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Introduction This study examined postpartum depression, food insecurity, and underestimation of infant size as potential early life factors for overweight risk at 12 months among infants of Hispanic immigrant mothers. Method Weight-for-length (WFL) measurements and face-to-face interviews were completed during well child visits. Regression models estimated the impact of early life factors (0-6 months) on overweight risk at 1 year. Results WFL ≥ 85th percentile was found among 2.4% at birth and 42.7% at 1 year. Most mothers (78.6%) experienced food insecurity, a factor that increased the likelihood of infant overweight risk by 2.29 times (1.03–5.09). Maternal underestimation of infant size increased the likelihood of overweight risk 5.07 times (2.57–9.99). Postpartum depression risk did not contribute to infant weight status. Discussion Assessment for maternal food insecurity and underestimation of infant weight status during early infancy may help reduce overweight risk and subsequent obesity for this vulnerable population.

Purposes Describe implementation of Institute of Medicine (IOM) early infant feeding recommendations for child obesity prevention by immigrant mothers from Central America; examine potential relationships with food insecurity and postpartum depressive symptoms. Design and Methods Using a cross-sectional, descriptive design, face-to-face interviews were conducted with 318 mothers of 2 month old infants at a large pediatric setting for low income families. Logistic regression models assessed feeding practices, food insecurity and postpartum depressive symptoms. Results Exclusive breastfeeding rates were low (9.4%); most mothers (62.7%) both breastfed and bottle fed their infants. Mothers who bottle fed at moderate and high intensity were twice as likely to affirm that if you give a baby a bottle, you should always make sure s/he finishes it (OR = 2.30, 95% CI = 1.13, 4.69; OR = 2.29, 95% CI = 1.26, 4.14). Food insecurity was experienced by 57% of mothers but postpartum depressive symptoms were low (Possible range = 0–30; M = 2.96, SD =3.6). However, for each increase in the postpartum depressive symptoms score, the likelihood of affirming a controlling feeding style increased by 11–13%. Conclusions Immigrant mothers from Central America were more likely to both breastfeed and bottle feed (las dos cosas) than implement exclusive breastfeeding. Bottle feeding intensity was associated with a controlling feeding style. Practice Implications Infant well visits provide the ideal context for promoting IOM recommendations for the prevention of obesity among children of immigrant mothers from Central America.

Introduction This study examined the association between early weight gain (0–6 months) and risk for overweight, as defined by the Institute of Medicine, at 1 year among infants of low-income Hispanic immigrant mothers. Method Weight-for-age data were extracted from electronic medical records of 335 infants with gestations of 37 weeks or longer and birthweights appropriate for gestational age and without medical problems likely to interfere with growth or feeding. Logistic regression models were constructed to examine the impact of early weight changes on weight status at 1 year. Results By 12 months, 36.7% of infants had crossed weight-for-age of 84.1% or greater on World Health Organization growth charts. In adjusted models, infants had 20.8 (95% confidence interval = [19.8, 44.0]) times the odds of reaching this benchmark at 1 year for each z score increase at 0 to 6 months. Discussion The study highlights a time-sensitive opportunity for interventions to reduce risk for overweight for this vulnerable population.

Hispanic preschoolers have higher rates of BMI ≥85th percentile than any other racial/ethnic group. To identify underpinnings of this disparity, we compared early feeding practices and subsequent weight status for a sample of infants of low-income, Hispanic immigrant mothers with participants from the Infant Feeding Practices Study II (IFPS II).Proyecto de Bebés Hispanos Saludables (PBHS) collected medical record data for mother-infant dyads (n = 550) from a large pediatric clinic for low-income families and merged it with IFPS II data (n = 1502) to compare early feeding practices and late infancy weight status.Mode of milk delivery for PBHS mothers was less likely to be exclusive breastfeeding at 6 months (9.0% vs. 27.5%), but more likely to be both breast and bottle feeding (43.5% vs. 26.3%) compared to IFPS II mothers. No difference was found in age for solid food introduction. Weight for age of PBHS infants was more likely to be ≥85th percentile at 12 months than IFPS II infants (39.1% vs. 25.4%). Both PBHS and IFPS II infants were more likely to be ≥85th percentile at 1 year if mode of milk delivery was bottle only at 6 months compared to those who were breastfed only, even after adjusting for potential confounders.Differences in PBHS and IFPS II feeding practices and weight status suggest additional studies of modifiable, early life risk factors are needed to inform clinical and public health interventions that reduce childhood obesity for this growing sector of the US population.

