Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT)

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The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) parenting model was designed to prevent rapid infant weight gain and childhood obesity. The model was grounded in developmental literature on responsive parenting and parenting sensitivities, which encourages mothers to respond to their child’s emotional and physical signals. INSIGHT focuses on responsive feeding, in which mothers respond to their baby’s hunger and satiety cues. Responsive feeding teaches children to eat in response to physiological needs and could encourage self-regulation in eating.

INSIGHT was a demonstration project implemented from 2012 to 2017 that was tested using a prospective, randomized controlled trial. The trial was led by researchers from Penn State College of Medicine and Penn State College of Health and Human Development. The information in this profile represents how the model was implemented during the demonstration trial.

Support to implement the model may be available upon request to the model developers.

INSIGHT served first-time mothers and their infants from birth until about the child’s third birthday.

The model aimed to prevent obesity in children at age 36 months by promoting a mother’s developmentally appropriate, prompt, and contingent responses to a child’s needs. Specifically, INSIGHT was designed to meet the following objectives:

• Improve mothers’ responsive feeding practices
• Reduce mothers’ use of food to soothe and increase use of alternative soothing strategies in response to infant fussiness
• Improve infants’ sleep duration and reduce nocturnal awakenings
• Reduce infants’ screen time
• Increase the amount of time mothers and children engage in interactive play

INSIGHT was a responsive parenting model that guided mothers on how to respond to their child’s needs across four behavioral states: (1) drowsy, (2) sleeping, (3) fussy, and (4) alert (interactive play and feeding).

The model development team mailed mothers the following materials when their child was two weeks old, to review and practice techniques before the first home visit: a DVD demonstrating infant soothing; a CD with white noise tracks; and handouts on infant stomach size, feeding guidance, lactation support, and postpartum depression.

Mothers were invited to participate in four home visits in the child’s first year, and two clinic visits and two telephone contacts between the child’s first and third birthdays. Home visitors taught mothers how to read growth charts that display typical patterns of child growth and weight gain. The home visitors also provided guidance on emotional regulation, feeding, sleeping, and interactive play, including the following topics:

Emotional regulation

• Understanding developmental norms for fussing and crying
• Establishing routines and expectations
• Setting limits, rules, and consequences
• Using strategies other than feeding to calm fussy but not hungry infants
• Providing positive reinforcement

Feeding

• Recognizing hunger and satiety cues
• Providing age-appropriate portion sizes
• Avoiding use of control-based feeding practices, such as restricting food, pressuring infants to eat, and using food as a reward
• Using repeated exposure to promote food acceptance
• Establishing consistent meal and snack routines
• Modeling healthy eating behaviors

Sleeping

• Putting infants to bed drowsy but awake
• Avoiding feeding infants to sleep
• Anticipating and responding to night awakenings
• Establishing bedtime and naptime routines

Interactive play

• Working toward language and motor milestones
• Fostering developmentally appropriate physical activities
• Setting limits on screen time

Home visitors followed a manualized curriculum that included facilitator guides and handouts that were developmentally appropriate for the timing of each visit.

Mothers participated in four home visits when the child was 3 to 4 weeks old, 16 weeks old, 28 weeks old, and 40 weeks old; two clinic visits when the child was 12 and 24 months old; and two telephone contacts when the child was 18 and 30 months old. The model provided services from the child’s birth until age 30 months.

The home visits typically lasted 60 minutes, clinic visits were 30 minutes, and phone contacts were approximately 20 minutes.

The model development team does not have any recommendations or requirements about the types of or characteristics of organizations that can implement the intervention.

Home visitors were required to meet a set of ongoing fidelity guidelines. Please contact the model developer for additional information about these guidelines.

Nurses implemented the model under the supervision of the model development team, whose members, at a minimum, held master’s degrees.

Supervisors monitored nurses’ fidelity to the model. Please contact the model developer for information on whether regular, ongoing reflective supervision was provided; the mode of supervision; the frequency of supervision; and whether supervisors were offered oversight or support.

The model development team provided in-person training for the nurses. Please contact the model developer for additional information about the pre-service training and ongoing professional development requirements.

Dr. Ian Paul
Penn State College of Medicine
Phone: (717) 531-8006
Email: ipaul@psu.edu

Penn State College of Health and Human Development
Center for Childhood Obesity Research
Phone: (814) 865-5246
Email: pennstateCCOR@psu.edu
Website: https://hhd.psu.edu/nutrition/insight-study