Infant feeding: a review of breast- and formula-feeding practices

The large scale use of cows' milk for infant feeding is a comparatively recent development. The trends in artificial formula and breast-feeding practices are reviewed by comparing the recommendations in infant feeding practices from the 1974, 1980 and 1988 DHSS Present Day Practices in Infant Feeding Reports.     

Infant feeding guidelines: an evaluation of their effect on health professionals>> knowledge and attitudes

Consensus infant feeding guidelines, which were developed by a multi-disciplinary working group, were adopted by the Eastern Health and Social Services Board (EHSSB) N. Ireland, in 1991. Implementation of the guidelines was undertaken using a cascade approach. Implementation teams were established in each of the nine Units of Management. These teams were provided with training and extra resources to facilitate the implementation process. In 1991, prior to the implementation of the guidelines, a postal survey was undertaken to establish the knowledge of infant feeding and attitudes to breast-feeding of health professionals working in the EHSSB area. Knowledge and attitude scales were developed for the questionnaire. The survey was repeated in 1993 to evaluate the impact and penetration of the guidelines. The penetration of the guidelines was good, 81% of respondents had read them. The knowledge of health professionals was significantly greater in 1993 than in 1991 ( P <0.0001); reading the guidelines was an independent variable for knowledge score (eta²=0.20, P <0.0001). Health visitors exhibited the highest and general practitioners the lowest mean knowledge scores. Attitude scores in the 1993 survey were almost identical to those found in 1991; reading the guidelines was an independent variable for attitude score ( P <0.0001), however the size of the effect was small (eta²=0.04).     

BREAST-FEEDING TRENDS AMONG BLACK AND WHITE WOMEN IN WASHINGTON, DC

The current prevalence of breast-feeding is 84 and 49 percent among white and black women, respectively, in metropolitan Washington, DC. Education is the most influential factor in breast-feeding practices.     

陕西镇安县36月龄以下婴幼儿喂养行为现况调查

【目的】 分析陕西省镇安县36月龄以下婴幼儿出生情况和喂养行为。 【方法】 采用PPS抽样,在陕西省镇安县抽取432名36月龄以下婴幼儿,进行问卷调查。 【结果】 婴儿平均出生体重为3 270 g,身长50.3 cm,性别间无显著差异。低出生体重儿占5.1%,巨大儿占5.6%。婴儿4个月内母乳喂养率为52.3%。分别有4.2%、 26.3%和73%的婴幼儿在4~5月龄、6~11月龄和12~17月龄断奶。该地区0~5月龄婴儿96.7%已添加汤汁饮料类辅食;开始添加半固体软质谷类食物的中位数大多是在6月龄;有一半婴幼儿在7、8月龄开始添加蛋类和肉类;18~35月龄婴幼儿中有一半是在12个月龄时开始添加鱼类;12~17月龄儿中分别有88.4%和56.5%的比例添加了肉类和鱼类。 【结论】陕西镇安农村婴幼儿母乳喂养率很低,婴儿抱奶时间长,断奶过早,辅食添加过早,6月龄以后辅食种类不丰富,添加优质蛋白的时间较晚。建议应在包括镇安在内的贫困农村加大力度宣传母乳喂养,尽量保证母乳喂养,同时要适时、合理地添加辅食。     

Infant feeding and maternal concerns about stool hardness

From a questionnaire completed by 195 mothers of infants aged 3-12 weeks we found that significantly more formula than breast-feeding mothers had concerns about stool hardness and had sought professional advice, resulting in both increased use of health care resources and more dietary interventions.     

Infant feeding in risk society

A large percentage of British women, in common with women in other Western countries, feed their young babies formula milk. The paper reports some findings of a study of infant feeding that focussed on women's experiences of feeding their babies this way. Data about this issue were collected through detailed, qualitative face to face interviews with 33 mothers and through telephone interviews using a structured questionnaire with 503 mothers. The study found overall that mother's accounts of feeding babies formula milk draw attention to contradictions and tensions in motherhood and mothering. Formula feeding is predominantly experienced by mothers as ‘easy,’ enabling them to address a wide range of demands and difficulties that mothering a small baby poses for them. At the same time, mothers demonstrate awareness of the socio-cultural construction of the ‘moral mother’ as the mother who minimizes and avoids risk, and so does not use formula milk for infant feeding. How women react to this tension between ‘real life’ and ‘doing what is healthy’ varies, but the study reported here found a large minority of women experience manifestly difficult and debilitating feelings as they attempt to reconcile a pragmatic wish or need to formula feed with dominant constructions of the ‘moral mother.’ By detailing women's accounts of this aspect of motherhood, the paper contributes to sociological investigation of everyday experiences of risk society. To contextualize this discussion, a brief account of the relationship between eating, feeding babies and risk society is also offered.     

