Reducing relative food reinforcement of infants using a music enrichment program: a randomized, controlled trial

Background: Food reinforcement or one's motivation to eat may be established early in life; it might not be the food reinforcement per se that drives weight gain, but rather the imbalance between food and nonfood reinforcement. Objectives: We implemented a 2-y randomized, controlled trial to assess the effects of a music enrichment program (music, n = 45) compared with an active play date control (control, n = 45) in 9- to 15-mo-old healthy infants who were strongly motivated to eat. Methods: The 12-mo intensive intervention phase included 4 semesters of Music Together® or a play date program (Winter, Spring, Summer, and Fall), comprised of once per week group meetings, followed by a 12-mo maintenance phase with monthly meetings. Parents were encouraged to listen to the Music Together® program CD or play with the play date group's toy with their infants at home, respectively. We performed a modified intention-to-treat analysis using all randomly assigned, non-excluded subjects for the outcome measures [relative reinforcing value of food (RRV_food), food reinforcement, music reinforcement, and weight-for-length z-score (WLZ)]. Results: There were significant differential group changes across time for RRV_food (group × month; P = 0.016; Cohen's f² = 0.034). The music group had significantly greater RRV_food decreases than the control group from baseline to the end of the intensive intervention phase (music change = −0.211; control change = −0.015; P = 0.002; Cohen's D = 0.379). However, these differences were not maintained during months 12–24 (music change = −0.187; control change = −0.143; P = 0.448; D = 0.087). We observed an overall moderation effect by sex for food reinforcement and WLZ. Boys in the music group had a significant attenuation in food reinforcement and WLZ compared with boys in the control group. Conclusions: This study extends our knowledge in infant eating behavior by providing insight into the role of nonfood alternatives in altering one's motivation to eat. There may be sex differences in altering one's motivation to eat. This trial was registered at clinicaltrials.gov as NCT02936284.