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Richardson TN, Reis P, Swanson M. Mental Health and Feeding Styles in Parents of Formula-Fed Infants. Child Obes 2024; 20:178-187. [PMID: 37130301 PMCID: PMC10979682 DOI: 10.1089/chi.2022.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background: Nonresponsive feeding styles can contribute to rapid weight gain in infancy and subsequent obesity in childhood. There is a need to investigate factors such as parental mental health symptoms (stress, depression, and anxiety) that may contribute to nonresponsive feeding styles. The purpose of this study was to investigate the relationship between parental mental health symptoms and feeding styles in parents of healthy, term formula-fed infants during the first year of life. Methods: A cross-sectional, descriptive correlational design was employed using online surveys. We recruited participants through Facebook groups and pediatricians' offices. Instruments included a demographic questionnaire, the Perceived Stress Scale-10, Patient Health Questionnaire-Depression Module-9, 7-item Generalized Anxiety Disorder Assessment, and Infant Feeding Style Questionnaire. Results: Participants were 306 parents of formula-fed infants. Greater depressive symptoms was the strongest predictor of the pressuring style (β = 0.54), while greater symptoms of stress (β = -0.13) and anxiety (β = -0.28) were associated with lower pressuring scores. Greater depressive symptoms was the strongest predictor of the laissez-faire style (β = 0.48), while greater symptoms of stress (β = -0.17) and anxiety (β = -0.23) were associated with lower laissez-faire scores. Engaging in ≤50% of the infant's feeds was the strongest control variable predictor for the pressuring and laissez-faire styles. None of the mental health variables were significantly related to the restrictive style. Conclusions: We recommend increased screening for depressive symptoms in parents of infants and responsive feeding support, especially for those experiencing depressive symptoms.
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Affiliation(s)
| | - Pamela Reis
- College of Nursing, East Carolina University, Greenville, NC, USA
| | - Mel Swanson
- College of Nursing, East Carolina University, Greenville, NC, USA
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2
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Slater CN, Juntereal NA, Kral TVE, Spatz DL, Chao AM. Comparison of the Effect of Direct Breastfeeding, Expressed Human Milk, and Infant Formula Feeding on Infant Weight Trajectories: A Systematic Review. Breastfeed Med 2024; 19:235-247. [PMID: 38497755 DOI: 10.1089/bfm.2023.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background: Formula and breastfeeding are known factors associated with infant weight trajectories. Evidence exploring the effect of expressed human milk feeding on infant weight in the community setting has not been well synthesized. Objectives: This systematic review examined (1) weight changes among infants fed expressed human milk and (2) differences in weight change between infants fed expressed human milk and infants fed at the breast or infant formula via bottle. Methods: A comprehensive search of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of each study was appraised using the Joanna Briggs Critical Appraisal Tools. Results: A total of six studies met the eligibility criteria and included a total of 5,152 infants. The within-subject analysis identified only 31 infants strictly or predominantly fed expressed human milk. The between-subject analysis comparing expressed human milk feeding to the available comparison groups (formula-fed or direct at the breastfed) revealed that higher weight gains were observed in the weight trajectories among infants in the bottle or formula-fed conditions in four of the six included studies. Conclusions: Findings from the few studies included in this review found a difference in the infant weight gain patterns among expressed human milk-fed infants when compared with their respective feeding groups (directly breastfed or formula-fed). Further research is needed to corroborate these findings and elucidate the clinical significance of the differences in weight gain patterns observed across infant feeding groups.
