Adequacy of the content on infant feeding on popular websites regarding the recommendations of the Dietary Guidelines for Brazilian children under 2 years of age

Santos, Adriana de Almeida; Silva, Evelyn Oliveira da; Gabe, Kamila Tiemann; Leite, Maria Alvim

doi:10.1590/1806-930202200040010

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 22 (04) • Oct-Dec 2022 • https://doi.org/10.1590/1806-930202200040010 copy

Adequacy of the content on infant feeding on popular websites regarding the recommendations of the Dietary Guidelines for Brazilian children under 2 years of age

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to verify the adequacy of recommendations on food and nutrition for infants available on popular websites in relation to the “Twelve Steps for a Healthy Diet” from the Dietary guidelines for Brazilian children under 2 years of age.

Methods:

popular websites were searched via the Google platform to collect data about food recommendations for children under 2 years of age. The data was categorized according to criteria developed with the Guide: totally agree, partially agree, disagree, contradictory and absent. The websites were described according to the frequency of each step and the distribution in the categories.

Results:

82 websites were included. Most frequent steps: 1 (84.1%), 2 (82.9%) and 4 (63.4%); least present: 8 (23.2%), 10 (19.5%), 11 (3.7%) and 12 (1.2%). The highest percentages of adequacy in relation to the Guide were steps 1 and 4 with 46.4% and 53.8%, respectively. Steps 3 (37.9%) and 7 (75.0%) had the highest percentages of disagreement or contradiction.

Conclusions:

there is proper information on the internet, however, these are mixed with missing, in disagreement, partially in agreement or contradictory information, which reinforces the importance of disseminating the recommendations of the Guide

Key words:
Internet; Breastfeeding; Complementary feeding; Dietary guidelines; Health communication

	Totally agree	Partially agree	Disagree	Contradictory	Does not contain the information
Step 1: “Breastfeeding up to for the first two years or longer and only offer breast milk in the first six months”	Instruct about breastfeeding up to 2 years or more AND advise that breastfeeding is exclusive up to 6 months.	Guide breastfeeding for up to 2 years or more OR Guide the offer breast milk only for up to 6 months.	Recommend exclusive breastfeeding for more or less than 6 months AND/OR recommend continued breastfeeding for less than 2 years.	Present information in agreement and disagreement on the same recommendation.	Absence of information.
Step 2: “Offer natural or minimally processed food, in addition to breast milk, after 6th-months of life”	Instruct on the introduction of different food groups from 6 months of age, whether natural or minimally processed food.	Guide the introduction of food by limiting food groups OR Guide about the introduction from 6 months, but do not specify which kinds of food.	Recommend the consumption of food before or after 6 months, except for specific situations^a a Children who are using insufficient amounts of formula, cow’s milk or stored breast milk are advised to start complementary feeding at 4 months.15 AND/ OR Recommend the consumption of food that are not natural or minimally processed.	Present information in agreement and disagreement on the same recommendation.	Absence of information.
Step 3: “Offer children potable water instead of juices soft t drinks and other sugary beverages”	Instruct primarily about the supply of water, citing examples of drinks to be avoided and/or the term "sweetened drinks".	Just guide them to avoid juices, teas, soft drinks or other sugary drinks.	Recommend offering drinks other than water, not prioritizing water.	Present information in agreement and disagreement on the same recommendation.	Absence of information.
Step 4: “Offer mashed food when children start to eat other kinds of food besides breast milk”	Instruct on the consistency with an age-appropriate texture^b b Only the texture was considered because it is the central theme of the step, the continuity of breastfeeding is contemplated in previous steps; , indicating porridge with the use of a fork or mashed consistency.	Advise on the correct consistency through examples of food/preparations OR Mention porridge as a synonym for consistency.	Recommend mixing in a blender and/or passing through a sieve AND/ OR Indicating soups, broths and purees as synonymous with consistency.	Present information in agreement and disagreement on the same recommendation.	Absence of information.
Step 5: “Do not offer sugar or preparations or products that contain sugar, to children up to 2 years of age”	Instruct children up to 2 years of age to exclude sugar-containing preparations and products.	Advise on the exclusion of a specific product/preparation that contains sugar OR Advise the harm of sugar to health, but not recommend its exclusion from the child’s diet up to 2 years old OR Advise a reduction in sugar consumption for children up to 2 years of age, but not its exclusion.	Recommend the use of sugar (any type), honey, sweeteners for children up to 2 years old AND/ OR Recommend the exclusion of sugar and preparations or products containing sugar up to 1 year old only.	Present information in agreement and disagreement on the same recommendation.	Absence of information.
Step 6: “Do not offer children ultra-processed food”	Instruct on the exclusion of ultra-processed products^c c The term “industrialized” was considered synonymous with ultra-processed food when present on websites.	Guide the exclusion of only one or a few ultra-processed food OR Guide about the harm, but not recommend their exclusion OR Guide the reduction of consumption of ultra-processed food, but not their exclusion.	Recommend any ultra-processed food including dairy compounds and excluding infant formula.	Present information in agreement and disagreement on the same recommendation	Absence of information.

