Infant Feeding Style Research Articles

Infant and young child feeding practices as mediators in the relationship between early temperament and children's eating behaviors: A longitudinal study during COVID-19 pandemic

Simultaneously investigating the influence of multiple early temperament dimensions on children's eating behaviors through infant and young child feeding practices may be essential for developing optimal intervention strategies. This longitudinal study gathered data at two assessment points: Time 1, evaluation of infant and young child feeding practices and children's temperament when they were between 6 and 12 months, and Time 2, assessment of children's eating behaviors at age 2. This study included sociodemographic characteristics, the Child Eating Behavior Questionnaire for Toddlers (CEBQ-T), the short form of Children Behavior Questionnaire (Revised IBQ-RSF), and the Infant Feeding Style Questionnaire (IFSQ) in eastern China. Structural equation modeling (SEM) was utilized to examine the pathways from three dimensions of early temperament to five types of children's eating behaviors mediated by three styles of infant and young child feeding practices. A total of 972 children, children's mean age was 14.58 ± 5.11 months, 464 (47.74%) being girls, while the mothers' mean age was 30.23 ± 3.56 years. Effortful control exhibited significant effects on food responsiveness and satiety responsiveness mediated by responsive feeding. Additionally, effortful control influenced enjoyment of food and satiety responsiveness mediated by restrictive feeding. Surgency had a significant effect on food responsiveness mediated by indulgent feeding. Negative affectivity impacted satiety responsiveness, enjoyment of food, and food responsiveness mediated by responsive feeding. This longitudinal study delineates the pathways from early temperament to eating behaviors mediated by infant and young child feeding practices among children aged 6–23 months. These findings highlight the need to prioritize intervention programs aimed at nurturing early temperament through appropriate infant and young child feeding practices to promote healthy eating behaviors for upper- and middle-income countries (UMICs) with similar contexts.

Child and Maternal Factors Associated with Feeding Practices in Children with Poor Growth.

The development of adequate growth and healthy eating behaviors depends on nutritious food and responsive feeding practices. Our study examined (1) the relationship between maternal concern about child weight or perceived feeding difficulties and their feeding practices, and (2) the moderating role of child temperament and maternal mental health on their feeding practices. A cross-sessional study included mother-child dyads (n = 98) from a tertiary growth and feeding clinic. Children had a mean age of 12.7 ± 5.0 months and a mean weight-for-age z-score of -2.0 ± 1.3. Responsive and controlling feeding practices were measured with the Infant Feeding Styles Questionnaire. Spearman correlation and moderation analysis were performed. Maternal concern about child weight and perceived feeding difficulties were negatively correlated with responsive feeding (r = -0.40, -0.48, p < 0.001). A greater concern about child weight or perceived feeding difficulties was associated with greater use of pressure feeding practices when effortful control was low (B = 0.49, t = 2.47, p = 0.01; B = -0.27, p = 0.008). Maternal anxiety had a significant moderation effect on the relationship between feeding difficulty and pressure feeding (B = -0.04, p = 0.009). Higher maternal concern about child weight and perceived feeding difficulties were associated with less responsive satiety feeding beliefs and behaviors. Both child effortful control and maternal anxiety influenced the relationship between weight and feeding concerns and the use of pressure feeding practices.

Sequential mediation of early temperament and eating behaviors in the pathways from feeding practices to childhood overweight and obesity.

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. 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. 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. 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.

Mental Health and Feeding Styles in Parents of Formula-Fed Infants.

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.

Confirmatory factor analysis of the infant feeding styles questionnaire in infant and toddler child care teachers

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.

Sleep SAAF responsive parenting intervention improves mothers’ feeding practices: a randomized controlled trial among African American mother-infant dyads

Background/ObjectiveParents 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.MethodsPrimiparous 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).ResultsRP 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.ConclusionsResponsive 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 registrationSleep SAAF: A Strong African American Families Study. www.clinicaltrials.gov NCT03505203. Registered 3 April 2018.

