baby food research paper

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Baby foods: Quality, Safety, Technology, and Regulation

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Adequate feeding during early childhood is essential for ensuring healthy growth and development. Global recommendations for optimal infant feeding include exclusive breastfeeding for 6 months, but when it is not possible or insufficient, infant formulae are used to supply the nutritional demands of suckling ...

Keywords : Infants, childhood, health, infant formula, contamination, legislation

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Nestlé: A journey of research and innovation in the fight against allergies

• Carine Blanchard 0 ,
• Anette Järvi 1 ,
• Isabelle Cristiani 2 ,
• Frédéric Destaillats 3 ,
• Evelyn Spivey-Krobath 4 ,
• Marie-Claude Robert 5 ,
• Ryan Carvalho 6 &
• Ralf G. Heine 7

Société des Produits Nestlé S.A., Nestlé Research, P.O. Box 44, 1000 Lausanne 26, Switzerland

Produced by

Breast milk is perfectly composed to ensure that a child has the best start in life. Beyond the nutritional benefits, it has long been recognised that breastfeeding supports the infant’s protective immune response against common infections and reduces the risk of developing a range of non-communicable diseases, including allergic conditions. However, not all mothers are able to exclusively breastfeed their baby. For these mothers, access to formula with a nutrient and benefit profile inspired by breast milk is paramount.

Food allergies present a major global health problem that, according to the World Allergy Organization, affects an estimated 240-550 million people worldwide. The risk of developing allergies is strongly influenced by early life experiences. Delivery mode, breastfeeding, early complementary feeding practices and environmental exposures are perhaps the most important risk modifiers for food allergy in infants and young children.Nestlé’s experience of more than 30 years in the field of paediatric allergy research has resulted in multiple clinically proven innovations which have helped to improve allergy prevention and management. This has also improved the quality of life of infants and their families. Nestlé Research is leading the way by connecting strong internal expertise with scientists and clinicians from world-leading academic institutions. In addition, Nestlé has successfully partnered with several start-up companies who have developed novel technologies and products in the field of allergy.

Nestlé: a leader in specialised nutrition and allergy

Over the past decades, the rising prevalence of allergies stimulated Nestlé Research to develop novel clinical solutions. Nestlé’s first partially hydrolysed formula was pioneered in 1987 in response to the surge in allergies observed since the 1960s. A hydrolysed formula contains cow’s milk proteins that have been partially or extensively reduced in size 1 . Nestlé’s whey-based, partially hydrolysed formula (pHF-W) is the only clinically proven pHF-W with more than 20 publications demonstrating atopic dermatitis risk reduction 2 . The German Infant Nutritional Intervention Study (GINI), a large government-funded study on the prevention of allergic diseases in children, demonstrated that Nestlé’s pHF-W significantly reduced the risk of atopic dermatitis by up to 50% in the first year of life 3 .

Participants of the GINI study have now been followed for more than 15 years 4 . This study has generated essential insights into the long-term health effects of pHF-W, extending from early infancy to adult life. While the findings from the GINI Study have been confirmed by numerous investigators, some studies have reported conflicting findings, as summarized in a recent meta-analysis 5 . In this context, it should be emphasized that each pHF-W is unique regarding its peptide profile ( Fig. 1 ). This is likely to affect outcomes in clinical trials and a meta-analysis combining studies with different formulas and patient populations may miss beneficial effects of specific pHF-W products. When limiting the analysis to the Nestlé pHF-W, a peer-reviewed meta-analysis confirmed the abovementioned risk reduction for atopic dermatitis 2 . Today, its efficacy has been demonstrated in infants from different countries, independent of family risk for allergic disease6. Nestlé Research continues to investigate the different mechanisms of action that could further enable this benefit. The use of pHF-W in at risk infants who are not breastfed has been shown to be a cost-effective risk reduction strategy in various health care settings, when compared to feeding with formula made with intact cow’s milk proteins 7 .

Nestlé also has a long history of developing solutions for the nutritional management of cow’s milk protein allergy, with their first whey-based extensively hydrolysed formula (EHF) launched more than 30 years ago. Within the global Nestlé portfolio, there are two whey-based EHF. The first is a lactose-containing EHF suitable for the nutritional management of the majority of infants with cow’s milk protein allergy, and the second is a lactose-free EHF designed for milk-allergic infants with persistent gastrointestinal problems. Nestlé has used state-of-the-art technologies and science to develop these formulas, applying consistent and high-quality manufacturing 8 in order to safeguard efficacy ( Fig. 1 ). The manufacturing process is designed to minimise residual allergen content and to prevent external contamination with cow’s milk allergens. Moreover, all formulas have been tested in rigorous clinical trials to confirm their hypoallergenicity and ability to support normal infant growth 9 . More recently, Nestlé has added an amino acid-based formula to its range of hypoallergenic formulas which is indicated for infants with severe symptoms of cow’s milk protein allergy and which, by design, is devoid of any residual cow’s milk proteins or peptides.

