Food labelling issues:
A qualitative consumer study related to food labelling of infant foods
5 . Information about introducing solids
OBJECTIVE 1: Whether primary caregivers receive education as to when to give their infants solid foods and if so, from what sources and what information they receive.
The decision about when and how to introduce solids is informed over a period of time, and via a number of solicited and unsolicited sources. These could be considered both formal and informal types of education.
Early influences
The initial trigger to thinking about introducing solids can occur at several points:
- ante-natal classes, where it is mentioned fleetingly, and usually forgotten until the parent is reminded at a subsequent point;
- whilst in hospital after the birth, via literature given to the parent by the hospital, infant food manufacturers, or parental aids such as the ‘bounty bag’. Once again, for the mother the focus at this time is on mastering breastfeeding, and little attention is paid to information about solids. At this point, some mothers will store the information away for future reference, which may or may not be used again, and for others it will be forgotten until a subsequent trigger causes them to recall this developmental stage, and reinforces it’s importance;
- early prompting by a child or maternal health nurse (at 3-4 months of age), or an older family member, usually the parent’s mother/father or mother-in-law. Often this prompt is given much earlier than the prompt by the child health nurse – as early as 2-3 months of age.
As these initial prompts occur very early on, they are often dismissed by the parent as a lesser priority to the much more immediate issues at hand; labour and breastfeeding. The issue of introducing solids rises in perceived importance as each of these tasks are resolved [1] and therefore it takes on greater salience as it is reinforced by subsequent triggers and prompts which tend to carry more weight. Parents then move into a more active decision process.
Active decision process
For most parents in this study, their active decision process around introducing solids commenced with one or a combination of:
- Suggestion by their child health nurse, at 3-4 months of age, more likely to be in response to a parent’s confusion, distress or uncertainty about their baby’s sleeping or feeding behaviour – an indirect and solicited prompt;
- Prompting by their child health nurse or community health centre, generally from 4-6 months of age – more likely to be an unsolicited prompt. At least a few parents in most groups mentioned attending a solids course promoted at the child health centre, and in a few cases this was prompted by the nurse at the 3 monthly check:
“…I just went along to my 3 month check and at the time one of the [name withheld] nurses said they were doing a little group session on feeding your baby and so I booked into one of them and watched a video and had a couple of leaflets and someone just to talk to about what to do, because you do sort of think, well, what do you do?”
- Information and advice in books, magazines and reference materials;
- The opinions and behaviour of other mothers – via the mothers’ ‘coffee group’, family or friends with children, and the feeing progress of other babies the same age;
- The advice of a parent’s own mother;
- The need to return to work, at least part-time – this was expressed by only a few participants, who acknowledged they were ‘fast tracking’ their baby.
Some of the above points are expanded upon below.
Parent’s confusion, distress or uncertainty about their baby’s sleeping or feeding behaviour can include:
- Baby’s disturbed sleeping patterns – no longer sleeping through the night – often justified because ‘he obviously needs it’or ‘he’s not getting enough from my breast milk anymore’;
- Identification of signs of reflux – several parents reported that they had a ‘reflux baby’ and were encouraged by their child health nurse or GP to start solids as a way of helping to ease reflux;
- Changes in baby’s feeding patterns – taking longer to finish a bottle or a breast feed;
- Signs from their baby of showing an interest in food – watching adults or older siblings eat, eyes following food from plate to mouth, reaching for or grabbing food.
In these situations, many participants sought the advice of their child health nurse for confirmation of readiness for solids, however there were also parents in each group that decided to start solids based on advice from mothers in their mothers group, or their own mother, without confirmation by a child health nurse. In these cases the parents had started during or just before 4 months.
“for me, it wasn’t any sign, I just thought I’d heard that at about four, four and a half months was about the time to start off and so I decided to give it a go and she seemed to know what to do.”
There were also participants who were prompted to introduce solids by their child health nurse at this point – a greater number in the New Zealand groups than in the Australian groups, however cases such as this did occur in both study locations:
“[name removed], he was not a good sleeper, still isn’t, and the [name removed] nurse actually suggested I should try some baby rice to see if that would help take him through the night. It didn’t work though but that’s why I started on 4 months and didn’t wait later.”
There was no agreement, and much confusion as to whether these signs were correct indicators of readiness for solids. In most groups there was at least one participant who felt they had introduced solids prematurely as a ‘quick fix’ to solving sleeping or feeding problems, which had not resolved with introducing solids. At the same time, most groups also included participants with babies for whom this had worked, and thus the introduction of solids was contested as the solution to the problem.
First-time parents were more likely to rely on their baby showing interest in food as a cue for readiness for solids, and expressed strong concern about doing ‘the right thing’ by their baby, and guilt about depriving their child by holding solids back – particularly if they felt their child was showing strong signs of readiness from 4 months or earlier and their child health nurse was advising them to wait till closer to 6 months. Their concerns were two fold:
- That they might be depriving their child of food – a hunger issue; or
- That they might be holding their child back from an important milestone, which may well be a window of opportunity that, if missed, could have longer term detrimental consequences – a developmental issue.
