Infant hunger and satiety cues during the first two years of life: Developmental changes of within meal signalling

Conceptual Considerations and Methodological Challenges to Measuring Food Acceptance During Infancy

PURPOSE OF REVIEW

The purpose of this review is to (1) present a conceptual definition of infant food acceptance, (2) explore methodological challenges to measuring different components of food acceptance, and (3) provide recommendations for future research on food acceptance during infancy.

RECENT FINDINGS

Infant food acceptance includes separate but overlapping components: wanting, liking, and consumption. Recent evidence suggests that although these components are often correlated, there is variability in the sensitivity of these measures to detect differences in infants' responses to target foods. To date, consumption and caregiver perceptions of liking have been the primary outcome measures of interest in studies of infant food acceptance. More diverse and precise measures across the three components of infant food acceptance are needed to address a wider scope of research questions, which would in turn strengthen the interpretability and translational potential of research in this area.

Comparison of mothers' perceptions of hunger cues in 3-month-old infant under different feeding methods

BACKGROUND

Mothers' perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explore the relationship between maternal perceptions of infant hunger cues and different feeding methods.

METHODS

A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers' perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators.

RESULTS

We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥ 2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant's "hand sucking" (67.6% vs. 53.6%) and "moving head frantically from side to side" (34.6% vs. 23.9%), all p < 0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR = 1.70, 95% CI: 1.01-2.85), "hand sucking" (OR = 1.72, 95% CI: 1.04-2.87), "moving head frantically from side to side" (OR = 2.07, 95% CI: 1.19-3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure.

CONCLUSION

EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers.

How much do preverbal children signal a wish to be fed? Nested case control study comparing weight faltering and healthy infants

We aimed to 1/develop an observational tool to rate non-verbal cues infants give when being fed 2/test whether these differ between healthy children and those with weight faltering (WF) 3/describe how well these predict whether offered food is eaten.

SUBJECTS

and methods: The study used videos of infants eating a standardised meal studied in a case control study nested within the Gateshead Millennium Study (GMS). Infants with weight faltering (WF) were each matched to 2 healthy controls. Half the control videos (N = 28) were used to develop the scale. Food offers were identified and the child's head, eyes, hands, and mouth position/activity rated as signalling a readiness to be fed (engaged), or not (disengaged) as well as whether food was accepted; 5 of these videos were used to assess inter-rater and test-re- test reliability. The scale was then applied to the videos of 28 WF infants (mean age 15.3 months) and 29 remaining controls (mean age 15.8 months) to identify and code all feeding events.

RESULTS

test-re-test rates varied from 0.89 for events to 0.74 for head; inter-rater reliability varied from 0.78 for hands to 0.67 for mouth. From 2219 observed interactions, 48% showed at least one engaged element, and 73% at least one disengaged; 67% of interactions resulted in food eaten, with no difference between WF and control. Food was eaten after 73% interactions with any engagement, but also in 62% with disengagement.

CONCLUSIONS

Infants were commonly disengaged during meals, but a majority accepted food despite this. Those with weight faltering did not differ compared to healthy controls.

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.

What Factors Predict the Use of Coercive Food Parenting Practices among Mothers of Young Children? An Examination of Food Literacy, Disordered Eating and Parent Demographics

Parents have the most significant influence on the development of young children’s eating patterns. Understanding what parental factors best predict specific negative feeding practices is important for designing preventive interventions. We examined the relationship between parents’ use of coercive food parenting practices (pressure to eat and restriction) and parents’ disordered eating, food literacy, Body Mass Index (BMI) and socio-economic status (SES). Adult mothers, with a mean age of 33 years, at least one child aged between 6 months and 5 years and living in Australia (n = 819) completed an online questionnaire. Regression models were used to examine predictors of pressure to eat and restriction, respectively. Although the amount of variance accounted for by the models was small, maternal eating disorder symptoms were found to be the most important predictor of coercive food parenting practices. This finding has implications for early nutrition education, which has traditionally focused heavily on nutrition literacy. Parental disordered eating may be a more important preventive target and thus including behavioral strategies for positive feeding practices may better assist mothers in promoting positive eating habits with their children, rather than traditional approaches that aim to increase nutrition literacy.

Young Children’s Learning about Hunger and Satiety through the Lens of the Norms of Those Who Feed Them

This article focuses on parental perceptions of signs of hunger and satiety in children under 4 years of age and their effects on feeding practices, in a sample of parents of children with typical development. Discourse analysis shows the close relationships between social food norms, nutritional norms, medicalized child care norms, and educational norms in adults’ determination of children’s appetites according to their perceived needs and psychomotor development. The results also indicate how these norms are expressed according to social position, parental experience and context. More broadly, this article addresses top-down education—from adults to children—in food socialization, and points to the varying attention paid to the signals given by the child. It thus highlights some of the processes by which biological, psychological and social factors interact in socializing children to food.

