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Fernández-Medina IM, Márquez-Díaz RR, Arcas-Rueda M, Ruíz-Fernández MD, Ortíz-Amo R, Ventura-Miranda MI. Experiences and opinions towards baby-led weaning by healthcare professionals. A qualitative study. Pediatr Res 2023; 94:1784-1788. [PMID: 37340099 DOI: 10.1038/s41390-023-02694-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/20/2023] [Accepted: 05/07/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Baby-led weaning (BLW) is an alternative method to spoon-feeding to introduce solid foods. This study aimed to describe and understand the experiences and opinions of pediatricians and pediatric nurse specialists of the implementation of the BLW approach. METHODS An interpretive descriptive qualitative research was carried out. A focus group with 7 participants and 13 face-to-face interviews were conducted between February and May 2022 (17 females and 3 males). All were audio-recorded, transcribed, and analyzed with the supported by Atlas.Ti qualitative data analysis software. RESULTS From the data, two themes developed: (1) BLW as an ideal method of introducing solid food, with the subthemes: "a natural method of introducing complementary feeding" and "BLW is a safe method"; (2) Perceived barriers to the uptake of the BLW method, with the subthemes: "a lack of BLW training prevents the best practice" and "the influence of family and social context on parents." CONCLUSIONS Healthcare professionals perceive BLW to be a safe and natural weaning approach. The lack of training of healthcare professionals and the influence of family social context on parents may limit the implementation of BLW. IMPACT Baby-led weaning is perceived by healthcare professionals as a safe complementary feeding method that promotes chewing, improves growth, and the development of fine motor skills. However, lack of training of healthcare professionals and the family social context of the parents hinders the uptake of baby-led weaning. The views of the family and parents' social context about baby-led weaning may restrict their willingness to use the method. Family education delivered by healthcare professionals may avoid risks and allay parental anxieties about safety.
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Affiliation(s)
| | | | - Marina Arcas-Rueda
- Torrecárdenas Maternity and Infant Hospital, Andalusian Health Service, Almería, Spain
| | - María Dolores Ruíz-Fernández
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia, Chile.
| | - Rocío Ortíz-Amo
- Department of Psychology, University of Almería, Almería, Spain
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de Paiva CSS, Nunes LM, Bernardi JR, Moreira PR, Mariath AAS, Gomes E. Choking, gagging and complementary feeding methods in the first year of life: a randomized clinical trial. J Pediatr (Rio J) 2023; 99:574-581. [PMID: 37400061 PMCID: PMC10594018 DOI: 10.1016/j.jped.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. METHODS Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) - group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05). RESULTS 130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05). CONCLUSION Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.
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Affiliation(s)
| | - Leandro Meirelles Nunes
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Seção de Neonatologia, Porto Alegre, RS, Brazil
| | - Juliana Rombaldi Bernardi
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação em Alimentação, Nutrição e Saúde, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Departamento de Nutrição, Porto Alegre, RS, Brazil
| | - Paula Ruffoni Moreira
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação em Alimentação, Nutrição e Saúde, Porto Alegre, RS, Brazil
| | - Adriela Azevedo Souza Mariath
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Odontologia, Departamento de Cirurgia e Ortopedia, Porto Alegre, RS, Brazil
| | - Erissandra Gomes
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Odontologia, Departamento de Cirurgia e Ortopedia, Porto Alegre, RS, Brazil.
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Golden RK, Sutkus LT, Bauer LL, Donovan SM, Dilger RN. Determining the safety and efficacy of dietary supplementation with 3'-sialyllactose or 6'-sialyllactose on growth, tolerance, and brain sialic acid concentrations. Front Nutr 2023; 10:1278804. [PMID: 37927504 PMCID: PMC10620723 DOI: 10.3389/fnut.2023.1278804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023] Open
Abstract
Sialylated oligosaccharides, including 3'-sialyllactose (3'-SL) and 6'-sialyllactose (6'-SL), comprise a large portion of human milk and have been known to support development over the first year of life. While research has investigated the impact of early-life supplementation, longer-term supplementation remains relatively unexplored. Consequently, the following study assesses the impact of supplementation of either 3'-SL or 6'-SL on growth performance, tolerance, and brain sialic acid concentrations. Two-day-old piglets (n = 75) were randomly assigned to a commercial milk replacer ad libitum without or with 3'-SL or 6'-SL (added at 0.2673% on an as-is basis). Daily body weight and feed disappearance were recorded to assess growth performance and tolerance. Pigs were euthanized for sample collection on postnatal day 33 (n = 30) or 61 (n = 33), respectively. Across growth performance, clinical chemistry and hematology, histomorphology, and sialic acid quantification, dietary differences were largely unremarkable at either time-point. Overall, SA was well-tolerated both short-term and long-term.