	Totally agree	Partially agree	Disagree	Contradictory	Does not contain the information
Step 7: “Prepare the same food for the child and the rest of the family”	Instruct that the same food be cooked for the child and the family from the beginning of complementary feeding, remembering to adapt the meal to the child.	Guide the use of some separate preparations for the child OR Just guide the adaptation of the meal for the child.	Recommend that separate food be cooked for the child and the family at any age from 6 months onwards.^* *Explicitly or implicitly in the way the baby’s food is prepared.	Present information in agreement and disagreement on the same recommendation.	Absence of information.
Step 8: “Make sure that the children’s mealtimes are moments full of positive experiences, learning and affection with the whole family”	Instruct the meal together with the family, being also a calm l moment.	Advise on the contraindication of distracting practices OR Advise a quiet time during the meal without indicating that it is done with the family.	Recommend a time and place for a meal exclusively for the child AND/OR Recommend the use of a distractor external to the food..	Present information in agreement and disagreement on the same recommendation.	Absence of information.
Step 9: “Pay attention to the children’s signs of hunger and satiety and talk to them during the meal”	Instruct on proper attention to hunger and satiety signals without forcing or blackmailing the child to eat.	Advise on adequate attention to the signs of hunger and satiety that the child presents OR Advise on not forcing or using blackmail to induce the child to eat.	Recommend the use of a distractor external to the food AND/OR Strictly recommend the amount of food to be consumed.	Present information in agreement and disagreement on the same recommendation.	Absence of information.
Step 10: “Ensure hygiene in all stages of the child and family’s diet”	Instruct about personal hygiene care for the family, the child and food, also instructing on the proper storage of food.	Advise on care for the family’s personal hygiene OR the child’s personal hygiene OR food (without specifying method) OR Advise the proper storage of food.	Recommend incorrect, insufficient or exaggerated hygiene of food, family or child.	Present information in agreement and disagreement on the same recommendation.	Absence of information.
Step 11: “Offer children adequate and healthy food even when you’re not at home”	Instruct on the provision of adequate and healthy food to the child, also outside the home, and may indicate planning a lunch box or places to find adequate and healthy food.	Advise on water consumption outside the home, but does not provide advice on food.	Recommend the use of ultra-processed food outside the home, such as industrialized baby food.	Present information in agreement and disagreement on the same recommendation.	Absence of information.
Step 12: “Protect children from food advertising”	Instruct that the consumption of food linked to advertisements is not encouraged, indicating the non-use of cell phones, television, computer before the age of 2 years.	Advise not to encourage the child to consume food linked to advertisements OR Advise not to use cell phones, televisions, computers before 2 years of age.	Recommend only a time limit for cell phone, television or computer use even before the age of 2.	Present information in agreement and disagreement on the same recommendation.	Absence of information.

