Development of a Scale to Measure Infant Eating Behaviour Worldwide.

In order to create a short, internationally valid scale to assess eating behaviour (EB) in young children at risk of undernutrition, we refined 15 phrases describing avidity or food refusal (avoidance). In study one, 149 parents matched phrases in English, Urdu, Cantonese, Indonesian or Greek to videos showing avidity and avoidance; 82-100% showed perfect agreement for the avidity phrases and 73-91% for the avoidant phrases. In study two, 575 parents in the UK, Cyprus and Indonesia (healthy) and in Kenya, Pakistan and Guatemala (healthy and undernourished) rated their 6-24 months old children using the same phrases. Internal consistency (Cronbach's α) was high for avidity (0.88) and moderate for avoidance (0.72). The best-performing 11 items were entered into a principal components analysis and the two scales loaded separately onto 2 factors with Eigen values > 1. The avidity score was positively associated with weight (r = 0.15 p = 0.001) and body mass index (BMI) Z scores (r = 0.16 p = 0.001). Both high and low avoidance were associated with lower weight and BMI Z scores. These scales are internationally valid, relate to nutritional status and can be used to inform causes and treatments of undernutrition worldwide.

Early caloric deprivation in preterm infants affects Bayley-III scales performance at 18-24 months of corrected age.

BACKGROUND: Adequate nutrition is essential for optimal neurodevelopment to preterm infants. Our aim was to evaluate the impact of caloric deprivation on Bayley-III scales performance at 18-24 months of corrected age, in a cohort of preterm infants. METHODS: We prospectively enrolled infants with gestational age <30 weeks and birth weight <1500 g. Apart from a whole cohort analysis, we performed a subgroup analysis between infants received inadequate calories (<85 Kcal/kg/day) during the first two weeks of age, compared to a standard nutrition group. All infants underwent a Bayley-III assessment at 18-24 months of corrected age. RESULTS: From the 63 preterm infants analysed, 25% had caloric deprivation compared to 75% with adequate nutrition. Caloric deprived infants were of lower gestational age and birth weight, and received a lower amount of enteral feeding during the first 14 days of age. There were no differences between the two groups regarding the common neonatal co-morbidities. Caloric deprived infants had significantly lower composite index scores at 18-24 months of corrected age. Caloric deprivation, late onset sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia were significant risk factors of neurodevelopmental impairment. CONCLUSIONS: Several neonatal factors affect the neurodevelopmental outcome of preterm infants, and nutrition may pose an important role.

Maternal depression and its association with responsive feeding and nutritional status of infants: A cross-sectional study from a rural medical college in central India.

Context: Globally, around half of all under-5 deaths are attributable to undernutrition. The magnitude of child undernutrition in India is one of the highest in the world. Responsive feeding that has the potential to optimize nutrition and development depends on a "healthy mother". Objectives: The objective of this study was to find out the magnitude and determinants of maternal depression among mothers of infants who attended immunization clinic in a rural medical college in central India and observe its association with infant-feeding practices and nutritional status of infants. Study Design: This was an analytical cross-sectional study. Materials and Methods: Study was conducted among consecutively chosen 300 mothers and their infants who visited the immunization clinic of hospital during May-September, 2016. Data were collected individually by interviewing each mother, and anthropometry of her infant was done. The mothers with depression were diagnosed according to the 10-item Edinburgh Postnatal Depression Scale. Magnitude of depression has been reported using frequency and percentage, whereas association has been studied using prevalence odds ratio with 95% confidence interval (CI) and logistic regression at 0.05 significance level. Results: The magnitude of maternal depression was 19% (95% CI 14.4-23.5). Mothers with depression had significantly higher odds for not indulging in responsive feeding. Maternal education had significant association with maternal depression after adjusting for other variables. Conclusions: Burden of maternal depression is high among mothers of infants who attended immunization clinic in a rural medical college in central India and is significantly associated with nonresponsive feeding practices.

Family influences on child nutritional outcomes in Nairobi's informal settlements.

