Comparing Maternal and Paternal Complementary Feeding Practices: Findings From an Online Survey

ObjectiveTo explore differences between mothers’ and fathers’ complementary feeding practices.MethodsAn online survey of UK parents with a healthy child in complementary feeding age. Timing of introducing solid foods and adherence to feeding guidelines were assessed. Dietary quality was measured using the Complementary Feeding Utility Index.ResultsIn a sample of 60 mothers and fathers (nondyads), there were no differences between fathers and mothers in the timing of introduction of solid foods, compliance with complementary feeding guidelines, or dietary quality. Most fathers who participated had a male child, whereas mothers had an equal number of male and female children (P < 0.001). The proportion of mothers who followed baby-led weaning was higher compared with fathers (P = 0.02).Conclusions and ImplicationsStudy findings reveal no gender differences in parental complementary feeding practices apart from the use of baby-led weaning. Future studies with bigger male samples are warranted to explore the paternal role during complementary feeding.     

When Fathers are Perceived to Share in the Maternal Decision to Breastfeed: Outcomes from the Infant Feeding Practices Study II

Objectives The present study investigates the influence of joint feeding preferences of both the mother and father on initiation and duration of breastfeeding. Methods Data from the Infant Feeding Practices Study II was analyzed. Female participants in a national consumer opinion panel were followed from pregnancy through 1 year postpartum, and were asked about infant feeding practices. We examined the association between maternal prenatal perception of the expectant father’s breastfeeding preferences and breastfeeding outcomes (initiation, duration of exclusive breastfeeding and any breastfeeding) and whether concordance between the parents’ infant feeding preferences influenced breastfeeding. Results Mothers who perceived that the father preferred exclusive breastfeeding (vs. no preference) were more likely to initiate breastfeeding [adjusted odds ratio (aOR)?=?1.9; 95% confidence interval (95% CI) 1.0–3.7], and they had a lower hazard of stopping exclusive and any breastfeeding at any given time [exclusive breastfeeding: adjusted hazard ratio (aHR)?=?0.8; 95% CI 0.6–0.9; any breastfeeding: aHR?=?0.6; 95% CI 0.5–0.7]. When both the mother and the father preferred exclusive breastfeeding, the hazard of breastfeeding cessation at any given time was lowest (exclusive breastfeeding: aHR?=?0.4; 95% CI 0.3–0.5; any breastfeeding: aHR?=?0.4; 95% CI 0.3–0.5). The risk of breastfeeding cessation remained lower even when only the father preferred exclusive breastfeeding. Conclusions for Practice Mothers tend to breastfeed for a longer duration when they perceive that the expectant father prefers exclusive breastfeeding and, even more so, when both parental preferences for exclusive breastfeeding concur. Efforts are needed to involve expectant fathers in breastfeeding decision-making and education to achieve breastfeeding success.     

中国7城市婴儿辅食添加状况调查

目的：了解目前城市婴儿辅食添加的状况及其影响因素。方法：采用分层整群抽样的方法,对北京、长春、呼和浩特、洛阳、西安昆明以及厦门7个城市内1123例有4－12个月婴儿的母亲进行了面对面的调查,采用交叉表方法分析数据。结果：（1）有35％的婴儿在4个月前已经开始添加了一种或一种以上的辅食;4－6个月时已添淀粉;水果、蔬菜、鸡蛋、鱼／肉和豆制品的比例分别是83％、70％、75％、79％、67％和64％;到6个月时添加一种及以上辅食的婴儿比例为99％,6种辅食全部都添加的达62％。淀粉、水果、蔬菜、鸡蛋添加次数为每天1次及以上的比例在70％及以上,而鱼、肉和豆制品仅为45％和32％。（2）促进婴儿4－6个月之间开始添加辅食的母亲方面因素有：职业为工人或干部、产后恢复工作,接受过辅食添加的宣传教育、正确掌握有关辅食添加的知识、知识来源于大众媒体、保健人员和医护人员等。结论：目前城市4－6个月的辅食添加率较高,应限制4个月以前开始添加辅食。应给广大育龄妇女提供更多、更好、更新的有关正确添加辅食的宣传教育,特别是要加强社区在宣传教育中的作用。     

Postpartum Symptoms of Depression are Related to Infant Feeding Practices in a National WIC Sample

