Manuscript Details

Source

Wen, L. M., Baur, L. A., Simpson, J. M., Rissel, C., & Flood, V. M. (2011). Effectiveness of an early intervention on infant feeding practices and "tummy time": A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 165(8), 701-707.

Rating
Moderate
Model(s) Reviewed
Healthy Beginnings
Author Affiliation

The authors are affiliated with the University of Sydney and the University of Wollongong. The first authors are also affiliated with the Health Promotion Service, which sponsors the Healthy Beginnings Trial model.

Funding Sources

The study was funded by the Australian National Health and Medical Research Council (ID number 393112) as part of the Healthy Beginnings Trial

Study Design

Design Attrition Baseline equivalence Confounding factors Valid, reliable measures?
Randomized controlled trial Low Not established on race or SES; no outcome measures assessable at baseline. No
Notes

In 2020, HomVEE updated this review to move measures of bottle at bedtime and food used as reward concept from the Positive Parenting Practices domain to the Child Health domain because ACF determined that HomVEE should place all child feeding outcomes under the Child Health domain.

This randomized controlled trial had low attrition, no confounding factors, and no reassignment; it qualifies for a moderate rating in the HomVEE review. A high rating requires that authors statistically control for any baseline differences in race/ethnicity, socioeconomic status (SES), or measures of the outcome. Because the study authors do not indicate that they assessed race/ethnicity of the study sample, nor do they indicate that their analysis controls for this or any other variables, moderate is the highest possible rating for the study.

Study Participants

Evaluators randomly assigned pregnant women receiving prenatal care through two hospitals to intervention or control groups (with women from each hospital in each study group). The study enrolled 337 women in the intervention group and 330 women in the control group. Most women were assessed and randomized before giving birth (61 percent); however, the remaining cases were assessed and randomized shortly after giving birth. Evaluators examined outcomes 6 and 12 months after the child's birth. At 6 months, the authors analyzed 561 women (278 intervention, 283 control); at the 12-month follow-up, they analyzed 527 women (268 intervention, 259 control).Among the original randomized sample, the plurality of women (42 percent) were younger than age 25; most (54 percent) were either employed or on maternity leave, and most (55 percent) had a high school or technical diploma before the study began. Among these women, about one-third earned less than $40,000 annually; one-third earned $40,000 to $79,999; and one-third earned $80,000 or more. Authors did not report collecting race/ethnicity data but stated that 64 percent of women in the study were born in Australia.

Setting

The study was conducted in southwestern Sydney, Australia, through Liverpool and Campbelltown Hospitals, and enrolled women in the study in 2007 and 2008.

Home Visiting Services

The intervention group received up to six visits in the first year: at 30 to 36 weeks of pregnancy (if recruited at that time); and 1, 3, 5, 9, and 12 months after birth. (A later study by these authors reports a subsequent 24-month visit). Each visit lasted about 1 to 2 hours. Working with the mother and infant, the nurse addressed infant feeding practices, nutrition and play/activity (of both child and family), and social support. Using a checklist, nurses followed a protocol for service delivery, with discussion points and resources.

Comparison Conditions

The control group received the usual services provided in Australia, which includes home visiting from a childhood nursing service within one month of the child's birth. The study provided home safety promotion materials at 6 and 12 months.

Subgroups examined

• Timing of enrollment in intervention (prenatally or postnatally)

Findings that rate moderate or high in this manuscript

Child health
Outcome measure Timing of follow-up Rating Effect size Stastical significance Sample size Sample description
Introduction of solids (before 6 months) 6 months Moderate -0.34 Statistically significant,
p = 0.00 		561 mothers Sydney, Australia Healthy Beginnings Trial
Introduction of solids (4 months or younger) 6 months Moderate -0.30 Statistically significant,
p = 0.00 		561 mothers Sydney, Australia Healthy Beginnings Trial
Introduction of solids (5 months) 6 months Moderate -0.10 Statistically significant,
p = 0.00 		561 mothers Sydney, Australia Healthy Beginnings Trial
Food used as reward 12 months Moderate -0.27 Statistically significant,
p = 0.04 		527 mothers Sydney, Australia Healthy Beginnings Trial
Bottle at bedtime 12 months Moderate -0.23 Statistically significant,
p = 0.04 		527 mothers Sydney, Australia Healthy Beginnings Trial
Breastfeeding (yes/no)-Chi-square 6 months 6 months Moderate 0.26 Not statistically significant,
p = <0.05 		561 mothers Sydney, Australia Healthy Beginnings Trial
Breastfeeding (yes/no)-Chi-square 12 months 12 months Moderate 0.25 Statistically significant,
p < 0.05 		527 mothers Sydney, Australia Healthy Beginnings Trial
Breastfeeding exclusive (yes/no)-6 months 6 months Moderate 0.45 Not statistically significant,
p = 0.14 		561 mothers Sydney, Australia Healthy Beginnings Trial
Breastfeeding duration (weeks)-12 months 12 months Moderate Statistically significant,
p = 0.03 		527 mothers Sydney, Australia Healthy Beginnings Trial
Introduction of solids (6 months) 6 months Moderate 0.35 Statistically significant,
p = 0.00 		561 mothers Sydney, Australia Healthy Beginnings Trial
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Positive parenting practices
Outcome measure Timing of follow-up Rating Effect size Stastical significance Sample size Sample description
Tummy time-age started (4 to 8 weeks) 6 months Moderate -0.12 Statistically significant,
p = 0.03 		561 mothers Sydney, Australia Healthy Beginnings Trial
Tummy time-age started (later than 8 weeks) 6 months Moderate -0.20 Statistically significant,
p = 0.03 		561 mothers Sydney, Australia Healthy Beginnings Trial
Tummy time-if daily 6 months Moderate 0.25 Statistically significant,
p = 0.05 		561 mothers Sydney, Australia Healthy Beginnings Trial
Tummy time-age started (less than 4 weeks) 6 months Moderate 0.22 Statistically significant,
p = 0.03 		561 mothers Sydney, Australia Healthy Beginnings Trial
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Child development and school readiness
Outcome measure Timing of follow-up Rating Effect size Stastical significance Sample size Sample description
Child use of cup 12 months Moderate 0.43 Statistically significant,
p = 0.01 		527 mothers Sydney, Australia Healthy Beginnings Trial
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant