The child care setting represents a crucial environment for infants and children to establish healthy feeding practices in order to prevent overweight and obesity. The objective of this research was to investigate the association between parental care (PC) and child care (CC) on infant feeding practices, food consumption, nutrient intake and growth in infants receiving Special Supplemental Nutrition Program for Women Infants and Children (WIC) assistance. Our hypothesis was that unhealthy feeding practices would be more common in CC compared to PC thus leading to greater weight for length (WFL) and weight for age (WFA) z-score at 1 year of age for infants in CC. This study sampled 105 infants aged 2 to 8 months of age from the Champaign Urbana WIC office from October 2009-August 2011. Mothers completed a 3-day food record and survey at the time of recruitment to assess their infant's feeding practices, nutrient intake, health status, and demographic characteristics. Baseline and follow-up weight and length for these children within the first year of age were collected from the WIC office.
The major differences in demographic characteristics of the study sample included child care hours per week, maternal employment, household income, and single parent home by CC use. Infants in CC had an average of 29 hours of care per week compared to the 0.64 hours in the PC group (p<0.01). A larger (p<0.01) percentage of mothers were employed in the CC group (73.9%) compared to the PC group (22%). However, the household income was greater (p<0.01) in the PC group ($15,986 ± $10,284 PC vs $9,967± $7,489.5 CC). In addition, there was a higher (p=0.04) percentage of single parents in the CC group (30.5 % PC vs. 50% CC).
Breastfeeding duration and age of solid food introduction did not differ between care type. Breastfeeding duration was on average 2.3 months while average solid food introduction was 4.4 months. No differences were observed between PC and CC infants in the rates of formula introduction. When comparing food consumption at the time of recruitment, there were no differences in the number of servings per day of food groups, but the CC group showed lower consumption of formula (p=0.03) and breast milk (p=0.18) compared to PC.
Energy intake did not differ between care type after adjusting for feeding practices and child, maternal and household characteristics. However, there was a pattern of greater energy intake in the PC group. Child age (β=34.8, p<0.01) and number of servings of infant formula (β=86.0, p<0.01) were the strongest predictors of energy intake. There was greater (p=0.05) calcium intake in the CC group (788 mg CC vs. 742 mg PC). Otherwise, there were no differences in macro or micronutrient intakes between CC and PC.
For growth measures, infants in PC had a significantly greater change in WFL (β=2.06, p=0.05) and WFA (β=1.69, p=0.01) z-score and a greater follow-up z-score, after adjusting for feeding practices and child, maternal and household characteristics. There were no differences by care type in the length for age (LFA) z-score over the first year of life.
The strongest predictors of the change in WFL z-score were PC use (β=2.06, p=0.05), maternal pre-pregnancy BMI (β=0.14, p<0.01), birth order (β=1.63, p<0.05), maternal age (β=-0.34, p<0.01), birth weight (β=-1.77, p=0.06), non-Black/African American (β=3.09, p=0.02) and male gender (β=-2.12, p=0.06). Change in WFA z-score was significantly affected by CC use (β=1.69, p=0.01), lower birth weight (β=-1.74, p<0.01), greater pre-pregnancy BMI (β=0.09, p<0.01), and less servings of infant formula (β=-0.53, p=0.05). Change in LFA was unaffected by CC use (β=1.69, p=0.11), but significantly affected by lower pre-pregnancy BMI (β=-0.04, p=0.04) and black race (β=-2.54, p=0.05).
Thus, we concluded that CC use did not affect feeding practices, overall nutrient intake or LFA z-scores for infants receiving WIC assistance. There was significantly greater calcium intake in the CC group. CC use also showed a trend of less formula and breast milk. Infants in PC had a statistically greater change in WFL and WFA compared to those in CC. The main finding in this study is that CC use may have influenced differences in the change in WFL and WFA z-scores, but not overall infant feeding practices, nutrient intake and LFA z-score. Future longitudinal studies are warranted to explore the role of CC use on feeding practices, nutrient intake and growth.
|Commitee:||Kim, Juhee, McBride, Brent, Teran Garcia, Margarita|
|School:||University of Illinois at Urbana-Champaign|
|School Location:||United States -- Illinois|
|Source:||DAI-B 75/01(E), Dissertation Abstracts International|
|Subjects:||Nutrition, Developmental biology|
|Keywords:||Body weights, Child care, Infant feeding, Infant growth, Infant nutrient intake|
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