Iron-deficiency anemia in infancy and mother-infant interaction during feeding

Abstract

Objective: This study was conducted to compare quality of mother-infant interaction during feeding in infants with or without iron-deficiency anemia (IDA).

Method: Infants and caregivers were screened at their 9- to 10-month-old health maintenance visits at an inner-city clinic in Detroit. Those who were full-term and healthy received a venipuncture blood sample to assess iron status. Of the 77 infants who met final iron status criteria, 68 infants and mothers were videotaped during feeding interaction at the Child Development Research Laboratory. The quality of mother-infant interaction during feeding was scored on the Nursing Child Assessment Feeding Scale. Twenty-five infants with IDA (hemoglobin [HB] <110 g/L and at least 2 abnormal iron measures) were compared to 43 nonanemic infants (HB > or = 110 g/L) using analysis of variance and general linear models with covariate control.

Results: Mothers of IDA infants responded with significantly less sensitivity to infant cues and less cognitive and social-emotional growth fostering behavior than mothers of nonanemic infants. The pattern of results was similar for scales of contingent behaviors. The magnitude of the differences in maternal ratings was large (0.8-1.0 SD after covariate adjustment). IDA infants were rated significantly lower on clarity of cues and overall (effect sizes 0.5 SD).

Conclusion: IDA in infancy was associated with less optimal mother-infant interaction during feeding. Future interventions might target feeding interaction and consider effects on infant iron status and developmental/behavioral outcomes among IDA infants, as well as infant feeding practices per se.

Figure 1

Conceptual model of effects of early iron deficiency. Modified with permission from Lozoff et al. Child Dev. 1998;69:24-36.

Figure 2

Maternal NCAFS scores by infant iron status. Values shown are adjusted means ± SE. Maternal anxiety was a significant covariate for social-emotional growth fostering and cognitive growth fostering. ** p ≤.01

Figure 3

Maternal NCAFS contingency scores by infant iron status. Values shown are adjusted means ± SE. Significant covariates were gestational age for sensitivity to cues and maternal anxiety for cognitive growth fostering. * p ≤ .05 ** p ≤ .01

Figure 4

Infant NCAFS scores by infant iron status. Values shown are adjusted means ± SE. Infant age and gestational age were significant covariates for clarity of cues. ** p ≤ .01