Evaluation Report Series No. 9
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The survey was designed to assess the understanding and use of food label information in food selection decisions made by the main grocery buyer in a household when shopping for foods for consumption by those who are ‘at risk’ of adverse or allergic reactions to food.
The 2003 release of the revised Australian National Health and Medical Research Council (NHMRC) Dietary Guidelines for Children and Adolescents (incorporating Infant Feeding Guidelines for Health Workers created an inconsistency with New Zealand government policy guidelines and an inconsistency between Australian government policy and current labelling requirements (indicating the age from which the food is suitable, from 4 months). As a result of these changes, Food Standards Australia New Zealand (FSANZ) has undertaken a review (Proposal P274) of the minimum age labelling so that infant food labelling reflects the revised Australian guidelines, and also takes into account New Zealand policy.
The initial assessment report from this review proposed a number of labelling options which FSANZ now has a need to review from a consumer perspective. FSANZ has subsequently commissioned this qualitative research study to investigate how primary caregivers make decisions around the introduction of solids; the influence of current labelling on these decisions; and reactions to alternate labelling options.
The research was conducted with primary caregivers in Australia and New Zealand, via nine focus group discussions. Participants were selected on the basis of their gender (i.e. mothers), their level of achieved education, and the number of children they had (first-time mothers and those with more than one child).
For most participants in this study, the decision of when and how to introduce solids was informed over a period of time, and via a number of solicited and unsolicited sources.There were three most important sources:
- the Child Health Nurse;
- reference materials, such as books and magazines; and
- the informal ‘mothers’ group or ‘coffee’ group’ that most participants in this study were part of.
Most parents relied on two main signals from their baby in determining if he or she was ready for solids – these were regarded more as signs of hunger rather than developmental readiness:
- an indication of strong interest in food by following with their eyes when others eat around them, or reaching for food from an adult’s plate; and
- disturbed sleep patterns at night, indicating that the breast or bottle feed was no longer enough.
Other physiological cues were less well known, and most participants did not understand that a number of physiological cues, rather than one or two alone, are a better indication of developmental readiness for solids.
Food labels were far less important than these and other sources, and played different roles for parents. Food label information was regarded as helpful in the selection of infant foods once solids have been first introduced, but the label had little if any influence on the decision to start solids (usually with rice cereal). Label information became much more useful when parents began to regularly buy infant foods, and to assist them in the transition to more textured foods.
First-time mothers place considerably greater importance on the age and texture information on food labels, using the age recommendation as a guide that is followed in consultation with the advice of the child health nurse, and often their own mother.
There was considerable and consistent self-reported evidence from the groups in both countries that a ‘4 months’, ‘from 4 months’ or ‘from 4-6 months’ food label encourages the introduction of solids closer to 4 months, rather than closer to 6 months. Many participants felt that, on reflection, had first stage (‘blue’) foods been labelled ‘from 6 months’ they would have reconsidered, and probably delayed introducing solids by a few weeks to a month or more.
Not surprisingly, it was difficult for some participants to retrospectively say what they would have done had they been faced with first foods labelled ‘around 6 months’. Seeing it as label information for the first-time (via label mock-ups on boards and sample products), ‘around 6 months’ was interpreted to mean aiming for 6 months, with 2-3 weeks leeway on either side. In the context of this recommended age being the first age on food labels, introducing solids at closer to 4 months was viewed as highly inappropriate. Based on the reaction and views of participants in this study, it is unlikely that most parents would contemplate solids before 5 months if there were no other information sources giving them counter information or advice (friends, mothers, child health nurses).
In New Zealand, where health advice (‘4-6 months’) is most likely to conflict with future label information (‘around 6 months’) participants indicated their likelihood to over-ride the label recommendation with conflicting advice from their nurse, but not without considerable confusion. Where the child health advice directs parents to delay solids until closer to 6 months, participants would most likely use the label recommendation to substantiate and defend this advice to other conflicting sources, such as ‘earlier’ generations of first-time parents.
Overall, only a minority of participants were aware of the warning statement ‘not recommended for infants under the age of 4 months’, until their attention was drawn to it in the group discussion. Those that were aware of it tended to be more avid label readers, and also those more likely to seek child health nurse advice on a frequent basis. Most participants did not regard the co-existence of the warning statement and the ‘around 6 months’ recommendation on the front of the product as a problem given, their typical process in checking and validating decisions to move from one infant feeding stage to another – via the nurse or reference materials. A small number of participants, particularly in New Zealand, saw the potential for the dual-advice to be confusing and would have needed to seek clarification on this issue from their nurse.
Consequently, it is the advice of the nurse that will determine which age recommendation (4 months in the warning statement, or 6 months on the front of the product) carries more weight. If a nurse is not consulted during this process, it is the age and graphic depiction of the ‘around 6 months’ recommendation on the front of the product that will most likely drive a parent’s choice of product far more than the warning statement.
A number of alternate label concepts were presented to participants and their reactions were sought. There was widespread endorsement of the concepts that provided colour coded age ranges and texture information at each stage . References to sequential ‘phases’ were rejected in favour of ‘stages’. The 1st Stage, 2nd Stage, 3rd Stage wording was not as important as the texture and age information, but nonetheless useful for first-time parents. It is this final concept that received universal endorsement in the second wave of the research, and it is recommended that FSANZ encourages the adoption of labelling that provides the three core elements that make it useful for parents:
- an easy to find texture descriptor;
- a consistent age recommendation, that offers flexibility through an age range; and
- colour coding.
The first two elements are most important to parents when making decisions about what food to purchase between the age solids are started and 12 months. Not all participants in this study were aware of the colour coding system, but all endorsed it as an excellent concept for quick reference and easy product selection (both for themselves and other family members who are sent to purchase baby food).
Full Report [ pdf format 308 kb ]