The online version of this article (https://doi.org/10.1186/s12887-017-0977-7) contains supplementary material, which is available to authorized users.
Infant formula feeding practices are an important consideration for obesity prevention. An infant’s diet is influential on their later risk of developing overweight or obesity, yet very little is known about infant formula feeding practices. It is plausible that certain modifiable practices may put children at higher risk of developing overweight or obesity, for example how much and how often a baby is fed. Understanding how parents use infant formula and what factors may influence this practice is therefore important. Moreover, parents who feed their infants formula have identified a lack of support and access to resources to guide them. Therefore this study aimed to explore parents’ infant formula feeding practices to understand how parents use infant formula and what factors may influence this practice.
Using an explorative qualitative design, data were collected using semi-structured telephone interviews and analysed using a pragmatic inductive approach to thematic analysis.
A total of 24 mothers from across Australia were interviewed. Mothers are influenced by a number of factors in relation to their infant formula feeding practice. These factors include information on the formula tin and marketing from formula manufacturers, particularly in relation to choosing the type of formula. Their formula feeding practices are also influenced by their interpretation of infant cues, and the amount of formula in the bottle. Many mothers would like more information to aid their practices but barriers exist to accessing health professional advice and support, so mothers may rely on informal sources. Some women reported that the social environment surrounding infant feeding wherein breastfeeding is promoted as the best option leads a feeling of stigma when formula feeding.
Additional support for parents’ feeding their infants with formula is necessary. Health professionals and policy around infant formula use should include how formula information may be provided to parents who use formula in ways that do not undermine breastfeeding promotion. Further observational research should seek to understand the interaction between advice, interpretation of cues and the amount formula fed to infants.
Additional file 1: Semi-structured interview guide. (DOCX 18 kb)12887_2017_977_MOESM1_ESM.docx
Additional file 2: The how and why of parents’ formula feeding practices – further supporting quotes. (DOCX 21 kb)12887_2017_977_MOESM2_ESM.docx
Additional file 3: Sources of information, advice and support about formula and social environment – further supporting quotes. (DOCX 19 kb)12887_2017_977_MOESM3_ESM.docx
Yang Z, Huffman SL. Nutrition in pregnancy and early childhood and associations with obesity in developing countries. Maternal & child nutrition. 2013;9(S1):105–19. CrossRef
Gaffney KF, Kitsantas P, Cheema J. Clinical practice guidelines for feeding behaviors and weight-for-age at 12 months: a secondary analysis of the infant feeding practices study II. Worldviews Evid-Based Nurs. 2012:234–42.
Baird J, et al. Being big or growing fast: systematic review of size and growth in infancy and later obesity. Br Med J. 2005;331(7522)
Shloim N, et al. Looking for cues – infant communication of hunger and satiation during milk feeding. Appetite. 2017;108:74-82.
Gildea A, Sloan S, Stewart M. Sources of feeding advice in the first year of life: who do parents value? Community Practitioner. 2009;82(3):27–31. PubMed
McInnes RJ, et al. Significant others, situations and infant feeding behaviour change processes: a serial qualitative interview study. BMC Pregnancy & Childbirth. 2013;13(1):1–13. CrossRef
Berry NJ, Jones SC, Iverson D. Relax, you're soaking in it: sources of information about infant formula. Breastfeeding Review. 2011;19(1):9–18. PubMed
Lakshman R, Ogilvie D, Ong KK. Mothers' experience of bottle-feeding: a systematic review of qualitative and quantitative studies. Archives of Disease in Children. 2009;94:596–601. CrossRef
Moreton JA, et al. Review 4: The effectiveness of public health interventions to promote safe and healthy milk feeding practices in babies. NICE Maternal and Child Nutrition programme 2008 [cited 2016 8/11]; Available from: https://www.nice.org.uk/guidance/ph11/evidence/review-4-milk-feeding-pdf-369892621.
Liamputtong P. Infant feeding beliefs and practices across cultures: an introduction. In: Infant feeding practices a cross-cultural perspective, P. Liamputtong. New York: Springer; 2011. CrossRef
Schafer EJ, et al. Social contexts of infant feeding and infant feeding decisions. J Hum Lact. 2015;32(1):132-140.