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Affiliation(s)
- Courtney N Slater
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Nina A Juntereal
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Tanja V E Kral
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Diane L Spatz
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Center for Pediatric Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ariana M Chao
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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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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Zhang X, Zhou Q, Vivor NK, Liu W, Cao J, Wang S. Sequential mediation of early temperament and eating behaviors in the pathways from feeding practices to childhood overweight and obesity. Front Public Health 2023; 11:1122645. [PMID: 37766743 PMCID: PMC10520502 DOI: 10.3389/fpubh.2023.1122645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Childhood eating behaviors and temperament may have important implication for constructing the pathways from maternal feeding practices to childhood overweight and obesity (OW/OB). Examining multiple feeding styles simultaneously to childhood OW/OB is critical through the mediators of early childhood temperament and eating behaviors. Methods This cross-sectional study recruited mothers mainly responsible for child care from two hospitals and two healthcare centers in eastern China. Sociodemographic characteristics, and data from the Infant Feeding Style Questionnaire (IFSQ), the short form of Children Behavior Questionnaire [Revised (IBQ-RSF)], and the Child Eating Behavior Questionnaire for toddler (CEBQ-T) were collected. Weight and recumbent length were measured to calculate the age- and sex-specific body mass index (BMI) z-scores (BMIz). The structural equation modeling (SEM) approach was used to examine direct and indirect pathways from five maternal feeding styles to childhood OW/OB through temperament and eating behaviors. Results A total of 486 children were recruited, 73 (15.02%) children were OW/OB; the age of the children was 14.55 (SD = 5.14) months, and the age of the mothers was 29.90 (SD = 3.63) years. The responsive feeding exerted significant direct (β = -0.098), indirect (β = -0.136) and total (β = -0.234) effects on childhood OW/OB. Restrictive feeding had significant direct (β = 0.222), indirect (β = 0.102) and total (β = 0.324) effects on childhood OW/OB. Indulgent feeding had significant direct (β = 0.220), indirect (β = 0.063), and total (β = 0.283) effects on childhood OW/OB. Pressuring feeding had significant direct (β = -0.116), indirect (β = -0.096) and total (β = -0.212) effects on childhood OW/OB. Discussion There was a direct effect of feeding practices on childhood OW/OB; feeding practices indirectly predicted childhood OW/OB through temperament and eating behaviors in children aged 6-23 months. This study could help governments agencies, policymakers, and healthcare workers to establish optimal intervention programs targeting feeding practices through childhood eating behaviors and temperament to prevent childhood OW/OB.
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Affiliation(s)
- Xiaoning Zhang
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
- Zhejiang Philosophy and Social Science Laboratory for Research in Early Development and Childcare, Hangzhou Normal University, Hangzhou, Zhejiang, China
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, China
| | - Qiong Zhou
- Department of Medical Nursing, Union Technical Institute, Lianyungang Subbranch of Traditional Chinese Medicine, Lianyungang, Jiangsu, China
| | | | - Wei Liu
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Junli Cao
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, China
| | - Sheng Wang
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Graf MD, Wasser H, Lynn MR, Karp SM, Lutenbacher M, Hodges EA. Parental food selection questionnaire - Infant version. Appetite 2023; 186:106548. [PMID: 36977445 PMCID: PMC10286103 DOI: 10.1016/j.appet.2023.106548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
PURPOSE Complementary feeding practices (CFPs) are associated with health outcomes (e.g., obesity and food allergies). Understanding how parents select foods for their infant is limited. This study's purpose was to develop a psychometrically sound measure of parents' food selection motives for their infant during the complementary feeding period. METHODS Development and testing of the Parental Food Slection Questionnaire-Infant Version (PFSQ-I) occurred in three phases. English-speaking, U.S. mothers of healthy infants, aged 6-19 months old participated in a semi-structured, face-to-face interview (Phase 1) or a web-based survey (Phases 2 & 3). Phase 1 was a qualitative study of maternal beliefs and motives surrounding complementary feeding. Phase 2 involved adaptation and exploratory factor analysis of the original Food Choice Questionnaire (Steptoe et al., 1995). Phase 3 involved validity testing of the relationships among PFSQ-I factors and CFPs (timing/type of complementary food introduction, frequency of feeding method, usual texture intake, and allergenic food introduction) using bivariate analyses, and multiple linear and logistic regression analyses. RESULTS Mean maternal age was 30.4 years and infant age was 14.1 months (n = 381). The final structure of the PFSQ-I included 30 items and 7 factors: Behavioral Influence, Health Promotion, Ingredients, Affordability, Sensory Appeal, Convenience, and Perceived Threats (Cronbach's α = 0.68-0.83). Associations of factors with CFPs supported construct validity. DISCUSSION The PFSQ-I demonstrated strong initial psychometric properties in a sample of mothers from the U.S. Mothers who rated Behavioral Influence as more important were more likely to report suboptimal CFPs (e.g., earlier than recommended complementary food introduction, delayed allergenic food introduction, and prolonged use of spoon-feeding). Additional psychometric testing in a larger, more heterogenous sample is needed, along with examination of relationships between PFSQ-I factors and health outcomes.
