O1034: The Rhythm of the Night: Responsive Feeding and Infant Overnight Sleep and Soothing Habits in a Low-income Latino Population

Background: Overweight and obesity now affect nearly half of all Latino children, but how pediatricians can support healthy growth and prevent obesity among this population is unclear. Parent responsive feeding and adequate child sleep are both protective against rapid weight gain in infancy. Specifically, permissive and authoritarian feeding styles are less appropriate and are associated with child obesity, and further, appropriate sleep habits are protective against obesity. To guide clinical practice, we assess the role of infant feeding styles in sleep behaviors at 2 and 6 months as sleep habits and feeding approaches are developing during infancy. We hypothesized that responsive feeding habits at 2 months would predict healthy sleep habits at 6 months.

Methods: 65 Latino mother-infant dyads were enrolled in a prospective study at a large FQHC in Central TX at age 2 months. The Infant Feeding Styles Questionnaire (IFSQ) measured parent feeding styles at 2 months of life in 5 domains: laissez-faire, pressuring, responsive, restrictive, and indulgent (permissive). The Brief Infant Sleep Questionnaire (BISQ) was completed at 2 months (n=65) and 6 months (n=48). Pearson correlation and ANOVA were used to assess associations between feeding style and sleep practices.

Results: At 2 months, over half of parents (54%) reported primarily responsive feeding, while 43% reported restrictive (authoritarian) feeding styles, and no parents reported indulgent feeding. For sleep behaviors, 35% reported feeding to sleep at 2 months, and 46% at 6 months, while 22% reported falling asleep in bed with a parent at 2 months and 23% at 6 months. For overnight sleep, the AAP recommendation is 9 hours at 2 months and 10 hours at 6 months. In our participants, average overnight sleep at 2 months was 8.2 hours with 49% meeting recommendations; overnight sleep increased to 8.7 hours at 6 months with 68% meeting recommendations. For feeding style and sleep behaviors, greater indulgent soothing domain (r=-0.40, p=0.02) and indulgent pampering domain (r=-0.35, p=0.04) at 2 months were inversely correlated with hours of nighttime sleep at 6 months. There were no specific feeding styles that were associated with feeding to sleep behavior at 2 or 6 months.

Conclusion: Many children in our study population are not getting adequate hours of sleep and experience inappropriate sleep behaviors, which are known risk factors for early life obesity. Inappropriate permissive feeding styles were associated with reduced hours of nighttime sleep; suggesting caregivers who fall into this domain may need additional support from clinicians to meet recommendations and follow best practices for their infant’s sleep, particularly in a population at high risk for early life obesity.