Information seeking of French parents regarding infant and young child feeding: practices, needs and determinants

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

A web-based and mobile randomised controlled trial providing complementary feeding guidelines to first-time parents in France to promote responsive parental feeding practices, healthy children's eating behaviour and optimal body mass index: the NutrienT trial study protocol

BACKGROUND

Childhood obesity is a crucial public health issue. Early childhood is a critical time to foster the establishment of healthy eating behaviours and growth, which are partly shaped by parental feeding practices. To inform French parents of the recently updated national complementary feeding guidelines for 0-3 years (in terms of nutrition and responsive feeding as a mean to encourage infant appetite control skills and promote healthy growth), an official printed brochure was developed and nationally disseminated in 2021 by the French public health agency, Santé publique France. This randomised controlled trial aims to investigate whether the provision of guidelines through digital (smartphone application) and printed (brochure) tools (vs. the printed brochure alone, usual service) results in healthier parental feeding practices, infant eating behaviours and weight status.

METHODS

This double-blinded monocentric 2-arm trial is currently conducted among first-time parents living in the area of Dijon (France) and recruited in a maternity ward. From child age 3 to 36 months (mo), an app provides a range of 106 age-adapted messages, including dietary recommendations, educational advice, recipes, and tips (intervention group only). Additionally, parents of both groups are provided with 48 messages related to child general development and the printed brochure at child age 2.7 mo. The primary outcome is the body mass index (BMI) z-score at child age 36 mo. Secondary outcome measures include a combination of online parents' reports and behavioural assessments (experimental meals) of parental feeding practices and infant eating behaviours from inclusion to 36 months of age. Analyses of covariance on these outcomes will assess the effect of the intervention, adjusted for relevant confounders. Complementary mediation and moderation analyses will be conducted. Sample size was determined to be n = 118 in each arm of the trial, plus 20% to compensate for potential attrition.

DISCUSSION

This is the first public eHealth randomised control trial in France to assess the effect of a web-based and mobile intervention targeted to first-time parents to improve child feeding practices and child growth.

TRIAL REGISTRATION

This trial was registered at clinicaltrials.gov as NCT05285761 (March 18, 2022).

Development of food literacy in children and adolescents: implications for the design of strategies to promote healthier and more sustainable diets

Food literacy has emerged as a key individual trait to promote the transformation of food systems toward healthy and sustainable diets. Childhood and adolescence are key periods for establishing the foundations of eating habits. Different food literacy competencies are acquired as children develop different cognitive abilities, skills, and experiences, contributing to the development of critical tools that allow them to navigate a complex food system. Thus, the design and implementation of programs to support the development of food literacy from early childhood can contribute to healthier and more sustainable eating habits. In this context, the aim of the present narrative review is to provide an in-depth description of how different food literacy competencies are developed in childhood and adolescence, integrating the extensive body of evidence on cognitive, social, and food-related development. Implications for the development of multisectoral strategies to target the multidimensional nature of food literacy and promote the development of the 3 types of competencies (relational, functional, and critical) are discussed.

Mothers' sociodemographic factors and use of health professionals for child feeding advice

This study examined sociodemographic factors associated with mothers seeking child feeding advice from health professionals (HPs). Cross-sectional analysis of survey data from linked randomized controlled trials was conducted. Surveys asked which sources of feeding information mothers used when their child was 6 months and 5 years old. Logistic regression was used to examine associations between sociodemographic characteristics and use of information from HPs. Here, 947 and 405 mothers completed 6-month and 5-year surveys, respectively. At 6 months, multiparous mothers were less likely to seek advice from child and family health nurses (CFHNs) (adjusted odds ratio [AOR]: 0.558, 95% confidence interval [95% CI]: 0.416-0.749) and other HPs (AOR: 0.706, 95% CI: 0.542-0.919), unmarried mothers were less likely to seek advice from other HPs (AOR: 0.582, 95% CI: 0.342-0.990). At 5 years, mothers with household income ≥$80,000 p.a. were less likely to seek advice from CFHNs (AOR: 0.514, 95% CI: 0.302-0.875) and working mothers less likely to seek advice from general practitioners (GPs) (AOR: 0.581, 95% CI: 0.374-0.905). Mothers born in Australia were less likely to seek information from CFHNs (AOR: 0.462, 95% CI: 0.257-0.833) and GPs (AOR: 0.431, 95% CI: 0.274-0.677). There was a greater likelihood that multiparous mothers (AOR: 2.114, 95% CI: 1.272-3.516) and mothers of children whose fathers had not attended university (AOR: 2.081, 95% CI: 1.256-3.449) had never sought advice from CFHNs, and that mothers who had not attended university (AOR: 1.769, 95% CI: 1.025-3.051), multiparous (AOR: 1.831, 95% CI: 1.105-3.035) and employed (AOR: 2.058, 95% CI: 1.135-3.733) mothers had never sought advice from other HPs. Understanding sociodemographic factors associated with seeking child feeding advice from HPs may inform priorities for engaging families in health promotion.

