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) | f: | e: 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 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) V alidated 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., ) 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 VariablesMean (SD) or Frequency N* Demographics and weight related variables Infant gender Girl215 (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/m 2 ) Overweight ( kg/m 2 ) Obese (≥ 30 kg/m 2 ) 204 (49%) 141 (34%) 73 (17%) 418 Age at assessment Infant’s age (weeks) Mother’s age (years) 19±4 30± Weight Birth weight (grams) Weight-gain (birth to baseline) z-score** 3491± ± Weight concern Maternal weight concern***2.5± Perception 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 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] Factor R 2 Parenting behaviours [Independent variable] Dimension β* Covariates Variables β Concern about infant under-eating or becoming underweight.229Parenting self-efficacy-.149 Infant’s weight-gain z-score-.197 Infant’s age (weeks).120 Breastfeeding only vs. formula feeding only a.169 Mother’s perception of child-weight as normal vs. underweight b.305 Pre- tertiary vs. tertiary education c.120 Concern about infant overeating or becoming overweight.297Parenting self-efficacy-.266 Infant’s age (weeks)-.122 Infant’s weight-gain z-score.128 Mother’s perception of child-weight as normal vs. overweight d.320 Lack of awareness of infant’s hunger and satiety cues.206Parenting self-efficacy None Parenting irritability.115 Inflexible infant- feeding.138 None Pre- tertiary vs. tertiary education c Maternal BMI <25 vs. ≥ 25 kg/m 2e Infant’s age (weeks).158 Breastfeeding only vs. formula feeding only a.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 ; Baughcum et al. J Dev Behav Pediatr 2001;22(6): : 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