Development of a digital intervention to promote healthy growth during the first 2 years of life

Context

According to the National Childhood Measurement Programme, more than 1/5 children in England have developed overweight or obesity by the time they start primary school. Children living in the most deprived areas are more than twice as likely to be affected by obesity as those living in the least deprived areas. Children with obesity are over five times more likely to have obesity as adults, and are at increased risk of developing asthma, type 2 diabetes, cancer, heart and liver disease, and associated mental health problems - even from childhood. Obesity costs the NHS more than £5.1 billion, and employers approximately £7 billion.

Once developed, obesity is difficult to reverse, and a substantial body of evidence has established that rapid infant weight gain (from birth to 2-years) is causally linked to future obesity. Infancy is therefore a key window of opportunity for obesity prevention. In high incomes countries, rapid infant weight gain is common, especially among formula fed infants, with large studies estimating up to 40% of healthy full-term infants experiencing it.

Managing rapid infant weight gain is challenging for parents: many infants have an avid appetite and a preference for sweet tasting foods, predisposing them to excessive milk and food intake; many parents use feeding to calm their unsettled infant or promote longer sleep duration; and parents and healthcare professionals often view rapid weight gain as healthy or advantageous. Three behavioural feeding interventions have succeeded in changing target behaviours among infants during the period of exclusive milk-feeding and/or weaning (starting solid foods): BABY MILK (UK), NOURISH (Australia) and INSIGHT (US).

However, all were delivered face-to-face, with additional written materials and phone support. Due to increasing workload pressures on healthcare providers, there is a need for a behavioural intervention that does not require face-to-face delivery, and is cost effective and sustainable. A digital intervention would support parents who are increasingly being signposted to self-help materials, and would allow the intervention to be scalable to the population level. 'Baby Buddy' is the UK charity Best Beginnings' free, multi-award winning app, which provides information and tools to support parents in infant care.

It has been downloaded >200,000 times (~1200 downloads per week), is accredited by the DHSC (and a large number of other organisations), available for download in the NHS apps library, and has a very wide reach with younger and more deprived mothers over-represented, making it an ideal platform for such an intervention.

Aims and objectives

In collaboration with Best Beginnings, we will adapt BABY MILK, NOURISH and INSIGHT for digital delivery in the UK, via Baby Buddy. Currently, Baby Buddy has very limited information about managing the key behaviours related to infant weight gain (milk-feeding, weaning, sleep, crying, activity, and understanding healthy weight gain). We will develop new interactive information on these topics, focusing on the first 2-years of infancy, based on the best available evidence of what works.

We will work with Best Beginnings' network of parents and health professionals to review and advise on all stages of the intervention development, to ensure the content is user-friendly, engaging, persuasive and salient. Potential applications and benefits

This digital intervention will provide parents with much-needed support on managing key behaviours related to infant weight gain, and will also offer a source of information for healthcare professionals to signpost families to, in order to free up their time. An effective and scalable intervention that optimises infant growth and nutrition has the potential to be rolled out on a population level and reduce the health and economic burdens of obesity both in childhood and adulthood.