BACKGROUND: Improving child nutritional status is an important step towards achieving the Sustainable Development Goals 2 and 3 in developing countries. Most child nutrition interventions in these countries remain variably effective because the strategies often target the child's mother/caregiver and give limited attention to other household members. Quantitative studies have identified individual level factors, such as mother and child attributes, influencing child nutritional outcomes. METHODS: We used a qualitative approach to explore the influence of household members on child feeding, in particular, the roles of grandmothers and fathers, in two Nairobi informal settlements. Using in-depth interviews, we collected data from mothers of under-five children, grandmothers, and fathers from the same households. RESULTS: Our findings illustrate that poverty is a root cause of poor nutrition. We found that mothers are not the sole decision makers within the household regarding the feeding of their children, as grandmothers appear to play key roles. Even in urban informal settlements, three-generation households exist and must be taken into account. Fathers, however, are described as providers of food and are rarely involved in decision making around child feeding. Lastly, we illustrate that promotion of exclusive breastfeeding for 6 months, as recommended by the World Health Organization, is hard to achieve in this community. CONCLUSIONS: These findings call for a more holistic and inclusive approach for tackling suboptimal feeding in these communities by addressing poverty, targeting both mothers and grandmothers in child nutrition strategies, and promoting environments that support improved feeding practices such as home-based support for breastfeeding and other baby-friendly initiatives.

Infant malnutrition is associated with persisting attention deficits in middle adulthood.

Infantile malnutrition is known to be associated with cognitive and behavioral impairment during childhood and adolescence. Data pertaining to longer-term effects on behavioral outcomes in adulthood are limited. In this study, we report associations between infantile malnutrition and attention problems in adults at midlife. Attention problems were assessed by the Conners Adult ADHD Rating Scales (CAARS) and the Conners Continuous Performance Test (CPT) in 145 Barbadian adults (aged 37-43 y) who had been followed longitudinally since childhood. Previously malnourished participants (n = 80) had experienced moderate to severe protein-energy malnutrition in the first year of life and were successfully rehabilitated thereafter. They were compared with healthy adults (n = 65) who were former classmates of the index cases and who had been matched for age, sex, and handedness in childhood. Multiple regression analyses showed persisting effects of childhood malnutrition on both the CAARS and the CPT, independent of effects of household standard of living assessed in childhood. The malnutrition effect on the CAARS ratings was independent of IQ, whereas this effect was attenuated for the CPT after adjustment for IQ. Teacher-reported attention problems in childhood predicted attention problems in adulthood, indicating continuity over the life span. Infantile malnutrition may have long-term effects on attentional processes nearly 40 y after the episode, even with excellent long-term nutritional rehabilitation and independent of socioeconomic conditions in childhood and adolescence. This finding has major public health implications for populations exposed to early childhood malnutrition.

Pregnant women's and community health workers' perceptions of root causes of malnutrition among infants and young children in the slums of Dhaka, Bangladesh.

Research in Bangladesh shows that malnutrition among infants and young children is most severe in urban slums. We examined the root causes of malnutrition as perceived by pregnant women and community health workers. We conducted 10 focus group discussions in the slums of Dhaka in 2008 and 2009. Participants accurately perceived inappropriate care, inappropriate environment, inappropriate food, and flooding to be major causes. Recurrent flooding has not traditionally been identified by experts as a cause of malnutrition. We recommend further research to address the nutritional risks flooding creates for vulnerable slum populations.

Early postnatal protein-calorie malnutrition and cognition: a review of human and animal studies.

Malnutrition continues to be recognized as the most common and serious form of children's dietary disease in the developing countries and is one of the principal factors affecting brain development. The purpose of this paper is to review human and animal studies relating malnutrition to cognitive development, focusing in correlational and interventional data, and to provide a discussion of possible mechanisms by which malnutrition affects cognition.

From Freud to a modern understanding of behavioral, physiological, and brain development.

Seymour Levine's first "early experience" experiments were inspired by Freud. Yet, Levine's lifetime of work, and the work of his colleagues and scientists who followed, unveiled a myriad of early experience effects that even Freud himself could not have imagined. Related to and extending beyond his work on early experience, Levine also made important, often seminal, contributions to overlapping and related areas, such as early maternal separation and deprivation, maternal behavior and physiology, sexual differentiation, perinatal malnutrition, attachment in non-human primates, hypothalamic-pituitary-adrenal (HPA) stress reactivity and its adaptive significance, and the development of the HPA system. Moreover, his work spawned new lines of research by investigators active today. The papers contained in this special issue provide a sampling of research demonstrating some of the important directions in which those earliest experiments have led, many with clinical applications.

Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers.

