of 80%. High dietary quality was associated with reliance on the NHS recommendation on timing of complementary feeding and maternal self-efficacy in promoting a healthy diet and limiting non-recommended foods. Responsive feeding, longer breastfeeding duration, frequent exposure to fruits and to a high variety of protein-rich animal foods were significantly associated with lighter child weight status. Consumption of sweetened drinks and delayed introduction of lumpy foods were associated with heavier child weight status.

Conclusions

This study provided an evaluation of dietary quality in complementary feeding in a UK sample of children and explored its relationship with maternal and child attributes. Increasing understanding of the current complementary feeding recommendations and strengthening maternal feeding self-efficacy may be key for healthcare professionals and researchers to improving complementary feeding practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00595-8.

Strategies to promote responsive bottle-feeding in WIC predict less frequent use of food to soothe and healthier weight status for infants with negative temperaments

BACKGROUND

Infants with greater temperamental negative affectivity are at higher risk for overfeeding and excess weight gain.

OBJECTIVE

To examine whether strategies to promote responsive bottle-feeding within WIC promoted healthier maternal feeding practices and infant weight status among infants with greater negative affectivity.

METHODS

Secondary analysis of data from a matched-pair cluster randomized trial. Policy, systems and environmental change (PSE) strategies to promote responsive bottle-feeding were implemented at three WIC clinics; these clinics were compared with three matched control clinics. Linear mixed models tested whether infant negative affectivity interacted with PSE strategies to predict feeding and weight outcomes when infants were 4-6 months old.

RESULTS

Significant interactions between infant negative affectivity and PSE strategies were noted. Among infants with high negative affectivity, mothers in PSE clinics reported less frequent use of food to soothe (p = 0.009) compared with mothers in control clinics. Among infants with moderate (p = 0.008) or high (p = 0.029) negative affectivity, infants in PSE clinics had healthier weight status compared with infants in control clinics.

CONCLUSIONS

Promotion of responsive bottle-feeding is an effective way to support WIC mothers and reduce risk for overfeeding and excess weight gain, particularly for mothers of infants with greater negative affectivity.

Associations of infant appetitive traits during milk feeding stage with age at introduction to solids and sweet food/beverage intake

BACKGROUND

Suboptimal feeding behaviors during infancy, such as introducing solids prior to 4 months and providing foods containing added sugars, are associated with increased risk of later obesity. Although focus group studies suggest that infant appetitive traits during milk feeding stage may influence complementary feeding practices, quantitative evidence on this relationship is lacking.

METHODS

This study included women who were followed from first trimester to 1-year postpartum. At 6-months postpartum, mothers (n = 217) completed the Baby Eating Behavior Questionnaire which assesses infant appetitive traits during exclusive milk-feeding (food responsiveness, satiety responsiveness, slowness in eating, enjoyment of food and general appetite). Mothers reported infant dietary intake via a food frequency questionnaire (FFQ) administered at 6, 9 and 12 months, from which age at introduction to solids and sweet foods/beverages, and 6- and 12-month sweet food/beverage intake frequency, were calculated. Linear regression analyses examined the relationship of appetitive traits with age at introduction to solids and sweet foods/beverages, and frequency of sweet food/beverage intake, whereas logistic regression examined associations of appetitive traits with odds of introduction to solids prior to 4 months.

RESULTS

Greater infant enjoyment of food was associated (B±SE = 0.45 ± 0.18, p = 0.01) with higher age at introduction to solids. Slowness in eating was inversely associated with 12-month sweet food/beverage intake frequency (B±SE = -0.25 ± 0.10, p = 0.01). Other associations of appetitive traits with age at introduction to solids and sweet food/beverage exposure were not statistically significant.

CONCLUSIONS

Findings imply that lower infant enjoyment of food and greater speed of eating during the period of exclusive milk-feeding could be associated with suboptimal complementary feeding practices. Understanding how parents respond to infant appetitive traits may be important considerations in efforts to promote appropriate complementary feeding practices during infancy.

Does social modeling increase infants' willingness to accept unfamiliar foods?

Despite a rich knowledge base about infants' social learning and studies observing social referencing in other species in food contexts, we know surprisingly little about social learning about food among human infants. This gap in the literature is particularly surprising considering that feeding unfamiliar foods to infants is a very common experience as infants begin to eat solid foods. The present study examines whether parental social modeling influences infants' willingness to accept unfamiliar foods. In two Zoom sessions, parents will be asked to feed unfamiliar foods to their 6- to 24-month-old infants (different unfamiliar foods in each session). In both sessions, infants' food acceptance and rejection will be measured. In the first session, parents will be asked to do what they would typically do; spontaneous social modeling will be recorded. In the second session, parents will be instructed to model eating the unfamiliar food. We will examine associations between infants' willingness to eat unfamiliar foods, parent social modeling, and extant parent and infant characteristics.

