Latino-American Mothers' Perspectives On Feeding Their Young Children A Qualitative Study

Research Article
Latino-American Mothers’ Perspectives

on Feeding Their Young Children: A
Qualitative Study
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Tsu-Hsin Howe, Jim Hinojosa, Ching-Fan Sheu
OBJECTIVE. We explored the cultural beliefs that influence Latino-American mothers’ feeding practices with their
young children and the sources they referenced in making food choices for their children.
METHOD. We conducted semistructured interviews with 12 Latino-American mothers focusing on their experiences
of feeding their young children. Data analysis, based in grounded theory, consisted of interview transcription, content
analysis, coding, and theme development.
RESULTS. We identified four themes summarizing the mothers’ feeding practices: (1) “Grandma knows best,” (2) “I
want my child(ren) to be healthy,” (3) “always soup and always rice,” and (4) “mealtime is family time.”
CONCLUSION. Occupational therapy practitioners need to obtain accurate information from families about feeding
practices and to understand and interpret those practices in broader cultural contexts to design and implement
targeted feeding intervention strategies that avoid stereotyping or misinterpreted information. To promote family-
centered, meaningful interventions, practitioners must understand the cultural influences on feeding practices and be
sensitive to mothers’ needs.
E ating is a uniquely social and cultural experience. The varied ways different cultures eat largely determine the diets
of young children in those cultures. As Segal (2014) described it, food is a vehicle for many nonbiological functions
with symbolic social and economic meanings. For mothers and fathers, feeding is an opportunity to exercise their
parental roles. The family is the first and most fundamental socioenvironmental context in which children establish their
eating patterns. Parents influence eating through their child-feeding strategies. They select the family diet, model eating
behavior, and provide direct instruction on when, where, and how to eat (Anderson et al., 2005; Johnson & Birch, 1994).
These child-feeding strategies often occur within a conditioned cultural context (Heaton et al., 2005). Awareness of
clients’ cultural practices and habits is necessary for occupational therapy practitioners to design and implement
effective feeding intervention strategies.
People of Latino origin are the largest ethnic minority in the United States. According to the National Vital Statistics
Report on U.S. births (Hamilton et al., 2016), 23% of U.S. resident births in 2015 were among Latino-origin groups. In this
study, the term Latino-American describes a person living in the United States who identifies racially or ethnically as
Latino or who racially or ethnically identifies with people from Mexico, Central America, South America, or the Ca-
ribbean (Rivera et al., 2010). This broad definition of Latino-American recognizes and honors the diverse ethnic and
racial experiences of Latino-Americans.
There is a pressing need for health professionals to better understand feeding practices in this population from a
broader cultural perspective. Limited data are available on the feeding practices of Latino-Americans. Most studies have
focused on parental behaviors known to influence early childhood weight issues (Crawford et al., 2004; Martinez et al.,
2014). Some studies reported Latino-American mothers as tending to promote hearty, high-calorie meals so that
The American Journal of Occupational Therapy, May/June 2019, Vol. 73, No. 3 7303205110p1
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children can become “big and strong” (Cartagena et al., 2015; Garcia, 2004; Lindsay et al., 2011). Other studies reported
Latino-American mothers as being more likely to be indulgent in feeding practices, making few rules for or demands on
children (Chaidez et al., 2011). These diverse findings could be a result of the diversity of Latino-American culture
(Brotanek et al., 2009; Bryant, 1982; Bunik et al., 2006).
Our goal was to better understand feeding behaviors and attitudes of Latino-American mothers of young children.
This study’s primary objective was to gather information to identify and describe common cultural beliefs that influenced
feeding practices of a small group of Latino-American mothers with young children in the greater New York met-
ropolitan area. Further, we explored the sources of recommendations they received on how, what, and when to feed
their young children.
Method
Design and Procedures
We used grounded theory to understand participants’ perspectives on feeding their young children (Bogdan & Biklen,
2007; Corbin & Strauss, 2015; Creswell, 1998). Under supervision from two authors (Tsu-Hsin Howe and Jim Hinojosa),
second-year graduate students collected data using open-ended, semistructured, in-depth, face-to-face interviews
(Kvale, 1996; Spradley, 2016). Before data collection, the students engaged in a research seminar that included
training in interviewing techniques and cultural considerations. They were given a list of topics and suggested open-
ended questions related to the objectives of the research so they could incorporate them into interviews. The primary
interview questions were as follows: “What are your daily feeding routines?” “How does your cultural upbringing
influence your feeding practices?” “What do you like or find most challenging about feeding your child(ren)?” “How do
you decide how, when, and what to feed your child(ren)?” This interview guide ensured that the same general areas of
information were covered in each interview while allowing interviewers a degree of freedom and adaptability (Turner,
2010).
Interviews were conducted in English at participants’ homes at a time convenient for each family. Each interview
lasted about 1 hr, and each participant was interviewed twice over a period of 1 mo. All interviews were audio recorded.
Interviewers took abbreviated field notes about the context and participants’ body language. During data collection, the
interviewers met with investigators (Howe and Hinojosa) weekly to review the interview process, receive feedback on
interview techniques, and reflect on potential biases.
Participants
Participants were recruited using snowball sampling. The graduate student interviewers initially contacted two ac-
quaintances each about participating in the study. They asked these contacts whether they knew other potential
participants, who were, in turn, asked whether they knew potential participants, and so forth. Sampling stopped when
12 Latino-American mothers agreed to participate. To participate in the study, potential participants were required to
self-describe as Latino-American, have at least one child younger than age 5 yr, be able to communicate well in English,
and be willing to share their feeding experiences. Child younger than age 5 yr was used as the cutoff for recruitment
because we believe children’s feeding behaviors are influenced most by their parents during the earliest stages of
development. The Institutional Human Research Ethics Committee of New York University provided permission to
conduct the study.
Trustworthiness and Methodological Integrity

