Abstract
Background
Teaching caregivers to respond to normal infant night awakenings in ways other than feeding is a common obesity prevention effort. Models can simulate caregiver feeding behavior while controlling for variables that are difficult to manipulate or measure in real life.
Methods
We developed a virtual infant model representing an infant with an embedded metabolism and his/her daily sleep, awakenings, and feeds from their caregiver each day as the infant aged from 6 to 12 months (recommended age to introduce solids). We then simulated different night feeding interventions and their impact on infant body mass index (BMI).
Results
Reducing the likelihood of feeding during normal night wakings from 79% to 50% to 10% lowered infant BMI from the 84th to the 75th to the 62nd percentile by 12 months, respectively, among caregivers who did not adaptively feed (e.g., adjust portion sizes of solid foods with infant growth). Among caregivers who adaptively feed, all scenarios resulted in relatively stable BMI percentiles, and progressively reducing feeding probability by 10% each month showed the least fluctuations.
Conclusions
Reducing night feeding has the potential to impact infant BMI, (e.g., 10% lower probability can reduce BMI by 20 percentile points) especially among caregivers who do not adaptively feed.
Impact
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Teaching caregivers to respond to infant night waking with other soothing behaviors besides feeding has the potential to reduce infant BMI.
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When reducing the likelihood of feeding during night wakings from 79% to 50% to 10%, infants dropped from the 84th BMI percentile to the 75th to the 62nd by 12 months, respectively, among caregivers who do not adaptively feed.
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Night-feeding interventions have a greater impact when caregivers do not adaptively feed their infant based on their growth compared to caregivers who do adaptively feed.
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Night-feeding interventions should be one of the several tools in a multi-component intervention for childhood obesity prevention.
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Acknowledgements
This project was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) via grant U01HD086861 and 5R01HD086013-02, as well as the NICHD and Office of Behavioral and Social Sciences Research (OBSSR) under award number U54HD070725, and the National Institute of General Medical Sciences (NIGMS) as part of the Models of Infectious Disease Agent Study (MIDAS) network under grant 1 R01 GM127512-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, U.S. Department of Health and Human Services, NICHD, NIGMS or OBSSR. None of the study sponsors had any role in the study design, collection, analysis, and interpretation of data, writing the report, nor the decision to submit the report for publication. This study was approved by the Johns Hopkins Bloomberg School of Public Health IRB (IRB #00006667).
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O’Shea, K.J., Ferguson, M.C., Esposito, L. et al. The impact of reducing the frequency of night feeding on infant BMI. Pediatr Res 91, 254–260 (2022). https://doi.org/10.1038/s41390-021-01397-7
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DOI: https://doi.org/10.1038/s41390-021-01397-7
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