Infant feeding patterns in the Finnish type I diabetes prediction and prevention nutrition study cohort

OBJECTIVE: To investigate infant feeding patterns during the first 2 y and their relation to sociodemographic factors. DESIGN: A population-based cohort study. SETTING: Oulu and Tampere University Hospital district areas 1996-1999, Finland. SUBJECTS AND METHODS: All newborn infants (n=675) with increased genetic risk for type I diabetes were invited to the study in 1996-1997. Of these, 429 (64%) completed the dietary follow-up form by the time they reached 2 y of age. RESULTS: The median duration of exclusive breastfeeding (BF) was 1.8 months (range 0-6 months) and that of total BF 7.0 months (0.3-25 months). Among the infants 20% were exclusively breastfed at least 4 months (recommendation 4-6 months). Infants were introduced to infant formula at the median age of 1.8 months (range 0-25 months) and other supplementary foods at the median age of 3.5 months (1-6 months). Infant's ponderal index at birth was inversely associated with the duration of total BF. The age of introduction of supplementary foods correlated positively with the duration of total BF. Longer parental education and increased maternal age were associated with a longer duration of BF and older age at introduction of supplementary foods. Infant formula and other supplementary foods were added earlier to the diet of the boys than that of the girls. CONCLUSION: Duration of breastfeeding in Finland is shorter than recommended. Compliance with the current recommendations on the timing of introduction of first supplementary food and dairy products is relatively poor. The diet during infancy seems to be conspicuously influenced by the duration of parental education, maternal age and the sex of the infant.     

Breast-feeding patterns in a rural village in Giza, Egypt.

In a longitudinal study of infant feeding in rural Giza, Egypt, we found that 68.8% of the recruited mothers initiated early suckling of colostrum, but only 51.2% of the infants were exclusively breast-fed in the first week. Solid foods were introduced much earlier than at the recommended age of 4 to 6 months. Sixty percent of the mothers who participated in the study considered breast-feeding plus regular or irregular complementary feeding to be exclusive breast-feeding.     

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.     

Maternal variables related to potentially high-sodium infant-feeding practices

Infant sodium intakes between 5 and 15 mEq per day for ages 0 to 6 months and between 11 and 33 mEq per day for ages 6 to 12 months are considered appropriate, safe, and adequate. Intakes exceeding these ranges should be avoided as a precautionary measure for infants who may be hereditarily predisposed to hypertension. The concern about high-sodium intakes is based on epidemiological findings of an association between such intakes by adults and hypertension. Feeding practices potentially associated with high-sodium intake were assessed in 87 white and 68 black mothers of a cross section of 1- to 12-month-old infants and were analyzed for associations with epidemiological correlates of hypertension. Lower frequency of breast feeding was reported by black mothers and by less educated mothers. Forward, stepwise regression analyses indicated that less education was also predictive of shorter breast-feeding duration, earlier introduction of solid foods, addition of salt to infant food, and use of salty foods as snacks. Addition of salt to infant food was also predicted by high maternal salt use and by positive family hypertension history; black mothers more often fed salty snacks. Considerable public attention has been drawn to the fact that commercial infant foods no longer contain added salt. This study implies a need for additional public attention to appropriate sodium levels in home-prepared and snack foods fed to infants.     

Breast-feeding among the urban poor in southern Brazil: reasons for termination in the first 6 months of life

A study of breast-feeding practices over the first 6 months of life among a cohort of urban poor infants in southern Brazil indicated that the median duration of breast-feeding was 18 weeks, and at 6 months 41% of the infants were still being breast-fed. The duration of breast-feeding was significantly associated with the following: the infant's sex, mother's colour, type of first feed, timing of the first breast-feed, breast-feeding regimen and frequency of breast-feeding at 1 month, and the use of hormonal contraceptives by the mother. The following were significant risk factors for early termination of breast-feeding: the infant's sex, type of first feed, use of supplementary feeds, frequency of breast-feeding, feeding regimen, weight-for-age, and weight-for-age after controlling for birth weight. Dissatisfaction with their infant's growth rate was the most frequent reason given by mothers for supplementing the diets of infants who were exclusively breast-fed in the first 3 months of life. Also, the mothers' perception that their milk output was inadequate was the most frequent reason expressed for stopping breast-feeding in the first 4 months. The roles of health services and family support in providing favourable conditions for increasing the duration of breast-feeding in the study population are discussed, as well as the possibility of bias being introduced into studies of the relationship between infant feeding and growth by the effect of the infant's rate of growth on the mother's decision to continue breast-feeding.     

