A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment

BACKGROUND: Infancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment.

METHODS: One-on-one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants' education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis.

RESULTS: Participants were 29 mothers of infants aged 2-11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother's likelihood to adopt the healthy target behaviours although the relative importance of each of the COM-B factors varied with each of the target feeding behaviours.

CONCLUSIONS: Interventions targeting healthy infant feeding practices should be tailored to the unique factors that may influence mothers' various feeding practices, taking into account motivational and social influences.

Associations between child temperament, maternal feeding practices and child body mass index during the preschool years: a systematic review of the literature

It is a research priority to identify modifiable risk factors to improve the effec- tiveness of childhood obesity prevention strategies. Research, however, has largely overlooked the role of child temperament and personality implicated in obesogenic risk factors such as maternal feeding and body mass index (BMI) of preschoolers. A systematic review of relevant literature was conducted to inves- tigate the associations between child temperament, child personality, maternal feeding and BMI and/or weight gain in infants and preschoolers; 18 papers were included in the review. The findings revealed an association between the temperament traits of poor self-regulation, distress to limitations, low and high soothability, low negative affectivity and higher BMI in infants and preschool- aged children. Temperament traits difficult, distress to limitations, surgency/ extraversion and emotionality were significantly associated with weight gain rates in infants. The results also suggested that child temperament was associated with maternal feeding behaviours that have been shown to influence childhood over- weight and obesity, such as using restrictive feeding practices with children per- ceived as having poor self-regulation and feeding potentially obesogenic food and drinks to infants who are more externalizing. Interestingly, no studies to date have evaluated the association between child personality and BMI/weight gain in infants and preschoolers. There is a clear need for further research into the association of child temperament and obesogenic risk factors in preschool-aged children.

Effects of parent and child behaviours on overweight and obesity in infants and young children from disadvantaged backgrounds: systematic review with narrative synthesis

BACKGROUND: Despite the crucial need to develop targeted and effective approaches for obesity prevention in children most at risk, the pathways explaining socioeconomic disparity in children's obesity prevalence remain poorly understood.

METHODS: We conducted a systematic review of the literature that investigated causes of weight gain in children aged 0-5 years from socioeconomically disadvantaged or Indigenous backgrounds residing in OECD countries. Major electronic databases were searched from inception until December 2015. Key words identified studies addressing relationships between parenting, child eating, child physical activity or sedentary behaviour and child weight in disadvantaged samples.

RESULTS: A total of 32 articles met the inclusion criteria. The Mixed Methods Appraisal Tool quality rating for the studies ranged from 25 % (weak) to 100 % (strong). Studies predominantly reported on relationships between parenting and child weight (n = 21), or parenting and child eating (n = 12), with fewer (n = 8) investigating child eating and weight. Most evidence was from socio-economically disadvantaged ethnic minority groups in the USA. Clustering of diet, weight and feeding behaviours by socioeconomic indicators and ethnicity precluded identification of independent effects of each of these risk factors.

CONCLUSIONS: This review has highlighted significant gaps in our mechanistic understanding of the relative importance of different aspects of parent and child behaviours in disadvantaged population groups.

Seasonal and diet comparisons of the diets of four dominant fish species within the main channel and flood-zone of a small intermittently open estuary in south-eastern Australia

The diets of four highly-abundant, dominant fish species within the Surrey River, a small intermittently open estuary in south-east Australia, were examined from specimens collected between July 2004 and June 2005. These four, similar-sized species (Atherinosoma microstoma, Galaxias maculatus, Philypnodon grandiceps and Pseudogobius olorum) have limited ability to spatially segregate along the length of the estuary owing to its small size relative to other estuarine habitats. All four species fed on a variety of prey items including crustaceans, insects and detritus. Despite this parity, the four species were demonstrated to occupy differing dietary niches that were concluded to be responsible for reducing interspecific feeding competition. Seasonal variations in the diets were observed for A. microstoma and Philypnodon grandiceps, with these species also exhibiting contrasting diel feeding behaviours. The closure of the estuary mouth led to the flooding of its margins, resulting in an increase in the size of the estuary and providing alternative food resources for the fish to exploit. It appears the inundation of the flood-zone facilitated further significant divergence in the diets of the fish and is likely to be of high ecological value to the estuary.

Parental socialisation of preschool children's food preferences

The research examined parental socialisation of preschool children's food preferences. The findings indicated that parents' beliefs, child characteristics and parents' feeding behaviours contribute to children's food preferences. In particular, parents' self-efficacy beliefs and beliefs about why children reject foods on the one hand, and children's food neophobia on the other hand appear to influence children's everyday food preferences.

