Baby-led weaning in Italy and potential implications for infant development.

Baby-led weaning is an approach to complementary feeding that emphasizes an infant's ability to self-feed rather than being spoon fed, and to eat minimally-processed foods rather than puréed foods. This study aimed to investigate the variability in infant feeding practices and the possible association with developmental milestones in an Italian population. A sample of 1245 mothers of 6-12 month-old infants completed an online survey about complementary feeding and their infant's attainment of developmental milestones. Infants' eating of family food was positively related to self-feeding and to a lower consumption of puréed foods. As in previous studies in the UK and New Zealand, a baby-led weaning style was positively associated with breastfeeding, exposure to complementary foods around six months of age, earlier exposure to both finger and family foods, and higher interest in family food and shared family meals. Infants who were introduced to solid foods using a baby-led weaning approach were more likely to have met important developmental milestones; when controlling for covariates, percentage of family feeding was positively associated with sitting unsupported at an earlier age and a low spoon-feeding style was associated with crawling at an earlier age. These data suggest that baby-led weaning should be defined more comprehensively. Moreover, its potential influence on developmental domains beyond diet and eating behavior warrants future targeted exploration.

Comparison of High and Normal Birth Weight Infants on Eating, Feeding Practices, and Subsequent Weight.

Objectives High birth weight (HBW ≥ 4000 g) infants are at increased risk for obesity, but research has yet to identify the mechanism for this increased risk and whether certain subsets of HBW infants are at greater risk. Methods This exploratory study examined child eating behaviors and maternal feeding practices and beliefs across 21 HBW and 20 normal birth weight (NBW, 2500-3999 g) infants at 7-8 months of age using maternal-report measures (n = 41) and a bottle feeding task (n = 16). Results HBW infants were at increased risk for high weight-for-length at 7-8 months (F (2, 38) = 6.03, p = .02) compared to NBW infants, but no statistically significance differences on weight gained per day since birth, child eating behaviors, or most maternal feeding practices and beliefs were found between HBW and NBW infants. However, HBW infants who maintained a high weight-for-length (≥ 85th percentile) at 7-8 months had a higher birth weight, gained more weight per day, and had lower maternal-reported satiety responsiveness and maternal social interactions during feedings than their HBW counterparts who were currently below the 85th percentile. Conclusions for Practice HBW infants did not differ from NBW infants on eating behaviors and feeding practices, but children born at HBW who maintain excess weight during infancy do differ from those infants who fall below the 85th percentile for weight-for-length. Future research should identify risk factors that longitudinally differentiate HBW infants at greatest risk for maintaining excess weight and develop early screening and intervention efforts for this subset of at-risk infants.

Whole Goat Milk-Based Formula versus Whey-Based Cow Milk Formula: What Formula Do Infants Enjoy More?-A Feasibility, Double-Blind, Randomized Controlled Trial.

(1) Background: While goat milk formula (GMF) is an alternative to cow milk formula (CMF), infants' preferences for one over the other have not been formally assessed. Specifically, our aim in this study was to determine whether infants experience fewer feeding behavior problems with whole milk-based GMF than with conventional whey-based CMF. (2) Methods: This was a multicenter, double-blind, randomized controlled trial with two-arm parallel assignment conducted in six pediatricians' offices in or near Paris, France, between June 2018 and 31 December 2021. Overall, 64 healthy infants (≤4 months old), predominantly formula-fed, were randomly assigned to either the whole milk-based GMF (n = 33) or whey-based CMF (n = 31) arm. Parents completed the Baby Eating Behavior Questionnaire (BEBQ) and the modified QUALIN questionnaire to evaluate infant feeding behavior and quality of life (psychomotor and socioemotional development), respectively, at inclusion (1 to 5 days before milk delivery) and the final visit (day 28 ± 3 after milk delivery). Informed consent was obtained for all recruited patients, and an ethical committee approved the study. (3) Results: Changes in BEBQ Enjoyment of Food and Slowness in Eating subscale scores from inclusion to final visit did not differ between arms. However, there were significant improvements in subscale scores for Food Responsiveness (GMF: 0.15 ± 1; CMF: -0.48 ± 0.81; p = 0.010) and General Appetite (GMF: 0.26 ± 1.2; CMF: -0.48 ± 0.88; p = 0.012), and modified QUALIN (GMF: 4.6 ± 9.4; CMF: -0.40 ± 7.6; p = 0.03) scores in favor of the GMF group. (4) Conclusions: In this double-blind, randomized controlled trial, GMF-fed infants exhibited a greater general appetite than CMF-fed infants, possibly due to differences in the composition of these formulas (i.e., protein and lipid profiles). In addition, GMF-fed infants enjoyed a better quality of life. There was no difference in food enjoyment between groups. These findings suggest that whole-milk-based GMF could be an attractive alternative to whey-based CMF. Clinical trial registration: NCT03488758 (clinicaltrials.gov).

