Some of you know that I recently went back to school to get my doctoral degree. That is one of the reasons you are seeing sporadic posts from me. I thought I would share some of the information that I am learning as I research different topics in pediatric feeding. Last semester, for one of my classes, I did a mini project looking at common cultural feeding practices in Latino families.
There’s a growing Hispanic population in our country as well as in my home state of North Carolina. “Nearly one in four children in the United States is Hispanic. Furthermore, while 90% of Hispanic children were themselves born in the United States, more than half of the children have at least one parent who is an immigrant to the United States” (Gaffney et al., 2016). I work with many Latino and Hispanic families in my feeding clinic and have noticed some similarities in feeding practice. I realized that I didn’t know a lot about their feeding culture and wanted to know more. My hope was to learn about cultural feeding practice and even possibly cultural feeding in the setting of pediatric feeding disorders. Most of the research I found in Latino cultural feeding was tied to weight and obesity.
I chose three research studies to focus on.
Howe, T., Hinijosa, J., & Sheu, C. (2019). Latino-American Mothers’ Perspectives on Feeding Their Young Children: A Qualitative Study. The American Journal of Occupational Therapy, May/June, Vol. 73, No. 3.
This study by Howe et al., (2019) was a qualitative study and was my favorite because it most closely addressed my question. This study consisted of face-to-face interviews with 12 Latino American mothers living in New York City. Each mother was interviewed about their feeding perspective. Limitations of the study included a small sample size and all participants were from the same geographical area.
After analysis, four major themes emerged.
- “Grandma knows best”. This involved decisions about food progression and determining what foods and when to introduce them. Mothers stated that grandmothers were the person to seek advice from and also stated that they would ask the grandmother before a healthcare professional.
- “Always soup and always rice”. This involved looking at food choices and preparation of food. Common foods served were rice, potatoes, soup, beans and milk. There is a preference for homemade meals.
- “I want my children to be healthy” This involved beliefs about health and healthy food and maternal perceptions of a child’s weight. Authors stated that Hispanic mothers often preferred chubby babies as they equated this with healthier babies. Conversely, they felt skinnier children were unhealthy.
- “Mealtime is family time” This reflects the value of mealtime and the traditional Latino American emphasis on family.
Authors recommended that practitioners need to recognize cultural influences on feeding practices and to interpret feeding evaluations in context. Feeding intervention needs to take into consideration cultural influences and be sensitive to the families needs. Involve people who are involved in decision making about child feeding. Support cultural practices involving native foods, home cooked meals, and the family meal.
Gaffney, K.F., Brito, A.V., Kitsantas, P., & Kermer, D. A. (2016). Early Feeding Practices and Weight Status at One Year of Age: A Comparison of Hispanic Immigrant Mother-Infant Dyads with Participants of the Infant Feeding Practices Study II. Childhood Obesity. October, Vol. 12, No. 5.
This study looked at weight and feeding throughout the first year of life. Authors compared early feeding practices and weight status in a sample of low income Hispanic immigrant mothers with participants from an established data set called the Infant Feeding Practice Study. This study involved 2,050 participants, 26% in the Hispanic group and 73% in the Infant Feeding Study group. Analysis revealed differences in how milk was delivered in the first six months but no difference in how solid foods were introduced. The infants in the Hispanic group tended to be bottle and breast-fed early on while the Infant Feeding Scale Group tended to have more breast-feeding early on. The infants in the Hispanic group were also heavier at six and 12 months.
Researchers identified that the Hispanic mothers may not exclusively breast-feed due to feelings that the combination of breast and bottle keep babies full and to helped them return to work. Mixed method of feeding may also support the notion of a chubbier baby being more desirable. Authors also stated that economic factors may influence the use of formula that may be provided by government programs. Limitations to the study include mothers from the same geographical location and the inability to quantify milk and solid food volumes that the children were eating.
Houston, K., Waldrop, J., & McCarthy, R. (2011). Evidence to Guide Feeding Practice for Latino Children. The Journal for Nurse Practitioners. Vol. 7, No. 4, pg. 271-276.
The last study I included was a review study that identified 22 articles focusing on feeding practice in Latino children and provided an analysis with a resulting group of themes.
Themes that emerged:
- Prolonged bottle feeding – it can be common to delay bottle weaning and offer milk and sugary drinks in a bottle, on occasion up until age four. This can be associated with obesity, iron deficiency anemia and poor oral health.
- Preference for heavier babies.
- Extended family influence on feeding practice specifically grandmothers.
