Journal of Pediatric Nursing (2014) 29, 108113

Baby Steps in the Prevention of Childhood Obesity: IOM

Guidelines for Pediatric Practice
Kathleen F. Gaffney PhD, RN, F/PNP-BC a,, Panagiota Kitsantas PhD b ,
Albert Brito MD c,d , Jennifer Kastello MSN, RN, WHNP a
a

George Mason University, School of Nursing, Fairfax, VA

Department of Health Administration and Policy, George Mason University
c
InovaCares Clinic for Children, Falls Church, VA
d
Virginia Commonwealth University, Richmond, VA
b

Key words:
Obesity;
Overweight;
Evidence-based practice;
Prevention;
Intervention;
Infant feeding practices;
Physical activity;
Growth monitoring;
Sleep;
Guidelines

The aim of this paper is to present an overview of the infancy-related guidelines from the Institute of
Medicine ( IOM, 2011) report Early Childhood Obesity Prevention Policies and highlight research
studies that support their implementation in pediatric practice. Findings from recent studies of infant
growth monitoring, feeding, sleep, and physical activity are presented. Research strategies that may
be applied to today's clinical assessments and interventions are specified. Participation by pediatric
nurses in the development of future multi-component interventions to prevent rapid infant weight gain
is recommended.
2014 Elsevier Inc. All rights reserved.

Benjamin is being seen today for his 6-month well child

visit at a pediatric clinic that cares for low-income
families. At birth, his weight-for-length was at the 25th
percentile according to World Health Organization
growth charts. Today it is at the 97th percentile. His
parents are proud of his weight gain. They moved to the
Washington, D.C., area from their native El Salvador
three years ago. Both work in a local restaurant. A
trusted friend cares for Benjamin eight hours/day, six
days/week. His mother reports that for approximately
five hours/day, Benjamin is strapped in a car seat in
front of the television, because he likes the movement
on TV. She is pleased with this arrangement because he
is safe. He is breastfed in the evening; otherwise he
receives infant formula. When he was two months old,
his babysitter added rice cereal to his formula to help
him sleep and gradually added other solid foods to his
diet. Benjamins story is not uncommon.

Corresponding author: Kathleen F. Gaffney, PhD, RN, F/PNP-BC.

E-mail address: kgaffney@gmu.edu.
0882-5963/$ see front matter 2014 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.pedn.2013.09.004

Background
Childhood obesity is a global problem. The World Health
Organization (WHO) estimates that over 40 million children
under 5 years of age are overweight or obese. While once
considered a public health issue primarily for high-income
countries, childhood obesity rates are rising quickly in
middle- and low-income countries, particularly in urban
areas (World Health Organization, 2012). The significance
of this change in child health status throughout the world is
the long term health consequences of obesity, including
cardiovascular morbidities and early development of type
2 diabetes.
International studies provide evidence that excess weight
gain during infancy is a significant risk factor for later
obesity. A population-based study of infants from the United
States (US) found a positive association between rapid
weight gain in the first 4 months of life and overweight status
at 7 years of age (Stettler, Zemel, Kumanyika, & Stallings,
2002). For American children from low-income minority

Prevention of Childhood Obesity: IOM Guidelines for Pediatric Practice

families, excessive weight gain in the first year of life has
been associated with a nine-fold increased risk for obesity at
age 3 years (Goodell, Wakefield, & Ferris, 2009). Similarly,
higher weight-for-length z-scores at 6 months of age have
been associated with the increased odds of obesity at 3 years
of age (Taveras et al., 2009). These findings are consistent
with those of the Avon Longitudinal Study of Parents and
Children in England that found rapid weight gain in the first
year to be a risk factor for obesity at age 7 years (Reilly et al.,
2005). The accumulating research evidence from these
studies points to the need for obesity prevention practice
guidelines that begin early in life.
In response to the childhood obesity epidemic, the
Institute of Medicine (Institute of Medicine (IOM), 2011)
has developed practice guidelines for preventing childhood
obesity. Unlike previous public health initiatives that have
focused primarily on school age children, the IOM's Early
Childhood Obesity Prevention Policies targets factors
related to overweight and obesity from birth to 5 years of
age. The IOM infancy-related guidelines are focused on
growth monitoring, healthy feeding, sleep, and physical
activity. The purpose of this paper is to present an overview
of the IOM infancy-related guidelines and highlight
research studies that support their implementation in
clinical practice.