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Affiliation(s)
- Rebecca K. Golden
- Neuroscience Program, University of Illinois, Urbana, IL, United States
| | - Loretta T. Sutkus
- Neuroscience Program, University of Illinois, Urbana, IL, United States
| | - Laura L. Bauer
- Department of Animal Sciences, University of Illinois, Urbana, IL, United States
| | - Sharon M. Donovan
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States
| | - Ryan N. Dilger
- Neuroscience Program, University of Illinois, Urbana, IL, United States
- Department of Animal Sciences, University of Illinois, Urbana, IL, United States
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States
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Arias-Ramos N, Andina-Díaz E, Granado-Soto M, Álvarez Rodríguez R, Liébana-Presa C. Baby-led weaning: Health professionals 'knowledge and attitudes and parents' experiences from Spain. A mixed methods approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1352-e1363. [PMID: 34534390 DOI: 10.1111/hsc.13543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/18/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
Baby-led weaning or self-regulated small chunk feeding by the baby has emerged as an alternative to the traditional method of complementary feeding. Parents and healthcare professionals often differ in the benefits and drawbacks about it. The research aims were to describe the knowledge of health professionals about complementary feeding and baby-led weaning (BLW) method and the attitudes towards its recommendation, and to explore the knowledge, experiences and attitudes of parents who have used this method to feed their children. A mixed methods research was carried out. A questionnaire was completed by 38 health professionals and 10 interviews were conducted with participating mothers. A total of 52.6% of health professionals recommended initiating complementary feeding at 6 months of age, a guideline followed by the mothers who used BLW. Some 86.8% of the professionals knew the BLW method and 76.3% knew its benefits, but the mothers consulted mainly informal sources of information sources to learn about and implement it. The health professionals stated that it facilitated family transition, enabled the infant to adapt better to flavours and textures, promoted chewing and the development of fine motor skills, improved growth and might also be a protective factor against obesity. The mothers noted that the method was natural, encouraged infant autonomy and promoted healthy eating habits. The health professionals expressed varied opinions concerning the risks entailed in the method. The main conclusions are that the majority of health professionals participating in the study know the BLW method, its benefits; however, they do not recommend it in all cases. Mothers listen to the advice of professionals but continue to rely on other informal sources of information.
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Affiliation(s)
- Natalia Arias-Ramos
- SALBIS Research Group, Faculty of Health Sciences, Ponferrada Campus, Universidad de León, Leon, Spain
| | - Elena Andina-Díaz
- SALBIS Research Group, Faculty of Health Sciences, Vegazana Campus, Universidad de León, Leon, Spain
- Nursing and Culture of Care Research Group (EYCC), Faculty of Health Science, University of Alicante, Alicante, Spain
| | - Mirena Granado-Soto
- Faculty of Health Science, Bierzo Hospital, Ponferrada Campus, University of León, Leon, Spain
| | | | - Cristina Liébana-Presa
- SALBIS Research Group, Faculty of Health Sciences, Ponferrada Campus, Universidad de León, Leon, Spain
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Klerks M, Román S, Juan Francisco Haro-Vicente, Bernal MJ, Sanchez-Siles LM. Healthier and more natural reformulated baby food pouches: Will toddlers and their parents sensory accept them? Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Complementary Feeding Methods-A Review of the Benefits and Risks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137165. [PMID: 34281101 PMCID: PMC8297117 DOI: 10.3390/ijerph18137165] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/19/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022]
Abstract
Complementary feeding methods have the potential to not only ensure a diet of nutritional adequacy but also promote optimal food-related behaviours and skills. While the complementary feeding practice known as baby-led weaning (BLW) has gained popularity, evidence supporting the potential benefits and/or risks for infant growth, development, and health warrants consideration. A review of 29 studies was conducted with findings indicating that parents who implement BLW typically have higher levels of education, breastfeed for longer, and differ in other personality traits. Fear of choking was an important factor in parents’ decision not to implement BLW; however, this fear was not supported by the literature. Benefits of BLW included lower food fussiness, higher food enjoyment, lower food responsiveness, and higher satiety responsiveness. While this profile of eating behaviours confers a reduced obesity risk, few studies have examined the relationship between BLW and infant growth robustly. BLW does not seem to increase the risk of inadequate zinc or iron intake; however, emphasis needs to be given to ensuring adequate intake of these micronutrients among all infants. A better understanding of the impacts of BLW is needed to inform evidence-based recommendations to support and guide parents in complementary feeding methods.
