Efforts to prevent obesity among low-income infants should focus not only on what babies are being fed but also the reasons behind unhealthy feeding practices, according to a study presented at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Adding cereal to bottles is one unhealthy practice that is discouraged by the American Academy of Pediatrics because it may lead to overfeeding and excess weight gain in infants.

Researchers sought to determine factors associated with putting cereal in bottles among low-income, primarily Latino households in which the risk for child obesity is high.

Mothers of 254 infants were asked if they ever added cereal to bottles to help their babies sleep longer or stay full longer. Researchers also collected information on mothers' age, language, country of origin, marital status, education and income; whether the mother had symptoms of depression; and infants' age, gender and whether the infant was felt to have strong emotional reactions (a high intensity temperament).

The data were collected as part of the larger Bellevue Project for Early Language, Literacy and Education Success (BELLE Project). Funded by the National Institutes of Health/National Institute of Child Health and Human Development, the BELLE Project is following infants from birth to first grade to study issues related to parenting and child development.

Results showed that 24 percent of mothers put cereal in bottles. Those with depressive symptoms were 15 times more likely to add cereal than mothers who did not have symptoms of depression.

"Depression is very common in low-income mothers and makes it more difficult to engage in beneficial parenting practices in general," said lead author and general academic pediatrics fellow Candice Taylor Lucas, MD, MPH, who also is the Alan Mendelsohn, MD, principal investigator and associate professor of pediatrics, New York University School of Medicine and Bellevue Hospital Center. "Our results are especially concerning because they suggest that depressed mothers may be more likely to add cereal to the bottle, which may increase their children's risk of obesity."

Data also showed that mothers who were single were significantly more likely to add cereal to bottles. "This suggests that mothers' support systems and family dynamics may influence feeding practices," said obesity researcher and fellow investigator Mary Jo Messito, MD, FAAP.

Mothers who felt that their children had intense emotional reactions to daily routines were 12 times more likely to add cereal to bottles.

"Overall, these findings demonstrate that stressors prevalent in low-income households, such as depression, single parenthood and associated infant behavioral challenges, influence feeding practices likely to promote obesity," Dr. Lucas concluded. "It is important to provide support for parents related to healthy feeding practices if we are to end the epidemic of childhood obesity."