Promoting successful breast-feeding skills.

Breast milk provides ideal nutrition for the newborn infant. More than half of mothers intend to breast-feed, yet many are unsuccessful at sustaining breast feeding beyond the first few weeks postpartum. Preparation for breast feeding should begin during prenatal care. Breast feeding early and often in the postpartum period promotes establishment of the milk supply. Attention to proper positioning is essential to successful nursing. The family physician can be especially helpful in the early postpartum weeks, when many mothers become discouraged and discontinue breast feeding. Formula supplements should be avoided in the early postpartum period. Most problems, such as sore nipples, engorgement and pain with latch-on, subside after several weeks; symptomatic relief and emotional support from the family physician during this period are crucial.     

Infant nutrition

Although breast feeding by the mother has long been the preferred method of infant feeding, it has come under scrutiny in recent years. The infant derives some immunologic benefit from breast milk during the first six months of life, but supplemental iron must be provided thereafter. The breast-feeding mother should avoid taking vitamin E and certain medications, such as anticonvulsant drugs.     

Intravenous Feeding—Nutritional Aspects

Intravenous feeding is essential in certain medical emergencies, and is often used for brief periods. Based on adequate clinical evaluation, relatively prolonged maintenance by the parenteral route is also feasible as an interim measure with the goal of restoring oral intake.

Recognition and proper management of altered requirements in intravenous feeding are a continuing challenge to the physician. Nutritional aspects are reviewed in relation to caloric needs; amino acid, carbohydrate and fat utilization; and vitamin and mineral requirements, as well as the available sources of each.     

Causes of Chronic Diarrhea in Infants and Children

The problem of diarrhea in an infant or a child can be and often is frustrating for all concerned. Without a reliable feeding history the physician will be hard pressed to know where to begin a search for the cause. With this information he will be able to put the newer diagnostic tests to their best use.     

Breast feeding and infant nutrition

Breast feeding is a management problem requiring knowledge of the physiology of lactation, maternal and infant nutritional requirements, and specifics such as drugs which enter the milk. The job of the physician is to allay anxiety; this helps establish the let-down reflex and increases milk production. "Caking," mastitis and even abscesses are not indications for weaning. Rest, warm compresses and frequent nursing are indicated. Breast-fed infants have less tendency to obesity than those who are bottle-fed. Early solid foods in the diet are not needed.     

An ethological study of the development of infant feeding

This paper outlines an ethological study of the development of infant feeding. Firstly, a framework for analysing the practice of infant feeding is presented from which five sources of faulty feeding and possible infant obesity are identified. Then there is a discussion of the research design which attempts to disentangle the various contributions of environmental, developmental and constitutional factors. This focuses on the infant's feeding behaviour and mother–infant interaction during feeding, and the appropriate observational methods developed by ethologists are described. Finally data from a part of the study concerned with early food regulation and the mother's concept of feeding are presented. It appears that at 3 days of age bottle fed babies are having more to eat than breast fed babies, that mothers are muddled about demand feeding and that mothers who are breast feeding are probably overemphasizing the psychological aspects of the feeding environment.     

The Effect of Maternal Depressive Symptoms and Early Maternal Feeding Behavior on Later Infant Feeding Behavior

Adaptive maternal feeding behaviors are sensitive and responsive to the infant and support the infant's participation in feeding. Adaptive infant behaviors help the infant to participate in the feeding within developmental capacities and to interact in a positive manner with the mother. Therefore, the purpose of this study was to explore the contribution of the adaptiveness of early maternal feeding behavior to the adaptiveness of later infant feeding behavior, accounting for maternal depressive symptoms and neonatal health. Thirty-seven premature infants and their mothers were assessed in the special care nursery just before discharge and in their homes at 4 months postterm age. The adaptive quality of maternal and infant behavior was assessed using the Parent-Child Early Relational Assessment. Maternal depressive symptoms were assessed using the Center for Epidemiological Study–Depression Scale. Infant health was assessed using the Neonatal Health Index. Linear regression analyses revealed that the adaptiveness of maternal feeding behavior before special care nursery discharge contributed significantly to the adaptiveness of infant feeding behavior at 4 months postterm age, accounting for neonatal health and maternal depressive symptoms. Although further study of the relationship is needed, findings support development of interventions to enhance the adaptiveness of mothers' early feeding behaviors.     

Infant feeding responsiveness: a conceptual analysis

BACKGROUND: The phenomenon of infant responsiveness to the caregiver during feeding interactions has been of interest to researchers for many years, because of its associated implications for child growth and development. Although many studies have examined feeding responsiveness in caregiver-infant dyads, it is infrequently and inconsistently defined in the literature. SPECIFIC AIMS: The purpose of this paper is to clarify the concept of infant feeding responsiveness through the provision of a working definition of the concept for further study and usage. METHODS: Medline, CINAHL, and PschInfo databases from the year 1970 to the present were searched for English articles containing the keywords 'infant', 'feeding', 'responsiveness', 'synchrony', and/or 'interaction'. Articles were selected for inclusion according to whether or not the phenomenon of infant feeding responsiveness was defined or assessed. Walker and Avant's (1995) method for concept analysis was employed for the development of defining attributes, case examples, antecedents, and consequences for further clarification of the concept of infant feeding responsiveness. FINDINGS: Infant feeding responsiveness was defined as the manifestation of physiologically influenced visual, expressive, vocal and motor reactive behaviours expressed by an infant in reaction to a caregiver's feeding attempts, indicating a readiness to feed. CONCLUSIONS: Implications for nursing are explored as well as the need for refinement of measures of this concept.     