The Longitudinal Relation between Infant Feeding Styles and Growth Trajectories among Families from Low-Income Households

BackgroundParental feeding styles, including the emotional environment parents create to modify a child’s eating behaviors, have been associated with measures of adiposity in cross-sectional studies. The longitudinal relation between parental feeding styles in early infancy and adiposity in later infancy/toddlerhood are scant and have shown mixed results, particularly in families from low-income households. ObjectivesThis study examined the relation between parental feeding styles and infant BMI z-score trajectories between 6 and 18 mo in families from low-income households. MethodsParent–infant dyads were recruited during the infant’s 6-, 9-, or 12-mo well-child visit. Feeding styles were assessed using the Infant Feeding Style Questionnaire (IFSQ). Infant anthropometrics from birth through 18 mo were extracted from the electronic medical record. BMI z-score slopes were estimated for each infant between 0-6 mo and 6–18 mo. Associations between feeding styles and BMI z-score slopes were examined using mixed models controlling for demographic, clinical, and feeding covariates. ResultsThe final analytic sample included 198 dyads (69% Black; median infant age: 9.0 mo; IQR: 6.8–10.3 mo). The predominant parent feeding styles included the following: laissez-faire (30%), restrictive (28%), responsive (23%), and pressuring (19%). In adjusted models, the predominant feeding style at enrollment was associated with the BMI z-score slope between 6 and 18 mo, with the responsive feeding style exhibiting a steeper increase in BMI z-score than other feeding styles. Infant feeding style was not associated with BMI z-score slope between birth and 6 mo of age. Infants of parents who exhibited restrictive feeding styles were more likely to have a BMI ≥85th percentile at their last measurement. ConclusionsThe predominant parent feeding style during infancy in a low-income population was associated with infant BMI z-score between 6 and 18 mo of age, but not earlier. Further studies are needed to better understand how predictive factors collectively contribute to BMI increase in the first 2 y.

Factors associated with infant feeding styles in the Federal District, Brazil

Responsive feeding is currently the recommended feeding style, in which the key principle is reciprocity between the child and the caregiver. The lack of reciprocity characterizes non-responsive feeding styles, which are associated with unhealthy eating behaviors, losses in the regulation of hunger and satiety, and childhood obesity. To assess factors associated with feeding styles between infants aged 6–12 months old, a cross-sectional study with 474 pairs of mothers and infants from 6 to 12 months old was conducted in Public Health Units in the Federal District, Brazil. The questionnaire applied to mothers evaluated four feeding styles from nine subconstructs (Infant Feeding Style Questionnaire), breastfeeding, bottle use, maternal depression and anxiety, household food insecurity (HFI), and prematurity. Multiple linear regression analysis was performed using the automated backward method. Bottle use was positively associated with feeding styles Laissez-faire (Attention) (β:0.56), Pressuring (Cereal) (β:0.58) and Restrictive (Quantity) (β:0.26). Breastfeeding was negatively associated with Laissez-faire (Attention) (β:-0.29) and Pressuring (Cereal) (β:-0.50). Higher maternal education was negatively associated with Pressuring (Cereal) (β:-0.34) and Pressuring (Soothing) (β:-0.36). HFI is positively associated with Restrictive (Quantity) (β:0.25), and Prematurity is negatively associated with Laissez-faire (Attention) (β:-0.33). An important positive association was found between non-responsive styles and both bottle use and HFI, while breastfeeding and higher maternal education exhibited a negative association. Therefore, feeding styles and their associated factors should be considered in the design of interventions that promote a healthy diet for infants.

Infant Feeding Varies Across Eating Behavior and Feeding Modalities in Mothers With Low Income

ObjectiveTo examine if eating behaviors in mothers with low income relate to attitudes toward infant feeding and whether associations differed between breastfeeding and formula-feeding mothers. DesignCross-sectional study. ParticipantsForty postpartum women (aged ≥ 18 years, body mass index ≥ 25 and < 40 kg/m2) in the Louisiana Women, Infants, and Children program participated in a telehealth postpartum intervention for health and weight loss. Main Outcome Measure(s)Maternal eating behaviors and infant feeding styles, assessed 6–8 weeks after birth (baseline) using validated questionnaires. AnalysisSignificance was detected using independent t tests, chi-square tests for independence, or linear models (P < 0.05). ResultsMost mothers formula-fed (n = 27, 68%). In formula-feeding mothers, maternal disinhibition and perceived hunger were positively associated with restrictive infant feeding (β = 0.41, P <0.001 and β = 0.41, P = 0.001, respectively). These relationships were significantly higher (Δ = −0.85, P = 0.006 and Δ = −0.59, P = 0.003, respectively) than among breastfeeding mothers. Comparatively, pressuring/overfeeding was lower in formula-feeding mothers than among breastfeeding mothers with dietary restraint (Δ slopes: 1.06, P = 0.02). Conclusions and ImplicationsIn this cohort of mothers with low income, maternal eating behavior was associated with infant feeding styles only when feeding modality was considered. Mothers may benefit from education on how their eating behaviors can influence their infants and children.

