Primarily Null Associations Between the Nursing Child Assessment Feeding Scale and Maternal Feeding Behaviors, Infant Eating Behaviors, Diet, and Growth: A Prospective Cohort Study.

Background/

Objectives

The predictive value of the Nursing Child Assessment Feeding Scale (NCAFS) for eating, diet, and growth outcomes among healthy infants is not well-described.

Methods

In this prospective cohort study, healthy infants (n = 227) were assessed with the NCAFS at 0.5, 2, and 4 months and outcomes were measured concurrently and at 12 months. Maternal feeding and infant eating behaviors were observed during a separate feeding and assessed with the Infant Feeding Styles Questionnaire, Baby Eating Behavior Questionnaire, Children's Eating Behavior Questionnaire-Toddler, and a diet questionnaire. Sucking was measured and anthropometry obtained.

Results

In mixed models with repeated measures, concurrent associations included maternal verbalization while waiting for a separate feeding with maternal Sensitivity to Cues (β = 0.80) and maternal Cognitive Growth Fostering (β = 1.05); maternal verbalization during a separate feeding with maternal Social-Emotional Growth Fostering (β = 1.10) and maternal Cognitive Growth Fostering (β = 1.37); suck duration with infant Clarity of Cues (β = -5.35); feeding duration with maternal Social-Emotional Growth Fostering (β = 0.04), maternal Cognitive Growth Fostering (β = 0.03), and infant Responsiveness to Caregiver (β = 0.06); and bottle-feeding intensity with maternal Social-Emotional Growth Fostering (β = -1.11). Prospective associations included maternal Sensitivity to Cues with infant weight-for-length z-score change per month (β = -0.02) and maternal Social-Emotional Growth Fostering with breastmilk feeding intensity (β = 0.06).

Conclusions

Associations were primarily null. However, more social interaction during feeding, less nutritive sucking (i.e., shorter suck duration), longer feeding duration, and lower bottle-feeding intensity were associated with more optimal NCAFS scores concurrently, and more optimal NCAFS scores were associated with lower weight-for-length z-score change and greater breastmilk feeding intensity prospectively.