Figure 1: Nestlé advances to deliver products for allergy risk reduction and management. Nestlé’s unique processes and technologies generate a partially hydrolysed formula indicated for the risk reduction of the atopic dermatitis in infants 2 , a hypoallergenic extensively hydrolysed formula 9 and an amino acid-based formula, for infants diagnosed with cow’s milk protein allergy.

Shaping the developing gut microbiome

The link between the commensal bacteria in our intestines (also known as the gut microbiome) and allergic diseases has been the focus of extensive research. Several studies have shown that infants delivered by Caesarean section or receiving antibiotics in early life have different gut microbiome compositions, and that these differences accompany a higher risk of developing allergies later in life 10 . This provides an opportunity to support the development of the microbiome in non-breastfed infants using probiotics (to deliver ‘good’ bacteria straight into the intestine), specific fibres or prebiotics (promoting the growth of beneficial bacteria). More recent studies investigating the relationship between microbiome, fibre and subsequent risk of allergies 11 have also demonstrated a role for postbiotics (bacterial metabolites, such as short chain fatty acids) in reducing allergic airway inflammation and supporting immune modulation. Postbiotics have since become an active field of study within Nestlé Research.

Human milk oligosaccharides are complex carbohydrates which are a major component of breast milk. Research done on the developing gut microbiome has shown that human milk oligosaccharides in breast milk confer a range of clinical benefits, including a reduced risk of respiratory and gastrointestinal infections, as well as positive effects on overall gut health and even brain development 12 . Nestlé has pioneered the addition of two human milk oligosaccharides in EHF and amino acid based formula. HMO supplementation has been shown to reduce respiratory tract infections in healthy infants 13 . Furthermore, early preclinical evidence has linked human milk oligosaccharides with enhanced tolerance following allergen challenges. Human milk oligosaccharides may thus stimulate the immune system and reduce the risk of food allergy 12 .

Early food allergen introduction

Emerging evidence suggests that exposure to dietary allergens in early life can reduce the risk of food allergies. The Learning Early About Peanut (LEAP) trial is a landmark investigation of early oral peanut exposure in high-risk infants 14 . In that study, introducing peanut into the diet of infants between 4 and 11 months of age reduced the prevalence of peanut allergy by 81%, compared to those who had strictly avoided peanut 14 . The emergence of baby food products containing one or multiple food allergens reflects a paradigm shift towards the early introduction of food allergens which is now part of many national and international prevention guidelines 15 .

Building on the research exploring early food allergen introduction, Nestlé has invested in Before Brands, a company that has pioneered products in this space. Their main product is designed to introduce the infant’s immune system to common food allergens in a baby-friendly format, as part of the complementary diet from 6 months of age 16 . Each serving contains a small amount of multiple food allergens which aim to prepare the infant’s immune system to tolerate a diverse diet. The use of this multi-allergen product reduces pressure on parents to introduce and maintain foods containing allergens in their infant’s diet, which in previous studies has been shown to be difficult to implement when following the allergy prevention guidelines 17 .

Oral immunotherapy for peanut allergy

Once a food allergy has been diagnosed, treatment relies on the strict dietary avoidance of the allergen. However, accidental exposure to food allergens, in particular to peanut, remains a significant problem. Oral immunotherapy is a novel treatment that aims to desensitize the patient (or prevent severe reactions) through gradual, repeated exposure to increasing amounts of a food allergen, such as peanut. Nestlé has recently acquired Aimmune Therapeutics, a California-based company that developed the only United States Food and Drug Administration-approved oral immunotherapy treatment for peanut allergy. Several studies have shown that desensitization is achieved in the majority of peanut-allergic patients, allowing them to tolerate at least two peanuts without experiencing significant allergic symptoms after accidental exposure 18 . This new treatment approach has global significance, since more than 1.6 million children and young people in the United States experience peanut allergy, with around one in five of these people needing to seek emergency treatment each year.

Advocating for science-based allergen labelling

Nestlé pledges in favour of science-based allergen labelling that is clear and trustworthy for consumers, and harmonised so that allergic consumers find the level of information that is relevant to their health and safety. This mission must be continuously supported by scientific advances in the domain of analytical method development, validation and standardisation, as well as by best-in-class allergen risk assessment 19 . As a result, allergen labelling is the visible tip of the iceberg underpinned by strong research and development.

