Managing Excess Infant Energy Intake by Increasing Satiation Responsiveness in Dyadic Feeding Interactions

PROJECT SUMMARY Emerging evidence suggests that infants with greater appetitive drive may benefit from different feeding approaches for the prevention of obesity and chronic disease. Slower milk delivery may be a promising strategy, given that slower eating is associated with reduced intake and lesser weight gain throughout the lifespan, including in infancy. In a sample of 243 infants aged 2-4 months, slower milk delivery increased sucking effort and reduced intake. The results of this experiment, though reflective of only a single pair of feedings, suggest that slower milk delivery may be a promising intervention strategy for addressing excessive infant weight gain. However, many questions remain before the development of such an intervention could be pursued, including the mechanism for this behavior change. The proposed project will examine infant, mother, and dyadic interaction behavior during the feedings with slower milk delivery from this experiment, and compare infant, mother, and dyadic behavior between faster and slower milk delivery to address the following aims. Aim 1 (K99): To examine the relative contributions of infant (satiation signaling, behavioral distress, sucking vigor), maternal (responsivity, behavioral distress), and dyadic (mutuality, feeding duration) behaviors as mechanisms explaining the effect of slowed milk delivery on reduced intake in a single feeding. Aim 2 (K99): To examine whether the pathways of association in this conceptual model differ between infants with typical versus high appetitive drive. Aim 3 (R00): Among 220 infants at age 8-12 weeks, to examine—across 72 hours of feedings in which milk delivery rate is slowed by 30% compared to typical—the cross-lagged associations of changes from baseline in sucking vigor and feeding frequency with infant satiation signaling, infant behavioral distress, and dyadic mutuality and to determine if these associations differ based on higher versus lower infant appetitive drive. The PI, Dr. Crandall, is a behavioral scientist with an interdisciplinary background in nutrition, psychology, and public health. Her growing research program seeks to understand the cascading effect of high infant appetitive drive, integrating the dyadic nature of infant eating/feeding with the hope of developing safe, effective, and equitable intervention strategies. With the support of a multidisciplinary team of mentors, during the training phase of this award Dr. Crandall will grow her content knowledge of the physiology of infant eating behavior and growth; gain experience with three levels of behavioral coding of mother-infant feeding interactions; gain experience with structural equation modeling techniques; and, in the R00 phase, conduct an independent investigation of infant/mother feeding behavior with slower milk delivery across multiple days. At the conclusion of the award period, Dr. Crandall will be poised to test an intervention designed to manage high appetitive drive and excessive intake, among infants most at risk, while promoting maternal and infant well-being and the health of the dyadic interaction.