Steps were taken to ensure trustworthiness and account for potential researcher bias. As part of the course
assignment, graduate student interviewers were required to explicitly state their biases and beliefs about Latino-
Americans. A discussion of these biases highlighted their views about their own ethnic background and about
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Latino-American culture. Open discussions of the interviewers’ perceptions of participants were an essential part of
data collection. One of the researchers (Hinojosa) had a Latino-American background and oversaw the data collection
process to ensure that information was not misinterpreted or lost.
After data were collected and transcribed, we asked participating families to review the transcripts and provide
feedback. We also shared with participants the themes we developed and solicited their reactions. Although it is almost
impossible to mask all researcher bias, we consciously considered the effects of our prejudices and worldviews.
Further, the research was conducted in accordance with the protocol approved by the institutional review board, and all
participants provided informed consent before the interviews began.
Data Analysis
Interview observation notes, audio recordings, and transcriptions were analyzed. Data included child-feeding tactics,
habits, and routines, as well as the families’ general feeding experiences. Four transcripts were reviewed to ensure
consistency with the corresponding audio recordings. The qualitative data analysis software ATLAS.ti Version 6.2
(Scientific Software Development, Berlin, Germany) was used for coding, text retrieval, data management, and content
analysis. Coding qualitative data involves labeling units of data (lines, sentences, or paragraphs) and aggregating units
into categories. Themes generated from the original study questions were used as categories (Hannon et al., 2000).
Major themes emerged after abstraction and logical analysis.
Authors Howe and Hinojosa independently reviewed the data to code and identify major categories and then reviewed
coding agreements and disagreements to reach a consensus, thus increasing the reliability of study findings. After dis-
cussing discrepancies in coding and categorization, the authors identified or redefined category definitions. In summarizing
the data in this article, we use participants’ exact words when possible. In addition, we present disconfirming evidence—that
is, the data not consistent with the theme we defined—as a means of increasing credibility (Creswell & Miller, 2000).
After completion of thematic analyses, all interview data were combined into one file. From this file, a word cloud
was created to visualize the frequency of words used in the interview responses (Figure 1). Words representing food
groups (starch, fruits, vegetables, meat) were then added to the actual interview words in an attempt to show the
frequency of mention of various foods. The more frequently a word was used in the interview responses, the larger
the word appears in the word cloud. Figure 2 represents the frequency of words extracted from the interviews.
Results
Table 1 provides detailed background information on the 12 participating families. Nine were two-parent families and 3
were single-parent families. Only 1 family lived with extended family; the rest lived in nuclear family households.
Children of 5 families attended day care on weekdays, five children were cared for by their grandmothers, and three
children stayed home with their mothers. All mothers except one held a full-time or part-time job outside the home.
Interview content included feeding practices and habits and the recommendations mothers considered when
feeding their young children. Four major themes emerged from the interviews. The first theme, “Grandma knows best,”
relates to decisions about food progression—determining what foods and when and how to introduce them to their
young children. The second theme, “I want my child(ren) to be healthy,” addresses the mothers’ beliefs about health
and healthy food. The third theme, “always soup and always rice,” relates to the food choices mothers made for their
children, including preparation methods (e.g., store-bought vs. homemade, seasonings, ingredients). The fourth
theme, “mealtime is family time,” reveals the mothers’ perceptions of the value of mealtimes.
Theme 1: “Grandma Knows Best”

