A qualitative study of providers' perceptions of parental feeding practices of infants and toddlers to prevent childhood obesity.

BACKGROUND: With a recent focus on establishing US Dietary Guidance for children ages 0 to 2 years old, the objective of this qualitative study was to determine misconceptions and barriers that prevent parents from implementing early childhood feeding and obesity prevention practices as reported by healthcare, community-based, and education providers. METHODS: Trained researchers conducted one-on-one qualitative phone interviews, using a semi-structured script, with early childhood health and education providers working with families of young children. Interviews were audiotaped, transcribed verbatim, and analyzed using the classic analysis approach. Transcripts were coded by researchers and analyzed for themes. RESULTS: Providers (n = 21) reported commonly observed obesogenic practices including overfeeding tendencies, early initiation of solids or less optimal feeding practices, lack of autonomy and self-regulation by child, and suboptimal dietary patterns. Sources of parental misconceptions about feeding were often related to cultural, familial, and media influences, or lack of knowledge about optimal feeding practices for infants or toddlers. CONCLUSIONS: Providers indicated a need for engaging and consistent child feeding and obesity prevention education materials appropriate for diverse cultural and literacy levels of parents, with detailed information on transitioning to solid foods. Early education and community-based providers reported limited access to evidence-based educational materials more so than healthcare providers. It is an opportune time to develop reputable and evidence-based child feeding guidance that is readily available and accessible for parents of infants and toddlers to prevent early childhood obesity.

Development and Qualitative Pretesting of Child Feeding and Obesity Prevention Messages for Parents of Infants and Toddlers.

BACKGROUND: Consistent, evidence-based child feeding guidance targeted to parents of children ages birth to 24 months (B-24) is needed for early childhood obesity prevention. OBJECTIVE: The aim was to develop and pretest a comprehensive set of child feeding and obesity prevention messages for parents of children ages B-24. DESIGN: A qualitative, 2-phase protocol, grounded in social and behavior change, was used as a conceptual interview framework to pilot test early childhood feeding messages with parents. PARTICIPANTS/SETTING: Participants were parents (n = 23) of children ages B-24. METHODS: A core set of 12 messages and supporting materials were developed for parents of children ages B-24 based on previous research findings, current research evidence, and feeding guidance. Parents were individually interviewed using a semistructured script along with additional questions to rank perceptions of message qualities. MAIN OUTCOME MEASURES: Overall comprehension, importance, believability, ease of implementation, and likelihood of use of messages were assessed. STATISTICAL ANALYSIS PERFORMED: Data analysis included qualitative thematic analysis and descriptive statistics for Likert-scaled responses. RESULTS: Participants were primarily female, non-Hispanic White, with a mean age of 33.3 ± 6.8 years and at least a bachelor's degree. Overall, most messages were understood, believable, perceived as important, and feasible by parents. Messages related to starting solid foods, encouraging child control of intake and self-feeding, and food allergen guidance were perceived as more difficult and less likely to be implemented by parents. CONCLUSIONS: Additional research is needed to evaluate actual implementation of messages by diverse parents and resulting outcomes including impact on child weight.

Feeding Infants and Toddlers: A Qualitative Study to Determine Parental Education Needs.

Background: Limited evidence-based guidance is available to parents regarding optimal child feeding practices to prevent early childhood obesity from birth to 24 months of age (B-24). The objective of this qualitative study was to determine current child feeding practices, barriers to implementation, and educational needs of parents of varying socioeconomic backgrounds as it relates to responsive feeding to prevent early obesity in children of ages B-24. Methods: One-on-one interviews were conducted with parents (n = 66) of children ages B-24 from both low-and non-low-income households. Interviews were audiorecorded, transcribed verbatim, and analyzed with NVivo using classical qualitative analysis. Results: Participants were primarily female (91%), married (53%), low-income (59%), and were not first-time parents (72%). The results revealed overarching themes, including parents' reported need for information on preparing child meals, optimal dietary intake, affordable healthy foods, promoting child self-feeding, and food and nutrition knowledge. Low-income parents more frequently requested guidance about identifying affordable healthy options and overfeeding while non-low-income parents requested information about food allergens, transitioning to solids, and creating structured mealtimes. Conclusions: Additional and focused outreach to parents of children ages B-24 regarding optimal feeding practices is needed especially on topics related to complementary feeding during the transition to solid food.

Delayed presentation of uterine and bowel perforation following insertion of an intrauterine device.

INTRODUCTION: Insertion of intrauterine methods of contraception (IUC) carries an inherent but small risk of perforation of the uterus, usually quoted at 2 in 1000. If perforation occurs, it is usually discovered either when a patient presents with 'missing threads' or with an unplanned pregnancy. Rarely, if the IUC has perforated bowel, patients can present acutely unwell although this sometimes occurs years after insertion. Asymptomatic perforation of the bowel (with IUC insertion or otherwise) is not common. CASE HISTORY: In January 2018, a 41-year-old woman attended our community sexual and reproductive health service requesting removal of her intrauterine system (IUS). The clinic nurse performed this and during the consultation the patient revealed that several days earlier she had passed a previous 'lost' intrauterine device (IUD) when she opened her bowels. She came to believe this was an IUD inserted in 2006 that had been 'lost' and resulted in a pregnancy with her third child. We counselled her about her options and she had the IUS removed as she was worried this could happen again and opted to use condoms. CONCLUSION: This case reports an unusual presentation of a delayed and importantly 'silent' perforation of the uterus and bowel on insertion of IUC. The case highlights the importance of cross-specialty communication when an IUD has perforated or expelled resulting in a continuing pregnancy, so that appropriate imaging can be arranged following delivery of the baby.

Instruments assessing parental responsive feeding in children ages birth to 5 years: A systematic review.

Responsive feeding of young children has been identified as a protective factor against the development of childhood obesity. Instruments developed to assess responsive feeding by parents of children birth to 5 years of age over the past 17 years were reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Four electronic databases (PubMed, CINAHL, PsycINFO, and Scopus) were used to search for relevant articles to include at least one parental responsive feeding category (Food Rewards, Pressure to Eat, Parental Control of Intake, Emotional Feeding, or Responsiveness to Cues/Child Autonomy), development, validation, or reliability of the instrument, and evaluated in at least one child between ages birth to 5 years old. The final review included 33 individual responsive feeding related instruments. Risk of bias for each article was assessed using the Risk of Bias in Non-randomized Studies (ROBINS-I) assessment tool. Of the 15 instruments intended for birth to 2-year-olds and the 28 intended for 3- to 5-year-olds, only three instruments showed rigorous validation and reliability testing (Feeding Practices and Structure Questionnaire, Comprehensive Feeding Practices Questionnaire, and Family Food Behavior Survey). The most commonly reported psychometric testing was construct validity and internal reliability. There were limited instruments intended for young children (birth to 2 years), low-income, diverse racial and ethnic groups (Hispanic and non-Hispanic black), and fathers or other caregivers. The most frequently assessed feeding practices included Pressure to Eat, Parental Control, and Food Rewards, but none of the instruments assessed all aspects of responsive feeding. This review identified the need for more comprehensive instruments that measure all aspects of responsive feeding, the need for further testing in diverse populations, and further validity and reliability testing.