Impact of breast-feeding promotion on infant feeding in the Czech Republic

OBJECTIVES: To assess infant feeding practices, identify factors that influence the duration of exclusive breast-feeding, and evaluate the impact of the National Breastfeeding Promotion Programme in the Czech Republic. HYPOTHESIS: We predicted the positive effect of the program in terms of increased prevalence of breast-feeding at discharge from the hospital and 6 months later. DESIGN: Multicenter cross-sectional survey. Mothers were randomly selected and interviewed in maternity hospitals in 1998 and were reinterviewed 6 months later. SETTINGS: Nine maternity hospitals in 6 cities across the country and households. PARTICIPANTS: 1104 mothers who gave birth within the 38th to the 42nd week of pregnancy to a healthy child with a minimum birthweight 2500 g; 1019 mothers were reinterviewed 6 months later. Intervention: The National Breastfeeding Promotion Programme implemented since 1991. VARIABLES MEASURED: Breast-feeding rates at discharge from the hospital and 6 months later, participation in prenatal classes, strategies related to breast-feeding promotion in the hospital, and support following discharge. ANALYSIS: Epi Info 6, SPSS (analysis of variance, F test), chi2. RESULTS: On leaving the hospital, 93.5% of newborns were exclusively breast-fed. Six months later, 23.1% of infants were breast-fed exclusively and 29.9% of infants were breast-fed while receiving complementary food. Participation in prenatal classes, first suckling within 2 hours of birth, breast-feeding on demand in the hospital, exclusive breast-feeding on leaving the hospital, and the duration of breast-feeding recommended by a pediatrician were positively related to the duration of exclusive breast-feeding (P <.001). CONCLUSIONS AND IMPLICATIONS: Compared with national data from the last 2 decades, the data from this study proved the increasing rates of breast-feeding at discharge from the hospital and 6 months later. The findings indicate the effectiveness of the National Breastfeeding Promotion Programme. However, further implementation of breast-feeding promotion strategies in health facilities coordinated by the Ministry of Health is needed.     

Infant feeding fractices within white and Asian Communities in inner-city Leeds

A structured questionnaire was devised in order to ascertain infant feeding practices. Multi-lingual interviewers visited the homes of 127 Caucasian and 184 Asian families with infants aged 6–24 months, in inner-city Leeds. The Asian families interviewed were from four-defined communities; Bangladeshis, Pakistanis, Punjabis and Gujaratis.
When compared with asian mothers, Caucasian mothers were more likely to breast-feed, and demonstrated a more positive approach to their chosen feeding pattern whether breast or bottle. Few differences in feeding practices were noted between the distinct Asian groups despite inter-group variations in English language ability, family size and duration of residence in Britain. Most of the Asian infants were still drinking from a feeding bottle at the age of 2 years, and two-thirds of the milk feeds were sweetened. In contrast, the majority of white Caucasian infants were no longer using a feeding bottle at 12 months of age, although one-third drank milk swetened, The mothers interviewed claimed that health professionals had advised them to add items to the milk, and to use vitamin fruit juices.
The feeding practices reported have clear implications for dental health, particularly among the Asain children. There is an urgent need for effective health education initiatives by health advisers based on a thorough evaluation of cultural differences in attitudes and practices     

Infant feeding: a review of weaning

Current advice on mixed feeding for the infant is reviewed, with reference to recent reports in the UK. Changes in practice are illustrated and the relevance to the infant of current advice for a prudent diet in adulthood is discussed. It is suggested that future reports on infant feeding may need to be more fully extended to the pre-school child.     

Infant feeding practices of the Igbo,Nigeria

The pattern of infant feeding and attitudes of the mothers towards breast feeding, morbidity and mortality of a sample of the Nigerian Igbo tribe was studied. The result showed that:

• Ninety‐four percent of all mothers breast fed their infants for at least six months. The duration was longer among the non‐educated than the educated mothers.