Cross-cultural adaptation and validation of the Infant Feeding Style Questionnaire in Brazil

We cross-culturally adapted and validated the Infant Feeding Style Questionnaire (IFSQ) in Brazil. The cross-cultural adaptation and content validity assessment was conducted in five steps: translation, synthesis of translations, back-translation, evaluation by experts, and pre-test. To evaluate reliability, construct validity, and floor and ceiling effects, interviews were conducted with 465 mother-infant pairs at Primary Health Centers in the Federal District, Brazil. The mothers answered the Brazilian Portuguese version of the IFSQ (IFSQ-Br), which evaluated four feeding styles (laissez-faire, pressuring, restrictive, and responsive) from 9 sub-constructs. The indulgent style was not evaluated due to time limitation. We performed reliability analysis using Cronbach’s alpha coefficient and construct validity was evaluated through Confirmatory Factor Analysis. Higher means were found in the sub-constructs of the responsive and restrictive styles. The IFSQ-Br presented adequate reliability (α = 0.73) with values for the Cronbach’s alpha coefficient of the sub-constructs ranging from 0.42 to 0.75. In the Confirmatory Factor Analysis, the final models presented good fit, with the Comparative Fit Indices (CFI) ranging from 0.86 to 1.0 and the Root-Mean Squared Error of Approximation (RMSEA) between 0.0 and 0.09. The IFSQ-Br was shown to be a valid and reliable questionnaire to evaluate maternal feeding beliefs and behaviors in Brazil. Future studies should evaluate the psychometric properties of the indulgent style and include mother-infant pairs from different cultural contexts in Brazil.

Parental considerations during complementary feeding in higher income countries: a systematic review of qualitative evidence

OBJECTIVE

Worldwide data suggest a clash between parental complementary feeding practices and recommendations. Understanding the circumstances under which parents form their feeding practices is a crucial step to improve such practices. This paper aimed to systematically review the existing qualitative literature and synthesise the factors that parents take into consideration in relation to complementary feeding.

DESIGN

A systematic review was undertaken. Four electronic databases were searched for qualitative studies published after 2001 exploring parental experiences during complementary feeding. A framework that included authors' outcomes of interest was used to extract and synthesise study findings. The Standards for Reporting Qualitative Research were used to critically assess the included studies.

SETTING

Upper-middle- and high-income countries.

PARTICIPANTS

Parents with a child below the age of 3 years.

RESULTS

A total of forty-seven studies met the eligibility criteria and were included in this systematic review. The themes were organised into three main categories: (1) factors related to introduction of complementary foods; (2) factors related to the type of complementary foods and (3) factors related to both timing and type. The selected literature highlights: prevalent baby cues that prompt parents to introduce solid foods; parents' views on the recommended timing of complementary feeding; factors that drive the choice of complementary foods and perceived value in advice received from health professionals and grandmothers.

CONCLUSIONS

This systematic review indicates factors that can be barriers to complying with the complementary feeding guidelines, and therefore, its findings are pertinent to improving parental feeding practices through intervention studies and through infant feeding education in a primary care setting.

Describing Maternal Knowledge of Infant Feeding Practices

INTRODUCTION

This qualitative study aimed to describe first-time mothers' knowledge of infant feeding practices, including the responsive feeding approach.

METHOD

This descriptive, qualitative study enrolled first-time mothers in the third trimester of pregnancy. Participants were asked plans for infant feeding and knowledge of infant feeding cues and responsive feeding. NVivo version 11 was used to analyze data using thematic analysis.

RESULTS

All mothers (n = 30) intended to breastfeed. Hunger cues such as rooting were described; cessation of eating was consistently mentioned as a fullness cue. Mothers were unfamiliar with responsive feeding yet deduced the meaning of feeding in response to infant cues. Readiness for complementary foods was described by infant age and/or health care provider recommendation; developmental readiness was not described.

DISCUSSION

Findings suggest future education and research should focus on responsive feeding and readiness for complementary foods. Finding ways to assist mothers to adhere to recommendations may promote healthy infant growth and prevent childhood obesity.

