Reducing childhood obesity: opportunities to influence transitional infant feeding

Abstract

Background Obesity is a global issue with its origins deep in the early years of life and tracking throughout the lifecycle. The challenges of changing established behaviour and the limited impact of childhood obesity interventions support the current preventative investment in addressing obesogenic factors within the first years of life. While existing early childhood obesity prevention interventions are grounded in responding to infant’s cues of hunger and satiety, they fail to fully appreciate the context in which feeding behaviours develop. A better understanding of the factors that govern family life and maternal food provisioning would strengthen efforts to support a healthy eating environment. Research design A three phase sequential mixed methods approach was used to investigate the determinants of maternal infant feeding in transitioning from milk feeds to family foods and their relationship to infant dietary intake and weight. Phase 1 comprised of in-depth interviews with key Australian and New Zealand researchers involved in early prevention of obesity in childhood (n=5) to provide information about infant feeding influences, support strategies and knowledge gaps to inform subsequent research phases. Phase 2 surveyed 290 mothers of infants aged between 5 and 13 months about infant feeding and growth. A subset of phase 2 mothers (n=15) were interviewed in phase 3 to validate the survey results and understand the dynamics behind infant feeding decisions. The ecological framework, the new health paradigm and the ideology of motherhood guided this research. Results Support during the transitional infant feeding period was found to be inadequate. Mothers were unsure of what to feed their infants, reflected in a lack of iron-rich first foods in over half the sample; and insufficient fruit and vegetable intake, regular intake of high energy takeaway foods and sweetened drinks identified in some infants’ diets. Mothers struggled to identify the best approach to transitioning from milk feeds to family foods with decisions built on ensuring adequate infant intake, growth and sleep. Mothers did not know what normal infant behavior or feeding cues were, with interpretation influenced by professional and lay expectations alongside what is thought to be “good mothering”. Mothers were found to misinterpreted normal infant weight, overstating underweight and not recognising overweight. Maternal concern for infant becoming underweight resulted in the early introduction of solids, pressure-to-eat and formula top-ups, specifically in mothers dissatisfied with infant intake or weight. Satisfying infants’ immediate needs were prioritised over recommendations, with concern for underweight influencing feeding practices early and concern for overweight only translating to monitoring of infant intake. Maternal infant feeding guideline knowledge had limited impact on infant feeding whereas maternal self-efficacy was associated with improved infant fruit and vegetable intake, responsive parenting style and less controlling feeding practices. The relationship between feeding and maternity identity was profound and needs to be considered by health practitioners in their approach to supporting new families. Mothers felt judged about their infant feeding decisions which impacted on their engagement with professional services. Many mothers used website platforms and virtual mothers groups for information and support. Conclusion An appreciation of all the factors upon which infant feeding is built will provide researchers and practitioners with the essential ingredients to support healthy family eating environments. The results in this study support early strategies which nurture the knowledge and skills of mothers around healthy infant food intake and responsive feeding based on the infant feeding cues of hunger and satiety, and not their temperament or weight. Health practitioners need to factor in the emotional decision making influences faced by mothers when providing support in this feeding window. Further research into the delivery of this support using of both traditional and newer modalities of communication is recommended.