Appetite 57 (2011) 816–825

Research report

Vegetables by stealth. An exploratory study investigating the introduction ofvegetables in the weaning period

Samantha J. Caton *, Sara M. Ahern, Marion M. Hetherington

University of Leeds, Institute of Psychological Sciences, United Kingdom

A R T I C L E I N F O

Article history:

Received 22 February 2011

Accepted 22 May 2011

Available online 27 May 2011

Keywords:

Infant feeding

Weaning

Vegetable intake

Appetite

A B S T R A C T

Few studies have examined in detail weaning practices and how mothers introduce vegetables into the

diets of their infants. The current exploratory study set out to use both qualitative and quantitative

methods to investigate approaches to nutrition in the weaning period and in early infancy with a

particular focus on vegetables. 75 mothers of infants aged 24–72 weeks filled out a postal questionnaire

regarding infant feeding during the weaning period. Mothers completed the infant feeding questionnaire

(IFQ) and a food frequency questionnaire (FFQ) to measure familial fruit and vegetable intake. Mothers

introduced solid food to their infants at around 20 weeks of age and those who breast-fed their infants

tended to introduce solid foods later compared to formula feeding mothers (21 wks versus 17.8 wks,

p < 0.05). Infants were offered around 3 different types of vegetable during the first 4 weeks of weaning.

13 mothers then took part in a follow-up in-depth interview. Mothers reported that they relied upon

advice from family and friends and their interpretation of cues from their infants indicating the readiness

for food, rather than relying on official guidelines. Mothers demonstrated high concern about the

nutrient quality of their child’s diet and perceived vegetables to be an integral part of the diet. A number

of strategies for promoting vegetable intake were identified by mothers, offering vegetables by stealth

was one of the most commonly identified strategies.

� 2011 Published by Elsevier Ltd.

Contents lists available at ScienceDirect

Appetite

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Introduction

A child’s early experience with food has the capacity toinfluence their taste development and food preferences rightthrough in to adulthood. An infant’s earliest experience with avariety of tastes has been demonstrated to occur in utero via theflavours ingested by the mother. This chemical continuity followsthrough in to the post-natal period whereby flavours are passedthrough to the infant through breast milk (Mennella & Beauchamp,1997; Mennella, Jagnow, & Beauchamp, 2001). However, aninfant’s very first experience with solid food occurs in the weaningperiod following the cessation of a milk only diet. The currentrecommendation in the UK is that the introduction of solid foodsshould be delayed until the infant reaches 24 weeks of age andcertainly no foods should be introduced before 16 weeks(Department of Health, 2008; World Health Organisation, 2003).Mothers are also advised to breast feed their infants exclusivelyuntil they are six months of age. Despite this advice, research hasdemonstrated a wide disparity between officially sanctionedrecommendations and what is actually practiced by mothers(Anderson et al., 2001). Weaning earlier than 6 months is very

* Corresponding author.

E-mail address: s.caton@leeds.ac.uk (S.J. Caton).

0195-6663/$ – see front matter � 2011 Published by Elsevier Ltd.

doi:10.1016/j.appet.2011.05.319

common in the UK. Savage, Reilly, Edwards and Durnin (1998)reported two major reasons why mothers weaned their infantsearly; these included the perception of the child not being satisfiedwith just milk and because babies were not sleeping throughoutthe night (Alder et al., 2004; Anderson et al., 2001; Harris, 1988;Rosen, 2008; Savage et al., 1998; White, 2009). Additionallymothers report that they ‘‘know best’’ as revealed by Alder et al.(2004). Readiness for solid foods is related to the individual babyand might occur at different ages for different infants (Alder et al.,2004). However, there is evidence that early introduction of solidfoods is linked to rapid infant weight gain (Sloan, Gildea, Stewart,Sneddon, & Iwaniec, 2008) and increased body fat duringchildhood (Forsyth, Ogston, Clark, Florey, & Howie, 1993; Wilsonet al., 1998). Rapid infant weight gain has also been linked toincreased risk of obesity in childhood and adulthood (Baird et al.,2005; Ong et al., 2006).

Despite the purported detrimental effects of early weaning onthe development of overweight or obesity, early weaning mayindeed have an associated benefit. The ‘‘sensitive period’’hypothesis (Harris, 1993) describes how between the ages of 4and 6 months infants are more likely to accept a wider range ofdifferent foods and that this willingness to eat a varied diet tracksinto later years. Infants who are offered a wide variety ofvegetables in the weaning period are more likely to accept novelfoods (Maier, Chabanet, Schaal, Leathwood, & Issanchou, 2008)

Table 1Postal questionnaire participant demographics (n = 75, means� SEM).

Mean� (SEM) Range

Maternal age (years) 30.47 (0.6) 16–41

Maternal BMI (kg/m2) 24.57 (4.2) 19.7–44.5

School leaving age (years) 18.31 (0.3) 15–26

Parity 1.67 (0.1) 1–4

Birth weight (g) 3474.6 (62.5) 1980–4564

Age of child at the time of

the questionnaire (weeks)

61.47 (1.7) 32–94

Table 2Interviewee demographics (n = 13, means� SEM).

Mean� (SEM) Range

Maternal age (years) 28.5 (1.2) 20–36

Maternal BMI (kg/m2) 24.6 (1.4) 19.2–38

School leaving age (years) 17.3 (0.5) 15–21

Parity 1.7 (0.3) 1–4

Birth weight (g) 3498.3 (161.2) 2495–4564

Age of child at the time of

the questionnaire (weeks)

58.4 (4.2) 34–76

S.J. Caton et al. / Appetite 57 (2011) 816–825 817

increasing their food repertoire. Nicklaus, Boggio, Chabanet, andIssanchou (2005) conducted a longitudinal study where by theyexamined children’s food preferences at age 2–3 years old andfollowed the participants in to early adulthood. Their resultsdemonstrate that variety seeking at age 2–3 years predictedvariety seeking until early adult life, highlighting the importance ofestablishing a varied food intake in early infancy.

