Complementary Feeding Interventions for Infants and Young Children Under Age 2 Scoping of Promising Interventions to Implement at the Community or State Level (2023) / Chapter Skim
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5 Identified Informative Studies and Elements
5 Identified Informative Studies and Elements
Pages 113-140
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This chapter describes these "informative studies" and "informative elements" (defined in more detail below) , along with key takeaways or lessons learned from each study or element.
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INfant Feeding, Activity, and Nutrition Trial The INfant Feeding, Activity, and Nutrition Trial (INFANT) program is designed to be an early life, family-centered, behavioral intervention intended to improve the dietary, physical activity, and screen time outcomes of children and caregivers with the ultimate goal of reducing childhood obesity incidence in the state of Victoria in Australia.
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. Target Behaviors and Conceptual Frameworks INFANT targeted children's behaviors in four domains (infant feeding, food provision and dietary intake, physical activity, and sedentary behaviors)
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Parents' regarding: upright and increased awareness of • parental modeling walks with child mobility of eating, sedentary, handhold and physical activity behaviors • impact of eating, activity, and sedentary behaviors on health of children and adults and the provision of opportunities 12, 15, Infant stands Increasing autonomy of Continued development of and 18 without support child in eating and activity themes/skills regarding: months and begins to • eating and moving for walk health of parents and children • how to feed/how to manage food rejection and demands • providing fail-safe food and activity environments SOURCE: Campbell et al., 2008.
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The committee assessed the potential scalability of INFANT and scored it positively on 13 of 22 scalability items in the WHO ExpandNet checklist, illustrating strong evidence base, stakeholder engagement, evidenceinformed pragmatic adaptations for scale-up, and funding mechanisms for scale-up. Attributes could not be determined for nine items, representing
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due to limited workforce capacity at scale and the inclusion of some of the activities in the app. -- Eight additional behavior change techniques were added Providers -- Delivery agent expanded to offer flexibility according to organization and staff capacity, given that no additional funding was provided for delivery.
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Although the real-world effectiveness of INFANT on a larger scale is still being studied, the systematic process being followed by the investigators is based on robust implementation science principles and offers important lessons for others interested in improving infant and young child feeding practices and other lifestyle behaviors. Overall, the process to scale INFANT offers the following lessons for scaling up infant and young child feeding programs: 1.
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was a responsive parenting intervention delivered to U.S. families via home visiting with the overarching goal of early childhood obesity prevention.
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were focused on helping caregivers recognize child hunger and satiation cues; provide age-appropriate portion sizes and repeated exposures to new foods and beverages; model healthy behaviors; avoid using food as a reward, punishment, or sole source of soothing; establish regular routines and limits; and understand growth charts. In addition, nurses provided caregivers with guidance and resources related to promoting healthy infant sleep, active play, and emotional regulation, and setting screen time limits.
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However, it is likely that all home visitors could be trained on the INSIGHT curriculum content, which is well aligned with positive parenting practices and child development content already included as part of the curriculum for many home visiting models. For INSIGHT, there was no reported community engagement in the curriculum design or study implementation.
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Target Behaviors and Conceptual Frameworks Family Spirit Nurture uses the same format and delivery system as Family Spirit, a national home visiting model designed by and for Tribal communities which meets the U.S. Department of Health and Human Services criteria to be designated as evidence-based (Bleiweiss-Sande et al., 2022; Rosenstock et al., 2021)
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aimed to encourage caregiver responsive feeding practices (e.g., identifying infant's hunger and satiation cues, modeling healthy eating) and recommended complementary feeding practices and to reduce child access to SSB (Rosenstock et al., 2021)
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. The program intensity was based on evidence of the visit frequency used by effective home visiting programs (approximately 60 planned visits over 1–5 years, with completion of at least one-third to half of the visits)
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. The potential scalability of Family Spirit Nurture was assessed using the WHO ExpandNet checklist, and it scored positively for 10 of 22 scalability items, with strong engagement of stakeholders and an accessible, nationwide network of affiliates already implementing the original, evidence-based Family Spirit home visiting model in rural and reservation-based communities which are disproportionately affected by obesity and its cardiometabolic consequences (see Appendix F)
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. The intervention in the pilot study incorporated the principles of social learning theory by organizing online, moderated social media peer groups that allowed participants to observe behavior among their peers and receive positive feedback in response to desired behaviors (Bandura, 1977; Gruver et al., 2016)
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Informative Aspects for Purpose of This Study Four Facebook groups were formed, with an average of 30 participant posts per week per group, indicating a high degree of participant engagement. At the final follow-up, 88 percent of participants agreed with the statements, "I would recommend this program" and "This program was helpful." These findings suggest that the use of Facebook to deliver a social learning complementary feeding intervention is easily implementable and accepted.
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No differences were observed in maternal feeding practices as measured by the Infant Feeding Questionnaire (Baughcum et al., 2001)
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understanding the impact of texting on energy, nutrient, and food group intake (Gibby et al., 2019; Macchi et al., 2022; Palacios et al., 2018) on infant feeding practices and weight gain (Palacios et al., 2018)
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Outcomes were measured using an infant food frequency questionnaire previously evaluated for validity at the end of the intervention (Macchi et al., 2022) ; an infant feeding practices questionnaire with questions about the type of infant feeding (breast or bottle-feeding)
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It uses associative learning theory and outlines interventions aimed at improving infant feeding behaviors (Baranowski, 2008)
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could allow the repeated exposure concept to be further incorporated within existing CACFP program guidelines. Other Intervention Elements: EniM Clinical Trial Overview The EniM study was conducted in Spain to evaluate the effectiveness of an educational program for parents of children 1 to 2 years of age that was focused on the acquisition of healthy eating habits for the parents themselves and their children (Roset-Salla et al., 2016)
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Informative Aspects for Purposes of This Study This research study outlines interventions aimed at improving adult and child feeding behaviors in an ECE setting within a high-income country (Spain)
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home visiting program. BFF Centers were paired by socioeconomic status and racial/ethnic composition and were randomly assigned to conduct either the standard NFN home visiting program or the intervention NFN home visiting program.
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The next chapter describes considerations for scaling infant and young child feeding programs based on the informative studies and informative elements reviewed by the committee, along with considerations related to settings and systems responsible for implementing complementary feeding interventions. REFERENCES Bandura, A
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2019b. Examining the effects of an eHealth intervention from infant age 6 to 12 months on child eating behaviors and ma ternal feeding practices one year after cessation: The Norwegian randomized controlled trial Early Food for Future Health.
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2016. Translating an early childhood obesity prevention program for local community implementation: A case study of the Melbourne InFANT program.
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2018. IN SIGHT responsive parenting intervention and infant feeding practices: Randomized clinical trial.
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