Factors influencing parental decisions on food choices during complementary feeding: a qualitative study in Uruguay

Understanding parental decision-making during complementary feeding is essential for designing effective interventions that address deviations from nutritional recommendations and support optimal growth and development. However, there is no consensus on the key factors shaping the characteristics of complementary feeding, particularly in Africa, Asia, and Latin America. In this context, the present work aimed to identify factors influencing parental decision-making on what foods to offer their child during complementary feeding in Uruguay, a Latin American country. Semi-structured interviews with 21 parents of children aged 6 to 15 months were conducted. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis, integrating inductive and deductive coding approaches. Several deviations from national and international complementary feeding recommendations were identified, including limited dietary diversity, focus on soft textures, delayed introduction of nutrient-dense foods like meat, and early introduction of ultra-processed dairy products high in sugar, such as yogurt and dairy desserts. A multifaceted range of factors influencing parental feeding practices during the complementary feeding period were identified. Health-related goals played a central role in parents' decisions about which foods to offer during complementary feeding. However, insecurity, misconceptions about food healthiness, fears of adverse health outcomes, and economic constraints often led to deviations from nutritional recommendations. In addition, parental decisions were also shaped by the external food environment and macro-level factors, such as the health system, childcare centers, and social norms. These findings underscore the need for comprehensive, multifaceted approaches to improve complementary feeding practices, extending beyond simply enhancing parental knowledge.