Most participants identified their mothers as the first person they contacted when seeking advice about feeding their
children. Some participants shared, “Grandma knows the best,” “She’s just kinda watching out for her,” and “Who else to
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give you the best advice than your own mother?” When
Figure 1. Word cloud: Visualization of word frequency participants were asked who decided when, what, and
in interview responses. how to feed their children, 2 responded, “It was my
mom—it was all my mom” and “Grandma tell me when
she thinks I need to give my babies food, and Grandma tell
me what to feed them.”
When asked about seeking advice from doctors about
feeding, 2 mothers responded, “No doctors; they scare the
crap out of you about everything” and “We try Mom’s old-
school remedies; if doesn’t work, we resort to the doctors.”
The participants tended to second-guess or disregard
medical advice. For example, 1 participant shared, “They
[the doctors] told me not to give him water before 1 year
old, but I gave him chamomile tea anyway.”
When faced with conflicting recommendations from
physicians and family, the mothers tended to rely on their
family’s advice. As 1 mother summarized,
I [would] really rather get information from my mother. The
doctor doesn’t always say everything. They always tell you to
avoid certain things but not everything. You know they also
Note. Larger type indicates words that were used more often. tell you that not to feed babies solids until they are certain age,
but we give it to them anyway. We know that they’ll be OK.
Other mothers made similar statements, particularly in regard to decisions about feeding babies solids. One said,
“Grandma said she is hungry, she needs more than just milk, so I started to give her food in addition to breast milk.”
Others stated, “My family wanted my child to be eating solid at a young age [1–2 mo]” and “My family told me to put
cereal in her bottle.”
Theme 2: “I Want My Child(ren) to Be Healthy”

The mothers unanimously expressed a strong desire to feed their children healthy food. When asked to describe what
foods she considered healthy, 1 participant stated, “Vegetables, fruits, meats, of course, and lots of milk.” When asked,
some participants elaborated on the importance of milk—for example, “Because they need it [milk] for their bones; they
are growing, you know. They need strong bones.”
The mothers seemed to place more emphasis on healthy children than on healthy food. All mothers expressed a
clear desire for their children to be robust. One mother stressed the point, saying, “You don’t want them to be these
fragile little things!” The mothers believed that a healthy child is “chubby, but not fat.” One mother elaborated, stating,
“According to the doctor, he is like 5 pounds overweight or something, but I don’t know if he’s just a big kid, because he
doesn’t really look overweight to me. He’s always been heavy.” These beliefs were reinforced by grandmothers and
older relatives. The mothers reported hearing comments from their grandmothers or older relatives such as “You are
not feeding her enough . . . she looks weak to me,” “They are skinny,” and “Oh my god, look, she is losing her cheeks.”
The expressed cultural perception that skinny is not healthy could explain the mothers’ reported leniency in feeding
habits. Most mothers allowed their children to eat snacks as often as they liked. Some mothers explained that children
in general are always hungry and should have the freedom to decide when they are full: “When she is hungry, she
goes to the refrigerator and takes whatever she wants.” “Throughout the day, they have some snacks. I let them have
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Figure 2. Words used in interview responses, by frequency.
chips, yogurt. They will have fruit, and they will eat their little junk, too.” “Chips, goldfish, crackers, just stuff.” “Snacks all
the time.”
Theme 3: “Always Soup and Always Rice”

The mothers reported specific food choices and preparation techniques that were affected by cultural influences. When
the mothers were asked what they fed their children, soup and rice were the two most common answers. One stated,
“It’s always soup and always rice.” Soup and rice were given to children at very young ages. One mother shared, “They
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Table 1. Cultural Background of Participating Families

