PEDIATRICS Vol. 107 No. 5 May 2001, p. e67
ELECTRONIC ARTICLE:
Home and Videotape Intervention Delays Early Complementary
Feeding Among Adolescent Mothers
Received Jul 13, 2000; accepted Nov 17, 2000.
,
From the * Department of Pediatrics, University of Maryland
School of Medicine, Baltimore, Maryland; Department of International
Health, Johns Hopkins University School of Hygiene and Public Health,
Baltimore, Maryland; and the § Department of Nutrition, University of
North Carolina at Chapel Hill, School of Public Health, Chapel Hill,
North Carolina.
Background. The American Academy of Pediatrics, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the World Health Organization recommend that infants receive only breast milk or formula for the first 4 to 6 months of life, followed by the introduction of complementary foods. Despite these recommendations, many infants, particularly those with adolescent mothers, receive solid foods (often cereal mixed with formula in a bottle) and liquids other than formula or breast milk in the first few weeks of life. Decisions on early feeding are often guided by grandmothers and influenced by beliefs that infants need complementary food to counteract signals of hunger, reduce crying, and sleep through the night.
Objective. This investigation evaluated the efficacy of an intervention to delay the early introduction of complementary feeding among first-time, black, adolescent mothers living in multigenerational households. The intervention focused on reducing the cultural barriers to the acceptance of the recommendations of the American Academy of Pediatrics, WIC, and World Health Organization on complementary feeding by highlighting 3 topics: 1) recognition of infants' cues; 2) nonfood strategies for managing infant behavior; and 3) mother-grandmother negotiation strategies. The intervention was delivered through a mentorship model in which a videotape made by an advisory group of black adolescent mothers was incorporated into a home-visiting program and evaluated through a randomized, controlled trial.
Methods. One hundred eighty-one first-time, low-income, black mothers <18 years old, living in multigenerational households were recruited from 3 urban hospitals. Infants were born at term, with birth weight appropriate for gestational age and no congenital problems. Shortly after delivery, mothers and grandmothers completed a baseline assessment and mothers were randomized into an intervention or control group. Intervention group mothers received home visitation every other week for 1 year. At 3 months, a subset of 121 adolescent mothers reported on their infant's intake through a food frequency questionnaire. Mothers who fed their infant only breast milk, formula, or water were classified as optimal feeders. Mothers who provided complementary foods other than breast milk, formula, or water were classified as less optimal feeders.
Results. Sixty-one percent of the infants received complementary foods before 3 months old. Multivariate hierarchical logistic regression was used to evaluate the determinants of being in the optimal versus less optimal feeders group. After controlling for infant age and family income, mothers of infants in the optimal feeders group were more likely to report accurate messages from WIC regarding the timing of complementary food and nearly 4 times more likely to be in the intervention group. The most common complementary food was cereal mixed with formula in the bottle.
Conclusions. The success of this relatively brief
intervention demonstrates the importance of using ecological theory and
ethnographic research to design interventions that enable participants
to alter their behavior in the face of contradictory cultural norms.
The intervention focused on interpreting infants' cues, nonfood
methods of managing infant behavior, and mother-grandmother
negotiations. It was delivered through methods that were
familiar and acceptable to adolescent mothers
a mentorship
model incorporating home visits and videotape. The skill-oriented
aspects of the intervention delivered in a culturally sensitive context
may have enabled the young mothers to follow the guidelines that they
received from WIC and from their pediatricians. Strategies, such as
those used in this intervention, may be effective in promoting other
caregiving recommendations, thereby enabling providers to meet the
increasing demands from parents for advice regarding children's early
growth and development.
Key words:
adolescent parenting,
infant
feeding,
complementary feeding,
home visiting,
intervention.
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