Evaluating the pathways linking complementary feeding practices to obesity in early life

The complementary feeding period, when solids and liquids other than breast milk and formula are added to the infant diet, is an important development window shaping infant growth and weight gain, metabolic development, and lifelong eating practices. Yet, relatively little is known about how the timing and types of foods offered to infants at this stage may shape their growth and subsequent risk of developing obesity. This narrative review describes the existing literature on complementary feeding practices, discusses potential biological and behavioral pathways linking complementary feeding practices to the development of obesity, and offers potential avenues for intervention. While further research is needed to more fully understand optimal complementary feeding practices, existing evidence supports the importance of healthful early feeding practices in the physiological and behavioral regulation of growth and metabolism and the need for early intervention to prevent the development of obesity.

Cultural Influences on Complementary Feeding Beliefs amongst New Chinese Immigrant Mothers in England: A Mixed Methods Study

Adequate nutrition during infancy and early childhood is essential for ensuring the growth, health, and development of children so that they can reach their full potential. There is a current void of data on infant and young child feeding practices (IYCF) in ethnic minority communities in the UK; specifically, it is difficult to find accurate Chinese IYCF data in the UK because survey data often includes Chinese in the category of ‘Chinese or other ethnic group’, further contributing to health inequalities. This mixed methods study aimed to explore the cultural influences on IYCF beliefs among new Chinese immigrant mothers. A total of 31 mothers of infants aged 6–23 months were recruited from informal community organizations. All 31 mothers were born in Mainland China, the mean length of their stay after immigrating to the UK was 10 years (range = 1–21 years), and their mean age was 29 ± 3.40 years. When using the Infant Feeding Style Questionnaire (IFSQ) to investigate IYCF beliefs, the highest score was obtained for responsive attention, with a value of 4.28 ± 0.92, indicating that parents were very attentive to child hunger and satiety cues; lower scores were obtained for indulgence soothing (1.82 ± 1.01), indulgence coaxing (2.11 ± 1.18), indulgence pampering (1.90 ± 0.95), and pressuring to soothe (1.92 ± 0.86), indicating lesser maternal indulgence and pressuring/controlling beliefs. A sub-sample (n = 14) participated in semi-structured interviews in order to understand the balancing sources of information and cultural preferences, the influence of traditional Chinese medicine, and language difficulties in accessing health services. The mothers reported barriers of IYCF beliefs and the introduction of solid foods earlier than the NHS guidelines. This study can promote optimal IYCF in Chinese immigrants and show health services the need to reconcile differences between the perceptions of British and Chinese health beliefs.

An Exploration of Complementary Feeding Practices, Information Needs and Sources

Following complementary feeding (CF) guidelines might be challenging for mothers lacking time, resources and/or information. We aimed to explore CF practices, information needs and channels used to obtain information in parents living in areas of socioeconomic deprivation. Sixty-four parents of infants aged 4–12 months completed a short questionnaire and 21 were interviewed. Mean (SD) weaning age was 5 ± 2.5 months, foods given >7 times/week included commercial baby foods (33%) and fruits (39%) while 86% gave formula daily. The main sources of CF information were friends and family (91%), the internet (89%) and health visitors (77%). Online forums (20%), e.g., Facebook and Netmums, were used to talk to other parents because they felt that “not enough” information was given to them by health professionals. Parents felt access to practical information was limited and identified weaning classes or online video tutorials could help meet their needs. Themes identified in qualitative findings were (1) weaning practices (i.e., concerns with child’s eating; and (2) information sources and needs (i.e., trust in the National Health Service (NHS) as a reliable source, need for practical advice). In conclusion, parents are accessing information from a number of non-evidence-based sources and they express the need for more practical advice.

Current practice in the introduction of solid foods for preterm infants

OBJECTIVE

The present study compared the age of first solid foods in a cohort of preterm infants with term infants and identified factors influencing timing of solid food introduction.

DESIGN

Structured interviews on infant feeding practices, growth and medical status at term equivalence and at 3, 6, 9 and 12 months corrected postnatal age. The age of solid food introduction was compared between term and preterm infants, and the influence of maternal, infant and milk feeding factors was assessed.

SETTING

This prospective longitudinal study recruited primary carers of preterm and term infants from a regional metropolitan referral hospital in eastern Australia.

PARTICIPANTS

One hundred and fifty infants (preterm, n 85; term, n 65).

