Infant Hunger Research Articles

The milk study protocol: A longitudinal, prospective cohort study of the relationship between human milk metabolic hormone concentration, maternal body composition, and early growth and satiety development in Samoan infants aged 1-4 months.

Current research suggests that energy transfer through human milk influences infant nutritional development and initiates metabolic programming, influencing eating patterns into adulthood. To date, this research has predominantly been conducted among women in high income settings and/or among undernourished women. We will investigate the relationship between maternal body composition, metabolic hormones in human milk, and infant satiety to explore mechanisms of developmental satiety programming and implications for early infant growth and body composition in Samoans; a population at high risk and prevalence for overweight and obesity. Our aims are (1) to examine how maternal body composition influences metabolic hormone transfer from mother to infant through human milk, and (2) to examine the influences of maternal metabolic hormone transfer and infant feeding patterns on early infant growth and satiety. We will examine temporal changes in hormone transfers to infants through human milk in a prospective longitudinal cohort of n = 80 Samoan mother-infant dyads. Data will be collected at three time points (1, 3, & 4 months postpartum). At each study visit we will collect human milk and fingerpick blood samples from breastfeeding mother-infant dyads to measure the hormones leptin, ghrelin, and adiponectin. Additionally, we will obtain body composition measurements from the dyad, observe breastfeeding behavior, conduct semi-structured interviews, and use questionnaires to document infant hunger and feeding cues and satiety responsiveness. Descriptive statistics, univariate and multivariate analyses will be conducted to address each aim. This research is designed to advance our understanding of variation in the developmental programming of satiety and implications for early infant growth and body composition. The use of a prospective longitudinal cohort alongside data collection that utilizes a mixed methods approach will allow us to capture a more accurate representation on both biological and cultural variables at play in a population at high risk of overweight and obesity.

Co-Design of a Reusable Learning Object (RLO) to Address Caregiver Responsive Infant Feeding Behaviours (CRIB) to Prevent Childhood Obesity: A Mixed-Method Protocol.

Responsive infant feeding is a key strategy for childhood obesity prevention. Responsive feeding involves caregivers responding to infant hunger and satiety cues in a timely and developmentally appropriate manner. There is a dearth of evidence-based information and guidance for caregivers on how to responsively feed their infants. The aim of this research is to co-design a Reusable Learning Object (RLO) and guidance infographic to improve caregiver awareness, understanding and use of responsive infant feeding behaviours. The Capability, Opportunity, Motivation and Behaviour (COM-B) model of behaviour change and the Aim, Storyboarding, Populate specification, Implement media, Review and release prototype, and Evaluate (ASPIRE) approach for digital intervention co-design will be utilised. Four co-design workshops with caregivers of infants and healthcare professionals (HCPs) will determine priority RLO content. Content analysis will enable RLO development and process reporting. Formative and summative surveys will be conducted to evaluate the usability of the RLO, its impact on caregivers and its potential implementation into NHS care pathways. The output will be a RLO on responsive feeding for caregivers and an infographic for HCPs/support workers which will contribute to a future obesity prevention intervention. The findings will be disseminated to stakeholders and submitted for publication in a peer-reviewed journal.

Non-Nutritive Suck Assessment Tool Development to Characterize Sucking Patterns in Infant with Various Hunger Levels

Sucking abilities are critical in early infant development, and the patterns of non-nutritive suck (NNS) have been found to potentially predict neurodevelopmental issues in the future. Proper NNS assessments are essential to ensure valid conclusions. Previous studies have shown that the level of infant arousal significantly affects NNS patterns. However, the author did not find any studies that observed the influence of infant hunger levels on NNS patterns. Therefore, this study aimed to develop an NNS assessment tool to characterize NNS patterns in infants with various hunger levels. The NNS assessment was conducted using a pressure transducer connected to a pacifier. The results showed that the level of hunger significantly affected the intra-burst frequency and the sucking pressure. The more hungry the infant, the more frequent the intra-burst frequency became, while the sucking pressure tended to decrease. The intra-burst frequency of infant sucking was 2.3, 2.46, and 2.5 Hz on average for a relative hunger index of 0.67, 0.83, and 1.0, respectively. The NNS pressure of infant sucking was 6.31, 4.51, and 2.62 kPa on average for a relative hunger index of 0.67, 0.83, and 1.0, respectively. This study's results suggest that during NNS assessments, the measurement time should consider the next feeding schedule for the infant.

