Eric A. Hodges

The role of responsive feeding in overweight during infancy and toddlerhood: a systematic review

A chronic mismatch of caregiver responsiveness to infant-feeding cues, such as feeding when the infant is not hungry, is hypothesized to have a role in the development of overweight by impairing an infants response to internal states of hunger and satiation. Although this concept of mismatch or discordance has long been acknowledged in scholarly writings, a systematic assessment of the evidence supporting the role of discordant responsiveness during infant feeding in the early origins of overweight is lacking. This review was undertaken to assess evidence for this hypothesized relationship between discordant responsiveness in feeding and overweight in infancy and toddlerhood, framed within the larger social-environmental context of the infant–caregiver dyad. A systematic method was used to extract articles from three databases of the medical, psychology and nursing fields. The quality of evidence collected was assessed using Oxford University Centre for Evidence Based Medicines level of evidence and through a narrative review. The systematic search resulted in only nine original research studies, which met a priori inclusion/exclusion criteria. Several studies provide support for the conceptual model, but most were cross-sectional or lower quality prospective studies. The need for consistent definitions, improved measures and longitudinal work is discussed. In conclusion, this review reveals preliminary support for the proposed role of discordant responsiveness in infant/child overweight and at the same time highlights the need for rigorous investigation of responsive feeding interactions in the first years of life.

Promoting Physical Activity in Preschoolers to Prevent Obesity: A Review of the Literature

This literature review summarizes clinical recommendations for adequate physical activity and reviews recently published studies that focus on identifying common factors associated with physical activity levels among preschoolers in the United States and Canada. Currently, there is inconsistency in both the definition of and recommendations for physical activity. In addition, there is relatively little research in this area. Common factors and contexts associated with physical activity levels in preschoolers in this review included (a) child characteristics; (b) interpersonal dynamics between preschoolers and their families, childcare providers, and health care providers; (c) childcare setting; and (d) neighborhood environment.

Development of the Responsiveness to Child Feeding Cues Scale

Parent-child feeding interactions during the first 2 years of life are thought to shape child appetite and obesity risk, but remain poorly studied. This research was designed to develop and assess the Responsiveness to Child Feeding Cues Scale (RCFCS), an observational measure of caregiver responsiveness to child feeding cues relevant to obesity. General responsiveness during feeding as well as maternal responsiveness to child hunger and fullness were rated during mid-morning feeding occasions by three trained coders using digital-recordings. Initial inter-rater reliability and criterion validity were evaluated in a sample of 144 ethnically-diverse mothers of healthy 7- to 24-month-old children. Maternal self-report of demographics and measurements of maternal/child anthropometrics were obtained. Inter-rater agreement for most variables was excellent (ICC>0.80). Mothers tended to be more responsive to child hunger than fullness cues (p<0.001). Feeding responsiveness dimensions were associated with demographics, including maternal education, maternal body mass index, child age, and aspects of child feeding, including breastfeeding duration, and self-feeding. The RCFCS is a reliable observational measure of responsive feeding for children <2 years of age that is relevant to obesity.

Food parenting measurement issues: Working group consensus report

Childhood obesity is a growing problem. As more researchers become involved in the study of parenting influences on childhood obesity, there appears to be a lack of agreement regarding the most important parenting constructs of interest, definitions of those constructs, and measurement of those constructs in a consistent manner across studies. This article aims to summarize findings from a working group that convened specifically to discuss measurement issues related to parental influences on childhood obesity. Six subgroups were formed to address key measurement issues. The conceptualization subgroup proposed to define and distinguish constructs of general parenting styles, feeding styles, and food parenting practices with the goal of understanding interrelating levels of parental influence on child eating behaviors. The observational subgroup identified the need to map constructs for use in coding direct observations and create observational measures that can capture the bidirectional effects of parent-child interactions. The self-regulation subgroup proposed an operational definition of child self-regulation of energy intake and suggested future measures of self-regulation across different stages of development. The translational/community involvement subgroup proposed the involvement of community in the development of surveys so that measures adequately reflect cultural understanding and practices of the community. The qualitative methods subgroup proposed qualitative methods as a way to better understand the breadth of food parenting practices and motivations for the use of such practices. The longitudinal subgroup stressed the importance of food parenting measures sensitive to change for use in longitudinal studies. In the creation of new measures, it is important to consider cultural sensitivity and context-specific food parenting domains. Moderating variables such as child temperament and child food preferences should be considered in models.