Infant Growth Monitoring

The IOM guideline for measuring infant growth is to
plot height and weight on WHO growth charts. The
rationale supporting use of WHO charts is that the data used
to generate these growth curves were collected from a large
cohort of children from varying cultures and countries,
including Brazil, Ghana, India, Norway, Oman and the US.
Additionally, the WHO charts were generated using sample
inclusion criteria that specified breastfeeding up to age
12 months, introduction of solid foods at approximately age
6 months, absence of maternal smoking, and living in a
household with adequate income (de Onis et al., 2004).
This approach to sampling was designed to generate
benchmark curves that reflect an ideal growth trajectory
for comparison to individual patterns (Garza & de Onis,
2004). Further, the IOM (2011) guideline for growth
monitoring in infancy calls for tracking weight-for-length
changes throughout the first year and identifying babies at
risk for overweight (84.1st97.7th percentile) and overweight (N 97.7th percentile).
With respect to growth monitoring, the WHO growth
charts also provide useful application for clinical practice.
For parents like Benjamin's who are from countries where
food scarcity is prevalent, the overweight status of their
infant as seen on the growth chart may be viewed with pride
and considered to be a marker for good health and successful
parenting. Misconceptions about healthy weight gain,

109

however, are not limited to parents from low income

countries. Researchers in the Netherlands found that a
substantial proportion of parents, regardless of educational
attainment and socio-demographic background, did not
recognize overweight status in their own children (Jansen
& Brug, 2006). Similarly, a recent study in the US found that
over 80% of mothers of overweight toddlers were satisfied
with their child's body size and inaccurately assessed their
weight as being within a normal range for age (Hager et al.,
2012). Another study used a simple assessment measure that
can be easily incorporated into a regularly scheduled well
child visit (Chaparro, Langellier, Kim, & Waley, 2011). The
researchers asked the question Do you consider your child
be overweight, underweight, or about right weight for
(his)(her) height? Almost all mothers classified their
overweight or obese child as being about the right weight
(93.6% and 77.5%, respectively). While this study focused
on preschoolers, using a comparable question for parents of
infants may open the door for anticipatory guidance to
prevent the rapid or excess infant weight gain that leads to
later obesity.

Infant Feeding
The IOM's (2011) infancy-related guidelines for the
prevention of childhood obesity call for health care providers
to encourage exclusive breastfeeding in the first 6 months
and continuation of breastfeeding with the introduction of
solid foods during the second half of infancy. Further, the
report underscores the importance of helping parents
recognize and respond to infant hunger and fullness cues.
Examples of hunger cues in early infancy include sucking on
fist, waking and tossing, and opening mouth while feeding to
indicate wanting more. Conversely, infant cues to satiety or
fullness include behaviors such as turning head away, sealing
lips, and decreasing or stopping sucking (USDA, 2013).
To date, the findings from health care research related to
the healthy infant feeding component of the IOM guidelines
are inconsistent. One systematic review of eight international studies of breastfeeding duration and risk for
overweight or obesity in later childhood found that only
half of the studies reported a dose response of breastfeeding
after adjusting for other known risk factors for obesity
(Arenz, Rkerl, Koletzko, & von Kries, 2004). A metaanalysis of the same relationship was conducted using 17
studies from seven countries in Europe and North America
(Harder, Bergmann, Kallischnigg, & Plagemann, 2005).
The findings strongly supported a dose-dependent association between longer breastfeeding duration and reduced
risk for later obesity. However, due to methodological
differences across studies, adjustment for potential confounders could not be calculated. A later study found a
relationship between breastfeeding duration and overweight at age 4 years, but when the researchers controlled

