Home and videotape intervention delays early complementary feeding among adolescent mothers.

Background. The American Academy of Pediatrics, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the World Health Organization recommend that infants receive only breast milk or formula for the first 4 to 6 months of life, followed by the introduction of complementary foods. Despite these recommendations, many infants, particularly those with adolescent mothers, receive solid foods (often cereal mixed with formula in a bottle) and liquids other than formula or breast milk in the first few weeks of life. Decisions on early feeding are often guided by grandmothers and influenced by beliefs that infants need complementary food to counteract 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, black, adoles- cent mothers living in multigenerational households. The intervention focused on reducing the cultural barri- ers to the acceptance of the recommendations of the American Academy of Pediatrics, WIC, and World Health Organization on complementary feeding by high- lighting 3 topics: 1) recognition of infants' cues; 2) non- food strategies for managing infant behavior; and 3) mother- grandmother negotiation strategies. The inter- vention was delivered through a mentorship model in which a videotape made by an advisory group of black adolescent mothers was incorporated into a home-visit- ing program and evaluated through a randomized, con- trolled trial. Methods. One hundred eighty-one first-time, low-in- come, black mothers <18 years old, living in multigen- erational households were recruited from 3 urban hospi- tals. Infants were born at term, with birth weight appropriate for gestational age and no congenital prob- lems. Shortly after delivery, mothers and grandmothers completed a baseline assessment and mothers were ran- domized into an intervention or control group. Interven- tion group mothers received 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 frequency questionnaire. Mothers who fed their infant only breast milk, formula, or water were classified as optimal feeders. Mothers who provided complementary foods other than breast milk, formula, or water were classified as less optimal feeders. Results. Sixty-one percent of the infants received complementary foods before 3 months old. Multivariate hierarchical logistic regression was used to evaluate the determinants of being in the optimal versus less optimal feeders group. After controlling for infant age and family income, mothers of infants in the optimal feeders group were more likely to report accurate messages 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 inter- vention demonstrates the importance of using ecological theory and ethnographic research to design interventions that enable participants to alter their behavior in the face of contradictory cultural norms. The intervention focused on interpreting infants' cues, nonfood methods of man- aging infant behavior, and mother- grandmother negoti- ations. It was delivered through methods that were familiar and acceptable to adolescent mothers—a men- torship model incorporating home visits and videotape. The skill-oriented aspects of the intervention delivered in a culturally sensitive context may have enabled the young mothers to follow the guidelines that they re- ceived from WIC and from their pediatricians. Strategies, such as those used in this intervention, may be effective in promoting other caregiving recommendations, thereby enabling providers to meet the increasing demands from parents for advice regarding children's early growth and development. Pediatrics 2001;107(5). URL: http://www. pediatrics.org/cgi/content/full/107/5/e67; adolescent par- enting, infant feeding, complementary feeding, home visit- ing, intervention.