Evaluation of YOUTUBE videos on complementary feeding: Content quality and reliability analysis

YouTube is an online platform that parents frequently use to access information on child health. Parents' watching YouTube videos to have information on complementary feeding requires evaluation of the videos regarding child health. This study which was conducted in descriptive design, aimed to analyze YouTube videos' content quality and reliability on complementary feeding. Searched by matching keywords "starting", "beginning", "introducing", "solid food", and "complementary feeding" through boolean operators in the English language on YouTube, on August 2022. The search identified 528 videos related to complementary feeding. Two independent researchers analyzed the content of 61 videos that met the inclusion criteria. The content quality of the videos was evaluated using the Checklist for Complementary Feeding (CCF), which was prepared by researchers in line with international guidelines, the reliability of the videos was analyzed using the DISCERN, and the content quality was evaluated using the Global Quality Score (GQS). Of the 61 videos included, 38 (62.3%) were informative, and 23 (37.7%) were misleading. The kappa value among independent observers was 0.96. The mean GQS, DISCERN, and CCF scores of the videos grouped as informative were significantly higher than the videos grouped as misleading (p = 0.000, p = 0.000, p = 0.000, respectively). There was a significant difference between the mean scores of GQS and DISCERN according to the publication source of the videos (p = 0.033 and p = 0.023, respectively). The GQS and DISCERN mean scores of the Ministrial/Academic/Hospital/Healthcare Institution channel videos were higher than the mean scores of the Individual/Parents content channel videos. Videos on YouTube about complementary feeding have high viewing rates, but also videos that are low in terms of quality and reliability.

Parents' and Health Care Professionals' Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study

BACKGROUND

Food allergy in children is increasing in prevalence in the western world and appears to become an important health problem. Parents of children at risk of food allergy live with the fear of allergic reaction, especially when the children are very young. The paradigm shift in allergy prevention in the last decade-away from allergen avoidance toward a tolerance induction approach-challenges both parents and health care professionals, as they have to deal with changing information and new evidence that often contradicts previous assumptions. Yet, research on health information-seeking behavior and needs of parents on primary prevention of food allergy in children as well as on prediction and prevention strategies of German health care professionals is lacking.

OBJECTIVE

The aim of the study is to explore and understand parents' and health care professionals' perspectives on the prediction and prevention of food allergies. We are particularly interested in information needs, information seeking, and health care usage and place a special focus on families' experiences when their child is at risk or diagnosed with food allergies. Furthermore, food allergy prediction and prevention strategies of health care professionals will be explored.

METHODS

This study is part of the NAMIBIO (food allergy biomarker) app consortium, which aims to identify early predictors for the development of food allergy in children and develop apps to guide health care professionals and parents of children with a high risk of food allergy toward prevention and timely tolerance induction. The study uses a qualitative approach with topic-guided interviews and focus groups with parents of children (0-3 years) and health care professionals. Data collection will continue until theoretical saturation is reached. The qualitative content analysis will be used according to Kuckartz to identify overarching themes toward information needs and seeking behavior as well as usage of health care and health care professionals' predictive and preventive strategies. In addition, a constructivist grounded theory approach will be used to explore and understand parents' experiences, interactions, and social processes in families in daily life.

RESULTS

Recruitment and data collection started in February 2022 and is still ongoing.

CONCLUSIONS

The qualitative study will provide insight into parents' information-seeking behavior and needs regarding the prevention of food allergy in children, parents' use of pediatric primary care, and health care professionals strategies for the prediction and prevention of food allergies in children. We assume that our results will highlight the challenges associated with the paradigm shift in allergy prevention for both parents and health care professionals. The results will be used to make practical recommendations from the user's perspective and inform the development of the NAMIBIO apps.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41436.