Types of drinks consumed by infants at 4 and 8 months of age: sociodemographic variations

Aim To investigate the variations in sociodemographic characteristics of mothers in relation to the types of milk and supplementary drinks consumed by their infants at 4 and 8 months of age. Study design The carers of a randomly chosen population sample of over 1000 infants from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) were asked to record all foods and drinks consumed by the child in a 24‐h period at both 4 and 8 months of age. Self‐completion postal questionnaires were used to ascertain sociodemographic characteristics of the mothers and their infants. Methods Significant differences in the types of milks and supplementary drinks consumed within sociodemographic groups were identified. Infants were also grouped according to the types of milks they were receiving at each age and further differences in sociodemographic characteristics were investigated. Results Highly significant differences existed among various sociodemographic characteristics with regard to the types of drinks used at both ages. Maternal educational level was the most influential of the sociodemographic variables in explaining the differences in consumption of all types of drinks given at 4 months, in particular for breast milk use. Maternal age was also significantly associated with breast feeding. The use of fruit drinks was significantly associated with the presence of older siblings in the family and the use of herbal drinks with the duration of breast feeding. At 8 months of age maternal educational level was again the most highly associated of the sociodemographic variables, being significantly associated with the use of most of the drinks. The presence of older siblings also had a significant independent effect as did duration of breast feeding. The feeding of cows’ (or animal) milk as a main drink at 8 months, contrary to recommendation, was most likely in the group of mothers with vocational education, those in council accommodation, those with two or more children and those with difficulty affording food. Conclusion We have identified certain characteristics of mothers who were more likely than others not to follow current recommendations on infant feeding. The educational level of mothers appears to be of major significance in the choices made about the types of drinks given to infants. It may be possible to target information about infant feeding to certain groups of mothers thus improving weaning patterns.     

Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes

OBJECTIVE: Current recommendations for infant feeding encourage breast-feeding through the first year. This research was conducted to evaluate associations among breast-feeding, maternal control of child feeding, and the dietary intake of toddlers during the second year of life. In particular, we sought to determine whether breast-feeding through the first year and subsequent toddler intake was mediated via maternal control of child feeding. DESIGN/SUBJECTS: Fifty-five white infants and their mothers were monitored longitudinally from age 12 or 13 months to age 18 months. MAIN OUTCOME MEASURES: Breast-feeding through the first year and maternal control in infant feeding were evaluated as predictors of energy intake at age 18 months. STATISTICAL ANALYSES PERFORMED: Regression analysis was used to evaluate predictors of toddler energy intake at age 18 months. A mediation model tested if the relationship between breast-feeding and infant intake was mediated by maternal control in feeding. RESULTS: Breast-feeding through the first year was associated with higher toddler energy intakes at age 18 months through its influence on maternal control in feeding. Mothers who breast-fed their infants for at least 12 months used lower levels of control in feeding. Lower levels of maternal control in feeding were associated with higher toddler energy intakes. The highest energy intakes among children aged 18 months were observed among taller and leaner toddlers. APPLICATIONS/CONCLUSIONS: Our findings suggest that breast-feeding through the first year may have an effect on children's energy intake by shaping mothers' child-feeding practices. These findings may be used by clinicians to assist parents in making informed decisions about choice of infant-feeding method and to provide anticipatory guidance regarding infant-feeding style when initiating dietary diversity.     

