Cultural Differences in Infant Feeding

Cultural beliefs influence infant feeding practices for recent immigrants and for resident US ethnic groups.

Examples of cultural infant feeding practices and beliefs that may affect an infant’s nutritional status: 

• A belief in a need for prelacteal feedings
• Avoidance of colostrum
• Concerns that breastfeeding encourages neediness
• A belief that human milk is insufficient
• Variations in perceptions of what constitutes appropriate weight
• A belief in a need for early food supplementation (as early as 2 weeks)
• Need for strong parental control over the act of feeding (in infants who are ready for self-feeding)
• Encouragement of prolonged bottle feeding (2 years and beyond)

Although it may not be feasible to learn the cultural feeding practices of each ethnic group, a sensitive and careful approach to breastfeeding and nutrition guidance helps to encourage successful breastfeeding and guide the introduction of complementary foods.

For example, in lieu of asking “How is the breastfeeding going?” specifically solicit information on the what the baby has eaten in the last 24 to 48 hours.

Other types of questions that may be appropriate:

• How have the other children in your family been fed (eg, for first 6 months)?
• How and what do you plan to feed your baby for the first 2 (or more) months?
• Have you heard of feeding honey to babies?
• Who else feeds your baby?

Some parents may listen more closely to the advice of their mothers or other family members than to the pediatrician. Directly soliciting information about feeding practices and then providing factual nutritional information to parents and other family members is helpful.

Encouragement from a clinician plays an important role in prolonging breastfeeding.

• Reports from Black (non-Hispanic) mothers reveal that videos and written material, without discussion of personal beliefs or experiences, do little to encourage breastfeeding.

A culturally competent staff builds trust.

• Use interpreters and include posters, handouts, and pamphlets in the languages that your patients speak.
• Ensure that all staff receive ongoing education and training in culturally and linguistically appropriate service delivery.
• Use trained community members to counsel parents.
• Use trained peer counselors for breastfeeding support who speak the same language (if not English) and who have the same cultural identity.

Avoid stereotypes of a particular ethnicity. Generalizations do not represent all members of a particular group. Careful questioning is the best tactic to avoid assumptions about beliefs.

For further information on culturally competent nutritional support and clinical care, visit Ethnomed.