110
for other social and environmental risk factors, the
association diminished and was no longer statistically
significant (Procter & Holcomb, 2008).
To further examine whether breastfeeding offers a
protective factor against later obesity, a study based on the
Copenhagen Perinatal Cohort compared the effects of
breastfeeding duration and age of introduction to solid foods
on body mass index through childhood and adulthood. The
researchers found that later introduction of solids (approximately 6 months of age) was protective against later
overweight, but did not find a protective effect for longer
breastfeeding duration (Schack-Nielsen, Srensen, Mortensen, & Michaelsen, 2010). Researchers in Northern Ireland
found that infants who were introduced to solids prior to
4 months of age were heavier at 7 and 14 months than those in
a comparison group who started solids later. Group
differences remained significant after controlling for breastfeeding duration (Sloan, Gildea, Stewart, Sneddon, & Iwaniec,
2007). Further, a study using a nationally representative data
set in the US that examined the relationship between weight at
12 months of age and adherence to clinical practice guidelines
for feeding behaviors found significant associations with
breastfeeding intensity during the second half of infancy and
age of introduction to solid foods (Gaffney, Kitsantas, &
Cheema, 2012).
In addition to monitoring the source of infant caloric
consumption from breastfeeding, formula feeding and solid
food, the IOM guidelines recommend that health care
providers encourage infant feeding behavior that is responsive to hunger and satiety cues. A recent longitudinal study
of infants offers potential insight into the role of sensitivity to
infant feeding cues in preventing obesity. In a comparison of
babies who were fed at breast with those bottle fed (either
human or nonhuman milk), those who were exclusively
bottle fed gained significantly more weight per month
throughout infancy (Li, Fein, & Grummer-Strawn, 2010; Li,
Magada, Fein, & Grummer-Strawn, 2012). This finding led
researchers to conclude that infant weight gain may not only
be associated with type of milk consumed but also the type of
milk delivery. They proposed that the underlying processes
may be that infants fed at breast develop better selfregulation of intake than bottle fed infants and that mothers
who have breastfed their infants may develop improved
sensitivity and responsiveness to infant cues of hunger and
satiety. Support for this explanation comes from studies of
maternal sensitivity that have found lower levels of
responsiveness to satiety cues to be inversely associated
with infant weight gain (Thompson et al., 2009; Worobey,
Lopez, & Hoffman, 2009). However, a limitation of the
study was the underrepresentation of Hispanic mother
infant pairs in the sample. This is particularly important in
light of a recent US population-based study that found
Hispanic children under 2 years of age have a greater
prevalence of high weight-for-length than non-Hispanic
White, or non-Hispanic Black children (14.8%, 8.4%, 8.7%,
respectively; Ogden, Carroll, Kit, & Flegal, 2012).

K.F. Gaffney et al.

Clinical application of the IOM recommendation for
responsive infant feeding styles may be the adoption of
assessment strategies used in research. For instance, a pilot
study by the Project Viva clinical research team derived a
responsiveness to infant satiety score based on the
following items from the infant feeding questionnaire
(Taveras et al., 2011):
1. If I did not guide or regulate my baby's eating, he/she
would eat much less than he/she should.
2. If I did not guide or regulate my baby's eating, he/she
would eat much more than he/she should.
3. My baby is never full enough.
4. My baby never seems very hungry.
Mothers were asked to respond with options ranging from
strongly agree (1) to strongly disagree (4) with higher scores
indicative of more responsive feeding styles. The composite
scale was found to have acceptable internal reliability
(Cronbach alpha = 0.70) when used with mothers of
6 month old infants. Use of this measurement tool in clinical
assessments may be useful in identifying parents and
caregivers, like those in our case story of Benjamin, who
practice non-responsive infant feeding styles in the belief that
they are doing what is best for their babies. Interventions that
help them identify and respond positively to infant hunger and
satiety cues may reduce the risk of excessive weight gain.