Increasing Maternal Anxiety in the Pre- to Postpartum Transition Predicts Infant Feeding Practices and Beliefs

ObjectiveAnxiety symptoms increase for some mothers in the perinatal period. Little is known about how increasing anxiety relates to infant feeding beliefs or weight-for-length. We examined relationships between clinically meaningful increases in maternal anxiety symptoms and perceptions of infant feeding behaviors and weight-for-length. MethodsParticipants were 237 mothers with singleton pregnancies enrolled from obstetric care between 2015 and 2020 who completed the Infant Feeding Questionnaire (IFQ) at 6 months. Anxiety symptoms were measured during pregnancy (M = 24.6 weeks, SD = 6.3) and 6 weeks postpartum using the PROMIS-6A. Linear regression was used to test associations of prenatal, postpartum, or clinically meaningful increases in anxiety symptoms (ie, 3T-score increase) with two outcomes: IFQ (seven factors) and infant weight-for-length at age 6 months. ResultsPrenatal symptoms were unrelated to IFQ factors. Postpartum symptoms predicted IFQ factors related to worry, such as concern for infant undereating/becoming underweight (B = 0.012, P = .02). Increasing symptoms predicted worry-related concerns as well as concern for infant hunger (B = 0.60, P ≤ .01) and greater preference for feeding on a schedule (B = 0.65, P ≤ .01). In a model including both increasing symptoms and postpartum symptoms, increasing anxiety symptoms drove associations with IFQ factors (eg, preference for feeding on a schedule, (B = 0.81, P = .01). Anxiety was unrelated to infant weight-for-length at 6 months. ConclusionsClinically meaningful increases in anxiety symptoms were associated with feeding beliefs related to worry. Increasing anxiety was a better predictor of feeding beliefs than the presence of pre- or postpartum symptoms alone. Mothers with increasing anxiety may benefit from support establishing health-promoting infant feeding practices.

Sleep SAAF Responsive Parenting Intervention for Black Mothers Impacts Response to Infant Crying: A Randomized Clinical Trial

ObjectiveMany 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. MethodsPrimiparous 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. ResultsRP 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. ConclusionsAn RP intervention positively impacted first-time Black mothers’ responses to infant crying.

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

BackgroundMothers’ 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.MethodsA 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.ResultsWe 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.ConclusionEBF 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.

Development of an Individualized Responsive Feeding Intervention-Learning Early Infant Feeding Cues: Protocol for a Nonrandomized Study.

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. 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. 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. 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. 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. DERR1-10.2196/44329.

Exploratory study on factors influencing the introduction of complementary feeding amongst caregivers of children between 6 and 24 months of age in Polokwane, Limpopo province.

Complementary feeding should be introduced at six months to meet infants' growing nutritional needs. Inappropriate complementary feeding poses threats to the health, development and survival of infants. The Convention on the Rights of the Child states that every child has the right to good nutrition. Caregivers should ensure that infants are fed properly. Factors such as knowledge, affordability and availability impact complementary feeding. Hence, this study explores factors influencing complementary feeding amongst caregivers of children between the age of six and 24 months in Polokwane, Limpopo province, South Africa. A qualitative phenomenological exploratory study design was used to collect data from 25 caregivers, using purposive sampling; the sampling size was dependent on data saturation. Data were collected through one-on-one interviews using voice recorders and field notes for non-verbal cues. Data were analysed using the eight steps of Tesch's inductive, descriptive and open coding technique. Participants had knowledge about when and what to introduce during complementary feeding. Participants alluded that availability and affordability, maternal beliefs about infant hunger cues, social media, attitudes, returning to work because of the end of maternity leave and painful breasts affect complementary feeding. Caregivers introduce early complementary feeding because of returning to work at the end of maternity leave and painful breasts. Additionally, factors such as knowledge about complementary feeding, availability and affordability, mother's beliefs about child hunger cues, social media and attitudes influence complementary feeding.Contribution:There is a need to establish credible social media platforms to disseminate appropriate complementary feeding messages. The established credible social media platforms must be promoted, and caregivers must be referred from time to time.

