Socio-cultural factors affecting breast feeding and other infant feeding practices in an urban community.

A study of infant feeding practices was carried out as part of a larger longitudinal study of an urban birth cohort in an area of South Delhi, India. 802 mothers of children over 1 year of age were selected randomly for interview. The study group is considered to be a representative sampling of the economic, cultural, and ethnic groups within the population of all of Delhi. Breast feeding was almost universal but for varying durations. 5.5%, 11.7%, and 22.8% of the children were breast fed for less than 1 month, 2 months, and 6 months respectively. Literate and older mothers tended to breast feed for shorter periods of time. Illiterate mothers, on the other hand, tended to prolong breast feeding unduly. The sex of the infant and the duration of the urban stay of the mother did not seem to affect the duration of breast feeding. Supplementation with liquid feeds, 50% diluted buffalo milk in the majority of cases, was begun rather early but the introduction of semisolids and solids was very often unduly delayed. This was particularly true among illiterate mothers. Thus, it is felt that a concerted effort to educate mothers, especially illiterate and underprivileged mothers, regarding the role of breast feeding and the benefits of supplementation feeding would improve infant nutritional status.     

Ear infection and infant feeding practices

Feeding practices were studied in 128 infants aged 18 months and below with middle ear infection, belonging to the low socio-economic group. By the age of one year, 117 (91.4%) had acquired the infection. At the onset of the first episode, 105 (82.0%) were breast-fed, 42 not receiving any other milk. There were no differences in the feeding practices between infants who had single and those who had multiple episodes. Ninety-six infants were being given water by spoon or bottle and 42, semisolids by spoon. Among the 105 breast-fed infants, in 93 (88.6%), the infants’ heads were often flat during feeding. In contrast, in the 86 infants on ‘top’ feeds 53 (61.6%) of the mothers said that they kept the infants’ head raised during feeding. The difference was significant (x² = 53.18, P < 0.001). Mothers should avoid feeding infants with the latter’s head flat, although the former may adopt any comfortable position.     

Prelacteal infant feeding practices in rural Egypt.

Data collected during a prospective cohort study of infant feeding and health in rural Bilbeis, Egypt, were analysed to define prelacteal infant feeding practices, identify their determinants, and assess whether these practices were predictive of breastfeeding and supplementation patterns and diarrhoea incidence during infancy. Sixty per cent (89/149) of study infants were prelacteally fed sugar-water, teas, or both. Lack of milk in the mother's breast (74 per cent), and maternal exhaustion or illness following labour (29 per cent) were the two most commonly stated reasons for prelacteal feeding. After multivariate adjustment, significantly higher incidence of prelacteal feeding was associated with childbirth during the warmer months [odds ratio (OR): 2.4; 95 per cent confidence interval (CI): 1.1-5.1], birth attendants with modern training (OR: 5.5; 95 per cent CI: 1.7-17.5), and labour lasting > 8 hours (OR: 2.3; 95 per cent CI: 0.1-4.9). Prelacteally fed infants were significantly less likely to be exclusively breastfed in age periods 0-3, 4-7, and 8-11 weeks. Diarrhoea incidence was higher among prelacteally fed infants in age periods 0-11, 12-23, and 36-47 weeks. Indiscriminate practice of prelacteal feeding and early supplementation of breastfeeding need to be discouraged.     

Prenatal office practices regarding infant feeding choices

The objective of this study was to determine the obstetric care providers' roles in breast-feeding promotion during prenatal care. A questionnaire addressing breast-feeding issues was sent to family practitioners (FP), obstetric-gynecologists (OB/GYN), and nurse midwives (NM) in Iowa, USA. All NM, 97% of FP, and 85% of OB/GYN reported asking infant feeding preference-usually only at the first prenatal visit. NM (73%) were most likely to provide extensive breast-feeding counseling. OB/GYN (68%) and FP physicians (90%) reported doing their own breast-feeding counseling. Breast examinations targeting future breast-feeding problems were done in 82% to 84% of patients. NM practices shared more information supportive of breast-feeding. Nearly all providers offered prenatal classes, but only 41% of FP offered breast-feeding classes. Free formula samples were available in 73% of FP, 54% of OB/GYN, and 36% NM offices. Pamphlets on formula feeding and also breast-feeding were readily available. Overall NM (64%) reported being strong breast-feeding advocates compared to only 13% of FP and 7% of OB/GYN. In conclusion, little promotion of breast-feeding occurs in most prenatal practice settings.     

