Caregiver- vs Infant-Oriented Feeding: A Model of Infant-Feeding Strategies among Special Supplemental Nutrition Program for Women, Infants, and Children Participants in Rural East Tennessee

doi:10.1016/j.jada.2010.07.009

Journal of the American Dietetic Association

Volume 110, Issue 10, October 2010, Pages 1485-1491

https://doi.org/10.1016/j.jada.2010.07.009 Get rights and content

Abstract

The aim of this project was to collect data from focus-group participants to inform the future development of region-specific educational strategies to modify infant-feeding practices that may predispose children to obesity. Infant-feeding perceptions and practices were collected from participants of the Special Supplemental Nutrition Program for Women, Infants, and Children, through recorded focus groups, in two East Tennessee counties. Focus groups replaced the participants' required, prescheduled nutrition-education classes for participants with infants younger than 6 months of age. Twenty-nine focus groups were convened and recorded, reaching a total of 109 participants. Results of this series of focus groups indicate that the Special Supplemental Nutrition Program for Women, Infants, and Children population in rural East Tennessee was similar to populations elsewhere in terms of early solid-food introduction, frequent switching of formula, and sources of and valuation of infant-feeding advice. However, this population seemed to be different in the magnitude at which they introduce infant cereal early (primarily as an addition to the bottle). For this reason, interventions designed to reduce inappropriate infant-feeding behaviors in this population should focus on early introduction of solid food (especially infant cereal) first. In addition to these findings, a model of infant-feeding strategy development based on caregiver-orientation (framed within parenting styles) is presented and discussed.

Section snippets

Script Development and Sampling

During the spring and summer of 2007, researchers convened focus groups consisting of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants with infants up to 6 months of age. To facilitate these focus groups, a script with five topic areas was developed based on prior research by Heinig and colleagues (11, 20) and with additional input from experts in the field of maternal and child nutrition. The five topic areas included the age at which complementary

Results and Discussion

Thirty-one focus groups were conducted. However, only 29 were used for analysis, as two failed to record. Of the 109 participants, the vast majority were mothers, although there were some grandmothers (n=8) and fathers (n=4) who participated. Therefore, use of the term participants here refers to mothers primarily. Because of constraints from the institutional review board, no demographic data were collected from participants, aside from confirming an age of 18 years or older. However, the

Conclusions

Results of these focus groups indicate that the WIC population in rural East Tennessee is similar to populations elsewhere in terms of several infant-feeding behaviors and sources of and valuation of infant-feeding advice (11, 20, 23, 24, 26). However, this population seemed to be different in the magnitude in which they introduce infant cereal early (primarily as an addition to the bottle) (34). For this reason, interventions designed to reduce inappropriate infant-feeding behaviors in this

K. F. Kavanagh is an assistant professor, Department of Nutrition, The University of Tennessee, Knoxville.

References (39)

S. Cummings et al.
Position of the American Dietetic Association: Weight management
J Am Diet Assoc
(2002)
K.F. Kavanagh et al.
Educational intervention to modify bottle-feeding behaviors among formula-feeding mothers in the WIC program: Impact on infant formula intake and weight gain
J Nutr Educ Behav
(2008)
L.M. Sacco et al.
Assessment of infant feeding styles among low-income African-American mothers: Comparing reported and observed behaviors
Appetite
(2007)
C.L. Wagner et al.
The breast or the bottle?Determinants of infant feeding behaviors
Clin Perinatol
(1999)
M. Bentley et al.
Infant feeding practices of low-income, African-American, adolescent mothers: An ecological, multigenerational perspective
Soc Sci Med
(1999)
K. Corbett
Explaining infant feeding style of low-income black women
J Pediatr Nurs
(2000)
L.L. Birch et al.
Confirmatory factor analysis of the Child Feeding Questionnaire: A measure of parental attitudes, beliefs and practices about child feeding and obesity proneness
Appetite
(2001)
A.L. Thompson et al.
Development and validation of the infant feeding style questionnaire
Appetite
(2009)
H.O. Luttikhuis et al.
Interventions for treating obesity in children
Cochrane Database of Syst Rev
(2009 Jan 21)
N. Stettler
Nature and strength of epidemiological evidence for origins of childhood and adulthood obesity in the first year of life
Int J Obes
(2007)

S.R. Daniels

The consequences of childhood overweight and obesity

Future Child

(2006)

A. Fagot-Campagna

Emergence of type 2 diabetes mellitus in children: Epidemiological evidence

J Pediatr Endocrinol Metab

(2000)

D.S. Freedman et al.

Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa Heart Study

Pediatrics

(2001)

N.B. Oldridge

Economic burden of physical inactivity: Healthcare costs associated with cardiovascular disease

Eur J Cardiovasc Prev Rehabil

(2008)

J.B. Schwimmer et al.