OBJECTIVE: To evaluate the efficacy of a paraprofessional-delivered, home-visiting intervention among young, reservation-based American Indian (AI) mothers on parenting knowledge, involvement, and maternal and infant outcomes. METHOD: From 2002 to 2004, expectant AI women aged 12 to 22 years (n = 167) were randomized (1:1) to one of two paraprofessional-delivered, home-visiting interventions: the 25-visit "Family Spirit" intervention addressing prenatal and newborn care and maternal life skills (treatment) or a 23-visit breast-feeding/nutrition education intervention (active control). The interventions began during pregnancy and continued to 6 months postpartum. Mothers and children were evaluated at baseline and 2, 6, and 12 months postpartum. Primary outcomes included changes in mothers' parenting knowledge and involvement. Secondary outcomes included infants' social and emotional behavior; the home environment; and mothers' stress, social support, depression, and substance use. RESULTS: Participants were mostly teenaged, first-time, unmarried mothers living in reservation communities. At 6 and 12 months postpartum, treatment mothers compared with control mothers had greater parenting knowledge gains, 13.5 (p < .0001) and 13.9 (p < .0001) points higher, respectively (100-point scale). At 12 months postpartum, treatment mothers reported their infants to have significantly lower scores on the externalizing domain (beta = -.17, p < .05) and less separation distress in the internalizing domain (beta = -.17, p < .05). No between-group differences were found for maternal involvement, home environment, or mothers' stress, social support, depression, or substance use. CONCLUSIONS: This study supports the efficacy of the paraprofessional-delivered Family Spirit home-visiting intervention for young AI mothers on maternal knowledge and infant behavior outcomes. A longer, larger study is needed to replicate results and evaluate the durability of child behavior outcomes.

Intra-individual variability in infancy: structure, stability, and nutritional correlates.

Intra-individual variability (IIV) refers to relatively stable differences between individuals in the degree to which they show behavioral fluctuations over relatively short time periods. Using temperament as a conceptual framework the structure, stability, and biological roots of IIV were assessed over the first year of life. Biological roots were defined by maternal and infant nutrition. The sample was 249 Peruvian neonates, followed from the second trimester of pregnancy through the first 12 months of life. Maternal anthropometry, diet, iron status, and fetal growth were assessed prenatally. Neonatal anthropometry and iron status were assessed at birth. Degree of exclusive breastfeeding was assessed at 3 and 6 months, infant anthropometry was assessed at 3, 6, and 12 months, infant dietary intake was assessed at 6 and 12 months and infant iron status was tested at 12 months. Individual differences in IIV at 3, 6, and 12 months were derived from a residual standard deviation score based on infant behaviors measured using the Louisville Temperament Assessment Procedure. Principal components analysis indicated that individual differences in IIV were defined by two components at 3, 6, and 12 months. There was modest stability between IIV components assessed at 3 and 12 months. Reduced levels of IIV at 3 months were predicted by higher maternal weight and higher fetal weight gains in the first and second trimesters of pregnancy. Higher levels of IIV at 3 months were predicted by higher levels of maternal hemoglobin during pregnancy and higher levels of neonatal ferritin.

"It's not an issue at the moment": a qualitative study of mothers about childhood obesity.

PURPOSE: To explore childhood obesity through mothers' perceptions, attitudes, beliefs, and behaviors. STUDY DESIGN AND METHODS: Descriptive qualitative study using in-depth interviews. Sixteen in-depth interviews were conducted with primiparous mothers of children aged 0-2 years. The questions focused on nutrition, the context of eating in the family, physical activity, television viewing, and the responsibility of parents as role models. Thematic analysis was used to identify regular patterns of meaning regarding the major issues pertaining to childhood obesity, nutrition, and physical activity. RESULTS: Five themes were identified: (1) developing eating habits, (2) developing active and sedentary habits, (3) differences between age groups, (4) sources of information, and (5) response to information. Although awareness about the need to provide a nutritious diet and opportunities for children to be active was high among the mothers, this was not always reflected in their behaviors. For many mothers, obesity became a concern only if excessive weight gain occurred. Prevention through establishing good habits early, although considered, was not always actively pursued. CLINICAL IMPLICATIONS: Interventions to prevent overweight and obesity need to focus on equipping parents with the skills to translate their knowledge into behavior and lay the foundations early for their children to develop healthy habits.

Malnutrition in the second year of life and psychosocial care: a case-control study in an urban area of Southeast Brazil.

The present study aimed to identify and measure the relationship between malnutrition and psychosocial care in the second year of life. A case-control study compared 101 malnourished 12-23-month-old children (weight-for-age < 5th percentile, WHO/NCHS) to 200 well-nourished children (weight-for-age > 25th percentile) for exposure to various maternal behaviors related to psychosocial care. A psychosocial care score was constructed, based on the number of desirable maternal behaviors that were absent (the higher the score, the worse the quality of childcare). The association was modified by per capita family income. After adjusting for possible confounders, children from higher-income households showed no association between psychosocial care and malnutrition. For children from lower-income households, worse psychosocial care doubled the risk of malnutrition (OR = 7.26; 95%CI: 2.42-21.82) compared to low income alone (OR = 3.08; 95%CI: 1.28-7.42).