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Affiliation(s)
- Michelle Dorsey Graf
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Heather Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Mary R Lynn
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sharon M Karp
- School of Nursing, Vanderbilt University, Nashville, TN, 37235, USA
| | | | - Eric A Hodges
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Carr T, Thompson AL, Benjamin-Neelon SE, Wasser HM, Ward DS. Confirmatory factor analysis of the infant feeding styles questionnaire in infant and toddler child care teachers. Appetite 2023; 183:106449. [PMID: 36621724 PMCID: PMC10041657 DOI: 10.1016/j.appet.2023.106449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
Early childhood is a critical time of development. Caregiver feeding style, including of child care providers, has been implicated in influencing children's food preferences and obesity. A better understanding of the determinants of child care providers' feeding styles is important as children increasingly receive daily care and nutrition in child care centers. Valid instruments to measure provider feeding styles specifically for infants are needed. This study's objective was to validate, for use with child care providers, the Infant Feeding Styles Questionnaire (IFSQ), an instrument originally designed for parents of infants and toddlers. Study data came from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) study, a cluster randomized trial, designed to evaluate the efficacy of a six-month-long obesity prevention intervention in child care centers. The IFSQ was administered at baseline and follow-up to infant and toddler teacher participants (n = 244). Scores for baseline IFSQ teacher responses (n = 219) were calculated for the 13 sub-constructs across the five feeding styles. We tested reliability with Cronbach's alpha coefficients and performed confirmatory factor analysis to examine factor loadings and goodness of fit characteristics, modifying constructs to achieve best fit. Reliability coefficients ranged from 0.42 to 0.82 for all sub-constructs. Goodness of fit indices for the final model ranged from: root mean square error of approximation (RMSEA) 0.000-0.082; comparative fit index (CFI) 0.943-1.000; Tucker-Lewis index (TLI) 0.906-1.000; and standardized root mean squared error (SRMR) 0.006-0.130. In a sample of racially diverse infant and toddler child care teachers, final models of the laissez-faire, pressuring, and responsive constructs and the restrictive-diet quality sub-construct performed well. Overall model fit was poor for the indulgence construct, but good for solely its corresponding belief items.
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Affiliation(s)
- Tara Carr
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Amanda L Thompson
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Department of Anthropology, University of North Carolina, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heather M Wasser
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
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7
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Bahorski J, Romano M, McDougal JM, Kiratzis E, Pocchio K, Paek I. Development of an Individualized Responsive Feeding Intervention-Learning Early Infant Feeding Cues: Protocol for a Nonrandomized Study. JMIR Res Protoc 2023; 12:e44329. [PMID: 36853761 PMCID: PMC10015354 DOI: 10.2196/44329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Responsive infant feeding occurs when a parent recognizes the infant's cues of hunger or satiety and responds promptly to these cues. It is known to promote healthy dietary patterns and infant weight gain and is recommended as part of the Dietary Guidelines for Americans. However, the use of responsive infant feeding can be challenging for many parents. Research is needed to assist caregivers recognize infant hunger or satiety cues and overcoming barriers to using responsive infant feeding. OBJECTIVE The Learning Early Infant Feeding Cues (LEIFc) intervention was designed to fill this gap by using a validated coaching approach, SS-OO-PP-RR ("super," Setting the Stage, Observation and Opportunities, Problem Solving and Planning, Reflection and Review), to promote responsive infant feeding. Guided by the Obesity-Related Behavioral Intervention Trials model, this study aims to test the feasibility and fidelity of the LEIFc intervention in a group of mother-infant dyads. METHODS This pre-post quasi-experimental study with no control group will recruit mothers (N=30) in their third trimester (28 weeks and beyond) of pregnancy from community settings. Study visit 1 will occur prenatally in which written and video material on infant feeding and infant hunger and satiety cues is provided. Demographic information and plans for infant feeding are also collected prenatally via self-report surveys. The use of responsive infant feeding via subjective (survey) and objective (video) measures is recorded before (study visit 2, 1 month post partum) and after (study visit 5, 4 months post partum) intervention. Coaching on responsive infant feeding during a feeding session is provided by a trained interventionist using the SS-OO-PP-RR approach at study visits 3 (2 months post partum) and 4 (3 months post partum). Infant feeding practices are recorded via survey, and infant weight and length are measured at each postpartum study visit. Qualitative data on the LEIFc intervention are provided by the interventionist and mother. Infant feeding videos will be coded and tabulated for instances of infant cues and maternal responses. Subjective measures of responsive infant feeding will also be tabulated. The use of responsive infant feeding pre-post intervention will be analyzed using matched t tests. Qualitative data will be examined to guide intervention refinement. RESULTS This study initially began in spring 2020 but was halted because of the COVID-10 pandemic. With new funding, recruitment, enrollment, and data collection began in April 2022 and will continue until April 2023. CONCLUSIONS After refinement, the LEIFc intervention will be tested in a pilot randomized controlled trial. The long-term goal is to implement LEIFc in the curricula of federally funded maternal-child home visiting programs that serve vulnerable populations-those that often have infant feeding practices that do not align with recommendations and are less likely to use responsive infant feeding. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44329.
