An online survey of knowledge of the weaning guidelines, advice from health visitors and other factors that influence weaning timing in UK mothers

Complementary Feeding Methods, Feeding Problems, Food Neophobia, and Picky Eating among Polish Children

Proper nutrition during the first period of life is primarily related to meeting energy needs and providing essential nutrients that ensure the infant's normal physical and psychomotor development. Improper nutrition during this period, inadequate amounts of nutrients, inappropriate timing and manner of introduction of individual foods, can permanently alter metabolism and the course of physiological processes, increasing the risk of diseases such as obesity, allergic diseases, and cardiovascular diseases. This study aimed to verify how the method of complementary feeding influences the occurrence of food neophobia between 2 and 7 years of age, as well as to assess the different nutritional aspects resulting from the process of starting feeding other than breast milk and milk formula. In this study, 490 mothers and their children aged 2-7 years participated. The research tool was a questionnaire consisting of a child's dietary assessment and standardized questionnaires assessing food neophobia among children: Food Neophobia Scale for Children (FNSC) and the Montreal Children's Hospital-Pediatric Feeding (MCH-FS). In the study group of children, 238 (48.57%) had no Baby-Led Weaning Method (no BLW) method used during complementary feeding (CF), and 252 (51.42%) children used Baby-Led Weaning Method (BLW). According to the FNSC questionnaire, a high risk of food neophobia was found in 32.65% of the children studied and a medium risk in 39.80%. The medium risk of feeding problem occured in 11.63% of children, the high risk in 6.73% of children, and the highest risk in 6.94% (MCH-FS). No statistically significant differences were observed between the BLW and NoBLW groups. High risk of food neophobia occured in 1/3 of the children studied, but there was no relationship in the study group between the mode of CF (BLW/NoBLW) and the risk of food neophobia.

The effect of baby-led weaning and traditional complementary feeding trainings on baby development

PURPOSE

The aim of this study was to evaluate the risks of self-feeding, transition to early solid food and family meals, choking risk, anemia risk and obesity risk in 6-12-month-old infants who were introduced to complementary feeding using the traditional complementary feeding (TCF) and baby-led weaning (BLW) methods/training.

DESIGN AND METHODS

Mothers of infants who had not yet transitioned to complementary feeding were included in this randomized study. The mothers of 62 infants included in the study were randomized into the intervention groups as TCF and BLW, classified according to the number of children and education level. The research was carried out according to the CONSORT-2010 guidelines after randomization and was concluded with 52 infants and their mothers.

RESULTS

It was found in the study that self-feeding and transition to solid foods in infants fed with the BLW method was higher than the infants fed with the TCF method (p < 0.05). A significant increase was observed in the hemoglobin level of infants fed with the BLW method over time (p < 0.001).

CONCLUSIONS

It was concluded that the BLW method did not lead to risks of obesity, anemia and iron deficiency in transition to complementary feeding. Secondary results indicated that feeding with the BLW method promoted self-feeding and early transition to solid foods and did not lead to the risk of choking.

PRACTICE IMPLICATIONS

Complementary feeding with the BLW method can be safely used by both mothers, healthcare professionals and researchers.

TRIAL REGISTRATION

register.

CLINICALTRIALS

gov; Identifier: NCT05771324.

Infant egg consumption during introduction to solid food remains low in the United Kingdom but increases with infant age and a baby-led weaning approach

BACKGROUND

As a nutritious food-providing protein, essential fatty acids, vitamin D, iodine and choline eggs have historically been central to an infant weaning diet. However, food poisoning scares and allergy concerns have contributed to low consumption among infants aged 6-12 months.

METHODS

This paper presents a secondary data analysis of infant egg exposure and intake using three weaning data sets: a 7-day food frequency questionnaire (n = 297), a 24-h recall (n = 180) and a 3-day weighed food diary (n = 71). Egg introduction, frequency of consumption and intake in grams were analysed for infants aged 6-8, 9-10 and 11-12 months). Comparisons were made by whether infants were following a baby-led approach to weaning (where infants self-feed family foods) or a traditional approach where pureed foods are given alongside finger foods. Data were collected in the United Kingdom between 2015 and 2018.

RESULTS

Our data showed that despite introduction being recommended from the start of weaning at 6 months of age by the Department of Health, just 54% of infants aged 6-8 months had ever been offered eggs. Average egg intake was one to two times per week, increasing with age. However, in terms of frequency and grams consumed, our data suggest a small increase in consumption compared with previous research, although limitations of our smaller sample size should be noted. Finally, a baby-led approach was associated with increased exposure and consumption; baby-led infants consumed eggs twice as frequently as spoon-fed infants.

CONCLUSIONS

The findings have important implications for public health messaging and for supporting families in introducing solid foods.

Early weaning causes small intestinal atrophy by inhibiting the activity of intestinal stem cells: involvement of Wnt/β-catenin signaling

BACKGROUND

Early weaning and shorter breastfeeding duration are applied by a proportion of young mothers, especially in the social spheres of poverty-stricken areas. Early childhood is a critical period for intestinal development, which is driven by intestinal stem cells (ISCs). However, how early weaning practice affects the function of ISCs to mediate intestinal development remains unclear.

METHODS

We established an excellent early weaning mice model that has significant intestinal atrophy and growth arrest symptoms to explore the responses of ISCs to early weaning. The primary and passaged intestinal organoids from the suckling or early weaning mice were cultured to explore the underlying mechanism of early weaning affecting the ISCs.

