Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.     

Infant Feeding Decision-Making and the Influences of Social Support Persons Among First-Time African American Mothers

Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Objective The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusions for Practice Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation.     

Infant Feeding Practices That Substitute Exclusive Breastfeeding in a Semi-Rural Mexican Community: Types,Moments, and Associated Factors

International organizations recommend mothers practice exclusive breastfeeding (EBF) during the first six months of their infant’s life and introduce complementary feeding (CF) thereafter while continuing breastfeeding. However, the earlier introduction of liquids and foods is common worldwide and may have negative effects on breastfeeding practice, nutrition, and health. In this formative cross-sectional study, we interviewed 143 mothers from semi-rural communities in Tabasco, Mexico, whose infants were 4–6 months old. We explored (1) which feeding practices substituted EBF and (2) which factors were associated with each practice. During the first month of life, 42.7% of infants received formula milk (FM); this proportion increased to 74.5% by the sixth month. Adjusted Poisson regression analyses showed that giving FM was positively related to working away from home (PR 1.27; 95% CI 1.06, 1.54) and the perception that FM is an important food to accompany breast milk (PR 1.38; 95% CI 1.19, 1.70). Giving FM was negatively associated with not being sure the infant is full after breastfeeding (PR 0.75; 95% CI 0.61, 0.92). Regarding CF, less than half (47.5%) of infants had not received it by the fifth month. Factors positively associated with timely CF introduction were: the mother was told during prenatal care visits the optimal age to start CF is 6 months (PR 1.17, 95% CI 1.06, 1.29); she is convinced that giving only breast milk is best for her baby (PR 1.15, 95% CI 1.03, 1.29), and a higher infant weight-for-length (PR 1.04, 95% CI 1.00, 1.08) and length for age (PR 1.04, 95% CI 1.00, 1.09) z-scores at the study visit; conversely, it was negatively associated to the idea that if the infant is not full, she/he should receive formula milk or some other food (PR 0.87, 95% CI 0.78, 0.96). In these communities, EBF is lost to the use of FM and early CF. The factors associated with these inadequate feeding practices are related to returning to work, information received during prenatal visits, and the mother’s beliefs and thoughts. This work will guide the design of an intervention on infant feeding practices for these communities and other similar ones.     

Feeding Practices of Infants and Toddlers by Their Mothers in Selected Northern Emirates of the United Arab Emirates

Research on the feeding practices of infants and young children in the United Arab Emirates (UAE) is limited, especially in the northern regions of the country. A retrospective web-based survey was conducted to assess child feeding practices among the mothers of young children aged 6 months to 2.5 years in the northern emirates of the UAE. Information from a total of 475 mothers was collected on maternal socio-demographic factors, child feeding practices, and the use of vitamin and mineral supplements. For the first 6 months, 46.7% of the infants were exclusively breastfed, 43.8% were fed on both breastmilk and formula, and 9.5% were given formula only. Significant differences in the types of feeding were found correlating with maternal age (p = 0.02) and employment status (p < 0.001) but not with educational level, with a higher proportion of younger and unemployed women exclusively breastfeeding. However, although a significantly higher proportion of mothers with lower educational levels breastfed their children for ≥6 months (p = 0.026), they introduced “other milk” (non-breastmilk or formula) before the child reached the age of 12 months (p = 0.022). In this study, 22.1% of the infants and 8.1% of the toddlers did not receive an animal source of iron, while 52.6% of the children received vitamin/mineral supplements. The median daily frequency intake of sweets and savory snacks was substantially higher than the respective intake of fruits and vegetables. Intervention programs that focus on healthy infant and toddler feeding, including food sources of iron and nutrient-dense food groups, are needed in the UAE.     

Decision Support Needs for Transgender and Gender-Diverse Youth and Families: A Patient-Centered Needs Assessment

PurposeDue to the intertwining of medical and social decision-making, new approaches to shared decision-making are likely needed for supporting decisions related to the care of transgender and gender-diverse (TGD) adolescents. Prior to developing decision support interventions for TGD youth, a decision support needs assessment must be completed.MethodsSelf-identified TGD youth, family members of TGD youth, clinicians caring for this population, and community advocates participated in one of six group level assessments (GLAs). GLA is a structured, participatory qualitative method that engages diverse groups of stakeholders in generating and evaluating ideas on the topic of interest. Upon completion of all GLAs, a survey was developed and distributed to GLA participants inviting them to rank ideas generated during the GLAs.ResultsSix major themes emerged from the GLAs regarding decision support needs, including: improving healthcare provider skills and education, increasing access to support outside the healthcare system, strengthening community and societal support, developing special information resources, supporting youth in leading decision-making about transition, and modifying the healthcare system. In the follow-up survey, improving healthcare provider skills and education was the most commonly chosen top priority.DiscussionParticipants identified decision support needs for TGD youth and their families that were mostly distinct from traditional decision support approaches. Participants' focus on the need to improve healthcare provider skills and education provides an opportunity to couple gender-focused education with shared decision-making skills, an approach that may be more sustainable than tools for specific decisions.     

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.     

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.     

