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This longitudinal study is part of a series examining the relationships between maternal mood, feeding practices, and infant growth and development during the first 6 months of life in 226 well-nourished mother-infant dyads in Barbados. In this report, we assessed maternal moods (General Adjustment and Morale Scale and Zung Depression and Anxiety Scales), feeding practices (scales describing breast-feeding and other practices associated with infant feeding in this setting), and infant cognitive development (Griffiths Mental Development Scales). Multivariate analyses, with and without controlling for background variables, established significant relationships between maternal moods and infant cognitive development. Infants of mothers with mild moderate depression had lower Griffiths scores than infants of mothers without depression. Maternal depressive symptoms and lack of trust at 7 weeks predicted lower infant social and performance scores at 3 months. Maternal moods at 6 months were associated with lower scores in motor development at the same age. Although no independent relationships emerged between feeding practices and infant cognitive development, the combination of diminished infant feeding intensity and maternal depression predicted delays in infant social development. These findings demonstrate the need to carefully monitor maternal moods during the postpartum period, in order to maximize the benefits of breast-feeding and related health programs to infant cognitive development.

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This study was designed to identify psychosocial variables affecting early infant feeding practices in Barbados. The sample included 93 healthy women and infants born at the Queen Elizabeth Hospital who were extensively evaluated 7 weeks, 3 months, and 6 months after birth. Maternal moods were assessed with the Zung Depression and Anxiety Scales and the General Adjustment and Morale Scale. Feeding practices were evaluated using a questionnaire developed for this population. The prevalence of mild depression in this population was 16% at 7 weeks and increased to 19% at 6 months, whereas there were very few cases of moderate-to-severe depression. Disadvantaged environmental conditions, including less information-seeking by the mother, lower family income, and poor maternal health, were closely associated with increased symptoms of depression and anxiety in all women. However, significant predictive relationships between mood and feeding practices remained even when the effects of the home environment were controlled. Specifically, depressive symptoms at 7 weeks postpartum predicted a reduced preference for breastfeeding at current and later infant ages. Conversely, feeding practices did not predict maternal moods at later ages. These findings have important implications for public policy dealing with programs promoting breastfeeding. Early interventions designed to treat mild postnatal depression should be instituted early in the postpartum period to improve the chances for successful breastfeeding.

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This longitudinal study was designed to examine reciprocal relationships between feeding practices and infant growth over the first 6 mo of life. The following three hypotheses were tested: 1) early feeding practices predict later infant growth; 2) early infant growth predicts later feeding practices; and 3) these relationships occur after controlling for related background variables. The sample included 226 healthy, well-nourished infants born at the Queen Elizabeth Hospital, Bridgetown, Barbados. Assessments were made at birth, 7 wk, and 3 and 6 mo of age. Factor analysis of a feeding practices questionnaire for those mothers who attended all three postnatal visits yielded five uncorrelated factors. Three of these factors, preference for breast-feeding, feeding intensity and feeding difficulty, declined with infant age. Two of these factors, father helps and relatives help, increased with infant age. Several background variables, including maternal age, anthropometry and reproductive history, and reliance on outside sources of information were correlated with infant growth. Multivariate analyses confirmed all three hypotheses. The group of feeding practices (particularly the preference for breast-feeding) at 7 wk predicted increases in infant lengths at subsequent ages. Conversely, infant weights at 3 and 6 mo predicted subsequent feeding practices, especially feeding intensity. These reciprocal relationships remained even after statistically controlling for the influence of the background variables. Implications for public policy include the need for comprehensive programs advocating breast-feeding and supporting the general health of mothers and infants.

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This is one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on the 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than healthy comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition.

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A self-rating scale was used to assess the presence or absence of depressive symptoms among mothers of 129 Barbadian school children, ages 5 to 11 years, who had experienced marasmus in the first year of life. They were matched with the same number of mothers of comparison children who had no documented histories of malnutrition. Depressive symptoms, especially feelings of hopelessness, occurred more often among the mothers of previously malnourished children than among mothers of comparison children. Depressive symptoms were also more common in association with disadvantaged socioeconomic and home conditions. Maternal depressive symptoms were significantly correlated with the behavioral and cognitive functioning of the child during the school years. When both nutritional history and environmental conditions were controlled, maternal hopelessness had significant effects on school attendance and grades in reading, but there was no association with IQ. This led us to hypothesize that maternal depressive feelings may be an independent factor contributing to long-term behavioral and cognitive deficits in children with histories of early malnutrition.

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A follow-up study of growth and development was conducted on 216 Barbadian children aged 9 to 15 yr, half of whom had histories of moderate to severe protein-energy malnutrition in their 1st yr of life. Although index girls had significant delays in sexual maturation and were reduced relative to comparison girls on measures of weight for height, arm circumference, and skinfold thickness, their rate of growth when compared with values obtained 4 yr earlier was equal to or better than that of the comparison group. In contrast, boys in the index group were slightly reduced in height compared with their matched comparisons and had similar patterns of growth and sexual maturation. This study suggests a relationship between an episode of infantile malnutrition and impaired endocrine functioning among girls in the adolescent years.

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One hundred nine children, aged 8 through 15 yr, who suffered from malnutrition in the 1st yr of life and 107 well-nourished comparison children were tested for fine motor skills by the Purdue Pegboard test. The performance of index children was impaired on three of the four test measures. IQ measured concurrently showed a reduction in the index group; when the effects of IQ were eliminated, there was no longer any significant difference between index and comparison groups. The data suggest that the effects of early malnutrition on Pegboard performance are largely mediated by deficits in IQ. The presence of soft neurologic signs measured 4 yr earlier in the same children was highly correlated with reduced Pegboard performance, implying that early malnutrition has effects on nervous system function that are evident at least through 15 yr of age.

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