RESULTS

Early weaning depressed the self-renewal of ISCs and attenuated the activity of ISCs-driven intestinal epithelial regeneration and crypt expansion in vivo and ex-vivo. Further results showed that early weaning retarded the differentiation of ISCs into transit-amplifying cells and Paneth cells, and accelerated the apoptosis of villous epithelial cells, jointly leading to intestinal epithelial atrophy. Mechanistically, early weaning inhibited Wnt signaling in ISCs, while an exogenous Wnt amplifier restored ISCs' function in ex-vivo.

CONCLUSION

Our findings indicate that early weaning depresses the activity of ISCs via attenuating Wnt/β-catenin signaling and triggers the proinflammatory cytokines TNF-α, IL-1β, IL-6, and IL-17 in jejunum, thereby impeding ISCs-driven epithelial regeneration and intestinal growth, which may provide a basal theory for the development of infant nutrients targeting stem cells to alleviate early weaning-induced intestinal problems.

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.

The developing juvenile distal tibia: Radiographic identification of distinct ontogenetic phases and structural trajectories

A novel combination of radiographic colour gradient mapping and radiographic absorptiometry was utilised to examine 96 human distal tibiae from 54 individuals ranging in age-at-death from the foetal to 23 years. The purpose of this was to identify previously undocumented changes in the internal organisation during the development of the distal tibia and determine whether these changes could be described as distinct phases. Previous studies have demonstrated a rudimentary structural organisation in other skeletal elements that mirror more mature patterns of bone organisation. Results showed that the perinatal tibia did not exhibit a rudimentary structural pattern similar to the architecture observed within the late adolescent tibia. This lack of early internal organisation is hypothesised to be related to the rudimentary ossification process that is being laid down around a pre-existing vascular template which will be subsequently modified by locomotive forces. Between birth and 2 years of age, the tibia exhibited a period of regression where radiodensity decreased in comparison to the perinatal tibia. This period of regression was postulated to be due to a combination of factors including changing locomotive forces, weaning and growth resulting in a stage of development which is extremely demanding on calcium liberation from the skeleton. After 2 years of age, the distal tibia demonstrated refinement where radiographic trajectories progressively developed into patterns consistent with adult trabecular organisation. These trajectories are linked to the forces associated with the bipedal gait, suggesting a strong influence of biomechanical forces on the development of the distal tibia.

"Baby-led weaning" - Progress in infant feeding or risky trend?

Baby-led weaning (BLW), proposed as a new form of complementary feeding, has emerged as a real trend phenomenon in the media. Infants are seated at the family table from the age of 6 months, facing the foods they grab and bring to their mouth: they decide which foods they want to eat and what amount. The consumption of mashed foods and the use of a spoon are totally discouraged. BLW is increasingly used in nurseries and centers of young children. A bibliographic search carried out between 2000 and 2021 found 423 articles, of which 38 were selected. The clinical studies selected are 11 cross-sectional observational studies and two randomized controlled studies. BLW promotes breastfeeding, the early introduction of morsels, the respect of the child's appetite, the use of unprocessed foods, and the choice of "homemade" and friendliness. These benefits can nonetheless be reached with usual complementary feeding (SCF), according to current recommendations. Other benefits are claimed without scientific evidence such as easier achievement of dietary complementary feeding and an optimal growth with prevention of excess weight gain. BLW has some obvious downsides. The infant may not get enough energy, iron, zinc, vitamins, and other nutrients, or too much protein, saturated fat, salt, or sugar. The risk of choking, which must be distinguished from the physiological gagging reflex, has not been ruled out by scientific studies. Currently, the Nutrition Committee of the French Pediatric Society considers that the data published to date in terms of benefits and risks of BLW do not lend themselves to advice for this practice in preference over SCF carried out according to current recommendations.

A Qualitative Analysis of a Caregivers' Experience of Complementary Feeding in a Population of Native Hawaiian, Other Pacific Islander and Filipino Infants: The Timing of the Introduction of Complementary Foods, and the Role of Transgenerational Experience

The aim of this study was to investigate caregivers’ experiences of complementary feeding (CF) among the Native Hawaiian and Other Pacific Islander (NHPI), and Filipino populations. Research focused on the timing of CF commencement, and the influence of transgenerational experience on feeding practices. The experiences and practices of those who fed human milk exclusively (HME), were compared to those who included infant formula (F&HM). Caregivers of a subset of 32 infants who were participating in a larger longitudinal study relating to CF and diet diversity, took part in voluntary in-depth interviews relating to CF practices. Interviews were recorded and transcribed. Two researchers analyzed interview transcripts. Interrater reliability and saturation were established. Institutional Review Board exemption was confirmed prior to study commencement. Interviews with 29 caregivers of infants were included in this study. Only infants of the F&HM group had an early introduction to complementary foods (<4 months of age). Caregivers reported receiving conflicting advice from healthcare professionals (HCPs) in relation to timing of the introduction of complementary foods. Nonetheless, the majority of caregivers reported following the advice of HCPs. Extended family (including grandparents) played less of a role in infant feeding, compared to previous generations. While transgenerational practices were valued and included, ultimately, the perceived health and safety of the practice for infants influenced decisions.