An Experimental Approach to Study Individual Differences in Infants' Intake and Satiation Behaviors during Bottle-Feeding.

BACKGROUND: As a group, bottle-fed infants are at higher risk for rapid weight gain compared with breast-fed infants. However, little is known about individual differences in feeding behaviors of bottle-feeding infants, as well as maternal and infant characteristics associated with bottle-feeding outcomes. METHODS: We conducted a 2-day, within-subject study of 21 formula-feeding dyads; the within-subject factor was feeding condition: mother-led (ML; mothers were given the instruction to feed their infants as they typically would) vs. infant-led (IL; the experimenter ensured feeding began when infants signaled hunger and ended when they rejected the bottle on three consecutive occasions). Intake was determined by bottle weight; feedings were video-recorded and later analyzed to determine feeding duration and types of satiation behaviors displayed. Percent difference scores were calculated for each outcome as [((ML - IL)/IL) × 100] to standardize differences among dyads. Mothers completed questionnaires of feeding styles and infant temperament. RESULTS: On average, infants consumed ∼42% more formula during the ML- than IL-condition (p = 0.03). However, notable variation existed in difference scores for intake (range = -52.8% to 268.9%; higher scores reflect greater intake during ML than IL). Stepwise regression illustrated that greater intakes during the ML-condition were predicted by the combination of: (1) higher infant age; (2) lower levels of infant rhythmicity and adaptability; (3) higher levels of infant positive mood; and (4) lower levels of maternal restrictive and responsive feeding styles. CONCLUSIONS: This objective, experimental approach illustrated that variation in bottle-feeding outcomes is associated with characteristics of both members of the dyad.

Early Lactation and Infant Feeding Practices Differ by Maternal Gestational Diabetes History.

BACKGROUND: Detailed data on lactation practices by gestational diabetes mellitus (GDM) history are lacking, precluding potential explanations and targets for interventions to improve lactation intensity and duration and, ultimately, long-term maternal and child health. OBJECTIVE: This study aimed to examine breastfeeding practices through 12 months postpartum by GDM history. METHODS: Women who delivered a singleton, liveborn infant at The Ohio State University Wexner Medical Center (Columbus, OH), in 2011 completed a postal questionnaire to assess lactation and infant feeding practices and difficulties. Bivariate and multivariate associations between GDM history and lactation and infant feeding practices were examined. RESULTS: The sample included 432 women (62% response rate), including 7.9% who had GDM during the index pregnancy. Women with GDM initiated breastfeeding (at-the-breast or pumping) as often as women without any diabetes but were more likely to report introduction of formula within the first 2 days of life (79.4% vs 53.8%, P < .01; adjusted odds ratio: 3.48; 95% confidence interval, 1.47-8.26). Women with GDM initiated pumping 4 days earlier than women without diabetes ( P < .05), which was confirmed in adjusted analyses. There was no difference in the proportion of women reporting breastfeeding difficulty (odds ratio: 2.08; 95% confidence interval, 0.78-5.52). However, there was a trend toward women with GDM reporting more formula feeding and less at-the-breast feeding as strategies to address difficulty compared with women without diabetes. CONCLUSION: Additional research is needed to understand why women with GDM engage in different early lactation and infant feeding practices, and how best to promote and sustain breastfeeding among these women.