Infant feeding patterns on Mauritius Island, 1991

The 1991 Mauritius Contraceptive Prevalence Survey (CPS) included a special module on infant feeding patterns in Mauritius. Since 1985, when a similar CPS was conducted, the incidence of breast-feeding has fallen from 86% to 72%. The duration of any breast-feeding among those breast-fed remained constant at 13.6 months. The module allowed for an assessment of the World Health Organization (WHO) breast-feeding indicators on exclusive breast-feeding, timely complementary feeding and continued breast-feeding. Only 16% of infants 0–3 months old are exclusively breast-fed; only 29% of infants 6–9 months old receive breast milk and complementary foods and only 27% of children 12–15 months are still breast-fed. These patterns of limited breast-feeding and early supplementation may signal future declines in breast-feeding for other African and Asian countries. Published by Elsevier Science Ltd     

Early short-term infant food supplementation, maternal weight loss and duration of breast-feeding: a randomised controlled trial in rural Senegal

OBJECTIVE: Early supplementation of breastfed infants may have consequences both for the mother and the child. We hypothesised that it would result in decreased maternal weight loss and in shorter durations of breastfeeding and birth intervals. DESIGN: Controlled randomised population-based trial. SETTING: Six villages in the Sine area of Senegal, West Africa.Subjects:Healthy breastfed infants and their mothers, 68 controls and 66 supplemented infants at randomization. INTERVENTION: Supplementation with high-energy, nutrient dense food from 4 to 7 months of age, twice daily under supervision of field workers. Both controls and supplemented infants were free to eat other complementary foods. Maternal weight was measured monthly. Dates of breastfeeding cessation and of subsequent births were collected prospectively through weekly demographic surveillance, and were analysed using Cox's regression models and 'intent-to-supplement' approach. RESULTS: Mean maternal weight gain from 4 to 7 months postpartum tended to be greater in the supplemented group (+0.25 kg/months, 95% confidence interval (CI): -0.07, +0.57). Supplemented infants were breastfed for significantly longer durations than controls (medians: 24.9 and 23.7 months, respectively, P: 0.034). Their adjusted hazard ratio (HR) for breastfeeding cessation was 0.59 (95% CI: 0.40, 0.89). Their mothers had a lower risk of a new birth than mothers of controls (adjusted HR: 0.57, 95% CI: 0.36, 0.92). CONCLUSIONS: Early short-term infant supplementation tended to decrease maternal postpartum weight loss, but it increased, rather than shortened, the duration of breastfeeding and birth interval. SPONSORSHIP: This study was supported by a grant from the French Ministry of Research (Grant 92L0623).     

Prevalent vitamin B-12 deficiency in twelve-month-old Guatemalan infants is predicted by maternal B-12 deficiency and infant diet

Approximately one-third of low-income women and children studied in Guatemala are reported to have deficient (<148 pmol/L) or marginal (148-220 pmol/L) plasma vitamin B-12 concentrations. Because vitamin B-12 deficiency can adversely affect infant development and cognitive function, the present study examined predictors of deficient plasma vitamin B-12 concentrations at the age of 12 mo. Analyses were performed on baseline data from a randomized clinical trial in 304 Guatemalan infants, 80% of whom were partially breast-fed, and their mothers. Exclusion criteria for infants included twins, severe stunting or moderate wasting, reported major health problems, severe developmental delay, hemoglobin <95 g/L, maternal age <17 y, and maternal pregnancy >3 mo. Data collected included socio-economic status, infant anthropometry, vitamin B-12 intake from complementary foods, and breast-feeding frequency reported by mothers. A complete blood count and plasma vitamin B-12, folate, ferritin, and C-reactive protein were measured. Deficient or marginal plasma vitamin B-12 concentrations were found in 49% of infants and 68% of mothers. The mean intake of maternal vitamin B-12 was 3.1 microg/d, and infants consumed 2.2 microg/d from complementary foods. In linear regression analysis, infant plasma B-12 concentration was strongly and positively associated with maternal plasma vitamin B-12 and B-12 intake from complementary foods (predominantly powdered cow's milk), and inversely associated with frequency of breast-feeding and larger household size (P < 0.0001). Vitamin B-12 supplementation of lactating women, food fortification, and education to improve infant's vitamin B-12 status are potential interventions that can improve the vitamin B-12 status of mothers and infants in this population.     