Evaluation of an Evidence-Based Prenatal Breastfeeding Education Curriculum Adapted for the COVID-19 Pandemic: Ready, Set, Baby Live COVID-19 Edition.

In response to the cessation of in-person prenatal education services during the COVID-19 pandemic, we adapted an evidence-based curriculum to a live virtual format entitled Ready, Set, Baby Live COVID-19 Edition (RSB Live). In a sample of 146 pregnant people, participation in RSB Live was associated with high levels of knowledge about the benefits of breastfeeding, early infant hunger cues, and recommended maternity care practices, as well as high levels of satisfaction with adaptations to the session's content and virtual delivery. Participation was also associated with a significant increase in prenatal breastfeeding intention, a known predictor of breastfeeding outcomes. This study supports live, virtual education with a standardized curriculum as an effective and acceptable means of providing prenatal education.

Postpartum Depressive Symptoms and Their Selected Psychological Predictors in Breast-, Mixed and Formula-Feeding Mothers.

BackgroundAlthough breastfeeding is recommended by WHO and professionals as the most beneficial for newborn babies, many women find it challenging. Previous research yielded ambiguous results concerning the role of breastfeeding in the development of postpartum depression. The study aimed to identify the best predictors of depressive symptoms for each of these feeding method.MethodsThe participants were 151 women (mean age 29.4 yrs; SD = 4.5) who gave birth within the last 6 months and included 82 women classified as breastfeeding, 38 classified as mixed-feeding (breast and bottle), and 31 as formula-feeding. The study had a cross-sectional design using a web-based survey for data collection. The following measures were administered: The Edinburgh Postnatal Depression Scale; Sense of Stress Questionnaire; The Postpartum Bonding Questionnaire; Parenting Sense of Competence Scale; Infant Feeding Questionnaire.ResultsWomen in study groups differed in stress, bonding difficulties, and beliefs related to feeding practices and infancy. There were no significant differences in the severity of depressive symptoms, but all mean EPDS scores were above 12. Maternal satisfaction, intrapsychic stress, and concerns about feeding on a schedule were the best predictors of EPDS scores for breastfeeding women. For mixed-feeding – emotional tension, concern about infant's hunger, overeating, and awareness of infant's hunger and satiety cues; while for the formula-feeding group, predictors included emotional tension, bonding difficulties, and such maternal feeding practices and beliefs as concern about undereating, awareness of infant's hunger and satiety cues, concerns about feeding on a schedule and social interaction with the infant during feeding.ConclusionDifferences in predictors of postpartum depression for study groups suggest that breastfeeding itself may not be a risk for postpartum depression. However, the specificity of maternal experiences with the various types of feeding is related to difficulties promoting postpartum depression. Providing emotional and educational support appropriate for different types of feeding may be an essential protective factor for postnatal depression.

Barriers and enablers to Caregivers Responsive feeding Behaviour (CRiB): A mixed method systematic review protocol.

Background: Childhood overweight and obesity is a major public health issue. Responsive feeding has been identified as having a protective effect against child overweight and obesity, and is associated with healthy weight gain during infancy. Responsive feeding occurs when the caregiver recognises and responds in a timely and developmentally appropriate manner to infant hunger and satiety cues. Despite its benefits, responsive feeding is not ubiquitous. To better support caregivers to engage in responsive feeding behaviours, it is necessary to first systematically identify the barriers and enablers associated with this behaviour. This mixed-methods systematic review therefore aims to synthesise evidence on barriers and enablers to responsive feeding using the COM-B model of behavioural change. Methods: 7 electronic databases will be searched (Maternal and Infant Care, CINAHL, Cochrane, PubMed, Medline, PsycINFO, EMBASE). Studies examining factors associated with parental responsive and non-responsive feeding of infants and children (<2 years) will be included. Papers collecting primary data, or analysing primary data through secondary analysis will be included. All titles, abstracts and full texts will be screened by two reviewers. Quantitative and qualitative data from all eligible papers will be independently extracted by at least two reviewers using pre-determined standardised data extraction forms. Two reviewers will independently assess the methodological quality of the studies using the Mixed Methods Appraisal Tool (MMAT). This review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA). Ethics and dissemination: Ethical approval is not required for this review as no primary data will be collected, and no identifying personal information will be present. The review will be disseminated in a peer reviewed journal. PROSPERO registration: CRD42019144570 (06/08/2019).

