Table 3.
Selected papers
| Authors and title | Participants and sample | Design and methods | Main findings | Implications for understanding hunger and satiation in infancy | Quality ratings first andsecond raters |
|---|---|---|---|---|---|
|
Anderson et al. (2001) |
N = 29 | Cross‐sectional | Introduction of solids was based on infant age, size, weight and a variety of increased infant hunger cues. | Both infant behaviours (chewing hands and crying) and infant characteristics (age and size) are used by mothers to determine feeding state along with external cues such as time. | 20/22 |
| ‘Rattling the plate – reasons and rationales for early weaning’ | Multiparous and primiparous mothers, mean age 27 years, of babies aged between 8 and 18 weeks, mean age 13 weeks. | Focus group discussions exploring beliefs and attitudes regarding the introduction of solid food. Qualitative content analysis. | 19/22 | ||
|
Blossfield et al. (2007) |
N = 70 | Quasi‐experimental | Variability in consumption of chopped carrots related to familiarity with different textures, higher dietary variety, food fussiness and the number of teeth infants possessed. Amount eaten was associated with level of enjoyment. | Amount of food consumed varies according to liking as well as with infant characteristics (e.g. pickiness or number of teeth). | 22/22 |
| ‘Texture preferences of 12‐month‐old infants and the role of early experiences’ | 39 male and 31 infants aged between 48 and 57 weeks, mean age 52.7 weeks. | Infants fed chopped or pureed carrots. Measures – amount of food consumed, maternal ratings of enjoyment and questionnaire measures, e.g. CEBQ* and FFQ.† | 22/22 | ||
| Darlington & Wright (2006) | N = 75 | Short‐term longitudinal | Slow weight gain was significantly associated with fearful temperament. Fast weight gain was associated with irritable behaviour. | Infant temperament may affect appetite or the communication of hunger, although mothers may feed irritable babies more in order to soothe them. | 20/22 |
| ‘The influence of temperament on weight gain in early infancy’ | 43 male and 32 female infants between 8 and 12 weeks of age, mean age 10 weeks. | Infants' birthweights and weights taken at 8–12 weeks. Completion of IBQ‡ and Baby's Day record by mothers. | 20/22 | ||
| Forestell & Mennella (2012) | N = 92 | Experimental | Infants with high scores on the approach dimension of temperament ate more of a test vegetable for longer and with fewer negative expressions. | Infant temperament may play a part in food acceptance and amount consumed. Consumption is therefore not purely determined by hunger. | 22/22 |
| ‘More than just a pretty face. The relationship between infant's temperament, food acceptance, and mothers' perceptions of their enjoyment of food’ | 48 male and 44 female infants, mean age 52 weeks. | Infants video‐recorded when fed test vegetable in laboratory conditions. Measures: facial expression coding; Infant Temperament Scale and maternal ratings of infants' enjoyment. | 21/22 | ||
| Gross et al. (2010) | N = 368 | Cross‐sectional | Hand sucking was viewed as a hunger cue and head turning as a satiation cue. Most mothers (72%) believed crying must be an indication of hunger. Most (93%) also believed their babies could sense their own satiety. Mothers with high BMIs and low educational levels appeared less sensitive to satiation cues. | Common cues are used by mothers to identify hunger and satiation. Lower maternal educational level and higher BMI may be associated with lower awareness of infant satiation. | 19/22 |
| ‘Maternal perceptions of infant hunger, satiety, and pressuring feeding styles in an urban Latina WIC population’ | Mothers, mean age 28 years with infants aged < 20 weeks, mean infant age 18.8 weeks. | Secondary analysis of survey data regarding maternal perceptions of hunger, satiation and pressuring feeding style. | 17/22 | ||
| Hodges et al. (2008) | N = 71 | Cross‐sectional | Mothers' responsiveness to feeding cues was variable. Some focused on amount consumed, while others focused on infant state or oral behaviours. Specificity of cues increased with infant age. | A range of overt and subtle hunger and satiation cues are reported by mothers, e.g. crying, licking the lips, spitting food out and stopping the meal. Different mothers focused on different cues. | 19/22 |
| ‘Maternal decisions about the initiation and termination of infant feeding’ | Mothers of full term infants at 12, 26 or 52 weeks of age, 35 males and 36 females. Mean maternal age, 28.9 years. | Structured interviewing and qualitative content analysis. | 17/22 | ||
