Transcript Parenting behaviours and maternal infant feeding practices in first-time Australian mothers Daniels L*, Jansen E, Nicholson J, Battistutta D, Kremers S, Magarey A *

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: [email protected]
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
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)
Mean (SD) or
Frequency
Infant gender
Demographics and weight related variables
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
Variables
Girl
215 (51%)
Education level
420
Pre-tertiary
Tertiary
192 (46%)
228 (54%)
Feeding mode
391
Breastfeeding
Formula
Combination
206 (53%)
119 (30%)
66 (17%)
Maternal BMI
418
Normal (< 25kg/m2)
Overweight (25-29.9 kg/m2)
Obese (≥ 30 kg/m2)
Infant’s age (weeks)
Mother’s age (years)
- Two items were excluded because they loaded weakly onto a
separate factor
 Covariates  See Table 1 for details
Maternal
Infant
• 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
19±4
30±5
421
420
3491±455
-.15±1.05
420
419
2.5±0.8
414
Weight
Birth weight (grams)
Weight-gain (birth to baseline) z-score**
Perception of infant’s
weight status
Underweight
Normal weight
Overweight
406
19 (5%)
355 (87%)
32 (8%)
* 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.
Feeding practices & beliefs
[Dependant variable]
Parenting behaviours
[Independent variable]
Factor
R2
Dimension
Concern about
infant under-eating
or becoming
underweight
.229
Parenting
self-efficacy
• Factor structure reanalysed due to:
• New factor structure: 15 items, 4 factors (62% variance):
1.Concern about infant undereating or becoming underweight
(α =.78; 16.2% variance)
2.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)
204 (49%)
141 (34%)
73 (17%)
Age at assessment
β*
-.149
 Feeding practices and beliefs
• Based on Infant Feeding Questionnaire (IFQ; Baughcum et al., 20010)
- 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
N*
421
Maternal weight concern***
Weight
concern
Aim
Concern about
infant overeating
or becoming
overweight
Lack of awareness
of infant’s hunger
and satiety cues
.297
.206
Parenting
self-efficacy
Parenting
self-efficacy
β
Variables
Infant’s weight-gain z-score
-.197
Infant’s age (weeks)
.120
Breastfeeding only vs. formula feeding onlya
.169
Mother’s perception of child-weight as
normal vs. underweightb
.305
Pre- tertiary vs. tertiary educationc
.120
Infant’s age (weeks)
-.122
Infant’s weight-gain z-score
.128
Mother’s perception of child-weight as
normal vs. overweightd
.320
-.266
-.331
None
Parenting
irritability
Inflexible infantfeeding
Covariates
.138
None
.115
Pre- tertiary vs. tertiary educationc
-.133
Maternal BMI <25 vs. ≥ 25 kg/m2e
-.136
Infant’s age (weeks)
.158
Breastfeeding only vs. formula feeding onlya
.311
Note: Reference groups are in italic; p < .05; cases with missing data on any independent variable or covariate were excluded; adjusted R 2 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 Behav Pediatr
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 Behav Nutr Phys Act 2008;5:15