Nutrition: health professionals can advise, but parents have the final say

If parents find advice from health professionals too dictatorial, it can put them off asking for help in the future

For Starters, a new report published by thinktank Demos on child nutrition, shows many parents are confused and anxious about healthy eating for their babies and toddlers.

A survey of more than 1,800 mothers of children aged 0-2, conducted for the report, found that one in five felt they had not received enough advice on breastfeeding; over a quarter of mothers wanted more advice about introducing solid food and a third wanted more information about toddler nutrition. Half of mothers also said they were unsure about appropriate portion sizes for their baby or toddler.

Demos’s research also found that health professionals are often a highly valued source of information and advice for parents on nutritional issues. Twenty-eight per cent of mothers would go to a health professional first for advice about feeding babies or toddlers (second only to friends and family, whom 33% of mothers would consult first). Thirty per cent also said that health professionals’ advice influenced their decision about when to start weaning their baby.

However, when we explored this subject in more detail with parents at four research workshops in Romford, Wigan, Knowsley and Gateshead, we found that parents’ relationships with health professionals were often quite complex.

In some cases if parents found the nutritional advice they were given to be too inflexible – or if it was delivered in a manner perceived as judgmental – this could be a barrier to the parent acting on the advice or seeking health professionals’ advice on nutrition in the future.

Breastfeeding was a particularly contentious issue for some of the mothers who participated in the research workshops. Mothers in each workshop spoke of feeling pressure to breastfeed from midwives and health visitors.

One mother also described a contrasting experience, in which she and her health visitor had fallen out because he recommended (against her wishes) that she should supplement breastfeeding her son with formula milk. She explained that this caused a loss of trust, so that she subsequently did not seek his advice on introducing solid food: «I didn’t really want to speak to my health visitor about anything because I didn’t really respect his opinion. So I was lucky that I did have friends and family I could talk to.»

Health visitors’ advice on the timing of introducing solid food was also perceived quite negatively by some parents.

One mother felt her health visitor reacted unnecessarily strongly when she introduced solid food to her baby before six months (against current Department of Health guidelines): «I didn’t really go to the health visitor after that for advice because they’d sort of told me off […] I felt like I’d sort of broken the law of six months only.»

Another mother simply ignored her health visitor’s advice because she felt it was too restrictive: «When I […] told her that I was giving two meals a day she said ‘she’s only five and a half months, you have to wait til she’s six months’. So I just carried on anyway.»

Nonetheless, For Starters shows that health professionals have a hugely important role in building parents’ confidence with breastfeeding and with introducing their children to a varied diet and establishing healthy feeding routines. Therefore, it is essential that health professionals who work with new parents (including GPs, midwives and health visitors) are able to give clear and consistent advice on nutrition for babies and toddlers.

To ensure that this is the case, health professionals need to have access to up-to-date, evidence-based information and training materials on early childhood nutrition. But perhaps most importantly, the advice that health professionals give to parents needs to be flexible enough to allow parents to exercise their own judgment.

If parents experience advice as too dictatorial, critical or (in some cases) confusing, this can damage their relationship with their doctor or health visitor, in some cases irreparably. Therefore it is not only the quality of the advice that is important, but the way in which it is delivered.

Put simply, health professionals need to recognise that while they may be the experts, it is parents who have the final say.