Infant Sleep
The IOM infancy-related guidelines for obesity prevention call on health care providers to help families achieve
age-appropriate sleep duration for their babies. While most
research about the link between sleep and childhood obesity
has been conducted with older children, two studies have
examined the relationship between sleep duration in infancy
and weight gain. One study of 6 month old infants found that
shorter nighttime sleep duration, as measured by both
actigraph sleep percentages and parental surveys, was
correlated with higher infant weight-for-length ratios. The
significance of this relationship persisted after adjusting for
potential confounders, such as infant gender, birth weight,
and gestational age (Tikotzky et al., 2010). Another study
used multivariate regression analyses to predict the effects of
infant sleep duration (b 12 h/d vs. 12 h/d) on weight status
among preschoolers. The researchers found that infant sleep
less than 12 h/d was associated with higher BMI and
increased odds of overweight at 3 years of age (Taveras,
Rifas-Shiman, Oken, Gunderson, & Gillman, 2008). Replication and extension of these studies with larger and more
diverse samples will add the body of evidence that informs
practice in this area.
Further, the IOM (2011) guidelines call for testing
strategies that address the behavioral factors that lead to
healthy sleep hygiene for infants. Proposed actions include

Prevention of Childhood Obesity: IOM Guidelines for Pediatric Practice

encouraging sleep-promoting behaviors, such as calming
routines at bedtime, and self-regulation of sleep by putting
infants to sleep drowsy but awake. Evidence to-date that
supports the effectiveness of these strategies is limited.
To address this gap, two pilot intervention studies have
been conducted. The First Steps for Mommy and Me study
tested the preliminary efficacy of a multi-component
intervention that was focused on breastfeeding exclusivity/
duration, delayed introduction of solid foods, increased sleep
duration and quality, TV avoidance, and responsiveness to
satiety cues. Intervention delivery occurred within the
context of well child visits, home visits, and parent
workshops during the first 6 months after birth. Researchers
found that infants in the intervention group had increased
nocturnal sleep duration and larger reductions in nighttime
wakefulness when compared to a usual care group. The
change in weight-for-length z-scores from birth to 6 months
appeared to be lower for the intervention group, but the
difference was not statistically different. However, fewer of
the intervention infants were in the highest weight-for-length
quartile at 6 months of age (22% vs. 42%; Taveras et al.,
2011).
As part of the implementation of this pilot study,
researchers assessed maternal feed-to-soothe behavior
with an item that pediatric nurses may find to be a useful
adjunct to the four responsive feeding style items listed
above. Specifically, mothers in the study signified their
level of agreement with the statement that The best way
to soothe a crying baby is to feed her/him. with
response options ranging from strongly agree (1) to
strongly disagree (4). Fewer mothers in the intervention
group agreed or strongly agreed with this statement than
those in the usual care group (12% vs. 24%). In the
clinical setting, this item may help identify parents and
caregivers most in need of information about non-feeding
strategies for soothing a fussy or irritable baby to
enhance sleep duration.
In the second pilot study, mothers also were taught
alternative strategies to feeding as a first response to
nocturnal crying and fussiness. Through instruction about
hunger and satiety cues, parents learned to distinguish these
cues from other causes of infant distress, such as boredom,
anger, or the discomfort of a soiled diaper. Intervention
content included alternative soothing and calming techniques
that allowed the non-hungry infant to experience being
comforted without being fed, learn to self-soothe, and
become drowsy and return to sleep without feeding. The
infants of mothers who participated in this soothe/sleep
instruction as well as an intervention about healthy
approaches to the introduction of solid foods had a mean
weight-for-length at 1 year of age significantly lower (33rd
percentile vs. 50th56th percentile) than comparison
groups that experienced only one or no part of the
intervention (Paul et al., 2011). One initial implication for
clinical practice is that multi-component behavioral interventions may be required to effectively overcome the

111

rapid weight gain in infancy that places children at risk for

long term obesity. The findings from both pilot studies
provide valuable insights for the design of future randomized
controlled trials that are likely to provide higher level
evidence for practice.