Infant appetite and weight gain in early infancy: Moderating effects of controlling feeding styles

Excessive infant weight gain is a strong predictor of later obesity. While controlling feeding has been linked to negative weight outcomes, research has not considered associations between infant appetite and maternal feeding simultaneously in relation to infant weight. This longitudinal study examined infant food responsiveness and slowness in eating as predictors of infant weight outcomes and tested controlling feeding styles (restrictive and pressuring) as moderators. Data came from a diverse sample of mothers and their infants participating in an ongoing longitudinal study. Mothers (n = 159) reported infant appetite and feeding styles at 2 postnatal timepoints (2-month visits and 6-month visits). The infant weight outcomes included change in weight-for-age z-scores (WAZ-change) and rapid weight gain (RIWG; WAZ-change ≥ 0.67 SD) from birth to the second postnatal visit. Data were analyzed using hierarchical multiple and logistic regressions, controlling for birthweight, gestational age, maternal race/ethnicity, feeding mode, and residing with an intimate partner. Over 25% of infants exhibited RIWG. Greater infant food responsiveness predicted both greater infant weight gain and RIWG status. Infant food responsiveness and slowness in eating interacted with controlling feeding styles in a unique way. Infants with higher food responsiveness whose mothers were less restrictive had greater weight gain (b = 0.61, p < 0.001) and increased probability of RIWG (b = 2.71, p < 0.01) than infants with more restrictive mothers. Higher slowness in eating was associated with a lower RIWG probability among infants of mothers with lower pressuring feeding (b = −1.86, p < 0.05). For infants with a large appetite, some level of restrictive feeding may be beneficial for preventing excessive weight gain while pressuring may exacerbate the positive association between faster eating and RIWG.

RAISE (Raising Infants to Be Smart Eaters) Pilot Study.

Background: Many of the complex determinants of obesity originate during infancy when small changes in the environment can permanently influence appetite, behavior, and energy metabolism. Parent feeding style ("how" rather than "what" to feed) has emerged as a potentially important factor in early obesity prevention. Objectives: (1) To assess the feasibility of conducting a brief responsive feeding education intervention by public health nurses during routine well-baby visits. (2) To assess whether this intervention affects parents' attitudes and behavior related to responsive feeding. Methods: Prospective, nonrandomized, comparative pilot study conducted in two communities. Intervention participants were exposed to enhanced responsive feeding education by public health nurses at routine well-baby visits from 0 to 18 months along with wall posters, handouts, automated text messages and tangible takeaways. Parent knowledge and behavior were measured using the Infant Feeding Style Questionnaire and the Toddler Development Index. Feasibility and acceptability were assessed by patients and nurses through open text feedback forms and mid-point and exit interviews. Results: Recruitment (18 intervention; 9 control) and retention fell below targets. Average adherence to protocol by nurses from 0 to 12 months was 89%. Delivery of the intervention was feasible and acceptable, but the additional research-related tasks were challenging in a busy clinical setting. Parents found the different formats and information new and helpful. There was a trend toward less nonresponsive (pressuring, restrictive, laissez-faire) feeding practices in the intervention group. Conclusions: This pilot study demonstrated encouraging results related to overall feasibility and effect on parent feeding style.

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.