• The size of the family decreased with increases in educational attainment. Eighty percent of the mothers gave their babies supplementary food between 3–7 months of age. A special weaning diet was used by 49 percent of the educated mothers and 27 percent of the non‐educated mothers.

• Twenty percent of the children has at least one attack of diarrhoea before the age of six months. One out of every eleven children was admitted at least once to the hospital before the end of six months.

The prevalence of diarrhoea, malnutrition and possibly death could be attributed to a number of factors. These include: the introduction of supplementary food too early in unsanitary conditions, the ignorance of the mothers of what the weaning diet should constitute, the large number of children in the family, and the unhiegienic environment.     

A survey on home generated medical waste in Mauritius

This study was carried out to evaluate home-generated medical waste in Mauritius. A questionnaire survey was undertaken among a random sample population in 250 houses in the nine districts of the island. Results of this study showed an overwhelmingly large proportion of medical waste arising from the domestic environment joins the common municipal solid waste stream and ends in landfills. This improper disposal process poses a serious health hazard to the general public, waste haulers and landfill personnel. It is therefore recommended that a national policy on medical waste management be urgently implemented, proper training of waste haulers be offered and education campaign be carried out to sensitize the general public on safe disposal of medical waste.     

Changes in breast-feeding in the Philippines, 1973–1983

Only limited research has been conducted on the patterns and determinants of changes over time in the extent and duration of breast-feeding. Methods are used that allow the examination of the effects of changes in population characteristics and behavioral factors on breast-feeding outcomes. Comparable national surveys are employed to examine the factors associated with the combination of a decline in the extent of and an increase in the duration of breast-feeding between 1973 and 1983 in the Philippines. Important differences are found in the factors explaining the extent and duration of breast-feeding between 1973 and 1983.     

Development milestones related to feeding status: evidence from the Child Health Supplement to the 1981 National Health Interview Survey

This study examines maternal reports of the health and attainment of developmental milestones for 1374 breast-fed v. 1414 formula-fed infants. Data were drawn from the 1981 Child Health Supplement to the National Health Interview Survey (NHIS-CHS), a nationally representative sample of some 40 000 households in the United States of America. The results showed smiling to be reported earlier for the infants of breast-feeding mothers. Formula-feeding mothers were quicker to introduce their infants to solid foods, and also reported earlier success in toilet-training their infants than did breast-feeding mothers. Ratings of physical health were comparatively better for the breastfed than for the bottle-fed infants. Although partially accounted for by duration of breast-feeding, demographic factors of low family income and maternal education predicted poorer infant health. These findings suggest that feeding method may modestly influence infant social development and physical well-being.     

Maternal employment: does it influence feeding practices during infancy?

Background: Although at least 30% of women with young children participate in the labour force, there has been very little research into the effect of maternal employment on the diets of young children. Increasingly it is being recognized that early feeding practices affect future health and may have a part to play in the development of eating disorders. Therefore it was decided to conduct a study in Sheffield to determine whether maternal employment influences infant feeding practices.
Methods: Mothers from social classes I and II (employed n =27; unemployed n =28) with infants aged 10–12 months were interviewed in their homes. Information was collected on past and present food and drink consumption, weaning practices, and progression to independent feeding.
Results: Employed mothers stopped breast-feeding earlier. This difference became evident after 2 months of age and reached significance at 4 months ( P < 0.05). Employed mothers introduced foods earlier and relied more on commercial baby foods, with significantly more spending over ú7–12 per week at the time of the survey ( P < 0.05).
Conclusions: Maternal employment does influence infant feeding practices and consequently may have repercussions on future health. Further studies are needed to investigate the long-term effects of maternal employment on infant feeding practices, particularly amongst lower socio-economic class families.     

