Parents' beliefs about appropriate infant size, growth and feeding behaviour: implications for the prevention of childhood obesity

Abstract

BackgroundA number of risk factors are associated with the development of childhood obesity which can be identified during infancy. These include infant feeding practices, parental response to infant temperament and parental perception of infant growth and appetite. Parental beliefs and understanding are crucial determinants of infant feeding behaviour; therefore any intervention would need to take account of their views. This study aimed to explore UK parents' beliefs concerning their infant's size, growth and feeding behaviour and parental receptiveness to early intervention aimed at reducing the risk of childhood obesity.MethodSix focus groups were undertaken in a range of different demographic localities, with parents of infants less than one year of age. The focus groups were audio-recorded, transcribed verbatim and thematic analysis applied using an interpretative, inductive approach.Results38 parents (n = 36 female, n = 2 male), age range 19-45 years (mean 30.1 years, SD 6.28) participated in the focus groups. 12/38 were overweight (BMI 25-29.99) and 8/38 obese (BMI >30). Five main themes were identified. These were a) parental concern about breast milk, infant contentment and growth; b) the belief that the main cause of infant distress is hunger is widespread and drives inappropriate feeding; c) rationalisation for infants' larger size; d) parental uncertainty about identifying and managing infants at risk of obesity and e) intentions and behaviour in relation to a healthy lifestyle.ConclusionsThere are a number of barriers to early intervention with parents of infants at risk of developing obesity. Parents are receptive to prevention prior to weaning and need better support with best practice in infant feeding. In particular, this should focus on helping them understand the physiology of breast feeding, how to differentiate between infant distress caused by hunger and other causes and the timing of weaning. Some parents also need guidance about how to recognize and prepare healthy foods and facilitate physical activity for their infants.

Exploring Maternal Perceptions of Infant Sleep and Feeding Method Among Mothers in the United Kingdom: A Qualitative Focus Group Study

“…In the US, mothers reported that they felt breastfeeding was associated with sleep disturbance (Kennedy et al, 2007) and that having the baby sleep through the night was a major benefit provided by formula (Marchand & Morrow, 1994). Two focus group studies, one of UK women (Redsell et al, 2010) and one of US women (Gross et al, 2010), both found that a need for feeding is parents' preferred explanation for night waking, so they may be less likely to recognise other contributing factors, such as developmental milestones or discomfort. In the UK study, mothers who introduced formula feeds reported being more comfortable with continued night-time crying once they felt confident that the infant was not hungry (Redsell et al, 2010).…”

“…Two focus group studies, one of UK women (Redsell et al, 2010) and one of US women (Gross et al, 2010), both found that a need for feeding is parents' preferred explanation for night waking, so they may be less likely to recognise other contributing factors, such as developmental milestones or discomfort. In the UK study, mothers who introduced formula feeds reported being more comfortable with continued night-time crying once they felt confident that the infant was not hungry (Redsell et al, 2010). 4 To contextualise maternal decision-making about infant feeding, much more information on women's perceptions of how infant sleep works and the interconnections between sleep and feeding method is needed.…”

Reducing childhood obesity: opportunities to influence transitional infant feeding

“…Growth was viewed as a measure of health, 139,223 with insufficient growth being a source of concern for many mothers 131 leading to supplementation with infant formula and/or early weaning to solids. 178,200,222,224 Weight was seen a safety net as illustrated in Kaufman and Karpati's study ("He should be fatter. He's so fragile.…”

“…177,178,200,225 The cultural value of heavier children and feeding practices was portrayed in Higgins's study of Puerto Rican families in New York where "mothers often feed babies until they spit up….Lots of mothers feed babies extra milk and put extra sugar and baby foods in a bottle with a big hole in the nipple." (p24) 178 A heavier infant was seen as safer 177 and a sign of good parenting.…”

“…196,197 The Theory of Planned Behaviour which links beliefs and behaviour has been used to explain and modify infant feeding. 182,198,199 Interventions based on Knowledge Deficit Models 200 only go part way to tackling obesity as they fail to capture the importance of considering parenting skills. These skills are considered in studies using the behavioural theory 6,183 and the Family Partnership Model.…”