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Gleeson JP, Fein KC, Whitehead KA. Oral delivery of peptide therapeutics in infants: Challenges and opportunities. Adv Drug Deliv Rev 2021; 173:112-124. [PMID: 33774115 PMCID: PMC8178217 DOI: 10.1016/j.addr.2021.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022]
Abstract
The vast majority of drugs are not designed or developed for pediatric and infant populations. Peptide drugs, which have become increasingly relevant in the past several decades, are no exception. Unfortunately, nearly all of the 60+ approved peptide drugs are formulated for injection, a particularly unfriendly mode of administration for infants. Although three peptide drugs were recently approved for oral formulations, this major advance in peptide drug delivery is available only for adults. In this review, we consider the current challenges and opportunities for the oral formulation of peptide therapeutics, specifically for infant populations. We describe the strategies that enable oral protein delivery and the potential impact of infant physiology on those strategies. We also detail the limited but encouraging progress towards 1) adapting conventional drug development and delivery approaches to infants and 2) designing novel infant-centric formulations. Together, these efforts underscore the feasibility of oral peptide delivery in infants and provide motivation to increase attention paid to this underserved area of drug delivery and formulation.
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Affiliation(s)
- John P Gleeson
- Department of Chemical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, United States
| | - Katherine C Fein
- Department of Chemical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, United States
| | - Kathryn A Whitehead
- Department of Chemical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, United States; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, United States.
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Webber C, Blissett J, Addessi E, Galloway AT, Shapiro L, Farrow C. An infant-led approach to complementary feeding is positively associated with language development. MATERNAL AND CHILD NUTRITION 2021; 17:e13206. [PMID: 34031998 PMCID: PMC8476407 DOI: 10.1111/mcn.13206] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/26/2021] [Accepted: 04/28/2021] [Indexed: 12/21/2022]
Abstract
The timing and strategy with which parents first introduce their infants to solid foods may be an important predictor of subsequent developmental outcomes. Recent years have seen a decline in the prevalence of traditional parent‐led feeding of soft, puréed food and a rise in the prevalence of infant‐led complementary feeding. Although there has been some research espousing the benefits of infant‐led complementary feeding for improving food fussiness and self‐regulation, there has been little exploration of this approach that may impact on other developmental outcomes in children. The current study explores whether aspects of the infant‐led approach, specifically the child eating unaided and consuming finger foods and eating with the family, are related to child language outcomes. One hundred thirty one parents of children aged 8–24 months completed questionnaires about their approach to complementary feeding, their current feeding practices, their child's experiences with family foods and child language comprehension/production. The findings suggest that an approach to complementary feeding which promotes infant autonomy in feeding (i.e., eating finger foods rather than puréed foods) and consuming more family foods is related to more advanced child language production and comprehension. Specifically, the prevalence of eating family foods mediated the relationship between eating unaided at the onset of the complementary feeding period and later language outcomes. This study is the first to find a significant relationship between different approaches to introducing solid foods and child language outcomes and these findings highlight the potential for different complementary feeding approaches to influence behaviour beyond mealtimes.
