Early Infant Routines May Influence Obesity Risk Within the First Six Months

A new study from researchers at Penn State suggests that everyday routines during the first two months of an infant’s life—especially those related to feeding, sleep, and active play—may already be shaping a child’s early weight trajectory. The findings, published in JAMA Network Open, point to specific behaviors that were linked to higher BMI and weight-for-length scores by six months of age, highlighting an unexpectedly early window when healthy guidance may make a measurable difference.

The research team analyzed data from 143 mother–infant pairs who received pediatric care through the Geisinger Health System and participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in northeastern Pennsylvania. All participating infants were full-term, and data were collected when the babies were two months old using a screening instrument called the Early Healthy Lifestyles (EHL) tool. At six months, each infant’s BMI and weight-for-length z-scores were assessed using standard pediatric measurements.

The EHL tool is a concise 15-item questionnaire that examines daily infant routines, including bottle-feeding practices, sleep patterns, appetite cues, tummy time and active play, and caregiver behaviors during interactions. Although brief, the tool aims to help pediatricians and nutritionists identify “obesogenic” risk behaviors—routines that may contribute to rapid early weight gain.

Across the collected data, researchers identified nine specific behaviors reported at two months that were significantly associated with higher infant weight measures just four months later. These behaviors fell into three main categories: feeding, sleep, and activity/play.

Under feeding practices, the study highlighted several patterns: caregivers using bottles that are too large for a baby’s developmental stage, infants receiving nighttime feedings, and mothers perceiving that their babies were “always hungry.” These patterns suggest potential overfeeding or misreading of infant cues, which can contribute to rapid early weight gain.

The sleep-related behaviors included infants being routinely put to bed after 8 p.m., waking two or more times during the night, having a television on in the room while sleeping, and being put to bed already asleep instead of drowsy but still awake. These routines may disrupt infant self-regulation and sleep quality, which prior research has associated with weight outcomes later in childhood.

In terms of activity and interaction, two behaviors stood out: having limited tummy time or active play and parents being distracted by cell phones or television during play. Active play promotes motor development and energy expenditure, while engaged caregiver interaction supports healthy regulation of hunger and soothing cues.

The research team then created a composite score by counting the number of these nine less-healthy behaviors each infant exhibited. They found a clear dose-response pattern: every additional behavior reported at two months corresponded to a significant increase in BMI and weight-for-length z-scores at six months. Even modest differences in routine seemed to influence early weight outcomes.

The findings are especially notable given how early these habits emerge—before infants can crawl, sit independently, or eat solid foods. Many pediatricians and parents tend to focus more on obesity risk later in childhood, but this study demonstrates that routines established in the very first weeks of life may already have measurable effects.

The study also highlights challenges for families in lower-income contexts, who may experience inconsistent guidance from pediatricians, WIC educators, and community support systems. Mixed messages around feeding, sleep expectations, and play routines can create confusion for new parents who are already navigating an overwhelming amount of information. With limited time during pediatric visits, a tool like the EHL may help providers focus on the most relevant issues for each family.

Researchers note that many of the identified behaviors are common and often used with good intentions. For example, feeding an infant at night or turning on a TV during bedtime might help soothe a fussy baby in the moment. However, these strategies may inadvertently reduce opportunities for infants to develop self-regulation skills, such as recognizing when they are hungry or tired. Self-regulation is an important foundation for healthy growth as children gain more independence.

At the same time, the study emphasizes responsive parenting—a caregiving approach that involves observing infant cues closely and responding in a timely, appropriate, and warm manner. Examples include recognizing hunger versus soothing cues, establishing consistent sleep routines, promoting active play, and minimizing screen distractions during interactions. These early practices support the development of healthy eating patterns, emotional regulation, and activity levels throughout childhood.

While the findings offer promising insights, there are limitations. The sample size was modest, and participants were drawn from a specific population—low-income families in northeastern Pennsylvania—so results may not generalize to all communities. The team plans to expand future studies to include more diverse cultural and socioeconomic groups. They also intend to examine how combinations of behaviors cluster together and influence growth trajectories over time, rather than treating each behavior in isolation.

The broader scientific context supports these findings. Prior research has long connected rapid infant weight gain with increased obesity risk later in childhood. Studies also show that bottle-feeding practices, early sleep routines, and feeding-for-soothing approaches affect both early weight and long-term eating patterns. This new study adds to the evidence by showing that specific behaviors at just two months old are already measurable predictors of growth outcomes.

The study’s implications extend into clinical practice. Because pediatric appointments in the first months of life are brief, having a simple screening tool may help clinicians better identify families who would benefit from targeted support. This is especially valuable for programs like WIC, where nutrition educators often play a central role in helping families build healthy routines early on. Consistent guidance across healthcare and community settings can make early interventions more effective and easier for parents to follow.

Physicians and researchers involved in the study believe that understanding these early behaviors can reduce the burden on parents, who often try to interpret conflicting advice. The goal is not to prescribe rigid routines but to empower caregivers with clear, practical strategies that support a child’s development from the beginning. Early, personalized interventions may help infants establish healthier growth patterns and reduce long-term obesity-related health risks, such as type 2 diabetes and cardiovascular disease, which affect millions of children and adolescents in the United States.

Because obesity prevention traditionally begins in toddlerhood or early childhood, these findings shift attention toward an even earlier stage of life. The research suggests that the two-month well-child visit may be a pivotal moment for identifying risks and providing guidance. By paying attention to feeding, sleep, and play patterns well before solid foods or mobility begin, families may be able to support healthier outcomes with relatively simple changes.

As the research team continues expanding the study, they hope to offer clearer frameworks that help pediatricians and community health workers deliver consistent advice. The ultimate aim is to reduce mixed messaging, simplify decision-making for parents, and create a more unified approach to early childhood health.

Research Paper:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2837959