Use of the Baby-Led Weaning (BLW) Method in Complementary Feeding of the Infant-A Cross-Sectional Study of Mothers Using and Not Using the BLW Method

Baby-led weaning (BLW) is an increasingly popular way of expanding a baby’s diet. It is based on the baby becoming physically ready to feed himself, effectively supplementing his diet, which until now has been based on breast milk or modified milk. The aim of the study was to assess mothers’ knowledge about the use of the BLW method to expand the diet of a young child. The essence of the study assumed the analysis of the advantages and disadvantages of using this method indicated by mothers. Materials and Methods: A total of 320 mothers participated in the study. Data for the study were collected anonymously using the CAWI method. The research tool was the original questionnaire relating to the knowledge about the BLW method and the application of the BLW method in practice. Results: The BLW method was used by 240 (75%) women. The reasons for not using the BLW method were: the child did not cooperate n = 30 (37.5%) and was not ready to use the BLW method n = 20 (25%). In total, 182 (75.8%) mothers using BLW and 63 (78.8%) mothers not using BLW started extending the diet before the child was 6 months old. According to 270 (84.4%) mothers, including 205 (85.4%) using BLW, stable sitting in a highchair/on the lap is a decisive factor for starting the dietary expansion with the BLW method. Conclusions: Mothers’ knowledge of the BLW method as a way of expanding a young child’s diet was insufficient. It seems important to implement appropriate educational activities on the methods of expanding children’s diets to broaden parents’ knowledge of the influence of nutrition on infant development.

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

OBJECTIVE

As part of an update of feeding benchmarks targeting children aged 0-3 years, this study aimed to explore parental perceptions, information-seeking practices and needs concerning infant and young child feeding (IYCF) to design an efficient communication strategy.

DESIGN

Participants were recruited using the quota sampling to complete an online survey. Effects of parity, child age, prematurity, parental education and financial situation on parents' responses were evaluated separately.

SETTING

France.

PARTICIPANTS

A nationally representative sample of 1001 parents of children <4 years.

RESULTS

Parents whose child had any medical condition affecting feeding (children with medical condition (CMC), 17 %) were considered separately from healthy children's parents. All the healthy children's parents recognised the importance of IYCF for children's health and growth; however, one-third considered the available advice contradictory and not guilt-free. The most used information sources were healthcare professionals (HCP, 81 %), internet (72 %) and parental networks (63 %). The most influential sources (mean influence ± sd) included HCP (7·7 ± 1·7/10), childcare professionals (7·3 ± 1·8/10) and parental networks (6·9 ± 1·8/10). Parents searched for practical tips for implementing IYCF starting when their child was 5 months old. Differences regarding the type of source used by parents with higher v. lower educations were small. Search strategies differed according to parity or child age but not to prematurity. The CMC parents reported slightly different practices and needs.

CONCLUSIONS

Parents receive information from multiple sources, which can lead to confusion when deciding which advice to follow. A public health communication strategy adapted to the current parental needs should target these various sources.

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.

Palliative and end-of-life care education in prelicensure nursing curricula: A nationwide survey in an Arab country

BACKGROUND

In the Arab and Islamic world, data on palliative and end-of-life (PEOL) care education are minimal.

OBJECTIVES

The current study's primary aim was to identify what PEOL care education is delivered to undergraduate nurses in Egypt and the teaching strategies used to deliver this education. A secondary aim was to assess the feasibility of using online surveys in nursing research in Egypt.

DESIGN

This is a cross-sectional survey.

SETTINGS

Ten randomly selected faculties of nursing across Egypt.

PARTICIPANTS

Nursing educators who were working at three academic departments; Medical-Surgical Nursing, Critical Care Nursing, and Gerontological Nursing; in the participating faculties.

METHODS

After face-to-face recruitment of participants, data were collected using an online questionnaire with an adjunctive use of paper questionnaires. The questionnaire assessed participants' and courses' characteristics, the inclusion of the PEOL Care Index content in the surveyed courses, and teaching strategies used to deliver this content.

RESULTS

A total of 95 nursing educators were involved in the current study (response rate = 86.4%). All participants were female, and 87.4% responded via online questionnaires. The overall coverage of the PEOL care content ranged from 76% to 100%. End-of-life care and spiritual care were the least frequently reported PEOL care topics; on average, by 19.6% and 36% of the educators, respectively. Lecture was the most frequently used teaching strategy, followed by clinical field practice (mean percentages of utilization: 77.7% and 53.6%, respectively).

CONCLUSIONS

In Egypt, most PEOL care topics are covered in undergraduate nursing curricula. Yet, educating these topics is predominantly theoretical. End-of-life care and spiritual care are the least frequently covered PEOL care topics. Online surveys are feasible for multisite curricular assessment, and this feasibility may be augmented by face-to-face recruitment of participants and adjunctive use of paper questionnaires.

Parents' experiences of complementary feeding among a United Kingdom culturally diverse and deprived community

Complementary feeding practices and adherence to health recommendations are influenced by a range of different and often interrelating factors such as socio‐economic and cultural factors. However, the factors underlying these associations are often complex with less awareness of how complementary feeding approaches vary across the UK’s diverse population. This paper describes a qualitative investigation undertaken in a deprived and culturally diverse community in the UK which aimed to explore parents’ knowledge, beliefs and practices of complementary feeding. One hundred and ten mothers and fathers, self‐identified as being White British, Pakistani, Bangladeshi, Black African/Caribbean or Polish took part in twenty‐four focus group discussions, organised by age group, sex and ethnicity.