In the UK children (Gregory and Lowe, 2000) as well as adults(Henderson, Gregory, & Swan, 2002) are not consuming therecommended five or more portions a day of fruit and vegetables(DOH, 2003). A diet rich in plant sources confers benefits to theconsumer including the prevention of chronic diseases in later life(Jew, AbuMweis, & Jones, 2009). In addition to their high nutrientquality, vegetables are also low in energy density (kcal/g) andwhen consumed as part of the habitual diet in the recommendedamounts, they might also serve to prevent the development ofoverweight and obesity in children. However, it is clear from manyof the papers in this issue vegetables are often disliked by children(Cooke & Wardle, 2005) making them difficult to incorporate in tothe diet. Liking and consumption of vegetables in infants andchildren is governed by a number of factors including exposure to avariety of vegetables during the weaning period and beyond(Mennella, Nicklaus, Jagolino, & Yourshaw, 2008; Sullivan & Birch,1994) and the family/maternal diet (Jones, Steer, Rogers, &Emmett, 2010). It has been shown that repeated and frequentexposure increases liking for vegetables (see Nicklaus this issue),however, parents tend to offer tastes of vegetables far fewer thanthe recommended 8–10 times. In addition to repeated exposurethere are also a number of techniques that can be used to attemptto promote vegetable intake in children, such as modelling ofsignificant others (Birch & Fisher, 1998; Savage, Fisher, & Birch,2007), making the food appeal visually (Jansen, Mulkens, & Jansen,2010; Houston-Price et al., 2009a; Houston-Price, Butler, & Shiba,2009b) and via the classical learning paradigms of flavour-nutrient(Zeinstra, Koelen, Kok, & de Graaf, 2009) and flavour-flavourlearning (Havermans & Jansen, 2007).

Overall, there is advice to wean infants at around 6 months oflife, there is encouragement to consume a diet which is rich infruits and vegetables, but vegetables are generally disliked. Theremay be a period early in the weaning period which presents anoptimal window for exposing babies to vegetable flavours, butparents who are convinced that their child dislikes vegetables maybe unwilling to persist in presenting infants with sufficientquantities and variety of vegetables to increase their liking andacceptance. How then do parents decide when to wean, what togive to their infants and what strategies do they use to encouragevegetable intake during the early development of food prefer-ences? The present study set out to address these questions usingboth questionnaire and in-depth interview techniques. The mainaim of the research was to explore parental feeding practicesrelative to official recommendations and to discover the ways bywhich parents encourage their children to like and to consumevegetables.

Methods

Participants

A sample of 220 families was contacted via SureStart (Hoyland,Barnsley, South Yorkshire, UK) with a postal questionnaire.SureStart children’s centres are government funded and provideintegrated information and services for all children under 5 andtheir families to ensure that each child get the best start in life. Allthe families contacted were identified as having an infant agedbetween six and eighteen months old at the time the questionnairewas sent out. A total of 75 mothers completed and returned the

postal questionnaire (Table 1, BMI from self-reported height andweight). Following the postal questionnaire 13 parents andcaregivers were then contacted to take part in a follow-upinterview (Table 2). Interviewees were randomly selected from alist of those who had returned the postal questionnaire. Allparticipants who filled out the questionnaires agreed to becontacted to take part in interviews.

Materials

Postal questionnaire

Based on current literature and a broad range of exploratoryresearch questions, a number of open and closed questions weregenerated in order to investigate several aspects of weaning andearly infant food intake. Participants were asked to reportgeneral demographic information including height, weight,school leaving age and parity. They were then asked a seriesof questions relating to their infant, who was between the agesof 6 and 18 months. Participants were asked questions aboutmilk feeding, age of introduction of solid foods, age ofintroduction of specific food items and to provide examples ofthe types of foods given during the first month of weaning.These were then used as an indication of the number of differentfruits and vegetables offered to the infant. Each different fruit orvegetable named as an example was scored and summed overthe first two-week period of weaning and the first month ofweaning for each infant.

Infant feeding questionnaire

The infant feeding questionnaire (Baughcum et al., 2001) is avalidated tool containing 20 items about maternal feedingpractices during the first year which might be related to the riskof development of childhood obesity. Each item has a 5-point scaleranging from 0 for ‘‘never’’/‘‘disagree a lot’’ to 5 for ‘‘always’’/‘‘agreea lot’’. The IFQ measures 7 factors; (1) concerns about the infantundereating or becoming underweight, (2) concern about theinfant’s hunger, (3) awareness of infant’s hunger and satiety cues,(4) concern about the infant overeating or becoming overweight,(5) feeding the infant on a schedule, (6) using food to calm infant’sfussiness, (7) social interaction with the infant during feeding.Scores were averaged across the items for a particular factor with aminimum score of 0 and a maximum score of 4.

S.J. Caton et al. / Appetite 57 (2011) 816–825818

FFQ

Habitual family food intake was assessed using a validated FFQ(Hammond, Nelson, Chinn, & Rona, 1993). The FFQ contains 45foods/food groups and respondents are required to indicate howmuch they consume each of them on a scale of ‘‘Never’’, ‘‘once amonth’’, ‘‘once a fortnight’’, ‘‘once a week’’, ‘‘2 days a week’’, ‘‘3 daysa week’’, ‘‘4 days a week’’, ‘‘5 days a week’’, ‘‘6 days a week’’ or‘‘every day’’. Final scores were calculated to reveal how many timesper day the family generally consumed an item. Particular focuswas paid to fruit and vegetable consumption in the analysis.

Interviews

An interview schedule was developed to explore the weaningprocess in more detail by allowing participants to voice theirindividual experiences and opinions and allowing researchers toinvestigate weaning behaviours in context (Henwood & Pidgeon,1992).

A semi-structured interview containing questions relating tovarious aspects of infant feeding behaviour were developed toinvestigate reasons for weaning, sources of information aroundweaning and thoughts on current weaning guidelines. Questionsalso considered the role of vegetables in the weaning period andbeyond and explored food rejection by infants (Table 3). Generalprompts were used such as ‘‘can you provide an example’’, ‘‘canyou tell me more about. . .’’. Interviewees were told that the aim ofthe interviews was to follow-up the questionnaire that they hadcompleted a few months earlier. Interviewees were asked to focuson their youngest child regarding specific questions on weaningand they were informed that all answers would be fullyanonymised. Two pilot interviews were carried out to test thesuitability of the questions and to assess interview length. Theinterviews lasted around 20 min. All interviews were recorded andtranscribed verbatim. The interviews were carried out by aresearcher who is also a mother and similar in age to theinterviewees and this is thought to have facilitated the relationshipbetween the investigator and the interviewee.

Data analysis

For all statistical analysis SPSS (v17, Chicago, USA) was used. Alldata is presented as mean (�SEM) and percentages. Independentgroups t-tests were carried out to examine differences betweenbreast-fed (BF) and formula-fed (FF) infants on a number of variablesrelating to milk feeding practices and solid food introduction. One-way ANOVA was used to examine differences between weaningcategories (�16 weeks, 17–23 weeks and 24 weeks) on variablesrelating to birth weight, maternal body mass index (BMI), and fruitand vegetable exposure. ANOVA was also used to examine differences

Table 3Interview questions.

Question 1: Mums tend to know what is best for their baby – how did

you decide that your child was ready to be given solid foods?

Question 2: What advice were you given on how to wean your baby

and who gave you this advice?

