Factors associated with successful establishment of breastfeeding in very preterm infants

Aim: To describe feeding practices at hospital discharge in relation to characteristics of the very preterm infants (VPI) and their mothers. Methods: Design. Prospective hospital‐based registration of very preterm infants born with a gestational age ≤32 weeks in Denmark during 2004–2008. Subjects. Healthy mothers and VPI without diseases causing eating disabilities at discharge. Results: A total of 478 VPI were registered. At discharge, 60% were exclusively breastfed, 35% were exclusively bottlefed, and 5% were both breast‐ and bottle‐fed. Mothers of high social class (p = 0.000) and ‘not smoking’ (p = 0.003) were significantly more often breastfeeding their preterm infant(s) at discharge. Single births infants tended more often to be breastfed (p = 0.09). Infant age at discharge and duration of hospitalization did not influence breastfeeding at discharge. Increase in weight z‐score from birth to discharge was largest in the bottlefeeding‐group compared with the breastfeeding‐group (p = 0.000) probably as a result of feeding practice the last week(s) of hospitalization. Conclusion: Breastfeeding can successfully be established in very preterm infants. Mothers of low social classes, smokers, multiple birth and very preterm infants with low weight for age may need extra attention in breastfeeding establishing policies.     

UK mothers' experiences of bottle refusal by their breastfed baby

Little is known about bottle refusal by breastfed babies; however, an informal review of global online forums and social media suggested large numbers of mothers experiencing the scenario. This study aimed to explore UK mothers' experiences of bottle refusal by their breastfed baby in order to provide understanding of the scenario and enhance support for mothers experiencing it. A 22‐point online questionnaire was developed and completed by 841 UK mothers. Findings suggest that mothers introduced a bottle to their breastfed baby due to physical, psychological and socio‐cultural factors. Advice and support for mothers experiencing bottle refusal was not always helpful, and 27% of mothers reported bottle refusal as having a negative impact on their breastfeeding experience. When compared with eventual bottle acceptance, bottle refusal was significantly associated with previous experience of bottle refusal (p < .001), how frequently mothers intended to feed their baby by bottle and babies being younger at the first attempt to introduce a bottle (p < .001). This study provides a unique insight into the complexities of bottle refusal by breastfed babies and the impact it can have upon mothers' breastfeeding experiences. It generates knowledge and understanding that can help to inform practice and policies. In addition, a ‘normalising’ of the scenario could enable mothers, and those supporting them, to view and manage it more positively.     

The association of breastfeeding with insulin resistance at 17 years: Prospective observations from Hong Kong's “Children of 1997” birth cohort

Breastfeeding has many benefits for mother and infant. Whether breastfeeding also protects against type 2 diabetes is unclear. To clarify the role of breastfeeding in type 2 diabetes, we assessed the association of breastfeeding with insulin resistance in late adolescence in a birth cohort from a non‐Western setting where breastfeeding was not associated with higher socio‐economic position. We used multivariable linear regression, with multiple imputation and inverse probability weighting, to examine the adjusted associations of contemporaneously reported feeding in the first 3 months of life (exclusively breastfed, mixed feeding, or always formula‐fed) with fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA‐IR) at 17 years in a subset (n = 710, 8.6% of entire cohort) of the Hong Kong Chinese birth cohort “Children of 1997.” We found a graded association of breastfeeding exclusivity in the first 3 months of life with lower fasting insulin and HOMA‐IR (p‐for‐trend < .05), but not fasting glucose, at 17 years. Exclusively breastfed adolescents (7%) had nonsignificantly lowest fasting insulin and HOMA‐IR, adjusted for sex, birth weight, parity, length of gestation, pregnancy characteristics, parents' education, and mother's place of birth. Exclusively breastfeeding for 3 months may be causally associated with lower insulin resistance in late adolescence. Further follow‐up studies into adulthood are required to clarify the long‐term protection of breastfeeding from type 2 diabetes.     

