An Evaluation of Mother-Centered Anticipatory Guidance to Reduce Obesogenic Infant Feeding Behaviors

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Childhood obesity occurs in 20% of children before they enter kindergarten. Treatment is difficult, making prevention desirable, but little is known about effective methods using anticipatory guidance to prevent obesity in pediatric primary care. WHAT THIS STUDY ADDS:This study provides a comparison of 2 approaches versus usual care using anticipatory guidance to improve infant feeding during the first year of life, and demonstrates positive specific feeding behavior differences at 1 year in the intervention groups. METHODS: This is a cluster randomized trial. A total of 292 mother/ infant dyads were enrolled at their first well-child visit to 3 urban pediatric clinics in Columbus, Ohio. Intervention-specific brief advice and 1-page handouts were given at each well visit. In addition to infant weights and lengths, surveys about eating habits and infant feeding practices were completed at baseline and 12 months. RESULTS:Baseline data revealed a group with high rates of maternal overweight (62%) and obesogenic habits. At 12 months, the maternalfocused group gave their infants less juice (8.97 oz vs 14.37 oz, P , .05), and more daily servings of fruit (1.40 vs 0.94, P , .05) and vegetables (1.41 vs 1.03, P , .05) compared with BF mothers. Ounce of Prevention mothers also gave less juice (9.3 oz, P , .05) and more fruit servings (1.26 P , .05) than BF.CONCLUSIONS: Brief specific interventions added to well-child care may affect obesogenic infant feeding behaviors of mothers and deserves further study as an inexpensive approach to preventing childhood obesity. Pediatrics 2012;130:e507-e517 AUTHORS:

Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review

“…14,19,34–36,38,39 However, behavior change counseling provided in the clinical setting is necessarily limited in its impact on individual and family lifestyles by manifold non-medical, but health-critical, influences from the social and physical environment— factors that are highlighted by the ecosocial 52 and Glass and McAtee 53 conceptual frameworks discussed above.…”

“…At age 13–15 months, children in the intervention group had lower BMI z-scores compared with the control group (0.23 vs 0.42; p =0.009) 36 ; however, this was not sustained at age 2 years. 37 Two clinic-based interventions—one focused on parenting practices to improve infant sleep 38 and one providing anticipatory guidance around either maternal or infant diet 39 —did not find an effect on childhood weight status.…”

“…Nine of the interventions had allocation concealed to participants 24,26–29,32,33,36,39 and in 16 interventions, participant allocation was concealed to researchers and data collection was blinded. 15,20,23,24,26–29,32–34,36,38,39,42,43 The remaining trials inadequately reported allocation concealment or were not able to conduct study blinding. Of the 34 published follow-up studies from the 26 trials, a quarter had dropout rates that were <20% at follow-up points.…”

Complementary Feeding: Critical Considerations to Optimize Growth, Nutrition, and Feeding Behavior

“…In a responsive feeding relationship, the caregiver ideally remains in an authoritative position, respecting the infant/toddler’s developing autonomy, but not yielding full control to the child [75]. Interventions targeting feeding style have often resulted in subtle improvements in infant intake and parental behaviors and knowledge, but have generally not impacted infant growth or obesity risk [76, 77]. Rarely do these studies control for initial infant feeding mode, or consider micronutrient status.…”

Randomized Controlled Trial of a Clinic-Based Intervention to Promote Healthy Beverage Consumption Among Latino Children

“…In addition, embedding nutrition education within primary care visits may be more convenient for parents than interventions which occur at a separate time or location, making them more acceptable and easier to disseminate. Three prior studies have demonstrated that brief targeted counseling on beverage consumption during primary care visits can reduce children’s consumption of SSBs 20 and 100% fruit juice 21,22 respectively. Limitations of these studies as applied to Latino children are that two out of three did not report the ethnicity of participants and none of the studies used materials which were culturally tailored to Latino families.…”