Barriers and enablers to Caregivers Responsive feeding Behaviour (CRiB): A mixed method systematic review protocol

Background: Childhood overweight and obesity is a major public health issue. Responsive feeding has been identified as having a protective effect against child overweight and obesity, and is associated with healthy weight gain during infancy. Responsive feeding occurs when the caregiver recognises and responds in a timely and developmentally appropriate manner to infant hunger and satiety cues. Despite its benefits, responsive feeding is not ubiquitous. To better support caregivers to engage in responsive feeding behaviours, it is necessary to first systematically identify the barriers and enablers associated with this behaviour. This mixed-methods systematic review therefore aims to synthesise evidence on barriers and enablers to responsive feeding using the COM-B model of behavioural change. Methods: 7 electronic databases will be searched (Maternal and Infant Care, CINAHL, Cochrane, PubMed, Medline, PsycINFO, EMBASE). Studies examining factors associated with parental responsive and non-responsive feeding of infants and children (<2 years) will be included. Papers collecting primary data, or analysing primary data through secondary analysis will be included. All titles, abstracts and full texts will be screened by two reviewers. Quantitative and qualitative data from all eligible papers will be independently extracted by at least two reviewers using pre-determined standardised data extraction forms. Two reviewers will independently assess the methodological quality of the studies using the Mixed Methods Appraisal Tool (MMAT). This review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA). Ethics and dissemination: Ethical approval is not required for this review as no primary data will be collected, and no identifying personal information will be present. The review will be disseminated in a peer reviewed journal. PROSPERO registration: CRD42019144570 (06/08/2019)

Infant feeding beliefs and practices: Effects of maternal personal characteristics

Information is limited about how mothers make food decisions on behalf of their children. Eating practices are established early in life and are difficult to change, so it is imperative to focus on the caregiver who influences a young child's food preferences and eating behaviors. The purpose of this secondary data analysis was to examine the relationship between maternal characteristics and infant feeding beliefs and practices in a sample of multiparous mothers with a history of a prior preterm infant birth. Secondary analysis of a subset of data (n = 112) collected from women who participated in a randomized clinical trial (RCT) assessing the efficacy of a home-based intervention to improve maternal and child outcomes. Inclusion criteria for the RCT: women ≥18 years of age at enrollment with a prior preterm live birth >20 and <37 weeks gestation, <24 weeks gestation at enrollment, spoke/read English, and received prenatal care at a regional medical center. Criteria for the subset included: completed the Infant Feeding Questionnaire at 5 months postpartum and had reported a prenatal body mass index (BMI). Univariate correlations and multiple linear regression analyses were used to assess the associations between maternal personal characteristics and infant feeding practices. Median age of the mothers was 27 years (interquartile range [IQR]: 23-32) with median education of 12 years (IQR: 12-16). More than two-thirds (68%) of the women breastfed their last baby. These women were less likely to be concerned about their infant's hunger (r = -.20; p = .035). After controlling for education, maternal BMI, breastfed last baby, self-esteem, locus of control, and depressive symptoms, decreased maternal age (β = -.35; p < .001) and higher levels of stress (β = .19; p = .042) were associated with greater concern about their infant's hunger. Maternal demographic and psychosocial variables were not found to be statistically significantly associated with either concern about infant overeating and becoming overweight or an awareness of infant's hunger and satiety cues. Differences in maternal psychosocial variables and attitudes toward infant feeding may contribute to long term eating habits and weight outcomes in children. A better understanding of maternal variables that influence infant feeding attitudes and practices could improve the design of future intervention studies aimed at mothers at risk for having poor infant feeding practices.