Types and timing of breastfeeding support and its impact on mothers' behaviours

Aim: To determine the types and timing of breastfeeding support for mothers of newborn babies and the extent to which this affects breastfeeding intentions and behaviours in a region with low rates of breastfeeding initiation and duration. Methods: A cross‐sectional study by interviewer‐administrated questionnaire was undertaken of women birthing at a large teaching hospital in South Western Sydney, between August and October 2006 (n= 164), with a 2‐week follow‐up of breastfeeding or breastfeeding‐intending women (n= 107). Types, timing and satisfaction with personal and professional sources of support (e.g. antenatal classes, help at birth, practical lessons on how to breastfeed, providing information, and attitude towards breastfeeding) and the impact of these on breastfeeding intention and behaviours were assessed. Results: Most women had intended to breastfeed (76.2%), and, within the first 24 hours, 77.4% of babies were breastfed to some extent (45.1% exclusively), and at 2 weeks 65.9% were breastfed (9.7% exclusively). Women felt most supported by their partners and least supported by their health‐care team. Antenatal classes, breastfeeding help within half an hour of birth and positive health‐care team attitudes were related to improved breastfeeding intentions and behaviours. However, these supports were infrequently reported. Personal support was commonly reported although support delivered by professionals was related to better breastfeeding behaviours. Conclusion: Despite the effectiveness of professional support interventions, particularly those delivered in the antenatal and immediate post‐natal period, access to these sources of support was very low. For breastfeeding outcomes to be improved, effective professional support strategies need to be much more widely available.     

First Hour Initiation of Breastfeeding and Exclusive Breastfeeding at Six Weeks: Prevalence and Predictors in a Tertiary Care Setting

Objective

To assess the prevalence of first hour breastfeeding initiation and exclusive breastfeeding at 6 wk and identify its barriers in healthy term babies born in a tertiary hospital setting.

Methods

A prospective observational cohort study was carried out in consecutively selected 400 mothers who delivered (normal, instrumental or cesarean) term healthy babies in a tertiary care hospital setting. All mother-infant dyads were enroled within 48 h of delivery.

Results

Breastfeeding was initiated within first hour in 255 out of 400, i.e., 64 % of babies. Cesarean delivery and male gender were strongest risk factors for delayed initiation of breastfeeding [OR (95 % CI)?=?1.99 (1.14–3.48) and 34.17 (17.10–70.40) respectively]. Among the babies followed up till 6–8 wk, 83 % were exclusively breastfed. Breast milk substitutes were given in 172/400 (43 %) babies on day one, which emerged as an independent predictor of failure to continue exclusive breastfeeding at 6 wk (OR 2.96; 95 % CI 1.09–8.06). Odds of exclusive breastfeeding were two times higher in babies breastfed within first hour (n?=?255/400, 64 %) when compared to babies initiated breastfeeds beyond first hour (n?=?145/400, 36 %) (OR 2.01;05 % CI 1.12–3.61).

Conclusions

Cesarean section and male gender emerged as significant risk factors for delayed initiation (beyond first hour) of breastfeeding in the index study cohort. In addition, use of breast milk substitute emerged as the only predictor for failure to continue exclusive breastfeeding at six weeks in a tertiary care hospital.     

Breastfeeding attenuates the effect of low birthweight on abdominal adiposity in adolescents: the HELENA study

The aim of this study was to examine whether breastfeeding may reduce the programming effect of birthweight on abdominal adiposity. Abdominal (in three regions: R1, R2 and R3) adiposity was measured by dual energy x‐ray absorptiometry in 314 adolescents. Breastfeeding duration, birthweight, duration of gestation and maternal educational level were obtained from questionnaire. Physical activity was objectively measured. We detected significant interactions between breastfeeding and birthweight on abdominal adiposity (Ps = 0.02–0.07). We observed that birthweight was associated with abdominal adiposity in the group who had never been breastfed (β = ?0.19 to ?0.23; Ps < 0.05), while no association was found in adolescents who had breastfeeding for ≥3 months (β = ?0.03 to ?0.07). The results were independent of duration of gestation, age, sex, maternal educational level and physical activity. Breastfeeding may reduce the adverse influence conferred by low birthweight on abdominal adiposity in adolescents.     

Why have a bottle when you can have draught? Exploring bottle refusal by breastfed babies

Bottle refusal by breastfed babies is a scenario that has received surprisingly little attention in the literature, given the number of mothers who appear to be experiencing it globally and the subsequent negative impact it can have. In line with this, we undertook a study to explore mothers’ views on why their breastfed baby refuses to bottle feed. A parallel, two-stage, exploratory qualitative design was employed using 30 semi-structured interviews and 597 online forum posts. Data were analysed using a thematic analysis, and a biopsychosocial model was applied resulting in four overarching themes being identified: ‘Breastfeeding is the answer to everything….’ ‘Bottle feeding: an alien concept… ‘Babies are individuals’ and ‘Find the right bottle and don't delay’. The psychological benefits of breastfeeding, not inherent in bottle feeding, appeared to underpin some mothers’ views on their baby's refusal. Other mothers explained refusal as being down to a baby's biological expectation to be fed by the breast; therefore, bottle feeding was not a normal concept to them. A baby's individual personality and temperament were also suggested as contributing to the scenario and refusal was linked to babies disliking a certain brand of bottle and being introduced to it ‘too late’. This study's findings point to a complex, multifactorial picture underpinning bottle refusal by breastfed babies, which transcends physical, psychological and biological concepts, and is influenced by socio-cultural norms surrounding infant feeding. Recognition of these contributing factors is needed to aid those supporting mothers experiencing the scenario and, importantly, to underpin mothers’ decision-making around managing it.     

