It is one of the most pressing health problems of the next generation, yet clinicians have had little success stemming the tide of childhood obesity. Attempt after attempt to prevent excessive weight gain in children has failed, and that excess body fat raises a child's immediate and long-term risk of debilitating conditions like diabetes, heart disease, and bone and joint problems.
Now, an early intervention program focused on teaching new parents to calm infants without using food as a solution has effectively prevented overweight status at age 1 year, and reduced rapid weight gain during the first 6 months after birth — an important period of infant metabolic development.
Part of that success was driven by simple bedtime routines that encourage infants to self-soothe rather than be fed to sleep. The work is described in a pair of articles published this summer in the journals JAMA Pediatrics and Pediatrics.
"Many parents of babies and young children will use food for a variety of behaviors," such as to get them to sleep or prevent fussiness, says coauthor Ian Paul, a pediatrician and professor of pediatrics and public health sciences at Penn State College of Medicine. "We wanted to give parents other tools to calm them or attend to them without using food as the first option."
Rapid infant weight gain in the first year after birth is associated with obesity into childhood and adulthood. There is also evidence that feeding patterns become hard-wired in our brains early in life, so that eating to soothe or distract oneself can become a habit right from infancy.
In an effort to intervene early and prevent those habits, the research team at Penn State recruited 291 first-time mothers and randomly assigned them to one of two programs: a control group or a "responsive parenting" intervention. Each program involved four 90-minute home visits from a nurse and a final one-year office checkup.
The control group of parents received safety training, such as how to safely put a baby to sleep, prevent injuries at home, and prepare food. The intervention group received training on how to appropriately respond to their infants' needs. For example, they learned how to recognize infant hunger and satiety cues, and to offer healthy food — in age-appropriate portions — only when the child was hungry, not fussy, and not as a reward. These parents were also encouraged to promote healthy behaviors such as regular physical activity, limited screen time, and good sleep habits.
At one year, fewer than 6 percent of the infants whose parents participated in the responsive parenting intervention were overweight, compared to 13 percent of infants in the safety training program.
The researchers are now examining the effects of individual strategies within the intervention. In the sleep section, for example, parents were taught to put the children to bed between 7 p.m. and 8 p.m., with a consistent routine that didn't involve feeding as the last step, and to allow infants to fall back to sleep on their own if they woke during the night. After one year, infants whose parents employed those strategies slept on average 1 hour and 20 minutes longer than babies whose parents did not. Overall, the sleep strategies led to babies who were less likely to be fed immediately before bed, and were more likely to fall asleep on their own — all of which likely contributed to their reduced risk of being overweight, says Paul.
The team continues to track the families who participated, following the children as they grow into toddlers and observing the effects on any new siblings. The researchers are also now looking into how to disseminate the program to a broader audience.