Helping children grow up healthy
In 2019, 68 percent of Pennsylvania’s adults and 28 percent of Pennsylvania’s children ages two to four had overweight or obesity. These rates have been increasing for decades, and many parents do not know how to protect their children from unhealthy weight gain. To combat this trend, researchers in Penn State’s Center for Childhood Obesity Research (CCOR) have identified ways that parents can help prevent weight problems before they start.
Infancy and early childhood are ideal times to establish healthy patterns and routines for children that promote healthy growth as they age. During these periods, very different outcomes are possible for every individual.
“Once a child establishes a higher body weight, that higher weight can track across their life,” said Amy Moore, postdoctoral fellow at CCOR. “Intervening before a problem exists is the most effective way to help children grow up to be a healthy weight.”
%
of Pennsylvania’s adults had overweight or obesity
%
of Pennsylvania’s children ages two to four of Pennsylvania’s adults had overweight or obesity
Traditionally, people have used the term ‘obese’ as an identifier, as in, “He is obese.” Obesity, however, is a medical condition, not a personal definition. For that reason, researchers now prefer to refer to obesity as a condition, as in, “He had obesity for several years.”
INSIGHTS about infant feeding
Researchers at CCOR come from a variety of disciplines, and their varied expertise contributed to the development and launch of their landmark INSIGHT study in 2012. The study began with 279 first-born infants from different families. Parents in the study were educated on how to respond to infant behavior states like fussiness, alertness (feeding and interactive play), drowsiness, and sleeping. Research has shown these situations are interrelated, so the lesson addresses them all.
Throughout the first three years of their lives, children in the INSIGHT study had lower body mass indices (BMIs) than children in the control group. The program content did not exclusively focus on weight; parents learned to recognize their child’s hunger and satiety signs, to allow their child to decide when the child was full, and—later in the child’s development—to establish routines and expectations around food, sleep, and behavior regulation.
CCOR’s research indicates that new parents should engage in responsive parenting and responsive feeding to establish a healthy weight trajectory early in their child’s life. Responsive parenting involves responding to children in a timely, sensitive, and age-appropriate manner based on the child’s presenting needs. Responsive feeding—one aspect of responsive parenting—involves paying attention to hunger and fullness cues from infants and responding to a child’s needs rather than defaulting to feeding whenever a child cries.
Author
Aaron
Wagner
– Amy Moore
What parents should do
“Although ‘responsiveness’ is an evidence-based framework, the definition can be a bit hard to wrap your mind around,” said Jennifer Savage Williams, director of CCOR and associate professor of nutritional sciences at Penn State.
In order to help parents channel responsiveness into action, INSIGHT program materials provide clear guidelines about feeding and other infant behavior situations.
“We encourage parents to establish routines, structure, and clear expectations early in their child’s development,” explained Lindsey Hess, education program specialist at CCOR. “This works better and is easier to maintain than using control-based practices like restricting foods or pressuring a child to eat certain foods. By parenting responsively, parents can take some of the struggle out of feeding and eating.”
For the first four to six months of a child’s life, CCOR recommends feeding babies only breastmilk or formula. Additionally, CCOR instructors teach parents to look for cues that their baby is full instead of encouraging their baby to ‘finish a bottle.’
The focus on responsiveness extends to bedtime as well. CCOR recommends that babies under the age of four months are put to bed drowsy but still awake between 7:00 and 8:00 p.m. and that parents use a pre-bedtime routine that is calming for the baby. When the baby wakes, parents are encouraged to use strategies like shushing or white noise and then escalate to rocking or bouncing if needed. Feeding should be provided only when the baby is showing signs of hunger.
Sometimes, parents are tempted to soothe children with food, but this can help an infant learn that food is necessary for calming. Shushing, swaddling, pacifiers, and changing positions can all be effective soothing techniques. Additionally, parents are encouraged to respond quickly to a fussing child and to address other possible problems (temperature, diaper change, needs soothing, etc.) before resorting to feeding. Feeding is an effective strategy to quiet a fussy child, but continually feeding children when they are not hungry can lead to unhealthy weight gain.
When parents practice responsive feeding, children still grow up to be a wide variety of shapes and sizes. Rapid infant weight gain is associated with later obesity, hypertension, heart disease, diabetes, and asthma, so preventing unhealthy weight gain is critical. Pediatricians can help parents monitor whether or not their child’s weight gain is healthy.
0-4 Months Do’s & Don’t’s
Sleeping Do's
Sleeping Don't's
Active Social Play Do's
Active Social Play Don't's
- Do put your baby to bed between 7:00 and 8:00 p.m.
