Patterns of infant feeding in the first six months

A quasi-experimental six months longitudinal study of women planning to breastfeed was carried out in Vancouver, B.C., Canada. The purpose was to increase breastfeeding duration through the provision of nursing support, and information about breastfeeding. This paper reports on the patterns of infant feeding by 131 mothers for six months postpartum. Included are data on initiation of breastfeeding, feeding intervals, supplementation, initiating semi-solids and duration of breastfeeding. Unsupplemented breastfeeding declined from 90.8% at the time of discharge from hospital to 65% at one month, 45% at three months and 3.9% at six months. For some infants, semi-solids were introduced at one month and by three months 11.4% were being fed semi-solids. The implications for health care professionals caring for breastfeeding women are outlined.     

婴儿早期不同喂养方式对体格生长的影响

目的：探讨不同喂养方式对婴儿体格生长的影响。方法选择出生、42 d、9个月时有完整的体重、身长数据,且生后～9个月喂养方式单一的婴儿304例,随访到18个月时有243例婴儿。按喂养方式分为母乳喂养、混合喂养和配方奶喂养组。计算18个月婴儿BMI对年龄Z评分（BAZ）并绘图。对不同喂养组的身长、体重及其增长量,BAZ分布进行比较。结果3组出生时体重、身长差异无统计学意义。42 d 时母乳喂养组体重[（5.0±0.5）kg]高于配方奶喂养组[（4.9±0.6）kg];出生～42 d母乳喂养组体重增长量[（1.7±0.4）kg]高于混合喂养组[（1.5±0.4）kg]和配方奶喂养组[（1.4±0.4）kg];42 d～9个月母乳喂养组体重增长量[（4.5±1.0）kg]低于混合喂养组[（4.8±0.8）kg]和配方奶喂养组[（5.1±1.1）kg];18个月时配方奶喂养组体重[（12.1±1.5）kg]高于母乳喂养组[（11.2±1.4）kg];9～18个月配方奶喂养组体重增长量[（2.3±0.8）kg]高于母乳喂养组[（1.8±0.7）kg]和混合喂养组[（1.9±0.5）kg];42 d～9个月配方奶喂养组身长增长量[（17.1±2.0）cm]高于母乳喂养组[（16.1±1.9）cm];18个月时配方奶喂养组身长[（83.1±3.7）cm]大于母乳喂养组[（81.5±2.9）cm];差异均有统计学意义。18月时配方奶喂养婴儿中超重（即Z评分大于2）的比例最高,为11.11％。结论3种喂养方式婴儿体重增长模式不同。早期母乳喂养的婴儿体重增长较快,配方奶喂养后期体重增长较快。不同喂养方式对婴儿早期的身长增长无影响,配方奶喂养的婴儿后期身长增长较快。配方奶喂养的婴儿18个月超重的比例最高。     

Nutrient intake in the United States during the first 12 months of life

Nutrient intakes of 463 infants ranging in age from 1 week to 12 months from the Nationwide Food Consumption Survey 1977-78 were evaluated according to different foods (milk and milk products, noniron-fortified formula, iron-fortified formula, infant cereal, commercial baby foods, and table foods). Breast-fed infants and infants fed a combination of cow's milk and formula were excluded. Results indicated that iron was the nutrient most often consumed in amounts less than the RDA. Infants fed a diet that included either cow's milk or noniron-fortified formula had a median iron intake less than the recommended allowance. In comparison, infants who were fed an iron-fortified formula had a median iron intake well above the RDA. The relative proportion of iron derived from different foods is discussed.     

北京市流动人口婴儿喂养现况调查

【目的】了解流动人口婴儿喂养现状及婴儿喂养过程中存在的问题,并分析产生问题的原因。【方法】对152名6~12个月龄流动儿童的母亲进行问卷调查。【结果】流动儿童母亲喂养知识缺乏较严重;婴儿喂养中存在问题较多,如母乳开奶时间晚,换乳期食物品种少、频率不足、零食和饮料过多,喂养行为存在许多问题。婴儿父母文化程度和来京时间、婴儿胎次、家庭收入对婴儿喂养现况产生影响。【结论】流动儿童母亲喂养知识缺乏,导致婴儿喂养现况存在诸多不合理现象。     

Effect of probiotic supplementation in the first 6 months of life on specific antibody responses to infant Hepatitis B vaccination

Probiotics have been shown to enhance specific immune responses to vaccines. We aim to assess the effect of probiotic supplementation on specific IgG antibody responses to Hepatitis B (HepB) vaccination in infants. Compared to controls, probiotic supplementation improved HepB surface antibody responses in subjects receiving monovalent doses of HepB vaccine at 0, 1 month and a DTPa–HepB combination vaccine at 6 months [placebo (n = 28): 187.97 (180.70–195.24), probiotic (n = 29): 345.70 (339.41–351.99) mIU/ml] (p = 0.069), but not those who received 3 monovalent doses [placebo (n = 68): 302.34 (296.31–308.37), probiotic (n = 77): 302.06 (296.31–307.81) mIU/ml] (p = 0.996). Probiotics may enhance specific antibody responses in infants receiving certain Hepatitis B vaccine schedules.     