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Affiliation(s)
- Jessica Bahorski
- College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Mollie Romano
- School of Communication Science and Disorders, Florida State University, Tallahassee, FL, United States
| | - Julie May McDougal
- Center for Prevention & Early Intervention Policy, Florida State University, Tallahassee, FL, United States
| | - Edie Kiratzis
- School of Communication Science and Disorders, Florida State University, Tallahassee, FL, United States
| | - Kinsey Pocchio
- College of Health and Human Sciences, Florida State University, Tallahassee, FL, United States
| | - Insu Paek
- College of Nursing, Florida State University, Tallahassee, FL, United States
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Nelson TB, Caiola CE, Tyndall DE. Integrative Review of Mental Health and Feeding Styles in Parents of Bottle-Fed Infants. J Obstet Gynecol Neonatal Nurs 2023; 52:21-35. [PMID: 36442519 PMCID: PMC9839476 DOI: 10.1016/j.jogn.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the literature regarding the relationship between symptoms of anxiety and depression and feeding styles in parents of bottle-fed infants. DATA SOURCES We conducted literature searches in PubMed, CINAHL, Scopus, and PsycINFO. STUDY SELECTION We used Covidence systematic review management software during the selection process to allow for full blinding of decisions by team members. Articles were eligible for inclusion if they were reports of primary research, written in English, and focused on the relationship between symptoms of anxiety or depression and feeding styles in parents of term, bottle-fed infants younger than 12 months of age. We placed no restriction on date of publication because of the sparse amount of published literature on this topic. We identified a total of 1,882 articles. After removing duplicates, we screened 988 articles and retained six articles that met criteria for our review. DATA EXTRACTION We used Whittemore and Knafl's integrative review methodology to guide data extraction and reporting. We extracted relevant data from all primary data sources and compiled the data into a matrix. We used the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies to assess the quality of the studies. DATA SYNTHESIS Using an a priori coding scheme, we summarized the data using categorization of established parental feeding styles in infancy applicable to bottle-feeding. We synthesized the data into two broad categories: responsive and nonresponsive feeding styles. CONCLUSION Although research on the topic is limited, our findings suggest that symptoms of postpartum depression may be associated with nonresponsive feeding styles in parents of bottle-fed infants. We suggest several areas for future research and recommend increased emotional and feeding support in practice for parents of bottle-feeding infants.
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Hernandez E, Lavner JA, Moore AM, Stansfield BK, Beach SRH, Smith JJ, Savage JS. Sleep SAAF responsive parenting intervention improves mothers' feeding practices: a randomized controlled trial among African American mother-infant dyads. Int J Behav Nutr Phys Act 2022; 19:129. [PMID: 36183135 PMCID: PMC9526457 DOI: 10.1186/s12966-022-01366-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background/Objective Parents shape children’s early experiences with food, influencing what is served, children’s food choices, and how much children eat. Responsive parenting (RP) interventions such as INSIGHT have improved maternal infant feeding practices, but have only been tested among predominantly White families. This secondary analysis of data from the Sleep SAAF (Strong African American Families) RCT tests the effects of an RP intervention designed to prevent rapid infant weight gain on African American mothers’ infant feeding practices. Methods Primiparous African American mother-infant dyads (n = 194) were randomized to an RP or safety control intervention delivered by community research associates at infant age 3 and 8 weeks. At 16 weeks, mothers completed the Babies Need Feeding questionnaire, the Infant Feeding Styles Questionnaire, and the Babies Need Soothing questionnaire. Logistic regression and general linear models examined the effect of study group on infant feeding practices. Moderation analyses explored whether effects varied by feeding mode (any breast milk versus exclusive formula), maternal age (≥ 20 years versus < 20 years), and maternal pre-pregnancy BMI (with obesity versus not). Results RP mothers reported more responsive feeding (p = 0.005, partial η2 = 0.02), lower likelihood of using beverages other than breast milk/formula to soothe their infant (p = 0.01, OR = 0.42, 95% CI [0.2–0.8]), and less pressure with cereal than control mothers (p = 0.09, partial η2 = 0.02). RP mothers also reported less pressure to finish/soothe than controls (p = 0.007, partial η2 = 0.04); feeding mode (B = 0.74, p = 0.003) and maternal age (B = 0.53, p = 0.04) moderated this effect. There were no significant group differences in bottle-feeding practices (e.g., adding cereal to bottle, using an appropriate nipple/bottle size), or in context-based or emotion-based food to soothe. Conclusions Responsive parenting education influenced some feeding practices of African American mothers. Mothers reported using less pressure, a control-based feeding practice, and more responsive feeding than controls. Trial registration Sleep SAAF: A Strong African American Families Study. www.clinicaltrials.gov NCT03505203. Registered 3 April 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01366-1.