Health-related quality of life of severely obese children and adolescents

JAMA

(2003)

N. Stettler et al.

Infant weight gain and childhood overweight status in a multicenter, cohort study

Pediatrics

(2002)

M. Habibi et al.

Well-fed and sleeping: Motivations driving infant feeding practices in rural Appalachia

FASEB J

(2008)

M.J. Heinig et al.

Barriers to compliance with infant-feeding recommendations among low-income women

J Hum Lact

(2006)

M. Horodynski et al.

Low-income mothers' decisions regarding when and why to introduce solid foods to their infants: Influencing factors

J Community Health Nurs

(2007)

Cited by (16)

Characteristics Associated With Adding Cereal Into the Bottle Among Immigrant Mother–Infant Dyads of Low Socioeconomic Status and Hispanic Ethnicity
2017, Journal of Nutrition Education and Behavior
Citation Excerpt :
The studies that did examine this practice specifically found that adding cereal into the bottle was common in low-income groups.8-10 Studies using both surveys and focus groups to assess reasons for adding cereal into the bottle found that mothers reported using this practice to help infants sleep or stay full longer, or to help their infant gain weight.8-15 Obesity-promoting feeding behaviors associated with excess infant weight include nonresponsive controlling feeding styles such as restrictive and pressuring feeding practices.11-19
Determine maternal and infant characteristics associated with adding cereal into the bottle.
Secondary data analysis.
Study participants were immigrant, low-income, urban mother–infant dyads (n = 216; 91% Hispanic, 19% US-born) enrolled in a randomized controlled trial entitled the Bellevue Project for Early Language, Literacy and Education Success.
Maternal characteristics (age, marital status, ethnicity, primary language, country of origin, education, work status, income, depressive symptoms, and concern about infant's future weight) and infant characteristics (gender, first born, and difficult temperament).
Fisher exact test, chi-square test, and simultaneous multiple logistic regression of significant (P < .05) variables identified in unadjusted analyses.
Twenty-seven percent of mothers added cereal into the bottle. After adjusting for confounding variables identified in bivariate analyses, mothers who were single (P = .02), had moderate to severe depressive symptoms (P = .01) and perceived their infant had a difficult temperament (P = .03) were more likely to add cereal into the bottle. Conversely, mothers who expressed concern about their infants becoming overweight were less likely to add cereal (P = .02).
Health care providers should screen for adding cereal in infant bottles. Further research is needed to investigate the impact of adding cereal into the bottle on weight trajectories over time. Causal associations also need to be identified to effectively prevent this practice.
Mothers’ perceptions of the influences on their child feeding practices – A qualitative study
2016, Appetite
Citation Excerpt :
This highlights the complexity of factors likely to influence health related behaviours. These findings regarding influences on child feeding practices are novel, but consistent with previous research regarding other aspects of child feeding which has identified similar influences (Kavanagh, Habibi, Anderson, & Spence, 2010; Pocock, Trivedi, Wills, Bunn, & Magnusson, 2010; Synnott et al., 2007). For example, studies focussing on breastfeeding, timing of solids introduction, and choice of foods, highlight a range of influences similar to those identified in this study, namely time and convenience, family and friends, personal intuition/beliefs, internet, and other literature sources (Kavanagh et al., 2010; Synnott et al., 2007).
Children’s diets are important determinants of their health, but typically do not meet recommendations. Parents’ feeding practices, such as pressure or restriction, are important influences on child diets, but reasons why parents use particular feeding practices, and malleability of such practices, are not well understood. This qualitative study aimed to explore mothers’ perceptions of influences on their feeding practices, and assess whether an intervention promoting recommended feeding practices was perceived as influential. The Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program was a cluster-randomised controlled trial involving 542 families aiming to improve child diets. Following the trial, when children were two years old, 81 intervention arm mothers were invited to participate in qualitative interviews, and 26 accepted (32%). Thematic analysis of interview transcripts used a tabular thematic framework. Eight major themes were identified regarding perceived influences on child feeding practices. Broadly these encompassed: practical considerations, family setting, formal information sources, parents’ own upbringing, learning from friends and family, learning from child and experiences, and parents’ beliefs about food and feeding. Additionally, the Melbourne InFANT Program was perceived by most respondents as influential. In particular, many mothers reported being previously unaware of some recommended feeding practices, and that learning and adopting those practices made child feeding easier. These findings suggest that a variety of influences impact mothers’ child feeding practices. Health practitioners should consider these factors in providing feeding advice to parents, and researchers should consider these factors in planning interventions.
Infant feeding: beyond the nutritional aspects
2016, Jornal de Pediatria
Citation Excerpt :
In this context, the mother has a predominant role, representing the main caregiver of the child. The manner in which she cares for her child is crucial for the child's health, and is related to her educational level, the information about health received from health professionals and/or the media, social support, and her availability to fulfill the role of caregiver.2,15–18 Another factor to be considered is the adequacy of food – variety, consistency, texture, and the use of a cup and spoon, respecting the child's development.
To draw attention to the importance of interaction between caregiver and child during feeding and the influence of parenting style on dietary habit formation.
A search was performed in the PubMed and Scopus databases for articles addressing responsive feeding; the articles considered most relevant by the authors were selected.
The way children are fed is decisive for the formation of their eating habits, especially the strategies that parents/caregivers use to stimulate feeding. In this context, responsive feeding has been emphasized, with the key principles: feed the infant directly and assist older children when they already eat on their own; feed them slowly and patiently, and encourage children to eat but do not force them; if the child refuses many types of foods, experiment with different food combinations, tastes, textures, and methods of encouragement; minimize distractions during meals; and make the meals an opportunity for learning and love, talking to the child during feeding and maintaining eye contact. It is the caregiver's responsibility to be sensitive to the child's signs and alleviate tensions during feeding, and make feeding time pleasurable; whereas it is the child's role to clearly express signs of hunger and satiety and be receptive to the caregiver.
Responsive feeding is very important in dietary habit formation and should be encouraged by health professionals in their advice to families.
Chamar a atenção para a importância da interação entre cuidador e criança durante a alimentação e a influência do estilo de parentalidade na formação do hábito alimentar.
Foi realizada busca na base de dados PubMed e Scopus de artigos abordando a alimentação responsiva, tendo sido selecionados aqueles julgados mais relevantes pelos autores.
O modo de alimentar as crianças é decisivo na formação do hábito alimentar, sobretudo as estratégias que os pais/cuidadores utilizam para estimular a alimentação. Nesse contexto, a alimentação responsiva tem merecido destaque, tendo como princípios-chave: alimentar a criança pequena diretamente e assistir as mais velhas quando elas já comem sozinhas; alimentar lenta e pacientemente, e encorajar a criança a comer, mas não forçá-la; se a criança recusar muitos alimentos, experimentar diferentes combinações de alimentos, de gostos, texturas e métodos de encorajamento; minimizar distrações durante as refeições; e fazer das refeições oportunidades de aprendizado e amor, falando com a criança durante a alimentação e mantendo contato olho a olho. Cabe ao cuidador a responsabilidade de ser sensível aos sinais da criança e aliviar tensões durante a alimentação, além de torná-la prazerosa; enquanto é papel da criança expressar os sinais de fome e saciedade com clareza e ser receptiva ao cuidador.
A alimentação responsiva é muito importante na formação dos hábitos alimentares e deve ser incentivada pelos profissionais de saúde, orientando as famílias como praticá-la.
Parental considerations during complementary feeding in higher income countries: A systematic review of qualitative evidence
2021, Public Health Nutrition
Self-Reported Parental Healthy Dietary Behavior Relates to Views on Child Feeding and Health and Diet Quality
2023, Nutrients
Timing of Introduction of Complementary Foods and Beverages to Infants of Low-Income Women
2021, Breastfeeding Medicine

