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Consider culture in counseling on infant feeding: study

By Ronnie Cohen

NEW YORK (Reuters Health) - Obesity prevention efforts directed at infants may not work if cultural differences in childcare are not taken into account, suggests a new U.S. study.

Researchers found specific practices thought to promote childhood obesity - from putting infants to bed with bottles to feeding them while watching television - were more common in certain racial and ethnic groups compared to others.

"Rather than focus on the ethnic and racial differences, these results show us that we can all do better and begin our efforts to prevent obesity earlier in life," lead author Dr. Eliana Perrin told Reuters Health.

"I'm hoping this study is a wakeup call that families of all races and ethnicities need early counseling to lead healthier lives," said Perrin, a pediatrician and professor at the University of North Carolina-Chapel Hill School of Medicine.

More than one quarter of U.S. children aged two to five years old are overweight or obese, according to Perrin and her coauthors, whose results are published in Pediatrics.

Early weight problems are linked to an increasing likelihood of obesity - and all its attendant health risks - as kids grow into teens and adults (see Reuters Health story of January 29, 2014, here:).

Perrin's team enrolled 863 parents who brought their infants to one of four university-affiliated pediatric clinics for a two-month-old preventive services visit. The researchers asked parents about a variety of behaviors that have been linked to childhood obesity in previous research.

Most of the participating parents were mothers and the questions covered topics including what infants ate, how the food was given to them, activities parents performed during or around mealtime and measures of babies' physical activity levels.

The researchers found that more than 80 percent of the two-month-olds had been introduced to formula, and 12 percent had been fed solid food, although the American Academy of Pediatricians (AAP) urges mothers to feed their babies breast milk exclusively for the first six months.

More than one third of parents reported coaxing their babies to finish drinking bottles, and nearly a quarter propped bottles in their infants' cribs or bassinets.

Nearly half the parents reported watching television while feeding their infants, and 43 percent reported putting their babies to bed with a bottle.

Half the infants in the study actively watched an average of 25 minutes a day of TV, although the AAP discourages television for children under the age of two.

"Most pediatricians don't talk about television until a baby is at least 12 to 15 months old. I think this study tells us we need to talk about television early on in a baby's life," Perrin said.

"The message should be 'talk with your babies, play with your babies, allow your babies to begin to prop themselves up in a safe space, try not to have them watch television and try to notice when you're feeding them whether they're hungry or full,'" she said.

Babies who get food every time they cry and are prodded to eat when they are sated may learn to reach for food whenever they feel any kind of need, Perrin said.

When the researchers looked at the unhealthy behaviors by racial and ethnic group, no single group was free of the bad habits, but some were more common in certain cultures compared to the others.

Hispanic infants watched an average of 11 minutes of television a day, for example, whereas white children watched an average of 24 minutes and African-American children watched an average of 51 minutes. Less than 4 percent of Hispanic parents had introduced their infants to solid foods, whereas 16 percent of white mothers and nearly a quarter of black mothers had.

Compared with white parents, black parents were twice as likely to put children to bed with a bottle and three times as likely to prop a bottle on something like a blanket during feeding instead of holding it.

Hispanic parents were about twice as likely as whites to encourage children to finish the contents of the bottle and to prop the bottle.

Dr. Alma Guerrero, a pediatrics professor from Mattel Children Hospital UCLA in California, called the findings on the amount of time babies spent in front of television "astonishing."

Guerrero agreed the results underscore the need for early counseling across ethnic groups. "It highlights the point that families from all races and ethnicities need counseling on early infancy feeding and activity behaviors," she told Reuters Health.

Guerrero, who was not involved in the current study, recently began work on a five-year study of dietary behaviors that lead to obesity in Latino children between six months and five years old. The results of the current study led Guerrero to consider looking at even younger babies, she said.

Perrin said she hoped that clinicians could use data from her study to target counseling for newborn parents based on their ethnic background.

SOURCE: http://bit.ly/1mfJ0lS Pediatrics, online March 17, 2014.

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