Addressing unmet needs through cutting-edge science

Nestlé develops science-based products to address specific unmet needs of allergic patients. This extends from the ‘classic’ domain of cow’s milk protein allergy in infants to peanut allergy in older children, and even environmental allergies, such as cat allergy.

Innovation in the field of allergy can present in different ways, when considering Nestlé Purina research. Allergies to cats affect up to 1 in 5 adults worldwide. In many cases, this sadly leads to owners having to re-home their pets. After more than a decade of research, Nestlé Purina is the first and only company to develop a cat food that significantly reduces the major cat allergen Fel d1 on cat hair and dander 20 . This innovative cat food is safe for the cat and has the potential to improve the quality of life for both cats and their owners by allowing closer interactions that strengthen the pet–human relationship 20 .

Future innovations

Nestlé is committed to continuing its scientific leadership in the allergy field and to identifying innovative solutions with scientifically proven safety and efficacy in the prevention, management and treatment of allergies. Efforts to further enhance existing products and deliver future innovations are based on continuous research, particularly in the field of breast milk composition and its physiological benefits. A recent key innovation of Nestlé Research is the development of formulas supplemented with human milk oligosaccharides which modulate the gut microbiome and may enhance immune health 12 . Collaboration with academic groups to pursue the identification of infants at risk of developing allergies is another crucial element in Nestlé’s scientific strategy. Building on innovative solutions for allergy prevention and management, Nestlé is currently collaborating with several significant start-up companies to accelerate the translation of early-stage discoveries into commercial products that will benefit allergic individuals and their families.

More information is available on https://www.nestle.com/randd/research-development-organization

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A nervous parent's guide to starting your baby on solid foods

Andee Tagle

To ensure your baby is ready to eat solid food, check for these developmental markers: good head control, the ability to sit upright with minimal support, loss of the tongue thrust reflex and an interest in food. Lindsey Balbierz for NPR hide caption

To ensure your baby is ready to eat solid food, check for these developmental markers: good head control, the ability to sit upright with minimal support, loss of the tongue thrust reflex and an interest in food.

When Marina Chaparro's baby was 6 months old, she felt that her daughter was ready to start eating solid foods. But when Chaparro offered some to her, "she would not open her mouth. Wouldn't even pick up the food!" she says.

Eventually, her baby started eating bananas three weeks later. But it made Chaparro, who is a pediatric dietician, realize, "Wow — feeding kids is hard. I had questions. I had doubts. I just imagined what other parents who didn't have the knowledge I had were going through."

Introducing your baby to solid foods can be an anxiety-inducing experience. Parents may be unsure about what to feed their baby, how to feed them or how to deal with allergies and choking hazards.

The emotional roller coaster of being a new mom

But with a little preparation and patience, you can feed your baby with confidence — and even make it "a fun, enjoyable experience," says Dr. Amna Husain, a pediatrician based in South Carolina who shares baby and child health resources on her Instagram account.

She and Chaparro, who runs Nutrichicos , a kids' nutrition organization targeted to the Latino community, answer common questions on the topic.

When should I introduce solids to my baby?

Infants should be introduced to solid foods at about 6 months of age , according to the American Academy of Pediatrics. But don't just go by the calendar. Instead, look out for these developmental markers.

• Head control: Your baby should be able to hold their head upright and steady throughout the duration of a meal, about 15 minutes. 
• Sitting upright . Make sure your baby has enough trunk strength to sit up straight with minimal support to avoid choking. If you put them in a high chair and they immediately tilt over or slump down, it might not be time yet. 
• Loss of tongue thrust reflexes. "They stick out their tongue if something is introduced into their mouth before they're ready," says Husain. 
• Interest. "They might be curious about your food. They might open their mouth or follow it with their eyes" as you're eating, says Chaparro. 

What you need to know about preparing financially for a baby

What should i feed my baby.

Babies who have shown signs of readiness should eat small amounts of soft, nutritious foods throughout the day, about a tablespoon at a time . Think mashed fruits and veggies; ground meat, fish or poultry; and grains like porridge or fortified infant cereal.

The key at this stage is to introduce a wide range of foods, says Husain. It doesn't matter if it's homemade, store-bought or takeout. Encourage your baby to eat the foods of your culture. Chaparro, who is Latina, fed her baby beans and tortillas, for example. And experiment with spices (though, when it comes to salt, be mindful — the evidence is mixed on its effect on babies).

There are benefits to variety. A baby's first year of life is a small window of opportunity in which they are extra receptive to all types of flavors and textures, according to recent research . And when they try new foods, it pays off down the line. It may increase their willingness to eat fruits and veggies later in life and decrease their risk of developing food allergies.

How should I feed my baby?

The baby is in the high chair. They've got their bib on. You're ready to feed them. But err — how? Here are a few approaches, each with their own pros and cons.