Background: The World Health Organization has identified childhood obesity as a major threat to global health. Accumulating evidence indicates that excess weight early in life is predictive of later childhood and adolescent obesity. Clinical practice guidelines for infant feeding behaviors have been developed by national and international health organizations. The relationship between these guidelines and infant weight status has not been established. Aim: To examine the relationship between weight-for-age at 1 year and adherence to four clinical practice guidelines for feeding behaviors: no bottle-to-bed, minimal juice consumption, breastfeeding throughout the first year of life, and introduction to solid food no earlier than age 4–6 months. Methods: Data were obtained from the Infant Feeding Practices Study II, a longitudinal, national survey administered by the U.S. Food and Drug Administration and Centers for Disease Control and Prevention that followed mother–infant dyads from pregnancy through 1 year postpartum. The sample was comprised of 691 infants for whom 12-month survey data were available. Results: Significant associations with weight-for-age were found for juice consumption (p= 0.003), breastfeeding during the second half of infancy (p < 0.001), and introduction to solid foods prior to age 4 months (p < 0.001). A regression model that controlled for infant and maternal characteristics demonstrated that these feeding behaviors remained significant predictors of weight-for-age at 12 months. Conclusions and Implications: Modifiable infant feeding behaviors contributed to weight-for-age at 1 year. Replication studies with economically and culturally diverse samples are needed. Further, testing longitudinal interventions that address infant feeding practices is likely to yield the evidence needed for shaping future clinical practice guidelines that reduce the risk for childhood obesity and related pediatric comorbidities.

The purpose of this study was to describe early infant feeding practices among overweight/obese mothers using the Infant Feeding Practices Study II (IFPS II).In this study, we used data pertaining to the first 2 months postpartum of IFPS II. The data set includes 2387 mothers who provided information about infant feeding habits at the 2-month postpartum period.Overweight/obese mothers were less likely to breastfeed exclusively at 2 months infant age and more likely to breastfeed at low intensity the first 2 months compared to mothers of normal body mass index (BMI). Logistic regression analysis revealed, that after controlling for potential confounders, obese mothers were 1.38 (95% CI: 1.11, 1.72) times more likely to introduce solids to their infants before 4 months of age, and 1.37 (95% CI: 1.10, 1.89) times more likely to add cereal to the infant formula than their normal BMI counterparts.In conclusion, overweight/obese mothers not only fall short of clinical practice guidelines in regards to breastfeeding, but also are more likely to initiate early introduction (4 months infant age) to solid foods compared to their normal BMI counterparts. Interventions should be targeted to this group.

The aim of this paper is to present an overview of the infancy-related guidelines from the Institute of Medicine (IOM, 2011) report “Early Childhood Obesity Prevention Policies” and highlight research studies that support their implementation in pediatric practice. Findings from recent studies of infant growth monitoring, feeding, sleep, and physical activity are presented. Research strategies that may be applied to today's clinical assessments and interventions are specified. Participation by pediatric nurses in the development of future multi-component interventions to prevent rapid infant weight gain is recommended.

The purpose of this study was to test Orem's theory of self-care deficit, one of three constituent theories included in her general self-care deficit theory of nursing. Specifically, the relationship between dependent care agent performance and basic conditioning factors was examined. Dependent care agent performance for children was defined as health promotion and self-care activities provided by a responsible adult on behalf of the child. The Dependent Care Agent Questionnaire was used with a sample of 380 mothers of children from ages 1 to 16 years. The hypothesis that basic conditioning factors influenced dependent care agent performance was supported (R2 = .13, p = .0001).

purpose.:To explore relationships between pregnant womens' childhood experiences with discipline and 1) prenatal plans for disciplining own child and 2) later maternal-infant interactions design. Prospective correlational study setting. Prenatal clinics and home visits participants. Low-income pregnant women (N = 205) with a mean educational level of 12 years main outcome measures. Adapted Ways of Handling Irritating Behaviors (Mother and you) Scales, NCAST Teaching Scale, Home Observation for Measurement of the Environment Scale results. Correlations between childhood experiences with discipline and 1) plans for later discipline strategies with own child and 2) infant components of maternal-infant interactions, including clarity of cues and responsiveness to the mother conclusions. Prenatal assessment for childhood experiences with discipline may uncover factors associated with a break in the trajectory for optimal maternal-child interactions described by Barnard's theoretical framework.