RESULTS

When corrected for prematurity, preterm infants received solid foods before the recommended age for the introduction of solid foods for term infants. Median introduction of solid foods for preterm infants was 14 weeks corrected age (range 12-17 weeks). This was significantly less than 19 weeks (range 17-21 weeks) for term infants (P < 0·001). Lower maternal education and male gender were associated with earlier introduction of solid foods among preterm infants.

CONCLUSIONS

Preterm infants are introduced to solid foods earlier than recommended for term infants, taking account of their corrected age. Further research is needed to assess any risk or benefit associated with this pattern and thus to develop clear evidence-based feeding guidelines for preterm infants.

The Association of Acculturation and Complementary Infant and Young Child Feeding Practices Among New Chinese Immigrant Mothers in England: A Mixed Methods Study

Acculturation has an influence on mothers' beliefs and the perceived behaviours of different ethnicities. Few studies have been conducted on complementary infant and young child feeding practices (CIYCFP) in minorities in England, particularly in Chinese immigrants. This mixed study aims to explore the association of acculturation and IYCF among new Chinese immigrant mothers using purposive snowball sampling from an informal Chinese community. The participants' responses to the Infant Feeding Style Questionnaire (IFSQ) and Mutual Intercultural Relations in Plural Societies (MIRIPS), questionnaire (n = 32) were collected. A sub-set of 15 also participated in semi-structured interviews. Pearson's correlation coefficient analysis and thematic analysis were performed to analyse the survey and semi-structured interview data, and triangulation was employed to integrate quantitative and qualitative findings. This study indicated that Chinese mothers who scored high in integration were more likely to respond to satiety and attention; those inclined to be marginalised were more likely to indulge their children. Those who were more culturally separated were more likely to restrict the food quality offered to their children. This study also indicated that Chinese immigrants balanced western and Chinese feeding practices to combat feeding and culture conflict. This study presents preliminary findings of the association between acculturation and CIYCFP, which can improve culturally appropriate CIYCFP in minorities. Further studies are needed to explore intervention programs to tailor CIYCFP with consideration for acculturation in the minority.

Associations between timing and quality of solid food introduction with infant weight-for-length z-scores at 12 months: Findings from the Nurture cohort

This study assesses associations of the timing and quality of solid foods introduced during infancy with weight-for-length (WFL) z-scores at 12 months within the Nurture cohort. Women from North Carolina self-reported sociodemographics, the timing and type of solid food introduction, and reasons for introducing solids; infant anthropometrics were measured every 3 months through 1 year (n = 666). Frequency (0-5x/day) infants consumed fruits and vegetables was used to compute a mean (4-12 months) healthy food score (HFS), and sweets, french fries, snacks, and ice cream was used to compute a mean unhealthy food score (UnHFS). Multivariable-adjusted generalized linear models were used to examine the relationship of early solid food introduction, HFS quartiles (Q), UnHFS quartiles, and interactions between these variables with WFL z-scores at 12 months (n = 449). Exploratory analyses evaluated WFL z-scores among 4 groups of infants with high/low HFS and high/low UnHFS. On average, mothers were 28 years with a pre-pregnancy BMI of 30.5 kg/m²; 65% were Non-Hispanic Black, and 59% had incomes <$20,000. Mean HFS and UnHFS were 2.4 (range 0-7.4 of 10) and 1.8 (range 0-9.9 of 20), respectively. Nearly 1/3 of mothers introduced solids early, but early introduction and the HFS were not associated with WFL z-scores. Infants in Q3 and Q4 of the UnHFS had higher WFL z-scores (0.75-0.79 ± 0.09) compared to infants in Q1 (0.42 ± 0.0.9), p < 0.05. Frequent unhealthy food intake was associated with higher WFL z-scores at 12-months, underscoring the importance of reducing unhealthy food intake in the first year.

Factors associated with early introduction of complementary feeding and consumption of non-recommended foods among Dutch infants: the BeeBOFT study

BACKGROUND

Timing and types of complementary feeding in infancy affect nutritional status and health later in life. The present study aimed to investigate the factors associated with early introduction of complementary feeding (i.e., before age 4 months), and factors associated with infants consumption of non-recommended foods, including sweet beverages and snack foods.

METHODS

This study used cross-sectional data from the BeeBOFT study (n = 2157). Data on complementary feeding practices and potential determinants were obtained by questionnaire at infant's age of 6 months. Logistic regression models were used to investigate factors associated with early introduction of complementary feeding and infants' consumption of non-recommended foods.

