Ecological momentary assessment of using food to soothe during infancy in the INSIGHT trial

Elizabeth L Adams, Michele E Marini, Timothy R Brick, Ian M Paul, Leann L Birch, Jennifer S Savage, Elizabeth L Adams, Michele E Marini, Timothy R Brick, Ian M Paul, Leann L Birch, Jennifer S Savage

Abstract

Background: Use of food to soothe infant distress has been linked to greater weight in observational studies. We used ecological momentary assessment to capture detailed patterns of food to soothe and evaluate if a responsive parenting intervention reduced parents' use of food to soothe.

Methods: Primiparous mother-newborn dyads were randomized to a responsive parenting intervention designed for obesity prevention or a safety control group. Responsive parenting curriculum included guidance on using alternative soothing strategies (e.g., swaddling), rather than feeding, as the first response to infant fussiness. After the initial intervention visit 3 weeks after delivery, mothers (n = 157) were surveyed for two 5-8 day bursts at infant ages 3 and 8 weeks. Surveys were sent via text message every 4 h between 10:00 AM-10:00 PM, with 2 surveys sent at 8:00 AM asking about nighttime hours. Infant fusses and feeds were reported for each 4-h interval. Food to soothe was defined as "Fed First" and "Not Fed First" in response to a fussy event. Use of food to soothe was modeled using random-intercept logistic regression.

Results: The control group had greater odds of having Fed First, compared to the responsive parenting group at ages 3 and 8 weeks (3 weeks: OR = 1.9; 95% CI = 1.4-2.7; p < 0.01; 8 weeks: OR = 1.4; 95% CI = 1.0-2.1; p = 0.053). More responsive parenting mothers reported using a responsive parenting intervention strategy first, before feeding, than controls at ages 3 and 8 weeks (3 weeks: 58.1% vs. 41.9%; 8 weeks: 57.1% vs. 42.9%, respectively; p < 0.01 for both). At both ages combined, fewer fusses from responsive parenting infants were soothed best by feeding compared to controls (49.5% vs. 61.0%, respectively; p < 0.01). For both study groups combined, parents had greater odds of having Fed First during the nighttime compared to the daytime at both ages (3 weeks: OR = 1.6, 95% CI = 1.4-1.8; p < 0.01; 8 weeks: OR = 2.1; 95% CI = 1.7-2.6; p < 0.01).

Conclusions: INSIGHT's responsive parenting intervention reduced use of food to soothe and increased use of alternative soothing strategies in response to infant fussiness. Education on responsive parenting behaviors around fussing and feeding during early infancy has the potential to improve later self-regulation and weight gain trajectory.

Trial registration: NCT01167270 . Registered July 21, 2010.

Keywords: Infant cry; Infant feed; Infant fuss; Obesity prevention; Responsive parenting; Soothing strategies.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Example of a series of questions asked in the EMA survey, developed for the INSIGHT study, and delivered using smartphones. The clock times in questions 1 and 2 changed to reflect each 4-h block of time within the day
Fig. 2
Fig. 2
Image provided to mothers to help them identify infants’ fussy events. A fussy event was considered fussing, crying, or hard crying, corresponding to the faces above
Fig. 3
Fig. 3
An interaction of study group by infant age on feeding first indicated the control group had greater odds than the responsive parenting group of feeding first at 3 weeks (p < 0.01), and this effect decreased over time at 8 weeks (p = 0.053)
Fig. 4
Fig. 4
A greater percentage of fussy bouts between 10:00 PM – 2:00 AM and 2:00 AM – 6:00 AM resulted feeding as the first response to infant fussiness (Fed First), rather than feeding not as the first response (Fed Later) or not feeding as any response (Not Fed)

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