Parents' Beliefs About Infant Size, Growth, and Feeding
Parents' Beliefs About Infant Size, Growth, and Feeding
The prevalence of childhood obesity in the UK has increased significantly since 1995, though more recent data suggests that rates have peaked and the incidence is leveling off. The most recent combined rates for childhood overweight and obesity amongst 2–15 year olds are 31% for boys and 30% for girls. Causes and consequences of childhood overweight and obesity have been investigated in a number of observational studies and three systematic reviews have concluded that rapid weight gain during infancy is associated with greater obesity risk in later life. An infant's weight trajectory may be influenced by a number of risk factors that are potentially modifiable during their early years. These include infant feeding practices, parental response to infant temperament and parental perception of infant growth and appetite.
The relationship between breast feeding and obesity risk in childhood has been investigated in a number of studies, with contradictory findings. A systematic review and meta analysis conducted in 2004, concluded that breast feeding has a small but consistent protective effect against the development of obesity during childhood. There is emerging experimental evidence that the higher protein content of formula milk may be partially responsible for greater weight gain. There is also observational evidence that early weaning onto solid foods (< 4 months) is significantly associated with overweight or obesity at 3 years. A UK longitudinal cohort study found that infants fed with formula milk were introduced to solid foods earlier than breast fed infants and were less likely to have consumed fruit and vegetables. These study results require cautious interpretation as the cohort consisted exclusively of white, singleton children, who were from more affluent backgrounds. There may be other differences between mothers who choose to breastfeed and those that do not (e.g. breastfeeding mothers may be more health conscious, more responsive to their infant and have a higher socio-economic status (SES)).
Parental response to infant temperament is a risk factor for childhood obesity. A qualitative study of 14 low income mothers with overweight young children reported that food was used to soothe fussy infants, calm temper tantrums and shape behaviour. In another study infants with a temperament dimension described as "fear" in relation to their acceptance or rejection of new objects or people were significantly slower to gain weight than those described as "distress to limitations" which is characterized by frustration, reduced sleep, excessive crying and fussiness. The authors speculate that parents who perceive their infants to be fussy or frustrated may use food as comfort which may account for the differences in weight gain between the two groups.
Parental perceptions about appropriate size, growth and feeding patterns play an important role in the development of childhood obesity. Baughcum and colleagues, in the study described above, reported that mothers had strong beliefs that heavy infants were desirable as weight was the best marker of health and successful parenting. In a later study, Baughcum and colleagues assessed maternal feeding practices and beliefs using feeding questionnaires for infants (n = 453) and pre-school children (n = 634). They described different feeding behaviours between high and low income mothers. Low income mothers reported greater concern about their child's hunger, a lower tendency to use food to calm and greater difficulty feeding their children. They also reported pushing their child to eat more and engaging in more age-inappropriate feeding.
Parental beliefs and understanding are crucial determinants of infant feeding behaviour, therefore any intervention will need to take account of these views. This study aimed to explore UK parents' beliefs concerning their infant's size, growth and feeding behaviours and their receptiveness to early intervention aimed at reducing the risk of childhood obesity.
The objectives were:
Background
The prevalence of childhood obesity in the UK has increased significantly since 1995, though more recent data suggests that rates have peaked and the incidence is leveling off. The most recent combined rates for childhood overweight and obesity amongst 2–15 year olds are 31% for boys and 30% for girls. Causes and consequences of childhood overweight and obesity have been investigated in a number of observational studies and three systematic reviews have concluded that rapid weight gain during infancy is associated with greater obesity risk in later life. An infant's weight trajectory may be influenced by a number of risk factors that are potentially modifiable during their early years. These include infant feeding practices, parental response to infant temperament and parental perception of infant growth and appetite.
Infant Feeding Practices
The relationship between breast feeding and obesity risk in childhood has been investigated in a number of studies, with contradictory findings. A systematic review and meta analysis conducted in 2004, concluded that breast feeding has a small but consistent protective effect against the development of obesity during childhood. There is emerging experimental evidence that the higher protein content of formula milk may be partially responsible for greater weight gain. There is also observational evidence that early weaning onto solid foods (< 4 months) is significantly associated with overweight or obesity at 3 years. A UK longitudinal cohort study found that infants fed with formula milk were introduced to solid foods earlier than breast fed infants and were less likely to have consumed fruit and vegetables. These study results require cautious interpretation as the cohort consisted exclusively of white, singleton children, who were from more affluent backgrounds. There may be other differences between mothers who choose to breastfeed and those that do not (e.g. breastfeeding mothers may be more health conscious, more responsive to their infant and have a higher socio-economic status (SES)).
Parental Response to Infant Temperament
Parental response to infant temperament is a risk factor for childhood obesity. A qualitative study of 14 low income mothers with overweight young children reported that food was used to soothe fussy infants, calm temper tantrums and shape behaviour. In another study infants with a temperament dimension described as "fear" in relation to their acceptance or rejection of new objects or people were significantly slower to gain weight than those described as "distress to limitations" which is characterized by frustration, reduced sleep, excessive crying and fussiness. The authors speculate that parents who perceive their infants to be fussy or frustrated may use food as comfort which may account for the differences in weight gain between the two groups.
Parental Perception of Infant Growth and Appetite
Parental perceptions about appropriate size, growth and feeding patterns play an important role in the development of childhood obesity. Baughcum and colleagues, in the study described above, reported that mothers had strong beliefs that heavy infants were desirable as weight was the best marker of health and successful parenting. In a later study, Baughcum and colleagues assessed maternal feeding practices and beliefs using feeding questionnaires for infants (n = 453) and pre-school children (n = 634). They described different feeding behaviours between high and low income mothers. Low income mothers reported greater concern about their child's hunger, a lower tendency to use food to calm and greater difficulty feeding their children. They also reported pushing their child to eat more and engaging in more age-inappropriate feeding.
Parental beliefs and understanding are crucial determinants of infant feeding behaviour, therefore any intervention will need to take account of these views. This study aimed to explore UK parents' beliefs concerning their infant's size, growth and feeding behaviours and their receptiveness to early intervention aimed at reducing the risk of childhood obesity.
The objectives were:
To explore perceptions of appropriate infant size and growth including possible cultural influences.
To investigate parental views around infants identified as at risk of childhood obesity by a health professional.
To determine parents' beliefs about infant feeding practices and weaning approaches