ObjectiveTo examine the association between elevated maternal postpartum depression symptoms and select targets of nutrition education within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), including infant feeding beliefs, feeding practices, and dietary intake choices.DesignLongitudinal analysis of secondary data from the WIC Infant and Toddler Feeding Practices Study-2.SettingEighty WIC sites.ParticipantsThe WIC Infant and Toddler Feeding Practices Study-2 participants interviewed through 13 months postpartum (n = 1,851).Main Outcome MeasuresLatent factor variables for infant feeding beliefs, feeding practices, and dietary intake choices.AnalysisConfirmatory factor analysis using structural equation modeling; multivariable linear regression models.ResultsBiological mothers with elevated postpartum depression symptoms engaged in significantly less optimal feeding practices than biological mothers with fewer symptoms of depression, in multivariable analyses controlling for sociodemographic variables (β = ?0.26; P = 0.02). Maternal depression symptoms were not significantly associated with infant feeding beliefs or dietary intake choices.Conclusions and ImplicationsMaternal depression symptoms are specifically associated with infant feeding practices. The Special Supplemental Nutrition Program for Women, Infants, and Children could consider screening for depressive symptoms and referring mothers for treatment. For mothers with elevated depression symptoms, nutrition education may need greater emphasis on healthy and safe feeding practices.     

Diet Beverage Intake during Lactation and Associations with Infant Outcomes in the Infant Feeding Practices Study II

Consumption of diet beverages (DB) containing low-calorie sweeteners (LCS) is widespread in the United States. LCS are ingested by nursing infants upon maternal DB consumption, which may impact infants’ weight and health. This study aims to examine cross-sectional associations between infants’ LCS exposure via maternal DB intake during lactation and infants’ health outcomes. Six hundred and eighty-two mother–infant dyads at three months postpartum, from the Infant Feeding Practices Study II, 2005–2007, were included in the analysis. Maternal DB consumption during lactation was estimated using the serving size and frequency of DB consumption reported on the diet history questionnaire. Infants’ LCS exposure was estimated by multiplying maternal DB consumption and breastfeeding intensity. Infant outcomes included weight, weight-for-age and BMI-for-age z-scores, overweight, and gastrointestinal (GI) symptoms including diarrhea, reflux, and vomiting. Associations between infants’ LCS exposure and continuous and categorical outcomes were examined using linear and logistic regressions adjusting for confounders, respectively. Forty-three percent of lactating women reported DB consumption. While no significant associations were observed between infants’ LCS exposure and BMI-for-age or risk of overweight, infants’ LCS exposure was associated with a 2.78-fold increased risk of vomiting (95% confidence interval 1.05–7.34). Potential adverse effects of LCS exposure on GI symptoms require further study, and null findings on infant weight should be interpreted with caution, given the small sample size. Additional research is needed to inform recommendations for or against DB consumption during lactation.     

Moving Beyond Breastfeeding Initiation: A Qualitative Study Unpacking Factors That Influence Infant Feeding at Hospital Discharge Among Urban,Socioeconomically Disadvantaged Women

BackgroundFactors that influence breastfeeding initiation and duration have been well established; however, there is limited understanding of in-hospital exclusive breastfeeding (EBF), which is critical for establishing breastfeeding. Grady Memorial Hospital, which serves a high proportion of participants receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and racial/ethnic minorities, had an in-hospital EBF rate in 2018 by the Joint Commission’s definition of 29% and sought contextualized evidence on how to best support breastfeeding mothers.ObjectiveThe objectives were to (1) identify facilitators and barriers to in-hospital EBF and (2) explore breastfeeding support available from key stakeholders across the social-ecological model.DesignIn-depth, semistructured interviews were conducted and analyzed using thematic analysis.ParticipantsThe sample included a total of 38 purposively sampled participants from Grady Memorial Hospital (10 EBF mothers, 10 non-EBF, and 18 key stakeholders such as clinicians, community organizations’ staff, and administrators).ResultsKey themes included that maternal perception of inadequate milk supply was a barrier to in-hospital EBF at the intrapersonal level. At the interpersonal level, a personable and individualized approach to breastfeeding counseling may be most effective in supporting EBF. At the institutional level, key determinants of EBF were gaps in prenatal breastfeeding education, limited time to provide comprehensive prenatal education to high-risk patients, and practical help with latching and positioning. Community-level WIC services were perceived as a facilitator due to the additional benefits provided for EBF mothers; however, the distribution of WIC vouchers for formula to mothers while they are in the hospital undermines the promotion of EBF. Cultural norms and a diverse patient population were reported as barriers to providing support at the macrosystem level.ConclusionMultipronged approaches that span the social-ecological model may be required to support early EBF in hospital settings.     

