Discussion
The results of this study demonstrate that the mixed method of complementary feeding, which includes offering foods cut into sticks or strips and mashed or pureed foods, had higher adherence in our sample of children at seven, nine, and 12 months of age. Additionally, the mixed method was followed by most of the children who did not adhere to the CF methods they were randomized into. In this sample, the BLISS method had the lowest adherence every month. Furthermore, the authors did not find any association between adherence to the introduction of food methods and maternal, familial, and infant variables analyzed.Concerning the three-group randomization, the authors observed no significant association between household income, maternal age, schooling level, parity, and BF up to six months of age of children. The authors [The authors [Adherence to BLISS was the lowest within our sample, in opposition to [Moreover, in our study, mother-child pairs either adhered to methods by feeding mode or food consistency, so the authors chose to separate them. Thus, it was the first study to separate feeding mode and food consistency in all months. The Brazilian Ministry of Health advises that, at 12 months of age, children must be encouraged to take food with their own hands to stimulate the pinch movement and teach them to cut food with their front teeth [Mothers using BLISS who did not follow the method migrated mainly to the mixed method, compared to a study by [Even though few studies assess the relationship between adherence to CF methods and maternal, family, or infant variables, the authors show that what would represent adherence to child-guided methods, identifying a cultural variable related to adherence to a combination with PLW, lacks definition. The literature does not clearly show how common the combination of PLW with child-guided methods is, as most studies ask participants to identify the specific method they are following [The authors found no association between adherence to methods of food introduction and family and maternal variables, such as maternal skin color and age, type of delivery, monthly household income, cohabitation with a partner, parity, daily working hours, and infant variables, such as BF at hospital discharge and BF up to six months of age of children. Our data is following [Other variables not analyzed in this study may influence adherence to CF methods. For example, parental behavior, as [Child-guided methods are associated with a low-control maternal feeding style, in which mothers control the children’s food intake less than mothers who use PLW; thus, parenting style could be an important factor to influence adherence to CF methods [This research has some limitations. Just under 30% of the mothers who met the inclusion criteria did not attend the intervention; these mothers had lower schooling and family income than those included. In Brazil, maternity leave lasts four months in most companies and our intervention occurred at 5.5 months of the children’s lives, therefore, there may be mothers unable to participate in this study. Family income and schooling level in our sample were higher than in the general population, which compromises the generalizability of results. The sample was spontaneously recruited mainly from the target social networks, which may result in mothers previously interested in complementary feeding. The sample size may have been insufficient to obtain significant results in the tests performed to assess the association. Another limitation of the study concerns how adherence was asked of those responsible for categorical questions with yes or no answers that took into account how the child’s diet was most of the time (75% of meals). There is no definition of what is the best way to measure adherence to CF methods, this can generate heterogeneity in the way researchers evaluate in their studies. The possibility to contact the nutritionist by phone or email wasn’t evaluated for the adherence to the method in this study.However, this study provides a significant and unprecedented contribution to the field of complementary feeding. As far as we know, it is the first study to evaluate adherence to the major feeding introduction methods described in the scientific literature at three different time points. The study design included personalized nutritional counseling and practical intervention, with the aid of an experimental kitchen equipped for food preparation. However, this study is not exhaustive on the topic of adherence to complementary feeding methods. The authors recommend further studies focusing on standardizing the way adherence is evaluated.