Nurses' knowledge of current guidelines for infant feeding and weaning

Background Poor infant feeding practices are common causes of nonorganic failure to thrive and may exacerbate the effects of many chronic conditions. It is important therefore that parents receive correct and consistent feeding advice from health professionals. The aim of this study was to determine whether hospital paediatric nursing staff are familiar with the recommendations of the Department of Health (DOH) Weaning Report ( DOH, 1994 ). Methods A total of 127 members of nursing staff (79%) at Derbyshire Children's Hospital were interviewed. Knowledge of recommended practices for the introduction and use of cow's milk, gluten, milk products, mashed foods, vitamin supplements and drinks was assessed. Results Overall, 42 people (33%) answered all questions correctly. In each clinical area, six outpatient (64%), 19 special care baby unit (61%) and 17 ward (20%) staff provided correct answers to all questions. No significant difference was found between staff at each grade in the number of questions answered correctly. Conclusions Knowledge of national infant feeding and weaning guidelines was limited suggesting that DOH recommendations are not widely understood or recognized. Further nutrition education and local dissemination of information is required if nurses are to continue to advise parents on aspects of infant feeding.     

Recommended zinc intake for the first six months of life

This paper suggests that recommended zinc intake for the 0–6 months age group is grossly overestimated and impossible to achieve by wholly breast-fed infants. This discrepancy may be explained by the high zinc concentrations in human milk considered by the National Research Council to establish the present RDA. An alternative approach based on absorbed amounts of zinc required is proposed. This method appears to be closer to the real needs of young infants; thus, for the first three months, 0.64 mg/day and for the second three months, 0.90 mg/day would be required to meet the proposed absorbed zinc needs.     

Breast feeding and jaundice in the first week of life

Infants who most commonly receive treatment for neonatal hyperbilirubinemia are breast-fed babies in whom no cause for the jaundice can be determined. Hyperbilirubinemia in these newborns may not be caused by the breast feeding as such, but rather by inadequate nursing. This paper reports attempts to decrease readmissions for phototherapy at the UCLA Medical Center by inducing earlier and more functional lactation in the entire nursery population and by formula feeding infants whose bilirubins approached recommended treatment levels. Nursing was interrupted for 24 to 48 hours in 87 newborns; six still required readmission, while 81 were successfully treated at home. At the two-week well-baby visit, no differences in the incidence of breast feeding were found when comparing nonjaundiced breast-fed babies with infants who were taken off the breast or who were readmitted for phototherapy. Differences in the cost of care were significant with an average cost per patient of $126 for those treated at home compared with $1,440 for those readmitted. Policies designed to induce earlier lactation did nothing to decrease the incidence of exaggerated jaundice in the study's breast-fed population. It was concluded that supervised setting with careful counseling and follow-up, can provide an effective alternative to readmission and phototherapy in the treatment of jaundice.     

Breast feeding, pacifier use and infant development at 12 months of age: a birth cohort study in Brazil

Many studies suggest that breast feeding confers developmental and intellectual advantages on children. In a recent study, however, no association was found between breast feeding and intelligence in adult life after adjustment for other variables, and the use of pacifier in infancy was the most important predictor of intelligence. We analysed the associations between breast-feeding duration, pacifier use and suspected developmental delay at 12 months of age in a birth cohort in Pelotas, southern Brazil. All 5304 hospital births occurring during 1993 were studied and a sample was followed up at 1, 3, 6 and 12 months of age. Breast-feeding practices and use of pacifiers were assessed at each visit, as well as suspected developmental delay, measured by the Denver II test. The prevalence of developmental delay was analysed, through logistic regression, according to breast-feeding status and pacifier use, accounting for the possible confounding effect of other variables. The prevalence of suspected developmental delay at 12 months was 34.1%, being slightly higher among children who used pacifiers at 6 months than among non-users (35.3% and 28.7% respectively). There was a marked negative association between breast-feeding duration and developmental delay, with children breast fed for 9 months or more presenting significantly less suspected developmental delay (25.5%) than those breast fed for less than 1 month (42.4%). The effects of multiple variables were tested, and only high parity, smoking during pregnancy, birthweight, gestational age, pacifier use and breast-feeding duration remained significantly associated with suspected developmental delay. The effect of pacifier use, however, disappeared after adjusting for breast-feeding duration, suggesting that breast feeding, and not pacifiers, affects child development.     

