Home and videotape intervention delays early complementary feeding among adolescent mothers

Background. The American Academy of Pediatrics, the Special Supplemental Nu trition Program for Women, Infants, and Children (WIC), and the World Healt h Organization recommend that infants receive only breast milk or formula f or the first 4 to 6 months of life, followed by the introduction of complem entary foods. Despite these recommendations, many infants, particularly tho se with adolescent mothers, receive solid foods (often cereal mixed with fo rmula in a bottle) and liquids other than formula or breast milk in the fir st few weeks of life. Decisions on early feeding are often guided by grandm others and influenced by beliefs that infants need complementary food to co unteract signals of hunger, reduce crying, and sleep through the night. Objective. This investigation evaluated the efficacy of an intervention to delay the early introduction of complementary feeding among first-time, bla ck, adolescent mothers living in multigenerational households. The interven tion focused on reducing the cultural barriers to the acceptance of the rec ommendations of the American Academy of Pediatrics, WIC, and World Health O rganization on complementary feeding by highlighting 3 topics: 1) recogniti on of infants' cues; 2) non-food strategies for managing infant behavior; a nd 3) mother-grandmother negotiation strategies. The intervention was deliv ered through a mentorship model in which a videotape made by an advisory gr oup of black adolescent mothers was incorporated into a home-visiting progr am and evaluated through a randomized, controlled trial. Methods. One hundred eighty-one first-time, low-income, black mothers <18 y ears old, living in multigenerational households were recruited from 3 urba n hospitals. Infants were born at term, with birth weight appropriate for g estational age and no congenital problems. Shortly after delivery, mothers and grandmothers completed a baseline assessment and mothers were randomize d into an intervention or control group. Intervention group mothers receive d home visitation every other week for 1 year. At 3 months, a subset of 121 adolescent mothers reported on their infant's intake through a food freque ncy questionnaire. Mothers who fed their infant only breast milk, formula, or water were classified as optimal feeders. Mothers who provided complemen tary foods other than breast milk, formula, or water were classified as les s optimal feeders. Results. Sixty-one percent of the infants received complementary foods befo re 3 months old. Multivariate hierarchical logistic regression was used to evaluate the determinants of being in the optimal versus less optimal feede rs group. After controlling for infant age and family income, mothers of in fants in the optimal feeders group were more likely to report accurate mess ages from WIC regarding the timing of complementary food and nearly 4 times more likely to be in the intervention group. The most common complementary food was cereal mixed with formula in the bottle. Conclusions. The success of this relatively brief intervention demonstrates the importance of using ecological theory and ethnographic research to des ign interventions that enable participants to alter their behavior in the f ace of contradictory cultural norms. The intervention focused on interpreti ng infants' cues, nonfood methods of managing infant behavior, and mother-g randmother negotiations. It was delivered through methods that were familia r and acceptable to adolescent mothers - a mentorship model incorporating h ome visits and videotape. The skill-oriented aspects of the intervention de livered in a culturally sensitive context may have enabled the young mother s to follow the guidelines that they received from WIC and from their pedia tricians. Strategies, such as those used in this intervention, may be effec tive in promoting other caregiving recommendations, thereby enabling provid ers to meet the increasing demands from parents for advice regarding childr en's early growth and development.