Breastfeeding progression in late preterm infants from birth to one month

This study aimed to describe and compare breastfeeding progression, infants' feeding behaviours, maternal feeding difficulties, and mothers' usage of breastfeeding interventions for singleton late preterm (LPT) and term infants. A further aim was to identify associated factors for exclusive breastfeeding at breast at 1 month in LPT infants. This was a cohort study where mothers of LPT infants from a neonatal unit (n = 60), LPT infants from a maternity unit (n = 62), and term infants from a maternity unit (n = 269) answered a questionnaire approximately 1 month after delivery. Findings showed no significant differences in exclusive breastfeeding at breasts between LPT infants admitted to the neonatal unit compared with the maternity unit, during the first week at home (38% vs. 48%), or at 1 month of age (52% vs. 50%). Term infants were more likely to be exclusively breastfed at the breast (86% and 74%, p < 0.05) compared with LPT infants. Multiple regression analysis showed that usage of a nipple shield, not feeding breast milk exclusively during the first week at home, or feeding less than 10 times per day at 1 month were statistically significant for not exclusively breastfeed at the breast. A protective factor was the mothers' experience of having an abundance of milk during the first week at home. In conclusion, LPT infants are less likely to be exclusively breastfed at the breast than term infants, highlighting the need for further research to guide interventions aimed at optimising exclusive breastfeeding rates.     

Breastfeeding and risk for ceasing in mothers of preterm infants—Long‐term follow‐up

Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long‐term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan–Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log‐rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term. Registered in www.clinicaltrials.gov (NCT01806480).     

Breastfeeding modifies the impact of diarrhoeal disease on relative weight: a longitudinal analysis of 2–12 month‐old Filipino infants

Undernutrition and diarrhoeal disease are major causes of infant mortality. We investigated the combined roles of breastfeeding and diarrhoea on infant size in 2940 infants from the Cebu Longitudinal Health and Nutrition Survey. The study aimed to assess whether breastfeeding status modified the deficits associated with diarrhoeal disease. The primary exposures were combinations of current breastfeeding status (yes/no), the presence of diarrhoeal disease in previous week (yes/no) and a categorical survey variable (six surveys taken at bimonthly intervals when infants were 2–12 months of age). Relative weight (weight‐for‐length z‐scores), calculated using the WHO growth standards, was estimated using sex‐stratified, fixed‐effects longitudinal models that also adjusted for energy from complementary foods. Post‐estimation Wald tests were conducted to identify subgroup differences in relative weight. Diarrhoea was associated with reduced relative weight in both breastfed and non‐breastfed infants of 6–12 months. Diarrhoea‐related deficits in relative weight were significantly exacerbated in non‐breastfed girls of 6 and 8 months. Importantly, in infants <6 months, being breastfed and having diarrhoea was still associated with greater relative weight compared with being non‐breastfed and diarrhoea‐free. Breastfeeding emerged as a strong contributor to relative weight in younger infants (<6 months) while diarrhoeal disease strongly contributed to deficits in relative weight in older infants (6–12 months). These findings underscore the importance of breastfeeding for promoting infant nutritional status in infants with or without diarrhoea from birth to 12 months.     

Acculturative type is associated with breastfeeding duration among low‐income Latinas

We sought to assess the relationship between acculturative type and breastfeeding outcomes among low‐income Latinas, utilising a multidimensional assessment of acculturation. We analysed data derived from a breastfeeding peer counselling randomised trial. Acculturation was assessed during pregnancy using a modified Acculturation Rating Scale for Mexican Americans scale. Analyses were restricted to Latinas who completed the acculturation scale and had post‐partum breastfeeding data (n = 114). Cox survival analyses were conducted to evaluate differences in breastfeeding continuation and exclusivity by acculturative type. Participants were classified as integrated‐high (23.7%, n = 27), traditional Hispanic (36.8%, n = 42), integrated‐low (12.3%, n = 14) and assimilated (27.2%, n = 31). The integrated‐low group was significantly more likely to continue breastfeeding than the traditional Hispanic, assimilated, and integrated‐high groups (P < 0.05, P < 0.05, and P < 0.01, respectively). The traditional Hispanic group was marginally more likely to continue breastfeeding than the integrated‐high group (P = 0.06). Breastfeeding continuation rates vary significantly between acculturative types in this multinational, low‐income Latina sample. Multidimensional assessments of acculturation may prove useful in better tailoring future breastfeeding promotion interventions.     

