The Relationships of Maternal Perceptions, Psychosocial, and Sociodemographic Factors with Complementary Infant Feeding Practices

Abstract

Dissertation under the direction of Professor Sharon Karp Background: Complementary feeding practices (CFP) are the ways in which caregivers transition their infant from a diet consisting exclusively of milk, to one of diverse foods. There is evidence of a linkage between CFP and the development of food allergies. To prevent food allergies, professional guidelines recommend introducing the eight most common allergenic foods when an infant is around 6 months old. There is limited empiric information of caregiver practices of allergenic food introduction or how maternal characteristics influence their transitioning their infant solid foods. A better understanding of these relationships provides the foundation for developing interventions. Purpose: To explore maternal perceptions surrounding complementary feeding and the relationships of maternal perceptions, psychosocial, and sociodemographic factors with CFP. Methods: Two phase, mixed-methods, sequential exploratory design. English speaking mothers, 18-40 years old with an infant 6-19 months old, were recruited from across the United States through local health departments, online volunteer sites, and research networks. For phase one, qualitative methods utilized private, face-to-face interviews (n=27) and piloted a short survey. Findings led to refinement of the survey. Phase two was a cross-sectional, correlational design using the final online quantitative survey (n=354). Results: Three primary themes of perceived threats emerged: choking, pickiness, and allergic reaction to food. Within each theme were subthemes that represented strategic CFP mothers used to mitigate the perceived threat. A majority of mothers reported a perceived threat of allergic reaction to food (56.6%). The median number of allergenic foods introduced was five out of eight, and only 16% had introduced all eight foods. Less than half had introduced tree nuts (44%), soy (42%), and shellfish (34%). After controlling for personal, sociodemographic, and psychosocial variables, the main factors associated with a greater number of allergenic foods introduced were higher maternal education, primiparity (vs. multiparty), income ≥ $80,000 (vs. <$40,000), and breastfeeding ≥ 6 months (vs. <6 months). These factors were also associated with the likelihood of having introduced specific allergenic foods. Conclusion: The findings can be used by pediatric healthcare providers to guide anticipatory guidance with the parents of their patients. Findings also suggest opportunities for interventions and additional research.