I flew to Japan with my baby. Here's the travel advice that helped me survive the trip

There are pros and cons to baby-led weaning and spoon feeding. Here, three foods are prepared in each style. On the left, avocado, banana and cooked butternut squash are sliced for a 6-month-old baby who is baby-led weaning. On the right, the same foods are prepared as soft purees for spoon feeding. Lindsey Balbierz for NPR hide caption

Baby-led weaning

In this process, babies feed themselves whole pieces of soft foods, says Husain — like slices of banana or avocado or wedges of baked sweet potato.

It can be a messy process and lead to a lot of waste, Husain says. Your little one may be interested in squishing and throwing the food rather than chewing and swallowing it. And you're likely to see a lot more gagging earlier on (more about that later) since you're starting with whole pieces of food rather than easier-to-manage purees.

But there are upsides. Advocates say BLW can foster independent eating and discourage pickiness , says Husain. And it "can help with appetite control, especially because a child is feeding themselves," not getting spoon after spoon from a parent.

Spoon feeding

With spoon feeding, parents take control of the process. You choose what your baby eats (often a spoonable food like a puree, cereal or porridge), hold the spoon and bring it to the baby's mouth.

The upside is that your baby may eat more and waste less, says Husain. The downside is that it may take your baby longer to eat independently. And some studies have shown that babies who were introduced to textures later on were more likely to develop preferences for softer foods and displayed more pickiness.

Combo-feeding

As the name implies, this is a combination of spoon feeding purees and baby-led weaning hand-held foods. Mixing the two may lead to confusion for the baby, says Husain. When should they eat with their hands? When should they eat with a spoon?

Whichever approach you use, remember that there's no right way to feed your baby. Be responsive to their needs, follow their hunger and fullness cues and let your baby lead the way, says Chaparro.

When should I introduce potential allergens to my baby? And how?

This might come as a surprise, but research shows strong evidence that introducing common allergens like eggs, peanuts, tree nuts and shellfish as soon as your baby starts solids can reduce the risk of allergies. In fact, one landmark 2015 study showed that introducing even at-risk babies to peanuts early on reduced the risk of allergy by 81%.

Introduce allergens one at a time in small amounts. Solid Starts , an online resource and app, suggests an eighth of a teaspoon. You may want to mix an allergen, say, peanut butter, into other foods like applesauce. Offer it early in the day so you'll have time to spot or treat any reactions, says Chaparro.

Watch out for allergic reactions

Hives, rash, and itching are some of the most common mild reactions . Monitor for any changes on the skin, as well as scratching, hoarse cries or other unusual behavior that might suggest discomfort.

Keep your pediatrician's phone number nearby and some allergy medication in case of more severe reactions like vomiting or diarrhea.

If there's no immediate reaction, wait a few days before introducing a new food. That way, you can be sure which new food was safe or caused a reaction, says Chaparro.

Then keep offering those common allergens. Just because your baby didn't have a reaction the first time doesn't mean it can't happen the next time, says Chaparro. And regular exposure is important for maintaining tolerance .

How do I prevent my baby from choking?

Choking can happen at any time and with anything, even liquids. To set up for success, make your baby's eating practices as safe as possible.

"If you can smush it in your hand, it should be OK for those little gums to play with," says pediatrician Dr. Amna Husain. Avoid firm, round and slippery foods, like grapes, nuts and popcorn, which can get stuck in a young child's airway. Lindsey Balbierz for NPR hide caption

Serve 'smushable' foods

"If you can smush it in your hand, it should be OK for those little gums to play with," says Husain. Think avocados, oatmeal, shredded chicken, scrambled eggs and rice.

Avoid firm, round and slippery foods, like grapes, nuts, popcorn and hard candies, says Husain. These foods can get stuck in a young child's airway, which is "about the size of a drinking straw in diameter."

Gagging vs. choking

What do you do if your baby starts sputtering? First, understand the difference between a gag and a choke.

Gags are often noisy and accompanied by a cough. "Gagging can be very frightening. But when the child is coughing or gagging, [it means] something tried to tickle their airway in such a way that their airway and their larynx spasmed and led to the gagging, but their airway is intact. They are moving air in and out because they are coughing," says Husain.

If your child is gagging, stay calm so your little one doesn't panic. Let them work through it on their own. "Watch them, comfort them, offer them small sips [of water], but don't offer another bite of food. Let them take a minute to get their bearings," says Husain.

"Choking, on the other hand, is silent," says Husain. "There is something obstructing or impacting your child's airway, so there is no noise coming out of your child." In some cases, you may hear a high-pitched noise called a stridor . It's usually caused by an obstruction in or narrowing of the airway. And you may possibly see a very panicked look on your child's face.