Question 3: Mums use a variety of foods to introduce their babies

to solid foods, what foods did you use and what made you decide

to use these foods?

Question 4: Some infants seem not to like particular foods – what

do you do when your child appears not like a particular food that

you have offered them?

Questions 5: Tell me about your child, how much do they eat vegetables,

when did you first introduce vegetables and how much do they like

or dislike them and what might you do to promote vegetable intake?

Question 6: What do you think of the current weaning recommendations?

between weaning categories of age of introduction of different fooditems. Pearson’s correlations were carried out to examine therelationship between age of solid food introduction and birth weight,maternal school leaving age, maternal BMI and duration of breastfeeding. Pearson’s correlations were also used to examine therelationship between age of solid food introduction and factors onthe IFQ, as well as fruit and vegetable exposure in the first month ofsolid food consumption. x2 was used to examine frequenciesdifferences between breast fed, formula fed and mixed fed infants.The alpha value chosen was 0.05.

Interview transcripts were analysed by two researchers usingthematic analysis, conducted according to guidelines set out byBraun and Clarke (2006). While the interview schedule formed thebasis of the interviews, this did not constrain the discussion.Therefore, an inductive approach was adopted in analysing thecomments of respondents. In examining the transcripts an ongoingreflexive dialogue between researchers was carried out to takeaccount of consensus, conflict and differences in interpretationbetween researchers (Henwood & Pidgeon, 1992).

Transcripts of the interviews were read carefully by each of theresearchers and then re-read to achieve immersion in the data(Hsieh & Shannon, 2005). Researchers made notes on their initialimpressions in margins and it was then read again systematicallyso that recurring patterns in the words and phrases used could beidentified. These were then clustered together and coded andobservations about the emerging ideas, such as their prevalencewithin the data set, were recorded allowing the researchers tobegin to develop themes. Both researchers (SC, SA) coded thetranscripts and discussed themes as they became more defined andevery data item was considered to ensure themes fit the data well(Henwood & Pidgeon, 1992). Key themes were agreed uponaccording to both their prevalence within the data set and theimportance of the topic in relation to the research question (Braun& Clarke, 2006). Each transcript was revisited and these codes wereapplied allowing data to be grouped in to the final themes. Fiveprimary themes were identified during thematic analysis of theinterviews; (1) vegetables, (2) concerns about their child’s diet, (3)child’s eating status, (4) guidelines versus reality and (5) weaningand sleep.

Results

Milk feeding practices

Of the 75 mothers completing the questionnaire, 60.5% (n = 46)of mothers reported breast-feeding (BF) their child from birth,either exclusively or mixed with formula in comparison to 39.6%(n = 29) who reported only formula-feeding (FF) their child. Theaverage duration of breast feeding was 22.4 � 2.6 weeks. Of the 46mothers who BF their children from birth, significantly more mothersreported exclusive BF (65.2%, n = 30) compared to a combination of BFand FF (34.8%, n = 16) (x2 = 4.26, df 1, p = 0.04). Duration of BF in theexclusive BF group was on average 27 � 3.1 weeks compared to13 � 3.8 weeks in the mixed feeding group (t(43) = 2.7, p = 0.01).Mothers who BF either exclusively or otherwise had a higher schoolleaving age than FF mothers, but no other differences for parity,maternal BMI and birth weight were found (see Table 4).

Weaning/solid food introduction

Overall infants were introduced to solid food around20.17 � 0.5 weeks with a range of 8–30 weeks. Mothers who BFtheir infants regardless of duration and exclusivity tended tointroduce solid food to their child’s diet significantly later incomparison to mothers who FF their infants (BF 21.6 � 0.8 wksversus FF 17.8 � 0.5 wks, t(73) = 4.0, p = 0.0). Age of introduction of

Table 4Maternal characteristic of mothers who chose to breast-feed either exclusively or

mixed with formula compared to mothers who formula-fed their infants

(**p<0.01).

Breast-fed (exclusively and mixed) Formula-fed

School leaving age 19.1� 0.4 16.9� 0.4**

Parity 1.6�1.3 1.8�1.25

Maternal BMI 24.8� 0.7 24.2� 0.6

Birth weight (g) 3489.9�71.5 3498.9�109.2

S.J. Caton et al. / Appetite 57 (2011) 816–825 819

solid foods did not differ between male and female children (males(n = 40) 19.9 � 0.7 and females (n = 36) 20.4 ADD IN SEM). To furtherinvestigate age of introduction of solid foods the sample was dividedin to those weaned �16 wks (n = 6), those weaned between 16–23 wks (n = 44) and those weaned according to current guidelines of24 wks (n = 26). In comparison to the number of infants weaned�16 wks, significantly more infants were weaned between 16 and23 wks (x2 = 28.9, df 1 p = 0.001) also, significantly more infants wereweaned at 16–23 wks in comparison to those weaned at 24 wks(x2 = 4.6, df 1, p = 0.03). Birth weight did not differ significantlybetween the three groups (�16 weeks 3624.5 � 259.4 g, 16–23 wks3520.5 � 71.8 g, 24 wks 3362.7 � 123.6 g). No significant correla-tions were found between age of weaning and birth weight, maternalschool leaving age, maternal BMI or duration of breast feeding.

Infant feeding questionnaire

Correlations were carried out to investigate any possibleassociations between age of weaning and maternal characteristicsas identified by the IFQ. A significant positive correlation was foundbetween age of introduction of solids (weeks) and factor 1(concerns about the infant under eating or becoming underweight)(r = 0.24, p = 0.037). A significant negative correlation was foundbetween the age of introduction of solid foods and factor 2(concern about infant’s hunger) (r = �0.48, p = 0.00) and asignificant negative relationship was found between factor 3(awareness of infant’s hunger and satiety cues) and the age ofintroduction of solid foods (r = �0.363, p = 0.001). Thus motherswho introduced solid food earlier had less concern about theirchild not eating enough or becoming underweight were morelikely to be aware of their child’s satiety cues, yet they are morelikely to have higher concerns about their child’s hunger.

Fruit and vegetable exposure in the first month of weaning

Mothers were asked to provide examples of the kind of foodsthat they offered to their infants in the first two to four weeks ofweaning. Each new item was scored and used as an indication ofthe number of fruit and vegetables offered to the infant. Table 5shows the number of examples of different fruit and vegetablesoffered in the first two weeks of weaning and the total amountgiven as examples in the first month of weaning. The majority of

Table 5Number of fruits and vegetables offered by example to infants during the weaning

period (means� SEM).