- Do each night, in the 20 to 45 minutes before bedtime:
- Feed if hungry and stop when full; bathe baby, if needed; change and dress for sleep; do a calm activity in the room where baby sleeps; put your baby to bed drowsy, but still awake; and turn off lights.
- Do consider a “dream feed” before you go to bed if your baby has already been asleep for a few hours.
- Do if your baby wakes fussing and crying at night:
- Check on your baby with lights dim and wait 1-2 minutes to see if your baby will calm down.
- Try calming strategies like shushing or white noise followed by strategies like rocking or bouncing.
- Only feed your baby when hungry.
- Put your baby down drowsy but awake.
- Don’t make it a habit to feed, rock, or bounce your baby to sleep.
- Don’t try to keep your baby up until you’re ready for bed.
- Don’t turn on the lights when checking on your baby at night.
- Do play with your baby on the floor every day, giving your baby the chance to move around freely.
- Do play with your baby by offering lots of different objects to look at and touch.
- Don’t overuse restrictive equipment, such as strollers or swings for holding infants while they are awake.
- Don’t be afraid to take your baby outside or to a public place on a nice day.
Sleeping Do's
- Do put your baby to bed between 7:00 and 8:00 p.m.
- Do each night, in the 20 to 45 minutes before bedtime:
- Feed if hungry and stop when full; bathe baby, if needed; change and dress for sleep; do a calm activity in the room where baby sleeps; put your baby to bed drowsy, but still awake; and turn off lights.
- Do consider a “dream feed” before you go to bed if your baby has already been asleep for a few hours.
- Do if your baby wakes fussing and crying at night:
- Check on your baby with lights dim and wait 1-2 minutes to see if your baby will calm down.
- Try calming strategies like shushing or white noise followed by strategies like rocking or bouncing.
- Only feed your baby when hungry.
- Put your baby down drowsy but awake.
Sleeping Don't's
- Don’t make it a habit to feed, rock, or bounce your baby to sleep.
- Don’t try to keep your baby up until you’re ready for bed.
- Don’t turn on the lights when checking on your baby at night.
Active Social Play Do's
- Do play with your baby on the floor every day, giving your baby the chance to move around freely.
- Do play with your baby by offering lots of different objects to look at and touch.
Active Social Play Don't's
- Don’t overuse restrictive equipment, such as strollers or swings for holding infants while they are awake.
- Don’t be afraid to take your baby outside or to a public place on a nice day.
Working directly with young children
The risk for rapid weight gain does not end in infancy. A new CCOR project will teach three-to-five-year-old children the skills they need to manage their own food intake.
CCOR’s ONE PATH study aims to prevent obesity in low-income children by improving their self-regulation. Researchers are working with children in preschool, their teachers, and their parents. All those who are regularly involved in the children’s eating and feeding are presented with the same information. Adults are taught which skills children need to master and how to reinforce those skills.
Children in the program are taught mindfulness techniques like ‘listening to their tummies’ to see if they are truly hungry. If they want food when it is not time for food, children learn to divert their energy into other areas, like singing or playing a game.
Data collection has been delayed by the COVID-19 pandemic, but the study will resume in January of 2022. Savage Williams, who leads the ONE PATH study, is excited for this next chapter in CCOR’s research.
“We will be in schools, observing whether young children can regulate their own diets when they receive proper instruction,” Savage Williams explained. “We are going into the homes and classrooms where children live and eat, in their natural environments. This is the next step towards creating sustainable programs that are available and work across the country.”
Raising healthy children
Through INSIGHT, ONE PATH, and many other projects, researchers at CCOR have worked to understand and prevent childhood obesity and its associated health problems for 17 years.
“One of the biggest gaps in behavioral research is getting messages into communities,” said Savage Williams. “So, CCOR takes the science from Penn State and elsewhere—ranging from basic research to clinical trials—and we find ways to translate and disseminate that research into widespread and sustainable community-based programs.
“This means carrying ideas from their conception to the point where they are proven to work for all sorts of people,” she continued. “Then, we need to make sure that resources and trainings exist and are broadly available to pediatricians’ offices, school districts, or whomever might deliver the information or training to the children and families that need it. All of us at CCOR are all excited to continue this work until all parents and children have the tools needed so that children grow up healthy.”
Photo Credits
Images:
teerapon by Adobe Stock
markus mainka by Adobe Stock
Svetlana Zinovieva by Adobe Stock
Author
Aaron Wagner
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