Infant Physical Activity

To increase physical activity and decrease sedentary
behavior, the IOM (2011) guidelines call for more daily
opportunity for infants to move freely both indoors and
outdoors, spend time on the ground engaging in adultinfant
interactions, and, for babies under 6 months of age, to
experience more tummy time (time in the prone position).
Additionally, the plan calls for limiting the long term use of
confining baby equipment such as car seats, strollers,
bouncer seats and playpens. In his award-winning book,
entitled Last Child in the Woods (2008), Robert Louv
observed that infants around the globe are increasingly being
raised more indoors than outdoors and are spending more
time being contained in smaller spaces. He points out that
infants are spending more time in car seats, high chairs, and
even baby seats for watching TV (p. 35).
Scientific underpinnings for the IOM infancy-related
recommendations for physical activity are limited. One
study found that percentage of body fat at ages 6, 9, and
12 months was inversely related to infant activity level and
that this relationship was stronger with increasing age (Li,
OConnor, Buckley, & Specker, 1995). Other studies have
examined the relationships among infant activity, motor
development and weight status. For example, a study of the
influence of wakeful prone positioning on infant motor
development found that the duration of prone positioning
predicted the acquisition age of three developmental
milestones: rolling, crawling-on-abdomen, and crawlingon-all-fours (Kuo, Liao, Chen, Hsieh, & Hwang, 2008).
Another study found that the frequency of gross motor delays
was significantly higher among infants whose weights-forlength ratios were between the 85th to 94th percentiles
compared to those who were not overweight (Shibli, Rubin,
Akons, & Shaoul, 2008). A longitudinal study of low-income
motherinfant dyads examined the associations of both
weight status and subcutaneous fat with motor development
in the first 18 months of life. Risks for gross motor delay were
found to be 1.8 times greater for overweight infants and 2.3
times greater for those with high levels of subcutaneous fat
when compared to infants whose anthropometric indices
were not in those categories (Slining, Adair, Goldman, Borja,
& Bentley, 2010). Based on these findings, the authors
suggested that gross motor developmental delays among
overweight infants and those with high subcutaneous fat may
lead to a cascade of increased risk for reduced physical
activity and limited exploration of the environment beyond
arms reach (p. 24).

112

Going Forward Toward Evidence-Based Practice

Current research provides initial support for the IOM's
Early Childhood Obesity Prevention Policies. In particular,
evidence has been utilized to develop recommendations for
identifying and addressing the early life risk factors for
overweight and obesity through infant growth monitoring
and strategies to promote healthful feeding, sleeping, and
physical activity. Going forward, further clinical research is
needed to inform practice. Replication and extension studies
are needed to better understand the role of infant selfregulation versus caregiver finish the bottle feeding
behavior on the risk for excess weight gain. Infant sleep
studies are needed to understand more fully how nurses may
effectively guide parents to provide restful environments
conducive to lifelong sleep regulation and reduced obesity
risk. The pediatric world is beginning to alert families to
issues that Robert Louv (2008) described in terms of infants
contained in small spaces with limited physical activity and
restricted opportunities for normal gross motor development
and exploration.
Research to support evidence-based practice in this new
area of clinical observation is sparse. Pediatric nurses need to
provide content expertise for future studies that will ensure
that research questions are significant and intervention
methods are feasible and acceptable for families from diverse
socioeconomic and racial/ethnic groups.
Further, multi-component clinical interventions that
implement IOM (2011) guidelines are needed. The pilot
studies by the Project Viva clinical research team (Taveras
et al., 2011) and the soothe/sleep infant interventionists
(Paul et al., 2011) give clinical nurse researchers a template
for study design. Their intervention content and delivery
methods mirror the long and successful nursing research
history of effective strategies for promoting maternalinfant
health. These strategies have included assessment of
sensitivity to infant cues during infant feeding (Barnard
& Kelly, 1990), development of nurse home visitation
programs (Brooten et al., 1986) and implementation of an
intervention that demonstrates ways to calm and soothe
irritable infant babies that extend beyond the feed-tosoothe approach to infant crying (Keefe et al., 2006). Each
of these pediatric nurse-led clinical initiatives has potential
application to the issues of infant growth, feeding, sleep,
and physical activity specified in IOM (2011) guidelines.
By transferring knowledge from prior clinical applications
for maternalinfant health promotion, we can advance
current practice guidelines and contribute to a healthier
future for infants like Benjamin.