Family No. Children Cultural Background
1 Amy, age 18 mo Amy lives with her mother, age 30. Amy’s mother is involved with Amy’s father, age 35, but they do not live with him. Amy has
an older stepbrother on her father’s side. Amy’s mother was born in Puerto Rico and raised in the United States; her father
was born in the United States (his mom is African-American, and his dad is Jamaican). Amy’s mother works as a nurse, and
Amy attends day care provided by Amy’s mother’s workplace. Amy’s mother is the primary caregiver.
2 Brian, age 3 yr Brian lives with his parents. Brian’s mother is of Peruvian descent, and his father is of Puerto Rican descent. Brian goes to day
care while both of his parents work, his mother as a teacher’s aide at a day care, and his father as a mail carrier. His mother
is the primary caregiver.
3 Carlos, age 2 yr, 10 mo Carlos lives with his parents. Carlos’ mother was born in Puerto Rico and raised in Brooklyn; his father, born and raised in
Brooklyn, is of Peruvian descent. Carlos’ mother works as a customer advocate at a utility company, and his father works in
a corporate sales department. Carlos spends most of his time with his paternal grandmother, who immigrated from Peru.
4 Daisy, age 10 mo Daisy and Danny live with their mother, who is of Dominican descent and works as a babysitter. Their maternal grandmother
Danny, age 5 yr prepares food for them most of the time.
5 Erika, age 3 yr, 9 mo Erika lives with her parents. Erika goes to day care while her mother, who is Ecuadorian, works for a medical billing company.
Her mother is the primary caregiver.
6 Frank, age 12 yr Frank and Frances live with their parents, who were Colombian. Their mother works as a paraprofessional at a school. Frank
Frances, age 4 yr goes to school, and Frances goes to day care. Their mother is the primary caregiver.
7 Gillian, age 12 yr Gillian, Gary, and Grace live with their parents, who are from the Dominican Republic. Their father works as a superintendent
Gary, age 8 yr in an apartment building and their mother is a housewife and the primary caregiver.
Grace, age 3 yr
8 Henry, age 8 yr Henry and Hanna live with their parents, who are both from Mexico. Their mother, age 28, was born in Mexico and immigrated
Hanna, age 2 yr to the United States when she was age 15. She works as a housekeeper. Their father, age 29, works as a landscaper. Henry
goes to school, and Hanna has a babysitter while their parents are at work. Their mother is the primary caregiver.
9 Ivan, age 6 yr Ivan and Isabel live with their parents, who both are from Brazil and had immigrated to the United States when they were
Isabel, age 3 yr young (father was age 9–10, mother was age 14). Their father, age 32, owns a painting company, and their mother, age 31,
works as a Zumba instructor at a gym. Their mother is the primary caregiver.
10 Jack, age 3 yr Jack lives with both parents and 5 other family members from Jack’s father’s side. Jack’s mother, age 25, was born in the
United States but considers herself Dominican. Jack’s father, age 25, is African-American and works at a convenience store.
Jack’s mother attends school part time and works part time at a retail store. Jack’s father and paternal grandparents take
care of him when his mother is not home. His mother does most of the cooking for him.
11 Kate, age 18 mo Kate lives with her parents, who are from El Salvador. Her mother, age 25, immigrated to the United States at age 5. She works
part time at a doctor’s office. Kate’s father works as a landscaper for most of the year. Kate stays with her maternal
grandmother when her mother is at work or with her father when he is not working. Her mother is the primary caregiver.
They eat most of their meals, which are prepared by her mother, at home.
12 Lily, age 3 yr Lily’s mother, age 39, was born in Peru and immigrated to the United States at age 6 mo. She works full time for a human
resources department in a city agency. She is a single parent and does not have a relationship with Lily’s father. Lily’s
primary caregivers are her maternal grandparents.
[family members] were giving him soup at 3 months old.” Another stated, “I started supplementary food around 2, 2½
months. I added it in the bottle.” When asked to describe what supplementary food she gave her child, the mother
responded, “soup, rice, mashed potatoes.” The preference for feeding soup and rice to young children relates to the
general cultural preferences for those foods. As one mother said, “We pretty much eat white rice or rice with everything.”
Others talked about the cultural belief that soup is healthy: “When we are sick, we drink soup” and “Soup is like brain
food; like if you eat enough soup, you won’t ever get sick.”
Participants shared their preferences for homemade meals: “I prefer cooking at home; I do not believe in pre-
packaged food or microwavable [food].” “A home-cooked meal is showing love to your family, to your child.” “I wanna
keep it that way, it’s better; homemade food is the best.” “I homemade cook about 6 days out of a week. Usually I make
rice, beans, chicken; some days soup.” They also described ethnic influences on food preparation: “The way I
prepare the food, that’s from Grandma—Brazilian way of cooking.” “I learned a lot of my cooking from my mom and my
sister and my mother-in-law.” “Peruvians love hot sauce.” “We always seasoned our food.” “[We put] garlic in ev-
erything.” “We use sofrito” (i.e., sauce used as a base in Latin American cooking). “He is supposed to eat more beans,
red beans, lentil beans, white beans . . . they are good for protein.”
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Theme 4: “Mealtime Is Family Time”

The mothers placed a high value on family mealtime. They considered togetherness during mealtime as a symbol of a
unified family, an important tradition in Latino-American culture. The mothers reminisced about their past family
mealtime experiences and felt those experiences contributed to fond childhood memories. All mothers expressed a
strong desire to replicate similar experiences for their own children: “When you sit down with your father, your mother,
you feel good . . . because you see the family’s union.” “The most important thing for me when I stay at the table with my
family and see my kids eating something, you know, I see my family.” “I like we all sit at the table together at dinner.”
Changes to Latino Cultural Feeding Practices

