Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study

Abstract

Background The 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. Objective The 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. Methods Dietary 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. Results This 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. Conclusions This 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 Registration Australian 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

A Qualitative Study of Parental Perceptions of Baby Food Pouches: A Netnographic Analysis

“…Studies should be undertaken to understand the reasons for the popularity of baby food pouches, with the current study demonstrating a range of views that would justify the expense of a large face-to-face study with families. Further research is also needed to ascertain the long-term effect of the use of pouches on the health of infants regarding eating habits, nutritional status, growth and development [ 30 ]. Given the range of attitudes of parents towards baby food pouches identified in this study, further qualitative research, using either individual interviews or focus groups, would be valuable to explore how parents negotiate their own attitudes towards baby food pouches with those of other parents, and health professionals.…”

“…Previous studies have noted other influences on baby food choice to include advertising and brand trustworthiness [ 21 , 30 ]. Many of the discussion threads in the present study did include brand names and talk around which products were the best to use but this was not included in the coding scheme of the present study because it did not provide much thematic insight as to the overall perception of the product.…”

Risks and benefits of Baby - Led Weaning, as a new proposal for the beginning of complementary feeding

“…De la misma forma lo expresa Jones et al (17) , en su revisión bibliográfica realizada en Reino Unido, poniendo de manifiesto que la alimentación de los más pequeños debería ser una práctica combinada tanto de leche materna o fórmula artificial y el método del Baby Led Weaning, en tanto que Taylor et al (16) en su estudio observacional con 625 bebés, destaca la importancia de iniciar la alimentación complementaria mediante el BLW ya que contribuye a la autosuficiencia por parte de los más pequeños, permitiendo un autocontrol y por ende promoviendo mantener una regularidad de su apetito.…”

“…No fue posible agrupar los resultados de resultados muy diferentes en los estudios incluidos. Ambos ensayos aleatorios tienen sesgo potencial; por lo tanto, la calidad de la evidencia es baja Taylor et al (16) 2021…”

Adherence to Infant Feeding Guidelines in the First Foods New Zealand Study

“…Data for the current study were obtained as part of the First Foods New Zealand (FFNZ) observational study. A detailed description of FFNZ's methods can be found elsewhere [34]. FFNZ recruited 625 infants from the Auckland and Dunedin regions of NZ using word of mouth and Facebook advertisements.…”