RESULTS

21.4% of infants had received complementary feeding before 4 months of age. At the age of 6 months, 20.2% of all infants were consuming sweet beverages daily and 16.5% were consuming snack foods daily. Younger maternal age, lower maternal educational level, absence or shorter duration of breastfeeding, parental conviction that "my child always wants to eat when he/she sees someone eating" and not attending day-care were independently associated with both early introduction of complementary feeding and the consumption of non-recommended foods. Higher maternal pre-pregnancy BMI and infant postnatal weight gain were associated only with early introduction of complementary feeding.

CONCLUSIONS

We identified several demographical, biological, behavioral, psychosocial, and social factors associated with inappropriate complementary feeding practices. These findings are relevant for designing intervention programs aimed at educating parents.

TRIAL REGISTRATION

The trail is registered at Netherlands Trial Register, trail registration number: NTR1831 . Retrospectively registered on May 29, 2009.

Infant temperament, maternal feeding behaviours and the timing of solid food introduction

Despite guidance from the World Health Organization and the U.K. Department of Health, many mothers introduce solid food before their infant is 6 months old. The current study aimed to investigate relationships between maternal feeding behaviours (preintroduction and postintroduction to solids), infant temperament, and the timing of introduction to solid food. Eighty‐one women were recruited on low‐risk maternity units and were contacted at 1 week, 3, and 6 months postpartum. Mothers of infants (45 males, 36 females, mean birth weight 3.52 kg [SD 0.39]) completed the behaviours component of the Infant Feeding Style Questionnaire via telephone interview at 3 months. At 6 months, they were observed feeding their infant solid food at home and reported infant temperament using the Infant Behaviour Questionnaire‐Revised (short form). Partial correlations (covariates: birth weight, maternal age, breastfeeding duration, and postnatal depression) revealed negative associations between age of introduction to solid food and temperament (smiling and laughter) and laissez‐faire milk feeding behaviours; and positive associations between age of introduction to solid food and restrictive milk feeding behaviours and verbal involvement during an observed mealtime. Hierarchical multiple regression analysis revealed that an infant's birth weight and the degree to which their mothers perceive them to smile and laugh are key predictors of when they will be introduced to solid food, over and above other variables of interest (e.g., maternal milk feeding behaviours, breastfeeding duration, and postnatal depression).

Comparing Indigenous and public health infant feeding recommendations in Peru: opportunities for optimizing intercultural health policies

BACKGROUND

The problem of childhood undernutrition in low-income countries persists despite long-standing efforts by local governmental and international development agencies. In order to address this problem, the Peruvian Ministry of Health has focused on improving access to primary healthcare and providing maternal and child health monitoring and education. Current maternal-child health policies in Peru introduce recommendations that are in some respect distinct from those of Indigenous highland communities. This paper analyses the similarities and differences between public health and mothers' infant feeding recommendations. Furthermore, it analyses persistence and change in those recommendations among women who were mothers before and after the introduction of current public health policies.

METHODS

Semi-structured interviews were conducted with 18 older mothers, 15 currently breastfeeding mothers, and 15 public health staff in highland rural communities of Peru. During data analysis, thematic codes and text passages were used in an iterative analytic process to document emerging themes.

RESULTS

The results highlight the existence of a traditional corpus of beliefs surrounding infant feeding and care that is consistent with Andean ethnomedical beliefs. This is illustrated by mother's accounts referring to the importance of maintaining a dietary balance of fluids and semi-fluids and of maintaining harmony with the elements in the natural environment. Mothers also incorporate aspects of public health recommendations that they find useful including initiating breastfeeding immediately after birth and exclusive breastfeeding up until 6 months. There are also tensions between the two systems including differences in the conceptualization of breastfeeding and infant food, the imposition of public health care services by coercive means, and negative stereotyping of rural Andean diets and mothers.

CONCLUSIONS

Identifying similarities and differences between distinct systems may provide useful input for effective intercultural health policies. Sources of tension should be carefully assessed with the aim of improving public health policies. Such efforts should apply a process of cultural humility engaging health care professionals in exchange and conversations with patients and communities acknowledging the assumptions and beliefs that are embedded in their own understanding. This process should also recognize and value the knowledge and practices of Andean mothers and their role as primary caretakers.