Fakten zum Stillen in Deutschland

Aim of the study. In the SuSe-Study 1997/98 breastfeeding management in German hospitals (n=177) and breastfeeding during the 1st year of life in mother-infant-pairs (n=1717) recruited in these hospitals were assessed. Results. The actual recommendations for breastfeeding in hospitals were realized variously (10–96%). 91% of the mothers initiated breastfeeding but breastfeeding rates decreased significantly already during the first weeks after birth. At the age of 4 (6) months 33 (10) % of the infants were exclusively breastfed. Follow-up formula was the most frequently used milk in the 2^nd half of the 1^st year of life. Problems with breastfeeding at home and perceived breastmilk insufficiency were mentioned among the predominant reasons for early cessation of breastfeeding. Supplementary feeding of fluids or formula during the first 3 days after birth was negatively associated with breastfeeding duration. Conclusion. Breastfeeding has increased in Germany compared to former studies but can and should be promoted further.     

Short‐term efficacy of two breast pumps and impact on breastfeeding outcomes at 6 months in exclusively breastfeeding mothers: A randomised trial

The provision of breast pumps is a potential strategy to increase breastfeeding duration. This trial compared the effectiveness and acceptability of two breast pumps in mothers exclusively breastfeeding (EBF) their healthy term infant. It also tested whether provision of pumps versus vouchers of equivalent value influenced breastfeeding or attainment of mothers' goals at 3 and 6 months. Mothers were randomised at 3‐ to 4‐week post‐partum (Beijing [n = 30], Moscow [n = 34], London [n = 45], New York [n = 3]) to groups A (Philips single‐electric pump, Natural bottle), B (Medela Swing single‐electric pump, Calma bottle), or C (Control; vouchers). At 6 weeks, group A and B mothers expressed for 10 min/breast; milk weight and opinions of pump/bottle were recorded. Feeding practices were assessed using questionnaires at 3 and 6 months. Milk weight/flow pattern did not differ between groups. Pump A scored significantly better for ease‐of‐use, cushion‐feel, need‐to‐lean‐forward, pleasant, comfort. At 3 and 6 months, %EBF or meeting their goal was not significantly different; (3 months: 86%, 85%, 84%; 6 months: 20%, 15%, 26%; meeting goal 24%, 17%, 27% for A, B, and C). Expressed breast milk (EBM) provision was higher in groups A and B (3 months: 76%, 76%, 24% (p < 0.001); 6 months: 83%, 87%, 32% (p < 0.001); and negatively predicted EBF at 6 months (OR no EBM 5.07, 95% CI [1.56, 16.5]). The pumps were equally effective for milk expression at 6 weeks. Pump provision did not significantly influence breastfeeding practices or attainment of goals but resulted in higher EBM provision, which was associated with lower EBF but not other breastfeeding categories at 6 months.     

Exclusive breastfeeding: Protective efficacy

A longitudinal study of feeding practices of and morbidity in 537 infants was undertaken. Feeding practices were assessed at monthly follow-up visits. All infants were initially exclusively breastfed but their percentage dropped to 59.8% and 35.3% at the end of 3 months and 6 months respectively. Exclusively breastfed babies were three-times less likely to fall sick than artificially fed babies. Exclusive breastfeeding was also associated with significantly lowered rate of serious illnesses as shown by fewer rate of hospitalisation (0.52/100 children months vs 4.5/100 children months). Premature introduction of supplementary feeding diluted the protective effects of breastmilk.     