In addition to the four identified themes, we also observed that despite these mothers’ positive feelings about cultural
influences on their feeding practices, some made attempts to change common practices. When they became aware that
culturally influenced choices or practices were unhealthy, they tried to change them to promote better outcomes for
their children. These changes were reflected in disagreements these mothers described regarding feeding: “We’re
Americanized, you know, so we were like, ‘no, no, we’re not doing that.’” “She [Grandma] drives me insane about
feeding. We’ll have a big argument all the time.” “She [Grandma]’ll be like, ‘She didn’t eat anything,’ and [I’ll say,] ‘But
she has a little stomach; she doesn’t need a ginormous plate that we eat.’”
Word Cloud Visualization Analysis

As depicted in Figures 1 and 2, “starch” was the food category most frequently mentioned in the interviews. Starch-
related terms, such as rice, potato, and cereal, appeared to be the most common foods these mothers chose to feed
their children. Vegetables, milk, fruit, chicken, and soup were also used frequently.
Discussion
Interviews were conducted with 12 Latino-American mothers residing in the greater New York metropolitan area.
Despite their heterogeneous ethnic backgrounds, these mothers provided responses that revealed common themes
regarding feeding practices. The findings of this study can help increase a general understanding of the ways culture
might play a role in mothers’ decisions about how, when, and what to feed their children.
In this study, we learned about the influences that relatives and others have on maternal feeding practices. These
influences were highlighted by the first theme, “Grandma knows best”; the mothers addressed the importance of their
own mothers, mothers-in-law, and grandmothers in their feeding decisions. This finding confirms Bryant’s (1982)
conclusion that social networks strongly influence infant feeding practices of Cuban, Puerto Rican, and Anglo families
in Florida. The mothers in our sample, like those in Bryant’s study, listened to members of their social network to
determine when to start feeding their children solid food.
Paternal and maternal grandparents have been found to play an essential role in determining feeding practices
(Lindsay et al., 2011; Losch et al., 1995), and this influence is not unique to Latino-American culture (Abel et al., 2001;
Bezner Kerr et al., 2008). Bezner Kerr and colleagues (2008) reported that grandmothers in Malawi held powerful
positions in extended families and communities in general. They often imposed their child care opinions on younger
mothers, and their ideas about early child feeding often differed from conventional Western medicine. Abel et al. (2001)
reported similar observations in a cross-cultural study of infant care practices in New Zealand.
Mothers of different racial and ethnic backgrounds engage in diverse feeding practices (Hughes et al., 2005;
Papaioannou et al., 2013). Maternal perceptions of a child’s weight and health status can be socially and culturally
influenced. In our study, the mothers reported that they preferred “chubby” babies and wanted their children to be
strong and robust. These findings are in line with reports from other researchers that Latino-American mothers perceive
heavier children as healthier (Crawford et al., 2004; Lindsay et al., 2011; Reifsnider et al., 2006).
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Several studies have examined health beliefs surrounding weight (Crawford et al., 2004). Crawford and
colleagues (2004) explored beliefs and attitudes toward early childhood weight issues in Latino-American
mothers. They presented 43 Latino-American mothers with a set of photographs of children aged 3–4 yr of various
shapes and sizes ranging from underweight to overweight. Mothers in the study consistently reported that “a
heavier child looked healthiest because her hair was ‘healthy and shining,’ her skin was ‘full of life,’ and she had
a ‘very happy expression’” (Crawford et al., 2004, p. 390). Lindsay et al. (2011) reported that within Latino-
American culture, a child’s weight reflects parenting skills; having a “skinny” child is a sign of bad parenting and
poor health.
In our study, the mothers focused on giving their children healthy food, as described in the “I want my child(ren) to be
healthy” theme. The mothers seemed to think they were making healthy feeding decisions, but their strategies were not
always consistent with the beliefs of health care providers—for example, some mothers reported allowing their children
to snack whenever they wanted. Similar parental feeding practices have been observed in other studies (Evans et al.,
2011; Sherry et al., 2004).
The theme “always soup and always rice” includes the mothers’ descriptions of their children’s diets. Latino-
American young children are frequently fed rice, potatoes, soup, and beans. Whereas Mennella et al. (2006) reported in
their study of feeding practices in Mexico that fruit was the predominant choice of first food for infants, in our study rice
cereal in children’s bottles was the most common first supplementary food. The mothers in our study also stressed the
importance of milk. Brotanek and colleagues (2009) reported a similar observation; they described the belief of Mexican-
American parents that toddlers should be given as much milk as they want because milk is a good nutritional
supplement in case they do not eat enough of the right foods. Brotanek et al. further proposed that this belief might
contribute to the high prevalence of bottle-feeding past age 15 mo among Mexican-American parents, a practice
associated with excessive milk intake and iron deficiency in toddlers.
In the literature, four parental feeding styles have been classified using dimensions of responsiveness and de-
mandingness: authoritative, authoritarian, indulgent–permissive, and uninvolved–neglectful permissive (Blissett, 2011;
Papaioannou et al., 2013). Chaidez et al. (2011) reported that the indulgent–permissive feeding style was dominant
among the Mexican-American mothers they studied. That is, in determining what to feed their children, these mothers
tended to cater to the child’s preferences. Moreover, in deciding when to feed their children or how much they should eat,
most of the mothers based responses on their interpretations of their children’s cues. The mothers in our study
reported similar behavior, especially in regard to snacks.
As captured in the theme “mealtime is family time,” all mothers in the study recognized and appreciated the value of
family mealtime. This finding reflects the traditional Latino-American emphasis on the family as the single most im-
portant social unit. Latino-Americans consider midday and evening meals important family and social events (Clutter &
Zubieta, 2009).
Limitations
This study has several limitations. The Latino-American mothers recruited for this study were exclusively from the
greater New York metropolitan area and may not share beliefs with other Latino-American groups around the country. In
addition, the qualitative approach necessarily limits generalizability. Despite intensive training, it may have been
impossible to mask all bias that the researchers and graduate student interviewers might have had. The snowball
sampling recruitment method and the fact that interviews were conducted only in English limited the pool of potential
participants and may have affected the scope of described phenomena. Moreover, our sample size was small, and
only mothers were included; the views of other family members were not represented. Conducting bilingual interviews
and including major social network members (e.g., grandmothers) in a larger sample will be considered in future studies.
We also acknowledge that Latino-Americans are a heterogeneous ethnic group, and feeding practices may vary
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widely depending on country of origin. We intend to further explore feeding practices, taking into consideration factors
such as country of origin and food acculturation.
Implications for Occupational Therapy Practice