View all citing articles on Scopus

K. F. Kavanagh is an assistant professor, Department of Nutrition, The University of Tennessee, Knoxville.

M. Habibi is a graduate student, Department of Nutrition, The University of Tennessee, Knoxville.

M. Spence is an assistant professor (Research) and the assistant director of the Public Health Nutrition Program, Department of Nutrition, The University of Tennessee, Knoxville.

K. Anderson is a Peace Corps volunteer; at the time of the study, she was a graduate student, Department of Nutrition, The University of Tennessee, Knoxville.

View full text

ResearchQualitative ResearchCaregiver- vs Infant-Oriented Feeding: A Model of Infant-Feeding Strategies among Special Supplemental Nutrition Program for Women, Infants, and Children Participants in Rural East Tennessee

Abstract

Section snippets

Script Development and Sampling

Results and Discussion

Conclusions

J Am Diet Assoc

J Nutr Educ Behav

Appetite

Clin Perinatol

Soc Sci Med

J Pediatr Nurs

Appetite

Appetite

Interventions for treating obesity in children

Cochrane Database of Syst Rev

Nature and strength of epidemiological evidence for origins of childhood and adulthood obesity in the first year of life

Int J Obes

The consequences of childhood overweight and obesity

Future Child

Emergence of type 2 diabetes mellitus in children: Epidemiological evidence

J Pediatr Endocrinol Metab

Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa Heart Study

Pediatrics

Economic burden of physical inactivity: Healthcare costs associated with cardiovascular disease

Eur J Cardiovasc Prev Rehabil

Health-related quality of life of severely obese children and adolescents

JAMA

Infant weight gain and childhood overweight status in a multicenter, cohort study

Pediatrics

Well-fed and sleeping: Motivations driving infant feeding practices in rural Appalachia

FASEB J

Barriers to compliance with infant-feeding recommendations among low-income women

J Hum Lact

Low-income mothers' decisions regarding when and why to introduce solid foods to their infants: Influencing factors

J Community Health Nurs

Research
Qualitative Research
Caregiver- vs Infant-Oriented Feeding: A Model of Infant-Feeding Strategies among Special Supplemental Nutrition Program for Women, Infants, and Children Participants in Rural East Tennessee