| Hodges et al. (2013) | N = 144 | Cross‐sectional | Mothers responded more to hunger than fullness cues. Responsiveness to cues was associated with maternal characteristics (education, BMI and breastfeeding duration). Mothers were more responsive to hunger cues in older self‐feeding children. | Hunger cues may be more salient for mothers than satiation cues. Mothers appear more responsive to the cues of older children. Responsiveness to satiation appears to be associated with higher educational level, lower BMI and longer breastfeeding duration. | 22/22 |
| ‘Development of the responsiveness to child feeding cues scale’ | Mothers of 28 to 104‐week‐old infants and toddlers, mean maternal and infant age and M : F ratio unknown. | Development and testing of an observational measure of caregiver responsiveness to child feeding cues using structured observation of infant/toddler feeding. | 21/22 | ||
|
Hwang (1978) |
N = 58 | Short‐term longitudinal | On day four, mean number of feeding periods was significantly higher for male than female infants. The first feeding period on day four was significantly longer for females than males. During feeding on both days, male infants cried more than females. | Newborn male and female infants appear to show different feeding behaviours, with possible implications for maternal perceptions of hunger and satiation. | 14/22 |
| ‘Mother–infant interaction – effects of sex on infant feeding behavior’ |
Primiparous mothers 23 male and 35 female newborn infants observed at <1 week (2 and 4 days). Maternal age unknown. |
Time sampled observation of two single breastfeeding sessions on days two and four of life in hospital setting. | 15/22 | ||
| Lew & Butterworth (1995) | N = 18 | Cross‐sectional | No difference found between the distribution of hand–face and hand–mouth contacts pre‐feed. Proportion of hand–mouth contacts was not greater before feeding than after feeding. Open mouth postures before hand–mouth contacts only occurred before feeding. | Open mouth postures prior to hand mouth contacts may be an indication of hunger in newborn infants. | 21/22 |
| ‘The effects of hunger on hand–mouth coordination in newborn infants’ | Newborn term infants born between 38 and 42 weeks gestational age observed at 1 week or younger. | Structured observations of infants before and after milk feeding by formula or breast. Analysis of differences between hand–face and hand–mouth contacts. | 20/22 | ||
| Llewellyn et al. (2011) | N = 2402 | Cohort study | Four appetite constructs were identified – food responsiveness, enjoyment of food, satiety responsiveness and slowness in eating. All constructs had good internal reliability and correlated with ‘general’ appetite. Group differences were observed in relation to appetitive behaviours. | Different groups of infants have different appetitive behaviours; e.g., males appear to have larger appetites and to be less satiety responsive than females; premature infants have smaller appetites and higher satiety sensitivity than term infants; and breastfed infants appear less satiety responsive than formula‐fed infants. | 21/22 |
| ‘Development and factor structure of the Baby Eating Behaviour Questionnaire in the Gemini birth cohort’ | 1194 male and 1208 female infants, mean age 32.8 weeks, range 16–80 weeks. | BEBQ§ for milk‐fed infants. Questionnaire items refined via interviews with a sample of mothers (n = 10). | 21/22 | ||
| Llewellyn et al. (2012) | N = 4634 | Cohort study | Infant weight was correlated with BEBQ appetite traits. Genetic influence was shown for satiety responsiveness, slowness in eating and appetite. | Eating traits of infants are heritable. Expression of appetite is therefore influenced by genotype. | 21/22 |
| ‘Inherited behavioral susceptibility to adiposity in infancy: a multivariate genetic analysis of appetite and weight in the Gemini birth cohort’ | 2289 males and 2345 female infants, mean age 32.8 weeks, range 16–80 weeks. | BEBQ§ and infant weight measures taken at 12 weeks + multivariate genetic modelling. | 21/22 | ||
| McMeekin et al. (2013) | N = 698 | Cross‐sectional | Mothers of infants with difficult temperaments reported a lower awareness of hunger and satiation cues and were more likely to use food to soothe. | It may be difficult for mothers of infants with difficult temperaments to distinguish hunger and satiation cues from other kinds of distress. Maternal depression also appears to be associated with lower awareness of infant feeding cues and greater use of food to calm babies. | 21/22 |