The reasons for early weaning among mothers in Teheran.

In order to identify the reasons for early weaning in Teheran, we interviewed 900 mothers using a systematic randomized sampling method. A total of 15% of the mothers were illiterate, 93% were housewives, and 97% had given birth in hospitals. Only 3% of the newborns benefited from rooming-in facilities in hospital, and 68% were bottle-fed while still in hospital. In 3.1% of cases the mother had not breast-fed her newborn at all. Of those who had breast-fed their infant, 38% used only their own milk, whereas 62% used a combination of breast milk and infant formula. The median duration of breast-feeding was 16 months (mean, 14 months). A total of 74% of mothers who used supplementary formula and 39% of those who had completely stopped breast-feeding blamed milk insufficiency, although 67% of these mothers had reached this conclusion only because their infants cried or were irritable. The following factors had a negative influence on the duration of breast-feeding: use of supplementary formula and of estrogen-containing oral contraceptives; fathers with high incomes; and mothers with a high educational level. In contrast, the mother''s religious motive to breast-feed and her insistence on breast-feeding had a positive impact. Unfortunately, 21% of the mothers started using supplementary formula during the first month postpartum, and two-thirds before the end of the fourth month. Every month that bottle-feeding was started prematurely shortened the duration of breast-feeding by 20 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Household food security is associated with infant feeding practices in rural Bangladesh

Although household food security (HHFS) has been shown to affect diet, nutrition, and health of adults and also learning in children, no study has examined associations with infant feeding practices (IFP). We studied 1343 infants born between May 2002 and December 2003 in the Maternal and Infant Nutrition Intervention in Matlab study to investigate the effect of HHFS on IFP in rural Bangladesh. We measured HHFS using a previously developed 11-item scale. Cumulative and current infant feeding scales were created from monthly infant feeding data for the age groups of 1-3, 1-6, 1-9, and 1-12 mo based on comparison to infant feeding recommendations. We used lagged, dynamic, and difference longitudinal regression models adjusting for various infant and maternal variables to examine the association between HHFS and changes in IFP, and Cox proportional hazards models to examine the influence of HHFS on the duration of breast-feeding and the time of introduction of complementary foods. Better HHFS status was associated with poor IFP during 3-6 mo but was associated with better IFP during 6-9 and 9-12 mo of age. Although better HHFS was not associated with the time of introduction of complementary foods, it was associated with the type of complementary foods given to the infants. Intervention programs to support proper IFP should target mothers in food-secure households when their babies are 3-6 mo old and also mothers in food-insecure households during the 2nd half of infancy. Our results provide strong evidence that HHFS influences IFP in rural Bangladesh.     

Do early infant feeding patterns relate to breast-feeding continuation and weight gain? Data from a longitudinal cohort study

OBJECTIVES: To describe the first-week feeding patterns for breast- vs bottle-fed babies, and their association with sustained breast-feeding and infant weight gain at 6 weeks. DESIGN: A longitudinal cohort study. SETTING: Feeding diaries were completed by mothers in an urban UK community shortly after birth; follow-up weight and feeding data were collected at routine health checks. SUBJECTS: Mothers of 923 full-term infants born during the recruiting period agreed to join the study. In all, 502 usable diaries were returned from 54% of the cohort. RESULTS: Breast-fed infants were fed more frequently (2.71 h between feeds) than bottle-fed infants (3.25 h between feeds) and mixed-fed infants (3.14 h between feeds) (P<0.001) in the first week of life, while duration of feeds was similar. Only exclusive breast-feeding in the first week (P<0.001) and maternal education (P=0.004) were related to continued breast-feeding at 6 weeks. Greater first-week feeding frequency (as measured by feed-to-feed interval, h) was associated with higher weight gain at 6 weeks for breast-feeders, but no analysed factors were associated with higher weight gain for bottle-feeders. CONCLUSIONS: This large-scale study of first-week feeding patterns sheds light on the important and complicated issues of breast-feeding continuation and infant weight gain, with implications for the feeding advice given to mothers. Supplementary bottle feeds were clearly associated with discontinued breast-feeding at 6 weeks. Over that period, higher weight gain was associated with more frequent feeding for breast-fed infants only. SPONSORSHIP: Henry Smith Charity, SPARKS, Child Growth Foundation.     

