Infantile diarrhoea due to water complementation of breast and bottle feeding.

This study investigated the prevalence of unusual infant feeding practices among 204 mothers of infants aged 1-12 months, who were admitted with acute diarrhoea to the only two national hospitals in Kuwait. Ninety per cent of the mothers boiled water to prepare a powdered milk formula, but only 15% boiled water for drinking. Thirty nine infants (19%) were admitted more than once. Better family state in terms of socioeconomic class, maternal education, and breast feeding gave some protection against re-admission, though this was not significant. It seems that the condition of drinking water is an important cause of diarrhoea and hence of re-admission. The number of re-admissions was twice as high among infants drinking unboiled (unfiltered or mineral) water than among those drinking boiled or unboiled but filtered water. Breast feeding is protective if no extra water is given.     

Determinants for breast feeding and bottle feeding in Botswana

In the Botswana Primary Health Care Survey 1983-84 data on breast and bottle feeding were collected as well as characteristics of households, mothers, and children. The country-wide median breast-feeding duration was 1 year and 7 months, with a tendency towards shorter duration in the urban areas. Better hygienic conditions, higher education of the mother, and wage employment of the mothers were associated with shorter breast-feeding duration. Similarly, the risk of starting bottle feeding was higher in households with better hygienic conditions. However, a substantial proportion of the bottle feeding took place in households lacking piped water indoors. These data may indicate a current shift from traditional feeding patterns towards shorter breast feeding and introduction of bottle feeding, starting among well-off families, but also threatening the health of children in less privileged conditions. The association with maternal factors such as type of occupation calls for breast feeding promotion including improved conditions for the salary employed mothers.     

Evaluation of paladai cup feeding in breast-fed preterm infants compared with bottle feeding

This pilot study developed an appropriate procedure to evaluate the paladai cup compared to bottle feeding in preterm infants, using weighed napkins and video analysis to assess amount of spillage, volume consumed, time taken and physiological stability. Paladai results demonstrated increased spillage, increased feed times with more stress cues.     

Queries concerning breast feeding and diarrhoea in Pakistan

Over the past year (1988-89) the following questions were most frequently asked by doctors during the Diarrhea Training Unit (DTU) programme and during visits to health facilities in the four provinces in Pakistan. They were collected by Ms Lucia Ferraz-Tabor, PRITECH, and presented to the authors for replies. They are published here as they have a general application with appropriate cultural modifications.     

Relationship of breast feeding versus bottle feeding with emergency room visits and hospitalization for infectious diseases

Breast-feeding habits of 480 Jewish infants visiting a pediatric emergency room (ER) with infectious diseases were compared to those of 502 healthy infants visiting maternalchild health centers (MCH). (These centers are attended by almost 100% of the Jewish infant population.) Among infants under 5 months of age with acute gastroenteritis and upper respiratory infections, breast feeding was significantly less prevalent than among age-matched infants in the MCH group (22.6%, 18.5% and 53.4% respectively,P<0.0001). Infants with acute otitis media and lower respiratory tract infections showed the same trend although the numbers were small. A very short breast-feeding period of 2 weeks or less was more prevalent among the ER group and was associated with increased hospitalization rate. These data emphasize the importance of breast milk in reduction of ER visiting and hospitalization rate.     

IgA deficiency in children: A clinical study with special reference to intestinal findings

Clinical, immunological, and intestinal studies on 26 children with IgA deficiency in the age range 2 to 16 years are reported. 9 of these children were suffering from autoimmune disease, namely thyroiditis (5), thyrotoxicosis (1), rheumatoid arthritis (2), and probable Sjögren''s syndrome (1). The last-mentioned patient had defective cellular immunity. Altogether 11 patients were subject to recurrent respiratory tract infections. The symptomatology of the remaining patients was variable. In a boy with growth retardation, a chromosome anomaly was found, and endocrinological studies indicated total absence of growth hormone.In 21 patients IgA was undetectable, while 5 had trace amounts of IgA in their sera. IgG was raised in 11 patients, and one patient had low serum IgG. IgM levels were mostly normal. Precipitating antibodies to cow''s milk proteins were present in all but one serum.Small intestinal biopsy was performed on all patients. In 3 cases total villous atrophy was detected and these probably had coeliac disease, though malabsorption symptoms were not always evident. Disaccharidase assay of biopsy specimens revealed 2 cases of isolated lactase deficiency among 8 tested.Results show that the increased incidence of autoimmune disease reported in IgA deficiency in adults also holds true in children; i.e. that there is a raised incidence of coeliac disease with or without symptoms in IgA deficiency.     

Breathing patterns of preterm infants during bottle feeding: role of milk flow

Milk flow achieved during feeding may contribute to the ventilatory depression observed during nipple feeding. One of the important determinants of milk flow is the size of the feeding hole. In the first phase of the study, investigators compared the breathing patterns of 10 preterm infants during bottle feeding with two types of commercially available (Enfamil) single-hole nipples: one type designed for term infants and the other for preterm infants. Reductions in ventilation, tidal volume, and breathing frequency, compared with prefeeding control values, were observed with both nipple types during continuous and intermittent sucking phases; no significant differences were observed for any of the variables. Unlike the commercially available, mechanically drilled nipples, laser-cut nipple units showed a markedly lower coefficient of variation in milk flow. In the second phase of the study, two sizes of laser-cut nipple units, low and high flow, were used to feed nine preterm infants. Significantly lower sucking pressures were observed with high-flow nipples as compared with low-flow nipples. Decreases in minute ventilation and breathing frequency were also significantly greater with high-flow nipples. These results suggest that milk flow contributes to the observed reduction in ventilation during nipple feeding and that preterm infants have limited ability to self-regulate milk flow.