Self-Reported Parental Healthy Dietary Behavior Relates to Views on Child Feeding and Health and Diet Quality

The aim of this cross-sectional study was to investigate whether parental views on child feeding and its impact on health differ between those parents whose self-perception was that they followed a healthy diet to those who do not. Furthermore, differences in the child's diet quality and weight were compared between the groups. Parents of 2-6-year-old children (n = 738), recruited from child health clinics throughout Finland, answered semi-structured questionnaires on their views on child feeding and health as well as their child's diet quality. Participants were divided into two groups based on their self-perceived report of following a healthy diet: health-conscious (HC, n = 396) and non-health-conscious (non-HC, n = 342) parents. HC parents considered health, eating behavior, and nutrient-related factors more often when feeding their child than non-HC parents (<0.001 < p < 0.03). Moreover, they more commonly considered diet to have an important impact on their child's long-term health than the non-HC parents (<0.001 < p < 0.05). Children of HC parents were more likely to have a good diet quality (p = 0.01) and lower BMI-SDS values (p = 0.015) than those of non-HC parents. Parental health consciousness was linked with better diet quality and healthier weight in their children. This information may be useful in the regular clinical monitoring of children's health.

Counseling parents about child feeding: a qualitative evaluation of French doctors and health/childcare professionals' experiences and perception of a brochure containing new recommendations

BACKGROUND

Parents are crucial in establishing their children's eating habits, and doctors and health/childcare professionals (HCCPs) can provide meaningful and trusted guidance on feeding, especially in the 0-3-year-old period. With the upcoming release of the official brochure containing the new child feeding recommendations in France, this study aims to: (1) assess professionals' practices and perceptions regarding their communication with parents on child feeding and (2) evaluate their perception of the draft of the new brochure.

METHODS

A 15-page draft brochure (without pictures) containing updated child feeding recommendations for children 0-3 years old was developed by Santé publique France (the French public health agency). Online semi-structured interviews were conducted with professionals (n = 21), including 13 pediatricians and general practitioners (doctors) and eight healthcare or childcare professionals (HCCPs) two weeks after they were provided with this draft brochure to read. The interview guide was developed and piloted with other professionals (n = 3) prior to these interviews. Interview data were transcribed verbatim and analyzed thematically using an inductive approach.

RESULTS

While doctors and HCCPs mostly communicate orally with parents, both acknowledged that the brochure might be a helpful supplement, especially for HCCPs to legitimize their advice to parents. For doctors, giving the brochure to parents may help provide systematic advice and save time during consultations. Professionals serving parents of lower socioeconomic status would prefer a supplement with less text and more illustrations. In general, the messages were perceived to be easily understandable but providing detachable cards to distribute according to the child's age would facilitate information dissemination and might be more useful to parents. Professionals reported that lack of training, the circulation of contradictory information, and language barriers were common challenges.

CONCLUSION

French professionals welcomed the new official brochure as a means to spread updated child feeding recommendations. However, this brochure could be modified and specific tools developed to better adapt to professionals' needs of communication with parents and to facilitate the relay of information. Providing updated and consistent information to parents should be considered a priority for public health stakeholders toward increased adherence to new recommendations.

Increasing Parental Knowledge About Child Feeding: Evaluation of the Effect of Public Health Policy Communication Media in France

Background

Unhealthy eating behaviors are risk factors for non-communicable diseases. Parents largely influence the development of eating behaviors during childhood through their feeding practices. Parental feeding practices in line with recommendations are more likely to turn into healthier outcomes in children. From a public health perspective, it should be first ascertained whether providing parents with recommendations about child feeding is a useful approach for increase parental knowledge. Recently, the French health authorities developed a brochure covering updated child feeding recommendations. The present study aims to evaluate the short-term effects of reading this brochure on parental knowledge about child feeding, distinguishing knowledge accuracy and certainty.

Methods

A brochure containing updated child feeding recommendations for 0-3 years old was developed by the French public health agency. A representative sample of French parents (n = 400) was targeted to complete an online questionnaire (T0) comprising 30 statements regarding child feeding. For each statement, parents indicated whether it was true/false and how certain they were of their answer (4-point scale). After receiving and reading the brochure, the same parents completed the same questionnaire 3 weeks later (T1). Accuracy (number of correct answers) and certainty (number of mastered answers: correct answers given with the maximal degree of certainty) were compared at T1 vs. T0 using paired t-tests. Knowledge evolution based on parental age, parity and education level was tested with linear models.

Results

A total of 452 parents responded at T0 and T1 and were considered for analysis. Between T0 and T1, the number of correct answers [median 22-25, t(451) = 17.2, p ≤ 0.001] and mastered answers [median 11-17, t(451) = 18.8, p ≤ 0.001] significantly increased. The median of the difference between T1 and T0 was larger for mastered than for correct answers. The observed evolution in knowledge was independent of parental age, parity or education level.

Conclusions

A brochure containing child feeding recommendations has the potential to increase the accuracy and, to an even greater degree, the certainty of parental knowledge. This increase was observed even for younger or less educated parents.