Misperceptions and misuse of Bear Brand coffee creamer as infant food: national cross sectional survey of consumers and paediatricians in Laos

OBJECTIVE To investigate the use of Bear Brand coffee creamer as a food for infants and the impact on consumers of the logo of a cartoon baby bear held by its mother in the breastfeeding position. DESIGN Interviews with paediatricians throughout the country and a national survey of potential consumers regarding their perceptions and use of the Bear Brand coffee creamer. SETTING 84 randomised villages in south, central, and northern Laos. PARTICIPANTS 26 Lao paediatricians and 1098 adults in households in a cluster sampling. RESULTS Of the 26 paediatricians, 24 said that parents "often" or "sometimes" fed this product to infants as a substitute for breast milk. In the capital city, paediatricians said that mothers used the product when they returned to work. In the countryside, they reported that poor families used it when the mother was ill or died. Of 1098 adults surveyed, 96% believed that the can contains milk; 46% believed the Bear Brand logo indicates that the product is formulated for feeding to infants or to replace breast milk; 80% had not read the written warning on the can; and over 18% reported giving the product to their infant at a mean age of 4.7 months (95% confidence interval 4.1 to 5.3). CONCLUSION The Bear Brand coffee creamer is used as a breast milk substitute in Laos. The cartoon logo influences people's perception of the product that belies the written warning "This product is not to be used as a breast milk substitute." Use of this logo on coffee creamer is misleading to the local population and places the health of infants at risk.