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Affiliation(s)
- Charlotte Webber
- Webber- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK
| | - Jacqueline Blissett
- Blissett, Shapiro & Farrow- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Elsa Addessi
- Addessi - Istituto di Scienze e Tecnologie della Cognizione, Rome, Italy
| | - Amy T Galloway
- Galloway- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
| | - Laura Shapiro
- Blissett, Shapiro & Farrow- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Claire Farrow
- Blissett, Shapiro & Farrow- College of Health and Life Sciences, Aston University, Birmingham, UK
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Jahan S, Bisrat F, Faruque MO, Ferdaus MJ, Khan SS, Farzana T. Formulation of nutrient enriched germinated wheat and mung-bean based weaning food compare to locally available similar products in Bangladesh. Heliyon 2021; 7:e06974. [PMID: 34027177 PMCID: PMC8120945 DOI: 10.1016/j.heliyon.2021.e06974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/17/2021] [Accepted: 04/27/2021] [Indexed: 11/02/2022] Open
Abstract
Poor weaning practice and malnutrition among under 5 (yrs) children are still major public health issues in Bangladesh. This study aimed to develop a cheap and nutritious weaning food for the children of Bangladesh. For this purpose, three weaning formulations of Q1, Q2, and Q3 with different ratios of germinated wheat, germinated mung-bean, and soya-bean, and a constant amount of sweet potato, sugar, salt, and milk flavor were processed and evaluated. The prepared formulations were investigated for proximate composition and sensory evaluation and compared with six commercial weaning food products. The proximate composition values indicated that the fat content of formulated foods ranged between 09.29% and 11.40%. The carbohydrate content was ranged between 52.80% and 61.20%, which was low compared with commercial ones. The protein content of the formulated foods was 20.33%-27.70%, and that was approximately two times more than available commercial foods. The energy content was also more than locally available commercial weaning foods, which were 411.40 ± 1.51 kcal to 419.30 ± 1.12 kcal. Sample Q2 had an 8.4 acceptance score in sensory analysis of a 9-point hedonic scale scorecard, which made it more acceptable than the other two samples. The values of mineral elements (Na, K, Fe) were similar to all analyzed varieties of commercial weaning foods. This nutrient-enriched weaning food will easily be affordable for the people of developing countries like Bangladesh. The results showed that the formulated weaning food had the desired characteristics of a weaning food; hence, it could decrease malnutrition in children.
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Affiliation(s)
- Sharmin Jahan
- Department of Food and Nutrition, College of Home Economics, University of Dhaka, Dhaka 1205, Bangladesh
| | - Fahiza Bisrat
- Institute of Food Science and Technology, Bangladesh Council of Scientific and Industrial Research, Dhaka 1205, Bangladesh
| | - M Omar Faruque
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore 7408, Bangladesh
| | - Md Jannatul Ferdaus
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore 7408, Bangladesh
| | - Shompa Sharmin Khan
- Department of Food and Nutrition, College of Home Economics, University of Dhaka, Dhaka 1205, Bangladesh
| | - Tasnim Farzana
- Institute of Food Science and Technology, Bangladesh Council of Scientific and Industrial Research, Dhaka 1205, Bangladesh
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Utami AF, Wanda D, Hayati H, Fowler C. "Becoming an independent feeder": infant's transition in solid food introduction through baby-led weaning. BMC Proc 2020; 14:18. [PMID: 33292247 PMCID: PMC7722414 DOI: 10.1186/s12919-020-00198-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Baby-led weaning (BLW), a method for introducing complementary foods, has become popular because it is considered beneficial for infants. METHODS This study investigated the experiences of mothers when using BLW in Jakarta, Indonesia using a qualitative descriptive approach. Thirteen mothers participated who had introduced complementary feeding using BLW for a minimum of 6 months. Semi-structured interviews and thematic analysis was used to work with the data. RESULTS Three themes were identified: avoiding being a 'picky' eater; infants gagging and choking; and becoming independent feeders. CONCLUSION Further research related to the growth and development of baby-led weaning infants in Indonesia is recommended.
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Affiliation(s)
| | - Dessie Wanda
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia.
