Health, nutrition and growth in infancy - a child health care perspective

Abstract Early childhood is recognised as a key period for the new family in which to promote health. There is evidence that infant feeding is one of the most influential factors affecting growth, development and life-long health. The aim of this thesis was to study infant food and feeding, as well as the impact of different feeding practices in infancy on early growth in childhood and, to explore parental views and considerations relating to child health. The Halland Health and Growth Study (H2GS) is a prospective, longitudinal, population-based, birth cohort study of 2666 infants in Halland, in south-western Sweden, between 1 October 2007 and 31 December 2008. A purposive sample of 16 parents was interviewed, after which the interviews were transcribed verbatim and analysed with content analysis. In the content analysis, six descriptive categories were identified: body and soul; parental behaviour; good enough parenting; interaction; growth; food and feeding issues. The parents perceived food and feeding issues as one of the most worrying aspects and a significant indicator of the concept of child health. With the parental desire to have a happy, contented child there is a risk of developing long-term, unhealthy feeding habits if and when the child is given something to eat in order to attain this state of mind. Almost a third (26.9%) reported breastfeeding problems, which is associated with early breastfeeding cessation. There was a significant correlation between breastfeeding problems and poor sucking technique and perceived poor weight gain. There was no association between breastfeeding or formula feeding at four months and a high BMI at 12 or 18 months. At six months, a positive correlation was found between gruel feeding and a high BMI at 12 and 18 months respectively. Many mothers breastfeed at six months (58.3%), but very few (1.6%) adhered to the recommendations of exclusive breastfeeding at six months. It was more common among parents with low education to choose milk cereal drink. The proportion of mothers not breastfeeding at four months was significantly associated with low neighbourhood purchasing power. After adjusting for maternal age, smoking and parental level of education, the corresponding odds ratio (1.63 (95% CI 1.07-2.56)) was significant and the trend across the strata was still evident. A multi-level analysis estimated that, in neighbourhoods where > 30% of the families had low purchasing power, 20% more mothers than expected, reported no breastfeeding at four months. Almost a third of the mothers reported breastfeeding problems, which can be prevented, but the timing is crucial. Further evidence that privileged mothers with high purchasing power are less likely to stop breastfeeding before four months was found. The neighbourhood purchasing power provided a spatial determinant of the number of mother’s breastfeeding at four months, which could be relevant when allocating resources for preventive measures. At six months very few mothers, 1.6% adhered to the recommendation on exclusive breastfeeding. None of the feeding habits during the first four months had any effect on a high BMI at 12 or 18 months of age. Milk cereal drink use at six months was a risk factor for a high BMI at 12 and 18 months. It was more common among parents with low education to choose milk cereal drink. The parents perceived food and feeding issues as important indicators of child health. These findings, suggest that a lack of responsiveness to parental beliefs and concerns may jeopardise the credibility of healthy infant diet messages.