Promoting Responsive Feeding During Breastfeeding, Bottle-Feeding, and the Introduction to Solid Foods

By Alison Ventura

Promoting Responsive Feeding During Breastfeeding, Bottle-Feeding, and the Introduction to Solid Foods addresses how caregiver feeding practices and styles shape the quality and outcome of feeding interactions during infancy. Emphasis is placed on how the quality and nature of caregiver-child interactions during breastfeeding, bottle-feeding, and the introduction to solid foods shape the development of children’s eating behaviors, growth trajectories and chronic disease risk. The book also considers the potential influence of broader contextual factors on early feeding interactions, including how psychological, social, cultural and economic factors may influence caregivers’ abilities to implement feeding recommendations.

• Highlights the importance of responsive, or infant-led feeding practices and styles
• Promotes high-quality caregiver-infant interactions during breastfeeding, bottle-feeding and the introduction to solid foods
• Discusses the socioemotional and cognitive benefits of high-quality feeding interactions

• Language: English
• Publisher: Academic Press
• Release date: Aug 3, 2022
• ISBN: 9780323884532

Alison Ventura

Alison Ventura received a B.S. in Psychology with an emphasis in Biology and a minor in Community Nutrition from the University of California, Davis. She then earned two Master’s degrees from the Pennsylvania State University: one in Nutritional Sciences and the other in Human Development and Family Studies. In 2008, she earned her Ph.D. in Human Development and Family Studies from the Pennsylvania State University. From 2008-2011, Dr. Ventura was a NIH Ruth L. Kirschstein National Research Service Award postdoctoral fellow at the Monell Chemical Senses Center, a taste and smell research institute in Philadelphia, PA. For the past decade, Dr. Ventura’s research has primarily focused on infant feeding interactions and understanding how these interactions affect the development of eating behaviors and growth trajectories across infancy and early childhood.

Book preview

Chapter 1: Introduction

Abstract

This chapter introduces the reader to the importance of early feeding interactions and the concept of responsive feeding. The overarching aims of this book are presented. The chapter concludes with an overview of what will be covered in the chapters to follow.

Keywords

Responsive feeding; Caregiver-child interactions; Infants; Health potential

Caring for children is one of the most important responsibilities—and one of the greatest privileges—adults will have in their lifetime. Caregivers play a critical role in ensuring the health, development, and survival of their children, as well as passing on their families’ culture and traditions. For these reasons, caregivers, and the practitioners and researchers that support them, are in need of evidence-based guidance to ensure caregiver-infant interactions foster the physical, cognitive, language, and socioemotional skills infants needed to thrive and achieve their health potential.

One of the first contexts within which parents interact with their newborn infants is during feeding. Throughout infancy and early childhood, children are dependent on caregivers for what, when, and—at times—how much they are fed. Indeed, no other type of interaction happens as frequently or consistently as early feeding interactions. These interactions have both nutritional and social significance because feeding interactions ensure the infant is properly nourished, but also afford the infant opportunities for socioemotional and cognitive growth when the caregiver is attentive, responsive, and engaged with the infant. Early feeding exposures and interactions directly influence infants’ short-term health and developmental outcomes, such as their rates of weight gain during infancy. However, these exposures and interactions also affect longer-term health potential and outcomes, including children’s biological propensity toward obesity and risk for obesity-related chronic diseases.

Until fairly recently, infant feeding advice was often narrowly limited to discussions of calories, macro- and micronutrients, and the amounts and types of foods infants should be fed at different developmental stages. During the late 1800s and early 1900s, scientific advances in the field of nutrition supported developments in pediatric nutrition research and practice and expanded our understanding of the nutritional requirements of young children. One particularly influential example of these scientific advances was the creation of commercial infant formulas, which reduced families’ reliance on wet nurses when breastfeeding was not desired or possible and increased reliance on pediatricians and other healthcare providers to support infant nutrition. Infant formulas came to be regarded as superior to breast milk (although later research disproved this perception), and their increased popularity and use coincided with perceptions that infant feeding should be prescriptive and under the control of pediatricians and parents to dictate what, how often, and how much the infant consumed.