Mean� SEM Range

Number of vegetables offered in

the

first two weeks (n = 46)

2.6� .21 1–7

Number of fruits offered in the first two weeks (n = 56) 1.9�0.1 1–4

Total number of vegetables

offered

in the first month (n = 63)

3.1� .21 1–9

Total number of fruits offered in the first month (n = 65) 2.0� .11 1–5

mothers reported offering baby cereal during the first two weeks ofweaning (88.8%, n = 67) where as 11.8% (n = 9) reported only usingfruits and vegetables. Total fruits and vegetables offered over thefirst month of solid food introduction did not differ according towhen solid foods were introduced to the infant. There was,however, a significant correlation between total number ofvegetables offered in the first month and total number of fruitsoffered in the first month of solid food introduction (r = 0.4,p = 0.002, n = 57).

Food preparation methods and age of introduction of different solid

food items

Mothers were initially asked how they offered the first food totheir infant. 97.4% (n = 74) infants were offered their first foodswith a spoon with only 2.6% (n = 2) consuming their first solid foodadded to their bottle (x2 = 68.2, df = 1, p = 0.00). Mothers were thenasked to report if they were most likely to offer first solid foods, as asingle food item, mostly mixed or a mixture of both methods. Themajority of mothers (43.4%, n = 33) reported offering these firstfoods mixed together, 38.2% (n = 29) reported offering single fooditems and 5.3% (n = 4) reported using both methods. There was nosignificant difference between the number of infants who receivedtheir initial foods as single food items and those who received theirinitial foods mixed. Mothers were also asked about their mostfrequent mode of infant food preparation. 10 infants were onlyoffered ready-made foods, 34 home cooked and 32 a mixture ofboth (x2 = 14, df 2, p = 0.001). There was no significant differencebetween the number of infants who received home cooked foods incomparison to those who were offered a mixture of home cookedand ready made foods.

Figure 1 demonstrates the average age of introduction ofdifferent food items and Table 6 is the guideline of age appropriatefood taken from the weaning leaflet that all mothers in the studyregion are given (NHS Barnsley, adapted from the British DieteticAssociation 2005). Age of introduction of each food group wasanalysed by weaning category (solid food introduced either before16 weeks, between 16 and 23 weeks or solid food introduced on orafter 24 weeks) to examine which foods were introduced at theearliest age. ANOVA demonstrated that the introduction of fruits( f(2,75) = 8.34 p = 0.001), vegetables (f(2,75) = 38.94, p = 0.000),cereals (f(2,74) = 26.91, p = 0.00) and bread f(2,74) = 4.1, p = 0.02)all differed significantly by weaning category (Table 7). Motherswho chose to wean before 16 weeks tended to introduce cerealsinitially, followed by vegetables and then fruit, with all other foodsconsumed by their children were offered at age appropriate times(Table 7). Interestingly mothers who weaned after 16 weekstended to introduce cereals, vegetables and fruits around the sametime. Although bread was introduced significantly earlier in early[(Fig._1)TD$FIG]

Fig. 1. Mean age of introduction of different foods.

Table 6summary of ‘‘age appropriate’’ recommended food adapted from paediatric group

of the BDA food fact sheet (2005).

Age range Foods

6 months Fruit, vegetables, rice, potatoes, meat, yoghurt,

cows milk (used in cooking, yoghurts)

6–9 months Pasta, bread and cereals, fish, pulses, egg, custard

12 months Cows milk (drink)

Box 1. Vegetables.

A – Frequency of vegetable consumption

‘‘well every day. He will have one proper cooked meal with at

least two different types of veg – his favourite is broccoli and

carrots and cauliflower – he absolutely loves broccoli so yes,

he has lots of vegetables’’ (02). ‘‘She will eat vegetables every

day and say at dinner time she will probably have broccoli,

carrots and one other veg plus a little bit of potato – so every

day she’s got varied vegetables’’ (03). ‘‘xxx has a lot of vege-

tables really – we’ve always got vegetables in’’ (9). ‘‘she has

usually about two pieces of fruit and then at teatime she will

have like her three vegetables – she’ll have like carrots, peas,

broccoli as these are her three favourites. . .’’ (10).

B – Liking of vegetables

‘‘she doesn’t like them a lot now. . .’’ (01). ‘‘he seems to like his

vegetables. I don’t think there is one yet that we have tried to

give him that he has not liked.’’ (04). ‘‘They like vegetables a lot.

Other than that they love it – they love carrots, peas – they love

all their vegetables’’ (05). ‘‘And he just loves them – he loves

his veg and his fruit.’’ (08). ‘‘She loves vegetables – absolutely

loves them. . .’’ (10).

C – Family diet

‘‘i don’t eat fruit and i don’t eat veg. . . and i have now got

myself and my partner eating more healthily because i do a

meal in the oven so that xxx can have it the next day where as

before i wouldn’t have cooked it’’ (01). ‘‘I actually were buying

certain vegetables and fruit that we had never had before.’’

(05). ‘‘It was just things like if we were having a cooked dinner I

just put things like potatoes and vegetables to one side’’(08).

‘‘Just by eating what we are eating and making it like a

community thing – it’s not just about the food it’s about being

together really.’’ (09).

D – Vegetables by stealth

‘‘well when I first tried him with this pasta sauce thing that I

make he spat the peppers out so then I decided to make it into a

smooth one. So rather than the lumps of the pepper and

mushrooms I blended it and then put it on his pasta – so I

did that. I blended it all up and then once he got used to the

taste of it now he will eat it in big lumps.’’ (02). ‘‘probably either

try and hide them in something else if I needed to or make a

soup or even something like a jacket potato and then make a

pate with vegetables or something if I needed to. . .’’ (03). ‘‘Hide

it in things – something like making a bolognaise and hide it

you know blend it in so they wouldn’t know. . .’’ (05). ‘‘Cut them

up really finely into mince and stuff, put it into fish pie – you

know so that he didn’t realise he was eating it. . .’’ (07). ‘‘Dis-

guise it in sauces and things like that.’’ (09).

S.J. Caton et al. / Appetite 57 (2011) 816–825820

weaned infants, this was not used in the initial weaning process.All other foods did not differ according to weaning category(p > 0.05) demonstrating that all other foods were introduced tothe infants at around the same age across the weaning categories.

Qualitative results

Five themes were identified during thematic analysis of theinterviews; (1) vegetables, 2) concerns about their child’s diet, (3)child’s eating status, (4) guidelines versus reality and (5) weaningand sleep.

Vegetables

Mothers reported that vegetables were very frequentlyconsumed in most of the households and variety of intakeappeared to be particularly salient to the mothers. Mothers talkedabout how their children consume a variety of different vegetablesand how they offer an array of both fruits and vegetables to theirchildren. Mothers accepted responsibility for ensuring that theirchild/children consume enough vegetables. This is exemplified bymothers describing having plenty of vegetables in the house andthat some mothers actively talk about how they try to ‘‘get as manydown them’’ as possible (Box 1, A).

