Prevention of Overweight in Infancy
Condition: Obesity; Growth; Sleep
MeSH terms: Obesity
Study type: Interventional

Summary: 
      Obesity is one of the biggest threats to health in the 21st century. Rapid weight gain in the
      first year of life tends to lead to overweight in children, which in turn leads to overweight
      in adults. This rapid early weight gain occurs most often at weaning when eating patterns
      emerge. Infant sleep problems also appear to be associated with the risk of becoming
      overweight, and contribute to maternal post-natal depression. We propose to undertake a 4-arm
      randomised controlled trial to determine whether extra education and support for families
      around weaning and development of early food and activity habits, with or without
      intervention to improve infant sleep, will decrease the current risk patterns of rapid
      excessive early childhood weight gain in New Zealand. This would provide strong evidence for
      the value of such a strategy in the long term control of the obesity epidemic and its
      consequent complications.

      This is a two-year intervention with follow-ups at 3.5, 5 and 11 years of age.
    

Detailed description: 
      We plan on undertaking a 4-arm randomised controlled trial to test the following hypotheses:

        1. That anticipatory guidance and extra education and support in infancy around weaning and
           decreasing/avoiding television watching will delay the timing of introduction of solid
           foods, will be associated with more successful introduction of nutrient dense foods with
           appropriate portion size and decrease small screen exposure leading to a lower number of
           children with excessive weight velocity in infancy and early childhood.

        2. That anticipatory guidance, education and extra support around the early development of
           infant sleeping patterns will decrease sleep problems, increase infant sleeping time,
           decrease arousals at night and lower sleep latency which will in turn influence rate of
           early infant weight gain.

        3. That interventions 1 and 2 will interact additively with regard to infant and early
           childhood weight gain.

        4. That intervention 2 will lead to lower rates of maternal depression and increased family
           well being.
    

Intervention name(s): FAB; Sleep
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Standard well child care plus 7 extra parent contacts for augmented education and support around breast feeding, food and activity with 1 before birth and then at 1-2 weeks, and 3, 4, 7, 9, 13, and 18 months post-partum.; Standard well child care plus 2 extra contacts focussed on Sleep with 1 before birth (anticipatory guidance), and sleep problem prevention at 3 weeks. A sleep problem intervention starting at 6 months was possible for those indicating their child had a sleep problem at 6 months of age. Main prevention advice focussed on placing baby to sleep awake, maximising night-day differences and use of sleep place in parents bedroom for first 6 months. Intervention after 6 months uses preferentially a technique called "parental presence", and if this does not fit family a technique called "camping out" and finally, if neither of the first two fit family, controlled crying.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Obesity; Sleep; Physical activity; Breast feeding; Depression