Maternal decisions about the initiation and termination of infant feeding.

Caregiver responsiveness to infant hunger and fullness cues is thought to play a role in the development of overweight during infancy, but this aspect of infant feeding has received little study. This research used a qualitative approach to understand aspects of feeding responsiveness involving maternal perception and interpretation of infant feeding cues by asking mothers about factors they used to initiate and terminate infant feeding. Participants were 71 ethnically diverse mothers of healthy, term infants at 3, 6, or 12 months of age. Mothers were asked three questions about feeding initiation and termination. Qualitative content analysis was used to derive major themes. Results revealed that the extent to which infant cues were prominent in maternal approaches to feeding was variable. Some mothers focused on amount consumed or eating schedule whereas others reported sole orientation to infant state and/or oral behaviors. Other themes involved the range of intensity and specificity of the infant cues that prompted feeding initiation and termination. The qualitative findings suggest that mothers may differ in the extent to which they perceive and rely upon infant hunger and fullness cues to initiate and terminate feeding.

The association of breastfeeding duration with later maternal feeding styles in infancy and toddlerhood: a cross-sectional analysis

BackgroundBreastfeeding modestly reduces obesity risk, yet the mechanisms are not well understood. The goal of the current research was to evaluate the association of breastfeeding duration with a wide range of maternal feeding approaches in late infancy and toddlerhood.MethodsA secondary analysis of cross-sectional data from an ethnically-diverse sample of 154 mothers of infants (aged 7–11 months) and toddlers (aged 12–24 months) was performed. Breastfeeding history was self-reported where 75% of mothers had weaned by the time of the interview. Multiple dimensions of maternal feeding approaches were measured using the Infant Feeding Styles Questionnaire which assesses pressuring, restriction, responsive, laissez-faire, and indulgent approaches to feeding. Analyses were performed separately for infants and toddlers and adjusted for maternal education level, ethnicity, and marital status.ResultsMothers of infants who breastfed for longer durations tended to report greater responsiveness to infant satiety cues (p≤0.01) and reduced pressuring in feeding complementary foods (p<0.05). Mothers of toddlers who breastfed for longer durations tended to report reduced pressuring in feeding complementary foods (p<0.01).ConclusionThese results suggest that breastfeeding may shape maternal feeding approaches related to responsiveness to infant cues as infants enter a period of complementary feeding, even after considering a range of demographic characteristics previously associated with breastfeeding behaviors. That responsiveness to feeding cues was not associated with breastfeeding duration in the toddler sample suggests that some aspects of this association might be isolated to infancy.

Who’s feeding baby? Non-maternal involvement in feeding and its association with dietary intakes among infants and toddlers ☆

This study examined non-maternal involvement in feeding during the first 2 years of life and its association with breastfeeding duration, early introduction of complementary foods, and dietary intakes of selected foods and beverages. Data were from the Infant Care, Feeding and Risk of Obesity Study, a cohort of 217 low-income, African-American mother-infant dyads, followed from 3 to 18 months postpartum. Non-maternal caregivers (NMCs) were defined as persons involved in feeding an infant/toddler 50% or more of the total daily feedings. Use of any NMC and the type of NMC was tabulated for each study visit (3, 6, 9, 12, and 18 months). At each time point, more than half of all households reported a NMC. Fathers, grandmothers, and licensed childcare providers were the most common types of NMCs. In longitudinal models adjusted for confounding variables, NMC use was associated with a decreased likelihood of continued breastfeeding, and an increased likelihood of infants and toddlers consuming juice or whole fruit. Given the high prevalence of non-maternal involvement in feeding, interventions targeting multiple family members are warranted as they are likely to be more effective than those targeting the mother alone.

Efficacy of semielevated side-lying positioning during bottle-feeding of very preterm infants: a pilot study.

