1. Parental attitudes to infant feeding and growth Rajalakshmi Lakshman. 1,2 Simon Griffin. 1,2 Ken Ong. 1,2,3 1 MRC Epidemiology Unit, IMS, Cambridge 2 UKCRC Centre of Excellence in Diet and Activity Research, Cambridge, 3 Department of Paediatrics, University of Cambridge Introduction In order to develop an intervention to avoid excessive formula milk intake and prevent rapid infancy weight gain, we sought to understand how parents decide on the amount and frequency of formula milk feeds, and their attitudes to their baby’s growth. Systematic reviews have described a consistent association between rapid infant weight gain and subsequent increased risk of obesity. 1 In the UK only 1% of babies are exclusively breastfed at age six months. 2 Infancy may be a critical period for obesity prevention. Methods We conducted individual, face-to-face interviews with thirty-eight parents (35 mothers) from the local community, using a flexible semi-structured interview schedule. In a separate study, we conducted three focus group discussions with 11 mothers who had formula-fed their babies since birth. We performed a thematic analysis using the Framework approach, in which a hierarchical thematic framework was used to classify and organise data according to key themes, concepts and emergent categories. Conclusions Parents may override satiation cues and overfeed babies if they increase the volume of formula feeds because their baby finishes the bottle, or cries, or to increase the interval between feeds, or in response to rapid growth. Such behaviours could result in excessive infant weight gain, and could also potentially programme babies to eat larger portions or to respond to stress by eating. Interventions to avoid rapid infant weight gain and prevent childhood obesity should target these parental behaviours and attitudes to infant feeding. Results - cont 2) ‘Follow guidelines’ “I follow instructions on the tin” “I make up what it says on the tin. If she doesn’t finish, I try again after half an hour” “I actually think they’ve overshot initially and undershot as it goes on for amounts” “then you’d be worrying because they’re not taking it” “I know that I was becoming very like ‘oh, you must drink, you must drink, because it says so on the tin” 3) ‘Baby’s growth’ “I weighed him every week and increased his feeds from 2 to 4 to 6 ounces as his weight increased” Among formula feeding mothers there was a feeling that the dangers of bottle feeding were exaggerated and so some ignored all recommendations. “you’re told that you’re going to have an obese child if you bottle fed them” “because they’ve blown everything up to try and make you breastfeed” “well don’t lie, then I won’t listen to anything you say” Parents were more concerned about underfeeding and inadequate weight gain than about overfeeding and excess weight gain. Many felt it was too early to worry about rapid weight gain during infancy. “he’s splodgy, he’s got lovely big rolls of fat on his thighs and that’s great” “I’m not too worried about having a fat baby” “They do have excess weight, they do carry excess weight, I suppose to keep them warm or whatever” “I think it’s a bit too early to worry about obesity at this stage” “I do worry about people worrying that they’re making their child fat, it’s a baby…” “it’s scary though, isn’t it? For people to be that obsessed with weight and vanity...” A major barrier to reducing formula feeds was the fear that the baby would cry, remain hungry, demand more frequent feeds and wake up more often at night. “load them up before bedtime” Results Regarding decision making on how much and how often to feed a baby, three themes emerged. 1) ‘Baby-led’ “so when they start draining then I make it up to another ounce” “I kept increasing feeds till he was satisfied” “if they are hungry every hour or two hours, they need more milk each feed” “he was always hungry so gave more. Once he drank nine ounces so started him on solids” “he was crying so much that I was feeding him every ten minutes” “he drank for six and a half hours and he was swallowing for six and a half hours. He used to do that almost every evening. He would drink about two and a half bottles” Investigating the causes and prevention of diabetes and obesitywww.mrc-epid.cam.ac.uk Reference list 1.Ong KK, Loos RJ: Acta Paediatr; 2006, 95: 904-908. 2.Bolling K: Infant feeding survey 2005. The information Centre; 2007