Coordination of Care Between Pediatricians and Women Infants & Children Nutritionists

This multi-site, randomized, controlled trial (RCT) will test the hypothesis that an
individually tailored responsive parenting obesity prevention intervention that coordinates
care provided by WIC nutritionists and primary care providers (PCPs) will be more effective
than usual care at 1) delivering consistent messages and 2) changing maternal and infant
behavior to 3) reduce/prevent rapid infant growth from birth to 6 months.

Geisinger research staff will recruit mother/infants dyads primarily from newborn nurseries
from Geisinger Health Systems hospitals in Central Pennsylvania (PA). Mother-infant dydas may
also be recruited directly from newborn well-child visits, prenatal WIC visits, and using
social media platforms such as Facebook. Key eligibility criteria include that infants
participate in the Special Supplemental Women, Infants and Children (WIC) program and receive
clinical care from a participating Geisinger Health Systems pediatrician. Upon eligibility
and receiving consent, mother/infant dyads will be randomized to 1 of 2 groups: intervention
(coordination of care) or control (Geisinger standard of pediatric care), stratified on
infant birth weight, race, and parity. In this study, coordination of care is defined at two
levels: (1) PCPs and WIC will deliver the same, consistent messages and (2) providers will
communicate with each other on preventive care plans regarding responsive parenting and
nutrition education.

The intervention will consist of 3 components: 1) a parent self-assessment and screening
survey called Early Healthy Living/Lifestyles (EHL) tool to assess the child's future obesity
risk and tailor education; 2) parenting and nutrition education using the Healthy Active
Living for Families curriculum (HALF) developed by the American Academy of Pediatrics,
supplemented by evidence-based materials that teach mothers alternatives to using feeding to
manage infant behavior, and establishing good sleep hygiene; and 3) coordination of care
between PCPs and WIC nutritionists utilizing HIT. Components 1 and 2 focus on teaching
mothers to recognize hunger and fullness signs in their infants, use alternative soothing
strategies to feeding, develop good sleep hygiene routines, and engage in active social play.

Once consented and enrolled, all parents receive a welcome packet with brief parenting tips
tailored to the group assignment. Intervention participants will also be mailed the
responsive parenting curriculum after enrolling that addresses the domains of infant sleep,
feeding, soothing and play. Pediatricians who have patients enrolled and randomized to the
intervention group will have access to the EHL data in the patient's electronic health record
which they then use to record notes about each well child visit. After each well-child visit,
these notes including the EHL data will be electronically sent to the child's WIC
nutritionist, to be read prior to a WIC nutrition appointment with that client.

Information from the WIC nutritionist appointments, including nutrition counseling codes from
each appointment in addition to collected health information will then be sent to the child's
pediatrician, to be included as part of the child's electronic health record.

Child's growth measures will be taken from the well baby visits, along with any unique
information from the WIC nutritionist visits. In addition, data collection surveys will be
distributed to all study participants at 2, 5 and 7 months after birth, either electronically
or by paper packet.

Inclusion Criteria:

- mother is English speaking, infant is a singleton birth, infant birthweight greater
than or equal to 2500g, infant gestational age at least 37 weeks, infant no more than
2 months old, no plans for baby to be put up for adoption, no congenital or neonatal
conditions that would affect growth, mother has no major morbidities that would affect
postpartum care, eligible and/or enrolled in a WIC program in central PA, infant
pediatrician is a Geisinger physician in a pediatric service line in Luzerne county

Exclusion Criteria:

- non-English speaking, mother is planning to leave the county where she enrolled within
6-9 months, mother is less than 18 years of age, mother is older than 55 years of age