A Preliminary Study of Depressive Symptoms in Mothers of 3-Year-Old Prematurely Born Children

This exploratory study examined the effects of maternal depressive symptoms on mothers’ perceptions of their 3-year-old prematurely born children, interactive behaviors, and child outcomes. Mother and child interactive behaviors were coded from naturalistic observations in their homes. Education and marital status were found to be significantly related to maternal depressive symptoms. Factor analyses were conducted to determine the most prominent behaviors related to maternal depressive symptoms. In a small sample of mothers, the quality of the maternal-child relationship was negatively affected by elevated depressive symptoms. Mothers of prematurely born children may report depressive symptoms that continue into early childhood.     

Maternal Depressive Symptoms and the Risk of Overweight in Their Children

To examine the association between maternal depressive symptoms during early childhood of their offspring and later overweight in the children. Only children (n = 1,090) whose weights and heights were measured at least once for three time points (grades one, three and six) from the National Institute of Child Health and Human Development Study were included. Maternal depressive symptoms, defined as a Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or greater, were assessed using CES-D when the child was 1, 24, and 36 months. Childhood overweight was based on standardized height and weight measures taken during the interviews, and was defined according to appropriate CDC age- and sex-specific BMI percentiles. Generalized estimating equation was used to examine the impact of maternal depressive symptoms on the childhood overweight after adjusting for covariates. Compared to children of mothers without depression at any of the three time points, when children were one, 24 and 36 months of age, children of mothers with depression at all three time points were 1.695 times more likely to be overweight after adjusting for other child characteristics (95 % CI = 1.001–2.869). When further adjusted for maternal characteristics, children of mothers with depression at all three time points were 2.13 times more likely to be overweight (95 % CI = 1.05–4.31). Persistent maternal depressive symptoms may be associated with an increased risk of childhood overweight in their offspring. Children of mothers with depression may benefit from special attention in terms of obesity prevention.     

Depressive Symptoms in Postmenopausal Women: Results from the MEDIS Study

Data regarding the factors associated with depressive symptoms are limited, especially in postmenopausal women. The aim of this study was to investigate to what extent depressive symptoms were present in postmenopausal women, to explore characteristics associated with depressive symptoms and to determine if time since menopause was independently associated with depressive symptoms. Data collected within the Mediterranean Islands (MEDIS) Study, a health and nutrition survey of elderly people living on Mediterranean islands was used. A total of 851 postmenopausal women living in various Greek islands, Cyprus, and Malta participated in the study. Depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). Age-adjusted logistic regression analysis showed that a year’s increase in the time since menopause increased the likelihood of postmenopausal women having severe depressive symptoms by 3% (odds ratio [OR] per 1 year = 1.03, 95% CI 1.001–1.05). This positive association was also evident when other potential confounding factors (i.e, living conditions, financial status, physical activity, adherence to the Mediterranean diet, smoking habits, and several clinical conditions) were also taken into account in multivariable analyses. Primary health care practitioners and public health care authorities could use the findings of this study to identify depressive symptoms early in postmenopausal women.     

Maternal Smoking and Infant Feeding: Breastfeeding is Better and Safer

The rise in smoking rates among young women has implications for children’s health aggravated in lower social strata where infant morbidity and mortality rates are higher. The protection afforded by breastfeeding is beneficial to infants in rich and poor countries alike. Women (especially when young, uneducated, and unsupported) who are smokers constitute a risk group for abandoning breastfeeding; moreover, their bottle-fed newborns run a greater risk of morbidity and mortality. Bottle-feeding is attendant on maternal cigarette smoking. The advantages of breastfeeding over bottle-feeding are discussed with regard to systemic effects and the specific effects of cyanide (which can affect the iodine metabolism of infants) and nicotine derived from food and maternal smoking. Despite great strides in bans on smoking, public health policies should be designed to keep in perspective that breastfeeding is an effective tool to counterbalance the health disadvantages that under-privileged infants of smoking mothers face. This paper argues that infants born to smoking parents are better protected by breastfeeding than by formula feeding. Therefore, if public health policies cannot stop addicted mothers from smoking during pregnancy it is fundamental not to miss the chance of encouraging and supporting breastfeeding. The food and health inequalities of socially disadvantaged groups demand well crafted public-health policies to reduce the incidence of diseases and compress morbidity: these policies need to make it clear that breastfeeding is better and safer.     

