Results from the Growth, Learning and Development GLAD Study Funded by R

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Results from the Growth, Learning and Development
(GLAD) Study (Funded by RD Office)Dr Laura Dunne
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The team

• Prof D Iwaniec (Social Work)
• Dr M Stewart (Pediatrics)
• Dr L Dunne (Psychology)
• Dr S Miller (Psychology)
• Dr H Sneddon (Psychology)
• Ms S Sloan (Nutrition)
• Ms A Gildea (Health Visiting)
• Ms L Mc Erlean (Speech and Language Therapy)

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Aim

• Examine how a broad range of risk and protective
  factors influence infant weight during the first
  year of life

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Background

• Examines non-organic weight faltering in one year
  old infants
• Multidisciplinary study
• Community-based cross-sectional
• Looks at a broad range of health, psychosocial
  and nutritional factors in relation to infant
  growth and development

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Methods

• Child Health System (CHS) sent monthly anonymised
  databases to team
• Two groups of infants from the EHSSB were
  selected
• Criteria for weight faltering
• Fallen across two of the major centile lines to
  be below the 50th centile over 2 or more
  measurements for a period of a month or more

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Methods

• Exclusion criteria
• Premature
• Low birth weight
• Multiple births
• Any diagnosed organic disease or condition which
  might impact on weight

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Methods

• CHS sent details on selected cases to the
  familys Health Visitor
• Health Visitors gained signed consent for the
  research team to make contact
• Information on growth, health, oral-motor skills,
  feeding, mental and motor development and
  experiences of parenting collected through 5 home
  visits

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Methods

• Five Home visits included
• Initial Home Visit
• Growth Visit
• Feeding Visit
• Psychometric Tests Visit
• Oral-motor assessment

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Results

• 234 families took part in the study
• 220 infants had growth measurements at the
  medical visit
• 33 infants met the study criteria for weight
  faltering

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Results and recommendations

• Defining failure to thrive
• Using crossing centiles weight based definition
  which in practice was limited in identifying
  children with physical or psychosocial problems
• Multidisciplinary assessment did not identify
  one factor predictive of weight faltering in
  infancy 

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Results and recommendations

• Breastfeeding
• Higher rates of breastfeeding initiation and
  duration influenced by age, educational
  attainment and socio-economic grouping.
• Children who were breastfed for 6 months gained
  weight more slowly between 6 weeks and 14 months
  compared to bottle-fed babies

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Results and recommendations

• Weaning
• Early weaning (lt 4 months) was related to formula
  feeding at birth and to shorter duration of
  breastfeeding
• Mothers who weaned early were significantly
  younger, with a lower level of education, poorer
  socioeconomic status and lower annual household
  income
• Early weaning related to rapid weight gain in
  infancy which may have implications for childhood
  obesity
• GLAD infants weaned early were heavier at seven
  and 14 months, and gained more weight between
  eight weeks and 14 months

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Results and recommendations Feeding skills and
problems 

• There was high consistency between the parental
  reports of feeding problems and the feeding
  interactions between parent and child observed by
  the research team
• Feeding problems were reported in both control
  and study children and were not necessarily
  associated with weight
• Majority of feeding difficulties referred to poor
  appetite due to teething or illness, and these
  were generally transient and not perceived by the
  parents to be of major concern
• Other problems took longer to resolve and
  included the transition to different textures
  such as moving from smooth to lumpy foods

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Results and recommendations Oral-motor skills
(measured by DFA)

• High consistency with parental reports of feeding
  difficulties and the childs observed level of
  co-operation and interest during feeding
  assessment
• Parental reporting of less positive interactions
  with their child during mealtimes associated with
  children removing smaller portions from the spoon
  and losing/rejecting food
• Weight faltering children were less likely to be
  co-operative than controls when presented with
  mashed texture food and more likely to
  demonstrate an immature eating pattern

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Results and recommendations

• Sources of support and advice
• Mothers tended to rely on their GP for advice on
  their childs health (88), grandparents (76) or
  health visitor (74)
• With respect to feeding, the most common source
  of advice was the health visitor (71) or the
  childs grandparents (55)

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Results and recommendations

• Depression
• GLAD mothers who reported that their childs size
  had been commented on had significantly higher
  depression scores
• Mothers scoring high on depression tended to feel
  less competent, more restricted in their role as
  a parent, more socially isolated, had lower self
  esteem, perceived their child as being less
  adaptable and did not view interaction with their
  child as rewarding

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Results and recommendations

• Social support
• GLAD identified that within the weight faltering
  group it was the quality of the support rather
  than the number of sources of support that was
  important
• Low partner support significantly contributed to
  the reporting of parenting stress
• Parenting stress
• Parenting stress in the first year of a childs
  life is especially relevant
• High scores in parenting stress were associated
  with the parent perceiving the child as being
  demanding, low parental self esteem, low levels
  of partner support and high levels of maternal
  depression

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Results and recommendations Parents history of
childhood maltreatment

• 24 of the mothers had been emotionally abused
• 23 had been emotionally neglected, 13 were
  physically abused
• 10 were physically neglected
• 9 had been sexually abused
• There was no significant association between a
  parents childhood experiences and their own
  childs physical growth, cognitive or motor
  development at around a year of age
• Parents who had experienced maltreatment showed
  significantly higher levels of parenting stress

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Results and recommendations

• Budgeting and financial pressure
• Mothers of children showing weight faltering
  reported significantly greater difficulty in
  paying bills 
•  Engagement with the diagnostic process  
• Some parents expressed disillusion with treatment
  from health professionals after children had been
  investigated with respect to their poor growth

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Results and recommendations

• Difficulties in accessing a community sample
• The Child Health System was developed in part to
  be a source of information for practitioners and
  also to facilitate research
• However, the GLAD study found that there were
  practical difficulties in accessing the system
  and inaccuracies in the data

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Publications and contact

• Stewart, M.C., Iwaniec, D., Sneddon, H., Dunne,
  L., Sloan, S., Gildea, A., Allen, S. Mc
  Erlean, L. (2007) GLAD Study Summary and
  Recommendations. Child Care in Practice 13(3)
  271-280.
• For more information contact l.dunne_at_qub.ac.uk