The findings revealed that most parents initiated complementary feeding before the World Health Organisation (WHO) recommendation of 6 months. Early initiation was strongly influenced by breast feeding practices alongside the extent to which parents believed that their usual milk; that is, breastmilk or formula was fulfilling their infants' nutritional needs. The composition of diet and parents' approach to complementary feeding was closely aligned to traditional cultural practices; however, some contradictions were noted. The findings also acknowledge the pertinent role of the father in influencing the dietary practices of the wider household. Learning about both the common and unique cultural feeding attitudes and practices held by parents may help us to tailor healthy complementary feeding advice in the context of increasing diversity in the United Kingdom.

Mothers' Reasons for Early Breastfeeding Cessation

PURPOSE

The purpose of this review is to assess maternal explanations for early breastfeeding cessation in economically developed countries.

STUDY DESIGN AND METHODS

The electromic databases EBSCO, CINAHL, Child Development & Adolescent Studies, PsycInfo, Health Source: Nursing/Academic Edition, Nursing and Allied Health; ProQuest databases: Family Health Database, Health and Medical Collection, Nursing and Allied Health, Psychology Database, and Public Health Databases were searched using the terms breastfeeding, cessation, stop, discontinuation, early weaning, quit*, early termination, and six months. Inclusion criteria included infants born at least 37 weeks gestation, single birth, and infant birthweight > 2,500 g.

RESULTS

Initial literature search yielded 117 studies; 10 studies met inclusion criteria. The two most common reasons for early breastfeeding cessation were perceived inadequate milk supply and maternal breast or nipple pain.

CONCLUSION

Research on maternal reasons for early breastfeeding cessation is limited. Reasons for early breastfeeding cessation are varied; however, the most common themes were perceived inadequate supply and breast or nipple pain. Nurses should tailor assessment of each breastfeeding mother-baby couplet and associated interventions based on these findings.

Determinants for early introduction of complementary foods in Australian infants: findings from the HSHK birth cohort study

OBJECTIVE

The purpose of this study was to examine the timing of introduction of complementary (solid) foods among infants in South Western Sydney, Australia, and describe the maternal and infant characteristics associated with very early introduction of solids.

METHODS

Mother-infant dyads (n = 1035) were recruited into the "Healthy Smiles Healthy Kids" study by Child and Family Health Nurses at the first post-natal home visit. Data collected via telephone interviews at 8, 17, 34 and 52 weeks postpartum included timing of introduction of solids and a variety of maternal and infant characteristics (n = 934). Multiple logistic regression was used to identify factors independently associated with the risk of introducing solids very early, which for the purpose of this study was defined as being before 17 weeks.

RESULTS

The median age of introduction of solids was 22 weeks. In total, 13.6% (n = 127) of infants had received solids before 17 weeks and 76.9% (n = 719) before 26 weeks of age. The practice of introducing solids early decreased with older age of the mother. Compared to women < 25 years of age, those who were 35 years or older were 72% less likely to introduce solids very early (OR = 0.28, CI95 0.14-0.58). Single mothers had more than twice the odds of introducing solids before the age of 17 weeks compared to married women (OR = 2.35, CI95 1.33-4.16). Women who had returned to work between 6 to 12 months postpartum were 46% less likely to introduce solids very early compared with those who were not working at the child's first birthday (OR = 0.54, CI95 0.30-0.97). Women born in Vietnam and Indian sub-continent had lower odds of introducing solids very early compared to Australian born women (OR = 0.42, CI95 0.21-0.84 and OR = 0.30, CI95 0.12-0.79, respectively). Infants who were exclusively formula-fed at 4 weeks postpartum had more than twice the odds of receiving solids very early (OR = 2.34, CI95 1.49-3.66).

CONCLUSIONS

Women who are younger, single mothers, those not working by the time of child's first birthday, those born in Australia, and those who exclusively formula-feed their babies at 4 weeks postpartum should be targeted for health promotion programs that aim to delay the introduction of solids in infants to the recommended time.

BABY-LED WEANING, AN OVERVIEW OF THE NEW APPROACH TO FOOD INTRODUCTION: INTEGRATIVE LITERATURE REVIEW

Objective:

To analyze the scientific literature on Baby-Led Weaning with an integrative literature review to identify risks and benefits.

Data source:

The databases used were: National Library of Medicine (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS – Literatura Latino-Americana e do Caribe em Ciências da Saúde), US National Library of Medicine (PubMed), and Virtual Health Library (BVS – Biblioteca Virtual em Saúde) in December 2017. The inclusion criteria established were publications in English with the descriptor “baby-led weaning” in the heading, abstract, or keywords, classified as original articles, of primary nature, and available online and in full. We excluded review articles, editorials, letters to the editor, critical commentaries, and books on the subject, as well as articles not available in full and duplicates.

Data summary:

We identified 106 articles, of which 17 met the selection criteria. The Baby-Led Weaning method was significantly associated with the baby’s satiety, the start of complementary feeding, and adequacy of weight gain. On the other hand, choking and the intake of micronutrients were negatively associated, however with no statistical differences.

Conclusions:

Despite the benefits found, the risks still deserve attention and should be investigated with longitudinal randomized controlled studies to ensure the safety of the method when practiced exclusively.