Infant feeding patterns during the first year of life in Denmark: Factors associated with the discontinuation of breast-feeding

We prospectively studied 500 infants born consecutively in a university-affiliated community hospital in Copenhagen, Denmark, over the first 12 months of life using a detailed monthly mailed questionnaire (overall response RATE = 73%) which focused on feeding practices and illnesses. Seventy-seven percent of respondents breast-fed their infants at 1 month of life compared to 19% at 12 months of life. Analysis of breast-feeding behavior using survival analysis showed that 50% of the mothers who breast-fed since the first month of their infant's life were still breast-feeding at 7 months of life. Also, there was a greater than two-fold increase in the rate of discontinuation of breast-feeding for infants in daycare compared to infants not attending daycare (RR = 2.08, 95% CI = 1.43, 3.01). Discontinuation of breast-feeding was not significantly associated with the number of children in the family or with social class.

These results give insight into infant feeding patterns in a developed country and suggest that: (1) breast-feeding is the dominant method of feeding during the infant's first year of life, and (2) the rate of discontinuation of breast-feeding is increased by the entry of these infants into daycare.     

新生儿血清瘦素水平与喂养方式间的关系研究

目的:测定母乳及配方乳中瘦素含量,比较不同喂养方式对足月新生儿血清瘦素水平的影响。方法:采用放射免疫分析法测定足月新生儿血清、母乳及配方乳中的瘦素水平。结果:①66例健康足月儿生后第3、7、28天其母乳中的瘦素水平分别为(1.31±0.67)μg/L、(1.33±0.14)μg/L、(1.26±0.98)μg/L,产后不同日龄母乳中瘦素水平差异无统计学意义(F=1.78,P>0.05)。配方乳中瘦素水平为0。②母乳喂养组新生儿生后第3、7、28天血清中瘦素水平分别为(2.45±1.04)μg/L、(3.38±1.54)μg/L、(4.98±2.16)μg/L;人工喂养组新生儿生后第3、7、28天血清中瘦素水平分别为(1.23±0.67)μg/L、(1.91±0.31)μg/L、(2.63±1.19)μg/L;两组间血清瘦素水平差异显著(t=1.113,t=3.176,t=2.152,P<0.05)。结论:①母乳中含有一定浓度的瘦素,初乳与成熟乳之间瘦素水平无显著差异,配方乳中未检测到瘦素。②母乳喂养儿血清瘦素水平明显高于人工喂养儿,母乳喂养有利于维持新生儿期血中较高的瘦素水平。     

Infant feeding practices of Pakistani mothers in England and Pakistan

Objectives To investigate infant feeding practices followed by Pakistani mothers in Pakistan and in England. To establish if practices conform to current guidelines and to investigate reasons for adherence and nonadherence. Methods Ninety mothers of weaning age children were interviewed; 45 were in England and 45 in Pakistan. A questionnaire available in English and Urdu sought to find out about the methods of milk feeding and weaning used and the advice received, together with general beliefs about weaning. Results Characteristics of the infants in terms of current age, gender distribution, birth order of baby and age of weaning showed no significant differences between the two groups. Thus, differences between the two groups could be attributed to cultural differences rather than any of these factors. Chi‐square analysis showed that the initial method of feeding chosen was significantly different (P < 0.001, d.f. = 2) with 73% of mothers in Pakistan breast‐feeding compared with 24% in England. Similar proportions of mothers in both groups commenced weaning between 3 and 4 months. Common weaning foods included rice, cereals and eggs with progression to fruit and vegetables and family food in Pakistan, and fruit, vegetables, meat and convenience foods (especially sweet options) in England. Both groups of mothers wanted more information about infant feeding practices. Conclusion Mothers in Pakistan demonstrated more confidence in weaning practices than in England because of experiences with other siblings and advice from relatives. More advice from health professionals was requested and is needed by all mothers in order to improve weaning practices of the infants.     

'Breast is best': Infant feeding decisions and maternal deviance

The insistence that breast feeding confers unique and significant benefits upon children underpins both health policy and professional practice and is part of the context in which women decide how to feed their babies and, in turn, how they display and defend their decisions. This paper applies a framework, drawn from the sociology of deviance, to the accounts which women give of their infant feeding intentions. It draws upon data from a longitudinal qualitative interview study of the food choices made by mothers on behalf of their infants and young children, to show how such choices are irreducibly moral and that the ways in which women can be judged, or indeed judge themselves, to be deviant are legion. However mothers decide to feed their babies, infant feeding is a highly accountable matter. Whether they intend to breast feed or formula feed, women face considerable interactional challenges as they seek to establish that they are not only good mothers but also good partners and good women.