Objective:   Maternal responsiveness to infant communication or cues to stop or start feeding begins as early as birth. Despite continued efforts to increase the number of mothers who breastfeed their infants to age six months, a majority bottle feed.  Because formula fed babies tend to gain more weight than breastfed infants, mothers who bottle feed need to be encouraged to allow infants to self-regulate. An infant self-regulates caloric intake by giving hunger and satiety cues. The objective of this study was to measure the association between maternal responses to infant feeding cues and feeding method in 129 low-income, mother-infant dyads in two Midwestern States.

Design: Secondary analysis of baseline data from Healthy Babies through Infant Centered Feeding (USDA 2009-55215-05220), an ongoing longitudinal study, was used for this study.

Setting: Mother-infant feeding interactions were videotaped in the mother’s home by trained data collectors.

Patients/Participants: Maternal participants were ≥ 18 years, eligible for WIC with no known chronic illness. Infants were < 4 months of age, had no known eating problems, and birth weight > 2500 grams.

Methods: The maternal-infant feeding interaction was scored by two certified research assistants using the Parent-Child Interaction tool for feeding (NCAST-F/PCI-F) and validated by consensus. Maternal responses were measured with the16-point caregiver contingency sub-scale (NCAFS-CC scale) of the NCAST-F/PCI-F tool.

Results:   Statistics were computed using SPSS 17.  Mothers’ ages ranged from 18 to 42 years, with 56% self-identified as African-American, 42% White, and 30% Hispanic. Infants ranged in age from one to 21 weeks; 51% were male. Seventy-three percent (n=94) of infants were observed bottle-feeding. The mean NCAFS-CC score was 8.48 (16 possible). One-way ANOVA showed that mean scores for bottle feeding (7.9) and breast feeding (10) were significantly different (F=18.26, p=.000). Mothers who bottle fed had lower scores on the NCAFS-CC than breastfeeding mothers.

Conclusion/Implications for nursing practice: In this sample the mean NCAFS-CC score was below the expected norm of 12. Nurses play a pivotal role in identification, development and delivery of interventions to foster maternal responsiveness. Maternal responses to infant hunger and satiety cues are foundational in promoting healthy eating habits and reducing childhood obesity. Observation of maternal responsiveness and help with cue recognition in bottle feeding mothers needs to begin at birth. Further research is needed in early infancy to help bottle feeding mothers develop responsive behavior to their infants’ hunger and satiety cues.

Keywords:   bottle feeding, maternal responsiveness, infant, obesity