Healthy Babies through Infant-Centered Feeding
This material was developed by Dr. Mildred Horodynski and colleagues at Michigan State University, with funding from the National Institute of Food and Agriculture and conducted in collaboration with Colorado State University and the University of Wisconsin, Madison.
Abstract: A growing body of evidence shows increasing incidence of infant obesity, especially among low-SES families. The first year of life, and particularly the first 6 months, is a critical period for reducing risk of obesity, especially since 40% of parents report feeding their baby solid food before the American Academy of Pediatrics’ (AAP) recommendation of 4-6 months. Early initiation of solid food is linked to obesity. The goal of this research project was to implement a relationship skill-building and educational curriculum, Healthy Babies (HB) through Infant-Centered Feeding in the prevention of childhood obesity. The Healthy Babies (HB) curriculum, a series of six lessons available in English and Spanish, is designed to promote the development of healthy infant feeding practices through nutrition and parenting education. The HB lessons are designed to teach the main messages of the current dietary recommendations of the AAP and the Academy of Nutrition and Dietetics. Healthy Babies is based on the theory of planned behavior which is useful in predicting and understanding motivational influences on behavior and provides guidance on how and when to target strategies for changing behaviors. The long-term goal of this project is consistent with the USDA goal of improving the nation’s nutrition and health by addressing childhood obesity through an effective intervention promoting the development of healthy eating habits at an early age.
The goal of this study is to design and implement a randomized, experimental, short-term, longitudinal controlled trial with a convenience sample of economically and educationally disadvantaged mothers of infants living in Colorado and Michigan. Participants are randomly assigned to the HB intervention or a control group. There are three assessment periods: baseline (Time 1), when the infant is 6 months of age (Time 2), and when the infant is 12 months of age (Time 3). The primary objectives of this project are to:
We hypothesize that the in-home HB intervention relative to usual nutrition education will be associated with:An increase in maternal responsiveness
- An increase in healthy maternal feeding style
- An increase in healthy age-appropriate infant feeding practices
- Healthy, age-appropriate infant growth patterns of weight and length
- Mothers’ satisfaction with the HB intervention
- Feasibility in a community-based setting in the United States
The development of effective, inexpensive, early interventions aimed at promoting healthy infant feeding practices by mothers is expected to reduce the risk of early childhood obesity and health care costs in both the short and long term.
Funding Source: National Research Initiative (NRI) Competitive Grants Program Award from USDA: National Institute of Food and Agriculture. USDA 2009-5215-052.
The risks of childhood obesity are seen early and are related, in part, to feeding practices in infancy.
The early introduction of solid foods and beverages, prior to the American Academy of Pediatrics (AAP) recommended 4-6 months of age, is a risk factor for later obesity, as well as other health-related problems.
Often mothers continue to introduce their babies to solids earlier than recommended, even when they are aware of these recommendations.
The Healthy Babies curricular intervention is a collaborative project between:
- Michigan State University
- Michigan State University Extension
- Colorado State University
- Colorado State University Extension
- University of Wisconsin, Madison
The Healthy Babies lessons were developed and refined based on a pilot project, the Infant Feeding Series (TIFS), which provided initial evidence of lower-income mothers delaying the early introduction of solid foods until the infant was between 4 and 6 months of age as recommended by the AAP.
Healthy Babies addresses core infant nutrition concepts but also focuses on:
- Infant normative growth and development (e.g., infant cues, temperament, behavioral states)
- Mother-infant feeding relationship skill-building (i.e., maternal responsiveness)
- Support for mothers in creating their own infant feeding plans
- Strategies for implementing and sustaining their feeding plans
- New feeding practices and styles
The curriculum focuses on a specific concern that emerged from our previous work: that economically and educationally disadvantaged mothers need help in delaying the early introduction of solids to their infants.
Poor feeding practices during infancy contribute to obesity risk.
As infants transition from human milk and/or formula-based diets to solid foods, these practices interfere with infant feeding self-regulation and healthy growth patterns. Compared with other socioeconomic groups, lower-income mothers are more likely to experience difficulty feeding their infants. This may include misinterpreting feeding cues and using less-than-optimal feeding styles and practices, such as pressuring infants during mealtimes and prematurely introducing solid food and sweetened beverages.