Observed behavioral indicators of child satiation at mealtime: Associations with child characteristics and parent-reported child eating behaviors

The notion of promoting parents' recognition of child satiation to reduce overfeeding and overeating in children is prevalent. To do so, it is important to identify common behaviors that may indicate satiation and can be easily recognized by parents. Relatively little work has focused on identifying behaviors that may indicate child satiation as they occur during naturalistic mealtimes, which is an important context for parents to observe their children's eating behavior. Hence, the goal of the current study is to examine whether observed behavioral indicators of child satiation at mealtimes are associated with child characteristics (i.e., sex, age, and BMIz) and parent-reported child appetitive traits. We coded observed behaviors thought to indicate satiation, specifically mealtime disengagement and mealtime negativity, in a cohort of 240 families with children between 4- and 8-years old (53% boys). First, we documented the occurrence of child disengagement and negativity during naturalistic mealtimes. Second, we found that lower child BMIz and being a boy were associated with greater mealtime disengagement, but child age was not associated with mealtime disengagement. No associations were found between child characteristics and mealtime negativity. Third, we found that mealtime disengagement and mealtime negativity were associated with mother-reported satiety responsiveness on the Child Eating Behavior Questionnaire. Taken together, our findings suggest observed mealtime disengagement and mealtime negativity behaviors could be helpful indicators of child satiation in a naturalistic mealtime context.

Bidirectional association of neurodevelopment with growth: a prospective cohort study

BACKGROUND

The study aims to use the cross-lagged model and utilize data from the Born in Shenyang Cohort Study to characterize the bidirectional associations of the term-born infants' neurodevelopment in five domains and physical growth in early life.

METHOD

This study consists of 688 mother-child dyads from the Born in Shenyang Cohort Study. Infants' anthropometric (weight and length) and development in neurological outcomes (Gesell Development Scale) were measured at the age of 6 and 12 months. Cross-lagged analyses and multiple linear regression analyses were used to explore the longitudinal relationships in both directions.

RESULTS

In terms of longitudinal studies, the inverse associations between infants' two skills (gross motor and social behavior) at the age of 6 months with BMI Z -scores at the age of 12 months (gross motor: aβ = - 0.20, 95% CI: - 0.31 to- 0.09; social behavior: aβ = - 0.23, 95% CI: - 0.33 to- 0.13) were found. Conversely, a higher infant Z -scored BMI at the age of 6 months predicted a lower gross motor at the age of 12 months (aβ = - 0.08, 95% CI: - 0.12 to- 0.04). In cross-lagged analyses, an adverse association in both directions between gross motor and Z -scored BMI was observed.

CONCLUSION

We found bidirectional relationships between infants' neurodevelopment of gross motor with physical growth and suggested the term-born infants, who are on the edge of the developmental danger, should not be overlooked.

Exploring Correlates of Infant Clarity of Cues During Early Feeding Interactions

BACKGROUND

Recommendations aimed at reducing infants' risk for rapid weight gain primarily focus on promoting caregivers' use of responsive feeding practices and styles. These recommendations are grounded in the belief that infants will effectively signal hunger and satiation to their caregivers. To date, few studies have explored how variability in infants' communication of hunger and satiation may contribute to feeding interactions.

OBJECTIVE

Our aim was to explore variability in, and correlates of, infant clarity of cues during feeding interactions.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTING

Mother-infant dyads (n=86) were video-recorded during a typical feeding interaction within laboratory-based settings in Philadelphia, PA and San Luis Obispo, CA between June 2013 and June 2017.

MAIN OUTCOME MEASURES

Trained raters later coded videos using the Nursing Child Assessment Parent-Child Interaction Feeding Scale's Infant Clarity of Cues and Maternal Sensitivity to Cues subscales. Infant weight was assessed and standardized to sex- and age-specific z scores. Mothers completed questionnaires related to family demographics, infant feeding history, feeding styles, and infant temperament and eating behaviors.

STATISTICAL ANALYSES PERFORMED

Linear models were used to test for associations between clarity of cues and breastfeeding vs formula-feeding, maternal sensitivity and responsiveness, and feeding and weight outcomes.

RESULTS

Infants were approximately 15.5 weeks of age and 53% were female. Clarity of cues was not associated with infant sex, age, temperament, or eating behaviors. Breastfed and formula-fed infants exhibited similar clarity of cues (P=0.0636). Greater clarity of cues for infants was associated with greater maternal sensitivity to cues (P=0.0011) and responsive feeding style (P=0.0464) for mothers. Lower clarity of cues was associated with greater weight-for-age z score change for formula-fed infants, but not breastfed infants.

CONCLUSIONS

Efforts to promote responsive feeding may need to also consider infant clarity of cues. Further research is needed to understand the implications of associations between infant communication and responsive feeding.

Duration of breastfeeding is associated with emotional eating through its effect on alexithymia in boys, but not girls

Emotional eating (EE), or eating in response to negative emotions, was earlier shown to be associated with difficulty in identifying emotions (alexithymia). To improve our understanding of possible causes of alexithymia and EE, we assessed possible associations with duration of breastfeeding in infancy. The aim of the present study was to examine in a prospective, longitudinal study whether duration of breastfeeding is associated with EE in adolescence, through its effect on alexithymia difficulty identifying emotions, and whether this mediation effect is contingent on gender. Our hypothesis was that longer duration of breastfeeding would be associated with lower EE in adolescence through its effect on lower alexithymia difficulty identifying feelings in boys but not in girls (Moderated mediation). The sample included 129 children and their families (67 boys and 62 girls). Duration of breastfeeding was reported by the mother when the infant was 15 months old. Alexithymia difficulty identifying feelings (Toronto Alexithymia Scale) and EE (Dutch Eating Behavior Questionnaire) were reported by the child at 12 years of age. EE was also reported by the child at 16 years of age. Moderated mediation was significant for EE at 12 years, and borderline significant for EE at 16 years. As hypothesized, for boys but not for girls, longer duration of breastfeeding was related to less difficulties in identifying feelings, resulting in lower degrees of EE in adolescence. It is concluded that breastfeeding in infancy may protect boys against EE through its positive association with better ability to identify feelings.