Parents and carers' choice of drinks for infants and toddlers, in areas of social and economic disadvantage

Background: Sugar rich drinks are a recognised risk factor in early childhood caries. Currently, in depth knowledge of factors influencing parents' choice of infant drinks is incomplete. Objectives: This study investigated parents and carers understanding of feeding practices potentially detrimental to oral health; barriers to adopting safe feeding practices and commercial factors influencing feeding bottle and cup contents. Methodology: A qualitative approach using semi-structured interviews was employed. Interviews were conducted by an experienced researcher and tape recorded. Following full transcription, emerging themes were identified, systematically explored and validated within the verbatim accounts. Thirty-three parents/carers of children aged three years and under, resident in areas of high caries prevalence in Cardiff, Wales, were interviewed. Results: Overall understanding of the prolonged effect of exposure to sugared drinks in feeding bottles and cups was poor. Greater concern was expressed over the use of bottles on the development of the occlusion. Milk was viewed as a food rather than as a drink. Many barriers to giving water were described: children reject it; mothers don't like it; it was 'cruel' to offer water instead of sweet drinks; water in feeding bottles or cups was seen as a sign of poverty. Commercial influences on choices were strong. Products offered by baby food manufacturers were viewed as safe, but a recently marketed "Toothsafe" drink was viewed with suspicion. Conclusions: There are significant barriers to adopting the traditional oral health education message, that only milk and water are truly safe for teeth. Future oral health education and promotion programmes must recognise and account for these factors.