Everyday routines in early infancy may shape later obesity risk, study finds

UNIVERSITY PARK, Pa. — In the United States, approximately 14.7 million children and adolescents between the ages of 2 and 19 are living obesity, according to the Centers For Disease Control and Prevention. Since children living with obesity are at greater risk for a number of long-term health consequences such as Type 2 diabetes and cardiovascular disease, early identification of risk behaviors is crucial. Pediatricians and other health professionals have opportunities to provide guidance on healthy eating, sleep and physical activity with families however, these preventative efforts are often limited by the brief time available during well child visits.

But could the routines that shape a child’s weight trajectory be set much earlier?

A new study from researchers at Penn State, published in JAMA Network Open, suggests that a handful of routines around feeding, sleep and play during the first two months of an infant’s life can be linked to higher weight just a few months later. The researchers analyzed data gathered from the Early Healthy Lifestyles (EHL) screening tool — a tool designed to identify child appetite, feeding, sleep and play routines linked to child weight outcomes — and demonstrated that it could help pediatricians and nutritionists working with families with young infants provide more personalized guidance during well child visits.

The findings could help pediatricians and other health care providers pinpoint risk behaviors for obesity. By identifying specific areas where families might benefit from personalized support, health professionals can promote responsive caregiving and improve a child’s health from the very start, the researchers said.

“By just two months of age, we can already see patterns in feeding, sleep and play that may shape a child’s growth trajectory,” said Yining Ma, doctoral student at The Child Health Research Center at Penn State and lead author on the study. “This shows how important it is to screen early in infancy so we can support families build healthy routines, prevent excessive weight gain and help every child get off to the best possible start.”

Children growing up in low-income contexts are more likely to experience challenges that affect healthy growth, including limited access to resources that support nutritious eating and active play, the researchers said. Parents may also receive mixed messages from sources such as pediatricians and community-based providers — like the federally funded Women, Infants, Children (WIC) program, which provides nutrition education and support to pregnant and postpartum women and children — and that can be confusing, especially for new parents, the researchers said.

“With the limited time available during pediatric and nutrition visits, it’s essential to help providers focus on what matters most for each family,” said Jennifer Savage Williams, professor and director of The Child Health Research Center at Penn State and senior author of the study. “Having something like the EHL tool that helps providers identify specific routines and behaviors linked to later child weight would be valuable for screening and counseling efforts.”

The researchers analyzed EHL tool submission data from 143 mothers and their infants receiving care from the Geisinger Health System and enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in northeastern Pennsylvania. The EHL tool is a 15-item questionnaire that asks about daily routines such as infant diet, sleep, play and appetite as well as caregivers’ approach to feeding, and can potentially help health professional provide more tailored support and guidance.

The researchers identified nine everyday behavioral routines, reported on the EHL when infants were two months old that were linked to higher BMI and weight-for-length z scores — a measure that compares a child’s weight to the median weight for their height and sex — at six months of age. The team then created a score by adding up the number of less healthy behaviors parents reported. For each additional behavior used at two months, infants had significantly higher BMI and weight-for-length z score. The findings suggest that even small differences in early habits can influence growth within the first months of life, according to the researchers.

Behaviors linked to higher weight at six months include:

• Feeding practices such as using bottle sizes that aren’t appropriate for an infant’s developmental stage, nighttime feeding and a mother’s perception that her infant is always hungry
• Sleep habits such as putting an infant to bed after 8 p.m., waking two or more times during the night, having a TV on in the room where an infant sleeps and putting a baby to bed when they are already asleep instead of drowsy
• Limited active play or tummy time and a parent using a cellphone or television while playing with the infant

The behaviors identified on the screener — like using food to calm an upset baby who isn’t showing signs of hunger — are common strategies that parents often use to comfort their infants in the moment. But these well-intended actions can sometimes limit a child’s chances to learn self-regulation, said Savage Williams. On the other hand, responsive parenting practices, when caregivers pay close attention to their child’s signals and respond in a warm, timely and appropriate way, helps children develop healthy regulation across a variety of needs, the researchers explained.

“Responsive parenting can sometimes feel harder in the moment,” Savage Williams said. “But, when families build consistent and predictable routines in the household, they can help the child develop the ability to regulate themselves. As kids grow up and they have more autonomy, those early routines give them the skills to make healthy decisions on their own.”

The research team plans to expand this work to include families from a wider range of backgrounds to see if the findings hold true across different populations. Since many of the identified behaviors don’t occur in isolation but rather together, the team said they also hope to investigate how these behaviors cluster and interact to shape children’s growth over time.

“When parents get mixed messages, it puts the burden on families to figure out what is right for them, and that can be overwhelming,” Savage Williams said. “Our goal is to help streamline that process by giving providers a consistent way to talk about unhealthy routines and the behaviors that matter most for children’s growth.”

Other Penn State authors include Amy Moore, assistant professor of nutritional sciences; and Zachary Fisher, assistant professor of human development and family studies. Lisa Bailey-Davis, professor of population health sciences and director of the Center for Women’s & Children’s Research at Geisinger College of Health Sciences, also contributed to this paper.

Funding from the Health Resources and Services Administration of the U.S. Department of Health and Human Services and the National Center for Advancing Translation Sciences of the National Institutes of Health supported this work.

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