Cultural feeding practices and child-raising philosophy contribute to iron-deficiency anemia in refugee Hmong children

Kathleen A. Culhane-Pera, Elanah D. Naftali, Cindy Jacobson, Zha Blong Xiong

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective: Iron-deficiency anemia is high in refugee Hmong toddlers attending Special Supplemental Food Program for Women, Infants, and Children (WIC) sites in St. Paul, Minnesota. We investigated social and cultural reasons for feeding practices of Hmong parents that result in excessive milk and inadequate food intake among infants and toddlers contributing to iron-deficiency anemia. Design: In-depth interviews with community members. Focus-group interviews with caregivers. Discussions of results with a professional healthcare group. Setting: St. Paul, Minnesota in 1997-1998. Participants: Eight Hmong and 7 non-Hmong community members. Thirty-two Hmong parents in focus groups. Thirteen Hmong and 11 non-Hmong healthcare professionals. Main Outcome Measures: Qualitative analysis identified themes from community and focus-group interviews. Professional group discussed meaning of results. Results: To successfully adjust to American lifestyle demands, Hmong refugee families bottle-feed, rather than breast-feed, their infants. In the traditional demand pattern, bottle-feeding can cause infants to be given too much milk at the expense of solid food, and can teach them to prefer milk to food. As these infants become toddlers, caregivers have difficulty weaning them due to a childraising philosophy of "hlu" that caters to children's desires. Conclusion: Hmong caregivers' child-raising philosophy of "hlu" coupled with feeding practices chosen to adjust to American society contribute to the high rate of iron-deficiency anemia in Hmong toddlers.

Original languageEnglish (US)
Pages (from-to)199-205
Number of pages7
JournalEthnicity and Disease
Issue number2
StatePublished - Jan 1 2002


  • Acculturation
  • Culture
  • Hmong
  • Infant nutrition
  • Iron-deficiency anemia


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