This study examined postpartum depression (PPD) as a potential risk factor for non-adherence to infant feeding guidelines and subsequent infant weight gain.Participants were mother-infant dyads from the Infant Feeding Practices Study II (N = 1447). Main study variables were PPD, breastfeeding intensity, addition of cereal to infant formula, and age of introduction to solid foods.In logistic models adjusted for sociodemographic factors, mothers with PPD were 1.57 times (95% confidence interval [CI]: 1.16, 2.13) more likely to breastfeed at low intensity and 1.77 times (95% CI: 1.16, 2.68) more likely to add cereal to infant formula. Although PPD was associated with the early introduction to solid foods (odds ratio: 1.42; 95% CI: 1.07, 1.89), this relationship was not significant after adjusting for potential confounders. A small but significantly greater average weight gain at 6 months was observed among infants of mothers with PPD (10.15 lb, SD = 2.32 vs. 9.85 lb, SD = 2.32).Screening for PPD at well-child visits may lead to improved maternal health outcomes and the prevention of early life risk factors for childhood obesity.

OBJECTIVE While socioeconomic status (SES) and race/ethnicity are known predictors of breastfeeding practices, the added disparity caused by the rising rates of obesity among women of childbearing age remains untested. The purpose of this study was to examine differences in breastfeeding initiation and duration among black, white and Hispanic women of low and middle SES within the context of prepregnancy body mass index (BMI). METHODS Data from the Early Childhood Longitudinal Study-Birth Cohort were analyzed. Adjusted logistic regression models were built to examine differences in breastfeeding initiation and duration for the three racial/ethnic groups of low and middle SES. RESULTS Normal BMI Hispanic women of low SES demonstrated higher rates of breastfeeding initiation (74%) compared to other groups. Overweight/obese black women of low SES had lower rates of breastfeeding initiation. Overweight/obese Hispanic women of middle SES were significantly less likely to continue breastfeeding up to 4 months (OR: 0.65, 95% CI: 0.41, 0.98) compared to their white counterparts. Among women who initiated breastfeeding, overweight/obese white women of low SES had the highest rate of stopping within two months of giving birth (66.7%). CONCLUSIONS Examination of SES and racial/ethnic differences within the context of prepregnancy weight revealed specific groups with low rates of breastfeeding initiation and duration. Interventions tailored for these at-risk groups are needed to increase the overall proportion of mothers and infants who benefit from the positive health outcomes associated with breastfeeding.

The aim of the current study was to examine the role of maternal prepregnancy body mass index (BMI) on overweight/obesity among US Hispanic children ages 2 and 4 years old. We used US nationally representative data from preschoolers enrolled in the Early Childhood Longitudinal Study-Birth Cohort study. The findings revealed that a significantly higher percent (41.6%) of Hispanic mothers were overweight/obese prior to pregnancy compared to white mothers (34.8%). At 2 years of age, 38.3% of the children born to Hispanic mothers were overweight/obese compared to 29.4% of children born to white mothers. By the age of 4, overweight/obesity increased significantly for both racial/ethnic groups with preschoolers whose mothers were Hispanic being more likely to be overweight/obese (44.6%) compared to children whose mothers were white (34.2%). Further, preschoolers born to overweight/obese Hispanic mothers were more than twice as likely [odds ratio = 2.74 (95% confidence interval (CI) 1.60, 4.69)] to be overweight/obese than those born to Hispanic mothers of normal prepregnancy BMI. Preschoolers born to overweight/obese white mothers were approximately 1.4 (95% CI 1.05, 1.93) times more likely to be overweight/obese in comparison to those born to mothers with a normal prepregnancy BMI. Maternal prepregnancy weight is potentially a modifiable risk factor for preschooler overweight/obesity. Study findings support the design of early and targeted interventions to reduce this risk to the long-term health of Hispanic maternal and child dyads.

To extend current knowledge of tobacco use by exploring whether subsets of mothers of infants have unique triggers for smoking relapse during the early stages of becoming a mother.Using data from a study of smoking relapse among mothers of infants (N = 133), comparative analyses were conducted for groups formed on the basis of their intention to be nonsmokers after delivery (yes/no) and their actual smoking behavior during the first 2 weeks of infant life (yes/no).The identified groups of mothers were found to be significantly different from one another in several ways, including self-reports that their baby's crying episodes caused them to think about smoking and their level of self-confidence to not smoke as response to infant crying.Pediatric nurses in primary and acute care settings are in a unique position to support mothers for whom the challenge of handling infant cry episodes is a trigger for smoking behavior. Interventions that teach mothers how to cope with infant irritability are likely to support the smoking cessation efforts, and consequently, interrupt the intergenerational cycle of tobacco-related maternal and child health morbidities.