Williams K, Donaghue N, Kurz T. “Giving guilt the Flick”? An investigation of mothers’ talk about guilt in relation to infant feeding. Psychol Women Q. 2013;37(1):97–112. CrossRef
Patton, M.Q., Qualitative research and evaluation methods. Fourth edition ed. 2015, Thousand Oaks California USA: Sage Publications.
Ritchie, J. and J. Lewis, Eds. Qualitative research practice: a guide for social science students and researchers. 2003, Sage: London.
QSR International Pty Ltd., NVivo qualitative data analysis Software. Version 10. 2012.
Hurley, K.M., M.B. Cross, and S.O. Hughes, A systematic review of responsive feeding and child obesity in high-income countries. The Journal of Nutrition, 2011: p. jn. 110.130047.
Lakshman R, et al. Development of a questionnaire to assess maternal attitudes towards infant growth and milk feeding practices. International Journal Behavioral Nutrition and Physical Activity. 2011;8(35).
Tarrant RC, et al. Mothers who formula feed: their practices, support needs and factors influencing their infant feeding decision. Child Care in Practice. 2012;19(1):78–94. CrossRef
McNally J, et al. Communicating hunger and satiation in the first 2 years of life: a systematic review. Maternal & Child Nut. 2016;12(2):205-228.
Australian Government Department of Health and Ageing. In: D.o.H a Ageing, editor. Marketing in Australia of infant iormulas: Manufacturers and importers agreement - The MAIF agreement. Canberra: ACT; 2003.
Cattaneo, A., et al., Advertisements of follow-on formula and their perception by pregnant women and mothers in Italy. Archives of disease in childhood, 2014: p. archdischild-2014-306996.
Berry NJ, Jones SC, Iverson D. Circumventing the WHO Code? An observational study. Arch Dis Childhood. 2012:97(4):320-325.
Trickey H, Newburn M. Goals, dilemmas and assumptions in infant feeding education and support. Applying theory of constraints thinking tools to develop new priorities for action. Maternal & Child nutrition. 2014;10(1):72–91. CrossRef
Blair, M., C. Frazer, and K. Gaskin, The feeding guide. Seventh edition ed. 2014, The Children's Hospital at Westmead: James Fairfax Institute of Paediatric Nutrition.
Battersby S. An evaluation of midwives' knowledge of formula feeding and their role in supporting mothers who formula feed their infants. The journal of family health care. 2010;20(6):192–7. PubMed
Hegedus, J. and J. Mullan, Are we adequately providing support services for optimal infant nutrition in Australia? A study in regional NSW. Australian Journal of Primary Health, 2014: p. -.
World Health Organisation, International code of marketing of breast-milk substitutes. 1981, World Health Organization: Geneva.
Sheehan A, Schmied V, The imperative to breastfeed: an Australian perspective, in Infant Feeding Practices: A Cross-Cultural Perspective, P. Liamputtong, editors. Springer. Dordrecht: The Netherlands; 2011. p. 55–76.
World Health Organization and UNICEF, Baby-Friendly Hospital Initiative: Revised, updated and expanded for integrated care. 2009.
NHMRC, Infant feeding guidlines. 2013, National Health and Medical Research Council: Canberra.
Fahlquist JN. Experience of non-breastfeeding mothers: norms and ethically responsible risk communication. Nursing Ethics. 2016;23(2):231-241.
Lechuga VM. Exploring culture from a distance: the utility of telephone interviews in qualitative research. Int J Qual Stud Educ. 2012;25(3):251–68. CrossRef
Department of Health. ASGC Remoteness Areas 2006. 2016 [cited 2016 20 September]; Available from: http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator.
Australian Institute of Health and Welfare. Remoteness classifications. 2016 [cited 2016 20 September]; Available from: https://www.aihw.gov.au/reports/rural-remote-australians/guide-to-remotenessclassifications/contents/table-of-contents.
Australian Bureau of Statistics. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia , 2011 2013 [cited 2016 20th September]; Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/2033.0.55.001main+features100082011.
- Infant formula feeding practices and the role of advice and support: an exploratory qualitative study
Catherine Georgina Russell
Karen J. Campbell
- BioMed Central