Infant feeding in diverse families; the impact of ethnicity and migration on feeding practices

ObjectiveTo investigate differences in infant feeding practices and styles by maternal migration status. DesignProspective cohort study. SettingMaternity unit of a large hospital in Northern England ParticipantsWomen recruited to the Born in Bradford longitudinal cohort study MeasurementsBreastfeeding initiation; breastfeeding at six months; breastfeeding at twelve months; timing of introduction of complementary feeding; maternal feeding style at twelve months. FindingsMigrant women were more likely to initiate breastfeeding and continue breastfeeding for longer compared to native women. Native women also introduced complementary feeding earlier than migrant women. There was evidence of feeding practices among second= generation migrants becoming increasingly more aligned with those of native women, with lower breastfeeding rates and earlier introduction of complementary feeding compared to first-generation migrants. Migrant women were more likely to adopt a ‘Demanding’ feeding style, with the strongest associations seen in first-generation migrants. Key conclusionsMigration status is an important factor to consider in reference to infant feeding practices. This is particularly important in considering intergenerational changes in families with migration backgrounds and the potential of culture to impact on family practices. Implications for practiceInterventions to maintain cultural norms around infant feeding in families with migration backgrounds would be beneficial, due to the observed higher rates of breastfeeding in first-generation migrants. Targeted interventions to improve breastfeeding in white British native women should consider the role that culture can play in encouraging positive health behaviours.

Sex Differences in Maternal Restrictive Feeding Practices in the Intervention Nurses Start Infants Growing on Healthy Trajectories Study.

Intervention Nurses Start Infants Growing on Healthy Trajectories tested an early life responsive parenting (RP) intervention designed for obesity prevention. Body mass index z-score at age 3 years was lower for the RP group versus controls with a larger effect for girls than boys. We sought to determine if child sex was associated with differing maternal feeding practices and whether sex moderated intervention effects on feeding. Mothers (N=279) completed the Infant Feeding Styles Questionnaire (IFSQ) at 28 weeks, the Structure and Control in Parent Feeding (SCPF) at 1, 2, and 3 years, and the Child Feeding Questionnaire (CFQ) at 3 years. Study aims were tested using 2-way analysis of variance and repeated measures. Mothers reported greater restriction (limiting food quantity) for boys at 28 weeks (IFSQ: 3.0 ± 1.1 vs 2.8 ± 1.0, P=.07) and across annual measurements from age 1 to 3 years (SCPF: P=.04). At age 3, the intervention group effect on restriction differed by sex (CFQ: P = .047) such that higher restriction was reported by RP group mothers of boys versus girls (3.4 ± 0.7 vs 3.0 ± 0.9, P=.002) with no control group sex difference (3.4 ± 0.8 vs 3.3 ± 0.9, P=.79). There were no sex differences or sex by intervention group interactions in other reported feeding practices at any assessment (ie, structure-based feeding, pressure). Mothers of boys used more restrictive feeding through age 3. These findings may be partially explained by previously reported better self-soothing and self-regulation abilities of participating girls.

Maternal Eating Behavior in Low-Income Mothers Influences Attitudes Toward Infant Feeding

ObjectivesEating behavior is established early in life, influences infant development and health, and is likely to originate with the mother. We examined if maternal eating behaviors influenced attitudes towards infant feeding styles and whether these associations differed by infant feeding mode (breastfeeding and formula-feeding). MethodsThis was an observational study in 35 low-income mother-infant dyads. Postpartum women (≥18 years old, 25 ≤ BMI < 40 kg/m2) in the Louisiana Women, Infants, and Children (WIC) program completed the Eating Inventory and Infant Feeding Styles Questionnaire to assess maternal eating behavior (dietary restraint, disinhibition, and perceived hunger) and infant feeding styles (restrictive feeding, responsive feeding, and pressuring/overfeeding), respectively, 8 weeks after delivery. Linear models with fixed effects were computed with maternal age, BMI, and maternal eating behavior as covariates using SPSS (p < 0.05 to indicate significance). ResultsThirty-four % of the mothers were breastfeeding (n = 12) and 66.0% were formula-feeding (n = 23). Infant feeding styles were not predicted by maternal eating behaviors (all p > 0.05). In mothers who breastfed, maternal dietary restraint was positively associated with infant pressuring/overfeeding (β = 0.91, p < 0.05) and was different from those in the formula fed group (Δ = 1.37, p = 0.02). In addition, maternal disinhibition was negatively associated with restrictive infant feeding (β = –0.53, p < 0.05) and was different from those in the formula fed group (Δ = –0.95, p = 0.003). Comparatively, in mothers who formula-fed, restrictive infant feeding was predicted by maternal disinhibition (β = 0.42, p < 0.01; Δ = –0.95, p = 0.003) and maternal perceived hunger (β = 0.43, p < 0.01; Δ = 0.71, p = 0.007). ConclusionsMaternal eating behavior is associated with infant feeding styles only when feeding mode is considered. Interventions educating mothers on how their own eating behaviors have the potential to influence eating behaviors of their children are needed. Funding SourcesUSDA Small Grants Program and the NIH (T32DK064584, and U54 GM104940).

