Testing the Feasibility & Fidelity of the Learning Early Infant Feeding Cues (LEIFc) Intervention

3.0 Background* 3.1 and 3.3 Health disparities in pediatric obesity are staggering; Non-Hispanic black and Hispanic children have obesity rates (22.2% and 25.8% respectively) higher than the national average (18.5%) and higher than non-Hispanic white children (14.1%).1,2 Additionally, children of low socioeconomic status (SES) are more likely to have obesity.2,3 These same populations are disproportionately affected by lifelong cardiometabolic conditions that result from obesity such as hypercholesterolemia, hypertension, and type 2 diabetes.4 Children with obesity are also more likely to suffer from mental health disorders (i.e., depression, anxiety) and complications of the pulmonary, orthopedic, and gastrointestinal systems.2,5,6 Lifestyle modifications implemented early in life are key to preventing obesity and the resulting lifelong complications. The first 1,000 days of life, from conception to age two years, is a critical period for development of habits that contribute to one's weight status later in life, such as dietary preferences and behaviors.7-10 Therefore, interventions implemented during the first 1,000 days and targeting infants from high-risk groups have potential to decrease one's obesity risk and address racial/ethnic and socioeconomic health disparities.

Infant feeding practices, which include what and how infants are fed, are one such habit that could be modified to decrease obesity risk.5 Exclusive formula feeding, short duration of breastfeeding when initiated, and early introduction of complementary foods contribute to rapid infant weight gain which, in turn, contributes to higher risk for childhood obesity.11,12 Many initiatives have targeted "what" infants are fed (i.e., promoting breastfeeding and healthy dietary intake) whereas "how" infants are fed is also important, yet understudied.5,8,13,14 The responsive feeding approach is thought to promote the ability to recognize and respond to internal cues of hunger and satiety.13-17 The ability to recognize these internal cues and self-regulate intake in response to physiologic need is associated with healthy weight gain trajectories.13,16 Responsive feeding occurs when a parent (or other caregiver) learns and recognizes the infant's cues of hunger and satiety, and responds promptly to these cues.18 The Dietary Guidelines for Americans recommend responsive feeding.19 Additionally, a recent systematic review found responsive feeding to be associated with healthy growth in children less than two years of age.13 Education on, and promotion of, responsive feeding should begin prenatally and evolve with the development of the child.18 Infant feeding during the first months after birth often occurs in the home, making this an ideal environment to promote responsive feeding.10,20-22 Interventions to promote responsive feeding have shown benefit in preventing rapid infant weight gain and promoting healthy dietary patterns in young children.20-28 However, this research has not been integrated using a validated coaching approach with the family's home. Additionally, responsive feeding has been largely measured via surveys.25 To address these gaps, an individualized responsive feeding coaching intervention, Learning Early Infant Feeding Cues (LEIFc), has been developed by the PI of the proposed study and her team.

The multicomponent LEIFc intervention involves maternal education on responsive feeding practices while using a family-guided caregiver coaching approach called SS-OO-PP-RR (Setting the Stage, Observation and Opportunities, Problem Solving and Planning, Reflection and Review) during feeding sessions.29,30 The SS-OO-PP-RR approach was developed based on adult learning theory and has been successfully used with parents and childcare providers to promote development across domains in infants and young children.29-31 For the LEIFc intervention, SS-OO-PP-RR was modified to be specific to communication during feeding to promote responsive feeding (Table 1). It is used as a guide for the interventionists during the coaching session but will also be used to evaluate the fidelity of the intervention. The purpose of this study is to test fidelity and feasibility of the LEIFc intervention in a group of diverse mother-infant dyads North Florida.

4.0 Study Endpoints* 4.1 The study will end when the participants complete all time points or the infant reaches 6 months of age.

5.0 Study Intervention