“Best” is not always best: Implications for early childhood nutrition messaging to pregnant women and mothers of infants

Theoretical Background and research questions/hypothesis:

Childhood obesity is a growing health concern in the United States with lifelong impacts. Behaviors to support optimal nutrition, including key nutrition practices during pregnancy and early childhood such as avoiding sugary drinks, breastfeeding, delaying solid food introduction until about 6 months of age, and encouraging responsive feeding, may help prevent childhood obesity (Hampl et al., 2023). The current study sought to uncover the behavioral determinants underlying early feeding practices of primary caregivers to inform messaging that motivates behaviors that support healthy childhood weight.

Methods:

Semi-structured interviews were conducted with low-income pregnant women (n = 8) and mothers of children aged 0-24 months (n = 27) who were not currently engaging in optimal nutrition behaviors. Interviews explored maternal health-focused decision-making for themselves and their child, including obstacles to consistently engaging in recommended health behaviors. Participants also provided feedback on messages designed to increase behaviors supportive of optimal nutrition (e.g., avoiding sugary drinks). Coding of interview transcripts was conducted by a primary and secondary coder utilizing a thematic coding strategy rooted in a behavioral determinant theoretical lens. Coding was conducted to identify participant comments and discussion of behaviors supportive or discouraging of optimal early nutrition that aligned with specific behavioral determinants.

Results:

Naming behaviors as “best” was off-putting to participants as it implied a singular path to child health that does not take into account mothers’ needs and experiences. “Breast is best” messaging invalidated the lived experience of mothers who were not able to breastfeed for reasons beyond their control and also made mothers who were able to breastfeed feel anxious if they feared they might not be able to adhere to this ideal behavior in the future.

Conclusions:

Researchers suggest replacing language that caused reactance in mothers – prescriptive advice, the injunctive “should” norm, and achievement-based verbiage – with inviting language that mothers identified as more helpful, such as tips and suggestions that address their needs, affirmations and encouragement when doing the desired behaviors, and a focus on the positive emotions evoked by their child’s milestones. Reframing early feeding practices in this way may decrease reactance to nutrition messaging and promote optimal nutrition behaviors among primary caregivers.

Implications for research and/or practice:

Findings have implications for future health-focused messaging campaigns aimed at pregnant women and mothers of young children and materials for pediatricians and other professionals who engage with and educate families around early feeding practices and optimal nutrition during pregnancy and through age 2. Presentation will include a broader discussion of methodology, implications for future research and implementation, and study limitations.