The Healthy Babies (HB) curriculum was originally developed for an in-home intervention with economically and educationally disadvantaged mother-infant dyads. The educational intervention focused on mothers with infants during the infant’s first six months of life to promote healthy transition to solids during their first year and is based on the theory of planned behavior.
- Overall, the mothers were very satisfied with the lessons, found them to be informative, and would recommend lesson content to friends.
- Data from maternal self-report of infant dietary feeding practices revealed that mothers were waiting to introduce solids, following AAP recommendations.
- Knowledge of appropriate infant feeding improved significantly.
- Data from random exit telephone interviews indicated that almost all participants agreed the HB lessons included the appropriate information they needed and thought the home was the ideal environment for the lessons.
The results indicate that the one-on-one, HB in-home infant feeding curriculum was feasible and well-received in low-income communities, and had a significant impact on mothers’ infant feeding knowledge.
- Feeding My Newborn
- Feeding My Older Baby
- What Is My Baby Telling Me?
- Is Your Baby Flexible, Shy or Fesity?
- Parent Provides, Baby Decides
- My Plan for Feeding My Baby
- The Lessons; materials for each lesson; parts of the lesson plans; teaching the lesson
- How adults learn
- Food preparation
- Participant questions
- Goal setting
For your Information
At the end of each lesson plan there is a, “For Your Information” section which is for the instructor and provides information about the research behind the lessons and to increase understanding and confidence in teaching the lesson content. This information will help instructors answer participants questions.
For additional information contact:
Dr. Mildred Horodynski
Dr. Beth Olson
Michigan State University
Mildred A. Horodynski, PhD, RN, FAAN, Professor
College of Nursing
Dr. Horodynski ‘s research focuses on identifying the origins of eating habits and developing effective programs to modify these behaviors through family and community-based parent education. Dr. Horodynski has conducted community-based studies over the past 20 years and was just awarded NIH funding for the. Tools for Teen Moms: Reducing Infant Obesity Risk research study. She has received numerous funding including the randomized clinical trial, multi-state, research project through USDA: NIFA-AFRI entitled, Healthy Babies through Infant-Centered Feeding. Dr. Horodynski’s theory, research, educational and policy contributions are significantly promoting healthy feeding practices and preventing obesity in vulnerable children. She has led the way in designing and studying childhood obesity from the theoretically-based perspective of infant self-regulation. Her investigations have resulted in innovative, evidence-based, multi-faceted curricula that empower parents to utilize appropriate nutritional guidelines and feeding practices.
Holly E. Brophy-Herb, PhD, Professor,
Department of Human Development & Family Studies, College of Social Science
Dr. Brophy-Herb’s research interests and substantive foci have been on early social and emotional development in the contexts of parent-child interactions and in childcare settings, particularly in lower income populations. Dr. Brophy-Herb has conducted and been involved with community based research projects for the past 11 years, including PI on a federally-funded research project through DHHS: ACYF entitled, Enhancing Social-Emotional Functioning in Infants and Toddlers Using a Relationship-Based Infant Mental Health Approach and currently Co-Project Director on a USDA: NIFA AFRI grant entitled, Enhancing Self Regulation as a Strategy for Obesity Prevention in Head Start Preschoolers.
University of Wisconsin Madison
Beth Olson, PhD, Associate Professor and Nutrition Specialist,
University of Wisconsin Cooperative Extension
Dr. Olson’s research focuses on health behavior as it relates to families and the feeding of young children, including infants. She has been the PI on a USDA funded grant to explore the culture of breastfeeding in workplace environments, as well as a Kellogg Foundation funded project to improve efficiencies in a peer counseling program for breastfeeding support of low-income women. Dr. Olson is currently an Associate Professor in the Nutritional Sciences Department at the University of Wisconsin-Madison, and an Extension Specialist with the University of Wisconsin Cooperative Extension (UWEx), Family Living Programs. She has been involved in numerous studies that focus on the development of validated instruments for the measurement of health-related knowledge, attitudes, and intentions, as well as nutrition education development, interventions, and evaluation. She is author or co-author on numerous peer-reviewed journal articles, as well as curricula and fact sheets on breastfeeding, healthy eating and physical activity. In addition to research, she is involved in the training of graduate students in Community Nutrition, provides content expertise to UW Extension programs for nutrition and physical activity, and serves as a UW-Madison and UWEx media contact on nutrition.