Demographic Correlates of Infant Feeding Practices and Growth Performance in the First Year of Life

The aims of this study are (1) to assess changes in infant WHO growth indicators (weight-for-age, weight-for-length, and head circumference z-scores) from birth to 12 months of age as a function of feeding practices (FP) and (2) to describe the proportion of infants experiencing rapid weight gain (RWG; defined as change in weight-for-age z-score of ≥0.67 between birth and six months) among different FP. The modified Infant Feeding Practices Study II questionnaire was administered to 149 diverse caretakers/mothers of infants who were less than six months of age in a pediatric outpatient clinic. Growth as a function of FP was assessed using repeated measures ANOVA, while logistic regression was used to describe the correlates of RWG. The largest proportion of caretakers was African American (37%), 46% completed college, and 48% were enrolled in the Women, Infants, and Children (WIC) program. Regarding FP, 32% of infants were formula fed, and 18% were breastfed, with the remaining being either mixed fed or complementary fed, with nearly 40% of infants demonstrating RWG. While changes in weight-for-age z-scores differed among FP across time (p<0.05), observed patterns for head-circumference-for-age and weight-for-length z-scores did not. Various demographic correlates (caretaker race-ethnicity, education, and WIC enrollment) were associated with FP. Only the patterns of change in weight-for-age z-scores at 9 and 12 months differed among FP (with breastfeeding being the lowest at both time points). Further study is needed to adequately characterize the correlates of infant growth performance and growth patterns among different FP in such diverse samples. Continued research will allow for the development of an easy-to-use, succinct questionnaire that will allow healthcare providers to individualize feeding recommendations for caretakers of infants.

Infant temperament and parent use of food to soothe predict change in weight-for-length across infancy: early risk factors for childhood obesity

OBJECTIVES

Greater weight gain in infancy is a risk factor for childhood obesity. The present study examined the interaction between infant temperament and parent use of food to soothe infant distress (FTS) as predictors of weight gain across the first 2 years of life.

SUBJECTS/METHODS

A total of 160 mother-infant dyads were recruited into a longitudinal study. Infant temperament was assessed by parents through a questionnaire (surgency, negativity) and by observer ratings (surgency, irritability) during a laboratory visit when infants were 6 months old. Parents also completed a 3-day infant cry diary when their children were 6 months of age to assess when they used food in response to infant cry/fuss bouts. Infant weight/length was measured in the lab at 6 and 18 months. Multiple regressions were run to test the moderating effect of FTS on weight gain.

RESULTS

Significant interactions were revealed for both measures of surgency and parent FTS in predicting weight gain. Surgent infants whose parents had a greater tendency to use FTS had greater weight-for-length gain in 1 year than if their parents tended to use less FTS. The interaction between observer ratings of irritability and parent FTS was also significant but in an unexpected direction.

CONCLUSIONS

The findings point to the role of temperament, specifically surgency, in weight gain during infancy, but only if their parents used FTS. Surgency may have evoked this feeding practice that increased their health risk.

Timing of complementary feeding and associations with maternal and infant characteristics: A Norwegian cross-sectional study

Norwegian Health authorities recommend solid food to be introduced between child age 4-6 months, depending on both the mother´s and infant's needs. The aim of this paper is to describe timing of complementary feeding in a current sample of Norwegian mother/infant-dyads and explore potential associations between timing of introduction to solid foods and a wide range of maternal and infant characteristics known from previous literature to influence early feeding interactions. The paper is based on data from the Norwegian randomized controlled trial Early Food for Future Health. In 2016, a total of 715 mothers completed a web-based questionnaire at child age 5.5 months. We found that 5% of the infants were introduced to solid food before 4 months of age, while 14% were not introduced to solid food at 5.5 months of age. Introduction of solid food before 4 months of age was associated with the infant not being exclusive breastfed the first month, receiving only formula milk at 3 months, the mother being younger, not married/cohabitant, smoking, less educated and having more economic difficulties. Not being introduced to solid food at 5.5 months was associated with the infant being a girl, being exclusive breastfed the first month, receiving only breastmilk at 3 months, the mother being older, married and having 3 or more children. This study shows that there are still clear socioeconomic differences regarding timing of complementary feeding in Norway. Infants of younger, less educated and smoking mothers are at higher risk of not being fed in compliance with the official infant feeding recommendations. Our findings emphasize the importance of targeting socioeconomically disadvantaged mothers for support on healthy feeding practices focusing on the infant`s needs to prevent early onset of social inequalities in health.

