Why are Mexican-American toddlers at high risk for prolonged bottle-feeding and iron deficiency?: A qualitative study

Background: Mexican-American toddlers (MATs) are the racial/ethnic group at greatest risk for prolonged bottle-feeding and iron deficiency (ID), yet little is known about reasons for prolonged bottle-feeding among MATs.

Objective: To assess infant feeding beliefs, knowledge, and practices among parents of MATs.

Methods: Parents of MATs 15-48 months old participated in 4 focus groups stratified by infant feeding practices (still vs. no longer bottle-feeding) and acculturation (less vs. more acculturated).

Results: The 24 focus group parents had a mean age of 28 years, and the mean child age was 2.5 years. Parents still bottle-feeding their children found weaning difficult (“he's totally used to the bottle”), lacked essential knowledge about infant feeding and ID (iron-rich foods for toddlers and adverse consequences of prolonged bottle-feeding), and distrusted physicians, whom they reported did not provide enough education. Low acculturation parents said toddlers drink more milk from the bottle than cup and should be bottle-fed until 3-4 years old. Parents no longer bottle-feeding their children (high and low acculturation) possessed fundamental knowledge about infant feeding practices and ID, including when and why to stop bottle-feeding and weaning by introducing the cup before 12 months; they reported physicians provided helpful advice. All parents supported educational interventions, including physician teaching, videos, brochures, and refrigerator magnet charts on when to stop bottle-feeding, weaning toddlers from the bottle, iron-rich foods, and adverse consequences of prolonged bottle-feeding.

Conclusions: Parents of MATs with prolonged bottle-feeding lack essential knowledge about infant feeding and ID. Low acculturation parents believe that toddlers should be bottle-fed until 3-4 years old. Parents no longer bottle-feeding their children possess fundamental knowledge about infant feeding and ID. All parents welcomed clinic-based educational interventions aimed at improving parental knowledge of healthy infant feeding practices and reducing prolonged bottle-feeding.