Quantification of allochthonous nutrient input into freshwater bodies by herbivorous waterbirds

1. Waterbirds are considered to import large quantities of nutrients to freshwater bodies but quantification of these loadings remains problematic. We developed two general models to calculate such allochthonous nutrient inputs considering food intake, foraging behaviour and digestive performance of waterbirds feeding in terrestrial habitats: an intake model (IM), mainly based on an allometric relationship for energy requirements and a dropping model (DM), based on allometric relationships for defaecation.

2. Reviewed data of nitrogen (N) and phosphorus (P) content of herbivorous food varied according to diet type (foliage, seeds and roots), season and fertilization. For model parameterization average foliage diet contained 38.20 mg N g⁻¹ and 3.21 mg P g⁻¹ (dry weight), whereas mean faeces composition was 45.02 mg N g⁻¹ and 6.18 mg P g⁻¹.

3. Daily allochthonous nutrient input increased with body mass ranging from 0.29 g N and 0.03 g P in teals Anas crecca to 5.69 g N and 0.57 g P in mute swans Cygnus olor. Results from IM differed from those of DM from ducks to swans by 63–108% for N and by −4 to 23% for P. Model uncertainty was lowest for the IM and mainly caused by variation in estimates of food retention time (RT). In DM food RT and dropping mass determined model uncertainty in similar extent.

4. Exemplarily applying the models to Dutch wetlands resulted in mean annual contribution of herbivorous waterbirds to allochthonous nutrient loading of 382.8 ± 167.1 tonnes N a⁻¹and 34.7 ± 2.3 tonnes P a⁻¹, respectively, which corresponds to annual surface-water loadings of 1.07 kg N ha⁻¹ and 0.10 kg P ha⁻¹.

5. There was a distinct seasonal pattern with peak loadings in January, when bird abundances were highest. Lowest inputs were in August, when bird abundance and nutrient content in food was low and birds foraged less in terrestrial habitats. Three-quarters of all nutrient input was contributed by greater white-fronted goose Anser albifrons, greylag goose Anser anser, wigeon Anas penelope and barnacle goose Branta leucopsis alone.

6. We provide general, easy to use calculation methods for the estimation of allochthonous nutrient inputs by waterbirds, which are applicable to a range of waterbird species, a variety of potential diets and feeding behaviours, and across spatial scales. Such tools may greatly assist in the planning and execution of management actions for wetland nutrient budgets.

Strategies used by parents to influence their children's food preferences.

Food preferences are important determinants of children's food intakes. Parental feeding behaviours have a significant influence on the development of children's food preferences. The aim of the present study was to describe the ways in which parents attempt to influence their children's food preferences.

Maternal feeding practices predict weight gain and obesogenic eating behaviours in young children : a prospective study

Background Maternal feeding practices have been proposed to play an important role in early child weight gain and obesogenic eating behariours. However, to date longitudinal investigations in young children exploring these relationships have been lacking. The aim of the present study was to explore prospective relationships between maternal feeding practices, child weight gain and obesogenic eating behaviours in 2-year-old children. The competing hypothesis that child eating behaviours predict changes in maternal feeding practices was also examined.

Methods A sample of 323 mother (mean age = 35 years, + 0.37) and child dyads (mean age = 2.03 years, + 0.37 at recruitment) were participants. Mothers completed a questionnaire assessing parental feeding practices and child eating behaviours at baseline and again one year later. Child BMI (predominantly objectively measured) was obtained at both time points.

Results Increases in child BMI z-scores over the follow-up period were predicted by maternal instrumental feeding practices. Furthermore, restriction, emotional feeding, encouragement to eat, weight-based restriction and fat restriction were associated prospectively with the development of obesogenic eating behaviours in children including emotional eating, tendency to overeat and food approach behaviours (such as enjoyment of food and good appetite). Maternal monitoring, however, predicted decreases in food approach eating behaviours. Partial support was also observed for child eating behaviours predicting maternal feeding practices.

Conclusions Maternal feeding practices play an important role in the development of weight gain and obesogenic eating behaviours in young children and are potential targets for effective prevention interventions aiming to decrease child obesity.