The seminal work of some important skeptics, such as Clara Davis’ studies of children’s self-selection of diet in the 1920s and 1930s, helped us better appreciate what the child brings to the table during feeding interactions. Their work highlighted the importance of preserving child autonomy during feeding interactions and fostering infants’ developing abilities to self-regulate intake in response to hunger and fullness cues and developmental needs.

Parallel research in the field of developmental psychology helped us better appreciate the idea that the benefits of feeding interactions extend far beyond the delivery of nutrients. Harry Harlow’s monkeys illustrated that caregivers’ provision of warmth and comfort is as important as the provision of calories for infants’ abilities to survive and thrive. Early attachment researchers, such as John Bowlby and Mary Ainsworth, highlighted the profound impact that caregivers’ sensitivity and responsiveness to infant cues and needs have on children’s understanding of their worth in their worlds, as well as the development of secure attachment to their caregivers, abilities to self-regulate behaviors and emotions, and overall achievement of positive developmental outcomes. In addition, early infant temperament researchers, such as Alexander Thomas, Stella Chess, and Mary Rothbart, helped us understand just how much infants and young children contribute to early caregiver-child interactions through their unique temperaments, which underline children’s distinctive ways of reacting to and interacting with their worlds. From these pioneering researchers and their seminal studies—as well as the related research that followed—emerged an appreciation for the benefits of responsive parenting, wherein caregivers are sensitive to their infant’s cues and developmental needs and contingently respond to these cues in ways that are warm, developmentally appropriate, and matched to the infant’s expressed need.

In the past few decades, we’ve seen the emergence of a distinct field of research on child feeding, or the ways in which parents and caregivers interact with children within mealtime contexts to influence their eating behaviors, dietary patterns, and weight outcomes. One of the pioneers in this field, Leann Birch, was among the first to integrate the fields of pediatric nutrition and developmental psychology to understand the how of feeding infants and young children, including how caregivers’ feeding practices and styles shape the quality and outcome of feeding interactions. Through innovative and creative experimental and longitudinal studies, Dr. Birch and the families she and her research team studied showed us that the ways in which caregivers interact with their children during mealtimes matter—sometimes even more than the food offered or the meals consumed. These interactions can leave lasting impressions on the child that shape his or her food preferences, abilities to eat in response to hunger and fullness cues, and tendencies toward problematic eating behaviors such as eating in the absence of hunger and picky eating. Notably, these interactions can also leave lasting impressions on caregivers that shape their future feeding and parenting perceptions, attitudes, and practices. By focusing on the how of feeding young children, recent child feeding researchers have further emphasized the importance of responsive feeding practices and styles that create positive mealtime interactions, protect infants’ important contributions to feeding interactions, and support the development of healthy eating behaviors, dietary patterns, and weight gain trajectories during early childhood.

The aim of Promoting Responsive Feeding during Breastfeeding, Bottle-feeding, and the Introduction to Solid Foods is to provide a comprehensive overview of research examining the how of infant feeding, with a focus on implications of the ways in which caregivers and infants interact in different feeding contexts. This book highlights the benefits of responsive feeding and provides recommendations for how researchers and practitioners can promote responsive feeding during breastfeeding, bottle-feeding, and the transition to solid foods. Although responsive feeding in lower-income countries is an important consideration and has been the topic of much research and writing, the specific focus of this book will be on responsive feeding in higher-income countries where issues related to overfeeding, obesity, and lifestyle-related chronic diseases are significant concerns and targets for primary prevention efforts.

Organization of the Book

This book is organized into three parts. Part 1 provides an overview of the foundational importance of feeding interactions during infancy for later physical and psychosocial health outcomes. Chapter 2 reviews the scientific evidence that illustrates the ways in which the first 1000 days (the period from conception through the child’s second birthday) are a sensitive period for the development of healthy dietary preferences, eating behaviors, self-regulatory abilities, and weight gain trajectories. This chapter emphasizes the importance of infant feeding for both short- and long-term physical, cognitive, and socioemotional outcomes. Chapter 3 outlines metrics for assessing weight gain and growth trajectories during infancy and introduces the reader to the World Health Organization (WHO) growth standards. This chapter differentiates healthy rates of weight gain in early infancy from rapid infant weight gain, which is one of the strongest risk factors for later obesity.

