Cognitive Stimulation and Maternal Feeding Styles in Families with Low Incomes: Impacts from a Randomized Clinical Trial

Elizabeth B Miller; Katherine A Hails; Caitlin F Canfield; Pamela A Morris-Perez; Daniel S Shaw; Alan L Mendelsohn; Rachel S Gross

doi:10.1016/j.acap.2024.09.012

Cognitive Stimulation and Maternal Feeding Styles in Families with Low Incomes: Impacts from a Randomized Clinical Trial

Acad Pediatr. 2024 Oct 9:102588. doi: 10.1016/j.acap.2024.09.012. Online ahead of print.

Authors

Elizabeth B Miller¹, Katherine A Hails², Caitlin F Canfield³, Pamela A Morris-Perez⁴, Daniel S Shaw⁵, Alan L Mendelsohn³, Rachel S Gross⁶

Affiliations

¹ Department of Population Health (EB Miller and RS Gross), New York University Grossman School of Medicine, New York, NY. Electronic address: elizabeth.miller@nyulangone.org.
² Prevention Science Institute (KA Hails), University of Oregon, Eugene, Ore.
³ Department of Pediatrics (CF Canfield, AL Mendelsohn, and RS Gross), New York University Grossman School of Medicine, New York, NY.
⁴ Department of Applied Psychology (PA Morris-Perez), Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY.
⁵ Department of Psychology (DS Shaw), University of Pittsburgh, Pittsburgh, Pa.
⁶ Department of Population Health (EB Miller and RS Gross), New York University Grossman School of Medicine, New York, NY; Department of Pediatrics (CF Canfield, AL Mendelsohn, and RS Gross), New York University Grossman School of Medicine, New York, NY.

PMID: 39389163
DOI: 10.1016/j.acap.2024.09.012

Abstract

Objective: To examine associations between cognitive stimulation in the home at 6 months and maternal feeding styles at 24 months, direct intervention effects of Smart Beginnings (SB) on feeding styles, and potential indirect effects of SB on feeding styles via earlier intervention effects on cognitive stimulation.

Methods: Single-blind, two-site randomized clinical trial (RCT) of the SB intervention. SB integrates PlayReadVIP, a universal, pediatric primary care-based program, and Family Check-Up (FCU), a targeted secondary home-based parenting intervention. Mother-infant dyads (N = 327) were randomized at birth to standard pediatric care or the SB intervention. Linear regression analyses determined associations between cognitive stimulation at 6 months and maternal feeding styles at 24 months, a secondary data analysis. Direct intervention impacts on feeding styles, a secondary RCT outcome, were also assessed and mediation analyses explored intervention effects on feeding styles via earlier intervention impacts on cognitive stimulation.

Results: Cognitive stimulation was significantly associated with higher responsive and lower indulgent feeding styles. SB mothers were less likely to exhibit pressuring styles compared with controls (Effect Size [ES]=-0.12, P = 0.02). Although no direct intervention effects were found on responsive or indulgent feeding styles, indirect effects of SB were evident on these feeding styles through intervention-induced increases in cognitive stimulation in the SB group.

Conclusions: This study found positive linkages between cognitive stimulation in the home and later feeding styles. Additionally, the SB intervention was associated with less pressured feeding and indirect pathways mediated by intervention effects on cognitive stimulation. Implications for early childhood parenting interventions are discussed.

Keywords: early cognitive home environment; feeding styles; infancy; parenting.

Grants and funding

R01 HD076390/HD/NICHD NIH HHS/United States