Foraging ecology of ground-feeding woodland birds in temperate woodlands of Southern Australia

Ground-foraging birds of temperate woodlands of southern Australia are prominent among bird species considered to be susceptible to population decline. We examined the foraging ecology, including foraging substrates, actions and heights, of 13 ground-foraging species at four woodland sites in northern Victoria. Nine species are regarded as declining in southern Australia and four are considered common. Ten foraging substrates were identified, of which leaf-litter (54% of observations) and bare ground (17%) were most frequently used. In all woodland sites, litter was used more frequently than expected from its proportional cover. Bare ground was frequently used as a substrate by individual species, and fallen timber and grass were important for some species. Most species were generalists in their use of substrates. Six foraging actions were observed, of which gleaning and pouncing were most frequently recorded. All species foraged close to the ground and four foraged almost entirely at ground level. For pouncing birds, dead branches and fallen timber were the most important launch substrates from which pouncing actions were initiated. Eight of the 13 species differed in some aspect of their foraging ecology between woodland sites, especially in relation to the use of substrates (seven species). Fewer species (four) displayed differences in foraging ecology between seasons, with the greatest seasonal variation being in use of foraging substrates (three species). Overall, no significant differences were evident in the foraging ecologies of common and declining species. Species in both groups encompassed a wide range of foraging behaviours. Owing to this range in foraging ecology, the conservation of diverse assemblages of ground-foraging birds requires the maintenance of heterogeneous ground layers and careful management of disturbance processes.

The infant feeding activity and nutrition trial (INFANT) an early intervention to prevent childhood obesity : cluster-randomised controlled trial

Background : Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.

Methods/Design : This cluster-randomised controlled trial, with first-time parent groups as the unit of randomisation, will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents' group at Maternal and Child Health Centres. Using a two-stage sampling process, local government areas in Victoria, Australia will be randomly selected at the first stage. At the second stage, a proportional sample of first-time parent groups within selected local government areas will be randomly selected and invited to participate. Informed consent will be obtained and groups will then be randomly allocated to the intervention or control group.

Discussion : The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge this will be the first randomised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating, physical activity and reduced sedentary behaviours. If proven to be effective, INFANT may protect children from the development of obesity and its associated social and economic costs.

Maternal correlates of preschool child eating behaviours and body mass index : a cross-sectional study

To the authors’ knowledge, this is the first study to evaluate maternal child feeding practices, maternal parenting characteristics and mother-child interactions as cross-sectional predictors of child eating and/or weight within the one sample. Maternal pressure for her child to eat was a significant positive correlate of fussiness and a negative correlate of enjoyment. Maternal parenting warmth was associated negatively with child BMIz, while mother-child dysfunctional interaction was associated positively with child BMIz. Our findings suggest that childhood obesity research may be better informed by evaluating not just what mothers do (feeding practices) but also how they parent (parenting behaviours and interactions with their child). Longitudinal studies are needed to identify causal influences of parenting on preschool child eating and weight.

Maternal predictors of preschool child-eating behaviours, food intake and body mass index : a prospective study

This study extends McPhie et al. (2011)'s [Maternal correlates of preschool child eating behaviours and body mass index: A cross-sectional study. International Journal of Pediatric Obesity, Early Online, 1–5.] McPhie et al. (2011)’s cross-sectional research, by prospectively evaluating maternal child-feeding practices, parenting style and mother–child interactions as predictors of child-eating behaviours, food habits and weight. A sample of 117 mothers of preschoolers (63 girls, 54 boys) participated at two time-points, Time 1 (T1) and Time 2 (T2), 12 months apart. Results from the two path models revealed maternal pressure to eat at T1 positively predicted change in child enjoyment of food. Maternal warmth at T1 negatively predicted child unhealthy food habits at T2. At T1, family income and maternal control negatively predicted change in child body mass index z-scores (BMIz); maternal pressure to eat at T1 also positively predicted change in child BMIz. There were significant results specific to each model. Both final path models provided an adequate fit. Our findings suggest childhood obesity is predicted by a complex interplay of demographic, maternal and child variables.

The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

Background
Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families.

Methods
Searches of major electronic databases identified articles published from 1993–2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.

Results
Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m2 to -0.54 kg/m2 for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3–5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery.

Conclusion
There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required.

Maternal correlates of maternal child feeding practices: a systematic review.

Establishing healthy eating habits early in life is one important strategy to combat childhood obesity. Given that early maternal child feeding practices have been linked to child food intake and weight, identifying the maternal correlates of maternal child feeding practices is important in order to understand the determinants of childhood obesity; this was the overall aim of the current review. Academic databases were searched for studies examining the relationship between maternal child feeding practices and parenting, personal characteristics and psychopathology of mothers with preschoolers. Papers were limited to those published in English, between January 2000 and June 2012. Only studies with mothers of normally developing children between the ages of 2 and 6 years were included. There were no restrictions regarding the inclusion of maternal nationality or socioeconomic status (SES). Seventeen eligible studies were sourced. Information on the aim, sample, measures and findings of these was summarised into tables. The findings of this review support a relationship between maternal controlling parenting, general and eating psychopathology, and SES and maternal child feeding practices. The main methodological issues of the studies reviewed included inconsistency in measures of maternal variables across studies and cross-sectional designs. We conclude that the maternal correlates associated with maternal child feeding practices are complex, and the pathways by which maternal correlates impact these feeding practices require further investigation.