Very preterm (VP, ⩽30 wk gestational age) infants are at risk for impaired lung function, which significantly limits their ability to eat. A semielevated side-lying (ESL) position is a feeding strategy that may improve oral feeding by supporting breathing during feeding. The study evaluated the efficacy of the ESL position compared with the semielevated supine (ESU) position on physiological stability and feeding performance of bottle-fed VP infants. Using a within-subject crossover design, 6 VP infants were bottle-fed twice on 1 day, in both the ESL and ESU positions in a random order. Physiological stability (heart rate, oxygen saturation [SaO2], and respiratory characteristics) and feeding performance (percent intake, proficiency, efficiency, and duration of feeding) were measured before and/or during feeding. Very preterm infants fed in the ESL position demonstrated significantly less variation in heart rate, less severe and fewer decreases in heart rate, respiratory rate that was closer to the prefeeding state, shorter and more regular intervals between breaths, and briefer feeding-related apneic events. No significant differences for SaO2 or feeding performance were found. The findings indicate that the ESL position may support better regulation of breathing during feeding, thereby allowing VP infants to better maintain physiological stability throughout feeding.

NURTURE: Development and pilot testing of a novel parenting intervention for mothers with histories of an eating disorder

OBJECTIVE To describe the treatment development and pilot testing of a group parenting intervention, NURTURE (Networking, Uniting, and Reaching out To Upgrade Relationships and Eating), for mothers with histories of eating disorders. METHOD Based on focus group findings, extant research, and expert opinion, NURTURE was designed to be delivered weekly over 16 (1.5 h) sessions via an interactive web conferencing forum. It comprises four modules: (1) laying the foundation, (2) general parenting skills, (3) eating and feeding, and (4) breaking the cycle of risk. Pilot testing was conducted with three groups of 3-6 mothers (N = 13) who had children ages 0-3 years to determine feasibility (e.g., retention), acceptability (e.g., feedback questionnaire responses), and preliminary efficacy. Maternal satisfaction with NURTURE and changes in mother-child feeding relationship measures, maternal feeding style, maternal self-efficacy, and maternal psychopathology (eating disorder, depression, and anxiety symptoms) across three time points (baseline, post-treatment, 6-month follow-up) were examined. All outcomes were exploratory. RESULTS The intervention was well tolerated with a 100% retention rate. Feedback from mothers was generally positive and indicated that the groups provided an engaging, supportive experience to participants. We observed changes suggestive of improvement in self-reported maternal self-efficacy and competence with parenting. There were no notable changes in measures of maternal feeding style or psychopathology. DISCUSSION NURTURE is a feasible, acceptable, and potentially valuable intervention for mothers with eating disorder histories. Results of this pilot will inform a larger randomized-controlled intervention to determine efficacy and impact on child outcomes.

Initial evaluation of the Robert Wood Johnson Foundation Nurse Faculty Scholars program

BACKGROUND The Robert Wood Johnson Foundation Nurse Faculty Scholars (RWJF NFS) program was developed to enhance the career trajectory of young nursing faculty and to train the next generation of nurse scholars. Although there are publications that describe the RWJF NFS, no evaluative reports have been published. The purpose of this study was to evaluate the first three cohorts (n = 42 scholars) of the RWJF NFS program. METHODS A descriptive research design was used. Data were derived from quarterly and annual reports, and a questionnaire (seven open-ended questions) was administered via Survey Monkey Inc. (Palo Alto, CA, USA). RESULTS During their tenure, scholars had on average six to seven articles published, were teaching/mentoring at the graduate level (93%), and holding leadership positions at their academic institutions (100%). Eleven scholars (26%) achieved fellowship in the American Academy of Nursing, one of the highest nursing honors. The average ratings on a Likert scale of 1 (not at all supportive) to 10 (extremely supportive) of whether or not RWJF had helped scholars achieve their goals in teaching, service, research, and leadership were 7.7, 8.0, 9.4, and 9.5, respectively. The majority of scholars reported a positive, supportive relationship with their primary nursing and research mentors; although, several scholars noted challenges in connecting for meetings or telephone calls with their national nursing mentors. CONCLUSIONS These initial results of the RWJF NFS program highlight the success of the program in meeting its overall goal-preparing the next generation of nursing academic scholars for leadership in the profession.