References
Arenz, S., Rkerl, R., Koletzko, B., & von Kries, R. (2004). Breast-feeding
and childhood obesity-A systematic review. International Journal of
Obesity, 28, 12471256.

K.F. Gaffney et al.

Barnard, K. E., & Kelly, J. F. (1990). Assessment of parentchild
interaction. In S. J. Meisels, & J. P. Shonkoff (Eds.), Handbook of
Early Childhood Intervention. New York: Cambridge University Press.
Brooten, D., Kumar, S., Brown, L. P., Butts, P., Finkler, S. A., BakewellSachs, S., Gibbons, A., & Delivoria-Papadopoulos, M. (1986). A
randomized clinical trial of early hospital discharge and home follow-up
of very-low-birth-weight infants. New England Journal of Medicine,
315, 934939.
Chaparro, M. P., Langellier, B. A., Kim, L. P., & Waley, S. E. (2011).
Predictors of accurate maternal perception their preschool childs weight
status among Hispanic WIC participants. Obesity, 19, 20262030, http:
//dx.doi.org/10.1038/oby.2011.105.
de Onis, M., Garza, C., Victora, C. G., Onyango, A. W., Frongillo, E. A., &
Martines, J. (2004). The multicentre growth reference study: Planning,
study design, and methodology. Food and Nutrition Bulletin, 25,
S15S26.
Gaffney, K. F., Kitsantas, P., & Cheema, J. (2012). Clinical practice
guidelines for feeding behaviors and weight-for-age at 12 months: A
secondary analysis of the Infant Feeding Practices Study II. Worldviews
on Evidence-Based Nursing, http://dx.doi.org/10.1111/j.17416787.2011.00236.x.
Garza, C., & de Onis, M. (2004). Rationale for developing a new international growth reference. Food and Nutrition Bulletin, 25, S5S14.
Goodell, L. S., Wakefield, D. B., & Ferris, A. M. (2009). Rapid weight gain
during the first year of life predicts obesity in 23 year olds from a lowincome, minority population. Journal of Community Health, 34, 370375.
Harder, T., Bergmann, R., Kallischnigg, G., & Plagemann, A. (2005).
Duration of breastfeeding and risk overweight: A meta-analysis.
American Journal of Epidemiology, 162, 397403.
Institute of Medicine (IOM). (2011). Early childhood obesity prevention
policies. Washington, DC: The National Academies Press.
Jansen, W., & Brug, J. (2006). Parents often do not recognize overweight in
their child, regardless of their socio-demographic background. European Journal of Public Health, 16, 645647.
Keefe, M. R., Lobo, M. L., Froese-Fretz, A., Kotzer, A. M., Barbosa, G. A.,
& Dudley, W. N. (2006). Effectiveness of an intervention for colic.
Clinical Pediatrics, 45, 123133.
Kuo, Y. -L., Liao, H. -F., Chen, P. -C., Hsieh, W. -S., & Hwang, A. -W.
(2008). The influence of wakeful prone positioning on motor
development during the early life. Journal of Developmental and
Behavioral Pediatrics, 29, 367376.
Li, R., OConnor, L., Buckley, D., & Specker, B. (1995). Relation of
activity levels to body fat in infants 6 to 12 months of age. The Journal
of Pediatrics, 126, 353357.
Li, R., Fein, S. B., & Grummer-Strawn, L. M. (2010). Do infants fed from
bottles lack self-regulation of milk intake compared with directly
breastfed infants? Pediatrics, 125, e1386e1393.
Li, R., Magada, J., Fein, S. B., & Grummer-Strawn, L. M. (2012). Risk of
bottle-feeding for rapid weight gain during the first year of life. Archives
of Pediatric and Adolescent Medicine, 166, 431436.
Louv, R. (2008). Last Child in the Woods. New York: Workman Publishing Co.
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence
of obesity and trends in body mass index among US children and
adolescents, 19992010. JAMA, 307, e1e8.
Paul, I. M., Savage, J. S., Anzman, S. L., Beiler, J. S., Marini, M. E., Stokes,
J. L., & Birch, L. L. (2011). Preventing obesity during infancy: A pilot
study. Obesity, 19, 353361.
Procter, S. B., & Holcomb, C. A. (2008). Breastfeeding duration and
childhood overweight among low-income children in Kansas, 1998
2002. American Journal of Public Health, 98, 106110.
Reilly, J. J., Armstrong, J., Dorosty, A. R., Emmett, P. M., Ness, A., Rogers,
I., Steer, C., & Sherriff, A.for the Avon Longitudinal Study of Parents
and Children Study Team. (2005). Early life risk factors for obesity in
childhood: Cohort study. BMJ, 330, 1357 Online, http://dx.doi.org/
10.1136/bmj.38470.670903.EO (published 20 May 2005).
Schack-Nielsen, L., Srensen, T. I. A., Mortensen, E. L., & Michaelsen, K.
F. (2010). Late introduction of complementary feeding, rather than