Awareness of feeding, growth and development among mothers of infants with cleft lip and/or palate

Background

Awareness of feeding among mothers plays an important role in the growth and development of children with cleft lip and palate. Mothers' increased awareness provides the right care and nutrition to these children in order to grow and achieve their developmental milestones.

Objectives

This study aimed at (1) assessing mothers' awareness on breastfeeding and formula-milk feeding, weaning, growth, and development of infants with cleft lip and palate and (2) the relationship of mothers' awareness with their level of education and monthly household income.

Methods

This cross-sectional pilot study included all the mothers of infants aged up to one year who had cleft lip and/or palate attended Dental Teaching Hospital, Peradeniya between the years 2015 and 2016. Mothers of infants with oral clefts associated with other syndromic features and chronic illnesses were excluded. A pre-tested interviewer-administered questionnaire was designed to collect data. To assess the clarity of the questions, prior to the study, the questionnaire was pre-tested in 10 mothers of infants with an oral cleft but not selected for the study. Frequency distributions and descriptive statistics were used to describe study variables. Spearman Rank test was used to determine the association of mothers' awareness with their level of education and monthly household income with a 95% confidence interval.

Results

The sample consisted of 101 mothers who had infants born with a cleft and the response rate was 100%. Except one, all mothers reported that they have received overall feeding instructions either from a doctor, nurse, cleft center staff or a midwife. Over 65.3% of mothers were aware of feeding-related factors including; breastfeeding, formula-milk feeding, and weaning of infants with a cleft. Overall more than 80% of mothers were aware of factors related to growth and development of the child including urination, sleeping pattern, weight and growth charts. The education level of mothers was not significantly associated with mothers' awareness of any factors related to breastfeeding, formula-milk feeding, weaning and growth, and development. Further, mothers' awareness of breastmilk as the best food for babies under 6 months (p = 0.028), weaning at 4-6 months (p = 0.024), replacing milk feeds by weaning foods (p = 0.02) and not providing junk foods to infants in between main meals (p = 0.01) were significantly associated with monthly household income.

Conclusions

The findings of this study suggest that mothers were aware of factors related to feeding infants with a cleft lip and palate and their growth and development. The awareness of mothers about certain factors related to feeding and weaning was significantly associated with monthly household income.

Physicians advice, parental practice and adherence to doctor's advice: an original survey on infant feeding

Abstract

Background: Despite several years of guidance on infant feeding, there has been only a slight change in consumer compliance. Therefore, this study aimed to analyse parents feeding practices, explore physicians’ advice about infant feeding and subsequent parent’s adherence to advice.

Methods

A multicentric cross-sectional qualitative and descriptive self-report online study was conducted in volunteers to participate in the study.

Results

Fifty-four physicians (paediatricians and general practitioners) and 600 parents of infants were recruited. Of the infants, 20.2% presented at inclusion with at least one type of functional gastrointestinal disorder. The breastfeeding prevalence was quite low (37.3%). The main initial deviance from guidelines said they observed in infant feeding was the early use of cow’s milk. More than two-thirds of infants older than 8 months were drinking cow’s milk. The introduction of solid foods was globally in line with recommendations. Most physicians gave advice about the different aspects of infant feeding but were seeking more information, as did the parents. A discrepancy between the physicians’ statements and the parents’ perceptions was observed. However the majority (95.4%) of parents reported that they followed totally or partially the advice received, especially by abandoning subsequently the use of cow’s milk in favour of a formula. The main reason for not adhering to the advice was that they did not consider it suitable for their infant and they preferred to rely on their feelings or recommendations from familiars.

Conclusions

This survey provides good insights into parents’ infant feeding practices together with the advice given by their doctor. The gap between practices and current guidelines is notable only for breast-feeding and use of formula. Despite several guidelines professionals and parents seek nutrition information. It highlights the need to deliver consistent, relevant, and less confusing messages about infant feeding.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1697-y) contains supplementary material, which is available to authorized users.

Assessing the Potential for Integrating Routine Data Collection on Complementary Feeding to Child Health Visits: A Mixed-Methods Study

There is no routine data collection in the UK on infant dietary diversity during the transition to solid foods, and health visitors (HVs) (nurses or midwives with specialist training in children and family health) have the potential to play a key role in nutrition surveillance. We aimed to assess items for inclusion in routine data collection, their suitability for collecting informative data, and acceptability among HVs. A mixed-methods study was undertaken using: (i) an online survey testing potential questionnaire items among parents/caregivers, (ii) questionnaire redevelopment in collaboration with community staff, and (iii) a survey pilot by HVs followed by qualitative data collection. Preliminary online questionnaires (n = 122) were collected to identify useful items on dietary diversity. Items on repeated exposure to foods, aversive feeding behaviors, flavor categories, and sugar intake were selected to correspond to nutrition recommendations, and be compatible with electronic records via tablet. HVs surveyed 187 parents of infants aged 12 months. Semi-structured interviews indicated that HVs found the questionnaire comparable with standard nutrition conversations, which prompted helpful discussions, but questions on eating behavior did not prompt such useful discussions and, in some cases, caused confusion about what was 'normal.' Lack of time among HVs, internet connectivity issues, and fear of losing rapport with parents were barriers to completing electronic questionnaires, with 91% submitted by paper. Routine nutrition data collection via child health records seems feasible and could inform quality improvement projects.