Cesarean section and breastfeeding outcomes in an Indigenous Qom community with high breastfeeding support

Background and objectivesCesarean section may lead to suboptimal breastfeeding outcomes, though evidence has been mixed. Factors, such as premature birth, birth weight and maternal age may independently increase risk of cesarean and hinder breastfeeding initiation, while maternal preferences, support and sociostructural barriers may influence breastfeeding practices beyond the immediate postpartum period.MethodologyWe assessed impacts of cesarean section and gestational factors on breastfeeding duration among Indigenous Qom mothers in Argentina who have strong traditional breastfeeding support. We modeled transitions from exclusive breastfeeding to complementary feeding and from complementary feeding to full weaning in a Bayesian time-to-event framework with birth mode and gestational covariates (n = 89 infants).ResultsEstimated median time to full weaning was 30 months. Cesarean-delivered babies were weaned an average of 5 months later adjusting for gestational age, maternal parity and infant sex. No factors were associated with time-to-complementary feeding, and time-to-complementary feeding was not associated with time-to-full weaning.Conclusions and implicationsAmong Indigenous Qom mothers in Argentina, cesarean section was not associated with suboptimal breastfeeding outcomes. Although some Qom mothers do experience early breastfeeding problems, particularly following first birth, problems are not more frequent following cesarean delivery. Traditional postpartum kin and community support during prolonged postpartum periods may be instrumental in helping mothers to overcome early breastfeeding problems due to cesarean or other risk factors.     

Infant feeding practices of Anglo American and Asian Indian American mothers.

OBJECTIVE: To compare infant feeding practices of Anglo-American (AA) (n = 25) and Asian-Indian American (AIA) mothers (n = 25) residing in the southeastern United States. METHODS: Feeding practices (breast-feeding, formula-feeding, introduction of solid foods) were assessed at infant ages one, three, six, nine and twelve months for a total of 250 interviews conducted in the home. Mothers' sources of information about infant feeding practices and dietary intakes of their infants were collected (24-hour recalls). RESULTS: Compared to their AIA counterparts, AA mothers breast-fed for significantly longer durations and introduced formula and solid foods into the infants' diet at a later age (p<0.05). Throughout the first year, AA mothers relied primarily upon health professionals for infant feeding information compared to AIA mothers, who sought information primarily from the family network during the first six months and relied more on health professionals during the second six months of the infant's life. Throughout the first twelve months, infants of both groups exceeded 100% of the RDA for energy, protein, calcium, iron, vitamin A, and vitamin C. CONCLUSION: Health professionals, including nutrition educators, should educate AIA mothers about and encourage AA mothers to follow current feeding recommendations and guidelines about breast-feeding, formula-feeding and introducing solid foods.     

Feeding practices and growth of infants from birth to 12 months in the central region of the Limpopo Province of South Africa