Effects of an Individualized Fasting Program on Fasting Time and Comfort in Infants and Young Children During the Perioperative Period

PurposeThe study was designed to evaluate the effect of an individualized fasting program on fasting time and comfort in infants and young children during the perioperative period. DesignA quasiexperimental design was used. MethodsThe study included 675 children (intervention = 353, control = 322). Data collection tools included Characteristics of Children Form and the Infant Hunger Rating Scale. The fasting program included individualized fasting education and fasting in batches. On the day of the operation, clear liquids were fed 2 hours before surgery and refed after the patient woke after surgery. FindingsThe duration of perioperative fasting and the time to refeeding were shorter, the hunger scores were lower in the intervention group than those in the control group (P < .05). There was no difference in the incidence of vomiting between the two groups (P > .05), and no coughing and bloating occurred. ConclusionsThe fasting program for infants and young children can shorten the duration of fasting and can reduce the degree of hunger. This program is safe and feasible.

Barriers and enablers to Caregivers Responsive feeding Behaviour (CRiB): A mixed method systematic review protocol.

Background: Childhood overweight and obesity is a major public health issue. Responsive feeding has been identified as having a protective effect against child overweight and obesity, and is associated with healthy weight gain during infancy. Responsive feeding occurs when the caregiver recognises and responds in a timely and developmentally appropriate manner to infant hunger and satiety cues. Despite its benefits, responsive feeding is not ubiquitous. To better support caregivers to engage in responsive feeding behaviours, it is necessary to first systematically identify the barriers and enablers associated with this behaviour. This mixed-methods systematic review therefore aims to synthesise evidence on barriers and enablers to responsive feeding using the COM-B model of behavioural change. Methods: 7 electronic databases will be searched (Maternal and Infant Care, CINAHL, Cochrane, PubMed, Medline, PsycINFO, EMBASE). Studies examining factors associated with parental responsive and non-responsive feeding of infants and children (<2 years) will be included. Papers collecting primary data, or analysing primary data through secondary analysis will be included. All titles, abstracts and full texts will be screened by two reviewers. Quantitative and qualitative data from all eligible papers will be independently extracted by at least two reviewers using pre-determined standardised data extraction forms. Two reviewers will independently assess the methodological quality of the studies using the Mixed Methods Appraisal Tool (MMAT). This review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA). Ethics and dissemination: Ethical approval is not required for this review as no primary data will be collected, and no identifying personal information will be present. The review will be disseminated in a peer reviewed journal. PROSPERO registration: CRD42019144570 (06/08/2019).

“An invisible map” - maternal perceptions of hunger, satiation and ‘enough’ in the context of baby led and traditional complementary feeding practices

Mothers' responsiveness to hunger and fullness cues has been implicated in the development of infant overweight, and baby led weaning (BLW) is argued to be one way to protect against overfeeding. Whilst studies have examined maternal perceptions of hunger, fullness and adequate intake to some degree in traditional weaning (TW) contexts, less is known about this in BLW. This study therefore aimed to understand and compare maternal perceptions of cues and intake in BLW and TW. Eleven mothers of infants (7–24m) participated in semi-structured interviews based on discussions of short videos featuring participants feeding their infants. Interviews were read and transcribed in full. Data were selected for coding which addressed mothers' perceptions of infant hunger, fullness and sufficient consumption and subsequently subjected to template analysis. A sample of data was coded to produce an initial template which was applied to all interviews and revised in an iterative process to produce a final template for interpreting findings. Mothers in the study were adept at recognising fullness cues and gauging feeding state. Both groups perceived similar hunger cues although TW mothers reported a wider range of fullness cues. Both groups used numerous strategies for judging the adequacy of their babies’ intake. These included the use of infant cues, however perceived adequacy of intake was also influenced by factors such as infant tiredness and maternal worries about over and under-eating. Findings have implications for the development of responsive feeding interventions while also highlighting the utility of video elicited interviews for understanding feeding interactions.

The eyes have it: Infant gaze as an indicator of hunger and satiation

Infant gaze serves as a measure of attention to food cues in adults and children and may play a role in signalling infant hunger and satiation. Maternal responsiveness to infant satiation cues, including gaze, supports healthy appetite development and may reduce obesity risk. However, mothers often experience difficulty in interpreting feeding cues, and there have been few attempts to study cues systematically. This study aimed to develop a reliable coding scheme for categorising and tracking infant gaze behaviours during complementary feeding (CF). Twenty infants aged between six and eighteen months were filmed during typical meals on two occasions at home. The Infant Gaze at Mealtime (IGM) coding scheme was devised from the analysis of a sample of videos, a piloting and testing process, and the feeding cues and developmental psychology literature. Inter and intra-rater reliability tests of the scheme with 20% of the study videos revealed high levels of reliability. When applied to the full sample of 225 video clips, the IGM coding scheme revealed a significant decrease over time in the frequency of infants gazing at food and a significant increase in exploratory gaze behaviour within a meal. These changes were consistent across main and dessert courses, suggesting they may be indicative of changes in infant feeding state. The results suggest that infant gaze may offer a means of identifying infant hunger and satiation and, as an easily observed behaviour, an effective tool for mothers and professionals for promoting responsive feeding.