The findings of this study have the following implications for occupational therapy practitioners who provide early
feeding interventions:
n Practitioners need to recognize cultural influences on feeding practices to interpret feeding evaluations in context.
For example, when a mother reports she has introduced supplemental food to her young child, the practitioner
should clarify how the supplemental food was given (e.g., spoon vs. bottle) and not assume the child has certain
oral–motor skills.
n It is essential to avoid using stereotypical or misinterpreted information when designing and implementing targeted
feeding intervention strategies. Understanding cultural influences on feeding practices promotes family-centered,
meaningful interventions that are sensitive to maternal needs.
n Practitioners can use our findings as a resource when choosing or introducing food during feeding interventions.
The inclusion of culturally relevant foods promotes implementation of interventions by mothers and family
members.
n Child feeding, and the people involved in decision making about child feeding, cannot be addressed in isolation.
When working with Latino-American families, practitioners must consider the multifaceted role grandmothers play
in child feeding and household social relations. Grandmothers are influential members of immediate social
support networks. Practitioners should consider their perspectives when recommending feeding practices and
planning interventions. Moreover, practitioners must remain alert to the inherent conflicts within extended families
and potential distrust of medical institutions (Bezner Kerr et al., 2008).
Conclusion
Understanding the range of perceptions and influences Latino-American mothers identify as affecting feeding practices
is vitally helpful to health care providers. Consideration of cultural beliefs and practices surrounding infant feeding and
well-being is important to successfully deliver health services to a diverse population. Understanding cultural in-
fluences on feeding practices promotes family-centered, meaningful interventions that are sensitive to maternal needs.
Recognition of cultural influences contextualizes information for health care providers and can be used to design and
implement effective targeted feeding intervention strategies that avoid stereotyping or misinterpreted information.
References
Abel, S., Park, J., Tipene-Leach, D., Finau, S., & Lennan, M. (2001). Infant care practices in New Zealand: A cross-cultural qualitative study. Social Science and
Medicine, 53, 1135–1148. https://doi.org/10.1016/S0277-9536(00)00408-1
Anderson, C. B., Hughes, S. O., Fisher, J. O., & Nicklas, T. A. (2005). Cross-cultural equivalence of feeding beliefs and practices: The psychometric
properties of the Child Feeding Questionnaire among Blacks and Hispanics. Preventive Medicine, 41, 521–531. https://doi.org/10.1016/j.ypmed.2005.01.
003
Bezner Kerr, R., Dakishoni, L., Shumba, L., Msachi, R., & Chirwa, M. (2008). “We grandmothers know plenty”: Breastfeeding, complementary feeding and the
multifaceted role of grandmothers in Malawi. Social Science and Medicine, 66, 1095–1105. https://doi.org/10.1016/j.socscimed.2007.11.019
Blissett, J. (2011). Relationships between parenting style, feeding style and feeding practices and fruit and vegetable consumption in early childhood.
Appetite, 57, 826–831. https://doi.org/10.1016/j.appet.2011.05.318
Bogdan, R., & Biklen, S. K. (2007). Qualitative research for education: An introduction to theories and methods (5th ed.). Boston: Pearson/Allyn & Bacon.
Brotanek, J. M., Schroer, D., Valentyn, L., Tomany-Korman, S., & Flores, G. (2009). Reasons for prolonged bottle-feeding and iron deficiency among
Mexican-American toddlers: An ethnographic study. Academic Pediatrics, 9, 17–25. https://doi.org/10.1016/j.acap.2008.10.005
Bryant, C. A. (1982). The impact of kin, friend and neighbor networks on infant feeding practices: Cuban, Puerto Rican and Anglo families in Florida. Social