| ‘Associations between infant temperament and early feeding practices. A cross‐sectional study of Australian mother–infant dyads from the nourish randomised controlled trial’ | 342 male and 356 female infants between 8 and 28 weeks of primiparous mothers. Mean infant age 17.2 weeks. Mean maternal age 30.1 years. | Maternal self‐report on STSI¶ and IFQ.∥ | 20/22 | ||
| Mennella et al. (2001) | N = 46 | Experimental | Infants exposed to carrot flavours in utero or during lactation exhibited fewer negative facial expressions to carrot‐flavoured cereal than plain cereal. Infants exposed to carrot flavour in utero were perceived by mothers to enjoy carrot‐flavoured cereal more than plain cereal. | Previous exposure to flavour leads to greater acceptance, greater enjoyment and greater consumption. Amount eaten is not purely determined by hunger. Facial expression may be one way of differentiating between cessation of eating due to dislike and that arising from satiation. | 21/22 |
| ‘Prenatal and postnatal flavor learning by human infants’ | 28 male and 18 female infants. Mean infant age 22.6 weeks. | Infants assigned to one of three groups involving drinking carrot juice or water during pregnancy and breastfeeding. Responses to cereals containing water or carrot juice were measured via facial expression coding, maternal ratings of enjoyment and amount consumed. | 20/22 | ||
| Mennella et al. (2009) | N = 97 | Experimental | Type of formula fed to infants impacted on responses to different tasting cereals. Formula‐fed infants eating complementary foods showed preferences for the tastes of foods to which they had already been exposed. | Prior exposure leads to greater consumption of food with familiar taste compounds. Negative facial expression may provide a basis for distinguishing between satiation and dislike. | 21/22 |
| ‘Early milk feeding influences taste acceptance and liking during infancy’ | Full term infants between 16 and 36 weeks, mean age 25 weeks, who had been spoon fed baby cereal for at least 2 weeks. | Subgroups of breastfed and two types of formula‐fed babies were observed on different occasions to measure acceptance of sweet, salty, bitter, savoury, sour and plain cereals. | 21/22 | ||
| Nisbett & Gurwitz (1970) | (Experiment 1) | Experimental | Heavy infants were more responsive than medium and light weight infants to sweetened formula. Female infants responded more to sweetened formula than males. Heavier and female infants consumed significantly less in the small hole condition. Medium weight, lighter weight and male infants' consumption was not significantly affected by this condition. | Sex and weight may impact on satiety responsiveness to sweetened milk. Sex and weight may impact on effort expended in feeding and consequent amount consumed. | 18/22 |
| ‘Weight, sex, and the eating behavior of human newborns’ | N = 42 | Infants in three weight groups were alternately fed a sweet and standard formula of the same energy density daily at the same time. Intake per feed was recorded. Infants were formula fed over 2 days with a normal or small hole teat. Mothers recorded consumption and time at which feeds began and ended. | 17/22 | ||
| 22 male and 20 female newborn infants. | |||||
|
(Experiment 2) N = 34 |
|||||
| 18 male and 16 female newborn infants. | |||||
| Parkinson & Drewett (2001) | N = 100 | Cross‐sectional | Despite similarity in the age of the toddlers self‐feeding and being fed varied highly. Intake was correlated with number of bites rather than meal duration. Self‐feeding led to a longer meal time on average, while longer meals were associated with lower food intake. | Number of bites may be a better indication of hunger levels than meal duration, although account needs to be taken of whether the child self feeds or is fed by the mother. Self‐feeding tends to lead to longer meal duration and lower intake in toddlers. | 20/22 |
| ‘Feeding behaviour in the weaning period’ | Mother infant dyads. 51 male and 49 female. Infants/toddlers observed between 52 and 61 weeks, mean age 55 weeks. Maternal age range ≤24 to ≥35 years. | Naturalistic observation of two meal times analysed using all occurrence sampling. Codes developed regarding mothers' feeding of children and child self‐feeding and related child behaviours. | 17/22 | ||
| Paul et al. (1996) | N = 20 | Short‐term longitudinal | Two‐week‐old infants were visually attentive when feeding. Motor activity and alertness shifted from pre‐feeding to post‐feeding time during the first 6 months. | Motor behaviours differ with feeding state and at different points in the feeding cycle according to infant age. Differences also appear to exist in the sucking behaviours and consumption patterns of formula‐fed and milk‐fed babies. | 15/22 |