It appeared that the mothers’ strategies of giving their childrenvariety and encouraging vegetable intake in their children wereeffective as 10 of the mothers described how their children liked allthe vegetables that they have been exposed to (Box 1, B). Only onemother reported that her child did not seem to be fond ofvegetables. Many of the mothers used quite emotive words todescribe their children’s liking of vegetables such as ‘‘absolutelyloves.’’ and ‘‘fantastic’’.

The issue of the family diet arose around vegetable intake andmothers reported that family meals are frequently modified toencourage vegetable intake in children, with some mothers evenmodifying the family diet to include more fruits and vegetables(Box 1, C). Two mothers mentioned that that they had begun toinclude more fruits and vegetables in their own diet since havingchildren.

Mothers were asked how they would deal with vegetablerejection in their children. A number of techniques were suggestedthat included modelling, in so much that mothers would often sitand eat meals with their children so that their children would alsosee that they are consuming vegetables. Other techniques includedmodifying the taste of vegetables by the use of dips and sauces orincorporating them in to other more liked foods and also modifying

Table 7Age of introduction of fruit, vegetables, cereals and bread (means� SEM).

Solid food introduced before 16 wks Solid food introduc

Fruit 21.5(5.3)* 21.7(0.6)

Vegetables 16.5(1.3)** 21.1(0.5)**

Cereals 15.5(3.9)** 21.1(0.6)**

Bread 27.3(2.5)* 31.1(0.5)

ANOVA pairwise comparisons across all 3 variables. Values sharing a sign are significa* p<0.05.** p<0.001.

the texture of vegetables by pureeing them or by cutting them upvery small (Box 1, D). Another technique was to introduce anelement of fun to vegetable consumption by making smiley facesout of the vegetables. A recurring theme was to introducevegetables by stealth. Mothers frequently mentioned that theywould encourage vegetable intake by masking the taste of thevegetable and/or presenting them in a form where it was notobvious. A common technique was to disguise the vegetables insauces and soups or cut them up so finely that they could not be

ed between 16 and 23 weeks Solid food introduced on or after 24 wks

26.6(0.5)*

26.3(0.18)**

26.1(0.3)**

35.6(1.1)*

ntly different.

Box 2. Concerns about their child’s diet.

A – Nutrient quality of foods

‘‘100% salmon, 100% haddock, 100% cod, took the bread-

crumbs off to reduce salt intake. . ., i promised myself that i

would ensure that xxx had a varied diet with as much fruit and

vegetables as i could. . .’’ (01). ‘‘even the xxx baby food for

weaning and stuff has still got sugar in it – it’s got concentrated

ingredients in which contain sugar and stuff and they say that

is quite bad for their teeth so they said the best thing to do is

just to stew your own fruit and mash this up. . .’’ (07). ‘‘I’d like to

think that she was eating a balanced diet’’ (09).

B – Dealing with food rejection and types of foods to promote

‘‘I’d just leave it and try it again a few days later. . .’’ (01). ‘‘I

would try it again – I would keep trying it. . . So fruit and veg are

the things I persist with most really’’ (02). ‘‘So it would really be

the foods that are good for him that I would keep trying him

over and over. . .’’ (04). ‘‘I just take it away from him – I don’t try

and push him if he doesn’t like it then he doesn’t like it’’ (05). ‘‘I

wouldn’t bother too much because if you get worked up about

it and they get worked up then they are never going to like it’’

(05). ‘‘Yes vegetables and fruit – without a doubt yes. Anything

healthy’’ (08) ‘‘I would never give up until he got used to eating

it – the things that were good for him anyway.’’ (08). ‘‘We try

her with it and if she is not eating it then you know we don’t

make a fuss over. . .’’ (09). ‘‘I would always keep trying to get

any fruit and any vegetables – definitely – I don’t push choco-

late or anything’’ (10). ‘‘I try to not fuss with it but then try him

with it again in a week or so just to see whether he wants it. . . I

tend to persevere.’’ (12).

Box 3. Child’s eating status.

A – Good versus bad eater

‘‘She’ll eat anything. . .’’ (03). ‘‘he is a fantastic eater now –

Really good he will eat anything’’ (05). ‘‘He’s quite good he will

eat everything I make for him.’’ (07). ‘‘xxx is quite a good little

eater. . .’’(09). ‘‘I have to be honest and say she’s pretty good. . .But she is a really good eater – there’s not many foods that I

have seen her dislike or refuse’’ (11).

B – Changes in taste

‘‘But bananas that was a tough one because he liked them at

first and then he didn’t like them’’ (09). ‘‘he likes fish which he

didn’t like straight away’’ (07). ‘‘because their tastes change as

they get older don’t they?’’ (01). ‘‘I know that the taste changes

as they get older so I just keep on persisting with her unless I

really thought she disliked it.’’ (11). ‘‘he did like parsnips when

he was younger but he doesn’t eat them now. I think they are

too sweet for him now.’’ (12).

S.J. Caton et al. / Appetite 57 (2011) 816–825 821

separated out from the rest of the food by the child. This isinteresting as again it highlights the mother’s perception of theimportance of including vegetables in their children’s diets almostby any means. Many mothers also talk about persisting with theirchild’s lack of liking of some vegetables by adopting the repeatedexposure tactic, where vegetables are frequently placed on thechild’s plate at meal times with a view that the children will learnto like them.

Concerns about their child’s diet

In addition to including a variety of fruits and vegetables in theirchildren’s diets, mothers frequently mentioned that the nutrientquality of food was an important factor in deciding what food tooffer to their children. Nutrient quality in this instance refers to theway in which mothers were paying particular attention to the saltand sugar levels in foods, offering highly digestible foods duringweaning and buying organic or ‘‘natural’’ produce. Several mothersmentioned that they preferred to offer their child home-cookedfoods as opposed to ready-made infant foods. Home-cooked foodsappeared to be considered superior in taste to ready-made foodssince the latter were often rejected by their infants and alsosuperior in terms of nutrients and ingredients. One mother talkedabout how ready made foods were only used in an emergency andanother, how she made her own food to avoid the excess sugar thatis contained in ready made fruit-puree. Overall mothers describeda great desire to ensure that their children are offered asnutritionally complete, varied a diet as possible and this isindicated in the discourse. Mothers frequently use words like‘‘nutritional’’ ‘‘healthy’’ and ‘‘balanced diet’’ (Box 2, A).