Science and Medicine, 16, 1757–1765. https://doi.org/10.1016/0277-9536(82)90269-6
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Bunik, M., Clark, L., Zimmer, L. M., Jimenez, L. M., O’Connor, M. E., Crane, L. A., & Kempe, A. (2006). Early infant feeding decisions in low-income Latinas.
Breastfeeding Medicine, 1, 225–235. https://doi.org/10.1089/bfm.2006.1.225
Cartagena, D., Ameringer, S. W., McGrath, J. M., Masho, S. W., Jallo, N., & Myers, B. J. (2015). Factors contributing to infant overfeeding in low-income
immigrant Latina mothers. Applied Nursing Research, 28, 316–321. https://doi.org/10.1016/j.apnr.2015.03.007
Chaidez, V., Townsend, M., & Kaiser, L. L. (2011). Toddler-feeding practices among Mexican American mothers: A qualitative study. Appetite, 56, 629–632.
https://doi.org/10.1016/j.appet.2011.02.015
Clutter, A. W., & Zubieta, A. C. (2009). Understanding the Latino culture [Fact sheet]. Columbus: Ohio State University Extension. Retrieved from
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.183.6912&rep=rep1&type=pdf
Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory (4th ed.). Thousand Oaks, CA:
Sage.
Crawford, P. B., Gosliner, W., Anderson, C., Strode, P., Becerra-Jones, Y., Samuels, S., . . . Ritchie, L. D. (2004). Counseling Latina mothers of preschool
children about weight issues: Suggestions for a new framework. Journal of the American Dietetic Association, 104, 387–394. https://doi.org/10.1016/j.
jada.2003.12.018
Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage.
Creswell, J. W., & Miller, D. L. (2000). Determining validity in qualitative inquiry. Theory Into Practice, 39, 124–130. https://doi.org/10.1207/s15430421tip3903_2
Evans, A., Seth, J. G., Smith, S., Harris, K. K., Loyo, J., Spaulding, C., . . . Gottlieb, N. (2011). Parental feeding practices and concerns related to child
underweight, picky eating, and using food to calm differ according to ethnicity/race, acculturation, and income. Maternal and Child Health Journal, 15,
899–909. https://doi.org/10.1007/s10995-009-0526-6
Garcia, R. S. (2004). No come nada. Health Affairs, 23, 215–219. https://doi.org/10.1377/hlthaff.23.2.215
Hamilton, B. E., Martin, J. A., & Osterman, M. (2016). Births: Preliminary data for 2015. National Vital Statistics Reports, 65, 1–15.
Hannon, P. R., Willis, S. K., Bishop-Townsend, V., Martinez, I. M., & Scrimshaw, S. C. (2000). African-American and Latina adolescent mothers’ infant
feeding decisions and breastfeeding practices: A qualitative study. Journal of Adolescent Health, 26, 399–407. https://doi.org/10.1016/S1054-139X
(99)00076-2
Heaton, T. B., Forste, R., Hoffmann, J. P., & Flake, D. (2005). Cross-national variation in family influences on child health. Social Science and Medicine, 60,
97–108. https://doi.org/10.1016/j.socscimed.2004.04.029
Hughes, S. O., Power, T. G., Orlet Fisher, J., Mueller, S., & Nicklas, T. A. (2005). Revisiting a neglected construct: Parenting styles in a child-feeding context.
Appetite, 44, 83–92. https://doi.org/10.1016/j.appet.2004.08.007
Johnson, S. L., & Birch, L. L. (1994). Parents’ and children’s adiposity and eating style.Pediatrics, 94, 653–661.
Kvale, S. (1996). InterViews: An introduction to qualitative research interviewing. Thousand Oaks, CA: Sage.
Lindsay, A. C., Sussner, K. M., Greaney, M. L., & Peterson, K. E. (2011). Latina mothers’ beliefs and practices related to weight status, feeding, and the
development of child overweight. Public Health Nursing, 28, 107–118. https://doi.org/10.1111/j.1525-1446.2010.00906.x
Losch, M., Dungy, C. I., Russell, D., & Dusdieker, L. B. (1995). Impact of attitudes on maternal decisions regarding infant feeding. Journal of Pediatrics, 126,
507–514. https://doi.org/10.1016/S0022-3476(95)70342-X
Martinez, S. M., Rhee, K., Blanco, E., & Boutelle, K. (2014). Maternal attitudes and behaviors regarding feeding practices in elementary school-aged Latino
children: A pilot qualitative study on the impact of the cultural role of mothers in the US–Mexican border region of San Diego, California. Journal of the