Exploring How the Home Environment Influences Eating and Physical Activity Habits of Low-Income, Latino Children of Predominantly Immigrant Families: A Qualitative Study

Latinos are the largest and fastest growing minority population group in the United States, and children in low-income Latino families are at elevated risk of becoming overweight or having obesity. A child’s home is an important social environment in which he/she develops and maintains dietary and physical activity (PA) habits that ultimately impact weight status. Previous research suggests the parents are central to creating a home environment that facilitates or hinders the development of children’s early healthy eating and PA habits. Therefore, the purpose of this study was to explore low-income Latino parents’ beliefs, parenting styles, and parenting practices related to their children’s eating and PA behaviors while at home. Methods: Qualitative study using focus group discussions (FGDs) with 33 low-income Latino parents of preschool children 2 to 5 years of age. FGDs were transcribed verbatim and analyzed using thematic analysis. Results: Data analyses revealed that most parents recognize the importance of healthy eating and PA for their children and themselves. However, daily life demands including conflicting schedules, long working hours, financial constraints, and neighborhood safety concerns, etc., impact parents’ ability to create a home environment supportive of these behaviors. Conclusions: This study provides information about how the home environment may influence low-income Latino preschool children’s eating and PA habits, which may be useful for health promotion and disease prevention efforts targeting low-income Latino families with young children, and for developing home-based and parenting interventions to prevent and control childhood obesity among this population group. Pediatric healthcare providers can play an important role in facilitating communication, providing education, and offering guidance to low-income Latino parents that support their children’s development of early healthy eating and PA habits, while taking into account daily life barriers faced by families. Moreover, pediatric healthcare providers also can play an important role in the integration and coordination of home-visitations to complement office-based visits and provide a continuum of care to low-income Latino families.

Timing of Introduction of Complementary Foods to US Infants, National Health and Nutrition Examination Survey 2009-2014

BACKGROUND

Although there has been inconsistency in recommendations regarding the optimal time for introducing complementary foods, most experts agree that introduction should not occur before 4 months. Despite recommendations, studies suggest that 20% to 40% of US infants are introduced to foods at younger than 4 months. Previous studies focused on the introduction of solid foods and are not nationally representative.

OBJECTIVE

Our aims were to provide a nationally representative estimate of the timing of introduction of complementary foods and to describe predictors of early (<4 months) introduction.

DESIGN

We conducted a cross-sectional analysis of 2009-2014 National Health and Nutrition Examination Survey data.

PARTICIPANTS

The study included 1,482 children aged 6 to 36 months.

MAIN OUTCOME MEASURES

Timing of first introduction to complementary foods (anything other than breast milk or formula) was analyzed.

STATISTICAL ANALYSES PERFORMED

Prevalence estimates of first introduction to complementary foods are presented by month. Logistic regression was used to assess characteristics associated with early (<4 months) introduction.

RESULTS

In this sample, 16.3% of US infants were introduced to complementary foods at <4 months, 38.3% between 4 and <6 months, 32.5% between 6 and <7 months, and 12.9% at ≥7 months of age. In unadjusted analyses, early introduction varied by breastfeeding status; race/Hispanic origin; Special Supplemental Nutrition Program for Women, Infants, and Children participation; and maternal age. In adjusted analyses, only breastfeeding status remained significant; infants who never breastfed or stopped at <4 months were more likely (odds ratio 2.27; 95% CI 1.62 to 3.18) to be introduced to complementary foods early than infants who breastfed ≥4 months.

CONCLUSIONS

Despite using a broader definition of complementary foods, this analysis found a lower prevalence of early introduction in this nationally representative sample than previous studies that included only solids. However, many young children were still introduced to complementary foods earlier than recommended. Strategies to support caregivers to adhere to infant feeding guidelines may be needed.

Associations between bottle-feeding intensity and maternal encouragement of bottle-emptying

Objective

To explore longitudinal associations between bottle-feeding and maternal encouragement of infant bottle-emptying during the first 6 months of infancy.

Design

Mothers 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.

Setting

The Infant Feeding Practices Study 2, conducted by the US Centers for Disease Control and Prevention and the Food and Drug Administration.

Subjects

Mothers (n 1776).

Results

Repeated-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).

Conclusions

More 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.

Knowledge, Attitudes and Practices of Mothers in Kosova About Complementary Feeding for Infant and Children 6-24 Months

AIM

This cross sectional study assessed knowledge, attitudes and practices regarding complementary feeding among mothers with children between 6-24 months at the national level.

METHODS

The sample of 492 mothers with children between 6-24 months, with a confidence level of 95%, the acceptable margin of 5%, the expected prevalence of 50% knowledge and effect of 1.3, were interviewed from all regions, in all Kosovo. Data were analyzed using SPSS version 17.0 and presented using descriptive and inferential statistics such as Chi-square with significance level set at 5%.