Moms and Media: Exploring the Effects of Online Communication on Infant Feeding Practices

Using a survey of mothers with young children (N = 455), this study applies Fishbein and Ajzen’s reasoned action approach (RAA) to examine the relationship between online communication and infant feeding practices. Contrary to expectations, attitudes, perceived normative pressure, and perceived behavioral control (PBC) did not fully mediate the relationship between time spent online and behavioral intentions. Our findings indicate a significant, direct, negative association between time spent online and breastfeeding intentions In this article, theoretical and practical implications for health communication are discussed.     

Association of Maternal Depressive Symptoms and Offspring Physical Health in Low-Income Families

Objectives The present study sought to examine the association between maternal depressive symptoms and characteristics of offspring physical health, including health status, health behaviors, and healthcare utilization, among low-income families. Maternal engagement was explored as a mediator of observed effects. Methods Cross-sectional survey data from a community sample of 4589 low-income women and their preschool-age children participating in the WIC program in Los Angeles County were analyzed using logistic, Poisson, and zero-inflated negative binomial regression. Mediation was tested via conditional process analyses. Results After controlling for the effects of demographic characteristics including maternal health insurance coverage, employment status, education, and preferred language, children of depressed women (N?=?1025) were significantly more likely than children of non-depressed women (N?=?3564) to receive a “poor” or “fair” maternal rating of general health (OR 2.34), eat fewer vegetables (IRR: 0.94) more sweets (IRR: 1.20) and sugary drinks daily (IRR: 1.32), and consume fast food more often (OR 1.21). These children were also less likely to have health insurance (OR 1.59) and more likely to receive medical care from a public medical clinic or hospital emergency room (OR 1.30). Reduced maternal engagement partially mediated associations between maternal depressive symptoms and several child health outcomes including poor diet, health insurance coverage, and use of public medical services. Conclusions for Practice Maternal depressive symptoms are associated with poor health among preschool-age children in low-income families. Prevention, screening, and treatment efforts aimed at reducing the prevalence of maternal depression may positively affect young children’s health.     

Maternal Depressive Symptoms and Participation in Early Intervention Services for Young Children

Many young children with developmental delay who are eligible for early intervention (EI) services fail to receive them. We assessed the relationship between depressive symptoms in mothers, a potentially modifiable risk, and receipt of EI services by their eligible children. We conducted multivariable analyses of a nationally representative sample of children eligible for EI services at 24 months using data from the Early Childhood Longitudinal Study-Birth Cohort. Maternal depressive symptoms were assessed at 9 and 24 months. Birthweight <1,000 g, genetic and medical conditions associated with developmental delay, or low scores on measures of developmental performance defined EI eligibility. Service receipt was ascertained from parental self-report. Models were adjusted for sociodemographic and child risk. Among the 650 children who were eligible to receive EI services as infants, 33.2% of children whose mothers were depressed received services compared to 27.0% whose mothers were not depressed (aOR 1.8; 95% CI 0.8, 4.0). Among the 650 children who became eligible to receive services as toddlers, 13.0% of children whose mothers were depressed received services compared to 2.6% whose mothers were not depressed (aOR 4.6, 95% CI 1.5, 14.6). Among children receiving EI services, prevalence of depressive symptoms was 23.0% for mothers whose children became eligible as infants and 57.5% for mothers whose children became eligible as toddlers. Depressive symptoms in mothers of children eligible to receive EI services did not appear to limit participation. EI programs may be an appropriate setting in which to address maternal depressive symptoms.     