Academy of Nutrition and Dietetics, 114, 230–237. https://doi.org/10.1016/j.jand.2013.09.028
Mennella, J. A., Ziegler, P., Briefel, R., & Novak, T. (2006). Feeding Infants and Toddlers Study: The types of foods fed to Hispanic infants and toddlers. Journal
of the American Dietetic Association, 106(1,Suppl.), 96–106. https://doi.org/10.1016/j.jada.2005.09.038
Papaioannou, M. A., Cross, M. B., Power, T. G., Liu, Y., Qu, H., Shewchuk, R. M., & Hughes, S. O. (2013). Feeding style differences in food parenting
practices associated with fruit and vegetable intake in children from low-income families. Journal of Nutrition Education and Behavior, 45, 643–651.
https://doi.org/10.1016/j.jneb.2013.05.007
Reifsnider, E., Flores-Vela, A. R., Beckman-Mendez, D., Nguyen, H., Keller, C., & Dowdall-Smith, S. (2006). Perceptions of children’s body sizes among
mothers living on the Texas–Mexico border (La Frontera). Public Health Nursing, 23, 488–495. https://doi.org/10.1111/j.1525-1446.2006.00588.x
Rivera, D. P., Forquer, E. E., & Rangel, R. (2010). Microaggressions and the life experience of Latina/o American. In D. W. Sue (Ed.), Microaggressions and
marginality: Manifestation, dynamics, and impact (pp. 59–83). Hoboken, NJ: Wiley.
Segal, R. (2014). Dimensions of occupations across the life span. In J. Hinojosa & M.-L. Blount (Eds.), The texture of life: Occupations and related activities
(4th ed., pp. 37–53). Bethesda, MD: AOTA Press.
Sherry, B., McDivitt, J., Birch, L. L., Cook, F. H., Sanders, S., Prish, J. L., . . . Scanlon, K. S. (2004). Attitudes, practices, and concerns about child feeding and
child weight status among socioeconomically diverse White, Hispanic, and African-American mothers. Journal of the American Dietetic Association, 104,
215–221. https://doi.org/10.1016/j.jada.2003.11.012
Spradley, J. (2016). The ethnographic interview. Long Grove, IL: Waveland Press.
Turner, D. W., III. (2010). Qualitative interview design: A practical guide for novice investigators. Qualitative Report, 15, 754–760. Retrieved from http://
nsuworks.nova.edu/tqr/vol15/iss3/19
Research Article
Tsu-Hsin Howe, PhD, OTR, FAOTA, is Associate Professor, Department of Occupational Therapy, Steinhardt School of Culture, Education, and
Human Development, New York University, New York, NY; tsuhsin.howe@nyu.edu
Jim Hinojosa, PhD, OT, FAOTA, was Professor Emeritus, Department of Occupational Therapy, Steinhardt School of Culture, Education, and
Human Development, New York University, New York, NY.
Ching-Fan Sheu, PhD, is Professor, Institute of Education, National Cheng Kung University, Tainan, Taiwan.
Acknowledgments
The authors thank participating families and New York University graduate students in the Department of Occupational Therapy for
making this project possible. This study is exempt from clinical trial registration.
Jim Hinojosa passed away while this article was in press. He is greatly missed.
Citation: Howe, T.-H., Hinojosa, J., & Sheu, C.-F. (2019). Latino-american mothers’ perspectives on feeding their young children: A qualitative study.
American Journal of Occupational Therapy, 73, 7303205110. https://doi.org/10.5014/ajot.2019.031336

Latino-American Mothers' Perspectives On Feeding Their Young Children A Qualitative Study

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Latino-American Mothers' Perspectives On Feeding Their Young Children A Qualitative Study

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Research Article

Latino-American Mothers’ Perspectives

Trustworthiness and Methodological Integrity

Theme 1: “Grandma Knows Best”

Theme 2: “I Want My Child(ren) to Be Healthy”

Figure 2. Words used in interview responses, by frequency.

Theme 3: “Always Soup and Always Rice”

Table 1. Cultural Background of Participating Families

Theme 4: “Mealtime Is Family Time”

Changes to Latino Cultural Feeding Practices

Word Cloud Visualization Analysis

Implications for Occupational Therapy Practice

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