Associations between maternal perceptions of infant growth and feeding and infant growth outcomes in community health clinics: a prospective multicentre longitudinal study

BACKGROUND: Exclusive breastfeeding (EBF) during the first six months of life is critical for infant survival, growth, and development. Maternal perceptions of infant growth and feeding, shaped by cultural norms and healthcare support, may influence feeding practices and subsequent growth outcomes. Guided by the Health Belief Model, Social Cognitive Theory, Theory of Planned Behaviour, and Ecological Systems Theory, this study examined the associations between maternal perceptions of infant growth and feeding and infant growth outcomes during early infancy. METHODS: A prospective multicentre longitudinal study was conducted from February 2015 to January 2019 across six community health clinics in the Gombak District, Malaysia. A total of 460 full-term mother-infant pairs were followed from 1 to 6 months postpartum. Maternal perceptions of infant growth and feeding were assessed using a culturally adapted questionnaire addressing feeding adequacy, growth concerns, and adherence to recommended feeding practices. Trained nurses measured infant length and weight. Pearson correlation and multiple linear regression analyses were performed to examine associations between maternal perception scores and infant growth indicators, adjusting for ethnicity and maternal education. RESULTS: Maternal perceptions of infant growth and feeding adequacy were positively correlated with length-for-age z-scores (LAZ; r = .18) and weight-for-age z-scores (WAZ; r = .60) at 1 month (p < .001 for both), and with LAZ at 6 months (r = .21; p < .001). Perceptions of feeding recommendations were also correlated with LAZ at both time points and were strongly associated with WAZ at 6 months (r = .90; p < .001). Multiple linear regression analysis indicated that more favourable maternal perceptions at 6 months were independently associated with higher LAZ at 6 months. CONCLUSIONS: More positive maternal perceptions of infant growth and feeding are associated with favourable infant growth outcomes during the first six months of life. Theory-informed interventions that strengthen maternal understanding of feeding adequacy and address perceived barriers, particularly through culturally tailored counselling and community-based support, may support optimal feeding practices and healthy early growth trajectories.