Cognitive function of children with cystic fibrosis: deleterious effect of early malnutrition.

OBJECTIVE: Patients who have cystic fibrosis (CF) and experience delayed diagnosis by traditional methods have greater nutritional insult compared with peers diagnosed via neonatal screening. The objective of this study was to evaluate cognitive function in children with CF and the influence of both early diagnosis through neonatal screening and the potential effect of early malnutrition. METHODS: Cognitive assessment data were obtained for 89 CF patients (aged 7.3-17 years) during routine clinic visits. Patients had been enrolled in either the screened (N = 42) or traditional diagnosis (control) group (N = 47) of the Wisconsin CF Neonatal Screening Project. The Test of Cognitive Skills, Second Edition was administered to generate the Cognitive Skills Index (CSI) and cognitive factor scores (Verbal, Nonverbal, and Memory). RESULTS: Cognitive scores in the overall study population were similar to normative data (CSI mean [standard deviation]: 102.5 [16.6]; 95% confidence interval: 99.1-105.9). The mean (standard deviation) CSI scores for the screened and control groups were 104.4 (14.4) and 99.8 (18.5), respectively. Significantly lower cognitive scores correlated with indicators of malnutrition and unfavorable family factors such as single parents, lower socioeconomic status, and less parental education. Our analyses revealed lower cognitive scores in patients with low plasma alpha-tocopherol (alpha-T) levels at diagnosis. In addition, patients in the control group who also had vitamin E deficiency at diagnosis (alpha-T < 300 microg/dl) showed significantly lower CSI scores in comparison with alpha-T-sufficient control subjects and both deficient and sufficient alpha-T subsets of screened patients. CONCLUSION: Results suggest that prevention of prolonged malnutrition by early diagnosis and nutritional therapy, particularly minimizing the duration of vitamin E deficiency, is associated with better cognitive functioning in children with CF.

Maternal depression and low maternal intelligence as risk factors for malnutrition in children: a community based case-control study from South India.

AIMS: To determine whether current and postpartum maternal depression and low maternal intelligence are risk factors for malnutrition in children. METHODS: In rural South India 72 children with malnutrition were identified from a central register; 72 controls were matched for age, gender, and residence. RESULTS: Major depression in the postpartum period (OR 5.0, 95% CI 1.0 to 24.0), current major depression (OR 3.2, 95% CI 1.1 to 9.5), and low maternal intelligence (OR 3.8, 95% CI 1.3 to 11.1) were associated with malnutrition in the child. Low birth weight (OR 2.9, 95% CI 1.2 to 6.8) was also significantly associated with infant malnutrition. Conditional logistic regression adjusting for all other determinants yielded the following results: major depression during the postpartum period (OR 7.8; 95% CI 1.6 to 38.51), current major depression (OR 3.1; 95% CI 0.9 to 9.7), low maternal intelligence (OR 4.6; 95% CI 1.5 to 14.1), and low birth weight (OR 2.7; 95% CI 2.5 to 6.8). The interactions between current maternal depression and low birth weight and between postpartum depression and low maternal intelligence were statistically significant. The level of maternal intelligence was associated with nutritional status. The severity of malnutrition was also significantly associated with major depression during the postpartum period and low maternal intelligence. CONCLUSION: There is evidence for an association between postpartum maternal depression, low maternal intelligence, and low birth weight with malnutrition in children aged 6-12 months.

Características de la madre, diversidad de la dieta y problemas de nutrición en niños de comunidades rurales de Sonora, México / Influence of personality characteristic of the mother on diversity of children diet

