Abstract
IMPORTANCE: Parents influence young children's diet, sleep, and physical activity behaviors. Pediatric primary care practitioners (PCPs) are uniquely positioned to identify obesogenic behaviors from infancy, yet few screening tools assess these behaviors in clinical settings. OBJECTIVE: To explore the association between parent-reported obesogenic behaviors and infant weight outcomes. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study is a secondary analysis of data from the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care study. Participants were recruited from the Geisinger Health System in northeastern Pennsylvania between July 6, 2016, and April 30, 2018. Mothers aged 18 years or older were eligible if their infant was enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children and who completed the Early Healthy Lifestyles (EHL) screening tool at infant age 2 months and had available infant growth data at 6 months. The analysis was completed on June 8, 2025. EXPOSURE: The 15-item parent-reported EHL tool assessing infant diet, mothers' feeding practices, infant sleep, interactive play, and appetitive traits. MAIN OUTCOMES AND MEASURES: Infant weight and length were measured at well-child visits. The primary outcomes were body mass index (BMI) and weight-for-length (WFL) z scores at infant age 6 months. RESULTS: Among 143 mother-infant dyads (median [IQR] maternal age, 26.5 [23.0-31.1] years; infant mean [SD] gestational age, 39.5 [1.2] weeks; 77 boys [53.8%]), the EHL tool identified 9 behaviors associated with higher BMI and WFL z scores at infant age 6 months, including developmentally inappropriate bottle size, nighttime feeding, putting the infants to bed after 8:00 pm, frequent night wakes, television on in the room where the infant sleeps, putting the infant to bed already asleep instead of drowsy but awake, limited active play or tummy time, using a cell phone or television while playing, and mothers' perception of the infant always being hungry. Higher composite scores were significantly associated with higher BMI z score (β = 0.22; 95% CI, 0.10-0.34) and WFL z score (β = 0.21; 95% CI, 0.09-0.33) at 6 months. CONCLUSIONS AND RELEVANCE: These findings show that the EHL screening tool, which identifies modifiable obesogenic behaviors, is associated with early-life weight outcomes. Validating this tool requires testing in clinical and community settings for early childhood obesity prevention.