| | - Happy Hayati
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Cathrine Fowler
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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Makame J, De Kock H, Emmambux NM. Nutrient density of common African indigenous/local complementary porridge samples. Lebensm Wiss Technol 2020. [DOI: 10.1016/j.lwt.2020.109978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Tournier C, Bernad C, Madrelle J, Delarue J, Cuvelier G, Schwartz C, Nicklaus S. Fostering infant food texture acceptance: A pilot intervention promoting food texture introduction between 8 and 15 months. Appetite 2020; 158:104989. [PMID: 33075444 DOI: 10.1016/j.appet.2020.104989] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 01/29/2023]
Abstract
Healthy infant feeding practices form the basis of healthy eating behaviour later in life. The effect of providing parents with recommendations on textured food introduction between 8 and 15 months on children's experience with and acceptance of textured foods was studied. Sixty parent/child dyads were randomly assigned to a control group (CG) receiving current French recommendations and an intervention group (IG) receiving a brochure with supplementary advice, tips and monthly counselling on food texture introduction. After the intervention, parents completed self-report measures about the introduction of 188 food items, including purees, soft/small pieces, hard/large pieces and double textures. Children's acceptance of eight textured foods was assessed in a laboratory setting. Parents in the IG introduced more soft/small food pieces (P = 0.004) but not more complex textures (P = 0.15). There was no group difference in children acceptance for any of the textured foods offered in the laboratory. Independent of their study group, children's exposure to texture was associated with birth order, self-feeding with fingers, low gagging frequency and seldom use of commercial baby foods. Higher acceptance was associated with higher exposure to food pieces but not to pureed foods (either smooth or rough) and with children's eating behavioural traits (high food enjoyment, high food responsiveness and low food fussiness). This pilot intervention demonstrated that providing information can be effective in promoting the introduction of small and soft food pieces, but the most effective way to influence the introduction of more challenging textures (hard pieces and double texture) is uncertain. Further research should focus on the identification of barriers to complex texture introduction and on how building on this knowledge for a population-based public health intervention.
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Affiliation(s)
- C Tournier
- UMR Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France.
| | - C Bernad
- UMR Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| | - J Madrelle
- UMR Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| | - J Delarue
- UMR SayFood, Université Paris-Saclay, INRAE, AgroParisTech, F-91300, Massy, France
| | - G Cuvelier
- UMR SayFood, Université Paris-Saclay, INRAE, AgroParisTech, F-91300, Massy, France
| | - C Schwartz
- UMR Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| | - S Nicklaus
- UMR Centre des Sciences du Goût et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
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Hutchinson J, Rippin H, Threapleton D, Jewell J, Kanamäe H, Salupuu K, Caroli M, Antignani A, Pace L, Vassallo C, Lande B, Hildonen C, Rito AI, Santos M, Gabrijelcic Blenkus M, Sarkadi-Nagy E, Erdei G, Cade JE, Breda J. High sugar content of European commercial baby foods and proposed updates to existing recommendations. MATERNAL AND CHILD NUTRITION 2020; 17:e13020. [PMID: 32862552 PMCID: PMC7729710 DOI: 10.1111/mcn.13020] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/24/2020] [Accepted: 04/21/2020] [Indexed: 01/12/2023]
Abstract
The aim was to determine whether commercial baby foods marketed within Europe (up to 36 months of age) have inappropriate formulation and high sugar content and to provide suggestions to update European regulations and recommendations as part of a nutrient profile model developed for this age group. The latter was produced following recommended World Health Organization (WHO) steps, including undertaking a rapid literature review. Packaging information from countries across the WHO European region was used to determine mean energy from total sugar by food category. The percentage of products containing added sugar and the percentage of savoury meal‐type products containing pureed fruit were also calculated. A total of 2,634 baby foods from 10 countries were summarised: 768 sold in the United Kingdom, over 200 each from Denmark (319), Spain (241), Italy (430) and Malta (243) and between 99–200 from Hungary, Norway, Portugal, Estonia and Slovenia. On average, approximately a third of energy in baby foods in these European countries came from total sugar, and for most food categories, energy from sugar was higher than 10%. Use of added sugars was widespread across product categories, with concentrated fruit juice most commonly used. Savoury meal‐type purees did not contain added sugars except in United Kingdom and Malta; however, fruit as an ingredient was found in 7% of savoury meals, most frequently seen in UK products. Clear proposals for reducing the high sugar content seen in commercial baby foods were produced. These suggestions, relating to both content and labelling, should be used to update regulations and promote product reformulation.