Infant feeding behaviours and attitudes to feeding amongst mothers with eating disorders: A longitudinal study.

This study aims to investigate breastfeeding, infant feeding behaviours, and attitudes to feeding amongst women with eating disorders (ED) and healthy controls (HC). Women with active ED (C-ED; N=25), past ED (P-ED; N=28), and HC (N=46) were recruited in pregnancy and followed up longitudinally. Post-natally infant feeding behaviour was investigated at 8weeks, 6months, and 1year and parental modelling at 1 and 2years. Women with P-ED and C-ED reported higher concerns about their infant being/becoming overweight compared with HC, respectively, at 8weeks and 6months and 6months only post-partum. Women with P-ED showed less awareness of infant hunger and satiety cues compared with HC at 8weeks. Despite few differences between ED and HC, both P-ED and C-ED predicted maternal attitudes and worries about child's eating. These are likely to impact on child's growth and later eating behaviours and might impact on the intergenerational transmission of ED.

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

Overfeeding in infancy may lead to overweight and obesity in later childhood. Mothers are advised to “tune in” to their infant's hunger, appetite and satiation cues to prevent overfeeding. The present study aimed to 1) assess stability and change in infant hunger and satiety cues (first two years of life) taken at six monthly intervals; 2) track the expression of appetite cues during the course of a meal (beginning, middle and end). Thirty-eight women (mean age 35.3 + 3.7 years) participated in the study. Mothers were within a normal weight range (BMI = 22 + 3.3 kg/m2), most were married (N = 35; 95%) and for most this was not their first child. After an initial investigation (T1) follow-up visits took place every six months with filmed meals involving solid foods. A typical meal contained foods high in protein and carbohydrate plus cooked vegetables. Films were viewed and communication cues (engagement indicating appetite and disengagement indicating satiation) identified and recorded by appearance using the NCAST (Nursing Child Assessment Satellite Training). Coding included the frequency and time at which each cue appeared. Results showed that infants were more likely to communicate potent engagement cues such as babbling, mutual gaze and looking at mother with age. None of the disengagement cues showed any significant main effects of time of follow up. Most, not all, feeding cues were stable across the segment of the feed and did not show a simple linear change across the meal, rather this appeared to develop with age. Raising awareness of these cues with mothers may encourage more responsive and positive mealtime interactions.

Maternal executive function, infant feeding responsiveness and infant growth during the first 3months.

There is limited research in young infants, particularly <3months of age, on maternal feeding practices in spite of increasing evidence that early weight gain velocity is a determinant of later obesity risk. To examine associations between maternal executive function (cognitive control over one's own behaviour), maternal feeding decisions and infant weight and adiposity gains. We used a checklist to assess cues mothers use to decide when to initiate and terminate infant feedings at 2weeks and 3months of age (N=69). Maternal executive function was assessed using the NIH Toolbox Cognition Battery subtests for executive function and infant body composition using air displacement plethysmography. Mothers with higher executive function reported relying on fewer non-satiety cues at 2weeks of age (β=-0.29, p=0.037) and on more infant hunger cues at 3months of age (β=0.31, p=0.018) in their decisions on initiating and terminating feedings. Responsive feeding decisions, specifically the use of infant-based hunger cues at 3months, in turn were associated with lower gains in weight-for-length (β=-0.30, p=0.028) and percent body fat (β=-0.2, p=0.091; non-covariate adjusted β=-0.27, p=0.029). These findings show both an association between maternal executive function and responsive feeding decisions and an association between responsive feeding decisions and infant weight and adiposity gains. The causal nature and direction of these associations require further investigation.