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

ABSTRACT: 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.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.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.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.

SUBMITTER: Cameron SL

PROVIDER: S-EPMC3863128 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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

Cameron Sonya L SL Taylor Rachael W RW Heath Anne-Louise M AL

BMJ open 20131209 12

<h4>Objective</h4>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.<h4>Design, setting and participants</h4>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 ...[more]

PMID: 24327363

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Project description:Previous research demonstrated that faster eating rates are linked with increased intake of energy during a meal. Here, we examined whether within-meal parental feeding practices show cross-sectional and prospective associations with children's oral processing behaviours and whether the previously demonstrated association between faster eating rates and higher energy intakes varies by parental feeding practices. A subset (n = 155) of children and their mothers from the Growing Up in Singapore Towards healthy Outcomes cohort participated in an ad libitum meal at age 4.5 years. Children's oral processing behaviours (eating rate, bite size, chews per gram, oral exposure time, and meal duration) and parental feeding practices (autonomy-supporting and coercive prompts, restrictions, hurrying, and slowing) were recorded during the meal. Subsequently, 94 of the children participated in a follow-up meal without their mothers at age 6 years. Parental feeding practices were not consistently associated with child oral processing behaviours overall. However, exploratory post hoc analyses revealed some sex differences. The mothers of girls with faster eating rates, larger bite sizes, and fewer chews were more likely to use hurrying, slowing, and restrictions, but similar associations were not observed among boys. Children who had the most problematic eating style and were eating fast and for long experienced more restrictions, instructions to slow down, and prompts. Faster eating rates were linked with the highest energy intakes if children were additionally prompted to eat. Prospective analyses showed that children who were more often prompted using coercive techniques and less frequently hurried at age 4.5 years had faster eating rates at 6 years and a larger increase in eating rates between ages 4.5 and 6 years but did not consume more energy. Although the direction of these associations cannot be assumed, these exploratory analyses suggest sex differences in the associations between feeding practices and oral processing behaviours and highlight the potential role of parents in the development of children's oral processing behaviours.

Project description:ImportanceBaby-led approaches to complementary feeding, which promote self-feeding of all nonliquid foods are proposed to improve energy self-regulation and lower obesity risk. However, to date, no randomized clinical trials have studied this proposition.ObjectiveTo determine whether a baby-led approach to complementary feeding results in a lower body mass index (BMI) than traditional spoon-feeding.Design, setting, and participantsThe 2-year Baby-Led Introduction to Solids (BLISS) randomized clinical trial recruited 206 women (168 [81.6%] of European ancestry; 85 [41.3%] primiparous) in late pregnancy from December 19, 2012, through March 17, 2014, as part of a community intervention in Dunedin, New Zealand. Women were randomized to a control condition (n = 101) or the BLISS intervention (n = 105) after stratification for parity and education. All outcomes were collected by staff blinded to group randomization, and no participants withdrew because of an adverse event. Data were analyzed based on intention to treat.InterventionsMothers in the BLISS group received lactation consultant support (≥5 contacts) to extend exclusive breastfeeding and delay introduction of complementary foods until 6 months of age and 3 personalized face-to-face contacts (at 5.5, 7.0, and 9.0 months).Main outcomes and measuresThe primary outcome was BMI z score (at 12 and 24 months). Secondary outcomes included energy self-regulation and eating behaviors assessed with questionnaires at 6, 12, and 24 months and energy intake assessed with 3-day weighed diet records at 7, 12, and 24 months.ResultsAmong the 206 participants (mean [SD] age, 31.3 [5.6] years), 166 were available for analysis at 24 months (retention, 80.5%). The mean (SD) BMI z score was not significantly different at 12 months (control group, 0.20 [0.89]; BLISS group, 0.44 [1.13]; adjusted difference, 0.21; 95% CI, -0.07 to 0.48) or at 24 months (control group, 0.24 [1.01]; BLISS group, 0.39 [1.04]; adjusted difference, 0.16; 95% CI, -0.13 to 0.45). At 24 months, 5 of 78 infants (6.4%) were overweight (BMI≥95th percentile) in the control group compared with 9 of 87 (10.3%) in the BLISS group (relative risk, 1.8; 95% CI, 0.6-5.7). Lower satiety responsiveness was observed in BLISS infants at 24 months (adjusted difference, -0.24; 95% CI, -0.41 to -0.07). Parents also reported less food fussiness (adjusted difference, -0.33; 95% CI, -0.51 to -0.14) and greater enjoyment of food (adjusted difference, 0.25; 95% CI, 0.07 to 0.43) at 12 months in BLISS infants. Estimated differences in energy intake were 55 kJ (95% CI, -284 to 395 kJ) at 12 months and 143 kJ (95% CI, -241 to 526 kJ) at 24 months.Conclusions and relevanceA baby-led approach to complementary feeding did not result in more appropriate BMI than traditional spoon-feeding, although children were reported to have less food fussiness. Further research should determine whether these findings apply to individuals using unmodified baby-led weaning.Trial registrationhttp://anzctr.org.au Identifier: ACTRN12612001133820.

Project description:BackgroundThe complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food "pouches" and "baby-led weaning" (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed purées, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined.ObjectiveThe aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not.MethodsDietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide "dose-to-mother" technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect.ResultsThis observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022.ConclusionsThis large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436.International registered report identifier (irrid)DERR1-10.2196/29048.

Project description:BackgroundFollowing the successful implementation of the Millennium Development Goals (MDGs) strategy in Tanzania, improvements in child health indicators were observed. However, it remains unclear whether complementary feeding practices have improved given the renewed global agenda on child nutrition. This study investigated trends and socioeconomic and health service factors of complementary feeding practices in Tanzania for the period spanning from 2004 to2016.MethodsThe study was based on the Tanzania Demographic and Health Survey data for the years 2004-2005 (n?=?2480), 2010 (n?=?2275) and 2015-2016 (n?=?2949) to estimate the trends in complementary feeding practices. Multivariate logistic regression models that adjusted for year of the survey, clustering and sampling weights were used to investigate the association between the modifiable study factors (socioeconomic and health service factors) and complementary feeding practices among children aged 6-23 months in Tanzania.ResultsOver the study period, minimum dietary diversity (MDD) and minimum acceptable diet (MAD) have worsened from 46% (95% confidence interval [95% CI] 41.5-50.7%) in 2004-2005 to 30% (95% CI 25.7-32.9%) in 2015-2016 and 16.9% (95% CI 14.9-18.9%) in 2004-2005 to 6.0% (95% CI 4.9-7.1%) in 2015-2016, respectively. Minimum meal frequency (MMF) remained unchanged, 37% in 2004-2005 and 2015-2016. The introduction of solid, semi-solid and soft foods improved from 79% (95% CI 74.5-83.9%) in 2004-2005 to 87% (95% CI 83.7-90.9%) in 2015-2016. Multivariate analyses revealed that higher maternal education and household wealth, mother's employment, health facility birthing and postnatal care (PNC) visit were associated with MDD, MAD and MMF. Traditional birth attendant-assisted births and PNC visits were associated with the introduction of complementary foods. In contrast, birthing in the health facility was associated with the delayed introduction of complementary foods.ConclusionBetween 2004 and 2016, the prevalence and determinants of complementary feeding practices varied in Tanzania. Improving complementary feeding practices is feasible in Tanzania given the renewed focus on child nutrition in the country. Child nutrition policy interventions should target all mothers, particularly mothers from low socioeconomic background and those with limited access to health services to maximise results.

Dataset Information

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

Publications

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

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