Low-income mothers' decisions regarding when and why to introduce solid foods to their infants: influencing factors

Preventive measures for long-life illnesses such as asthma, obesity, and diabetes can start as early as in infant feeding practices. The American Academy of Pediatrics recommends introducing babies to solid foods, anything other than breast milk or formula, no earlier than 4-6 months of age (Kleinman, 2004). This study's purpose was to assess beliefs and attitudes of mothers enrolled in Medicaid about the introduction of solid foods and other infant feeding behaviors. Six focus groups (N = 23) were conducted with Black and Caucasian mothers with infants under 1 year old. The Theory of Planned Behavior was used as a framework for moderator questions and interpretation of themes. Maternal knowledge about infant feeding, maternal perceptions of applicability of infant feeding guidelines, and manner and type of information useful for infant feeding decisions emerged as themes. Implications of themes for informing an educational program for mothers to delay the introduction of solid foods are discussed.     

Infant feeding practices in complex emergencies: a case study approach

The majority of deaths associated with complex emergencies are attributed to infants and children under the age of five years. Most of these deaths are related to preventable diseases such as malnutrition, diarrhea, and malaria. Infant feeding emergencies have emerged as a major factor in complex emergencies. This paper reviews the current information relative to infant feeding, and uses four case studies as educational tools for the management of infant feeding emergencies. Child mortality rates in refugee population have been linked directly to protein-energy malnutrition (PEM). Breast feeding has many advantages over all other forms of feeding for children up to the age of two years of age. These advantages are discussed in detail in this paper. In addition, the appropriate and inappropriate uses of breast-milk substitutes (BMS) are discussed. Breast feeding also may play a role in the spread of HIV infections from the mother to the infant. However, in the setting of complex emergencies in the developing world, the risk of an infant dying of malnutrition and infection when not breastfed is likely to be greater than is the risk of death due to HIV acquisition through breastfeeding. The physiology of lactation is reviewed with particular reference to the roles of prolactin, oxytocin, and the feedback inhibitor of lactation (FIL) hormone. No medications have been demonstrated to augment milk production that can be used in a practical sense in complex emergencies. Lastly, the principles promulgated by the WHO and UNHCR for the feeding of infants and children in emergencies and for milk powder distribution are summarized.     

Factors contributing to preterm infant engagement during bottle-feeding

BACKGROUND: Preterm infants have difficulty maintaining engagement throughout early oral feedings, which can lead to less efficient feeding and prolonged feeding skill development. OBJECTIVE: To examine contributions of the infant, mother, and feeding context to infant engagement during bottle-feeding. METHODS: Bottle-feedings of very-low-birthweight infants (n = 22) by their mothers were observed. Infant and maternal behaviors were coded and synchronized with physiologic measures. At completion of the feeding, the mothers were interviewed, and their working model of feeding coregulation was scored. Feedings were subdivided into feeding episodes (n = 114). Using multilevel linear regression analyses, four dyadic characteristics (working model of the caregiver's role as coregulator, birthweight, postconceptional age, baseline oxygen saturation) and five episode characteristics (readiness at episode onset, episode baseline oxygen saturation, mean oxygen saturation during the episode, maternal feeding behavior, and phase of feeding) were examined as potential predictors of feeding episode engagement. RESULTS: Conditions observed during the feeding observation explained most of the variation in engagement. Engagement was more likely to occur during the early phase of feeding (p <.05), during feeding episodes that began with infant readiness (p <.05), and during feeding episodes with higher mean oxygen saturation during the episode (p <.05). Feeding episodes with less jiggling of the nipple had a significantly greater amount of engagement (p <.05). CONCLUSIONS: The ability of the preterm infant to maintain engagement during bottle-feeding cannot be explained by characteristics of the infant or by the prefeeding condition of the infant alone. Rather, engagement is coregulated by the caregiver and the infant throughout the feeding. Strategies to assist infants in maintaining physiologic stability during bottle-feeding and further study of effective and contingent caregiver feeding behaviors are needed.     