When asked about dealing with food rejection and the kinds offood they would be more likely to persist in encouraging their childto consume, mothers again raised the issue of nutrient quality.Mothers said they were most likely to encourage intake of foodsthat are considered ‘‘good for them’’ ‘‘healthy’’ ‘‘well varied diet’’(Box 2, B). In addition to promoting fruit and vegetable intake andother foods that were considered ‘‘healthy’’. Repeated exposure toa less liked food was frequently mentioned by mothers as a meansof encouraging intake of more ‘‘healthy’’ foods. Many mothersreported not giving up on certain foods that they would like theirchild to consume. In addition to this it was clear that some mothersadopted similar kinds of approaches in terms of dealing with foodrefusal. The common consensus was that it was best to stay calmand not make a ‘‘fuss’’ when their child refuses to consume aparticular food offered to them.

Child eating status

Most mothers reported on the success of their strategies withfeeding their children (Box 3, A). Ten out of the thirteeninterviewed classified their children as being good eaters, onlyone mother freely admitted that she thought that her child wasturning in to a ‘‘fussy’’ eater. However, while classifying their childas a ‘‘current’’ good eater mothers did also appear to recognise thata child’s appetite and liking for certain foods is transient ratherthan fixed (Box 3, B)

Guidelines versus reality

All mothers identified differences between the guidelines theyhad been advised to follow while weaning and their ownexperiences, the experiences of others known to them andprevious guidelines. The mothers’ perceptions of the ‘reality’ ofthe weaning process could sometimes diverge greatly from theguidelines. Mothers’ identified that ‘every baby is different’ and, insome cases, gave examples (Box 1, A). In many cases they felt these

individual differences justified a certain degree of flexibility intheir use of the guidelines and their approaches to weaning, and inothers a total disregard for them. This feeling that there should bemore flexibility within the advice handed down from thegovernment through health professionals was highlighted againwith the majority of mothers reporting that they felt that there wastoo much of a focus on the guidelines or that they are toostructured (Box 4, B). Mothers described feeling restricted by theguidelines and a sense of obligation to hold off or begin weaningpurely because they are instructed to do so by the information theyhave received from their health professional. Some mothersseemed to feel intimidated by the perceived pressure from thehealth care professionals while others disregarded it as unhelpful.

While most mothers reported that they had tried to adhere tothe guidelines, in the majority of interviews mothers reported thatthey felt they, or mothers in general, are best placed to make anydecisions regarding their infants due to knowledge and experience

Box 4. Guidelines versus reality.

A – Individual differences

‘‘I think every baby is different and they have all got different

needs. . .’’ (01). ‘‘I’m not just going to wean her because I feel as

though I should be because she’s over six months old – every

baby is different. Not every baby is the same at six months are

they?’’ (01). ‘‘I mean I know every baby is different – but I don’t

particularly think that there’s babies that are really more ‘hun-

gry babies’.’’ (02). ‘‘But with xxx he were a lot more difficult, he

weren’t as interested – I started with him at four months

although they said six months because that is what I had done

with xxx. Although looking back I would have been better at six

months because he still liked his milk and he just didn’t bother

with food until her was six months so it was as though he

weren’t ready. So it was surprising the difference in them

two.’’ ‘‘I think each baby is different’’ (05).

B – Too much focus on guidelines

‘‘I think everyone is wrapped up with the idea that if you do it

earlier you will be frowned upon and if you do it later then do

you know anything about your child’’ (01). ‘‘I think there is too

much emphasis that it has got to be done at six months. . . but

you always think that you are not doing as well as you can if

you are not doing it according to the guidelines. And they are

only guidelines and it is up to yourself. . . I do think Health

Visitors can be strict and stringent with certain things espe-

cially when it is written all over that it is advised to have

exclusive breast feeding for the first six months.’’ (01). ‘‘It’s

everywhere you know it’s not just Health Visitors, its books, it’s

wherever you look – on the television with the adverts it’s on

there isn’t it?’’ (01). ‘‘Yes if it was only slight moveability. I

wouldn’t like to think people would go to extreme moveability I

mean maybe five or seven months something like that but I

would advise weaning at two months or anything like that you

know.’’ (09). ‘‘I remember when I used to go in with xxx they

used to say ‘‘no it’s six months you really shouldn’t wean

before’’ – so you felt as though you were doing something

wrong then.’’ (11).

C – Mums know best

‘‘. . .it is up to yourself – and up to me as a parent to do what I

think is best for xxx.’’ (01). ‘‘. . .I just knew that he was telling me

that he was ready to try something else.’’ (03). ‘‘Well the Health

Visitor tried – she really did try but no I knew from having my

other two and when you know that they are ready and with

knowing all the signs from my other two.’’ (04). ‘‘You know

when your baby is ready – you really do.’’ (04). ‘‘I think you

should go for what you think your baby needs.’’ (10).

D – Inconsistency of guidelines

‘‘Which is what quite a few ‘old school’ like my mum – she

couldn’t understand why they were saying six months because

back then they did it at three months. So it does change quite a

lot – the guidelines do change and that’s confusing. . .’’ (02).

‘‘. . .because there are so many different foods now that they

are not allowed and are allowed. It’s so different I mean my

oldest one is five now but it is so different from what it was with

him she just kept telling me ‘‘no, no’’.’’ (04). ‘‘Because I think

when my mum was weaning us that a lot of things have

changed – they weaned at four months whereas our guidelines

say to wean at six.’’ (06). ‘‘xxx is six now. But She was four

months old then and I think that was the guidelines for them at

that time.’’ (11)

E – Advice from trusted others

‘‘I did it that way because my mum advised. . .’’ (01). ‘‘I am so

lucky to have my mum – but if I didn’t have my mum you know

you ask advice and you don’t know whether you are getting the

best advice. . .’’ (01). ‘‘the information that was most helpful

was probably the stuff that was in for example the Tesco

magazine with the stories from other mums – you know

relatively new mums. . . And then probably other friends that

have got children that are not that much older than xxx and so

have gone through the process themselves maybe six months

before.’’ (03). ‘‘really I asked my sister like because my sister

has got three kids and my other sister’s got two and my other

sister’s got five. So I just asked them how they did it and just

got advice off them more than anything – not off any you know

professional people.’’ (10). ‘‘But you know my mum’s had us

two and then I had xxx and she helped me with xxx and so I

trusted my mum’s advice a lot more that I did the Health

Visitors.’’ (11).

S.J. Caton et al. / Appetite 57 (2011) 816–825822

they have of their own child (Box 4, C). Many felt that whileguidelines are helpful the final decision making comes down to thejudgement of the mother and their ability to recognise when theirbaby is ready to commence weaning onto solid food. In some cases,this sense of ‘mother knows best’ is used to justify not adhering tothe guidelines at all.

Mothers’ highlighted the inconsistency between the informa-tion they had received during this weaning experience and thatwhich had been available previously, particularly those who hadhad earlier children (Box 4, D). Many highlighted the changes inguidelines over the years and the confusion this can cause,explaining that they had been given different guidelines fordifferent children within their family despite only a few yearspassing between their births. In some cases because of a previous,successful experience using the old guidelines with an older child,mothers had chosen to stick to the four month suggestion as theywere able to see the results for themselves.