Maternal Feeding Styles of Young Infants: Associations With Race and Feeding Mode

ObjectivesFeeding styles, defined as parental attitudes and practices related to feeding, have been examined in early childhood in relation to risk of developing overweight/obesity. However, less is known about feeding styles in the first few months of life. The current study examined whether early feeding styles differ by feeding mode and race in a community sample of mothers/infant dyads participating in the Infant Growth and Development Study (iGrow). MethodsData was collected from 148 mother/infant dyads participating in iGROW. Maternal characteristics were assessed during the third trimester of pregnancy and feeding styles and feeding mode were assessed when infants were between 2–4 months. Scores across 5 feeding styles were estimated using the Infant Feeding Style Questionnaire (IFSQ): pressuring/controlling, restrictive, indulgent, responsive, and laissez-faire. Differences in feeding style by race and feeding mode were examined using analysis of variance, controlling for socioeconomic and demographic variables. ResultsMothers identified as non-Hispanic white (n = 73), black (n = 50), or multiracial/other (n = 25) and 46.6% reported exclusive breastfeeding. After controlling for covariates (maternal demographic and socioeconomic factors), indulgent feeding was significantly higher among black mothers compared to other mothers (F (1,126) = 2.98, p = .05, partial n2 = 1.44). Significant differences in restrictive feeding scores were identified by feeding mode (F (1,126) = 6.22, p = .01, partial n2 = 2.21), with exclusively breastfeeding mothers scoring lower than mothers who used formula/mixed feeding. ConclusionsDifferences in feeding styles are apparent in the first months of life. Future research is needed to understand factors that contribute to the development of early feeding styles. Funding SourcesEunice Kennedy Shriver National Institute of Child Health & Human Development.

Maternal characteristics influence infant feeding styles in Caribbean women.

To examine associations between maternal characteristics and feeding styles in Caribbean mothers. Participants were mother-child pairs enrolled in a cluster randomised trial of a parenting intervention in three Caribbean islands. Maternal characteristics were obtained by questionnaires when infants were 6-8 weeks old. Items adapted from the Toddler Feeding Behaviour Questionnaire were used to assess infant feeding styles at the age of 1 year. Feeding styles were identified using factor analysis and associations with maternal characteristics assessed using multilevel linear regression. Health clinics in St. Lucia (n 9), Antigua (n 10) and Jamaica (n 20). A total of 405 mother-child pairs from the larger trial. Maternal depressive symptoms were associated with uninvolved (β = 0·38, 95 % CI (0·14, 0·62)), restrictive (β = 0·44, 95 % CI (0·19, 0·69)) and forceful (β = 0·31, 95 % CI (0·06, 0·57)) feeding and inversely associated with responsive feeding (β = -0·30, 95 % CI (-0·56, -0·05)). Maternal vocabulary was inversely associated with uninvolved (β = -0·31, 95 % CI (-0·57, -0·06)), restrictive (β = -0·30, 95 % CI (-0·56, -0·04)), indulgent (β = -0·47, 95 % CI (-0·73, -0·21)) and forceful (β = -0·54, 95 % CI (-0·81, -0·28)) feeding. Indulgent feeding was negatively associated with socio-economic status (β = -0·27, 95 % CI (-0·53, -0·00)) and was lower among mothers ≥35 years (β = -0·32, 95 % CI (-0·62, -0·02)). Breast-feeding at 1 year was associated with forceful feeding (β = 0·41, 95 % CI (0·21, 0·61)). No significant associations were found between maternal education, BMI, occupation and feeding styles. Services to identify and assist mothers with depressive symptoms may benefit infant feeding style. Interventions to promote responsive feeding may be important for less educated, younger and socio-economically disadvantaged mothers.

