Parenting behaviours and maternal infant feeding practices in first-time Australian mothers

1. Parenting behaviours and maternal infant feeding practices in first-time Australian mothers Daniels L*, Jansen E, Nicholson J, Battistutta D, Kremers S, Magarey A * Institute of Health and Biomedical Innovation (IHBI), School of Public Health (SPH), Queensland University of Technology (QUT) 60 Musk Ave Kelvin Grove Qld 4059, Australia | t:61 (0) 7 3138 6139 | f: 07 3138 6030 | e: l2.daniels@qut.edu.au • Background • Emerging evidence that parenting style and early feeding practices are associated with child food intake, eating behaviours and weight status (Ventura & Birch, 2008) • 14-17% of 2-3 year old Australian children are overweight; 4% are obese (Australian Government – Dep. Health & Ageing, 2008) • General parenting styles potentially provide a framework within which specific parenting and feeding practices may be executed (Gubbels et al., 2009; Rhee, 2008) • Unclear if a focus on quality of parenting can influence feeding practices Aim Examine the cross-sectional relationships between mothers’ general parenting behaviour and their infant-feeding practices and beliefs taking into account maternal and infant-related characteristics Table 1: Characteristics of study sample • Methods • Participants • Enrolled in the NOURISH RCT (in 2008) (Daniels et al, 2009) • N = 421 mother-child dyads • Mothers: • First-time mothers; facility with English • > 18 years; mean age 30±5 years • No self report of eating or mental health problems • Infants: • Healthy term (gestational age >35 weeks, birth weight >2500g) • 9-22 weeks old (mean age 19±4 weeks) • 206 boys (48.93%) • Outcome measures • Baseline data collection for NOURISH RCT; prior to allocation • Self-reported • Parenting behaviours • 15 items, 3 domains: • - Parenting self-efficacy (4 items) • - Parenting warmth (6 items) • - Parenting irritability (5 items) • Validated in the Longitudinal Study of Australian Children (LSAC; • Australian Institute Family Studies, 2003) • Feeding practices and beliefs • Based on Infant Feeding Questionnaire (IFQ; Baughcum et al., 20010) • Factor structure reanalysed due to: • Concurrent use of IFQ rather than retrospective • High prevalence of breastfeeding  3 items related to bottle feeding excluded • Infant sample (Baughcum sample mean age 16.2±3.5 months) • Australian sample • New factor structure: 15 items, 4 factors (62% variance): • Concern about infant undereating or becoming underweight • (α =.78; 16.2% variance) • Concern about infant overeating or becoming overweight • (α =.65; 8.9% variance) • 3. Lack of awareness of infant’s hunger and satiety cues • (α =.74; 22.3% variance) • 4. Inflexible infant-feeding • (α =.75; 14.7% variance) • Two items were excluded because they loaded weakly onto a separate factor • Covariates  See Table 1 for details • MaternalInfant • BMI (measured) • Gender • Weight concern (Killen et al, 1994) • Weight status (birth w. & w.-gain z-score) • Age • Age • Education level • Feeding mode • Mother’s perception of infant’s weight status • Data analyses • Descriptive statistics • Multivariate regression analysis • 4 models: one per each infant-feeding factor • Parenting behaviours entered first • Covariates entered simultaneously for model adjustment * N varies from 356 cases to 421 due to missing data on different variables ** UK standards *** Mother’s concern about her own weight; Weight Concern Scale by Killen et al. (1994); range 0-5, higher scores indicate more concern Results Table 2: Associations of feeding practices & beliefs with parenting behaviours controlling for infant & maternal covariates (N= 356). Significant relationships only – inverse or positive. Note: Reference groups are in italic; p < .05; cases with missing data on any independent variable or covariate were excluded; adjusted R2 reported * Standardized β a Dummy variable 1 for feeding mode, ‘0’ = breast feeding or combination, ‘1’ = formula feeding b Dummy variable 1 for mother’s perceptions of her child’s weight status, ‘0’ = normal or overweight, ‘1’ = underweight c ‘1’ = pre-tertiary level, ‘2’ = tertiary level d Dummy variable 2 for mother’s perceptions of her child’s weight status, ‘0’ = normal or underweight, ‘1’ = overweight e ‘1’ = underweight/normal weight, ‘2’ = overweight/obese • Conclusions • Parenting behaviours partly explained maternal feeding beliefs in the adjusted models • Self-efficacy was related to 3 of 4 feeding practices & beliefs • 4 covariates were independent predictors across multiple feeding • practices & belief factors • Maternal perception of infant’s weight status and infant’s actual weight • were consistent with the factors ‘concern about infant becoming overweight’ and ‘concern about infant becoming underweight’ • Strategies to improve early feeding practices & beliefs need to be • cognisant of and support broader parenting approaches, particularly • self-efficacy and irritability • Longitudinal studies are needed to determine direction of relationships • Strengths and limitations • + Concurrent use of the Infant Feeding Questionnaire (Baughcum et al., 2001) • + Adjustment for a range of maternal & infant-related characteristics • Maternal self-report of feeding & parenting behaviours • ± Maternal BMI measured but categorization according to standard guidelines (no post-natal BMI classification available) • ± Applied less frequently used measurement tools as commonly used • instruments have not been validated in infants References Australian Institute Family Studies. www.aifs.gov.au/growingup/pubs.html#wave1, 2003; Baughcum et al. J Dev BehavPediatr 2001;22(6):391-408: Daniels et al. Bmc Public Health 2009;9:387; Department of Health and Ageing. Canberra, 2008; Gubbels et al. Appetite 2009;52(2):423-9; Killen et al. Int J Eat Disorder 1994;16(3):227-38; Rhee K. Ann Am Acad Polit SS 2008;615:12-37; Ventura & Birch. Int J BehavNutr Phys Act 2008;5:15