More than 20% of US children between ages 2 and 5 years are overweight suggesting efforts to prevent obesity must begin earlier. This study tested the independent and combined effects of two behavioral interventions delivered to parents, designed to promote healthy infant growth in the first year. Mother–newborn dyads intending to breastfeed were recruited from a maternity ward. With a 2 × 2 design, 160 dyads were randomized into one of four treatment cells to receive both, one, or no interventions delivered at two nurse home visits. The first intervention (“Soothe/Sleep”) instructed parents on discriminating between hunger and other sources of infant distress. Soothing strategies were taught to minimize feeding for non-hunger-related fussiness and to prolong sleep duration, particularly at night. The second intervention (“Introduction of Solids”) taught parents about hunger and satiety cues, the timing for the introduction of solid foods, and how to overcome infants’ initial rejection of healthy foods through repeated exposure. A total of 110 mother–infant dyads completed the year-long study. At 1 year, infants who received both interventions had lower weight-for-length percentiles (P = 0.009). Participants receiving both interventions had a mean weight-for-length in the 33rd percentile; in contrast, those in other study groups were higher first intervention only—50th percentile; second intervention only—56th percentile; control group—50th percentile).This suggests that multicomponent behavioral interventions may have potential for long-term obesity prevention (ClinicalTrials.gov number, NCT00359242).

BackgroundBecause early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This “parenting” intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT’s central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent–child responsibility for feeding, reducing subsequent risk for overeating and overweight.Methods/Design316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the “parenting” or “safety” groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3–4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second-born siblings of INSIGHT participants will be enrolled in an observation-only study to explore parenting differences between siblings, their effect on weight outcomes, and carryover effects of INSIGHT interventions to subsequent siblings.DiscussionWith increasing evidence suggesting the importance of early life experiences on long-term health trajectories, the INSIGHT trial has the ability to inform future obesity prevention efforts in clinical settings.Trial registrationNCT01167270. Registered 21 July 2010.

Postpartum state anxiety is a common, acute phenomenon during the maternity hospitalization that is associated with increased maternal health care utilization after discharge and reduced breastfeeding duration. State anxiety screening during the postpartum stay could improve these outcomes.

IMPORTANCE Rapid growth and elevated weight status in early childhood increase risk for later obesity, but interventions that improve growth trajectories are lacking.OBJECTIVE To examine effects of a responsive parenting intervention designed to promote developmentally appropriate, prompt, and contingent responses to a child's needs on weight outcomes at 3 years. DESIGN, SETTING, AND PARTICIPANTSA single-center randomized clinical trial comparing a responsive parenting intervention designed to prevent childhood obesity vs a home safety intervention (control) among 279 primiparous mother-child dyads (responsive parenting group, 140; control group, 139) who enrolled and completed the first home visit from January 2012 through March 2014 with follow-up to age 3 years (completed by April 2017).INTERVENTIONS Research nurses conducted 4 home visits during infancy and annual research center visits. The responsive parenting curriculum focused on feeding, sleep, interactive play, and emotion regulation. The control curriculum focused on safety. MAIN OUTCOMES AND MEASURESThe primary outcome was body mass index (BMI) z score at 3 years (z score of 0 represents the population mean; 1 and −1 represent 1 SD above and below the mean, respectively). BMI percentile at 3 years was designated previously as the primary outcome. Secondary outcomes included the prevalence of overweight (BMI Ն85th percentile and <95th percentile) and obesity (BMI Ն95th percentile) at 3 years. RESULTS Among 291 mother-child dyads randomized, 279 received the first home visit and were included in the primary analysis. 232 mother-child dyads (83.2%) completed the 3-year trial. Mean age of the mothers was 28.7 years; 86% were white and 86% were privately insured. At age 3 years, children in the responsive parenting group had a lower mean BMI z score (−0.13 in the responsive parenting group vs 0.15 in the control group; absolute difference, −0.28 [95% CI, −0.53 to −0.01]; P = .04). Mean BMI percentiles did not differ significantly (47th in the responsive parenting group vs 54th in the control group; reduction in mean BMI percentiles of 6.9 percentile points [95% CI, −14.5 to 0.6]; P = .07). Of 116 children in the responsive parenting group, 13 (11.2%) were overweight vs 23 (19.8%) of 116 children in the control group (absolute difference, −8.6% [95% CI, −17.9% to 0.0%]; odds ratio [OR], 0.51 [95% CI, 0.25 to 1.06]; P = .07); 3 children (2.6%) in the responsive parenting group were obese vs 9 children (7.8%) in the control group (absolute difference, −5.2% [95% CI, −10.8% to 0.0%]; OR, 0.32 [95% CI, 0.08 to 1.20]; P = .09).CONCLUSIONS AND RELEVANCE Among primiparous mother-child dyads, a responsive parenting intervention initiated in early infancy compared with a control intervention resulted in a modest reduction in BMI z scores at age 3 years, but no significant difference in BMI percentile. Further research is needed to determine the long-term effect of the intervention and assess its efficacy in other settings.

Women who have breastfed previously have significantly different breastfeeding experiences than primiparous women. Pre- and postdelivery breastfeeding support should differentially target primiparous women to improve breastfeeding outcomes.