First Steps for Mommy and Me: A Pilot Intervention to Improve Nutrition and Physical Activity Behaviors of Postpartum Mothers and Their Infants

Abstract

To assess the feasibility of a pediatric primary care based intervention to promote healthful behaviors among 0–6 month old infants and their mothers. We enrolled two intervention practices (60 mother-infant pairs) and one usual care control practice (24 pairs) in a non-randomized controlled trial. We completed visits and interviews with 80 (95%) pairs at birth and 6 months. The intervention included (1) brief focused negotiation by pediatricians, (2) motivational counseling by a health educator, and (3) group parenting workshops. We evaluated the intervention effects on infant feeding, sleep duration, TV viewing, and mothers’ responsiveness to satiety cues. Maternal behavioral targets included postpartum diet, physical activity, TV and sleep. At 6 months, fewer intervention than control infants had been introduced to solid foods (57% vs. 82%; P = 0.04), and intervention infants viewed less TV (mean 1.2 vs. 1.5 h/d; P = 0.07). Compared to control infants, intervention infants had larger increases in their nocturnal sleep duration from baseline to follow up (mean increase 1.9 vs. 1.3 h/d; P = 0.05); larger reductions in settling time (mean reduction −0.70 vs. −0.10 h/d; P = 0.02); and larger reductions in hours/day of nighttime wakefulness (mean reduction −2.9 vs. −1.5 h/d; P = 0.08). There were no differences in breastfeeding, response to satiety cues, or maternal health behaviors. A program of brief focused negotiation by pediatricians, individual coaching by health educators using motivational interviewing, and group parenting workshops tended to improve infant feeding, sleep and media exposure, but had less impact on mothers’ own health-related behaviors.

Group Visits to Improve Pediatric Attention-Deficit Hyperactivity Disorder Chronic Care Management

“…As with any pediatric chronic condition, it is imperative to engage both parents and children in the process of self-care to improve short and long-term outcomes 21,31 . Our promising findings add support to the consideration of using a group visit model to improve adherence to recommended visits and medical home management of chronic conditions 14,16,32,33 .…”

“…This model has been explored for well-child care 12,13 , prenatal care 14 , treatment of childhood disruptive behaviors 15 , and chronic care management for pediatric asthma 16 . However, there are no studies in the literature examining its use for pediatric ADHD chronic care management.…”

A Parent-Focused Intervention to Reduce Infant Obesity Risk Behaviors: A Randomized Trial

“…This focus for obesity prevention has gained considerable currency since this study commenced, with 1 published protocol, 28 2 pilot studies, 29,30 and 1 additional RCT published. 31 Data from the pilots and RCTs, targeting mothers and infants ,6 months of age, provide additional support for a focus on early childhood with 1 nonrandomized trial (n = 80) reporting a trend to reductions in television viewing 30 and another (n = 110) reporting a lower weight-forlength percentile in intervention children (P = .009).…”

“…This focus for obesity prevention has gained considerable currency since this study commenced, with 1 published protocol, 28 2 pilot studies, 29,30 and 1 additional RCT published. 31 Data from the pilots and RCTs, targeting mothers and infants ,6 months of age, provide additional support for a focus on early childhood with 1 nonrandomized trial (n = 80) reporting a trend to reductions in television viewing 30 and another (n = 110) reporting a lower weight-forlength percentile in intervention children (P = .009). 29 Wen' s RCT intensive home visiting intervention 31 targeting families living in socially and economically disadvantaged areas of Sydney, Australia (n = 667), reports lower BMI and improvements in some obesitypromoting behaviors at age 2 years in the intervention compared with the control group.…”

Life Course Research Agenda (LCRA), Version 1.0

“…For example, the chapter by Hawkins and colleagues (Hawkins et al 2017) suggests that a key to reducing childhood obesity is finding the right level and time in the life course to intervene for the maximal effectiveness and efficiency of interventions. However, the challenge of mounting programs designed to modify obesogenic health development pathways may be quite complex, involving multiple settings (e.g., medical care, homes, child care, school) (Taveras, Blackburn, et al 2011a;Taveras, Gortmaker, et al 2011b;Taveras et al 2012), or components (e.g., system redesign, individual behavior change strategies including e-technology) (Lubans et al 2010;Taveras et al 2012), and targeting single or multiple factors (Taveras, Gortmaker, et al 2011b;Vesco et al 2012).…”