Colorado State University
Susan Baker, EdD, CLC, Associate Professor and Extension Specialist
Department of Food Science and Human Nutrition
Dr. Baker’s primary research interests relate to nutrition education and obesity prevention for low-income families with young children, breastfeeding promotion and support, and the use of paraprofessionals as nutrition educators. Dr. Baker has over 20 years of experience working with nutrition education programs targeting limited-resource families and diverse audiences including Cooperative Extension’s Expanded Food and Nutrition Education Program (EFNEP). In addition, Dr. Baker has extensive experience in designing, implementing, and evaluating community nutrition education programs delivered by paraprofessional educators.
Kathryn Rogers, MS, RD, Research Associate III
Colorado State University Extension
Kathryn McGirr is primarily responsible for paraprofessional training, curriculum development, and is the liaison to Human Resources for EFNEP and SNAP-Ed programs at Colorado State University Extension. Katie’s work included the development of the nutrition education curriculum Eating Smart • Being Active, as one of the primary authors. Eating Smart • Being Active is the most widely used curriculum among EFNEP programs and includes 40 US states and territories.
The authors would like to acknowledge the following contributors.
The Research Team for providing feedback, curriculum suggestions, and dedication:
- Garry Auld, PhD, RD, Professor, Colorado State University
- Laurie A. Van Egeren, PhD, Director, Community Evaluation and Research Center, Michigan State University
- Joel Lindau, MS, Healthy Babies Project Manager, Colorado State University
The contributors of other nutrition education programs for providing resource material and content:
- Eating Smart ● Being Active (2007) – Baker, S., Sutherland, B., Rogers, K., Mitchell, R., Diker, A. Colorado State University Extension (EFNEP) and University of California-Davis Department of Nutrition. www.eatingsmartbeingactive.com
- The Nutrition Education Aimed at Toddlers (NEAT) –Horodynski (Omar), M.A., Coleman, G., Contreras, D., & Hoerr, S. DHHS: Administration on Children, Youth, and Families.
- The Infant Feeding Series (TIFS)-- Horodynski, M.A., Olson, B., Arndt, M.J., Brophy-Herb, H.E., Padonu, G., & Ruonavaara, D., & Shirer, K. Michigan Department of Community Health and Michigan State University.
Spanish translation expertise:
- Allison Fritz, Student of Agriculture Sociology at FLACSO, Buenos Aires, Argentina
Artistic expertise for visual design:
- Debby Weitzel and Staff, Communications and Creative Services, Colorado State University
- Joe Mendoza, Communications and Creative Services Coordinator/Photographer, Colorado State University
Funders of this project:
- Healthy Babies Through Infant-Centered Feeding. Supported by the National Research Initiative of the USDA Cooperative State Research, Education and Extension Service, grant number 2009-55215-05220.
- Healthy Babies Through Infant-Centered Feeding. FACT Supplemental Grant for USDA-NRI CSREES, Michigan State University Families and Communities Together.
- Healthy Babies Through Infant-Centered Feeding. Supplemental Grant for USDA-NRI CSREES, Michigan State University, College of Nursing.
Horodynski, M. A., Baker, S., Van Egeren, L., Olson, B., Brophy-Herb, H., & Auld, G. (2013). The Healthy Babies Curriculum. Journal of Nutrition Education and Behavior. Advance online publication. doi: 10.1016/j.jneb.2013.10.002
Horodynski, M.A., Olson, B., Baker, S., Brophy-Herb, H., VanEgeren, L., Auld, G., Lindau, J., & Singleterry, L., (2011). Healthy babies through infant-centered feeding protocol: an intervention targeting early childhood obesity in vulnerable populations. BMC Public Health,11:868. Doi:10.1186/1471-2458-11-868.
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