INfant Feeding, Activity and NutriTion (INFANT)

Childhood obesity is a problem in the United States, putting children and adolescents at risk for poor health. For youth aged 2 to 19 years, the prevalence of obesity is 19.7%, affecting about 14.7 million individuals. People with obesity are at higher risk of health problems such as high blood pressure, high cholesterol, type 2 diabetes, breathing problems (e.g., asthma and sleep apnea), joint problems, and several types of cancer.

Establishing healthy feeding practices is important for the growth of infants. In addition, healthy habits for physical activity in early childhood can influence activity levels as children grow up. There is a need for early intervention that aims to improve health behaviors from infancy and reduce obesity.

INfant Feeding, Activity and NutriTion (INFANT) is designed to help parents and caregivers (hereafter called caregivers) increase healthy eating and reduce screen time for their infants from birth to 18 months of age. Informed by social cognitive theory, the program involves group sessions in which a trained facilitator teaches strategies to promote healthy dietary intake and active play. The content is delivered using an anticipatory guidance approach in which support is provided before caregivers need it given expected developmental phases. The INFANT program components include the following:

-- Four 1.5-hour, in-person group sessions, facilitated by a trained practitioner, when the infant is 3, 6, 9, and 12 months of age
-- Additional support for caregivers through the My Baby Now mobile app, which includes push notifications and a discussion forum, throughout the duration of the program

The facilitators are health practitioners such as dietitians, maternal and child health nurses, health promotion officers, midwives, and other parenting support or allied health workers. Facilitators complete a 6- to 8-hour online training course over a 4- to 6-week period and also participate in 1 to 2 hours of online refresher training every 2 years.

The currently available version of the intervention has been modified from the version used in the study that was reviewed for this summary. In the intervention that was used in the study, the screen time content focused on television viewing, the main form of screen viewing at that time. The currently available version now addresses all forms of screen use. The intervention used in the study consisted of six 2-hour group sessions when infants were approximately 3, 6, 9, 12, 15, and 18 months of age; a DVD and written materials used during the group sessions (and provided to parents to take home); and five newsletters distributed to parents between sessions. The facilitators were trained dietitians who had attended a 2-hour, in-person training prior to delivering each of the six sessions.

-- Facilitators complete a 6- to 8-hour online training course and also participate in 1 to 2 hours of online refresher training every 2 years.

-- Caregivers participate in 6 hours of group sessions between their infant’s birth and 12 months of age and access the My Baby Now app as often as they desire.

The intervention is intended for caregivers of infants from birth to 18 months of age.

The program is suitable for implementation in community, clinical, and home settings.

Required resources to implement the program include the following:

-- INFANT program website

For costs associated with this program, click on Contact Program Developer on the Program Materials page.

In this cluster randomized controlled trial, parent groups in 14 local government areas in Victoria, Australia, were randomly assigned to the intervention group (31 parent groups, n=271 children) or usual care group (31 parent groups, n=271 children). Parent groups, which consisted of first-time parents of infants, were eligible to participate in the study if at least eight parents in the groups enrolled (or at least six parents in the groups enrolled in areas of low socioeconomic position). Parents were eligible if they gave written informed consent, were first-time parents, and were able to communicate in English.

Both the intervention and usual care groups received the typical care that first-time parents receive from the free universal services by maternal and child health nurses in Victoria, Australia. This care included nurses engaging parents in “first-time parent groups” and through their “key ages and stages” visits across the first 18 months of life. In addition, the intervention group participated in six 2-hour, quarterly group sessions between the time infants were about 3 months old to 18 months old. The groups were led by trained dietitians who had attended a 2-hour, in-person training prior to delivering each of the six sessions. A DVD and written materials were used during the group sessions (and were provided to parents to take home), and parents received five newsletters between sessions. The usual care group received a different set of newsletters over the same 15-month period as the intervention group. The six newsletters sent to the usual care group addressed topics unrelated to any of the behaviors of interest to the study.

Nearly half (47%) of the children were female. The mean age of the main caregiver at baseline was 32.3 years old. Approximately 54% of the main caregivers had university as the highest level of education.

At baseline, infants were approximately 4 months old. At the post-intervention assessment, infants were 20 months old. Long-term outcomes were assessed 2 years post-intervention, when the children were 3.6 years old, and at 3.5 years post-intervention, when the children were 5 years old.

The primary outcomes were diet quality, sweet snack intake, and television viewing time. An Obesity Protective Dietary Index (OPDI) was created to assess key dietary targets of the INFANT program. Dietary intake was measured using three unscheduled, 24-hour recalls, and intake of three index items (fruits, vegetables, and noncore foods) was used to construct diet quality scores on the OPDI. The score for diet quality on the OPDI was 0 to 30, with 30 representing the healthiest diet. Dietary intake data were also used to determined sweet snack intake. Television viewing time was assessed using a questionnaire on the amount of time spent watching television on a typical day.

• At post-intervention, children in the intervention group had better diet quality (higher OPDI scores) than did those in the usual care group (p=.01).

• Compared to children in the usual care group, children in the intervention group had lower sweet snack intake at post-intervention (p=.008), 2 years post-intervention (p=.006), and 3.5 years post-intervention (p=.017).

• At post-intervention, children in the intervention group viewed fewer daily minutes of television than did those in the usual care group (p=.002).