Analysis: a new programme is underway to support parents in developing healthy infant feeding practices

This week is World Breastfeeding Week (August 1st to 7th), an annual campaign aimed at promoting and supporting breastfeeding worldwide. The campaign is coordinated by the World Alliance for Breastfeeding Action (WABA), a global network of individuals and organisations dedicated to protecting, promoting and supporting breastfeeding. A key theme of WABA's World Breastfeeding Week campaign this year is empowering parents and helping to create an enabling environment where mothers can breastfeed optimally (as highlighted by its #WBW2019 slogan "Empower Parents, Enable Breastfeeding").

Having a new baby is an exciting time, but also potentially stressful. One aspect that can prove particularly challenging is infant feeding, an umbrella term that includes activities such as milk feeding (breastfeeding or formula feeding), solid foods introduction and responding to a baby’s feeding signals.

Healthy infant feeding is crucial to promote the health, well-being and proper growth and development of young children. The World Health Organization (WHO) and HSE recommend exclusive breastfeeding for the first six months to obtain maximum benefits, as breastmilk provides the optimum nutrients and energy that infants need in the first months of life.

From RTÉ One's Nine News, a 2017 report on how rates of breastfeeding rising steadily in Ireland

In terms of solid foods, the WHO and HSE recommend that parents start introducing nutritionally appropriate, healthy and safe solids to babies from six months onwards, alongside continued breastfeeding for up to two years or beyond. HSE guidelines advise parents not to introduce solid foods to babies before 17 weeks or after 26 weeks of age.

Increasingly, evidence suggests that breastfeeding and the appropriate introduction of solid foods are associated with both healthier infant growth patterns and preventing or reducing the risk of childhood obesity. Breast milk, for example, has a lower protein content than formula milk, therefore reducing the risk of rapid weight gain in infants. There is also mounting evidence that breast milk may have a positive effect on colonising infants’ microbiome, which is important for their growing immune system and metabolism, and may even predict later risk of obesity.

On the other hand, early introduction of solid foods may increase obesity risk in childhood, along with other conditions such as allergies, eczema, enteritis and unhealthy eating behaviours. Infant feeding represents an important piece of the larger puzzle of reducing obesity and overweight, and understanding this link is crucial given the rising rates of overweight/obesity among children and adults. In Ireland, as many as one in four children is now considered to be affected by obesity or overweight, and evidence suggests that these children are more likely to remain overweight/obese into adulthood.

From RTÉ Radio 1's Today with Miriam O'Callaghan show, Janis Morrissey, Health Promotion Manager with the Irish Heart Foundation and Professor Donal O'Shea, HSE Clinical Lead for Obesity, discuss how to tackle childhood obesity in schools

Identifying ways to improve early infant feeding practices and to support parents in this regard represents an important strategy therefore in efforts to address the rising incidence of childhood obesity and overweight. More broadly, establishing positive child feeding behaviours from an early age is crucial for children’s overall health and well-being, including healthy growth and development.

While there is increased recognition of this issue, we clearly have a considerable way to go. Estimates of the proportion of infants in Ireland who are exclusively breastfed at six months range from 15% to as low as 3.4% and 2.4%. This is compared to a global average of 38% and a European average of 25%, according to WHO World Health Statistics. Moreover, research indicates that many children in Ireland are not introduced to solid foods in line with formal guidelines. The Growing Up in Ireland results found that 13.5% of infants had been regularly taking solids at 12 to 16 weeks, increasing to 47% at 16 to 20 weeks.

To address this issue, a new interdisciplinary and cross-institutional initiative, funded by the Irish Health Research Board, called CHErIsH (Choosing Healthy Eating for Infant Health) has been established to help improve early infant feedings practices among parents in Ireland and, in turn, reduce the risk of child obesity and overweight.

From RTÉ Radio 1's Morning Ireland, Siobhan Hourigan, HSE National Breastfeeding Coordinator, discusses the launch of National Breastfeeding Week 2016 and why Ireland still has one of the lowest breastfeeding rates in the world

A novel aspect of CHErIsH is its focus on the transition from milk feeding to solid foods introduction. A further novel aspect of the programme is that it is to be delivered to parents/caregivers during infants’ routine vaccination visits, using the practitioner-parent contact as a time to potentially influence feeding practices and to offer support to parents or caregivers early on. 

CHErIsH comprises a multi-disciplinary team of researchers from UCC, NUI Galway and Trinity College Dublin in partnership with healthcare practitioners at the Mallow Primary Healthcare Centre (MPHC) in Co. Cork, the Nurture Programme and parents and primary caregivers from the CHErIsH public and patient involvement group. The research team consists of researchers from health psychology, developmental psychology, implementation science, public health, epidemiology, nutrition and health economics.

Based on their research, the CHErIsH team has developed and is currently piloting an approach to support parents or caregivers in infant feeding to be delivered by primary healthcare practitioners. This consists of verbally-delivered brief infant feeding messages, additional infant-feeding resources and a strategy to help practitioners deliver the programme. The parent-level messages address a range of issues related to early infant feeding, including guidance around appropriate milk feeding (exclusive breast milk or formula feeding until 6 months old); advice on the timing, frequency and type of solid foods introduced to babies; and advice on responsive feeding (learning and responding appropriately to your baby’s cues for hunger and being full). Results of the CHErIsH feasibility study will help to inform future development of the programme and to determine its viability for future roll-out to other primary healthcare centres across Ireland.

Identifying ways to establish positive child feeding habits from an early age should be an important part of any national strategy aimed at improving children's health and well-being

As with any nutritional advice, parents may struggle with conflicting information and misinformation in relation to their baby’s feeding, with significant knock-on effects. For example, lack of information on weaning is associated with earlier introduction of solid foods before the recommended time. The CHErIsH study acknowledges the importance of providing parents/caregivers with accurate, consistent and timely information from a trusted source. In line with WABA’s slogan, it aims to empower parents/caregivers by giving them accurate and consistent messages, along with additional materials to help reinforce these messages.

Early infant feeding represents a critical window where parents or caregivers can impact on the health and development of their baby, but also lower their risk of obesity and overweight in childhood and even into adulthood. Identifying ways to establish positive child feeding habits from an early age should therefore constitute an important part of any national strategy aimed at improving children’s health and well-being, including reducing their risk of obesity and overweight, viewed by the WHO as one of the most serious public health challenges of the 21st century.

Further information can be obtained from the CHErIsH or HSE websites

The views expressed here are those of the author and do not represent or reflect the views of RTÉ