Mothers' Understanding of Infant Feeding Guidelines and Their Associated Practices: A Qualitative Analysis

There is limited evidence to describe Australian mothers’ understanding of the Australian Infant Feeding Guidelines (AIFG). A qualitative inductive methodological approach was used in this study to explore experiences with the introduction of solid food. Seven focus groups with 42 mothers of children aged 4–18 months were conducted in disadvantaged areas in Perth, Australia. The mean age of infants was 9.6 months and mean age of introduction of solid food was 4.3 months (range 1.2 to 7.5 months). Almost half of the mothers in this study were aware of the AIFG however, only half again could correctly identify the recommended age for introducing solid food. Four themes and nine subthemes emerged from the analysis. Themes were (1) Every child is different (judging signs of readiness); (2) Everyone gives you advice (juggling conflicting advice); (3) Go with your gut—(being a “good” mother); and (4) It’s not a sin to start them too early or too late (—guidelines are advice and not requirements). The findings indicated that in spite of continued promotion of the AIFG over the past ten years achieving the around six months guideline is challenging. Professionals must address barriers and support enablers to achieving infant feeding recommendations in the design education materials and programs.

Baby-led complementary feeding: Randomized controlled study

BACKGROUND

Baby-led weaning (BLW) is an approach to introducing solid foods to infants that gives control of the feeding process to the infant. Anecdotal evidence suggests that BLW is becoming popular with parents, but scientific research is limited to a few publications. This study assessed growth, hematological parameters and iron intake in 6-12-month-old infants fed by traditional or baby-led complementary feeding.

METHODS

We recruited 280 healthy 5-6-month-old infants allocated to a control (traditional spoon feeding; TSF) group or an intervention (BLW) group in a randomized controlled trial. Infant growth, hematologic parameters and iron intake were evaluated at age 12 months.

RESULTS

Infants in the TSF were significantly heavier than those in the BLW group. Mean weight in the BLW group was 10.4 ± 0.9 kg compared with 11.1 ± 0.5 kg in the TSF group. There was no statistically significant difference in the iron intake from complementary foods between the BLW (7.97 ± 1.37 mg/day) and TSF (7.90 ± 1.68 mg/day) participants who completed the diet records. Hematologic parameters were similar at 12 months. The incidence of choking reported in the weekly interviews was not different between the groups.

CONCLUSIONS

To the best of our knowledge, this is the first randomized -controlled study to have examined the impact of weaning method on iron intake, hematological parameters and growth in breast-fed infants. BLW can be an alternative complementary feeding type without increasing the risk of iron deficiency, choking or growth impairment.

Complementary Feeding Practices for South Asian Young Children Living in High-Income Countries: A Systematic Review

Sub-optimal nutrition among South Asian (SA) children living in high-income countries is a significant problem. High rates of obesity have been observed in this population, and differential complementary feeding practices (CFP) have been highlighted as a key influence. Our aim was to undertake a systematic review of studies assessing CFP in children under two years of age from SA communities living in high-income countries, including dietary diversity, timing, frequency and promotors/barriers. Searches covered January 1990⁻July 2018 using MEDLINE, EMBASE, Global Health, Web of Science, BanglaJOL, OVID Maternity and Infant Care, CINAHL, Cochrane Library, POPLINE and World Health Organisation (WHO) Global Health Library. Eligible studies were primary research on CFP in SA children aged 0⁻2 years. Search terms were "children", "feeding" and "South Asian", and derivatives. Quality appraisal used the Evidence for Policy and Practice Information (EPPI) Weight of Evidence scoring. From 50,713 studies, 13 were extracted with ten from the UK, and one each from the USA, Canada and Singapore. Sub-optimal CFP were found in all studies. All ten studies investigating timing reported complementary feeding (CF) being commenced before six months. Promoters/barriers influencing CFP included income, lack of knowledge, and incorrect advice. This is the first systematic review to evaluate CFP in SA children living in high-income countries and these findings should inform the development of effective interventions for SA infants in these settings.

Baby-led weaning: what a systematic review of the literature adds on

The term weaning describes the time period in which a progressive reduction of breastfeeding or the feeding of infant-formula takes place while the infant is gradually introduced to solid foods. It is a crucial time in an infant’s life as not only does it involve with a great deal of rapid change for the child, but it is also associated with the development of food preferences, eating behaviours and body weight in childhood and also in adolescence and adulthood.

Therefore, how a child is weaned may have an influence later, on the individual’s entire life. Babies are traditionally first introduced to solid foods using spoon-feeding, in most countries.

Beside to traditional approach, an alternative method, promoting infant self-feeding from six months of age, called baby-led weaning or “auto-weaning”, has grown in popularity. This approach causes concern to healthy professionals and parents themselves as data from observational studies pointed out to a potential risk of iron and energy inadequacy as well as choking risk. Aim of this systematic review was to critically examine the current evidence about baby-led weaning approach and to explore the need for future research.

A systematic search was conducted in Cochrane library databases and DARE (Database of Abstract of Reviews of Effects), EMBASE and MEDLINE in the period 2000–2018 (up to March 1st) to address some key questions on baby-led weaning. Prisma guidelines for systematic reviews has been followed.

After the inclusion/exclusion process, we included for analysis of evidence 12 articles, 10 observational cross-sectional studies and 2 randomized controlled trials. Pooling of results from very different outcomes in the studies included was not possible. Both randomized trials have potential bias; therefore, the quality of the evidence is low.

There are still major unresolved issues about baby-led weaning that require answers from research and that should be considered when advices are requested from health professionals by parents willing to approach this method.

