Intervention
choking, breast milk
ADVERSE EVENTS, CHOKING
The intervention sessions were conducted in groups of up to eight pairs of mothers and/or caregivers and children, according to the CF randomized method (PLW, BLISS, or mixed).The first intervention took place when the children were 5.5 months old in a private nutrition clinic equipped with an experimental kitchen and a classroom. They were performed by a team consisting of two nutritionists, who provided detailed guidance on the CF method of each group.During a one-hour meeting, a nutritionist cooked examples of dietary foods and explained standardized information about the CF method to which participants were randomized. During the ‘first 12 months of the life of children, the nutritionist’s phone number and email address would be available to provide any extra support related to the CF method or for mothers to report adverse events. Flyers with additional information about CF and examples of healthy foods were also provided.This study occurred in the transition period between information from the 2015 notebook 23 on breastfeeding and complementary feeding and the new information from the 2019 Dietary Guide for Brazilian Children Under 2 Years of Age, therefore, guidelines regarding food consistency for the group using PLW were those recommended by the notebook 23 [Regarding PLW, guidelines addressed the importance of EBF for up to six months of age of children and starting a slow and gradual introduction of complementary foods (cereals, tubers, meats, fruits, and vegetables) three times per day, without rigid schedules and respecting the children’s appetite, when children are six months old, increasing this offer as the months go by and maintaining breast milk up to two years of age or more. Food consistency should be initially (from six to eight months of age) mashed with a fork until it gradually reaches the consistency of the family’s food at 12 months of age, with a variety of colors and food groups at every meal, without mixing and/or sieving the food. Food preparations should be separated so that children assimilate the flavors and characteristics of each one. Parents should not offer low-energy density preparations, such as soups and broths, besides sugar, coffee, canned goods, fried foods, soft drinks, juices, candies, snacks, and others in the first two years of life [For BLISS, guidelines on BF were the same as for PLW, but on CF, parents should encourage their children to feed themselves-although always be assisted by an adult, and participate in family meals. Food from six months of age should be natural and cut into sticks or strips, instead of rounded shapes, for example. These formats allow children to eat with their own hands, making food easier to be pinched by children’s ‘fingers and preventing choking. Parents should avoid rushing children, respecting their time to explore flavors and textures while eating. The variety and quality of food in this method are the same as in PLW, as well as the notions of hygiene and the use of salt (8). Parents were also encouraged to offer three types of food at each meal: a food source of iron (for example, red meat), a food source of energy, and a food source of fiber, such as fruits or vegetables [As for the mixed method, BF recommendations were the same as for the two methods mentioned before, but concerning CF, mothers should initially use BLISS. If children were not satiated or interested in foods offered according to BLISS, foods were offered according to PLW at the same meal.Regardless of the group of which they were part, all mothers received guidance on how to avoid and manage possible choking during feeding. The caregivers were also trained and received printed material on how to perceive the child’s satiety signals for all three methods.