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Affiliation(s)
- Erika Hernandez
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA, USA
| | - Justin A Lavner
- Department of Psychology, Psychology Building, University of Georgia, Athens, GA, 30602-3013, USA.
| | - Amy M Moore
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA, USA
| | | | - Steven R H Beach
- Department of Psychology, Psychology Building, University of Georgia, Athens, GA, 30602-3013, USA.,Center for Family Research, University of Georgia, Athens, GA, USA
| | - Jessica J Smith
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA, USA
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Ventura AK, Whaley SE. 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. Pediatr Obes 2022; 17:e12908. [PMID: 35224881 DOI: 10.1111/ijpo.12908] [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: 10/07/2021] [Revised: 01/31/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Alison K Ventura
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Shannon E Whaley
- Division of Research and Evaluation, Public Health Foundation Enterprises WIC Program, Irwindale, California, USA
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11
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Gattis M, Winstanley A, Bristow F. Parenting beliefs about attunement and structure are related to observed parenting behaviours. COGENT PSYCHOLOGY 2022; 9:2082675. [PMID: 36686722 PMCID: PMC9844204 DOI: 10.1080/23311908.2022.2082675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We compared self-reported parenting beliefs about caring for infants with observed parenting behaviours during play interactions between 32 parents and their infants. We measured parenting beliefs about the value of attunement and structure in caring for infants using the Baby Care Questionnaire (BCQ) (Winstanley & Gattis, 2013; Winstanley, Sperotto, Putnick, Cherian, Bornstein & Gattis, 2014). We used a micro-coding approach to distinguish between responsive parenting behaviours (maintaining infant attention) and demanding parenting behaviours (introducing or redirecting infant attention) (Landry, Garner, Swank & Baldwin, 1996). Attunement beliefs were positively related to responsive parenting behaviours and negatively related to demanding parenting behaviours. Structure beliefs were weakly related to demanding parenting behaviours. These results are an important first step toward identifying relations between self-reported parenting beliefs about attunement and structure and observed parenting behaviours.
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Affiliation(s)
- Merideth Gattis
- School of Psychology, Cardiff University, Cardiff, UK,Corresponding author: Merideth Gattis School of Psychology, Cardiff University, Park Place, CardiffCF10 3AT, UK E-mail:
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Schneider-Worthington CR, Fouts A, Chandler-Laney PC, Bahorski JS. Infant temperament is associated with maternal feeding behaviors in early infancy. Appetite 2022; 168:105686. [PMID: 34500015 PMCID: PMC8671203 DOI: 10.1016/j.appet.2021.105686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 01/03/2023]
Abstract
Parental feeding practices shape infant eating behaviors and may impact obesity risk. For example, feeding on a schedule and using food to soothe have been associated with greater infant weight gain and future obesity risk. Most studies focus on parental determinants of feeding practices, but infant temperament might influence feeding practices parents select. Studies examining associations of infant temperament with parental feeding practices in early infancy are needed. Thus, the purpose of this cross-sectional, observational study was to test the hypothesis that infant temperament would be associated with use of food to soothe and feeding on a schedule. Mother-infant dyads (N = 98) from 3 parent birth cohort studies presented for clinic visits at infant age of 3-5 months. Mothers completed a demographic questionnaire. Feeding practices (use of food to soothe and feeding on a schedule) and maternal perceptions of 3 dimensions of infant temperament (surgency, orienting/regulating, and negative affect) were collected by survey. Spearman partial correlations were used to examine if any of the 3 infant temperament dimensions were associated with use of food to soothe or feeding on a schedule, adjusting for maternal marital status, race/ethnicity, BMI, infant age at the visit, and infant weight-for-length z-score. Greater perceived infant surgency/extraversion was associated with greater use of food to calm (Spearman partial r = 0.25, p < 0.05), but not feeding on a schedule (Spearman partial r = -0.11, p = 0.31). Greater perceived infant negative affect was associated with greater use of food to calm (Spearman partial r = 0.21, p < 0.05). Perceived infant orienting/regulating was not associated with either of the feeding practices examined. These results provide evidence that as early as 3-5 months of age, perceived infant temperament is associated with maternal feeding practices which influence infant growth outcomes.