| ‘Infant feeding behavior: development in patterns and motivation’ | Full term infants at 2, 10, 18 and 26 weeks. Sex unknown. | Structured observation prior to during and after milk feeding. Observations supported by video and polygraphic recording of behaviours such as sucking, breathing and swallowing. | 13/22 | ||
| Reau et al. (1996) | N = 281 | Cross‐sectional | No differences were reported between feeding time in terms of birthweight or birth order. 90% of infants and toddlers took fewer than 30 min to eat a meal. Reports of feeding problems were especially common in toddlers. | Feeding problems are common in infants and especially toddlers. Variability in hunger is normal. Meal durations beyond 30 min may indicate feeding problems. | 17/22 |
| ‘Infant and toddler feeding patterns and problems: normative data and a new direction’ | 157 male and 124 female infants and toddlers, age range 12–108 weeks. Mean age unknown. | Survey research using an unvalidated self‐report questionnaire. Questionnaire items included infant and toddler hunger at the start of a meal, feeding behaviours, feeding problems and feeding duration. | 14/22 | ||
| Skinner et al. (1998) | N = 98 | Longitudinal | Hunger communication appeared before satiation (4.4–5.7 and 5.8–7.5 months, respectively). Extreme variability was identified in communicative behaviours at meal times. Food likes and dislikes increased with age as did verbal communication relating to eating. | Hunger and satiation communication is highly variable. Likes/dislikes are easier to discern in older infants than younger ones, although liking was exhibited less than dislike through facial expression. | 19/22 |
| ‘Mealtime communication patterns of infants from 2 to 24 months of age’ | Infant mother dyads. Typically developing infants from 8 to 96 weeks. Infant sex, mean infant age and mean maternal age unknown. | Structured interviews and researcher administered questionnaire at 10 time points from 2 to 24 months. Participants were randomly assigned to six interviews. Data were collected regarding infant and toddler mealtime communication at each time point. | 15/22 | ||
|
Stevenson et al. (1990) |
N = 34 | Cross‐sectional | Feeding outcomes were similar for both groups. Pre‐term infants fussed more during feeding than term infants. Vocalisations did not differ between groups. However, mothers of premature babies responded to vocalisations with offers of food more than mothers of term infants. | Expression of hunger may differ subtly in premature babies. Mothers of these babies offer food more in response to vocalisation than those of full term babies. | 17/22 |
| ‘Rhythms in the dialogue of infant feeding: preterm and term infants’ | Mother infant dyads with 17 pre‐term infants and 17 full term infants at 32 weeks (age gestationally adjusted). Maternal age and infant sex unknown. | Solid food feeding interactions video‐recorded through a one‐way mirror. Coding of maternal and infant behaviours such as gaze, vocalisation and self‐feed. | 15/22 | ||
| Turkewitz et al. (1966) | N = 35 | Cross‐sectional | The proportion of hand flexion to extension movements was greater prior to feeding than post‐feeding, regardless of whether infants were awake or asleep. | Hand flexion appears to be associated with hunger in new born infants. | 17/22 |
| ‘Relationship between feeding condition and organization of flexor–extensor movements in the human neonate’ | Newborn female infants, aged < 1 to 1.5 weeks, mean age ≏ 1 week | Observational study of flexion and extension movements of infants' hands during two 5‐min periods prior to and post‐feeding. | 19/22 | ||
|
van Dijk et al. (2009) |
N = 20 | Short‐term longitudinal | Amount consumed per meal increased over time. Mealtime duration was stable across time (average 8 to 10 min). Frequency of food refusals decreased over time. Variability was found in feeding behaviours both across and within infants particularly during the period after the introduction of solids. | Infant feeding behaviour is highly variable during the weaning period; however, meal duration increases over time. Food refusal is also common during weaning. | 19/22 |
| ‘Variability in eating behavior throughout the weaning period’ | 12 male and 8 female full term infants aged between 16 and 24 weeks, mean age 22 weeks. | Naturalistic observation of infants and caregivers across a 12‐week period following the introduction of solids. Feeding video‐recorded and coded. | 17/22 | ||
