Infants' Transitions out of a Fussing/Crying State Are Modifiable and Are Related to Weight Status

Abstract

Currently, about 10% of infants have a weight for length greater than the 95th percentile for their age and sex, which puts them at risk for obesity as they grow. In a pilot obesity prevention study, primiparous mothers and their newborn infants were randomly assigned to a control group or a Soothe/Sleep intervention. Previously, it has been demonstrated that this intervention contributed to lower weight-for-length percentiles at 1 year; the aim of the present study was to examine infant behavior diary data collected during the intervention. Markov modeling was used to characterize infants' patterns of behavioral transitions at ages 3 and 16 weeks. Results showed that heavier mothers were more likely to follow their infants' fussing/crying episodes with a feeding. The intervention increased infants' likelihood of transitioning from a fussing/crying state to an awake/calm state. A shorter latency to feed in response to fussing/crying was associated with a higher subsequent weight status. This study provides preliminary evidence that infants' transitions out of fussing/crying are characterized by inter-individual differences, are modifiable, and are linked to weight outcomes, suggesting that they may be promising targets for early behavioral obesity interventions, and highlighting the methodology used in this study as an appropriate and innovative tool to assess the impact of such interventions.

Figure 1

Behavior diaries completed by mothers for 4 days at infant ages 3 and 16 weeks. Mothers were instructed by nurses on how to complete the diaries and indicated one of four mutually exclusive infant behavioral states for each 15-min interval depicted above. These diaries were adapted from Barr et al. (1988). The major difference is that fussing and crying were collapsed into one behavioral state in our version of the diaries.

Figure 2

The latency to feeding mediates the relationship between infants’ probabilities of transitioning from fussing to feeding at 3 weeks and weight status at ~6 months. Thus, a shorter latency to feeding in response to infant distress seems to be the aspect of fuss to feed transitions that is problematic with regards to subsequent weight status. Regression models depicted in both a and b were adjusted for maternal pre-pregnancy BMI, infant birth weight, sex, and intervention group(s). Note: #p < .10, *p < .05, ***p < .001.