Coordination of Care Between Pediatricians and Women Infants & Children Nutritionists
Condition: Childhood Obesity
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      WEE Baby Care is a 6 month intervention that coordinates care across multiple settings-
      health care clinics and WIC clinics on responsive parenting practices to increase parenting
      competence thereby preventing infant rapid weight gain. The investigators will recruit
      mother/infant dyads in Central PA, who participate in the Women, Infants, and Children (WIC)
      program and receive clinical care from a Geisinger pediatrician participating in this study.
    

Detailed description: 
      This multi-site, randomized, controlled trial (RCT) will test the hypothesis that an
      individually tailored responsive parenting obesity prevention intervention that coordinates
      care provided by WIC nutritionists and primary care providers (PCPs) will be more effective
      than usual care at 1) delivering consistent messages and 2) changing maternal and infant
      behavior to 3) reduce/prevent rapid infant growth from birth to 6 months.

      Geisinger research staff will recruit mother/infants dyads primarily from newborn nurseries
      from Geisinger Health Systems hospitals in Central Pennsylvania (PA). Mother-infant dydas may
      also be recruited directly from newborn well-child visits, prenatal WIC visits, and using
      social media platforms such as Facebook. Key eligibility criteria include that infants
      participate in the Special Supplemental Women, Infants and Children (WIC) program and receive
      clinical care from a participating Geisinger Health Systems pediatrician. Upon eligibility
      and receiving consent, mother/infant dyads will be randomized to 1 of 2 groups: intervention
      (coordination of care) or control (Geisinger standard of pediatric care), stratified on
      infant birth weight, race, and parity. In this study, coordination of care is defined at two
      levels: (1) PCPs and WIC will deliver the same, consistent messages and (2) providers will
      communicate with each other on preventive care plans regarding responsive parenting and
      nutrition education.

      The intervention will consist of 3 components: 1) a parent self-assessment and screening
      survey called Early Healthy Living/Lifestyles (EHL) tool to assess the child's future obesity
      risk and tailor education; 2) parenting and nutrition education using the Healthy Active
      Living for Families curriculum (HALF) developed by the American Academy of Pediatrics,
      supplemented by evidence-based materials that teach mothers alternatives to using feeding to
      manage infant behavior, and establishing good sleep hygiene; and 3) coordination of care
      between PCPs and WIC nutritionists utilizing HIT. Components 1 and 2 focus on teaching
      mothers to recognize hunger and fullness signs in their infants, use alternative soothing
      strategies to feeding, develop good sleep hygiene routines, and engage in active social play.

      Once consented and enrolled, all parents receive a welcome packet with brief parenting tips
      tailored to the group assignment. Intervention participants will also be mailed the
      responsive parenting curriculum after enrolling that addresses the domains of infant sleep,
      feeding, soothing and play. Pediatricians who have patients enrolled and randomized to the
      intervention group will have access to the EHL data in the patient's electronic health record
      which they then use to record notes about each well child visit. After each well-child visit,
      these notes including the EHL data will be electronically sent to the child's WIC
      nutritionist, to be read prior to a WIC nutrition appointment with that client.

      Information from the WIC nutritionist appointments, including nutrition counseling codes from
      each appointment in addition to collected health information will then be sent to the child's
      pediatrician, to be included as part of the child's electronic health record.

      Child's growth measures will be taken from the well baby visits, along with any unique
      information from the WIC nutritionist visits. In addition, data collection surveys will be
      distributed to all study participants at 2, 5 and 7 months after birth, either electronically
      or by paper packet.
    

Intervention name(s): Early healthy lifestyles; Responsive parenting curriculum; Data sharing/coordination
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Patient reported data to identify parenting practices and child behaviors associated with child's obesigenic risk in the future; Information from the American Academy of Pediatrics Healthy Active Living for Families (HALF) program supplemented with messages from the INSIGHT study, that were written at the 5th grade reading level, with messages focused on 4 categories: 1) feeding the baby 2) soothing the baby 3) sleep health and 4) playing with the baby; Data integration into child's electronic health record that is shared between settings (WIC and GHS PCPs) with display and documentation features that informs counseling.
Other intervention name(s): EHL
Allocation: Randomized
Intervention model: Single Group Assignment
Intervention model description: A multi-site, randomized controlled trial (RCT) to test that hypothesis that an individually tailored responsive parenting obesity prevention intervention that coordinates care provided by WIC nutritionists and primary care providers will be effective to ultimately reduce/prevent obesity in infants.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Responsive parenting