Abstract
BACKGROUND: Recommendations aimed at reducing infants' risk for rapid weight gain primarily focus on promoting caregivers' use of responsive feeding practices and styles. These recommendations are grounded in the belief that infants will effectively signal hunger and satiation to their caregivers. To date, few studies have explored how variability in infants' communication of hunger and satiation may contribute to feeding interactions. OBJECTIVE: Our aim was to explore variability in, and correlates of, infant clarity of cues during feeding interactions. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: Mother-infant dyads (n=86) were video-recorded during a typical feeding interaction within laboratory-based settings in Philadelphia, PA and San Luis Obispo, CA between June 2013 and June 2017. MAIN OUTCOME MEASURES: Trained raters later coded videos using the Nursing Child Assessment Parent-Child Interaction Feeding Scale's Infant Clarity of Cues and Maternal Sensitivity to Cues subscales. Infant weight was assessed and standardized to sex- and age-specific z scores. Mothers completed questionnaires related to family demographics, infant feeding history, feeding styles, and infant temperament and eating behaviors. STATISTICAL ANALYSES PERFORMED: Linear models were used to test for associations between clarity of cues and breastfeeding vs formula-feeding, maternal sensitivity and responsiveness, and feeding and weight outcomes. RESULTS: Infants were approximately 15.5 weeks of age and 53% were female. Clarity of cues was not associated with infant sex, age, temperament, or eating behaviors. Breastfed and formula-fed infants exhibited similar clarity of cues (P=0.0636). Greater clarity of cues for infants was associated with greater maternal sensitivity to cues (P=0.0011) and responsive feeding style (P=0.0464) for mothers. Lower clarity of cues was associated with greater weight-for-age z score change for formula-fed infants, but not breastfed infants. CONCLUSIONS: Efforts to promote responsive feeding may need to also consider infant clarity of cues. Further research is needed to understand the implications of associations between infant communication and responsive feeding.