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Affiliation(s)
- Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Holly Rippin
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Diane Threapleton
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Jo Jewell
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Haidi Kanamäe
- Nutrition and Exercise Unit, Centre for Health Risks Prevention, National Institute for Health Development, Tallinn, Estonia
| | - Kristin Salupuu
- Department of Nutrition Research, National Institute for Health Development, Tallinn, Estonia
| | | | - Angelo Antignani
- Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy
| | - Lucienne Pace
- Health Promotion and Disease Prevention Directorate, Msida, Malta
| | | | - Britt Lande
- Division Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | - Christina Hildonen
- Division Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | - Ana Isabel Rito
- Department of Food and Nutrition, National Health Institute Dr.Ricardo Jorge (INSA), Lisbon, Portugal
| | - Mariana Santos
- Department of Food and Nutrition, National Health Institute Dr.Ricardo Jorge (INSA), Lisbon, Portugal.,NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | | | | | - Gergő Erdei
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Joao Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, Copenhagen, Denmark
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14
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Oladiran DA, Emmambux NM. Locally Available African Complementary Foods: Nutritional Limitations and Processing Technologies to Improve Nutritional Quality—A Review. FOOD REVIEWS INTERNATIONAL 2020. [DOI: 10.1080/87559129.2020.1762640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Dolapo A. Oladiran
- Department of Consumer and Food Sciences, University of Pretoria, Hatfield, South Africa
| | - Naushad M. Emmambux
- Department of Consumer and Food Sciences, University of Pretoria, Hatfield, South Africa
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15
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Hübl N, Costa SPD, Kaufmann N, Oh J, Willmes K. Sucking patterns are not predictive of further feeding development in healthy preterm infants. Infant Behav Dev 2020; 58:101412. [DOI: 10.1016/j.infbeh.2019.101412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
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16
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Wallace R, Lombardi K, De Backer C, Costello L, Devine A. Sharing is Caring: A Study of Food-Sharing Practices in Australian Early Childhood Education and Care Services. Nutrients 2020; 12:nu12010229. [PMID: 31963185 PMCID: PMC7019312 DOI: 10.3390/nu12010229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 11/16/2022] Open
Abstract
Food connects people, and can significantly impact the physical, social and emotional development of young children. Food sharing and family-style mealtimes can support healthy eating practices and psychological well-being among young children, and carersother than family members, such as Early Childhood Education and Care staff, play an important role in the provision of these practices. Despite increasing numbers of Australian children attending Early Childhood Education and Care services, there is often reluctance among staff to promote such mealtime practices, to the detriment of children's social and emotional development. The aim of this paper was to focus on the potential role of Early Childhood Education and Care services in facilitating food sharing and family-style mealtime practices in the earliest stages of the lifespan. A qualitative, netnographic approach was used, and data was collected as part of the broader 'Supporting Nutrition for Australian Childcare' (SNAC) study, via online conversation threads, observations and qualitative interviews. Findings demonstrated that whilst many Early Childhood Education and Care services are committed to supporting food sharing and family-style mealtime practices, a number of barriers were reported. These included the perception that babies and toddlers could not participate in these practices, concerns about food hygiene and cross contamination of allergens, and negative parental influences on food sharing. In conclusion, this paper supports the practice of food sharing in Early Childhood Education and Care settings and calls for them to become embedded in everyday operations to support the physical, social and emotional development of Australia's future generations.
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Affiliation(s)
- Ruth Wallace
- School of Medical & Health Sciences, Edith Cowan University, Perth, WA 6027, Australia; (L.C.); (A.D.)
- Correspondence: ; Tel.: +61-863-042-731
| | | | - Charlotte De Backer
- Department of Communication Studies, University of Antwerp, 2000 Antwerpen, Antwerp, Belgium;
| | - Leesa Costello
- School of Medical & Health Sciences, Edith Cowan University, Perth, WA 6027, Australia; (L.C.); (A.D.)
| | - Amanda Devine
- School of Medical & Health Sciences, Edith Cowan University, Perth, WA 6027, Australia; (L.C.); (A.D.)
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17
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Utami AF, Wanda D. Is the baby-led weaning approach an effective choice for introducing first foods? A literature review. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Cichero JAY. Evaluating chewing function: Expanding the dysphagia field using food oral processing and the IDDSI framework. J Texture Stud 2019; 51:56-66. [PMID: 31269230 DOI: 10.1111/jtxs.12462] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/07/2019] [Accepted: 06/16/2019] [Indexed: 01/21/2023]
Abstract
The dysphagia field is still in relative infancy with a sophisticated knowledge base amassed since the early 1980's. The desire to identify aspiration and prevent life threatening pneumonia has resulted in a focus on the complexities of swallowing liquids. However, humans also ingest saliva, food, and oral medications, with the potential for these substances to incompletely clear the pharynx, be aspirated or block the airway. Safe swallowing of solid food in particular requires adequate chewing function, good oral control, and sufficient higher cortical function. Although screening and assessment for liquid swallowing safety is well established, the same cannot be said for the evaluation of safety to chew and swallow different food textures. While research into liquid swallowing physiology and its clinical application has largely come from the medical and allied health fields, our knowledge of chewing function for food textures comes from food texture research and food sensory science arenas. There is an exciting opportunity to bring the medical and food texture science fields together to expand our knowledge base on human chewing function, with clinical application to people with dysphagia. The development of the IDDSI Framework as an international standardized way of describing and labelling food texture and drink thickness allows the field to move toward management of texture modified food and thick liquids in a coordinated fashion, speaking the same language. This commentary will describe what we know of chewing function and how it is assessed clinically, proposing methods of assessment that utilize the IDDSI Framework.
