Background/Purpose: Childhood obesity is a serious long-term risk factor for a variety of illnesses and generates higher health care cost in the United States. In turn, infant overweight is a risk factor for childhood obesity, and nearly 11% of U.S. infants are overweight. Because infant weight is nutrition dependent, maternal responses to infant feeding cues in the maternal-infant feeding interaction is a starting point in understanding influences on infant overweight. Yet, there are few studies focusing on how maternal responsiveness in the feeding interaction is associated with rapid weight gain (RWG). The primary purpose of the study was to determine to what extent maternal responses to infant feeding cues are associated with weight gain patterns in infants between birth and 6 months of age. Framework:Specific Aims: (1) Determine to what extent maternal responses to infant feeding cues are associated with weight gain in infants between birth and 6 months. (2) Determine to what extent maternal characteristics (age, depressive symptomatology, education, and feeding method) are associated with maternal responses to infant cues. (3) Determine to what extent infant characteristics (age, sex, and temperament) are associated with maternal responses to infant cues. Methods: This study was an analysis of data from the first data collection point of the Healthy Babies through Infant Centered Feeding (USDA 2009-55215-05220) study. The study sample included all mother-infant dyads with complete Time 1 data entries between January 2010 and May 2011. A total of 129 mother-infant dyads were examined for this study. Results: (1) The proposed regression model using maternal responses to infant feeding cues and maternal and infant characteristics during the maternal-infant interaction did not predict infant weight gain; however, using logistic regression and RWG as the dichotomous dependent variable, a minimally significant result (p = .048) was seen using the proposed model to predict the odds of RWG. (2) The regression model using the proposed maternal characteristics explained 14% of the variability in Nursing Child Assessment Satellite Training Tool Caregiver Contingency Subscale (NCAFScc) scores. Maternal responses to infant feeding cues were observed less often in maternal-infant interactions where the feeding method used was a bottle. Maternal characteristics of age, education, and postpartum depressive symptomatology were not significant predictors within the regression model. (3) The regression model using the proposed infant characteristics was not found to be significant. Two characteristics, infant age and infant temperament (negative affect), were significant. As infant's age increased, NCAFScc scores declined, and as scores on the Infant Behavior Questionnaire -negative affect scale increased, NCAFScc scores declined. Implications: Nurses can be influential in the process of infant weight tracking and bottle-feeding education. Careful tracking of infant weight gain in comparison to the World Health Organization infant growth standard during the first 6 months of life by health care providers is a key element in the overall risk assessment to reduce the prevalence of childhood obesity. Nurses need to acknowledge that a majority of mothers will transition to bottle-feeding in the first few months of an infant's life. Along with the breastfeeding initiative already in place, a tandem initiative to support mothers while they start or transition to bottle-feeding is recommended, according to the findings of this dissertation, so mothers remain responsive to their infant's feeding cues.
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