- Breast-feeding with formula supplementation – a preference for the combination of breast and bottle feeding from early on. The articles mentioned that “offering breast and bottle is giving the infant the best of both” and “occasionally mother’s feel that they infants can’t get everything they need from breastmilk”. Authors stated that expressing breastmilk is not a common practice in this cultural group. As families become more acculturated, there is an associated decrease in breast feeding with increasing demands to work.
- Influence of acculturation on the diet – In the US, fresh produce is expensive and fast food and high calorie snacks are often more affordable. Researchers discussed that socioeconomic status may influence feeding practice as well as food insecurity.
Authors stated “It is becoming increasingly necessary for providers to understand how to administer culturally and linguistically competent care to these patients and their families” (Houston et al., 2011). They recommended purposeful education regarding healthy feeding practices to families and to include extended family. They also mentioned that data shows that Latino parents with limited English are less likely to bring their children in for care. It’s important to address language barriers with the use of an interpreter and to provide materials written in Spanish.
In conclusion, there were similar themes represented in all three studies on cultural feeding practices. These included preference for a combination of bottle and breast-feeding, prolonged bottle feeding, family influence especially grandmothers on decisions regarding feeding, preference for formula, home-cooked meals, milk, rice and soup, and a preference for heavier babies.
By understanding, these cultural common practices we can improve healthcare delivery and effectiveness to our Hispanic and Latino families.
- Improve cultural sensitivity and effectiveness of feeding evaluation.
- By understanding the importance of certain foods in the family meal, we can make more sensitive and effective recommendations.
- Involve extended family in discussions so that we may have better carryover.
Lastly, there appears to be a lack of specific research on this subject and in particular a lack of quantitative research studies. The research I found did not separate the ethnic background of its participants which may be more informative. I was unable to find anything focusing specifically on Latino or Hispanic children with feeding disorders.
I would love to hear your thoughts on this topic!
Barbara Coven-Ellis says
In our area we have see patients from the Latino, Native American, and the Filipino populations. This information, particularly that grandmothers are relied upon over the advice of healthcare professionals, is very interesting and will definitely better inform my practice as I work with these families…
Thank you Krisi, for yet another wonderful post!
Barbara Coven-Ellis says
typo: should read: “In our area we regularly see…”
Krisi Brackett says
Hi Krisi Brackett,
Thank you for sharing this post about this important topic. I’m a Puerto Rican (born and raised) SLP, working in NYC in the Early Intervention Area. I would love to see more specific research in this area. As you mentioned, it is also important to look more into specific countries and backgrounds, since Latino and Hispanic communities are diverse. Some will look into what grandma says, but others (people of my generation) are looking for advice from specialized health professionals, such as, SLPs, lactation consultants, pediatricians and doulas. Also, I think the socioeconomic and educational levels will impact families decisions. For example: My friend’s baby (10 month-old) is eating home-made meals, not consuming processed foods, was breastfed exclusively for 6 months and now drinks both breastmilk and formula. The baby eats well, but she is skinny and active. I think my generation (I”m 32) is becoming more aware about weigh, healthy diets, obesity and getting professional advice.
When I was I child, I remember that eating more and gaining weight was considered healthy, but I’ve been skinny all my life, so my extended family would talk about my weight. My mother did not follow other peoples opinions and did not pressure me to eat. I remember using prolonged bottle (infrequently until 3 or 4) and sugary drinks, such as, Nestquik (OMG).
Krisi Brackett says
Thank you for sharing – I was surprised at the lack of research looking at this and there was nothing related to feeding disorders the I found.
Justine Alcocer says
Thanks so much for posting these studies. At least 90% of my OT caseload comprises Hispanic Pediatric feeding population, in California. I’ve made casual observations, but this inspires me to perhaps collect some data. I’m wondering what other questions some your readers may have regarding feeding disorders and Hispanic population?
Nannette Martin says
Thank you for this interesting post! I have not had much time these days to read research! In my experience, I definitely agree with the influence of the grandmothers. In fact, sometimes it can be an older aunt or sister but the point is that parents rely on the older generation for advice. I think we are providers have to take this into consideration and listen to the advice of the grandparent. I also agree that hispanic families feel that “heavier is healthier.” I would note that I find that hispanic parents are often very doting and concerned about their children’s happiness and well-being. This can impact their actions by not wanting to upset the child by offering a non-preferred food or taking the bottle away.
This is so great! Thank you so much for sharing! I would love to read more highlights from the literature you are reviewing!
This was very interesting. Do you know if there is any specific info or research on the Indian culture (not American Indian… those from India)