The Mother-Infant Dyad Study: A grounded theory inquiry into the day-to-day experiences, between first-time mothers and their infants, that influence feeding practices

Background: Inappropriate infant-feeding practices linked to excessive, rapid, early weight gain, are potentially powerful intervention points for reducing risk of later obesity. Understanding how and why these behaviors begin is currently the topic of much research. Because breastfeeding has been found to be somewhat protective against early rapid gain, and because low-income, Southeastern U.S. populations are significantly less likely to initiate and maintain breastfeeding, it is critical to focus efforts in these populations. Grounded theory methodology provides the optimal theoretical underpinnings for exploring development of these practices. Research Objective: The objective was to explore, using grounded theory methodology, the set of interactions between mothers and infants that may influence development of feeding practices, and to do so among a low-income, primiparous sample in the Southeastern U.S. Methods: A total of 15 interviews were included in the final sample. Using grounded theory methodology, participant responses to in-depth phone interviews were analyzed for major emergent themes and concepts and a theoretical model proposed. Per grounded theory protocol, recruitment, data collection, analysis, and model development occurred simultaneously throughout the course of the study. Results: ‘Mother-Infant Communication Dynamic’ emerged as the central phenomenon. Main themes supporting the central phenomenon included: 1) ‘Perceived Infant Development and Communication Capability’; 2) ‘Primary Maternal Focus Driving Response’; and 3) ‘Resulting Feeding Practices’. Discussion/ Implications for Nutrition Educators: The theoretical model captured the experiences, perceptions, and motivating factors influencing maternal response to infant cues and behaviors. Constant comparative analysis and model development during the theoretical coding phase revealed supporting concepts that emerged temporally related to infant age and maternal perception of infant development and communication capabilities from birth to 12 months. The central phenomenon, illustrated with a visual model, suggests a communication pattern developed over the first year of life, culminating in the maternal perception of ‘Speaking the Same Language’. The mother-infant communication pattern swiftly becomes synced and potentially difficult to change. Importantly, this communication pattern, though synced, may not always be the result of accurate maternal interpretation of infant cues and behaviors. If communication patterns result in inappropriate infant-feeding practices, early intervention is likely to be of greatest benefit in reducing these behaviors and their associated negative health outcomes