Part 2 of this book explores the concept of responsive feeding, both broadly and within the specific contexts of breastfeeding, bottle-feeding, and the transition to solid foods. First, Chapter 4 illustrates the various ways infants communicate their needs and how this communication relates to infants’ developing abilities to self-regulate; this understanding is an important foundation for appreciating the need for and benefits of responsive feeding. Chapter 5 builds upon the information covered in Chapter 4 to further the reader’s understanding of the importance of supporting infants’ developing abilities to communicate and self-regulate through responsive feeding. The concept of responsive feeding is defined and discussed, and tangible examples of responsive feeding are provided. An emphasis is placed on illustrating how caregiving that is responsive to infants’ behavioral cues and developmental needs is a critical foundation for supporting infants’ developing abilities to self-regulate, and, ultimately, infants’ overall health and well-being. Chapter 6 applies the concepts of responsive feeding to breastfeeding interactions. This chapter illustrates the importance of responsive, infant-led feeding for establishing and sustaining breastfeeding, as well as how learning to trust infants’ cues and abilities to self-regulate can be an important foundation for mothers’ breastfeeding success. Chapter 7 applies concepts of responsive feeding to bottle-feeding interactions. The reader will be educated about key features of bottles and bottle-feeding interactions that may lead to overfeeding and rapid weight gain. An emphasis is placed on highlighting potential solutions and best practices for achieving responsive feeding during bottle-feeding. Finally, Chapter 8 focuses on the transition to solid foods and examines how to apply the concepts of responsive feeding to this developmental stage. Novel implications of infants’ increased motor skills and autonomy are examined within the context of responsive feeding. Best practices for promoting infants’ preferences for healthy foods are also outlined.

Part 3 of this book provides additional considerations related to support for and barriers to promoting responsive feeding for today’s families. Chapter 9 raises awareness about the potential implications of caregiver distraction by technological devices (e.g., televisions, mobile devices) during infant feeding and care interactions. The vast majority of adults own some sort of portable device, and many caregivers report using some sort of technological distractor while feeding their infants. Thus, this chapter reviews research illustrating how caregivers’ engagement with technological distractions decreases the quality of caregiver-child interactions. Practical suggestions related to balancing the benefits of technology use with the infant’s need for an engaged caregiver are provided. Chapter 10 provides a broad overview of a variety of psychological, social, cultural, familial, and economic factors that influence caregivers’ abilities to implement feeding recommendations. This chapter aims to provide the reader with an appreciation of how caregivers’ feeding practices may be shaped by factors such as their own relationship with food and eating, previous experiences with child-rearing, cultural practices and beliefs, and social and economic determinants of health. This chapter also considers how research, education, and support can be tailored to promote inclusiveness and appreciation for diversity.

Overall, it is my hope that Promoting Responsive Feeding during Breastfeeding, Bottle-feeding, and the Introduction to Solid Foods will help the reader develop an appreciation for what responsive feeding interactions look like within a diverse array of early feeding contexts and will empower the reader to promote responsive feeding in their future research and practice.

Part 1

The Importance of Infant Feeding for Later Health Outcomes

Chapter 2: Healthy Beginnings

Abstract

This chapter reviews evidence for the ways in which the first 1000 days are a sensitive period for interventions to promote the development of healthy eating behaviors, dietary patterns, self-regulatory abilities, and weight gain trajectories. First, the concept of sensitive periods of development is defined, and mechanisms underlying the unique impacts and importance of sensitive periods of development are reviewed. Next, evidence for sensitive periods for the development of eating behaviors, dietary patterns, self-regulatory abilities, body composition, and weight gain trajectories during pregnancy and early infancy are discussed. Finally, implications of sensitive periods for research and practice are emphasized.

Keywords

First 1000 days; Sensitive periods of development; Food preferences; Dietary patterns; Eating behaviors; Self-regulation; Weight outcomes

Introduction

Recent research and public health initiatives have recognized the foundational importance of the first 1000 days, which represents the period between a child’s conception and second birthday. The first 1000 days are a sensitive period of development because they are a time of rapid development and high plasticity (Fig. 2.1). Rates of brain development and physical growth are greater during this period compared to any other stage of development and young children are especially sensitive to environmental inputs (e.g., responsive parenting, dietary exposures), which shape their behaviors, preferences, and understanding of the world. Consequently, many experiences and exposures during this sensitive period have a more profound impact on later health outcomes than experiences and exposures that occur during later life.

Fig. 2.1

Fig. 2.1 The first 1000 days (the period from a child’s conception to second birthday) are a time of rapid development and high plasticity. Plasticity and reversibility decrease over time as development slows, while the cumulative impact of the child’s experiences grows. Combined, these developmental trends underline the foundational importance of the first 1000 days for supporting healthy growth and development.

Early life interventions to promote healthy feeding choices and interactions hold the potential to provide the most bang for their buck because they target children and parents during times when they are ready to learn and adapt, thus are most amenable to change (World Health Organization, 2016). As rates of development (and, in particular, brain development) slow with increasing age, learned behaviors and expectations become entrenched and more difficult to change. This is especially true for behaviors that have become habitual because they are deeply engrained in neural networks. Thus, an understanding of sensitive periods of development can facilitate the development of targeted interventions designed to promote the development of healthy diets and weight gain trajectories during early childhood, which will create a foundation of healthy habits that will serve children well for the rest of their lives.

This chapter reviews evidence for the ways in which the first 1000 days are a sensitive period for interventions to promote the development of healthy eating behaviors, dietary patterns, self-regulatory abilities, and weight gain trajectories. First, the concept of sensitive periods of development is defined and mechanisms underlying the unique impacts and importance of sensitive periods of development are reviewed. Next, evidence for sensitive periods for the development of eating behaviors, dietary patterns, self-regulatory abilities, body composition, and weight gain trajectories during pregnancy and early infancy are discussed. Finally, implications of sensitive periods for research and practice are emphasized.

Sensitive Periods Defined

A sensitive period is defined as a developmental period that has a disproportionate influence on long-term developmental and health outcomes compared to other developmental periods (Colombo, Gustafson, & Carlson, 2019; Halfon, Larson, Lu, Tullis, & Russ, 2014). Sensitive periods are typically periods of rapid development, such as the prenatal and neonatal periods, during which organ systems develop more rapidly than during other developmental periods. Of particular relevance is the rate of brain development during infancy, which underlines patterns of early adaptive learning that occur as infants experience their worlds through their senses of smell, taste, touch, sound, and sight (Hepper, 2015; Lagercrantz, 2016; National Research Council and Institute of Medicine Committee on Integrating the Science of Early Childhood Development, 2000).

A neonate’s brain at birth is approximately a quarter of the size of an adult brain but already contains a vast number of neurons, meaning the infant is primed to learn from sensory inputs (National Research Council and Institute of Medicine Committee on Integrating the Science of Early Childhood Development, 2000). This learning is evident in many ways but manifests anatomically by the brain doubling in size by the end of the child’s second year and reaching 90% of adult size by the time the child turns 5 years. Additionally, the period between birth and 2 years is a time of neural blooming wherein an extensive number of neural connections are made to embed within the brain the vast amount of learning that occurs (Huttenlocher, 1979; Huttenlocher & Dabholkar, 1997). Of note, learning that occurs during interactions with caregivers is particularly potent and preferentially encoded within neural networks. After age 2, pruning occurs, wherein the brain begins to prune connections that are less used (thus, deemed as less biologically relevant), leading to lower levels of plasticity with maturity (Huttenlocher, 1979; Huttenlocher & Dabholkar, 1997).

During sensitive periods, both endogenous or internal (e.g., hormones) and exogenous or environmental (e.g., responsive caregiving) influences shape trajectories of development (Lerner, 1984). Signals received via both endogenous and exogenous inputs during sensitive periods guide the development of the brain and other organ systems as a way of preparing the infant to quickly learn from early experiences, facilitating the infant’s abilities to respond most efficiently and effectively to current and future exposures and environments. Thus, the infant’s organ systems are literally programmed through a type of anticipatory adaptation. Effects of programming via endogenous and exogenous influences during sensitive periods are twofold: (1) the infant is more vulnerable to harmful exposures or environmental deficits but (2) the infant also receives greater benefits from positive exposures or environmental enrichments (Bornstein, 1989). As illustrated in Figs. 2.2 and 2.3, sensitive periods serve as important windows of opportunity to minimize the infant’s exposure to harmful stimuli and deficient environments (Fig. 2.2), but also to maximize the infant’s exposure to health-promoting stimuli and enriching environments (Fig.