Immigrant parents' perspectives on healthy growth in children: a qualitative study

In many high-income countries, children with immigrant background exhibit a higher prevalence of obesity, compared to non-immigrant children. We explored the perspectives of immigrant-background parents regarding their children's healthy growth, feeding practices, physical activity, and factors supporting a healthy lifestyle.

We conducted in-depth interviews with 22 immigrant-background parents living in Southeastern Norway. These parents represented 8 countries of origin and varied widely in terms of length of residence in Norway and educational attainment. The age of their children varied from 3 months to 40 years. Interviews were audiotaped, transcribed verbatim and analysed using a thematic approach.

Many informants expressed deep concern about their infants being too small, viewing chubbiness in babies as a sign of health, wealth, and good parenting. Parents and grandparents often encouraged children to eat and fed them by spoon or hand, sometimes well beyond school age. Feeding older children was described as a cultural expression of love and care. While parents recognized the importance of physical activity, high cost of organized sports was a significant barrier. Girls were generally allowed to participate in sports, provided they could wear culturally appropriate sportswear. Parents of children aged 1-5 expressed strong trust in kindergartens to promote healthy lifestyles and saw these institutions as important sources of information about nutrition and physical activity. Building trust in healthcare professionals was often a gradual process. Some parents reported conflicts between professional health advice and views held by family members or social networks. Parents expressed a need for culturally adapted oral and written information, including online resources in their native languages, and access to interpreters and bilingual community leaders. All parents emphasized the need for lower food prices and the provision of daily healthy meals in kindergartens and schools.

Public health strategies aimed at preventing childhood obesity should be tailored to the specific needs of immigrant families. These strategies might include strengthening the role of kindergartens and schools in providing healthy environments; encouraging collaboration between health and education professionals to address perceptions of healthy child appearance and potentially unfavourable feeding practices; and improving access to organized physical activities by offering financial support and allowing girls to wear culturally adapted sportswear.