Feeding preterm infants: application of developmental care

Developmental care is the core concept of the preterm infant caring model. It is characterized by interaction, individualization, and evolving process. In order to enhance family competency with regard to preterm infant care, health professionals should include parents as team members when preterm infants are hospitalized so that parents can provide care helpful to facilitate preterm infant adaptation to external environmental stimulation. The preterm infant's 6-8 feedings per day represent the most frequent daily activity and an activity in which safety is essential. Potential adverse feeding responses in preterm infants such as tachypnea, cyanosis, and fatigue may stress the mother. This is a particular risk when the mother tries to increase her infant's intake volume by over-stimulating oral-motor activity. Theories and guidelines for feeding preterm infants in western societies have been evolving since the 1980s. However, little has been done in this area in Taiwan. This article addresses preterm infant feeding characteristics and cues, the application of developmental care in feeding infants, and proposes guidelines for feeding preterm infants. Healthcare professionals may reference our suggestions in feeding preterm infants and educating parents.     

Contributing to Content Validity of the Infant-Driven Feeding Scales© through Delphi surveys

The Infant-Driven Feeding Scales© (IDFS) assess a preterm infant’s readiness for oral feeding, evaluate the infant’s quality of feeding, provide a guide for intervention, and provide a standardized format for documentation (Ludwig and Waitzman, 2007). Since its inception, the IDFS have evolved over time with changes in language and clarity founded on clinical experience, best-practice information from the literature, and knowledge of existing infant feeding assessments. This paper presents additional evidence to support the content validity of the IDFS by reporting opinions collected from neonatal feeding experts by way of the Delphi Technique. Updates to the IDFS are presented.     

Identifying infant hydrocephalus in the emergency department with transfontanellar POCUS

Hydrocephalus carries significant morbidity in the infant population. Although clinical symptoms are often nonspecific, hydrocephalus is easily identified using transfontanellar sonography. In this review, we provide the emergency physician with a succinct overview of infant hydrocephalus and the point-of-care ultrasound (POCUS) technique for identification of this pathology.     

先天性唇腭裂患儿手术前后的喂养护理

目的：研究先天性唇腭裂患儿手术前后的特殊喂养护理。方法：对３６例患儿分别采取母乳喂养、奶瓶喂养和汤匙喂养,并对喂养中容易出现的问题及时采取对策,预防并发症。结果：３６例患儿顺利渡过了手术前后的特别喂养阶段,患儿身高、体重增加。结论：针对患儿的特点,选择适合患儿的喂养方法是保证患儿手术前后喂养成功的关键。     

Feeding the infant with congenital heart disease: an occupational performance challenge.

This review article uses the Canadian Model of Occupational Performance (CMOP) as a theoretical framework to organize a discussion of the complexities of infant feeding when the infant has congenital heart disease (CHD). Literature from many fields indicates that feeding supports the physical, cognitive, and affective development of infants within their various environmental contexts. Many infants with CHD, who are now surviving in increasing numbers, experience feeding difficulties that affect their growth and development and that challenge their caregivers. The feeding experiences of infants with CHD illustrate the clinical applicability of the CMOP and the need for further research. Research using the framework of the CMOP will enable the development and implementation of evidence-based interventions that support the occupation of feeding from both the infant and the caregiver perspective.     

Successful breast feeding: the mother''s dilemma

A content analysis of 141 articles on breast feeding by discipline revealed differences in the factors considered necessary for breast feeding success and in the criteria used to determine success. Whereas medical articles focused on maternal factors prenatally and infant health post-natally, or the length of time breast feeding was maintained, lay articles focused on the relationship of the mother with her infant (the nursing couple) and the mother's ability to manage breast feeding within the family context. The implications of this discrepancy for nursing practice and research are discussed.     

The relationship of a mother's working model of feeding to her feeding behaviour

AIMS OF THE STUDY: This study aimed to examine the difference the attunement of a mother's working model of feeding to her infant makes for her positive feeding affect and behaviour, accounting for infant and mother conditions. BACKGROUND/RATIONALE: The concept of a mother's working model of feeding is derived from attachment theory. Caregiving, including feeding, is a component of this theory. The conditions that may influence the attunement of a mother's working model of feeding to her infant include infant birth maturity status (premature, full-term), age at assessment, and robustness, indexed by weight-for-age z score (WAZ). Mother conditions include symptoms of depression and feeding practice (breast feeding or exclusive bottle feeding). DESIGN/METHODS: Participants in this longitudinal study were 99 mothers and their infants (47 full-term, 52 premature, very low birth weight). After written informed consent was given, home assessments were made when infants were approximately 1, 4, 8 and 12 months old (adjusted age for premature infants). Working model attunement was assessed with a video-assisted interview. A mother's positive affect and behaviour, including sensitivity and responsiveness, were rated from videotaped feeding interaction. RESULTS/FINDINGS: Repeated measures analysis with a general linear mixed model showed a significant positive relationship with positive affect and behaviour for both working model attunement and the WAZ score and a significant negative relationship for symptoms of depression. Neither birth maturity status, infant age, nor feeding practice had a significant effect on mother's positive affect and behaviour during feeding. CONCLUSIONS: Nurses' efforts to enhance the attunement of a mother's working model of feeding may help mothers feed with greater positive affect and behaviour. Further study of how the attunement of a mother's feeding expectations and intentions are related to her symptoms of depression and with what she makes of the infant's growth and well-being is needed. The theoretical model needs testing with infants from the entire premature population.