Abstract
There is no routine data collection in the UK on infant dietary diversity during the transition to solid foods, and health visitors (HVs) (nurses or midwives with specialist training in children and family health) have the potential to play a key role in nutrition surveillance. We aimed to assess items for inclusion in routine data collection, their suitability for collecting informative data, and acceptability among HVs. A mixed-methods study was undertaken using: (i) an online survey testing potential questionnaire items among parents/caregivers, (ii) questionnaire redevelopment in collaboration with community staff, and (iii) a survey pilot by HVs followed by qualitative data collection. Preliminary online questionnaires (n = 122) were collected to identify useful items on dietary diversity. Items on repeated exposure to foods, aversive feeding behaviors, flavor categories, and sugar intake were selected to correspond to nutrition recommendations, and be compatible with electronic records via tablet. HVs surveyed 187 parents of infants aged 12 months. Semi-structured interviews indicated that HVs found the questionnaire comparable with standard nutrition conversations, which prompted helpful discussions, but questions on eating behavior did not prompt such useful discussions and, in some cases, caused confusion about what was ‘normal.’ Lack of time among HVs, internet connectivity issues, and fear of losing rapport with parents were barriers to completing electronic questionnaires, with 91% submitted by paper. Routine nutrition data collection via child health records seems feasible and could inform quality improvement projects.
Highlights
The transition to solid feeding is an important aspect of development during infancy.Recommendations advise exclusive breastfeeding for the first six months of life, which is followed by increased nutrient density by introducing complementary solid foods [1,2]
An online survey of parents of infants aged 9–15 months, investigating milk and complementary feeding practices, the results of which we used to assess the use of individual survey items in generating valid and useful information related to adherence of formal recommendations
Development of a second more succinct and appropriate questionnaire using results from stage (a), in addition to stakeholder consultation, to be compatible with the electronic record system, which is used in the field by health visitors (HVs) teams
Summary
The transition to solid feeding is an important aspect of development during infancy.Recommendations advise exclusive breastfeeding for the first six months of life, which is followed by increased nutrient density by introducing complementary solid foods [1,2]. During the complementary feeding period, increasing the variety of foods and textures is important for healthy growth and to set the foundations for food preferences and healthy eating later in life [3,4]. It has been documented in the literature that parents/caregivers find the complementary feeding period challenging to navigate [5,6]. Health visitors have been identified for their key role in providing infant feeding advice as relied upon by parents/caregivers [7,8] and for their potential to encourage appropriate feeding for preventing obesity [9]. A health visitor (HV) is a qualified nurse (or midwife) who has completed specialist
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