Baby's first bites: Association between observed maternal feeding behavior and infant vegetable intake and liking.

Positive experiences with the introduction of solid food in infancy may lead to positive associations with feeding in both parent and infant. During this transitional period, parental feeding behavior and infant eating behavior might mutually reinforce each other. A feeding style that is found to be associated with positive child eating behavior, is sensitive feeding. In the present study we tested bidirectional prospective relations between mother and infant behavior in a cross-lagged model using observations of two feeds on two consecutive days on which the first bites of solid food were offered. The sample consisted of 246 first-time mothers and their infants, whose feeding interactions were videotaped during two home visits. Maternal sensitive feeding behavior (consisting of responsiveness to child feeding cues, general sensitivity and non-intrusiveness) and maternal positive and negative affect were coded. In addition, infant vegetable intake was weighed and vegetable liking was reported by mother. Results showed at least some stability of maternal feeding behavior and infant vegetable intake and liking from the first to the second feed. In addition, during the second feed maternal sensitive feeding and positive affect were associated with infant vegetable intake (r=.34 and r=.14) and liking (r=.33 and r=.39). These associations were mostly absent during the first feed. Finally, infant vegetable liking during the first feed positively predicted maternal sensitive feeding behavior during the second feed (ß=.25), suggesting that the infant's first response might influence maternal behavior. Taken together, mother and infant seem more attuned during the second feed than during the first feed. Future studies might include multiple observations over a longer time period, or micro-coding. Such insights can inform prevention programs focusing on optimizing feeding experiences during the weaning period.

Baby's first bites: a randomized controlled trial to assess the effects of vegetable-exposure and sensitive feeding on vegetable acceptance, eating behavior and weight gain in infants and toddlers.

BACKGROUND: The start of complementary feeding in infancy plays an essential role in promoting healthy eating habits. Evidence shows that it is important what infants are offered during this first introduction of solid foods: e.g. starting exclusively with vegetables is more successful for vegetable acceptance than starting with fruits. How infants are introduced to solid foods also matters: if parents are sensitive and responsive to infant cues during feeding, this may promote self-regulation of energy intake and a healthy weight. However, the effectiveness of the what and the how of complementary feeding has never been experimentally tested in the same study. In the current project the what and how (and their combination) are tested in one study to determine their relative importance for fostering vegetable acceptance and self-regulation of energy intake in infants. METHODS: A four-arm randomized controlled trial (Baby's First Bites (BFB)) was designed for 240 first-time Dutch mothers and their infants, 60 per arm. In this trial, we compare the effectiveness of (a) a vegetable-exposure intervention focusing on the what in complementary feeding; (b) a sensitive feeding intervention focusing on the how in complementary feeding, (c) a combined intervention focusing on the what and how in complementary feeding; (d) an attention-control group. All mothers participate in five sessions spread over the first year of eating solid foods (child age 4-16 months). Primary outcomes are vegetable consumption, vegetable liking and self-regulation of energy intake. Secondary outcomes are child eating behaviors, child anthropometrics and maternal feeding behavior. Outcomes are assessed before, during and directly after the interventions (child age 18 months), and when children are 24 and 36 months old. DISCUSSION: The outcomes are expected to assess the impact of the interventions and provide new insights into the mechanisms underlying the development of vegetable acceptance, self-regulation and healthy eating patterns in infants and toddlers, as well as the prevention of overweight. The results may be used to improve current dietary advice given to parents of their young children on complementary feeding. TRIAL REGISTRATION: The trial was retrospectively registered during inclusion of participants at the Netherlands National Trial Register (identifier NTR6572 ) and at ClinicalTrials.gov ( NCT03348176 ). Protocol issue date: 1 April 2018; version number 1.

Introducing maternal morbidity audit in the Netherlands.

OBJECTIVE: To describe the panel audit process and to identify substandard care in selected women from a nationwide prospective cohort study into severe acute maternal morbidity (SAMM) in the Netherlands. DESIGN: Prospective audit of selected women with SAMM. SETTING: Eight audit meetings held throughout the Netherlands. POPULATION: All pregnant women in the Netherlands. METHODS: Before each meeting, SAMM details of selected women were sent to all panel members for individual assessment by completing an audit form. During a subsequent plenary meeting, findings were discussed and substandard care factors as judged by the majority of assessors were scored. MAIN OUTCOME MEASURES: Incidence of substandard care and recommendations for improving the quality of care. RESULTS: Substandard care was identified in 53 of 67 women (79%). Specific recommendations were formulated concerning the procedure of audit and concerning local as well as national management guidelines. CONCLUSION: Our findings reflect SAMM in the Netherlands and substandard care is present in four out of five women. Ongoing audit of women with SAMM is promoted both at local and national level.

