Determinants of complementary feeding practices – a qualitative study exploring mothers and fathers’ experiences in Canada

The complementary feeding period, defined as the introduction of solid foods alongside continued breastmilk and/or infant formula, is increasingly recognized as a critical window of opportunity for the healthy development of children. However, parental adherence to complementary feeding guidelines remains variable worldwide, and few studies have addressed the complex factors surrounding these practices, thus hindering the development of evidence-based interventions. The aim of this qualitative study was to gain a deeper understanding of the individual, interpersonal and environmental determinants of complementary feeding practices in Quebec, Canada. Twenty-four mother/father dyads (half first-time and half non-first-time parents) completed a phone-questionnaire to assess breastfeeding and complementary feeding practices. We then conducted semi-structured qualitative interviews based on the Socio-Ecological Model with each parent ( n = 48) when their child was 9 months. Descriptive statistics were performed for participants’ characteristics and feeding practices, and a directed content analysis was employed to identify salient determinants of complementary feeding. Most participants had a favorable socio-economic status (university degree and high income), and 42% identified as first or second-generation immigrants. The first complementary foods were introduced at a median age of 5.5 (IQR 1.0) months. Parents looked forward to creating pleasurable first experiences and were motivated by the health and development of their children. Whereas non-first-time parents tended to seek simplicity and practicality, first-time mothers particularly showed a strong adherence towards guidelines, some even expressing feelings of anxiety. Many mothers felt burdened by the mental workload associated with complementary feeding. Fathers typically adopted a supportive role and showed lower levels of confidence and knowledge towards CF introduction. Mothers tended to seek information and support from their close friends and sisters, online support groups and parent-baby activities. Although governmental resources were generally appreciated, guidance from in-person healthcare providers were often perceived as insufficient, and many sought information from social media and other non-governmental resources. This qualitative study is the first to identify individual, interpersonal and environmental determinants of complementary feeding practices in Quebec. Our findings provide an array of opportunities for the development of evidence-based interventions aiming to support parents during this period.