Most mothers reported having received or sought advice fromsources other than any health professional such as their mother,other family members, friends, parenting magazines and books(Box 4, E). While some recognised that information from thesesources was outdated, others felt that they had found thisinformation more helpful than what they had received from theirhealth professional. Mothers appeared to trust advice coming fromthose around them with experience in weaning, especially wherethe mother had been able to experience or witness a weaningprocess that has had an apparently positive outcome with noovertly negative consequences e.g. advice from their own motheror other family members and friends.

Weaning and sleep

Many of the mothers described a link between weaning and theamount of sleep either they or their infant was getting, with severalbelieving their baby’s sleeping pattern was directly connected tothe amount of food they received and whether or not they were onsolid foods. A large proportion of mothers mentioned lack of sleep,as one of the reasons they had decided to wean (Box 5, A). Thosethat reported their infant waking up in the night or not sleepingthrough often perceived this to mean that their baby was stillhungry or needed something more to satisfy them. Of those thatmentioned sleep in relation to weaning, there were severalmothers who felt weaning an infant in order to improve sleep wasnot a valid strategy to use and one went so far as to state that thissuggested laziness on the part of the mother.

This belief that a fuller or more satisfied infant will sleep forlonger durations or sleep more often was an observation that manyof the mothers made throughout the interview (Box 5, B). Animprovement in sleep pattern was explained by the change in dietor increase in food. It did seem that this belief of ‘if you fill baby,baby will sleep’ was a common one.

Discussion

The current study was designed to explore maternal feedingpractices during weaning and early infancy using both quantitativeand qualitative methods. Compared to national statistics on BF the

Box 5. Weaning and sleep.

A – Lack of sleep of parent/infant as a reason to start weaning

‘‘. . .and waking up in the night for feeds that he had not had

before so I decided that I would try him on some solid food

basically.’’ (02). ‘‘I think people try but it’s just so they can get

them to sleep on a night. . .’’ (05). ‘‘She was getting up as well

through the night so it was another sign that she needed

something else really’’ (09). ‘‘If you are giving them as much

milk – xxx was taking 9 ounce of milk and she was still waking

up during the night – that’s telling me that there is something

wrong. She is still hungry.’’(10). ‘‘I think sometimes it’s be-

cause they want them to sleep through – I think it is laziness on

the mum’s part.’’ (12).

B – Sleep as a sign of fullness/satisfaction

‘‘He was quite a young age as well and so I thought I am going

to have to try something different and so I thought I am just

going to try him with a bit of baby rice and he liked it and he

seemed to have less bottles when I was giving it to him so he

was a lot better and I finally managed to get more sleep.’’ (04).

‘‘Give them solid foods definitely – it satisfies them more and

they sleep more on a night. I’ve noticed that these two sleep a

lot more on a night than what they used to.’’ (13). ‘‘So if you

introduce solids at an earlier stage then you know it fills them

up. Well she slept through – you know that’s what made her

better by having that extra for dinner or tea or just before she

went to bed – it was a lot easier.’’ (10). ‘‘. . .and people tend to

think if their tummies are full then they will sleep but if they’re

not going to sleep then they’re not going to sleep. . .’’ (05).

‘‘. . .and then she started sleeping better as well because she

had been waking up and that through the night.’’ (10).

S.J. Caton et al. / Appetite 57 (2011) 816–825 823

current sample compared favourably with around 60%, initiatingBF (Bolling, Grant, Hamlyn, & Thorton, 2007). Mothers in thecurrent study tended to introduce solid foods to their infant 4weeks earlier than recommended by both the WHO (2003) and theDepartment of health (2008) with BF mothers showing delayedintroduction of solid food in comparison to mothers who FF theirinfants but still before 6 months. Early weaning foods comprised ofmainly baby cereals, fruits and vegetables with all other foodstuffbeing introduced at age appropriate times according to the localinformation available to the women in this area (adapted fromBritish Dietetic Association, 2005). In 2009 the European FoodSafety Association reported that there were no reported dis-advantages of weaning between 20 and 24 weeks compared towaiting until 24 weeks. Additionally weaning before 24 weeks butnot before 16 weeks might confer an advantage as specified in the‘‘sensitive period’’ hypothesis whereby between the ages of 16 wksand 36 wks infants readily accept a wide variety of flavours (Harris,1993).

The variety of vegetables offered in the weaning period wascomparable to previous findings (Maier, Chabanet, Schaal, Leath-wood, & Issanchou, 2007) with infants being exposed to 3 typesduring the first month of weaning. Mothers placed importance onthe nutrient quality of their children’s diet and vegetables wereperceived to be an essential part of children’s diets, with mothersmaking every effort to ensure their children are consuming whatthey perceive to be an adequate amount. A strong sense of ‘‘motherknows best’’ and ‘‘babies are different’’ emerged in the currentinvestigation as an explanation of introducing solid food early totheir children. Mothers were also able to identify a number ofeffective strategies that could be employed to increase vegetableconsumption in their children.

Introducing solid foods earlier than officially recommendedappears to be common practice in the UK (Alder et al., 2004;Anderson et al., 2001; Savage et al., 1998). In the current studymothers reported introducing solids to their infants around the age

of 20 weeks, 4 weeks earlier than recommended. Mothers who BFtheir infant either exclusively or mixed with formula, regardless ofduration tended to delay the introduction of solid foods to around22 weeks in comparison to mothers who FF their infants (18weeks) This was also found in a UK cohort (Wright, Parkinson, &Drewett, 2004) and similarly in a US cohort (Burdette, Whitaker,Hall, & Daniels, 2006). Results from the IFQ demonstrated arelationship between early introduction of solid foods and mothershaving less concern about their child becoming underweight,increased reported awareness of their child’s hunger and fullnesscues but with higher concerns about their child’s hunger. Theseresults appear to be contradictory, however it may be the case thatthese mothers are concerned that their child is consuming toomuch food yet they have difficulty in with holding food from themdue to them observing what they perceive to be hunger cues fromtheir infant or child (Baughcum et al., 2001). These findingssupport the claim that mothers ‘‘know’’ when their child is ready tobe given solids. They perceive cues in their child that indicates areadiness for something other than milk (Harris, 1988). Mothersinterviewed had all been given formal weaning guideline advice,yet these guidelines were not adhered to and the importance ofadvice from family and friends was very apparent (Alder et al.,2004; Anderson et al., 2001). A strong sense of ‘‘every baby isdifferent’’ emerged and due to this many mothers reported thatthey felt that the current guidelines were too rigid and should bemore flexible to accommodate individual differences. Weaningguidelines in the UK have changed to be in line with WHOrecommendations, this, however created confusion amongstmothers and created a lack of confidence and motivation to followthe guidelines set (Alder et al., 2004; Snethen, Hewitt, & Goretzke,2007). Sleep was linked to the amount of food consumed by theinfant. For this group of mothers, the lack of sleep was offered as anexplanation for introducing solid foods to their infants, a findingthat has previously been reported (Alder et al., 2004; Andersonet al., 2001; Rosen, 2008; Savage et al., 1998; White, 2009).