Using Positive Deviance to Understand the Uptake of Optimal Infant and Young Child Feeding Practices by Mothers in an Urban Slum of Mumbai

Objectives Positive deviance research seeks out well-nourished children living in disadvantaged contexts to understand local growth-promoting behaviors. This study explored the factors that influence the uptake of infant and young child feeding behaviors among mothers. Methods Children with a height-for-age z-score (HAZ) > 0 (n = 10) or a HAZ < ?2.0 (n = 12) were purposefully selected from households enrolled in a community management of acute malnutrition (CMAM) program in an urban slum of Mumbai, India. Qualitative methods were employed by means of semi-structured key informant interviews with positive and non-positive deviant mothers. Eligibility was restricted to households with limited resources and more than one child. A 24-h dietary recall and anthropometric measurements were taken for the index child. An observation checklist assessed household hygiene. Data analysis was based on the Grounded Theory of qualitative research. Results Positive deviant mothers (those with children with a HAZ > 0) largely exhibited optimal infant and young child feeding practices explained by maternal information seeking behaviors; mothers acknowledging the importance of maternal health; and social support. The relationship between mother and health worker seemed to influence how well they listened to the health workers’ recommendations. Across all households, the daily consumption of high-energy, processed foods was apparent. Conclusions Practical considerations include exploring how to tailor CMAM programs to include social support and counseling training for health workers to engage more closely with mothers; exploring the feasibility of a women’s social group for mothers to share information on child rearing; and teaching mothers about healthy eating and the link between nutrition and health.     

Culture and Caregivers: Factors Influencing Breastfeeding among Mothers in West Belfast, Northern Ireland

Breastfeeding is a key public health measure to protect and promote the health of one of the most vulnerable groups of the population—infants and children. Northern Ireland, however, has one of the lowest breastfeeding rates in the world. This paper reports the results of a questionnaire survey of 120 mothers attending mother and toddler groups in a socio-economically deprived area of Belfast Northern Ireland. Mothers' attitudes to breastfeeding were measured by the Iowa Infant Feeding Attitude Scale (IIFAS). In line with previous research, mothers who were older, had a husband or partner, who were of higher social class and who had themselves been breastfed as a child were more likely to breastfeed their own children. It was found that high scores on the IIFAS were significantly associated with breastfeeding and exclusive breastfeeding. However, of the 57% of study participants who reported that they had initiated breastfeeding, the majority (85.4%) reported that they had breastfed for less than the six months recommended by the World Health Organisation. Breastfeeding mothers reported that health benefits and information were the main reasons for their choice of feeding method and were more likely to rate information received from health professionals positively. Bottlefeeding mothers rated convenience, experience and “the norm” as the main reasons for choice of feeding and were more likely to rate information from health professionals negatively. The authors conclude that Northern Irish society needs to proactively encourage a positive breastfeeding culture and that the IIFAS may be useful in targeting interventions.     

Household Food Insecurity,Maternal Nutritional Status,and Infant Feeding Practices Among HIV-infected Ugandan Women Receiving Combination Antiretroviral Therapy

Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial (NCT00993031), a prospective, longitudinal cohort study in Tororo, Uganda. HHFI was common; the prevalence of severe, moderate, and little to no household hunger was 7.3, 39.9, and 52.8 %, respectively. Poor maternal nutritional status was common and women in households experiencing moderate to severe household hunger (MSHH) had statistically significantly lower body mass index (BMIs) at enrollment (21.3 vs. 22.5, p < 0.01) and prior to delivery (22.6 vs. 23.8, p < 0.01). BMI across time during pregnancy, but not gestational weight gain, was significantly lower for MSHH [adjusted beta (95 % CI) ?0.79 (?1.56, ?0.02), p = 0.04; ?2.06 (?4.31, 0.19), p = 0.07], respectively. The prevalence (95 % CI) of EBF at 6 months was 67.2 % (59.7–73.5 %), and the proportion of women BF at 12 months was 80.4 % (73.3–85.7 %). MSHH was not associated with prevalence of EBF at 6 months or BF at 12 months. However, among those women still EBF at 4 months (81.4 % of population), those experiencing MSHH were significantly more likely to cease EBF between 4 and 6 months (aHR 2.38, 95 % CI 1.02–5.58). The prevalence of HHFI, maternal malnutrition, and suboptimal infant feeding practices are high and the causal relationships among these phenomena must be further explored.     

Maternal Depressive Symptoms and Infant Feeding Practices at Hospital Discharge: Findings from the Born in Queensland Study

Maternal and Child Health Journal - This study aims to explore association between maternal depressive symptoms and infant feeding practice at hospital discharge. Data were obtained from a birth...     

Assessing the Knowledge, Attitudes, Behaviors and Training Needs Related to Infant Feeding, Specifically Breastfeeding, of Child Care Providers

Objective The purpose of this study was to assess the knowledge, attitudes, behaviors and training needs of child care providers on infant feeding practices, specifically breastfeeding. Methods Needs assessment surveys for child care directors and infant room teachers were developed, tested and mailed to the 277 Colorado child care centers licensed to care for infants (≤12 months); 1,385 surveys were mailed. Results A total of 267 surveys were received for an overall response rate of 20%. The majority (79%) of infant room teachers and directors reported low knowledge on ways to adequately store breastmilk and formula. Perceived attitudes on the advantages and disadvantages of breastmilk versus formula as well as behaviors associated with offering working mothers a supportive breastfeeding environment (e.g. breast pumps available at center, offer mothers a place to breastfeed) were also examined. Directors and infant room teachers desired updated infant feeding information for themselves, co-workers and parents. They wanted English and Spanish information regarding breastfeeding, formula feeding and introducing solid foods. Eighty-six percent of directors and 67% of teachers stated they have Internet access at work. Eighty-eight percent of directors and 79% of teachers would be interested in an infant feeding website. Conclusions According to the results of the needs assessment, child care directors and infant room teachers are in need of current, accessible infant feeding information. Child care directors and infant room teachers desired a website with bilingual and best practice infant feeding information specific to the needs of child care providers.