Introducción. Con base en el modelo de Creencias en Salud, se llevó a cabo un estudio para conocer la influencia que tienen sobre la diversidad de la dieta algunas características de personalidad y estimaciones de riesgo que presentan las madres en el cuidado de niños de 1 a 6 años. Material y métodos. Doscientas diez familias de la zona rural del estado de Sonora, México, fueron evaluadas en sus hogares utilizando instrumentos validados y confiabilizados en muestras de poblaciones indepedientes a las de este estudio utilizando el modelo conceptual de atributolatente. Como características de personalidad se midieron los estilos de autoridad, estado anímico y estrés de la crianza y las estimaciones de riesgo fueron evaluadas a través de indicadores tales como: susceptibilidad, amenaza y control percibido. Resultados. Los resultados indican que lo niños cuyo peso para la talla fue menor a la primera desviación estándar, presentaron a la diversidad en el consumo de energía como única variable, mientras que para los niños cuyo peso se sitúa por arriba de la primera desviación estándar, tienen en la diversidad de la dieta algunas características conductuales y estimaciones de riesgo que presentan las madres con niños de 1 a 6 años. La variable que lo explica fue la diversidad en el consumo de frituras. En ambos casos las variables predictoras fueron el estilo de autoridad y las estimaciones de riesgo. El estrés de la crianza aparece como variable importante en preescolares para diversidad total. Conclusión. Aún cuando los valores del coeficiente de determinación son bajos, los datos pueden ser útiles en la orientación programática de actividades encaminadas a establecer dietas variadas en la población

Estrategias de intervención en desarrollo psicológico y desnutrición infantil primaria / Intervention strategies in psychological development and child malnutrition primary

El retraso en el desarrollo psicológico infantil en poblaciones carecientes se multiplica tres veces en relación con las cifras esperadas para la población general. En la Unidad de Rehabilitación Nutricional (URN) se desarrolla un progrma permanente de asistencia integral a la población de alto riesgo social con desnutricón de causa primaria. El objetivo desde el área psicológica es intervenir tempranamente para prevenir déficit en el el desarrolo psicològico. El propósito de este trabajo es estudiar la correlaciones existentes entre diferenctes variables como: escolaridad materna, actitud de los padres, desarrollo de los niños y evolución en el tratamiento, para lao cual se tomo una casuítitica de 42 familias y sus niños de 0 a 5 años ingresados al progrma de julio a diciembre de 1995. Se utilizaron como instrumentros para la evaluación una entrevista semiestructurada con los padres y la Escala de Evaluación del Desarrollo Psicomotor (EEDP) para 0-2 años y el Test de Desarrollo Psicomotor (TEPSI) para 2-5 años. Se implementaron estrategias de promoción del desarrollo personalizadas y se constato una evolución favorable en el 50 por ciento de los casos. Una de las conclusiones mas importantes es que resulta imprescindible un cambio de actitud de la madre en cuanto a la imporancia concedida al desarroollo psicológico y la relación de éste con el futuro del niño.

Estrategias de intervención en desarrollo psicológico y desnutrición infantil primaria / Intervention strategies in psychological development and child malnutrition primary

El retraso en el desarrollo psicológico infantil en poblaciones carecientes se multiplica tres veces en relación con las cifras esperadas para la población general. En la Unidad de Rehabilitación Nutricional (URN) se desarrolla un progrma permanente de asistencia integral a la población de alto riesgo social con desnutricón de causa primaria. El objetivo desde el área psicológica es intervenir tempranamente para prevenir déficit en el el desarrolo psicològico. El propósito de este trabajo es estudiar la correlaciones existentes entre diferenctes variables como: escolaridad materna, actitud de los padres, desarrollo de los niños y evolución en el tratamiento, para lao cual se tomo una casuítitica de 42 familias y sus niños de 0 a 5 años ingresados al progrma de julio a diciembre de 1995. Se utilizaron como instrumentros para la evaluación una entrevista semiestructurada con los padres y la Escala de Evaluación del Desarrollo Psicomotor (EEDP) para 0-2 años y el Test de Desarrollo Psicomotor (TEPSI) para 2-5 años. Se implementaron estrategias de promoción del desarrollo personalizadas y se constato una evolución favorable en el 50 por ciento de los casos. Una de las conclusiones mas importantes es que resulta imprescindible un cambio de actitud de la madre en cuanto a la imporancia concedida al desarroollo psicológico y la relación de éste con el futuro del niño. (AU)

Maternal sensitivity in a developing society: the context of urban poverty and infant chronic undernutrition.

This study focuses on young children's chronic undernutrition and its association with maternal sensitivity, sociodemographic variables, children's play, and problem-solving measures. Data were obtained with home observations and laboratory procedures on 85 mothers and infants (M age = 18 months) in a low-income urban population in Santiago, Chile. Maternal sensitivity was correlated with maternal education, maternal weight, and marital satisfaction. Observed in a variety of maternal roles, maternal sensitivity was also significantly associated with children's nutritional status, attachment security, and mastery behavior. These findings demonstrate the relevance of the maternal sensitivity construct outside industrialized societies and underline the need for intervention strategies to extend beyond nutritional supplementation to address deficits of maternal care associated with specific caregiver's roles.