Infant Mortality Among Arab-Americans: Findings from the Arab-American Birth Outcomes Study

Arab-Americans (AAs) have lower risk of preterm birth relative to Non-Arab Whites. This has been attributed to lower likelihood of birth out of wedlock, maternal tobacco use during pregnancy, and foreign maternal birthplace among AAs. We were interested in understanding the roles of these and other demographic factors in the etiology of infant mortality among this group. Using data about all live, singleton births between 1989 and 2005 in the state with the highest proportion of AAs in the US, we calculated infant mortality (death prior to 1 year of life) for AAs and Non-Arab Whites. To clarify the etiology of potential differences in infant mortality, we also assessed infant mortality sub-categories, including neonatal mortality (death prior to 28 days of life) and post-neonatal mortality (death between 28 and 365 days of life). We fit trivariable and multivariable logistic regression models adjusted for explanatory covariates to assess each covariate’s contributions to the relation between ethnicity and infant mortality. AAs had a lower infant mortality rate (4.7 per 1,000 live births) than non-Arab Whites (5.6 per 1,000 live births), overall (odds ratio = 0.84, 95 % confidence interval: 0.74–0.96). In trivariable models, adjusting for marital status, maternal tobacco consumption during pregnancy, and maternal birthplace each separately attenuated the bivariate ethnicity-mortality relation to non-significance. Our findings suggest that lower risk of infant mortality among AAs relative to non-Arab Whites may be explained by differences in demographic characteristics and parental behavioral practices between them.     

Frailty Predicts New and Persistent Depressive Symptoms Among Community-Dwelling Older Adults: Findings From Singapore Longitudinal Aging Study

ObjectiveThis study aimed to examine the cross-sectional and longitudinal relationships between physical frailty at baseline and depressive symptoms at baseline and at follow-up.DesignFour-year prospective study.SettingCommunities in the South East Region of Singapore.ParticipantsWe analyzed data of 1827 older Chinese adults aged 55 and above in the Singapore Longitudinal Aging Study-I.MeasurementsThe frailty phenotype (based on Fried criteria) was determined at baseline, depressive symptoms (Geriatric Depression Scale ≥5) at baseline and follow-ups at 2 and 4 years.ResultsThe mean age of the population was 65.9 (standard deviation 7.26). At baseline, 11.4% (n = 209) had depressive symptoms, 32.4% (n = 591) were prefrail and 2.5% (n = 46) were frail. In cross-sectional analysis of baseline data, the adjusted odds ratios (OR)s and 95% confidence intervals controlling for demographic, comorbidities, and other confounders were 1.69 (1.23–2.33) for prefrailty and 2.36 (1.08–5.15) for frailty, (P for linear trend <.001). In longitudinal data analyses, prospective associations among all participants were: prefrail: OR = 1.86 (1.08–3.20); frail: OR = 3.09 (1.12–8.50); (P for linear trend = .009). Among participants free of depressive symptoms at baseline, similar prospective associations were found: prefrail OR = 2.26 (1.12–4.57); frail: OR = 3.75 (1.07–13.16); (P for linear trend = .009).ConclusionThese data support a significant role of frailty as a predictor of depression in a relatively younger old Chinese population. Further observational and interventional studies should explore short-term dynamic and bidirectional associations and the effects of frailty reversal on depression risk.     

Association of Infant Feeding Indicators and Infant Feeding Practices with Coexisting Forms of Malnutrition in Children under Six Months of Age

Breastmilk is the only recommended source of nutrition for infants below six months of age. However, a significant proportion of children are either on supplemental breastfeeding (SBF) or weaned due to the early introduction of solid/semi-solid/soft food and liquids (SSF) before six months of age. There is good evidence that exclusive breastfeeding (EBF) in infants below six months of age protects them from preventable illnesses, including malnutrition. The relationship between infant feeding practices and coexisting forms of malnutrition (CFMs) has not yet been explored. This study examined the association of different feeding indicators (continuation of breastfeeding, predominant feeding, and SSF) and feeding practices (EBF, SBF, and complete weaning) with CFM in infants aged below six months in Pakistan. National and regional datasets for Pakistan from the last ten years were retrieved from the Demographic Health Surveys (DHS) and UNICEF data repositories. In Pakistan, 34.5% of infants have some form of malnutrition. Among malnourished infants, 44.7% (~15.4% of the total sample) had a CFM. Continuation of breastfeeding was observed in more than 85% of infants, but less than a quarter were on EBF, and the rest were either SBF (65.4%) or weaned infants (13.7%). Compared to EBF, complete weaning increased the odds of coexistence of underweight with wasting, and underweight with both wasting and stunting by 1.96 (1.12–3.47) and 2.25 (1.16–4.36), respectively. Overall, breastfed children had lower odds of various forms of CFM (compared to non-breastfed), except for the coexistence of stunting with overweight/obesity. Continuation of any breastfeeding protected infants in Pakistan from various types of CFM during the first six months of life.