A telepsychiatry transition clinic: the first 12 months experience

To improve the management of soldiers with combat-related mental health problems, an interdisciplinary telepsychiatry service was established between a clinic at the Fort Bragg army base and the Veterans Affairs (VA) Medical Center in Salem. In the first 12 months of operation, 120 soldiers (105 males) were seen in a total of 394 telepsychiatry sessions. The time spent on telepsychiatry by the six VA psychiatrists increased from 13 hours in the first month to 41 hours in the twelfth month. The number of telepsychiatry sessions increased from nine in the first month to 56 in the twelfth month. The mean global assessment of function score (GAF) in the soldiers increased significantly (P < 0.001) from 58.0 at intake to 62.3 at the last visit. Soldiers received VA telepsychiatry on average 22 days after the initial consultation with a primary care provider, a reduction of at least eight days compared to the previous delay. The majority of soldiers (89%) who were treated by VA psychiatrists enrolled in the VA within about six months of discharge. Similar VA-US Military collaborations may prove beneficial for other military bases that have returning combat soldiers.     

Body mass index and duration of breast feeding: a survival analysis during the first six months of life.

STUDY OBJECTIVE--The aim was to determine whether excess weight in lactating women is associated with earlier cessation of breastfeeding. DESIGN--The study was to prospective cohort analysis using a community sample of women. SETTING--Geelong the regional centre of the Barwon Region of Victoria, Australia, in 1984-85. SUBJECTS--All women who were breast feeding and whose first infant was born between 1 May 1984 and 30 April 1985 were asked to participate. Of these, 739 women participated, a response rate of 81%. MAIN RESULTS--Smoking, mother's age and occupation, the time the infant was first put to the breast, and mother's body mass index at one month postpartum all exerted statistically significant independent effects on the duration of breast feeding, assessed using Cox's proportional hazards regression modelling. The strongest effects were for smoking, with an adjusted relative risk for cessation of breast feeding of 2.5 (95% CI 1.9 to 3.1) for 10 cigarettes per day v no smoking, and maternal age, with relative risk of 2.2 (95% CI 1.5 to 3.1) for a 20 year old mother relative to a 30 year old. The relative risk for women with a body mass index above 26 was 1.5 (95% CI 1.1 to 2.0). CONCLUSIONS--Excess weight at one month postpartum, as determined by a body mass index above the normal range, was found to be an independent risk factor for early cessation of breast feeding and together with smoking, maternal age, occupation, and the time the infant is first put to the breast can be used to identify, early in the postpartum period, those women most likely to benefit from counselling in order to breast feed their infants successfully.     

北京市4～12月龄婴儿辅食添加喂养行为评估

目的 调查了解2009年北京市4～12月龄婴儿喂养现状,为婴儿营养干预提供科学依据.方法 采用分层整群抽样的方法,在城区和郊区分别抽取431名和469名4～12月龄婴儿为调查对象,通过问卷收集婴儿的基本情况、辅食添加等情况进行统计分析.结果 北京市城区婴儿辅食添加率为94.9％,郊区为92.1％,且随着年龄的增加辅食添加率也增加.除了奶类外,10％左右的婴儿在4月龄前就开始添加辅食,5％左右的婴儿在8个月后才开始添加辅食.与《中国孕期、哺乳期妇女及0～6岁儿童膳食指南》相比,各年龄段婴儿辅食添加量的达标率不高,其中水果的达标率较高,分别为37.3％、60.6％和67.2％.达标率相对较低的是肉类和蛋类.结论 目前,北京市婴儿的喂养还存在一定问题,需要进一步改善.     

Intestinal flora during the first months of life: new perspectives

Increasing awareness that the human intestinal flora is a major factor in health and disease has led to different strategies to manipulate the flora to promote health. The complex microflora of the adult is difficult to change in the long term. There is greater impact of diet on the infant microflora. Manipulation of the flora particularly with probiotics has shown promising results in the prevention and treatment of diarrhoea and allergy. Before attempting to change the flora of the infant population in general, a greater understanding of the gut bacterial colonisation process is required. The critical stages of gut colonisation are after birth and during weaning. Lactic acid bacteria dominate the flora of the breast-fed infant. The formula-fed infant has a more diverse flora. The faeces of the breast-fed infant contain mainly acetic and lactic acid whereas the formula fed-infant has mainly acetic and propionic acid. Butyric acid is not a significant component in either group. The formula-fed infant also has higher faecal ammonia and other potentially harmful bacterial products. The composition of the microflora diversifies shortly before and particularly after weaning. The flora of the formula-fed infant develops more quickly than that of the breast-fed infant. Before embarking on any strategy to change the flora, the following questions should be considered: Should we retain a breast-fed style flora with limited ability to ferment complex carbohydrates? Can pro- and prebiotics achieve a flora with adult characteristics but with more lactic acid bacteria in weaned infants? Are there any health risks associated with such manipulations of the flora?