Infant responsiveness, alertness, haemoglobin and growth in rural Sidama, Ethiopia

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.

The association of early linear growth and haemoglobin concentration with later cognitive, motor, and social-emotional development at preschool age in Ghana

It is important to identify the periods during childhood when exposure to environmental risk factors results in long-term neurodevelopmental deficits. Stunting and anaemia may be sensitive indicators of exposure to such risks. In a prospective cohort enrolled before birth, we investigated the association of developmental scores at 4-6 years with (a) birth length and linear growth during three postnatal periods and (2) haemoglobin (Hb) concentration at three time points. Children were participants in a follow-up study of a randomized controlled trial of nutritional supplementation in Ghana. At 4-6 years, cognitive, motor, and social-emotional developments were assessed using standard tests adapted for this population. We estimated the associations of length-for-age z-score (LAZ) at birth and postnatal linear growth (n = 710) and Hb (n = 617) with developmental scores in regression models, using multistage least squares analysis to calculate uncorrelated residuals for postnatal growth. Cognitive development at 4-6 years was significantly associated with LAZ at birth (β = 0.12, 95% CI = 0.05, 0.19), ΔLAZ from 6 to 18 months (β = 0.16, 95% CI = 0.04, 0.28), and Hb at 18 months (β = 0.13, 95% CI = 0.06, 0.20), but not with ΔLAZ during 0-6 months, ΔLAZ from 18 months to 4-6 years, Hb at 6 months, or Hb at 4-6 years. No evidence of associations with motor or social-emotional development were found. These results suggest that in similar contexts, the earlier periods prior to birth and up to 18 months are more sensitive to risk factors for long-term cognitive development associated with LAZ and Hb compared with later childhood. This may inform the optimal timing of interventions targeting improved cognitive development.

Adaptation of the Infant Behavior Questionnaire-Revised for use in Ethiopia: Expanding cross-cultural investigation of temperament development

Cross-cultural differences in temperament were evaluated for Ethiopian (N=109) and U.S. (N=109) samples of infants. We anticipated that the Sidama version of the Infant Behavior Questionnaire-Revised (IBQ-R; Gartstein & Rothbart, 2003) developed for use in Ethiopia would demonstrate satisfactory psychometric properties, and hypothesized significant cross-cultural differences in levels of fine-grained temperament characteristics. Interactions between culture, infant age, and sex were also considered. Internal consistency was satisfactory for 13 of the 14 IBQ-R scales (with a somewhat low estimate observed for Duration of Orienting), and an examination of the structure indicated patterns similar to those observed in the US, and elsewhere. Differences between Ethiopia and the US were noted for Activity Level, Distress to Limitations, Fear, Smiling/Laughter, Falling Reactivity, Cuddliness/Affiliation, Sadness, Approach, and Vocal Reactivity. Parents of infants in the US reported higher levels of attributes associated with Surgency/Positive Affectivity (Activity, Smiling/Laughter, Approach Vocal Reactivity), whereas Ethiopian infants' scores were higher for Distress to Limitations and Fear, linked with the over-arching temperament factor of Negative Emotionality; however, US infants received higher ratings on Sadness, also associated with this factor. Higher Falling Reactivity, a regulation-related attribute, was reported for Ethiopian infants, with US babies receiving higher Cuddliness/Affiliation scores. Significant culture*age interactions were observed for Activity and Fear, along with a significant culture*age*sex interaction for Distress to Limitations.