A necessary prerequisite for reducing infant morbidity associated with passive smoking is effective measurement of this health risk factor. The purpose of this review was to evaluate questionnaires currently used in research to measure infant environmental tobacco smoke (ETS) exposure. Systematic searches were conducted using MEDLINE and CINAHL databases to identify current studies of infant ETS exposure. Sixty research reports published between 1996 and 2002 met the selection criteria. All of these investigations used brief investigator-developed, parental self-reports; no two studies used the same questionnaire. Reliability testing for questionnaires was lacking. Preliminary support for concurrent and construct validity is presented. Nursing studies are needed that lead to the development of ETS exposure questionnaires with established reliability and validity that measure both risk and protective mechanisms that occur in the infant environment.

The purpose of this cross-cultural, correlational study was to evaluate two popular clinical/research assessment tools, the NCAST Teaching Scale and the Home Observation Measurement of the Environment (HOME) Inventory, as measures of infant health promotion behaviors for low-income, foreign-born Hispanic mothers in the United States. Based on the assumption that both measures tap universal attributes of the mother-infant relationship, it was hypothesized that maternal performance for the study group and a comparison group of U.S.-born, low-income mothers would be similar. Comparable performance on the NCAST Teaching Scale included a full range of scores, including the capacity to identify mothers most in need of clinical intervention. Study findings supported the clinical use of this assessment scale with mothers represented by the study sample. Consistently lower scores by the foreign-born Hispanic mothers on the HOME Inventory led to the conclusion that the instrument may not tap cultural universals in the mother-infant relationship.

PURPOSE: To examine the relationships among four maternal variables: 1) prenatal report of discipline expectant mothers received when they were children, 2) prenatal intentions for disciplining one's own child, 3) report of intended child discipline strategies when infant is 8 months old, and 4) observed maternal role sufficiency behaviors. DESIGN: Replication and extension study; 3-wave prospective longitudinal design. METHODS: The procedure consisted of prenatal clinic interviews in which women (N = 185) reported how their mothers handled specific child behaviors and how they intended to handle the same behaviors with their children. During a home visit when their babies were 8 months old, the mothers (n = 126) were again asked how they intended to handle these behaviors, and observations were made of maternal role sufficiency behaviors. Correlation and regression analyses were performed with data generated from an adaptation of the Ways of Handling Irritating Behavior scale, the NCAST Teaching Scale, and the HOME scale. RESULTS: A significant relationship was found between mothers' prenatal reports of discipline received as a child and prenatal reports of intentions for disciplining their own children. For mothers of infants, reported intentions for future child discipline strategies were predicted by their prenatal reports. Mothers with clinically at-risk scores on the NCAST Teaching Scale and HOME scale reported more intended harsh child discipline strategies than those not at-risk. CLINICAL IMPLICATIONS: Assessment for harsh, nonnurturing child discipline strategies during prenatal and well-baby health maintenance checks may assist in uncovering "red flags" for early intervention to reduce the risk of later child abuse and neglect. Language: en

Purpose: To identify infant health outcomes that have been empirically associated with environmental tobacco smoke (ETS) exposure in current international research literature. Methods: Reports of infant ETS exposure, obtained using computerized searches of CINAHL and Medline databases, were reviewed. Studies of infant health outcomes published between 1995 and 2000 were included if they met specific criteria including the selection of infant ETS exposure as a major study variable. Findings: The 10 studies in this integrative review of the literature were conducted in a variety of international health care settings. Positive associations were found between infant ETS exposure and gastroesophageal reflux, colic, sudden infant death syndrome, lower respiratory tract infections, and other infant morbidities. Parental self-reports were the predominant measures of ETS exposure. Maternal smoking was reported as a significant predictor of infant health outcomes. Conclusions: Nurses who care for mother-infant dyads in the first year of life are needed to support the development of a ‘gold standard’ for the measurement of ETS exposure that is reliable, valid, and economical. In the interim, the global nursing community may use the findings of these current studies as justification for directing infant health care resources to smoking cessation interventions specifically tailored to meet the needs of mothers who smoke.