A study of feeding patterns in young infants

With the aim of studying the feeding patterns in infants under 6 months of age, 451 mothers attending the children's clinic in two university hospitals in the north of Tehran were interviewed. All babies had been born in hospital and > 98 per cent had been breastfed during the first few hours of birth. The rate of full breastfeeding at 6 months of age, with no introduction of the bottle, was 83 per cent; approximately 6.5 per cent of infants were fed on breast and bottle concomitantly, and in about 10.5 per cent breastfeeding had been discontinued before 6 months and the babies were fed on bottle only. About 60 per cent of mothers who stopped breastfeeding, did so during the first postnatal month and another 20 per cent during the 2nd and 3rd month after the babies' birth. The mother's age, education or parity, did not affect the rate of breastfeeding. Low birthweight, especially birthweight less than 2 kg, was a risk factor for early termination of breastfeeding. Caesarean delivery and hospitalization of the infant during the neonatal period was also associated with a higher rate of bottlefeeding compared with newborns who had been delivered normally, discharged early, and nursed at home. Although breastfeeding rates are high, the finding that the majority of mothers who give up breastfeeding do so in the early weeks, calls for better support to all mothers by committed health personnel during the period when breastfeeding is being established, and for extra assistance to women whose infants are hospitalized or have a low birthweight.     

Infant brain structures,executive function,and attention deficit/hyperactivity problems at preschool age. A prospective study

Background: Neuroimaging findings have provided evidence for a relation between variations in brain structures and Attention Deficit/Hyperactivity Disorder (ADHD). However, longitudinal neuroimaging studies are typically confined to children who have already been diagnosed with ADHD. In a population‐based study, we aimed to characterize the prospective association between brain structures measured during infancy and executive function and attention deficit/hyperactivity problems assessed at preschool age. Methods: In the Generation R Study, the corpus callosum length, the gangliothalamic ovoid diameter (encompassing the basal ganglia and thalamus), and the ventricular volume were measured in 784 6‐week‐old children using cranial postnatal ultrasounds. Parents rated executive functioning at 4 years using the Behavior Rating Inventory of Executive Function‐Preschool Version in five dimensions: inhibition, shifting, emotional control, working memory, and planning/organizing. Attention Deficit/Hyperactivity Problems were assessed at ages 3 and 5 years using the Child Behavior Checklist. Results: A smaller corpus callosum length during infancy was associated with greater deficits in executive functioning at 4 years. This was accounted for by higher problem scores on inhibition and emotional control. The corpus callosum length during infancy did not predict Attention Deficit/Hyperactivity Problem at 3 and 5 years, when controlling for the confounders. We did not find any relation between gangliothalamic ovoid diameter and executive function or Attention Deficit/Hyperactivity Problem. Conclusions: Variations in brain structures detectible in infants predicted subtle impairments in inhibition and emotional control. However, in this population‐based study, we could not demonstrate that early structural brain variations precede symptoms of ADHD.     

Development of a biochemical marker to detect current breast milk intake

The WHO recommends exclusive breastfeeding for 6 months, but despite interventions, breastfeeding rates remain stubbornly low. Financial voucher incentives have shown promise but require a biomarker for validation of intake. This study aimed to develop a simple biochemical assay of infant urine that would tell if an infant was receiving any breast milk to validate maternal report. Urine samples were collected and snap frozen from 34 infants attending with minor illness or feeding problems, of whom 12 infants were exclusively breastfed, nine exclusively formula fed, and 11 mixed breast/formula fed. High‐performance anion exchange chromatography was used to identify discriminating patterns of monosaccharide composition of unconjugated glycans in a sequence of three experiments. The absolute concentration of all human milk oligosaccharides measured blind could detect “any breastfeeding” only with a sensitivity of 48% and specificity of 78%. Unblinded examination of N‐acetylglucosamine (GlcNAc) measured as GlcNH₂ after hydrolysis of GlcNAc improved sensitivity to 75% at the expense of a specificity of 28%. Estimation of the relative abundance of GlcNH2 (GlcNH2[%]) or the ratio of GlcNH2 to endogenous mannose (Man) improved accuracy. In a further blind experiment, the GlcNH2/Man ratio with a cut‐off of 1.5 correctly identified all those receiving “any breast milk,” while excluding exclusively formula fed infants. The GlcNH2/Man ratio in infant urine is a promising test to provide biochemical confirmation of any breastfeeding for trials of breastfeeding promotion.     

