The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study

Paul, Ian M.; Williams, Jennifer Savage; Anzman‐Frasca, Stephanie; Beiler, Jessica S.; Makova, Kateryna D.; Marini, Michele; Hess, Lindsey; Rzucidlo, Susan; Verdiglione, Nicole; Mindell, Jodi A.; Birch, Leann L.

doi:10.1186/1471-2431-14-184

Cited by 114 publications

(181 citation statements)

References 138 publications

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“…The study design and inclusion/exclusion criteria have been published previously. 30 Major eligibility criteria included term singletons weighing ≥2500 g delivered to English-speaking, primiparous mothers ≥20 years old. Using a computer-generated algorithm, 291 dyads were randomized 2 weeks after delivery to the RP or control groups, stratified on birth weight for gestational age (<50th percentile or ≥50th percentile) and intended feeding mode (breastfeeding or formula).…”

Section: Methodsmentioning

confidence: 99%

“…As described previously, research nurses were trained in administering both the RP and control interventions 30 at home visits conducted at infant age 3–4, 16, 28, and 40 weeks, and a research center visit occurred at age 1 year. This study was approved by the Penn State College of Medicine’s Human Subjects Protection Office and registered at http://www.clinicaltrials.gov without sleep noted as an a priori outcome.…”

Section: Methodsmentioning

confidence: 99%

“…30 Lessons include instructing parents to (1) recognize infant hunger and satiety cues; (2) use alternatives to feeding to soothe a fussy, but nonhungry, infant; (3) provide appropriate portions of healthy foods and allow children to determine the amount consumed; (4) improve acceptance of developmentally appropriate foods such as vegetables through repeated exposure and positive role modeling, while discouraging controlling feeding practices; and (5) actively engage infants in playtime to reduce sedentary behaviors.…”

Section: Methodsmentioning

confidence: 99%

“…On the basis of previous research, 26–28 the sleep components focused on consolidating sleep and extending night sleep duration by providing guidance on sleep-related parenting behaviors, particularly establishing consistent bedtime routines, encouraging self-soothing and early bedtimes, and strategies to address night waking. 30 In this ongoing randomized, controlled trial, the RP intervention is compared with a home safety control intervention that includes a safe sleep component. We assessed intervention effects on infant sleep in the first year with the hypothesis that sleep duration would be longer and positive sleep-related behaviors would be more prevalent compared with controls.…”

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confidence: 99%

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INSIGHT Responsive Parenting Intervention and Infant Sleep

et al. 2016

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OBJECTIVES Inadequate sleep during infancy is associated with adverse outcomes for infants and families. We sought to improve sleep behaviors and duration through a responsive parenting (RP) intervention designed for obesity prevention. METHODS The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is a randomized trial comparing a RP intervention with a safety control. Primiparous mother-newborn dyads were randomized after childbirth, and research nurses delivered intervention content at home visits at infant ages 3, 16, 28, and 40 weeks and at a research center visit at 1 year. The RP sleep component included developmentally appropriate messages about bedtime routines, sleep location and behaviors, and responses to wakings. Portions of the Brief Infant Sleep Questionnaire were administered 2, 8, and 52 weeks after birth with expanded sleep-related data collection at 16 and 40 weeks. RESULTS Two hundred and seventy-nine dyads completed the first home visit; 90.7% completed the 1-year visit. Compared with controls, RP group infants were less likely to have prolonged bedtime routines >45 minutes and more likely to have earlier bedtimes at 16 and 40 weeks. They were less likely to be fed immediately before bed and more likely to self-soothe to sleep. At 8, 16, and 40 weeks, RP group nocturnal sleep duration was longer by 35, 25, and 22 minutes, respectively (P < .05 for all). Sleep duration at 1 year was similar between groups. CONCLUSIONS The INSIGHT RP intervention positively influenced developmentally appropriate bedtime routines, sleep-related behaviors, and sleep duration for infants.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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INSIGHT Responsive Parenting Intervention and Infant Sleep

et al. 2016

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“…The study design and inclusion and exclusion criteria have been previously published. 26 Major eligibility criteria specified that the subjects be term singletons weighing ≥2500 g delivered to English-speaking, primiparous mothers ≥20 years old. Dyads were randomly assigned 2 weeks after delivery to a responsive parenting (RP) intervention or a safety control group.…”

Section: Participants and Designmentioning

confidence: 99%

Mother-Infant Room-Sharing and Sleep Outcomes in the INSIGHT Study

et al. 2017

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The American Academy of Pediatrics recommends infant-parent room-sharing until age 1. We assessed the association between room-sharing and sleep outcomes. METHODS:The Intervention Nurses Start Infants Growing on Healthy Trajectories study is an obesity prevention trial comparing a responsive parenting intervention with a safety control among primiparous mother-infant dyads. Mothers completed the Brief Infant Sleep Questionnaire at 4, 9, 12, and 30 months. Reported sleep duration and overnight behaviors, adjusted for intervention group, were compared among early independent sleepers (own room <4 months), later independent sleepers (own room between 4 and 9 months), and room-sharers at 9 months. RESULTS:At 4 months, reported overnight sleep duration was similar between groups, but compared with room-sharers, early independent sleepers had better sleep consolidation (longest stretch: 46 more minutes, P = .02). At 9 months, early independent sleepers slept 40 more minutes nightly than room-sharers and 26 more minutes than later independent sleepers (P = .008). The longest stretch for early independent sleepers was 100 and 45 minutes more than room-sharers and later independent sleepers, respectively (P = .01). At 30 months, infants sleeping independently by 9 months slept >45 more minutes nightly than those room-sharing at 9 months (P = .004). Room-sharers had 4 times the odds of transitioning to bed-sharing overnight at both 4 and 9 months (P < .01 for both). CONCLUSIONS:Room-sharing at ages 4 and 9 months is associated with less nighttime sleep in both the short and long-term, reduced sleep consolidation, and unsafe sleep practices previously associated with sleep-related death.

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Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age

Paul

Savage

Anzman‐Frasca

et al. 2018

JAMA

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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.

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The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study

Cited by 114 publications

References 138 publications

INSIGHT Responsive Parenting Intervention and Infant Sleep

INSIGHT Responsive Parenting Intervention and Infant Sleep

Mother-Infant Room-Sharing and Sleep Outcomes in the INSIGHT Study

Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age

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