Mixing vegetables together was a common practice in thiscohort of mothers. Adopting this practice might mask the true tasteand texture of the vegetable thereby reducing the likelihood of theinfant acquiring liking for the individual vegetable taste. Mothersmight benefit from guidelines that incorporate the use of a varietyof single vegetable flavours in the weaning period as a means ofincreasing the likelihood of vegetable consumption in the postneo-phobic period. Maier et al. (2008) demonstrated that varietyof vegetable exposure coupled with frequent changes had anadditive effect on the likelihood of the infant accepting a new food.Additionally, longer durations of breast feeding would also exposeinfants to a wider variety of tastes via the foods consumed by themother (Maier et al., 2007; Mennella et al., 2001).

The maternal diet in particular has a strong influence on achild’s food preferences and intake as quite often the motherdecides what foods are purchased and how they are prepared(Birch, Fisher, & Davison, 2003; Cooke et al., 2004; Faith, 2005;Fisher, Mitchell, Smiciklas-Wright, & Birch, 2002; Gibson, Wardle,& Watts, 1998; Longbottom, Wrieden, & Pine, 2002). Results of thefamily FFQ (data not shown) indicate that individuals within thefamilies were consuming around 2.8 portions of fruits andvegetables per day which is below the recommended intake ofat least 5 portions of fruit and vegetables per day (DOH, 2003). Oneway in which the maternal diet influences children’s diets is viamodelling (Fisher et al., 2002; Savage et al., 2007). The classicstudy by Harper and Sanders (1975) reported that children weremore likely to consume unfamiliar foods if an adult was consumingit and that this effect was more evident in younger children. Oneobvious way of promoting vegetable consumption is to alter thefamily diet so that children are frequently exposed to and offeredvegetables (Spurrier, Magarey, Golley, Curnow, & Sawyer, 2008).

S.J. Caton et al. / Appetite 57 (2011) 816–825824

Several mothers mentioned how they had altered their own diet toinclude more vegetables as a means of acting as ‘‘good role models’’for their children around meal times. Repeated exposure (Forestell& Mennella, 2007; Sullivan & Birch, 1994) was also referred to bymothers as a method of promoting intake by having a good varietyof vegetables in the household for consumption and repeatedofferings. Many mothers reported that they ‘‘try to get as manydown them as possible’’ (vegetables) and that they ensured thattheir children had a healthy varied diet. In a recent study Jones etal. (2010) found that mothers who make an effort to serve a varietyof vegetables with each meal promoted vegetable consumption byup to 40% in their children compared to children belonging tofamilies who did not have this rule. The common consensus wasthat it was also very important to ‘‘not make a fuss’’ if the child didnot consume what was offered to them. This is interesting, aspressure to eat has been demonstrated to have the opposite of thedesired effect resulting in reduced intake of the target food offeredto the child (Birch et al., 2003; Birch & Davison, 2001; Galloway,Fiorito, Francis, & Birch, 2006).

Increasing the visual appearance of fruits and vegetables underexperimental conditions have been demonstrated to be effective atincreasing intake (Jansen et al. 2010; Houston-Price et al., 2009a,2009b). Mothers in the current study reported how they wouldmake faces from vegetables and refer to broccoli as ‘‘little trees’’ inorder to encourage vegetable intake. The presentation of vege-tables with dips and sauces was also suggested as a means ofpromoting intake. Pairing the vegetable with a liked dip or saucecould lead to increased liking of the vegetable, however in anexperimental setting flavour-flavour learning was not successful(Havermans & Jansen, 2007). Alternatively, pairing the relativelylow energy dense vegetable with an increased energy dense dip orsauce might also lead to increased liking of the vegetable but again,in an experimental situation the flavour-nutrient paradigm failed(Zeinstra et al., 2009). However, these results might have beencontext specific in that in a real-world setting in the home this kindof learning might be effective; this however, remains to be furtherinvestigated.

Offering vegetables by stealth was mentioned by most mothers.A number of popular authors suggest that vegetables by stealth isone of the most effective method of increasing vegetable intake(Sneaky Chef, Deceptively Delicious). This is achieved by mothersby incorporating vegetables in every meal not in their original formbut in ways where by children do not notice, for example in saucesand soups or by hiding vegetables in other food items. However, itis currently unknown if this approach leads to increased liking forvegetables and not just increased intake. In a recent paper Zeinstraet al. (2009) proposed that children might have an innate dislike ofpure vegetable tastes and if this is indeed the case vegetables bystealth might be the way forward for promoting vegetable intake inchildren. Kirby et al. (1995) reported that vegetables are rarelyeaten alone, they are quite often served with rice, potatoes,flavoured with cheese, butter or other sauces. When a vegetable isincorporated in to a dish the pure vegetable taste is somewhatdiluted, therefore it could be the case as identified by Zeinstra et al.that the pure taste of vegetables is too strong for children and thatthe taste is only acceptable in a weakened form.

In conclusion, mothers introduced solid food to their infant’sdiets around 20 weeks and the types of foods used during thisperiod tended to be fruits, vegetables and infant cereals. All otherfoods were offered at age appropriate times in line with BDAguidelines. Infants were reported to be exposed to around 3different types of vegetables in the first month of weaning, similarto previous findings in other European countries (Maier et al.,2008). It appears that mothers may benefit from additionalguidelines regarding the introduction of a variety and frequentchange of vegetables during the weaning period and also to offer

the vegetables as single flavours as opposed to mixed. Mothersreported a distinct lack of trust in official weaning guidelines andwere more likely to accept information from significant otherssuch as friends and family members. Mothers also acknowledgedthat each infant has individual needs and that they as the motherare best placed to know when their infant is ready to move on froma milk only diet from the cues displayed by their infant. In theweaning period through in to toddlerhood mothers placed greatemphasis on the nutrient quality of their child’s diet and viewedthe inclusion of vegetables as an integral part. When vegetablerefusal occurred mothers demonstrated that they were wellequipped with many methods of getting their child to consumevegetables. The most popular method was to give the vegetables ina form where by the child was unaware that they were consumingthem; vegetables by stealth. It is currently unknown if this methodof promotion vegetable intake has any positive effect on liking andwarrants further investigation given the lack of experimentalevidence on this frequently used approach.

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