Preventing Childhood Obesity : From feeding pratices to dietary recommendations
Providing information to promote introduction and acceptance of food of varied textures during complementary feeding
It is well known that dietary experiences during the period of complementary feeding play a role in shaping later eating habits and that fostering food acceptance before the onset of food neophobia is a way of leveraging the development of healthier eating habits (Schwartz, 2018). Complementary feeding is a key period of food discovery for infants that is punctuated by several food transitions. It involves a gradual introduction of foods from different groups (when nutritional needs cannot be fully covered by breast milk or infant formula alone) along with a gradual transition in terms of food texture. Exposing infants to a variety of textured foods during this period may help them learn how to orally process solid foods and subsequently increase their acceptance for these foods. In France, there is evidence showing that parents tend to introduce food textures rather late in their child’s diet because of the fear of choking (Marduel Boulanger, 2018; Demonteil, 2018; Schwartz, 2013) but also due to a lack of information to support them during complementary feeding (INPES, 2005; Schwartz, 2011). However, observation of infant’s acceptance of food textures at the laboratory reveals than often, infants are able to swallow foods at an earlier age than proposed by their parents (Demonteil, 2019)
Based on these findings, a pilot intervention was developed to provide parents living in France with more information about the introduction of a variety of food textures into their child’s diet between 8 and 15 months. The effect on children’s experience with and acceptance of textured foods was studied. This is the first study to develop precise information on texture introduction (why, how and what), a topic that was not addressed in the national French guidelines at that time.
Providing advice and regular counselling are effective to promote introduction of small/soft food pieces
The introduction of food textures was highly impacted by the 7-month intervention. Indeed, parents who received advice and regular counselling about complementary feeding (Intervention Group “IG”) provided a significantly higher global exposure score to texture to their infant than those who did not (Control Group “CG”).
At texture levels, they were significantly more likely to introduce more soft/small food pieces but not more complex textures that are more challenging (hard/large pieces). This absence of effect could be explained by the fact that children were already well advanced in their transition towards family foods.
Independent of their study group (IG or CG), children’s exposure to texture was associated with birth order, self-feeding with fingers, low gagging frequency and seldom use of commercial baby foods.
Higher acceptance was associated with higher exposure to food pieces and specific eating behavioural traits
Concerning the food acceptance outcome, there was no significant difference in children acceptance for any of the textured foods offered in the laboratory between both groups.
However, a higher acceptance in both groups was associated with higher exposure to food pieces but not to pureed foods (either smooth or rough) and with children’s eating behavioural traits (high food enjoyment, high food responsiveness and low food fussiness).
A pilot study that provided a solid framework for future exploration
This pilot study provides a solid framework as the laboratory setting for evaluating texture acceptance allowed a standardization of the evaluation procedure among all children, but also thanks to the large number of foods of different textural properties studied.
Although findings demonstrated that providing information can be effective in promoting the introduction of small and soft food pieces, the most effective way to encourage the introduction of more challenging textures (hard pieces and double texture) is not clear. Thus, future work should focus on the further identification of the barriers to piece introduction among French mothers and on how building on the knowledge of this pilot study for a future population-based public health intervention.
Based on: Tournier C, et al. Fostering infant food texture acceptance: A pilot intervention promoting food texture introduction between 8 and 15 months. Appetite. 2021 ;158 :104989.
- The study is a pilot intervention with a prospective follow-up of children between 8 and 15 months old.
- Infants were enrolled at 7.5 months old.
- 2 lab sessions organized at 8 months (measurement before intervention)
- 60 parent/child dyads were randomly assigned to a control group (CG) and an intervention group (IG)
- CG received recommendations and individual counselling on food texture (advice, tips)
- IG only received available information on Complementary feeding
- Parents completed self-report measures about the introduction of 188 food items, including purees, soft/small pieces, hard/large pieces and double textures.
- 2 lab sessions organized at 15 months (end of the intervention period) + a debrief interview
- Providing information about the introduction of a variety of food texture during complementary feeding for French parents results in an increase in parents’ introduction of small/soft pieces but not on the introduction of more complex textures.
- A higher exposure to food textures was associated with a better acceptance of foods.
- Acceptance is higher in children reported as enjoying food, food responsive and less fussy.
- The most effective way to encourage the introduction of more challenging textures is not clear.
- Child readiness to accept food textures should be defined for parents.
- Future work is needed to identify the barriers to pieces introduction among French mothers.