Maternal Behavior and Infant Weight Gain in the First Year

Abstract

The risk for overweight for low-income Hispanic children younger than age 5 in the United States is significantly higher than for non-Hispanic blacks, which in turn is higher than for nonHispanic whites (1,2). Using the criterion of a Body Mass Index (BMI) ≥ the 95 th percentile for age and sex for defining overweight, the prevalence among low-income young children age 2-4 years in the US as of the year 2000 was around 19% (3). Though the sample was not nationally representative, a review of over 20 years of records from a Massachusetts health maintenance organization on over 120,000 children found that the percentage of infants under 6-months who were overweight or at risk for overweight increased from approximately 10% in 1980-81 to 17% in 2000-01 (4). In that report, overweight was defined as weight for length ≥ the 95 th percentile for age and sex; at risk for overweight as weight for length ≥ the 85 th percentile for age and sex. In that same report, Hispanic infants were higher than black, who in turn were higher than white in prevalence as well as in relative increase of overweight. Using NHANES data, the National Center for Health Statistics reports that the prevalence of overweight for infants (children < 2-years-old) increased from 7.2% over 1976-80 to 11.5% over 2003-2004 (5). Such trends speak to the need for examining the factors that may contribute to excess weight gain in infancy, since there is accumulating evidence that the rate of infant growth may bear on childhood or later obesity (6).To illustrate, recent work has sought to link patterns of infant growth to child obesity by relating infant characteristics to older weight outcomes, with some reporting a direct association between birth weight and BMI in young adulthood (7,8). For example, rapid weight gain by formula-fed infants in the first week of life was shown to relate to adult overweight status by Stettler et al.(9), while Dennison et al. (10) reported that the rate of weight gain during the first six months of life was associated with a significantly increased risk of overweight at 4-years. Several studies suggest an association between increased rates of weight gain during the first 4 to 24 months of life and risk of overweight during later childhood or early adulthood (11)(12)(13)(14). The impact of weight gain during infancy on child overweight may therefore be substantial, but the factors that contribute to early weight gain are not completely understood.Some research on weight gain in infancy has taken an energy balance approach. In an oft-cited study, Roberts et al. (15) studied18 infants, two-thirds with obese mothers, and tracking the babies from birth to 1-year. The six infants who became overweight consumed 42% more energy at 6-months than the 12 infants who remained lean (16). As these six infants also had reduced total energy expenditure at 3-months of age, the authors argued that energy spent on activity played a more important role in infant overweight than energy intake. In contrast, and with a larger sample of infants ...

Looking for cues – infant communication of hunger and satiation during milk feeding

“…In support of this contention, Worobey et al (2009) noted that mothers' lower sensitivity to infant's feeding cues at 6 months was positively associated with infants' higher weight gain at 12 months. Brown and Lee (2011) demonstrated that lower levels of responsiveness to a child's needs were positively associated with higher child weight gain at the age of 2 years.…”

Differences in modifiable feeding factors by overweight status in Latino infants

“…Excessive maternal control during feedings may interfere with infant"s ability to self-regulate intake and display clues of satiety, [15] and have been associated with unhealthy feeding and weight gain in children. [16][17][18] A study of 368 Latina mothers participating in WIC programs reported that 50% of the participants described tendencies toward more "pressure feeding" or controlling maternal feeding patterns, as they always promoted bottle bottleemptying practices. [19] Maternal controlling feeding patterns may contribute to higher energy intake and thus represent an important preventable and modifiable risk factor for the prevention of obesity in early childhood.…”

Understanding infant eating behaviour – Lessons learned from observation

“…Overfeeding may arise from insensitivity to fullness cues, the use of food to comfort (Worobey et al, 2009) as some infants have a more avid appetite than others (Lumeng, 2016). In turn, mothers may restrict intake for children they perceive to over-eat, or may pressure children with small appetites to eat more (Webber et al, 2010).…”