If a baby is choking, the evidence-backed and proven method is to do back blows followed by chest blows on your child — and then, if they're unresponsive, proceed to call 911 and do CPR .

Beware of anti-choking devices

You might have seen anti-choking devices on commercials or social media. Husain says not to rely on them. They may create a false sense of security for parents. Her No. 1 advice? Take infant CPR or brush up on that class you took already. If you have a pamphlet on it, keep that next to baby's eating area.

How do I make mealtime fun for my baby?

Create a peaceful environment, says Husain. "If your child refuses to eat, don't force them. You don't want this to be stressful for them."

And remember, introducing solids to your baby is a journey. Savor the experience, says Chaparro, and remember that "food is about family, memories and love."

The digital story was written by Malaka Gharib and edited by Andee Tagle and Meghan Keane. The visual editor is Beck Harlan. We'd love to hear from you. Leave us a voicemail at 202-216-9823, or email us at [email protected].

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A Qualitative Study of Parental Perceptions of Baby Food Pouches: A Netnographic Analysis

Madeleine rowan.

1 Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand

Miranda Mirosa

2 Department of Food Science, University of Otago, Dunedin 9054, New Zealand

Anne-Louise M. Heath

Ioanna katiforis, rachael w. taylor.

3 Department of Medicine, University of Otago, Dunedin 9054, New Zealand

Sheila A. Skeaff

Associated data.

Data presented in this study can be obtained, upon reasonable request, from the corresponding author.

Globally, a recent phenomenon in complementary feeding is the use of squeezable baby food pouches. However, some health agencies have raised concerns about their possible long-term health effects. The aim of this study was to describe parental perceptions of the use of baby food pouches during complementary feeding (i.e., the transition from an entirely milk-based diet to solid foods) using a netnographic analysis of discussions on publicly available forums. In this study, the community was parents of young children. Six parenting forums were identified through a Google search using defined selection criteria. Discussion threads relating to baby food pouches were collected and imported into NVivo12 for thematic analysis via inductive reasoning. Perceptions of baby food pouches fell within two broad categories—benefits and concerns. The most commonly reported themes related to benefits were: convenience, health, baby enjoys, variety, and cost; whereas the most common concerns reported were: health, cost, lack of dietary exposure, dependence, and waste. Many parents reported both benefits and concerns. Once research has determined the long-term effect of using pouches on infants’ health regarding eating habits, nutritional status, growth, and development, the findings of this study can inform educational strategies to either encourage or discourage their use.

1. Introduction

Navigating complementary feeding, the transition from an entirely milk diet to solid food, can be daunting for parents. Many new challenges occur during this stage, leading parents to access advice on complementary feeding including what products to use, and how to provide their baby with food in a way that best suits the family’s lifestyle. A relatively recent phenomenon in complementary feeding is the increased use of squeezable baby food pouches. Globally, the unit sales of baby food pouches increased from 1.2 billion in 2015 to 2.2 billion in 2021 [ 1 ]. To date there is no research on the consumption of these food products. It has been proposed that parents or caregivers may choose to offer these squeeze pouches for convenience, ease of use, and to allow children to self-feed [ 2 ]. On the other hand, it has been suggested that feeding with squeeze pouches is an expensive alternative to making purées at home, and that food in pouches is less likely to provide the sensory experience of seeing, smelling, and touching new foods which may result in increased feeding difficulties [ 3 , 4 ]. To date, these questions have not been investigated in research studies, yet these opposing perspectives can make the use of pouches polarizing.

Today, parents can access online the type of information and support they would, in the past, have received from parents and friends [ 5 ]. A recent study reported that 94% of Australian parents with young children accessed the internet every day and 45% sourced parenting information from social networking sites (Facebook, Twitter, forums) [ 6 ]. Al-though virtual communities on social networking sites interact through the internet, they function very similarly to offline communities [ 7 ], however, in online spaces, parents can easily express their experiences and opinions with fewer inhibitions and greater honesty, due to the anonymity offered by the internet [ 8 ]. Given the accessibility and wealth of online parenting discussions now available, netnography, or online ethnography, is an innovative methodology which uses internet-based communications on social networking sites as a data source to understand a community [ 9 ] and to generate data about issues of relevance to parents, including food and nutrition [ 6 ]. Of note is the call by Ottrey et al. [ 10 ] to generate more ethnographic work within the field of nutrition. The aim of this study was to describe parental perceptions of the use of baby food pouches using thematic and content analysis of netnographic data from discussions on publicly available forums.

2. Materials and Methods

This was a netnographic study using internet-based communications on social networking sites as a data source to understand a community; in this study, the community was parents of young children. Discussion forums relevant to parents undertaking complementary feeding were found through a Google search. This search was refined to six websites from which 78 threads relating to squeezable baby food pouches were captured for thematic analysis using NVivo12.

