Role of Health Care Professionals Scale-Up Nutrition and Behavioral Education that Support Parents During Infant Feeding

Key messages:

• Infant nutritional advice from the internet, family and friends is not always adequate and of
good quality.
• Parents expect the Health Care Professionals (HCPs) they consult will provide individualized instructions on infant feeding.
• A prenatal visit to the pediatrician and after birth and frequent visits to HCPs during the first year of life are of fundamental importance in order to provide nutritional counseling.

The nutrition infants receive during their first 1000 days has a critical influence on their immediate and long-term physical and cognitive development. The first year of life is a
unique period in which parents or caregivers make essentially all dietary decisions on what and how to feed their infant.1 It is common practice for parents to seek advice online, from a wide variety of sources including relatives and friends. This can influence parents’ behavior and their nutrition decisions during the child’s first two years of life.
However, this lay information they receive is not always appropriate, or of adequate quality. Advice from family and friends is often contradictory to validated nutritional guidelines and based on family habits passed down from older generations. At the same
time, nutritional guidance for infants and young children found on many blogs - often of which are not managed by health professionals – can be based on ideas and opinions
with no scientific basis and often in conflict with recommended dietary practices.2

Parents expect Health Care Professionals (HCPs) to provide them with individualized instructions on infant feeding. However, studies indicate that many parents consider this nutritional counseling by HCPs to be inadequate, inconsistent, contradictory, or even
missing. This may be due to the short consultation times that health care professionals often have. It may also be that the health professional does not give due attention to the importance of nutritional questions parents have, or to the influence of cultural and
regional eating habits. They may even not fully understand the emotional impact of these questions on a parent, with all their anxieties about feeding their child correctly.

In particular, there are some actions that are essential from HCPs in guiding the mother and the family in their nutritional choices, including the critical support aimed at enabling and maintaining breastfeeding. A prenatal visit to the pediatrician offers the ideal opportunity to create a lasting personal relationship between parents and the pediatrician, one of the most important aspects in all ongoing pediatric care.3

After birth, frequent visits to HCPs during the first year of life are of fundamental importance in order to provide ongoing nutritional counseling in accordance with established guidelines and, above all, to guide and support successful continuation of breastfeeding or, in its absence, the use of appropriate infant formulas. It is noteworthy to observe the high frequency of use of whole cow milk as a substitute to breastfeeding based on family advice, and its negative consequences such as a high prevalence of iron deficiency anemia observed in infants.



Of major importance is also instruction on complementary nutrition as the child ages, aimed at ensuring the adequate intake of macro and micronutrients and avoidance of
possible dietary diffculties.5 Nutritional guidance by HCPs is thus of paramount importance in order to monitor and ensure growth and adequate cognitive development of the infant, and to establish healthy eating habits that will accompany the individual throughout life.

References
1. Dattilo, A. M.; Saavedra, J. M. Nutrition Education: Application of Theory and Strategies during the First 1,000 Days for Healthy Growth. Nestle Nutr Inst Workshop Series. 2019;92:1-18.
2. Cheney, A.M.; Nieri, T.; Davis, E.; Prologo, J.; Valencia, E.; Anderson, A.T.; Widaman, K.; Reaves, C.; Sullivan, G. The Sociocultural Factors Underlying Latina Mothers’ Infant
Feeding Practices. Glob. Qual. Nurs. Res. 2019. Feb 1;6:2333393618825253.zvv
3. Yogman M, Lavin A, Cohen G. The Prenatal Visit. Pediatrics. 2018;142(1):e20181218.
4. Morais, M.B.; Cardoso, A.L.; Lazarini, T.; Mosquera, E.M.B.; Mallozi, M.C. Habits and
attitudes of mothers of infants in relation to breastfeeding and artificial feeding in 11 brazilian cities. Rev. Paul. De Pediatr. 2017, 35(1):39-45.
5. Fewtrell M, Bronsky J, Campoy C, et al. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition
(ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2017;64(1):119-132.