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

AimExamine the cross-sectional relationships between mothers’ general parenting behaviour and their infant-feeding practices and beliefs taking into account maternal and infant-related characteristics

MethodsParticipants 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): 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)

- 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

Variables Mean (SD) or Frequency

N*

Demographics and weig

ht related

variables

Infant gender Girl 215 (51%)

421

Education level Pre-tertiary Tertiary

192 (46%)228 (54%)

420

Feeding mode Breastfeeding Formula Combination

206 (53%)119 (30%)66 (17%)

391

Maternal BMI Normal (< 25kg/m2) Overweight (25-29.9 kg/m2) Obese (≥ 30 kg/m2)

204 (49%)141 (34%)73 (17%)

418

Age at assessment Infant’s age (weeks) Mother’s age (years)

19±430±5

421420

Weight Birth weight (grams) Weight-gain (birth to baseline) z-score**

3491±455-.15±1.05

420419

Weight

concern

Maternal weight concern*** 2.5±0.8 414Perception of infant’s weight status Underweight

Normal weight Overweight

19 (5%)355 (87%)32 (8%)

406

Table 1: Characteristics of study sample

* 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

ResultsTable 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]

Factor R2

Parenting behaviours[Independent variable]

Dimension β*

Covariates

Variables β

Concern about infant under-eating

or becoming underweight

.229 Parenting self-efficacy -.149

Infant’s weight-gain z-score -.197Infant’s age (weeks) .120

Breastfeeding only vs. formula feeding onlya .169Mother’s perception of child-weight as

normal vs. underweightb .305Pre- tertiary vs. tertiary educationc .120

Concern about infant overeating

or becoming overweight

.297 Parenting self-efficacy -.266

Infant’s age (weeks) -.122

Infant’s weight-gain z-score .128

Mother’s perception of child-weight as normal vs. overweightd .320

Lack of awareness of infant’s hunger and satiety cues

.206 Parenting self-efficacy

-.331

None

Parenting irritability

.115

Inflexible infant-feeding

.138

None

Pre- tertiary vs. tertiary educationc -.133 Maternal BMI <25 vs. ≥ 25 kg/m2e -.136

Infant’s age (weeks) .158Breastfeeding 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 βa Dummy variable 1 for feeding mode, ‘0’ = breast feeding or combination, ‘1’ = formula feedingb Dummy variable 1 for mother’s perceptions of her child’s weight status, ‘0’ = normal or overweight, ‘1’ = underweightc ‘1’ = pre-tertiary level, ‘2’ = tertiary leveld Dummy variable 2 for mother’s perceptions of her child’s weight status, ‘0’ = normal or underweight, ‘1’ = overweighte ‘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 weightwere 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

ReferencesAustralian 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