To locate parenting discussion forums, the phrases “parenting forum”, “mum forum”, “motherhood discussion board”, and “motherhood forum” were typed into the commercial search engine Google. Advertisements were ignored, and the first 20 websites generated after each search were collected, resulting in a sample of 80 potential websites.

From the 80 potential websites, forums were included if they met the following criteria recommended by Kozinets [ 11 ]: (i) publicly available with no membership or password protection; (ii) the name of the website or description of the forum suggested it provided relevant discussions; (iii) discussions have been created within a timeframe relevant to the topic [ 12 ] written in English. To meet criterion (ii) discussions were identified for parents with children aged 6–24 months by forum titles such as “Babies: 0–12 months” or “introducing solids”; to meet criterion (iii) discussions between 2014 and 2019 were captured to align with the emergence of pouches. This refined the potential websites down to the six which were used for analysis. All forums contained a search engine where discussions threads were manually searched for using the key word “pouch”.

This study focused on archival data, which have been defined as comprising anything the researcher can gather from the web that is not a part of his or her involvement to create or prompt the creation of data, this constitutes a “cultural baseline” of the online community as it describes what is already occurring prior to researcher observation [ 11 ]. All data were collected between 26 November and 2 December 2019.

As there were insufficient data on the demographics of forum participants across the six websites, this information has not been reported. Other netnographic studies [ 8 ] have also not included demographic data due to anonymous online user profiles.

There is some debate in netnographic research around the ethical issue of informed consent [ 9 , 13 , 14 ]. The current study followed the protocol of Lynch [ 14 ] to only include public discussions using the following inclusion criteria: message boards were not required to have a membership, registration, sign-in, or a password; and the boards were publicly accessible through a popular internet search engine. This ensures that participants are aware that what they post is publicly available.

While the data collected in this study did contain personal opinions, these were not about controversial or sensitive topics that could result in harm for the participants if quoted. Despite this, the names of the forum websites and the members who participated in the forums captured for this study are not reported, ensuring no identifying information is provided. Members who participated in threads are quoted in this paper without any label even where pseudonyms were used. This is to protect all the participants, as Bruckman [ 15 ] suggests that pseudonyms function similarly to real names and should be treated with equal caution.

The entire webpage of the threads were captured into the software NVivo12 [ 16 ]. Consistent with the thematic analysis approach outlined by Braun and Clarke [ 17 ], the first phase of analysis began with data familiarisation by reading and re-reading all data items and making reflective notes. Following familiarisation, coding began [ 17 , 18 ]. Initially themes were created via inductive reasoning, at the point when there was only accumulation of existing themes and no new themes, theoretical saturation was reached [ 19 ]. Through cycles of refinement and grouping, a final coding scheme was created. Counts of themes in NVivo12 were used for content analysis. A first level theme is a main over-arching theme, second level themes are subthemes within first level themes, and third level themes are subthemes within second level themes [ 17 ].

The components of a forum include the original comment or query made under the title, followed by a series of comments in reply. The original comment and all those which follow make up the total thread, which gives an overall discussion. The total thread was not coded in its entirety because it usually contained a range of views. Instead, statements within individual comments were coded. Purely behavioural or emotive statements were not coded. For example, the first part of the quote “ I’ve never bought a pouch and I don’t really like them ” does not give any thematic insight. Rather, themes were identified based on the reason the parent provided for considering that baby food pouches provided benefit or were a concern. For example, the concern expressed in the following quote was coded into the theme “cost”: “I’ve never bought a pouch and I don’t really like them. A big reason is the cost! I just can’t justify it with all the other easy and cheaper options” .

All the data were collected and coded by the lead researcher (M.R). A second researcher (I.K.) independently coded 80% of the dataset, using the final coding scheme. A Cohens kappa value was calculated to establish inter-rater agreement. Across the discussion threads, there was almost perfect agreement between the raters (k = 0.92) [ 20 ].

Following the inclusion criteria recommended by Kozinets [ 9 ], 6 of the initial 80 forum websites were included in the final sample. There were 35 websites which did not include a forum aspect (news articles, journal articles, parenting websites) and 14 duplicates reducing the prospective sample to 31. Three websites were not written in English, 7 websites were password protected, 5 websites had not been active past the year 2014, and 12 websites did not relate to children at the stage of life of interest (6 to 24 months). Within the final 6 websites, 78 discussion threads were identified that were relevant to baby food pouches.