| Ventura et al. (2012) | N = 30 | Experimental | Infants consumed significantly less cows' milk formula and showed higher satiety ratios after the enhanced cows' milk formula and the protein hydrolysate than standard cows' milk formula. | Formula composition impacts on both satiation and satiety regardless of energy content. The study potentially offers five means of identifying hunger and satiety in a research context: amount of milk initially consumed, rate of consumption, response to additional offers of milk, compensation feeding at subsequent meal and satiety ratio. | 21/22 |
| ‘Infant regulation of intake: the effect of free glutamate content in infant formulas’ | 14 male and 16 female infants, mean age 8.5 weeks. | Infants were fed one of three different formulas over 3 days: cows' milk formula, a protein hydrolysate formula and cows' milk formula with added free glutamate. Satiety ratios were calculated for each formula. | 20/22 | ||
| Wasser et al. (2011) | N = 217 | Cross‐sectional | Infants with high distress to limitations were more likely to receive solid foods early. Maternal obesity was associated with early introduction of solids, and maternal depression was associated with the early introduction of juice. | Infants with difficult temperaments may be perceived to be hungrier or may be fed to soothe them. Infants with difficult temperaments may also be given juice to soothe them or as a coping response by depressed mothers. Obese mothers may misinterpret difficult temperament for hunger or may have larger, hungrier babies. | 22/22 |
| ‘Infants perceived as “fussy” are more likely to receive complementary foods before 4 months’ | Infant mother dyads visited at 12, 24, 36, 48 and 72 weeks of infant age. 101 males and 116 females. Mean maternal age 22.7 years. | Infant feeding patterns assessed thorough dietary history and 24‐h dietary recall. Infant temperament traits measured by Infant Behaviour Questionnaire – revised | 22/22 | ||
| Wright et al. (1980) | N = 190 | Short‐term longitudinal | Where long intervals occurred between feeds, breastfed infants consumed a larger meal than formula‐fed infants. Differences were noted in the sucking pattern of breastfed and formula‐fed infants. Over the first 2 months, diurnal differences appeared in the size of feed consumed in breastfed but not formula‐fed infants. | Breastfed and formula‐fed babies show different patterns of feeding behaviour in terms of sucking behaviour and variability of consumption. | 15/22 |
| ‘Do breast‐feeding mothers know how hungry their babies are?’ | 132 formula‐fed and 58 breastfed infants in the first 8 weeks of life. Infant sex unknown. | Video recording of feeding sessions at monthly intervals from just after birth for formula and breastfed infants. Mothers also kept diaries of infants' feeds. | 15/22 | ||
|
Wright (1986) |
N = 30 | Short‐term longitudinal | 77% of mothers reported their infants' hunger varied across the day, more so for boys than girls. Milk intake did not vary significantly across the day, and no significant difference was reported between boys' and girls' milk consumption. Mothers' ratings of hunger correlated with those for intake for 9 of the 14 mothers. | Most breastfeeding mothers were able to assess accurately their infant's hunger. However, infant sex may exert an influence on mothers' interpretation of hunger cues. Mothers of boys may misinterpret high activity and arousal levels as hunger. | 15/22 |
| ‘The development of differences in the feeding behaviour of formula and breastfed human infants from birth to 2 months’ | Mothers of 14 male and 16 female breastfed infants, mean infant age 4 weeks. Mean maternal age unknown. | Mothers asked three questions regarding infant hunger. 14 mothers also kept a 4‐day diary of feeds, provided hunger ratings and weighed infants before and after feeds. | 16/22 | ||
| Young & Drewett (2000) | N = 30 | Short‐term longitudinal | Median meal duration was 17 min. There was high variability between infants in feeding behaviours and across meals. Refusal was a common but highly variable behaviour – median 11, range 0–101. | At 52 weeks of age, toddlers' eating behaviour is variable across meals. Food refusal is common in this age group. Toddlers also consume desserts faster and with fewer refusals than main courses. | 19/22 |
| ‘Eating behaviour and its variability in 1‐year‐old children’ | 13 female and 17 male infants aged 50–57 weeks old. Mean age unknown. | Video‐recorded observations of meals in the home over 2 consecutive days coded with a scheme developed from two other studies. | 18/22 |
*
Child Eating Behaviour Questionnaire.
†
Food Frequency Questionnaire.
‡
Infant Behaviour Questionnaire.
§
Baby Eating Behaviour Questionnaire.
¶
Short Temperament Scale for Infants.
∥
Infant Feeding Questionnaire.