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MCN Am J Matern Child Nurs. 2016 Jul/Aug;41(4):244-251.

Development of Feeding Cues During Infancy and Toddlerhood.

Author information

Eric A. Hodges is an Associate Professor, University of North Carolina-Chapel Hill, School of Nursing, Chapel Hill, N.C. The author can be reached via e-mail at eahodges@email.unc.eduHeather M. Wasser is a Research Assistant Professor, Center for Women's Health Research, University of North Carolina-Chapel Hill, School of Medicine, Chapel Hill, N.C.Brook K. Colgan is Vice President and Director of Training for WISE (Women-Inspired Systems' Enrichment) in Chapel Hill, N.C.Margaret E. Bentley is a Professor, University of North Carolina-Chapel Hill, Gillings School of Global Public Health, Chapel Hill, N.C.



To enhance responsive feeding, this study aimed to characterize the development of feeding cues during infancy and toddlerhood.


A secondary analysis was performed on a dataset of first-time, low-income African American mother-infant pairs assessed at infant age 3, 6, 9, 12, and 18 months. A subsample with the 15 highest, middle, and lowest infant body mass index (BMI) Z-scores at 18 months was selected (n = 45). Using video-recorded home feedings, early, active, and late receptiveness and fullness cues were assessed using the Responsiveness to Child Feeding Cues Scale at each time point. Descriptive statistics were used to characterize development.


Early receptiveness cues were relatively rare over time, whereas active receptiveness cues were much more common. However, there were changes over time. For example, settling into the feeding decreased from ~50% at 3 and 6 months to 4.8% by 18 months, whereas postural attention and reaching for food increased after 6 months. In the first 6 months, falling asleep and decreasing muscle tone and activity level were the most common early fullness cues. Thereafter, taking interest in surroundings was most prevalent. Active fullness cues became increasingly diverse after 6 months, led by more assertive cues such as pushing or pulling away and communicating "no" verbally or nonverbally.


These findings provide an empirical description of waxing and waning in feeding cues and indicate increasing intentionality of cues over the first 18 months of life. Knowing common cues across development may aid clinicians in enhancing parental feeding responsiveness, avoiding overfeeding, thereby decreasing risk of early childhood obesity.

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