Infant feeding cues, maternal feeding decisions and the development of a self-directed responsive feeding resource

Low maternal responsiveness to infant feeding signals is a reported risk factor for childhood obesity, however, mothers may have difficulty in responding to cues. The thesis had 3 aims: to better understand infant feeding cues within complementary feeding (CF); to understand mothers’ feeding decisions, perceptions and practices in the context of weaning approach (baby led or traditional weaning), and to develop a self-directed, online resource to facilitate cue recognition with a view to promoting responsive feeding. A systematic review of the feeding cues literature was undertaken (Study 1) followed by an observational study of infant gaze, gesture and vocalisation during feeding with 20 mother-infant dyads (Study 2). 11 mothers from Study 2 then participated in qualitative, video-elicited interviews concerning choice of feeding method, and decisions and perceptions during feeding interactions (Study 3). Studies 1-3 informed the development of a self-directed, online responsive feeding resource (Study 4), which was evaluated by 23 parents and professionals for acceptability and satisfaction. Findings suggest that low responsiveness to feeding cues may arise from poor recognition, but that attention to infant gaze, gesture and vocalisation during feeding may help mothers to recognise satiation (Study 2). However, mothers may have difficulty following cues, even when recognised, because of worries about infant intake, behaviour which deviates from maternal feeding expectations, and practical pressures (Study 3). Such issues were reported by mothers across different CF approaches. Study 4 indicated that an online, self-directed responsive feeding intervention is feasible to deliver and acceptable to parents. The thesis offers potentially new insights for understanding infant communication of hunger and satiation and responsive feeding, and identifies research directions to investigate these further. It also highlights the need for feeding interventions to address cue recognition, issues which compromise maternal responsiveness, and to be flexible to the specific needs of individual mother-infant dyads.