Allergic diseases among very preterm infants according to nutrition after hospital discharge

To cite this article: Zachariassen G, Faerk J, Esberg BH, Fenger‐Gron J, Mortensen S, Christesen HT, Halken S. Allergic diseases among very preterm infants according to nutrition after hospital discharge. Pediatr Allergy Immunol 2011; 22 : 515–520. To determine whether a cow’s milk‐based human milk fortifier (HMF) added to mother’s milk while breastfeeding or a cow’s milk‐based preterm formula compared to exclusively mother’s milk after hospital discharge, increases the incidence of developing allergic diseases among very preterm infants (VPI) during the first year of life. Of a cohort of 324 VPI (gestational age 24–32 wk), the exclusively breastfed VPI were shortly before discharge randomized to breastfeeding without fortification or supplementing with a fortifier. Those not breastfed were fed a preterm formula. The intervention period was from discharge until 4 months corrected age (CA). Follow‐up was performed at 4 and 12 months CA including specific IgE to a panel of allergens at 4 months CA. The incidence during and prevalence at 12 months CA of recurrent wheezing (RW) was 39.2% and 32.7%, while atopic dermatitis (AD) was 18.0% and 12.1%, respectively. Predisposition to allergic disease increased the risk of developing AD (p = 0.04) [OR 2.6 (95% CI 1.0–6.4)] and the risk of developing RW (p = 0.02) [OR 2.7 (95% CI 1.2–6.3)]. Boys had an increased risk of developing RW (p = 0.003) [OR 3.1 (95% CI 1.5–6.5)]. No difference was found between nutrition groups. None developed food allergy. Compared to exclusively breastfed, VPI supplemented with HMF or fed exclusively a preterm formula for 4 months did not have an increased risk of developing allergic diseases during the first year of life.     

Exclusive breastfeeding and nutritional status in Bangladesh

Objective : The purposes of the study were to assess exclusive breastfeeding practice and examine the factors effect on nutritional status of children from 0 to 24 months age.Method : Data from a national survey entitled “Surveillance on Breastfeeding and Weaning Situation and Child and Maternal Health in Bangladesh were used to investigate the exclusive breastfeeding practice and to examine the factors having influence on child nutrition. Information was collected from mothers of 2781 children between 0 and 24 months of age.Results : It was that 16% of women still exclusively breastfed their children for less than 6 months. Of the children 38.1% were stunted and 38% were under weight for their age. Overall, 46% of children were suffering from diseases. Bivariate analysis showed that maternal education and family income were important correlates of exclusive breastfeeding (Chi-square p<0.001). Exclusively breastfed children were nutritionally better off (p<0.001). Logistic regression analysis showed that the children of illiterate women were nutritionally more vulnerable than children of women who had secondary and higher education (OR=1.69, 95% Cl=1.33–2.15). The children of older age women were less likely to be stunted than children of younger age women (OR=0.78, 95% CI=0.64–0.96).Conclusion : Despite efforts of different government agencies and NGOs, exclusive breastfeeding rate was still low in Bangladesh. Traditional cultural barriers still exist. In order to remove the harmful cultural beliefs and to spread the messages of the benefit of exclusive breastfeeding for survival and nutritional status of the children more behaviour change communication should be made to promote, protect and support breastfeeding.     

Baby‐Friendly Hospital designation has a sustained impact on continued breastfeeding

The Baby‐Friendly Hospital (BFH) Initiative has led to an increase in breastfeeding rates and duration worldwide. But little is known about whether the beneficial effects persist beyond a facility's designation as a BFH. To investigate the association of BFH designation (current, former, and never) and compliance with Baby‐Friendly (BF) practices on breastfeeding in Switzerland, this study combined nationwide survey data on breastfeeding with BFH monitoring data. In this cross‐sectional study, 1,326 children were born in 34 current (N = 508), 28 former (N = 425), and 34 never designated BFHs (N = 393). We compared exclusive and any breastfeeding according to BFH designation over the first year of life, using Kaplan‐Meyer Survival curves. Logistic regression models were applied to analyse breastfeeding prevalence, and Cox‐regression models were used for exclusive (0–6 months) and continued (6–12 months) breastfeeding duration. Average duration of exclusive breastfeeding (13.1 weeks, 95% confidence interval [12.0, 17.4]) and any breastfeeding (32.7 weeks, 95% confidence interval [30.5, 39.2]) were the longest for babies born in currently accredited BFHs. Exclusive breastfeeding was associated with high compliance with monitored BF practices in current BFHs and with the number of BF practices experienced in all hospitals. Continued breastfeeding was significantly longer when babies were born in current BFHs (cessation hazard ratio 0.60, 95% confidence interval [0.42, 0.84]) or in former BFHs (cessation hazard ratio 0.68, 95% confidence interval [0.48, 0.97]). Overall, the results support continued investment into BFHs, because babies born in current BFHs are breastfed the most and the longest, whereas a former BFH designation shows a sustained effect on continued breastfeeding.