Exploring parental attitudes and practices during complementary feeding
Background Children’s introduction and transition to a mixed diet is gradual and covers the first 18-24 months of life. In the UK, all parents have the opportunity to access information on complementary feeding (also referred to as weaning) through the health services. Parental adherence to the weaning guidelines however, has been assessed to be unsatisfactory on a national level. A big challenge therefore for researchers working in the field of complementary feeding is to understand the factors that influence parents’ decisions regarding weaning and target those that are associated with the level of compliance to the weaning guidelines. Aim and objectives This project aims to increase understanding of the factors that influence parents’ feeding behaviours and attitudes during the complementary feeding period in high-income countries, particularly in the United Kingdom. Methods Three studies were undertaken to achieve the overall aim: 1) Using a framework approach, a systematic review synthesised qualitative evidence available from four electronic databases in relation to weaning practices of parents in developed countries with a child younger than 3 years. 2) A qualitative study gathered data from eight focus groups consisting of 37 mothers from Northern Ireland with a healthy child in weaning age. Using inductive thematic analysis opportunities to establish healthy eating habits during complementary feeding, and relevant challenges were explored. 3) An online survey collected data from 466 mothers and 30 fathers living in the UK with a healthy child up to the age of 18 months. This study investigated the factors associated with the timing of introduction of solid foods and the quality of weaning diet. Results Qualitative data revealed a high maternal perceived value for food diversity during complementary feeding. Modelling healthy foods, using covert approaches to feed, and offering repeated exposure to foods were some practices that mothers engaged in to establish healthy eating behaviours; having a limited understanding of food variety and using distractions during feeding were some of the challenges faced by mothers. Cross-sectional data demonstrated that a diet of high quality was provided. Maternal feeding self-efficacy and relying on the NHS guidelines to start weaning were independently correlated with the dietary quality provided. Weaning from 6 months was strongly predicted by reliance on the NHS recommendation; it was also positively associated to distress infant temperament and negatively associated to perceived social support. Conclusions This work discussed factors that shape parental weaning practices. It highlighted prevalent baby and maternal cues to initiate weaning, mothers’ views on the WHO recommendation for the age of weaning and the main drivers of choosing weaning foods. The project additionally addressed the perceived value of the advice from health providers and grandmothers, mothers’ suggestions for improved weaning education and experiences of baby-led weaning. The nature of fathers’ role during weaning and their under-representation in relevant research was discussed. Mothers encouraged their children to develop a preference for healthier foods through modelling and repeated exposure. While a high perceived value for food variety was demonstrated, the definition of a diverse weaning diet and the methods to provide it were poorly understood. Using distractions whilst offering food and being flexible about where the feeding takes place were practical strategies used to reduce feeding-related stress. Mothers demonstrated good adherence to the UK complementary feeding recommendations and a good ability to offer a nutritious weaning diet. Maternal self-efficacy in feeding a child and reliance on the official feeding recommendations to initiate weaning were predictive of dietary quality during weaning. Aspects of children’s temperament may influence the timing of introduction and the type of complementary foods. Recommendations An effective weaning education should be provided to parents with the most up-to-date official recommendations and enable them access to easy-to-understand education material, whilst taking into consideration the diversity of cultural and religious backgrounds. Areas to focus on include infant signs of readiness to receive solids, health implications of early weaning, and the age marking the appropriate inclusion of various complementary foods. Additionally, misconceptions around food exposure and food variety are common and health practitioners need to be aware of them. Mothers’ perceptions around their own eating behaviours, such as food neophobia, should also be addressed as part of the guidance on complementary feeding. Emphasis should also be placed on strengthening mothers’ confidence in feeding by equipping them with ways to promote the consumption of healthy foods and to restrict intake of high-fat and high-sugar snacks.
complementary feeding, solid food introduction, weaning guidelines, feeding behaviours, parental practices
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