Prevention of Childhood Obesity: IOM Guidelines for Pediatric Practice

duration of breastfeeding, may protect against adult overweight. American Journal of Clinical Nutrition, 91, 619627.
Shibli, R., Rubin, L., Akons, H., & Shaoul, R. (2008). Morbidity of overweight ( 85th percentile) in the first 2 years of life. Pediatrics, 122,
267272.
Slining, M., Adair, L. S., Goldman, B. D., Borja, J. B., & Bentley, M.
(2010). Infant overweight is associated with delayed motor development. The Journal of Pediatrics, 157, 2025.
Sloan, S., Gildea, A., Stewart, M., Sneddon, H., & Iwaniec, D. (2007). Early
weaning is related to weight and rate of weight gain in infancy. Child:
Care, Health and Development, 34, 5964.
Stettler, N., Zemel, B. S., Kumanyika, S., & Stallings, V. A. (2002). Infant
weight gain and childhood overweight status in a multicenter, cohort
study. Pediatrics, 109, 194199.
Taveras, E. M., Rifas-Shiman, S. L., Oken, E., Gunderson, E. P., & Gillman,
M. W. (2008). Short sleep duration in infancy and risk of childhood
overweight. Archives of Pediatrics and Adolescent Medicine, 162,
305311.
Taveras, E. M., Rifas-Shiman, S. L., Belfort, M. B., Kleinman, K. P., Oken,
E., & Gillman, M. W. (2009). Weight status in the first 6 months of life
and obesity at 3 years of age. Pediatrics, 123, 11771183.

113

Taveras, E. M., Blackburn, K., Gillman, M. W., Haines, J., McDonald, J.,
Price, S., & Oken, E. (2011). First steps for mommy and me: A pilot
intervention to improve nutrition and physical activity behaviors of
postpartum mothers and their infants. Maternal & Child Health Journal,
15, 12171227.
Thompson, A. L., Mendez, M. A., Borja, J. B., Adair, L. S., Zimmer, C. R.,
& Bentley, M. E. (2009). Development and validation of the infant
feeding style questionnaire. Appetite, 53, 210221.
Tikotzky, L., DeMarcas, G., Har-Toov, J., Dollberg, S., Bar-Haim, Y., &
Sadeh, A. (2010). Sleep and physical growth in infants during the first
6 months. Journal of Sleep Research, 19, 103110.
USDA (2013). Infant nutrition and feeding: A guide for use in the
WIC and CSF programs. http://www.nal.usda.gov/wicworks/
Topics/FG/Chapter2_DevelopmentofFeedingSkills.pdf Retrieved,
July 21, 2013.
World Health Organization. (2012). Obesity and overweight: Fact sheet No.
311, Retrieved, July 21, 2013. http://www.who.int/mediacentre/
factsheets/fs311/en/.
Worobey, J., Lopez, M. I., & Hoffman, D. J. (2009). Maternal behavior and
infant weight gain in the first year. Journal of Nutrition Education and
Behavior, 41, 169175.