RESULTS

Overall, 88.4% of respondents had good knowledge of complementary feeding, while only 38.4% of mothers had good practices regarding time for starting complementary feeding. We found association between maternal knowledge and level of education for complementary feeding.

CONCLUSION

There is a need to further explore the factors responsible to improving practices for complementary feeding.

The influence of maternal psychosocial characteristics on infant feeding styles

Maternal feeding styles in infancy and early childhood are associated with children's later risk for overweight and obesity. Maternal psychosocial factors that influence feeding styles during the complementary feeding period, the time during which infants transition from a milk-based diet to one that includes solid foods and other non-milk products, have received less attention. The present study explores how maternal psychosocial factors-specifically self-esteem, parenting self-efficacy, parenting satisfaction, and depression symptoms-influence mothers' infant feeding styles at nine months of age, a time during which solid foods eating habits are being established. Participants included 160 low-income, African-American mother-infant pairs in central North Carolina who were enrolled in the Infant Care and Risk of Obesity Study. Regression models tested for associations between maternal psychosocial characteristics and pressuring and restrictive feeding styles. Models were first adjusted for maternal age, education, marital status and obesity status. To account for infant characteristics, models were then adjusted for infant weight-for-length, distress to limitations and activity level scores. Maternal self-esteem was negatively associated with pressuring to soothe. Maternal parenting self-efficacy was positively associated with restriction-diet quality. Maternal parenting satisfaction and depression symptoms were not associated with feeding styles in the final models. Focusing on strengthening maternal self-esteem and parenting self-efficacy may help to prevent the development of less desirable infant feeding styles.

Factors Associated with the Early Introduction of Complementary Feeding in Saudi Arabia

Mothers' instigation of complementary feeding before their infant reaches 6 months old risks shortening their breastfeeding duration, and high morbidity and mortality for their child. Complementary feeding practices require further investigation in Saudi Arabia. The present study aims to evaluate complementary feeding practices, and to establish which factors are associated with the early introduction of complementary feeding in the Saudi Arabian context. Cross-sectional research was conducted with 632 mothers of infants aged between 4 and 24 months attending five primary health care centers (PHCCs) between July and December 2015 in Saudi Arabia. Data on participants' socio-demographic characteristics and complementary feeding practices were collected via structured questionnaires. A regression analysis identified the factors associated with the early introduction of solid foods, defined as before 17 weeks. 62.5% of the study's infants received solid foods before reaching 17 weeks old. The maternal factors at higher risk of early introduction of solids were: younger age; Saudi nationality; shorter education; employment within 6 months post-birth; caesareans; not breastfeeding fully for six weeks post-birth, and living in low-income households. Complementary feeding prior to 6 months postpartum was common in Saudi Arabia. Public health interventions are needed to reduce early complementary feeding, focusing on mothers at highest risk of giving solids too early.

Maternal and infant correlates of maternal feeding beliefs and practices in a multi-ethnic Asian population: the GUSTO (Growing Up in Singapore Towards healthy Outcomes) study

OBJECTIVE

Little is known about the influences of maternal and infant correlates on maternal feeding beliefs and practices in the first 2 years of life, despite its important role in early obesogenic eating behaviours and weight gain.

DESIGN

Cross-sectional study using demographic data of mothers and infants obtained at 26-28 weeks of gestation, and postnatally from birth to 15 months, respectively. The Infant Feeding Questionnaire was administered at 15 months postpartum. The associations between maternal and infant characteristics with seven maternal feeding beliefs and practices subscales were evaluated using multivariate linear regression analysis.

SETTING

Data obtained from the Singapore GUSTO (Growing Up in Singapore Towards healthy Outcomes) mother-offspring birth cohort.

SUBJECTS

Mothers and infants (n 1237).

RESULTS

Among other maternal correlates such as age, education, BMI, income and milk feeding practices, ethnicity was a consistent factor associated with six subscales, including concern about infant overeating/undereating and weight status, concern and awareness about infants' hunger and satiety cues, social interaction during feeding and feeding an infant on schedule. Similarly, among infant correlates such as gender and birth order, infant body size gain (reflected by BMI Z-score change from 0 to 15 months) was significantly associated with all subscales except feeding an infant on schedule. Overall, maternal correlates had greater influence on all subscales compared with infant correlates except for the maternal concern about infant undereating or becoming underweight subscale.

CONCLUSIONS

The present study highlights that maternal feeding beliefs and practices can be influenced by both maternal correlates and infant correlates at 15 months of age.