Dopamine system genes associated with parenting in the context of daily hassles.

The current study examined the molecular genetic foundations of sensitive parenting in humans and is the first to test the interaction between genes and environment in modulating parental sensitive responses to children. In a community sample of 176 Caucasian, middle class mothers with their 23-month-old toddlers at risk for externalizing behavior problems, the association between daily hassles and sensitive parenting was investigated. We tested whether two dopamine-related genes, dopamine D4 receptor (DRD4) and catechol-O-methyltransferase (COMT) gene polymorphisms, modulate parents' vulnerability to the negative influence of daily hassles on sensitive parenting behavior to their offspring. Sensitive parenting was observed in structured settings, and parents reported on their daily hassles through a standard questionnaire. In parents with the combination of genes leading to the least efficient dopaminergic system functioning (COMT val/val or val/met, DRD4-7Repeat), more daily hassles were associated with less sensitive parenting, and lower levels of daily hassles were associated with more sensitive parenting d = 1.12. The other combinations of COMT and DRD4 polymorphisms did not show significant associations between daily hassles and maternal sensitivity, suggesting differential susceptibility to hassles depending on parents' dopaminergic system genes. It is concluded that the study of (multiple) gene-environment interactions (in the current case: gene by gene by environment interaction, G x G x E) may explain why some parents are more and others less impacted by daily stresses in responding sensitively to their offspring's signals.

Early preschool predictors of preadolescent internalizing and externalizing DSM-IV diagnoses.

OBJECTIVE: To investigate the independent predictive value of parent-reported psychopathology and family risk factors in early preschool in relation to parent-reported internalizing and externalizing psychopathology in preadolescence. METHOD: Subjects were participants in a longitudinal study of 420 two- to three-year-olds from the general population of Zuid-Holland, the Netherlands, which started in 1989. At a second follow-up 8 years later (ages 10-11 years), 358 children participated. For this study, 332 children were included for whom DSM-IV diagnoses (derived from the Diagnostic Interview Schedule for Children-Version 4-Parent Version) were obtained at age 10 to 11 years. Preschool risk factors were obtained through the Child Behavior Checklist for ages 2 to 3 years and a parent interview. RESULTS: Early preschool internalizing and externalizing problems were predictive of their DSM-IV counterparts 8 years later, independent of the influence of early parent-reported family risk factors. Preschool child physical problems were independently predictive of both internalizing and externalizing diagnoses in preadolescence. Of the environmental risk factors, only stressful life events contributed independently to the prediction of later externalizing problems. CONCLUSION: Early adverse family circumstances and parenting characteristics do not contribute to the prediction of later psychopathology once child characteristics are accounted for.

Preschool developmental pathways to preadolescent internalizing and externalizing problems.

The present study investigated longitudinal pathways from specific early preschool behavioral problems (ages 2-3 years) to internalizing and externalizing problems in preadolescence (ages 10-11 years), and the role of social problems at school entry (ages 4-5 years) in such pathways. Path analyses were performed using both parent and teacher reports in a sample of 251 to 346 children from the general population, depending on the availability of parent and teacher data at each time of assessment. Structural equation modeling revealed homotypic internalizing and externalizing pathways, predictions from early preschool externalizing problems to later internalizing problems, and negative predictive paths from early internalizing problems to externalizing problems in preadolescence. Cross-informant predictions spanning 8 years were found between parent-reported aggression and overactivity at ages 2-3 years and teacher-reported externalizing problems at ages 10-11 years. Further, results showed that boys' pathways were more complex and showed greater predictive validity than pathways for girls, and that social problems at school entry played a significant role in pathways to internalizing problems, but only for boys. The results are discussed from a developmental psychopathology perspective.

Clinical value of an antibody-dependent cell-mediated cytotoxicity assay in the management of Rh D alloimmunization.

