forums such as Facebook groups, were approached and if they agreed, the recruitment poster (see Figure 1) was shared in order to advertise the study, along ...
PARENTAL SOURCES OF WEANING INFORMATION: AN IRISH PERSPECTIVE: Preliminary Results Sarah Scanlan1 , Marita Hennessey2, Annemarie E. Bennett3, Tracey Harrington1 1School
of Nursing & Human Sciences, Dublin City University, Ireland 2Heath Behaviour Change Research Group, School of Psychology, NUI Galway, Ireland 3School of Biological Sciences, Dublin Institute of Technology, Kevin Street, Dublin 8, Ireland
Introduction Background: Weaning, or the introduction of complementary foods (CF) is necessary for both nutritional and developmental reasons, and an important stage in the transition from milk feeding to family foods. The Health Service Executive (HSE) have adopted the WHO’s1 public health recommendation for infant feeding, and recommends exclusive breastfeeding for the first 6 months (26 weeks) followed by the introduction of CF alongside breast-feeding (3) but not before 17 weeks. These recommendations resulted from evidence that introducing CF before the end of the 3rd month is detrimental and places infants at risk of developing food allergies. Data suggest that early (≤3 months after birth), and possibly late (≥7 months after birth), introduction of gluten may be associated with an increased risk of coeliac disease (CD)2. The introduction of gluten is considered to have a role in causing type-1 diabetes (IDDM)3. Early weaning also increases the risk of obesity in later life4. Health professionals play an important role in the provision of evidence-based advice on weaning to parents. However, a recent Irish study investigating the weaning advice given by healthcare professionals (HCPs) to parents indicated varying levels of knowledge on weaning5. Parents, as a result, may be confused and may look for alternative sources for guidance. Aim: The aim of this study was to identify the main sources of weaning advice for parents and examine their understanding of weaning guidelines.
Materials and methods Design: The survey was approved and conducted in accordance with the ethical standards of Dublin City University Research and Ethics Committee. An on-line survey of parents living in Ireland was conducted. The survey was made available online (Qualtrics, Provo, UT). The survey had 54 questions with a number of responses, such as yes/no, multiple choices and Likert Scales. Different aspects of weaning were investigated, such as current understanding of weaning guidelines, factors that influenced the timing of weaning, methods of feeding i.e. breast or formula, sources of weaning information and demographic data. A number of sections were provided for additional comments. Data were analysed using Windows SPSS, version 24.0 and analysis is ongoing. Recruitment of sample: A self-selected sample of Irish parents was recruited. A number of Irish parenting support organisations and on-line forums such as Facebook groups, were approached and if they agreed, the recruitment poster (see Figure 1) was shared in order to advertise the study, along with the link to the electronic survey. The host organisations included, ‘Nothing but support’, Cuidiú Breastfeeding Support, Extended Breastfeeding’, ‘New Mums 2016/2017’ & Rollarcoaster.ie. Many more organisations were approached. The poster and the electronic link were also shared on Twitter, Facebook and LinkedIn. Eligible participants lived in Ireland and had recently weaned a child onto solids. The non-Ireland based participants and parents who have not yet weaned are excluded from analysis. Participation was voluntary, no incentives were offered. Data is anonymised. The survey takes approximately 15-20 minutes to complete. It was conducted over a two month period in December 2016.
Results :Survey response rate n= 824 Fully completed n=529 Approximately 99.5% respondents are child's mother, 60% were primiparous and the majority of respondents were Caucasian (99%) . Ranked in order of greatest sources of weaning information; 1) internet 2) books and magazines 3) friends with children 4) public health nurse and 5) own mother. Just 6 parents weaned onto solids prior to 17 weeks (1%) therefore majority of parents adhered to the HSE weaning guidelines, with 64% waiting until 26 weeks to wean.
Figure 2 . Sources of influence
Figure 3: Parents understanding of current weaning guidelines “A lot say phn (HCPs) guidelines are out of date and that you should wait until 26 wks before introducing solids but hse literature says to introduce solids between 4mo this and 6 months. There is lot of conflicting info out there regarding signs of being ready to wean versus growth spurt etc “ “my decision not to introduce solids until 26 weeks was heavily (positively) influenced by the bf and blw online communities, and my own subsequent research. I found there to be a lot of mixed messages from health care providers on introducing solids” “It is shocking that health nurses and even some doctors are advising solid food prior to 26weeks - the baby lead weaning approach should be advocated for more strongly” “Although I understand the current HSE guidelines are to introduce solids from 17 weeks (according to PHN) I prefer to go by the newer advice of 26 weeks and felt my baby was more able once she herself hit 27 weeks”
Figure 4: Examples of parents comments & feedback
Conclusions This study showed that parents are more likely to use the internet, followed by books and magazines as source of information in relation to weaning advice. While most were adhering to HSE recommendations, some parents expressed frustration regarding what they perceived was conflicting advice received from different HCPs. Parents appear to be confused by the 9-week "window" from 17-26 weeks for weaning. The results of this study suggest that parents may need clarification on the timing window as well as further education on signs of readiness that an infant can exhibit during this window, to ensure that a responsive feeding approach is taken. In order to gain parental trust, there is a need for consistent advice to be given to parents by all HCPs.
Acknowledgements Figure 1: Recruitment Poster
We would like to thank everyone who participated in the survey and those that helped distribute the link.
References 1. WHO, 2001. The optimal duration of exclusive breastfeeding." A systematic review. Geneva. 2. Agostoni, C., Decsi, T., Fewtrell, M., Goulet, O., Kolacek, S., Koletzko, B., Michaelsen, K.F., Moreno, L., Puntis, J., Rigo, J. and Shamir, R., 2008. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. Journal of pediatric gastroenterology and nutrition, 46(1), pp.99-110 Complementary Feeding: A Position Paper by the ESPGHAN Nutrition Committee. J Pediatr Gastroenterol Nutr. 2017; 64(1):119-132. 3. Guandalini, S., 2007. The influence of gluten: weaning recommendations for healthy children and children at risk for celiac disease. In Issues in Complementary Feeding (Vol. 60, pp. 139-155). Karger Publishers.. 4. Buchan, I.E., Heller, R.F., Clayton, P., Bundred, P.E. and Cole, T.J., 2005. Early life risk factors for obesity in childhood: early feeding is crucial target for preventing obesity in children. BMJ: British Medical Journal, 331(7514), p.453. 5. Allcutt, C. and Sweeney, M.R., 2010. An exploration of knowledge, attitudes and advice given by health professionals to parents in Ireland about the introduction of solid foods. A pilot study. BMC public health, 10(1), p.201.
