Parental considerations during complementary feeding in higher income countries: a systematic review of qualitative evidence

Abstract

Objective Worldwide data suggest a clash between parental complementary feeding practices and recommendations. Understanding the circumstances under which parents form their feeding practices is a crucial step to improve such practices. This paper aimed to systematically review the existing qualitative literature and synthesise the factors that parents take into consideration in relation to complementary feeding. Design A systematic review was undertaken. Four electronic databases were searched for qualitative studies published after 2001 exploring parental experiences during complementary feeding. A framework that included authors’ outcomes of interest was used to extract and synthesise study findings. The Standards for Reporting Qualitative Research were used to critically assess the included studies. Setting Upper-middle- and high-income countries. Participants Parents with a child below the age of 3 years. Results A total of 47 studies met the eligibility criteria and were included in this systematic review. The themes were organised into three main categories: 1) factors related to introduction of complementary foods; 2) factors related to the type of complementary foods; and 3) factors related to both timing and type. The selected literature highlights: prevalent baby cues that prompt parents to introduce solid foods; parents’ views on the recommended timing of complementary feeding; factors that drive the choice of complementary foods; and perceived value in advice received from health professionals and grandmothers. Conclusions This systematic review indicates factors that can be barriers to complying with the complementary feeding guidelines and therefore, its findings are pertinent to improving parental feeding practices through intervention studies and through infant feeding education in a primary care setting. PROSPERO registration ID: CRD42017067091

Implementing a ‘Vegetables First’ Approach to Complementary Feeding

“…Hence, parental guidelines for CF should be sensitive to these factors and, where possible, tailored to suit family circumstance. Also, given the sensitive period of 6 months for introducing novel vegetables during CF, this presents an opportunity for the entire family to adopt a more healthy eating pattern [ 78 ].…”

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

“…Caregivers' self-reported experiences of CF are scarcely reported. A review by Spyreli et al among parents in high-income countries, found infant behavioral cues, infant size and desire to expand familial feeding roles influenced decision-making around the timing of CF commencement [19]. Demographic factors such as younger maternal age, lower levels of maternal education, and formula-feeding were also found to be associated with EIOCF [10,18,20,21].…”

Investigating group-based classes (‘weaning workshops’) to support complementary infant feeding in Irish primary care settings: a cross-sectional survey

“…More recently, Gutierrez-Camacho et al (9) identified that higher maternal education, higher age and higher household income are positively associated with healthy infant feeding behaviours. In addition, recent qualitative evidence syntheses explored parents' perceptions and experiences of infant feeding and identified many factors influencing parents' complementary feeding behaviours (10,11) . Both reviews found that complementary feeding behaviours are influenced by multiple sources of advice, in particular those of peers (i.e.…”

“…family and friends) and healthcare professionals. The studies identified a need for greater education and support for parents regarding complementary feeding, particularly within primary care settings (11) , and considering practical issues such as time and cost (10) . The reviews also highlighted greater barriers within lower SES populations, such as the lack of affordability of healthy food (12) , greater misconceptions and lack of knowledge (10) .…”

“…Despite an increasing focus on the importance of appropriate complementary infant feeding, and the need to support parents and primary caregivers to engage in recommended behaviours, the existing evidence regarding the effectiveness of interventions to improve complementary feeding behaviours is inconsistent (10)(11)(12) . Recent systematic reviews of infant feeding interventions have shown minimal effects on infant feeding practices and other important outcomes such as child weight (10,12,13) .…”