OBJECTIVE: The aim of this study was to evaluate the clinical value of an antibody-dependent cell-mediated cytotoxicity assay relative to the indirect antiglobulin test titer in the management of Rh D-alloimmunized pregnancies. STUDY DESIGN: Data from 172 Rh D-alloimmunized pregnancies were analyzed retrospectively. The accuracies of the highest antibody titer and of the highest antibody-dependent cell-mediated cytotoxicity assay result during pregnancy to predict fetal and neonatal Rh disease, defined as the need for intrauterine (n = 30) or neonatal (n = 37) blood transfusion, respectively, were assessed. RESULTS: At different cutoff levels with equal sensitivities the antibody-dependent cell-mediated cytotoxicity assay consistently showed a higher specificity than the antibody titer for the prediction of fetal disease. No difference was found between the receiver operating characteristic curves of the 2 tests for the prediction of neonatal disease. CONCLUSIONS: Selection of patients for referral and invasive testing for Rh D alloimmunization may be improved with the use of an antibody-dependent cell-mediated cytotoxicity assay.

Child-reported depression and anxiety in preadolescence: I. Associations with parent- and teacher-reported problems.

OBJECTIVE: To examine a wide range of parent- and teacher-reported behaviors in relation to child-reported depression and anxiety in preadolescence. METHOD: Subjects were participants in a longitudinal study of 420 preschool children from the general population that started in 1989. At second follow-up 8 years later (ages 10-11 years), usable parent information was obtained for 358 children. For this study, 274 children for whom complete child, parent, and teacher reports were obtained at age 10 to 11 years were included. Measures included the Dimensions of Depression Profile for Children, the State-Trait Anxiety Inventory for Children, the Child Behavior Checklist/4-18, and the Teacher's Report Form. RESULTS: Of 120 parent-reported problem items, only 11 and 9 were associated with child-reported depression and anxiety, respectively. For teachers, 33 and 20 items (of 120) were significantly associated with child-reported depression and anxiety, respectively, including items referring to withdrawal, anxiety, depression, social problems, and academic problems. CONCLUSIONS: Teachers are more likely than parents to notice internalizing problems and related problems such as social and academic problems in children reporting depression or anxiety.

Child-reported depression and anxiety in preadolescence: II. Preschool predictors.

OBJECTIVE: To examine the predictive association of parent- and teacher-reported behaviors at age 2 to 3 years in relation to child-reported depression and anxiety at age 10 to 11 years. METHOD: Subjects were participants in a longitudinal study of 420 children aged 2 to 3 years from the general population first assessed in 1989 and again in 1991 (n = 397) and 1997 (n = 358). For the present study, 249 children were included for whom all relevant measures were obtained. These measures include the Child Behavior Checklist (CBCL) for 2- to 3-year-olds at time 1, the CBCL for 4- to 18-year-olds and the Teacher's Report Form at time 2, and the Dimensions of Depression Profile for Children and the State-Trait Anxiety Inventory for Children at time 3. RESULTS: Only 5 and 8 of 220 parent-reported preschool problem items were significantly related to later child-reported depression and anxiety, respectively, and only 3 of 120 teacher-reported problem items were related to later anxiety. Of 120 teacher-reported preschool problem items, 21 were significantly related to later depression, including items referring to early signs of depression and social and academic problems. CONCLUSIONS: Teachers, but not parents, can provide valuable information regarding preschool signals of preadolescent depression, but not anxiety. These signals include early social and academic problems.

Common and specific correlates of preadolescent internalizing and externalizing psychopathology.

The specificity of various child characteristics and environmental correlates of childhood internalizing and externalizing problems was examined using both cross-sectional and longitudinal analyses (from ages 2-3 and 4-5 years) in a general population sample of 10-11-year-olds. Specificity was defined according to a between-subjects and a within-subjects method, using parent and teacher reports of psychopathology. Temperamental withdrawal, parental internalizing psychopathology, and early single parenthood (for girls) were identified as correlates that are specific for internalizing problems, whereas temperamental high general activity level was identified as externalizing-specific. Further, parenting stress, poor school results (only for boys), and stressful life events (only for girls) were found to be common correlates of psychopathology. Research implications regarding the findings and the use of a within-subjects method are discussed.