There were a couple of parents however who were still contemplating introducing solids (baby aged around 4.5-5 months) and had observed signs of interest in food in their child, but wondered if this was just their baby showing an interest in lots of different adult behaviours, including eating. These mothers challenged the assertion that these signs were automatic cues to readiness for solids.
Second-time parents were more likely to be led by physiological cues (see Section 7). Some second-time parents also claimed, and others agreed, that their second child was ready for solids well before their first child because in the parent’s opinion, their baby was modelling on their older sibling’s eating – “she wants what he’s got”.
Books, magazines and reference materials
Reference materials were more frequently mentioned, but not limited to, the groups of higher educated parents. Popular books included Robin Barker’s ‘Baby Love’ (frequently mentioned in Australia); ‘What to Expect in the First Year’, ‘Baby Wrangling’, “New Zealand Baby and Toddler’ and the Plunket ‘Well Book’. Baby magazines were more often but not exclusively mentioned by parents with lower levels of education. Other useful information materials included the Heinz feeding chart fridge magnet; Heinz booklet given out in hospital, as part of the ‘bounty bag’, or at the child health centre; and to a much lesser extent, articles in women’s magazines.
Relative importance of information sources
The introduction of the solids decision process involves both consciously and unconsciously evaluating solicited and unsolicited, trusted and less trustworthy advice and information. This information is filtered by the parent by attributing importance to each source and piece of advice, and the process generally extends over the period of a few days to a week before solids are first introduced, or a decision is made to delay until their baby is older.
After discussing all of the various sources of information and advice about introducing solids, participants were asked to individually rank each source in terms of how important they regarded each to be, from highest to lowest.
The most important or trusted sources of information and advice are:
- The child health nurse (or Plunket nurse in New Zealand), who is seen as entirely credible, trustworthy and is regarded as the ‘specialist’, compared to other health professional such as a GP or paediatrician;
- Books and magazines;
- The ‘mother’s group’ – which is regarded as more important and helpful for the parent than advice from other friends or family, even if they have babies the same age; and
- For some participants only, one’s own mother.
The least important or trusted sources of information and advice are:
- Mother-in-law;
- Chemists, GPs and Paediatricians – because they less accessible rather than being less credible;
- Internet websites
- Help & support organisations, such as Tresillian, Karitane;
Occupying the ‘middle ground’, in terms of perceived importance, were sources such as:
- Food labels;
- Information given in hospital, particularly the ‘bounty bag’;
- Introducing solids courses;
- Coles Baby Club information;
- Family, friends and other mothers;
- TV programs – such as a recent ABC Reality Bites series, and segments in lifestyle programs;
- TV advertising – mentioned in Auckland only, where many participants talked about a recent Plunket & Watties television ad ‘when to start your baby on solids’;and
- Heinz information.
Food labels were not mentioned spontaneously in any group as a source of information or advice, and thus made their way onto the list after prompting by the Moderator. However, when prompted, most participants acknowledged that labels offered some level of assistance in selecting foods, but did not play a role in their decision about when to first introduce solids, or what to introduce first. This issue is discussed in detail in Section 6.
First-time parents were much more likely to trust the advice of the child health nurse implicitly, and take her advice without question, particularly if the parent felt comfortable with the nurse and had developed a trusting relationship early on. There were a few instances where first-time mothers had not liked the nurse they saw first, and objected to the advice/information they were given, or the way in which it was given. In these cases, a couple of parents had simply abandoned using a child health nurse, except for essential ‘check up’ milestones, and the rest had switched to another child health nurse, on recommendation from the mothers’ group. There was a strong understanding amongst most of the focus groups that one could ‘shop around’ for a child health nurse that was preferred for personality or convenience reasons.
Similarly, first-time parents were more likely to trust books and reference materials, and filter their information through their mothers’ group. Second-time parents were more likely to ‘throw the book away’. These parents mostly felt confident with their second or third child, and reported that they had introduced solids at a time when they judged their baby was ready. Readiness was more likely to be described around definite physiological or developmental cues, and these parents often used terms such as “you just know”or“your baby let’s you know”.
Reasons for delaying solids
In each groups discussion there were one or a number of parents that had observed speculated signs of readiness for solids, but chosen to delay the introduction until their baby was closer to 5 or 5.5 months (usually their intention was to wait till 6 months). Reasons for delay were both practical and emotional, and mostly expressed by breastfeeding mothers:
- For breastfeeding mothers who had a well-established routine and the convenience of ‘portability’ that breastfeeding offers, there was an acknowledgement that breastfeeding was ‘so easy’ and they wanted to enjoy it a bit longer;
- A mother’s reluctance to progress to another significant milestone that signifies that their baby is getting older, and grief associated with no longer solely breastfeeding;
Many breastfeeding and infant formula feeding parents had experienced disrupted sleeping patterns (for them and their baby) at the time when they were also contemplating introducing solids. Some of these parents expressed as another reason for delaying solids their reluctance to tackle solids, which they anticipated to be a difficult task, at an already difficult time.