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Table 1 FSN Intervention Components

From: Family Spirit Nurture (FSN) – a randomized controlled trial to prevent early childhood obesity in American Indian populations: trial rationale and study protocol

  Period (Frequency) Responsive Parenting & Responsive Feeding Infant and Young Child Feeding (IYCF) and PA Maternal & Child Well-being and Home Environment
28 weeks gestation Prenatal (biweekly) • Introduction: fetal & child growth, development, & behaviors • Prenatal nutrition & PA
• Breastfeeding basics
• Planning for a healthy delivery
34 weeks gestation Prenatal (biweekly) • Introduction: responsive parenting/ feeding • Prenatal nutrition & PA goal-setting
• Breastfeeding promotion
• Baby care basics/ making a safe home for play
Birth Neonatal (weekly) • Normal growth, feeding, & sleeping patterns
• Recognition of hunger/ satiety cues
• Feeding support visit
• Importance of exclusive breastfeeding (or formula feeding if breastfeeding not possible)
• Family planning options
• Daily routines for healthy living
1 month post-partum Early infancy 1 (weekly) • Understanding baby’s needs & behaviors
• Managing fussy behavior
• Responding quickly & appropriately to behavior cues
• Discussing reduced screen time
• Promotion of exclusive breastfeeding (or formula feeding if breastfeeding not possible)
• Feeding during illness
• Child opportunities to explore through touch, movement, sight, & sound (tummy time)
• Resisting drug use
• Conflict/ communication skills with baby’s father and/or family/ household members
• Involving fathers and other caregivers in baby’s care
3 months post-partum Early infancy 2 (biweekly) • Play & communication activities
• Looking/ smiling at child during feeding
• Responding to baby’s cues and gestures
• Establishing healthy sleep routines
• Reducing exposure to screen time
• Promotion of exclusive breastfeeding (or formula feeding if breastfeeding not possible)
• Gross & fine motor play
• Continued tummy time
• Monitoring patterns/ reducing screen time
• Skills for healthy living: handling stress, positive thinking, addressing home food, beverage, & PA environment
6 months post-partum Mid-infancy (monthly) • Play & communication activities (talking, singing, imitation)
• Providing consistent routine
• Eating with few distractions
• Finger foods for child to touch
• Continued breastfeeding and/or formula feeding, along with complementary feeding (sequence)
• Types/ textures of complementary foods
• Increasing healthy diet variety
• Gross & fine motor play
• Revisiting family planning/ sexual health (STI knowledge & testing)
• Safe & reliable play spaces
• Meal planning
9 months post-partum Late infancy (monthly) • Play & communication activities (“bye-bye”, imitation)
• Singing to child during daily activities
• Eating with child (modeling healthy eating)
• Updating routines as needed
• Helping infant transition to healthy family lifestyle (diet & PA)
• Ensuring infant is hungry at meals (avoid SSBs, snacks, desserts)
• Continued breastfeeding and/or formula feeding
• Skills for healthy living: saying “no”, healthy relationships, problem-solving, positive thinking, accessing resources for a positive food & beverage environment
12 to 18 months post-partum Toddlerhood (monthly) • Monitoring toddler routines
• Maintaining consistent routines (sleeping, eating)
• Play & communication activities (reading, playing games)
• Modeling healthy eating
• Self-feeding
• Avoiding food as a reward
• Giving toddler fixed “healthy” choices (e.g. banana or orange)
• Transitioning to a cup
• Dealing with food refusal and pickiness
• Promoting PA/ reduced screen time
• Involving toddler in food shopping & preparation
• Providing daily opportunities for gross motor play
• Budgeting for family’s needs
• Confident & effective parenting (consistent rules)
• Toddler care practices/ making a safe home for play
• Safe/ consistent alternative caregivers