Carer perspectives on overweight, obesity and dental caries in early childhood: findings from a systematic qualitative review

Heilok Cheng^1,2,3*Rebecca Chen^4,5,6Bradley Christian^6,7Jessica Appleton^3,8Amit Arora^6,9Elizabeth Denney-Wilson^1,2,3

• ¹Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
• ²Sydney Institute for Women, Children and their Families, Sydney, New South Wales, Australia
• ³NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood, Sydney, Australia
• ⁴Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
• ⁵Institute of Dental Research, Westmead Centre for Oral Health, Westmead Hospital, Wentworthville, New South Wales, Australia
• ⁶School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
• ⁷Australian Centre for Integration of Oral Health, Western Sydney University, Sydney, Australia
• ⁸Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
• ⁹School of Health Science, Western Sydney University, Penrith, New South Wales, Australia

Introduction: Formula and bottle feeding behaviours can increase obesity and tooth decay (early childhood caries, ECC) in early childhood, through non-responsive feeding and prolonged exposure to sugar. Parents’ beliefs can be barriers to behaviour change for obesity and ECC prevention. Understanding these beliefs towards children’s teeth and weight can address parents’ priorities and develop prevention messages. This qualitative systematic review (PROSPERO registration #CRD42022348783) aimed to identify parent or carer perspectives on obesity and ECC in children aged ≤6 years. Methods: Database searching of CINAHL, Medline and EMBASE, with hand searching, was undertaken. Included papers were qualitative research publications, focused on parent or carer beliefs and attitudes towards overweight, obesity or ECC in infants and children. Inductive thematic analysis was undertaken to generate themes, with a strengths-based approach focused on parents’ lived experience. Quality appraisal was undertaken with the CASP Qualitative Checklist. Descriptive characteristics of the study and participants, and qualitative findings, were extracted qualitatively in NVivo. Results: 7365 references were identified from database and hand searching, with 98 references included for analysis. Three research themes were generated: 1) parenting to support child wellness, including healthy teeth and weight; 2) parents’ response to unwellness, including identifying symptoms, causes and protective factors for unhealthy weight and teeth; 3) information and resources needed to support healthy weight and teeth. There was high or potential risk of bias in qualitative methodology when studies did not address researcher-participant relationships or rigorous data analysis processes. Discussion: Findings highlight the need for strength-based messages for children’s teeth and weight, increased understanding of formula and bottle feeding as obesity and ECC risk factors, and holistic approaches to care by dental and primary care professionals.