Baby-Led Weaning: The Evidence to Date

PURPOSE OF REVIEW

Infants are traditionally introduced to solid foods using spoon-feeding of specially prepared infant foods.

RECENT FINDINGS

However, over the last 10-15 years, an alternative approach termed 'baby-led weaning' has grown in popularity. This approach involves allowing infants to self-feed family foods, encouraging the infant to set the pace and intake of the meal. Proponents of the approach believe it promotes healthy eating behaviour and weight gain trajectories, and evidence is starting to build surrounding the method. This review brings together all empirical evidence to date examining behaviours associated with the approach, its outcomes and confounding factors.

SUMMARY

Overall, although there is limited evidence suggesting that a baby-led approach may encourage positive outcomes, limitations of the data leave these conclusions weak. Further research is needed, particularly to explore pathways to impact and understand the approach in different contexts and populations.

Does concurrent breastfeeding alongside the introduction of solid food prevent the development of food allergy?

The timing of introduction of solid food on the subsequent development of food allergy is under debate and the role of concurrent breastfeeding is unclear. The aim of the present study was to investigate the role of solid food introduction whilst concurrently breastfeeding on food allergy outcome, with a specific focus on cows' milk allergy. Prospectively collected infant feeding data from a birth cohort were analysed. Participants with histories suggestive of food allergy underwent diagnostic food challenges. Children with food allergy were matched to control participants for age and sex. Mann-Whitney U tests, χ2, Fisher exact tests and logistic regression calculations were undertaken. A total of thirty-nine food-allergic children and seventy-eight matched controls were identified, including twenty-two cows' milk-allergic children and forty-four matched controls. The control group introduced solid food earlier than the food-allergic group (P < 0·05). There was no effect of concurrent breastfeeding alongside cows' milk introduction or other food allergens on the development of food allergy. Due to small numbers, it was not possible to explore differences for food allergy phenotype. We have therefore found no evidence that introducing solids, or food allergens, whilst breastfeeding has an allergy-preventative effect; however, the results should be interpreted with caution due to sample size. Recommendations regarding infant feeding and food allergy should be carefully considered. Although breastfeeding should be promoted for many health reasons, larger studies looking at the introduction of food allergens on the development of food allergy are needed to make a final conclusion.

Maternal and infant factors associated with reasons for introducing solid foods

The current UK Department of Health advice is to introduce solid foods to infants at around 6 months of age, when the infant is showing signs of developmental readiness for solid foods. However, many mothers introduce solid foods before this time, and for a wide variety of reasons, some of which may not promote healthy outcomes. The aim of the current study was to examine infant and maternal characteristics associated with different reasons for introducing solid foods. Seven hundred fifty-six mothers with an infant aged 6-12 months old completed a questionnaire describing their main reason for introducing solid foods alongside demographic questions, infant weight, gender, breast/formula feeding and timing of introduction to solid foods. The majority of mothers introduced solid foods for reasons explicitly stated in the Department of Health advice as not signs of readiness for solid foods. These reasons centred on perceived infant lack of sleep, hunger or unsettled behaviour. Maternal age, education and parity, infant weight and gender and breast/formula feeding choices were all associated with reasons for introduction. A particular association was found between breastfeeding and perceiving the infant to be hungrier or needing more than milk could offer. Male infants were perceived as hungry and needing more energy than female infants. Notably, signs of readiness may be misinterpreted with some stating this reason for infants weaned prior to 16 weeks. The findings are important for those working to support and educate new parents with the introduction of solid foods in understanding the factors that might influence them.

Age at introduction of solid foods and feeding difficulties in childhood: findings from the Southampton Women's Survey

This study aimed to determine whether age at introduction of solid foods was associated with feeding difficulties at 3 years of age. The present study was carried out using data from the Southampton Women's Survey (SWS). Women enrolled in the SWS who subsequently became pregnant were followed-up during pregnancy and postpartum, and the offspring have been studied through childhood. Maternal socio-demographic and anthropometric data and child anthropometric and feeding data were collected through interviews and self-administered questionnaires. When the children were 3 years of age, mothers/carers rated six potential child feeding difficulty questions on a four-point Likert scale, including one general question and five specific feeding difficulty questions. Age at introduction of solids as a predictor of feeding difficulties was examined in 2389 mother-child pairs, adjusting for child (age last breast fed, sex, gestation) and maternal characteristics (parity, pre-pregnancy BMI, age, education, employment, parenting difficulties, diet quality). The majority of mothers/carers (61 %) reported some feeding difficulties (general feeding difficulty question) at 3 years of age, specifically with their child eating enough food (61 %), eating the right food (66 %) and being choosy with food (74 %). Children who were introduced to solids ≥6 months had a lower risk of feeding difficulties (RR 0·73; 95 % CI 0·59, 0·91, P=0·004) than children who were introduced to solids between 4 and 6 months. No other significant associations were found. There were few associations between feeding difficulties in relation to age at introduction of solid foods. However, general feeding difficulties were less common among infants introduced to solid foods ≥6 months of age.

Using text messaging to obtain weekly data on infant feeding in a Danish birth cohort resulted in high participation rates

AIM

Our aim was to use text message questions to obtain prospective, real-time data on exclusive and partial breastfeeding and introduction to complementary foods in a Danish birth cohort. We also wanted to identify factors influencing breastfeeding initiation and cessation.