OBJECTIVE: We evaluated feeding practices and growth patterns of infants in the central region of the Limpopo Province over the first 12 mo of life. METHODS: A follow-up study on a cohort of term infants born to 276 mothers recruited during their third trimester of pregnancy was undertaken. The mothers were recruited by the nursing staff at nine randomly selected clinics. From this sample, 219 women gave birth at the local hospital and the infants were followed from birth to 12 mo. Data collected included infant feeding practices and anthropometry at regular intervals (1, 3, 6, 9 and 12 mo). The anthropometric measurements taken were body weight, length, and head circumference. RESULTS: At birth 8.8% of infants had a low birth weight, 9.6% were stunted, 48.9% were underweight, and 7.3% were wasted. Mothers in this study breastfed their infants for long periods with more than 80% still breastfeeding by the ninth month. However, exclusive breastfeeding during the first 3 mo was uncommon as mothers tended to introduce supplementary feeds at an early age, with 56% of the infants receiving some form of supplement by the end of the first month. The most common supplementary foods were maize meal porridge and mabella (sorghum). Stunting became increasingly apparent in the early months with 30% of infants being stunted (<-2 standard deviations [SD] of the National Center for Health Statistics [NCHS] reference curves) by the first month, and this percentage remained high for the 12-mo period, remaining at below - 1 SD NCHS height-for-age standard. Increased weight gain was seen during the first 3 mo and then declined until mean weight-for-age at 12 mo was below 0 SD NCHS. Twelve percent of infants were overweight (>2 SD NCHS) by the 12th month. Postnatally the infants showed a pattern of gradual stunting. Postnatal factors associated with this pattern were related to maternal socioeconomic status, and these included the mother's level of education, employment status, parity, and access to electricity. CONCLUSION: There was a high frequency of underweight infants at birth but stunting was less common. With respect to feeding practices, the mothers tended to introduce supplementary feeds at an early age.     

A longitudinal study of breastfeeding and weaning practices during the first year of life in Dunedin,New Zealand

OBJECTIVE: To investigate infant feeding practices during the first year of life in a group of white infants in Dunedin, New Zealand. DESIGN: Prospective study of infants from birth to 12 months of age. PARTICIPANTS: A self-selected sample of 74 white mothers and their infants born in Dunedin, New Zealand, between October 1995 and May 1996. Statistical analyses Regression analyses were performed to determine factors associated with successful breastfeeding initiation and duration. RESULTS: Among mothers, 88% (n=65) initiated breastfeeding, 42% (n=31) were exclusively breastfeeding at 3 months, and 34% (n=25) were partially breastfeeding at 12 months. Intention to breastfeed increased the likelihood of successful breastfeeding initiation. Mothers who reported that they did not have enough breastmilk tended to exclusively breastfeed for a shorter period of time. Tertiary education and exclusively breastfeeding at 1 month were associated with a longer duration of breastfeeding. Perception of breastfeeding in public as embarrassing was associated with a shorter duration of breastfeeding. Among infants, 45% (n=33) were given nonmilk foods before 4 months of age, and 69% (n=51) were given unmodified cow's milk as a beverage before 12 months. APPLICATIONS: Breastfeeding rates in this study, although higher than in many Western countries, were still lower than current recommendations. Our findings suggest that women should be taught how to increase their breastmilk supply. Parents should also be informed of the importance of delaying the introduction of nonmilk foods until their infant is 4 to 6 months of age and cow's milk until they are 12 months of age. Society also needs to address the social issue of embarrassment many mothers feel when breastfeeding in public.     

Historical review of the changing pattern of infant feeding in developing countries: The case of Malaysia, the Caribbean, Nigeria and Zaire

Prolonged lactation and early supplementation have been traditional practices among low-income mothers in Malaysia, the Caribbean, Nigeria and Zaire. Early supplementation is still the norm but there have been some substantial changes in the types of supplement offered. Thus, except in Zaire, there is now widespread use of processed milks as supplements for very young infants. The use of processed milks began in the 1920s in Malaysia and the Caribbean, but not until the 1960s in Nigeria. Processed milks are, as yet, rarely used in Zaire. The use of processed milks has not, however, led to the abandonment of traditional paps. The latter are still given as supplements to young infants in Nigeria and to older infants in Malaysia and the Caribbean. Breast-feeding duration has declined in Malaysia and the Caribbean although initiation is almost universal. In Nigeria and Zaire most low-income mothers continue to breast-feed for at least 12 months. The changes in the types of supplements used and in breast-feeding duration are analogous to the changes observed in industrialised countries from the mid-19th century, and many of the associated factors are similar: urbanisation; female participation in the labour force; increased availability of processed milks and their promotion both by companies and the health sector; and the regimentation of breast-feeding. This review highlights the negative role played by the health sector in the past, and discusses its future role in promoting and supporting breast-feeding.