Table 1 summarizes the attitudes coded as “benefit” themes (only themes which were expressed at least 10 times are reported). A total of 22 benefit themes were identified through data analysis, 8 first level themes and 14 second or third level themes. Convenience was the theme related to benefits that appeared most often in the data, suggesting it may be a key determinant influencing use. It encompassed many time and effort considerations which are of importance to parents with young children. Health effects, such as the nutritional value, use while navigating allergies, and how much the baby enjoys having food in pouches were also reported by many parents to be benefits. Table 1 also summarizes the attitudes coded as “concern” themes (again, only themes which were expressed at least 10 times are reported). Seventeen concern themes were identified through thematic analysis with 9 being first level themes and 8 being second or third level themes. Benefits (i.e., 628 counts) were reported almost twice as often as concerns (i.e., 337 counts). Themes with <10 counts coded as benefits at first level included “less food waste” (8 counts) and “takes up less space” (7 counts), at second level was “great for allergies” (5 counts), and a third level was “more healthy than own foods” (4 counts). A concern about “allergic reaction” was a third level theme with 5 counts.

Parental attitudes regarding benefits and concerns of baby food pouch use across forum thread.

1 Themes are presented as follows; level one theme , under this are the level two themes, followed by level three themes. Not all level one themes had level two and level three themes. Only themes with ≥10 counts are included in this table. 2 Count is the number of times the theme was referenced across 78 forum threads.

The key finding of the thematic analysis was that there were a wide variety of perceptions of baby food pouches within the categories of benefits and concerns ( Table 2 ). It was clear from the analysis that parents were invested in the complementary feeding transition, and it seemed there were a range of influencing factors which resulted in more nuanced, rather than clearly divided, opinions. Many participants noted that they could see both benefits and concerns from the use of the pouches as this participant quote illustrates (coded as “Easier to feed fruit and vegetables” and “Dependence”): [what are your thoughts on pouches these days?] “Well, it’s the only way my kid would eat any fruits or vegetables for a long time. The pediatrician said, like all things, as long as they’re given in moderation. He’s finally opening up to real fruits and vegetables, so we are limiting the pouches more and more, but I don’t think they’re necessarily “bad” unless you’re giving them in place of more nutritious food.”

Categories, themes, and illustrative quotes related to parental perceptions of the use of squeezable baby food pouches via parenting discussion threads as identified by netnographic analysis 1 .

1 Themes are presented as follows; level one theme , under this are the level two themes, followed by level three themes. Not all level one themes had level two and level three themes. Only themes with ≥10 counts are included in this table.

Many parents were open to using the pouches in certain situations, especially when away from home, if they were short on time, or to encourage fruit and vegetable intake, but not many parents recommended using them as the sole source of food for an infant. Interestingly, the substantially higher counts for benefits compared to concerns suggests that the study population were, overall, in favour of the pouches.

4. Discussion

The goal of this netnographic study was to determine parental perceptions of the use of baby food pouches during complementary feeding. The key finding was that parents expressed a wide range of opinions regarding baby food pouches that fell under the broad categories of benefits and concerns. Interestingly, health and cost appeared as both a benefit and a concern to parents, whereas themes specific to benefits were convenience, baby enjoys, and variety, and those only appearing as a concern included lack of dietary exposure, dependence, and waste.

The finding that health was the predominant concern is in line with the limited previous research. The survey by Seaman et al. [ 21 ] on choice of weaning foods found that 30% of mothers with 18-month-old babies believed commercial infant food had low nutritional value with nearly half of these mothers stating that commercial infant foods had a high sugar content. Beauregard et al. [ 22 ] found squeeze pouches from 3 of the 5 food groups commercially available in the USA in 2015 were more likely to contain added sugars compared to other packaging types. In another USA study, Moding et al. [ 23 ] found that baby food pouches contained significantly more total sugar per serving compared to baby foods in jars, packs, and other containers (although not per 100 g). Interestingly, a recent study of infant baby pouches in New Zealand reported significantly higher median total sugar content for pouches than their non-pouch equivalents (per 100 g), but that, on average, squeeze pouches did not contain any free or added sugar [ 24 ]. As discussed in that paper, these findings depend on the definition of free or added sugars, as well as on the food supply. Regularly feeding an infant with high sugar pouches may increase the risk of overfeeding because of their palatability and result in excessive infant weight gain, which has been associated with an increased risk [ 12 ] of obesity later in life. The Nutrition Commission of the German Society for Pediatrics and Adolescent Medicine also expressed a concern about the increased risk of dental caries and their position paper discouraged the use of baby food pouches [ 25 ]. However, no research to date has reported on the impact of using baby food pouches on infant growth or dental health.