METHODS

This study formed part of the Odense Child Cohort and focused on mothers who gave birth to full-term singletons between April and October 2012. They received the same three to five questions, about breastfeeding, infant formula and introduction to complementary food, three days after birth and then at weekly intervals.

RESULTS

We recruited 499 mothers, and the response rate to the first of the weekly questions was ≥89.4% during the study. Three days after birth, 96.7% of mothers were breastfeeding, 61.2% exclusively and 30.2% partially, and 26 weeks after birth 60.2% of mothers were breastfeeding, 1.1% exclusively. Complementary food was introduced at an average age of 20 weeks. Breastfeeding cessation was associated with maternal smoking, lower maternal age and supplementation with infant formula in the first days after birth (all p < 0.05).

CONCLUSION

Most mothers initiated breastfeeding, but only 1.1% were exclusively breastfeeding at 26 weeks. Text messaging resulted in high response rates and was a feasible data collection method.

Experiences of baby-led weaning: trust, control and renegotiation

Baby-led weaning (BLW) is an approach to introducing solid foods that relies on the presence of self-feeding skills and is increasing in popularity in the UK and New Zealand. This study aimed to investigate the reported experiences and feelings of mothers using a BLW approach in order to better understand the experiences of the mother and infant, the benefits and challenges of the approach, and the beliefs that underpin these experiences. Fifteen UK mothers were interviewed over the course of a series of five emails using a semi-structured approach. The email transcripts were anonymised and analysed using thematic analysis. There were four main themes identified from the analysis: (1) trusting the child; (2) parental control and responsibility; (3) precious milk; and (4) renegotiating BLW. The themes identified reflect a range of ideals and pressures that this group of mothers tried to negotiate in order to provide their infants with a positive and healthy introduction to solid foods. One of the key issues of potential concern is the timing at which some of the children ingested complementary foods. Although complementary foods were made available to the infants at 6 months of age, in many cases they were not ingested until much later. These findings have potentially important implications for mother's decision-making, health professional policy and practice, and future research.

Parent-led or baby-led? Associations between complementary feeding practices and health-related behaviours in a survey of New Zealand families

OBJECTIVE

To determine feeding practices and selected health-related behaviours in New Zealand families following a 'baby-led' or more traditional 'parent-led' method for introducing complementary foods.

DESIGN, SETTING AND PARTICIPANTS

199 mothers completed an online survey about introducing complementary foods to their infant. Participants were classified into one of four groups: 'adherent baby-led weaning (BLW)', the infant mostly or entirely fed themselves at 6-7 months; 'self-identified BLW', mothers reported following BLW at 6-7 months but were using spoon-feeding at least half the time; 'parent-led feeding', the mother reported not having tried BLW; and 'unclassified method', the mother reported they were not following BLW at 6-7 months but reported the infant mostly or entirely fed themselves at 6-7 months.

RESULTS

8% were following 'adherent BLW', 21% 'self-identified BLW' and 0% were following the 'unclassified method'. Compared with 'self-identified BLW' and 'parent-led feeding', a higher proportion of the 'adherent BLW' met the WHO recommendations to exclusively breastfeed for 6 months and to introduce complementary foods at 6 months. The 'adherent BLW' group was more likely to have family foods (p=0.018), and less likely (p=0.002) to have commercially prepared baby food. Both BLW groups were more likely to share meals with the family compared with 'parent-led feeding'. In contrast to 'self-identified BLW' and 'parent-led feeding', the 'adherent BLW' group did not offer iron-fortified cereal as a first food.

CONCLUSIONS

This study suggests that although many parents consider they follow BLW, a very few are following it strictly. The extent to which BLW was followed was associated with potential benefits (eg, sharing family meals) and risks (eg, low iron first foods) highlighting the importance for health professionals and researchers of accurately determining the extent of adherence to BLW.

Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review

The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity during childhood. Electronic databases were searched from inception until 30 September 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at <3 months (two studies), 4 months (2 studies) or 20 weeks (one study) was associated with a higher BMI in childhood. Seven of the studies considered the association between complementary feeding and body composition but only one study reported an increase in the percentage of body fat among children given complementary foods before 15 weeks of age. We conclude that there is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or >6 months, may increase the risk of childhood overweight.

How feasible is Baby-led Weaning as an approach to infant feeding? A review of the evidence

Baby-Led Weaning (BLW) is an alternative method for introducing complementary foods to infants in which the infant feeds themselves hand-held foods instead of being spoon-fed by an adult. The BLW infant also shares family food and mealtimes and is offered milk (ideally breast milk) on demand until they self-wean. Anecdotal evidence suggests that many parents are choosing this method instead of conventional spoon-feeding of purées. Observational studies suggest that BLW may encourage improved eating patterns and lead to a healthier body weight, although it is not yet clear whether these associations are causal. This review evaluates the literature with respect to the prerequisites for BLW, which we have defined as beginning complementary foods at six months (for safety reasons), and exclusive breastfeeding to six months (to align with WHO infant feeding guidelines); the gross and oral motor skills required for successful and safe self-feeding of whole foods from six months; and the practicalities of family meals and continued breastfeeding on demand. Baby-Led Weaning will not suit all infants and families, but it is probably achievable for most. However, ultimately, the feasibility of BLW as an approach to infant feeding can only be determined in a randomized controlled trial. Given the popularity of BLW amongst parents, such a study is urgently needed.