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Affiliation(s)
- Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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19
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Makame J, Cronje T, Emmambux NM, De Kock H. Dynamic Oral Texture Properties of Selected Indigenous Complementary Porridges Used in African Communities. Foods 2019; 8:foods8060221. [PMID: 31234403 PMCID: PMC6617364 DOI: 10.3390/foods8060221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 02/03/2023] Open
Abstract
Child malnutrition remains a major public health problem in low-income African communities, caused by factors including the low nutritional value of indigenous/local complementary porridges (CP) fed to infants and young children. Most African children subsist on locally available starchy foods, whose oral texture is not well-characterized in relation to their sensorimotor readiness. The sensory quality of CP affects oral processing (OP) abilities in infants and young children. Unsuitable oral texture limits nutrient intake, leading to protein-energy malnutrition. The perception of the oral texture of selected African CPs (n = 13, Maize, Sorghum, Cassava, Orange-fleshed sweet potato (OFSP), Cowpea, and Bambara) was investigated by a trained temporal-check-all-that-apply (TCATA) panel (n = 10), alongside selected commercial porridges (n = 19). A simulated OP method (Up-Down mouth movements- munching) and a control method (lateral mouth movements- normal adult-like chewing) were used. TCATA results showed that Maize, Cassava, and Sorghum porridges were initially too thick, sticky, slimy, and pasty, and also at the end not easy to swallow even at low solids content—especially by the Up-Down method. These attributes make CPs difficult to ingest for infants given their limited OP abilities, thus, leading to limited nutrient intake, and this can contribute to malnutrition. Methods to improve the texture properties of indigenous CPs are needed to optimize infant nutrient intake.
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Affiliation(s)
- James Makame
- Department of Consumer and Food Sciences, University of Pretoria, Private Bag X20, Hatfield, Pretoria 0028, South Africa.
| | - Tanita Cronje
- Department of Statistics, University of Pretoria, Private Bag X20, Hatfield, Pretoria 0028, South Africa.
| | - Naushad M Emmambux
- Department of Consumer and Food Sciences, University of Pretoria, Private Bag X20, Hatfield, Pretoria 0028, South Africa.
| | - Henriette De Kock
- Department of Consumer and Food Sciences, University of Pretoria, Private Bag X20, Hatfield, Pretoria 0028, South Africa.
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20
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Lau ETL, Steadman KJ, Cichero JAY, Nissen LM. Dosage form modification and oral drug delivery in older people. Adv Drug Deliv Rev 2018; 135:75-84. [PMID: 29660383 DOI: 10.1016/j.addr.2018.04.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 02/15/2018] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people.
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Affiliation(s)
- Esther T L Lau
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Lisa M Nissen
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
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21
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Patterns and predictors of food texture introduction in French children aged 4–36 months. Br J Nutr 2018; 120:1065-1077. [DOI: 10.1017/s0007114518002386] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractThe aims of this study were to describe which and when food textures are offered to children between 4 and 36 months in France and to identify the associated factors. An online cross-sectional survey was designed, including questions about 188 food texture combinations representing three texture levels: purées (T1), soft small pieces (T2) and hard/large pieces and double textures (T3). Mothers indicated which combinations they already offered to their child. A food texture exposure score (TextExp) was calculated for all of the texture levels combined and for each texture level separately. Associations between TextExp and maternal and child characteristics and feeding practices were explored by multiple linear regressions, per age class. Answers from 2999 mothers living in France, mostly educated and primiparous, were analysed. Over the first year, children were mainly exposed to purées. Soft and small pieces were slowly introduced between 6 and 22 months, whereas hard/large pieces were mainly introduced from 13 months onwards. TextExp was positively associated with children’s number of teeth and ability to eat alone with their finger or a fork. For almost all age classes, TextExp was higher in children introduced to complementary feeding earlier, lower for children who were offered only commercial baby foods and higher for those who were offered only home-made/non-specific foods during the second year. Our study shows that until 12 months of age the majority of French children were exposed to pieces to a small extent. It provides new insights to further understand the development of texture acceptance during a key period for the development of eating habits.
