Lakshman R, Landsbaugh J R, Schiff A, Cohn S, Griffin S, Ong K K
MRC Epidemiology Unit, UKCRC Centre of Excellence in Diet and Activity Research, Cambridge, UK.
Child Care Health Dev. 2012 Sep;38(5):675-82. doi: 10.1111/j.1365-2214.2011.01283.x. Epub 2011 Jul 13.
Avoiding excess energy intake and rapid weight gain during infancy may be effective in preventing childhood obesity. We developed a programme for healthy growth and nutrition in formula milk-fed babies. The aim of this study was to understand users' perspectives about the programme and planned trial.
We conducted three focus group discussions (10 mothers) and nine individual interviews (seven health visitors, one midwife and one mother) discussing the programme materials and trial protocol. All sessions were transcribed verbatim and a thematic analysis was performed using the framework approach.
Mothers reported receiving conflicting messages about infant feeding and were keen for consistent advice. They welcomed the support that the programme would offer to mothers who gave their babies formula milk, but some were sceptical about the feasibility of limiting formula milk quantities. They suggested that recommended quantities should be presented as general guidelines rather than rigid rules. Some mothers said that it was too early to intervene to prevent obesity, that babies could not be overfed and that the risks of formula milk feeding had been exaggerated. Because of the routine advice to feed on demand, babies were fed in response to crying, and crying was equated with 'hunger'. Some mothers said that growth was genetically determined so they ignored the growth charts. Health visitors used the growth charts to assess adequate weight gain rather than to identify excess weight gain. Health visitors said that mothers would need a lot of education and support to limit formula milk quantities.
Efforts to prevent childhood obesity by avoiding excess weight gain during infancy have to address mothers' beliefs that babies cannot be overfed, that crying always signals hunger and that growth is determined by genes rather than nutrition. Mothers and healthcare providers have different motivations and understanding these are important in the development of any intervention.
在婴儿期避免能量摄入过多和体重快速增加可能对预防儿童肥胖有效。我们为配方奶喂养的婴儿制定了一项促进健康成长和营养的计划。本研究的目的是了解用户对该计划及计划中的试验的看法。
我们进行了三次焦点小组讨论（10位母亲）和九次个人访谈（7位健康访视员、1位助产士和1位母亲），讨论计划材料和试验方案。所有会议均逐字记录，并采用框架法进行主题分析。
母亲们表示在婴儿喂养方面收到了相互矛盾的信息，渴望得到一致的建议。她们欢迎该计划为给婴儿喂配方奶的母亲提供的支持，但一些人对限制配方奶量的可行性表示怀疑。她们建议推荐量应以一般指导原则而非严格规定的形式呈现。一些母亲表示，预防肥胖的干预为时过早，婴儿不会被喂得过饱，配方奶喂养的风险被夸大了。由于按需喂养的常规建议，婴儿因哭闹而被喂食，哭闹被等同于“饥饿”。一些母亲表示，生长由基因决定，所以她们忽略生长图表。健康访视员使用生长图表评估体重是否适度增加，而非识别体重增加过多的情况。健康访视员表示，母亲们需要大量教育和支持才能限制配方奶量。
通过避免婴儿期体重增加过多来预防儿童肥胖的努力必须解决母亲们的一些观念，即婴儿不会被喂得过饱、哭闹总是意味着饥饿以及生长由基因而非营养决定。母亲和医疗保健提供者有不同的动机，了解这些对于任何干预措施的制定都很重要。
