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.

Evaluation of a breastfeeding assessment score in a diverse population.

A previous study performed in a predominately suburban population developed a breastfeeding assessment score (BAS) that was designed to predict, prior to hospital discharge, those mothers who would discontinue breastfeeding within the first 10 days of age. The purpose of the present study was to assess the BAS in a more diverse population. Patients were solicited from 3 urban hospitals serving patients primarily supported by public funding. Results of the present study with 1182 mother-infant pairs confirmed that 5 variables scored on a 0-2 scale (maternal age, previous breastfeeding experience, latching difficulty, breastfeeding interval, number bottles) remained highly significant for predicting discontinuation of breastfeeding. The data also demonstrate that the BAS is inversely related to the risk of cessation of breastfeeding at 7 to 10 days of age. Those at an early risk of cessation of breastfeeding, identified by the BAS, may benefit from early identification and a lactation consultation.

Assignment to a hospital-based breastfeeding clinic and exclusive breastfeeding among immigrant Hispanic mothers: a randomized, controlled trial.

A randomized controlled trial is used to determine whether assigning mixed feeders to a breastfeeding clinic within 1 week postpartum will increase exclusive breastfeeding at 1 month among Hispanic immigrants. Subjects are eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 85% are monolingual Hispanic. Mothers (n = 522) of infants at low risk for hyperbilirubinemia are approached at bedside 20 to 48 hours after delivery and randomly assigned to treatment or control groups. Intent-to-treat analysis of feeding behavior at 4 weeks postpartum indicates that the intervention group is more likely to be exclusively breastfeeding (16.4% vs 10% in the control group, P = .03; adjusted odds ratio 1.87; 95% confidence interval, 1.07-3.26); that the incidence of formula supplementation does not differ between groups; and that the intervention group is less likely to supplement with water and tea (P < .002).

Maternal response to two electric breast pumps.

BACKGROUND AND OBJECTIVE: Mechanical characteristics of breast pumps have been shown to influence milk extraction and hormone release in laboratory settings. However, few studies evaluate impact of differences in pump design on long-term breastfeeding success. This study evaluated the impact of a novel pump design on milk extraction, milk fat content, maternal hormone response, maternal satisfaction, long-term milk production, and duration of breastfeeding following return to the workforce. DESIGN AND METHODS: Healthy women intending to return to work or school and to breastfeed exclusively for

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.

Benefits and risks of breastfeeding.

In the absence of significant, unpreventable risks, breastfeeding should be the norm for the nourishment of human infants and should, therefore, be encouraged for populations in all countries. Continued efforts of international and national agencies and healthcare professionals to aid and abet breastfeeding, reduce the risks that occur in some women during breastfeeding, provide the safest substitutes for human milk when that is necessary, and encourage further research into the posed questions should considerably improve the health of many children.

Composition of gestational weight gain impacts maternal fat retention and infant birth weight.

OBJECTIVE: The purpose of this study was to evaluate how changes in gestational weight and body composition affect infant birth weight and maternal fat retention after delivery in underweight, normal-weight and overweight women. STUDY DESIGN: We assessed the body composition of 63 women (low body mass index, 17 women; normal body mass index, 34 women; and high body mass index, 12 women) on the basis of measurements of total body nitrogen by prompt-gamma activation analysis, total body potassium by whole body counting, and a multicomponent model based on total body water by deuterium dilution, body volume by densitometry, and bone mineral content by dual energy x-ray absorptiometry (DXA) before pregnancy, at 9, 22, and 36 weeks of gestation, and at 2, 6, and 27 weeks after delivery. Infant weight and length were recorded at birth; infant anthropometry and body composition by DXA were assessed at 2 and 27 weeks of age. RESULTS: Gestational weight gain was correlated significantly with gains in total body water, total body potassium, protein, fat-free mass, and fat mass (P=.001-.003). Gains in total body water, total body potassium, protein and fat-free mass did not differ among body mass index groups; however, fat mass gain was higher in the high body mass index group (P=.03). Birth weight was correlated positively with gain in total body water, total body potassium, and fat-free mass (P<.01), but not fat mass. Postpartum weight and fat retention were correlated positively with gestational weight gain (P=.001) and fat mass gain (P=.001) but not with total body water, total body potassium, or fat-free mass gain. CONCLUSION: Appropriate, but not excessive, gestational weight gain is needed to optimize infant birth weight and minimize maternal postpartum fat retention.

Energy requirements of women of reproductive age.

BACKGROUND: The energy requirements of women have been based on total energy expenditure (TEE) derived from the factorial approach or as multiples of basal metabolic rate (BMR). OBJECTIVE: This study was designed to reevaluate the energy requirements of healthy, moderately active underweight, normal-weight, and overweight women of reproductive age. DESIGN: The energy requirements of 116 women [n = 13 with a low body mass index (BMI), n = 70 with a normal BMI, and n = 33 with a high BMI] were estimated from TEE measured by the doubly labeled water method. Twenty-four-hour EE and BMR were measured by room respiration calorimetry, activity EE was estimated from nonbasal EE as TEE - BMR, and physical activity level was calculated as TEE/BMR. Body composition was derived from a multicomponent model. Fitness, strength, and physical activity level were assessed, and fasting serum indexes were measured. RESULTS: Energy requirements differed among the low-BMI (8.9 +/- 0.9 MJ/d), normal-BMI (10.1 +/- 1.4 MJ/d), and high-BMI (11.5 +/- 1.9 MJ/d) groups (P = 0.02-0.001, all pairwise comparisons). Major predictors of BMR, 24-h EE, and TEE were weight, height, and body composition; minor predictors were fasting metabolic profile and fitness. Fat-free mass and fat mass accounted for the differences in EE seen between the BMI groups. The mean physical activity level of 1.86 suggested that the multiples of BMR used to estimate energy requirements have been underestimated. CONCLUSION: Recommended energy intakes for healthy, moderately active women of reproductive age living in industrialized societies should be revised on the basis of TEE.