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22
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Morison BJ, Heath ALM, Haszard JJ, Hein K, Fleming EA, Daniels L, Erickson EW, Fangupo LJ, Wheeler BJ, Taylor BJ, Taylor RW. Impact of a Modified Version of Baby-Led Weaning on Dietary Variety and Food Preferences in Infants. Nutrients 2018; 10:nu10081092. [PMID: 30111722 PMCID: PMC6115843 DOI: 10.3390/nu10081092] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to determine whether food variety and perceived food preferences differ in infants following baby-led instead of traditional spoon-feeding approaches to introducing solids. A total of 206 women (41.3% primiparous) were recruited in late pregnancy from a single maternity hospital (response rate 23.4%) and randomized to Control (n = 101) or BLISS (n = 105) groups. All participants received government-funded Well Child care. BLISS participants also received support to exclusively breastfeed to 6 months and three educational sessions on BLISS (Baby-Led Weaning, modified to reduce the risk of iron deficiency, growth faltering, and choking) at 5.5, 7, and 9 months. Food variety was calculated from three-day weighed diet records at 7, 12, and 24 months. Questionnaires assessed infant preference for different tastes and textures at 12 months, and for 'vegetables', 'fruit', 'meat and fish', or 'desserts' at 24 months. At 24 months, 50.5% of participants provided diet record data, and 78.2% provided food preference data. BLISS participants had greater variety in 'core' (difference in counts over three days, 95% CI: 1.3, 0.4 to 2.2), 'non-core' (0.6, 0.2 to 0.9), and 'meat and other protein' (1.3, 0.8 to 1.9) foods at 7 months, and in 'fruit and vegetable' foods at 24 months (2, 0.4 to 3.6). The only differences in perceived food preferences observed were very small (i.e., <5% difference in score, at 12 months only). Infants following the modified Baby-Led Weaning were exposed to more varied and textured foods from an early age, but only an increased variety in 'fruit and vegetable' intake was apparent by two years of age.
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Affiliation(s)
- Brittany J Morison
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Anne-Louise M Heath
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Jillian J Haszard
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Karen Hein
- Department of Food Science, University of Otago, Dunedin 9054, New Zealand.
| | - Elizabeth A Fleming
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Lisa Daniels
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | | | - Louise J Fangupo
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin 9054, New Zealand.
| | - Barry J Taylor
- Office of the Dean, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin 9054, New Zealand.
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23
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Affiliation(s)
- G. A. Rapley
- Canterbury Christ Church University; Canterbury UK
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24
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Schwartz C, Vandenberghe-Descamps M, Sulmont-Rossé C, Tournier C, Feron G. Behavioral and physiological determinants of food choice and consumption at sensitive periods of the life span, a focus on infants and elderly. INNOV FOOD SCI EMERG 2018. [DOI: 10.1016/j.ifset.2017.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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25
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Cichero JAY. Unlocking opportunities in food design for infants, children, and the elderly: Understanding milestones in chewing and swallowing across the lifespan for new innovations. J Texture Stud 2016; 48:271-279. [DOI: 10.1111/jtxs.12236] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/28/2016] [Accepted: 10/23/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Julie A. Y. Cichero
- Honorary Senior Fellow, School of Pharmacy; The University of Queensland; Brisbane, Qld, Australia
- Senior Speech Pathologist, Speech Pathology Department; The Wesley Hospital; Auchenflower, Qld Australia
- Co-Chair, International Dysphagia Diet Standardisation Initiative; Brisbane, Qld Australia
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26
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Hetherington MM. Nutrition in the early years - laying the foundations for healthy eating. NUTR BULL 2016. [DOI: 10.1111/nbu.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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27
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Rapley G. Is spoon-feeding justified for infants of 6 months? What does the evidence tell us? ACTA ACUST UNITED AC 2016. [DOI: 10.12968/johv.2016.4.8.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gill Rapley
- Writer, part-time lecturer, Canterbury Christ Church University
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