In the current study, thematic analysis suggested that a greater proportion of parental comments within these online communities were related to the benefits of using baby food pouches, than concerns. In particular, the most frequently expressed benefit for baby food pouches was convenience. Although studies have reported a negative reaction by some parents towards pre-prepared infant foods [ 26 ], increased use of commercial infant food is a consequence of limited time and resource constraints experienced by busy parents who often work and may have poor cooking skills [ 27 ]. About a decade ago, manufacturers of infant foods began to shift away from glass jars to plastic packaging and pouches [ 28 ]. For the manufacturer, plastic was easier and cheaper to transport because it weighs less than glass; furthermore, it does not break. For parents, pouches can also be heated in a microwave (although this is not recommended because of the potential for hot spots to develop than can cause burns), allow children to “self-feed”, and can be resealed if not completed in a single sitting (although it is recommended that food not eaten at the end of the meal that has come into contact with the infant’s mouth is thrown out) [ 29 ]. Given this, it is no wonder that the sales of these products are rising [ 2 ], and in many countries, pouches are the predominant form of packaged infant foods. Research is beginning to emerge that suggests parents may need to be more cautious about their use [ 22 ]; however, these findings are not necessarily unanimous [ 24 ], and there is not yet the necessary scientific evidence to discourage, or indeed promote, the use of baby food pouches. Studies should be undertaken to understand the reasons for the popularity of baby food pouches, with the current study demonstrating a range of views that would justify the expense of a large face-to-face study with families. Further research is also needed to ascertain the long-term effect of the use of pouches on the health of infants regarding eating habits, nutritional status, growth and development [ 30 ]. Given the range of attitudes of parents towards baby food pouches identified in this study, further qualitative research, using either individual interviews or focus groups, would be valuable to explore how parents negotiate their own attitudes towards baby food pouches with those of other parents, and health professionals.

Of interest to these authors was the relative lack of parental discussion about packaging concerns related to pouches. As the discussion of single use plastics is growing in other areas [ 31 ], it may be advisable that manufacturers use biodegradable plastics to avoid potential future negative feedback given concerns about sustainable food choices and climate change. It is surprising to note that some parents (5 counts) associated baby food pouches with less waste (i.e., a benefit) although there were considerably more parents (27 counts) who expressed a concern about waste. Interestingly, the waste-related benefits of pouches tended to be around food waste, while concerns were more around packaging; baby food pouches typically utilise multi-material multilayer packaging which is difficult to recycle [ 32 ].

Previous studies have noted other influences on baby food choice to include advertising and brand trustworthiness [ 21 , 30 ]. Many of the discussion threads in the present study did include brand names and talk around which products were the best to use but this was not included in the coding scheme of the present study because it did not provide much thematic insight as to the overall perception of the product. However, this could be an opportunity for future research to see if brand recognition and trustworthiness is an influencing factor for pouch use. The current research highlights three key strengths of netnography as a methodology. First, the method is unobtrusive and objective. Second, it allows researchers to exploit a freely accessible wealth of data to rapidly gather an understanding of a community’s baseline views [ 11 ]. Finally, at the time this research was undertaken, only a single netnography study in the field of nutrition and dietetics [ 14 ] had been published; the findings of both that study and the current study confirm that it is a method well suited to understanding parents views on feeding their children

The limitations of this study should also be noted. The extent to which this sample of online posts is representative of all parents is unknown. Although the socio-demographic characteristics and geographical location of the parents are not available, this information is less relevant for this type of analysis because social media is not bound by these limits. We purposefully chose websites any parent could access via the internet, both to post comments and to read other people’s comments. Parents could have commented on multiple websites; however, it was assumed they would express the same attitudes which would fall under the same theme or subtheme. In the current sample, only limited posts shared demographic information such as gender, age, and number of the children, while socioeconomic status and cultural background were never indicated. Additionally, parents who do not have strong opinions regarding pouches may not engage in these online forums.

5. Conclusions

The wide variety of ways in which parents in this study discussed the use of baby food pouches illustrates the complex and sometimes polarising perceptions towards this food product. There were several themes which fitted under the broad categories of benefits and concerns, with convenience seeming to be a primary determinant of use despite concerns about health. Further research is urgently needed in the area, particularly in light of rising sales of these products. Once research has determined the long-term effect of using pouches on infant’s health regarding eating habits, nutritional status, growth and development, the findings of this study can inform educational strategies to either encourage or discourage their use.

Funding Statement

M.R. completed this study as part of a University of Otago summer studentship.

Author Contributions

Conceptualization, M.M., A.-L.M.H. and S.A.S.; methodology, M.R., M.M., A.-L.M.H. and S.A.S.; formal analysis, M.R. and I.K.; data curation, S.A.S.; writing—original draft preparation, M.R.; writing—review and editing, M.R., M.M., A.-L.M.H., I.K., R.W.T. and S.A.S.; supervision, M.M., A.-L.M.H. and S.A.S. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

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