	N	%
Link with industry	17	20.8
Link with research institution or official organ	7	8.5
Absence of link	58	70.7
Presence of bibliographic reference	18	22.0
Presence of professional reference	17	20.7
Both references	26	31.7
Absence of reference	21	25.6
Date of the last update
Pre-publication of the Guide	52	63.4
Until Nov. 2014	6	7.3
Dec. 2014 to Oct. 2019	46	56.1
Post publication of the Guide	3	3.7
From Nov. 2019	3	3.7
No update information	27	32.9
Presence of advertising	46	56.1
non-food children’s products	5	9.1
children’s food products	1	1.8
general food products	5	9.1
health products and services	10	18.2
Other^* * Other: banks, software, newsletter from the page itself.	34	61.8
Total	82	100.0

	N	%*	Agreement		Partial agreement		Disagreement/ Contradiction
	82	100.0	n	%**	n	%**	n	%**
Step 1	69	84.1	32	46.4	30	43.5	7	10.1
Step 2	68	82.9	24	35.3	38	55.9	6	8.8
Step 3	29	35.4	8	27.6	10	34.5	11	37.9
Step 4	52	63.4	28	53.8	8	15.4	16	30.8
Step 5	30	36.6	4	13.3	21	70.0	5	16.7
Step 6	23	28.0	9	39.1	12	52.2	2	8.7
Step 7	24	29.3	5	20.8	1	4.2	18	75.0
Step 8	19	23.2	7	36.8	12	63.2	0	-
Step 9	29	35.4	13	44.8	13	44.8	3	10.4
Step 10	16	19.5	2	12.5	14	87.5	0	-
Step 11	3	3.7	2	66.7	0	-	1	33.3
Passo 12	1	1.2	0	-	1	100.0	0	-

Characteristics of websites		Step 1			Step 2			Step 4
	n	%	IC95%**	n	%	IC95%	n	%	IC95%
Present link
Industry	4	25.0	9.2 - 52.3	7	46.7	23.1 - 71.8	7	58.3	29.1 - 82.7
Research or official organ	7	100.0*	-	4	57.1*	20.4 - 87.4	4	80.0*	24.5 - 98.0
No link	21	45.7	31.6 - 60.4	13	28.3	16.9 - 43.3	17	48.6	32.2 - 65.3
Present reference
Bibliographic	24	28.6	10.5 - 57.7	15	21.4	6.6 - 51.2	16	53.8	26.7 - 78.9
Professional	19	52.9	29.3 - 75.3	12	42.9	19.7 - 69.7	17	60.0	27.7 - 85.5
Both	15	57.7	37.8 - 75.4	9	42.9	23.3 - 64.9	10	71.4*	42.2 - 89.6
Absence	4	33.3	12.2 - 64.2	6	31.6	14.4 - 55.9	5	33.3	13.8 - 60.9
Present advertising
Yes	15	37.5*	23.7 - 53.7	15	41.7	26.5 - 58.6	16	48.5	31.6 - 65.7
No	17	58.6*	39.7 - 75.3	19	28.1	15.0-46.5	12	63.2	39.1 - 82.1
Date of the last update
until Nov. 2014	4	80.0	24.8 - 97.9	3	50.0	14.4 - 85.6	3	100.0	-
Dec. 2014 to Oct.2019	16	42.1	27.2 - 58.5	15	41.7	26.5 - 58.6	19	59.4	41.2 - 75.3
From Nov. 2019	1	50.0	1.8 - 98.1	1	33.3	2.4 - 90.9	1	50.0	1.8 - 98.2
No information	11	45.8	26.8 - 66.1	5	21.7	9.0 - 43.8	5	33.3	13.8 - 60.9

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[TFN1] ^a
Children who are using insufficient amounts of formula, cow’s milk or stored breast milk are advised to start complementary feeding at 4 months.¹⁵15 Oliveira LP, Assis AM, Pinheiro SM, Prado MS, Barreto ML. Complementary feeding in the first two years of life. Rev Nutr. 2005; 18: 459-69.

[TFN2] ^b
Only the texture was considered because it is the central theme of the step, the continuity of breastfeeding is contemplated in previous steps;

[TFN3] ^c
The term “industrialized” was considered synonymous with ultra-processed food when present on websites.