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Affiliation(s)
- Camille R. Schneider-Worthington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham 1720 2nd Avenue South, Birmingham, AL 35294
| | - Amelia Fouts
- Department of Nutrition Sciences, University of Alabama at Birmingham 1720 2nd Avenue South, Birmingham, AL 35294
| | - Paula C. Chandler-Laney
- Department of Nutrition Sciences, University of Alabama at Birmingham 1720 2nd Avenue South, Birmingham, AL 35294
| | - Jessica S. Bahorski
- College of Nursing, Florida State University 98 Varsity Way, 419 Duxbury, Tallahassee, FL 32306
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Ventura AK, Silva Garcia K, Meza M, Rodriguez E, Martinez CE, Whaley SE. Promoting Responsive Bottle-Feeding Within WIC: Evaluation of a Policy, Systems, and Environmental Change Approach. J Acad Nutr Diet 2021; 122:99-109.e2. [PMID: 34090838 DOI: 10.1016/j.jand.2021.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/02/2021] [Accepted: 05/03/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Bottle-fed infants are at greater risk for overfeeding and rapid weight gain (RWG); evidence-based strategies for promoting healthy bottle-feeding practices are needed. OBJECTIVE Our aim was to assess whether policy, systems, and environmental (PSE) strategies for promoting responsive bottle-feeding practices within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were associated with lower risk for RWG. DESIGN We conducted a matched-pair cluster randomized trial. PSE strategies were implemented at 3 WIC clinics in Los Angeles County. PSE clinics were compared with 3 matched control clinics. Mothers and infants were assessed when infants were newborn and 3 months and 6 months of age. PARTICIPANTS/SETTING Participants were mothers (n = 246) who enrolled their newborn infants (younger than 60 days) into WIC between May and August 2019. MAIN OUTCOME MEASURES Infant weight was assessed and standardized to sex- and age-specific z scores. RWG was defined as weight-for-age z score change > 0.67. Mothers completed questionnaires assessing responsive and pressuring feeding styles, breast- and bottle-feeding patterns, and perceptions of WIC experiences. STATISTICAL ANALYSES PERFORMED Logistic regression with estimation via generalized estimating equations and linear mixed models with repeated measures assessed effects of PSE strategies on categorical and continuous outcomes, respectively. RESULTS Infants in PSE clinics had significantly lower likelihood of exhibiting RWG (P = .014) than infants in control clinics. Mothers in PSE and control clinics reported similar levels of responsive and pressuring feeding style and similar prevalence of breastfeeding and bottle-feeding. Mothers in PSE clinics trended toward feeling better supported with respect to their decision to bottle-feed (P = .098) and had more stable intentions to stay in the WIC program (P = .002) compared with mothers in control clinics. CONCLUSIONS PSE strategies focused on promoting more inclusive assessment of infant feeding, tailored bottle-feeding counseling, and increased education and support for responsive bottle-feeding were associated with lower risk for RWG among WIC infants.
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Affiliation(s)
- Alison K Ventura
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo.
| | - Karina Silva Garcia
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo
| | - Martha Meza
- Division of Research and Evaluation, Public Health Foundation Enterprises WIC Program, Irwindale, CA
| | - Elizabeth Rodriguez
- Division of Research and Evaluation, Public Health Foundation Enterprises WIC Program, Irwindale, CA
| | - Catherine E Martinez
- Division of Research and Evaluation, Public Health Foundation Enterprises WIC Program, Irwindale, CA
| | - Shannon E Whaley
- Division of Research and Evaluation, Public Health Foundation Enterprises WIC Program, Irwindale, CA
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