Feeding style profiles are associated with maternal and infant characteristics and infant feeding practices and weight outcomes in African American mothers and infants

Much literature links individual feeding styles to infant feeding practices and growth; however, parents’ feeding styles are not discrete and may vary by context. We use latent profile analysis (LPA) as a person-centered approach to categorize infant feeding style patterns, test factors predicting profile membership, and examine if profiles are associated with infant feeding and weight. Additionally, we test the impact of a responsive feeding intervention on profile membership and stability. Data come from 270 African-American women and infants participating in the Mothers and Others Study, an early life obesity prevention intervention. LPA was used to categorize mothers across five constructs (laissez-faire, pressuring, restrictive, responsive and indulgent) measured at 28-weeks gestation and 3- and 15-months postpartum. Adjusted multinomial regression and regression models test the characteristics associated with profile membership and the associations between profile membership and breastfeeding and infant weight-for-age z-score (WAZ). We identified two groups (Positive and Less Responsive) prenatally, an additional group (High Controlling) at 3 months and a fourth group (High Indulgent) at 15 months. Several characteristics differed between the groups, including maternal age, income and depressive symptoms, infant sex and temperament, and treatment group. Mothers in the Positive group were more likely to breastfeed at 3 months. Infants with mothers in the High Controlling group had higher WAZ at 15 months. The intervention was associated with more Positive feeding practices at 15 months and a greater likelihood of remaining in the Positive group across the study. LPA identified profiles that are associated with maternal and infant characteristics and treatment group and with better feeding practices and growth outcomes, providing preliminary evidence that early intervention promoting more responsive feeding profiles may improve infant outcomes.

Grow well/Crecer bien: a protocol for research on infant feeding practices in low-income families

BackgroundThe prevalence of obesity among children remains high. Given obesity’s significant lifelong consequences, there is great interest in preventing obesity early in life. There is a need to better understand the relation of common infant feeding styles and practices to obesity in infants using longitudinal study designs. There is also an urgent need to understand the role of caregivers other than mothers in feeding. A better understanding of variation in feeding styles and practices can inform the identification of risk groups and the tailoring of interventions to them.MethodsIn partnership with Early Head Start programs across four counties in southern California, mothers and infants will be enrolled in a two-year longitudinal study collecting survey and anthropometric data. A subsample of mothers and their selected other caregivers will participate in qualitative research involving feeding diaries and dyadic interviews. The results will be used to develop and test an enhanced nutrition education program.DiscussionWe outline a study methodology to examine feeding styles and practices and their association with early childhood obesity risk and enhance an existing intervention to promote healthy infant feeding and growth among children in low-income families.

Associations between maternal and paternal feeding styles of infants in a racially diverse US birth cohort.

Maternal feeding style has been associated with childhood obesity and has been the target of numerous interventions, but few studies included fathers. We assessed correlations and associations between maternal and paternal feeding style. We examined 202 mothers, fathers, and infants in Nurture, a racially diverse US cohort (2013-2017). Mothers and fathers completed the Infant Feeding Style Questionnaire when infants were 6 and 12 months. We examined unadjusted correlations using Spearman's Rho and adjusted associations using linear regressions. All feeding styles were significantly correlated. After adjustment, maternal feeding style was associated with paternal feeding style at 6 and 12 months for responsive (ß 0.31; CI 0.18, 0.45; P ≤ 0.0001 and ß 0.67; CI 0.50, 0.84; P ≤ 0.0001), restrictive (ß 0.24; CI 0.09, 0.38; P = 0.001 and ß 0.44; CI 0.29, 0.59; P ≤ 0.0001), pressuring (ß 0.46; CI 0.34, 0.58; P ≤ 0.0001 and ß 0.51; CI 0.38, 065; P ≤ 0.0001), indulgent (ß 0.36; CI 0.20, 0.52; P ≤ 0.0001 and ß 0.57; CI 0.40, 0.73; P ≤ 0.0001), and laissez-faire (ß 0.39; CI 0.24, 0.55; P ≤ 0.0001 and ß 0.55; CI 0.37, 0.72; P ≤ 0.0001). Maternal and paternal feeding styles were correlated. Associations held after adjustment, suggesting that mothers and fathers are in relative agreement in their reporting.