Development of Feeding Cues During Infancy and Toddlerhood

Abstract

Purpose To enhance responsive feeding, this study aimed to characterize the development of feeding cues during infancy and toddlerhood. Study Design and Methods A secondary analysis was performed on a dataset of first time, low-income African-American mother-infant pairs assessed at infant age 3, 6, 9, 12, and 18 months. A subsample with the 15 highest, middle, and lowest infant body mass index (BMI) Z-scores at 18 months was selected (n=45). Using video-recorded home feedings, early, active, and late receptiveness and fullness cues were assessed using the Responsiveness to Child Feeding Cues Scale at each time point. Descriptive statistics were used to characterize development. Results Early receptiveness cues were relatively rare over time, whereas active receptiveness cues were much more common. However, there were changes over time. For example, settling into the feeding decreased from ~50% at 3 and 6 months to 4.8% by 18 months, whereas postural attention and reaching for food increased after 6 months. In the first six months, falling asleep and decreasing muscle tone and activity level were the most common early fullness cues. Thereafter, taking interest in surroundings was most prevalent. Active fullness cues became increasingly diverse after 6 months, led by more assertive cues such as pushing or pulling away and communicating “no” verbally or non-verbally. Clinical Implications These findings provide an empirical description of waxing and waning in feeding cues and indicate increasing intentionality of cues over the first 18 months of life. Knowing common cues across development may aid clinicians in enhancing parental feeding responsiveness, avoiding overfeeding, thereby decreasing risk of early childhood obesity.

Early rapid weight gain among formula‐fed infants: Impact of formula type and maternal feeding styles

“…Neither infant formula intake nor rapid weight gain during these early months of life was related to the feeding styles of the mothers, a finding consistent with prior studies . Because mothers of young infants focus more on hunger cues than on satiation cues, and because satiation at this early age is typically characterized by decreased motor tone and activity levels, often culminating in sleep, infants may be subtly controlling intake via their post‐ingestive behavioural state that would be difficult for the mothers to override.…”

“…Guiding mothers on how to feed their children solid foods responsively by recognizing hunger and fullness resulted in lower weight‐for‐length percentiles and less likelihood of overweight in their 1‐year‐old children . We hypothesize that responsive feeding plays a more important role when the child transitions to a mixed diet rich in palatable, high‐sweet, and high‐salt foods and when satiation is not accompanied by sleep or lack of motor tone as it is during early infancy …”

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

“…the main course). Findings regarding exploratory gaze also provide support for hypothesis 1, and the increase in this behaviour as main and dessert courses progressed is consistent with Gerrish and Menella's (2000) finding that infants showed greater visual attention to a mobile after, rather than before, breastfeeding, and, with parental reports of infants playing with their food as a satiation sign (Hodges et al, 2008;Hodges et al, 2016;Skinner et al, 1996). Importantly, changes in this behaviour and gazing at food also provide support for hypothesis 3 that similar patterns of gaze change would be seen between main and dessert courses as a result of sensory specific satiety (Rolls et al, 1981).…”

Engaging national and regional partners to accelerate broad-scale implementation of nurse-developed interventions

“…A chronic mismatch between a caregiver’s feeding behavior and the infant’s state (feeding in the absence of hunger and/or feeding beyond fullness) is thought to contribute to obesity by undermining the infant’s capacity to self-regulate intake (Disantis, Hodges, Johnson, & Fisher, 2011). Dr. Hodges et al have developed an intervention that teaches parents American Sign Language signs indicative of hunger, thirst, and satiety, which they in turn teach to their preverbal infant to add to the infant’s repertoire of reflexive and increasingly intentional cues (Hodges, Wasser, Colgan, & Bently, 2016). Dr. Hodges is partnering with the national PAT research and training directors to integrate his intervention within their existing curriculum and systems.…”