Study of infant feeding practices: factors associated with faulty feeding

KEM Hospital, Mumbai was recognized as a 'baby-friendly' hospital on the basis of adherence to the 'Ten steps to successful breastfeeding', a decade ago. This study was undertaken to determine the sustainability of the programme in terms of feeding practices undertaken by the mothers on the basis of advice given to them. A total of 92.11 per cent of the infants up to 6 months of age received exclusive breastfeeding. Timely complementary feeding rate was 95 per cent. Thus interventions used in the programme seem sustainable.     

Iron status with different infant feeding regimens: relevance to screening and prevention of iron deficiency

The objective of this study was to evaluate the benefit of screening for anemia in infants in relation to their previous diet. The iron status of 854 nine-month-old infants on three different feeding regimens and on a regimen including iron dextran injection was determined by analysis of hemoglobin, serum ferritin, and erythrocyte protoporphyrin levels and of serum transferrin saturation. Infants were categorized as having iron deficiency if two or three of the three biochemical test results were abnormal and as having iron deficiency anemia if, in addition, the hemoglobin level was less than 110 gm/L. The prevalence of iron deficiency was highest in infants fed cow milk formula without added iron (37.5%), intermediate in the group fed human milk (26.5%), much lower in those fed cow milk formula with added iron (8.0%), and virtually absent in those injected with iron dextran (1.3%). The corresponding values for iron deficiency anemia were 20.2%, 14.7%, 0.6%, and 0%, respectively. The use of iron supplements is therefore justified in infants fed cow milk formula without added iron, even when there is no biochemical evidence of iron deficiency. The low prevalence of iron deficiency in the group fed iron-fortified formula appears to make it unnecessary to screen routinely for anemia in such infants. These results also support the recommendation that infants who are exclusively fed human milk for 9 months need an additional source of iron after about 6 months of age.     

Attitudes and practices of family paediatricians in Italy regarding infant feeding

Aim: The aim of this study was to examine attitudes and practices of family paediatricians in Italy towards infant feeding. Methods: A questionnaire was sent to 850 paediatricians across Italy, asking about attitudes and practices towards infant feeding with focus on the World Health Organization’s criteria. Results: The response rate was 91.2%. Breastfeeding is recommended for 6–11 months (70.6%) or longer (29.4%). A 95% of paediatricians recommend introducing complementary foods throughout 4–5.9 months. Among paediatricians who give indications about the minimum acceptable diet (61.7%), recommendations agree with WHO in 71.3% and 83.3% of cases for infants aged 6–8 or 9–11 months, respectively. A 95.6% of paediatricians recommend consumption of meat for infants aged 6 months or more, and 98.4% use of formula milk for infants having breastfeeding stopped in the first year of life. Paediatricians reported own experience (73.4%) and reading (54.2%) as main sources of information. A 70% of paediatricians know the WHO/Infant and Young Child Feeding Practices criteria regarding breastfeeding but <5% the complementary feeding indicators. Conclusion: Family paediatricians in Italy have positive disposition towards infant feeding but their knowledge and practices are suboptimal with respect to the WHO criteria, especially regarding complementary feeding.     

Some infant feeding and rearing practices in a rural community in Pondicherry

The feeding and common childrearing practices in a rural area in Pondicherry, India are reported. The study was conducted in the village of T. Palayam which is located 14 miles away from the town of Pondicherry. A house to house survey was conducted by doctors and field staff. The village of T. Palayam had a total population of 1823 and consisted of 2 main communities--Reddiars and Harijans. The population of Reddiars was in a better socioeconomic position than Harijans. Also, most parents in Reddiars were literate in contrast to Harijans where the majority was illiterate. In both sections the deliveries were at home, most of them being attended by untrained persons. In the majority of the cases, 92.8% of the Harijans and 93.7% of the Reddiars, the 1st feed consisted of water and sugar. In the Harijan community, breastfeeding was continued up to 2-3 years and in a few instances up to 4 years. There was no supplementation with cow's milk. Among the Reddiars, 47% of the babies were receiving artificial milk in the 1st 6 months of life. In 90% of the cases, cow's milk diluted with an equal proportion of water was used. Solids were started only after the age of 2 years by the Harijans. The infants were then offered rice, bread, or other foods depending on what was eaten by the rest of the family. In the Reddiar community, in 73% of the cases, solids were started at the end of the 1st year. The habit of giving oil baths to infants was universally practiced in both of the communities. The earlier cessation of breastfeeding in the Reddiar community had obvious deleterious effects. It is a source of infection, and it can lead to malnutrition because of the low nutritive value of the substitute, namely diluted milk. Another detrimental food fad was the practice of restriction of the diet during illnesses.     

Infant and young child feeding practices and nutritional status in Bhutan

In South Asia, childhood undernutrition persists while overweight is increasing. Internationally recommended infant and young child feeding (IYCF) practices promote healthy nutritional status; however, little is known about IYCF in Bhutan, investigated here using 2015 National Nutrition Survey data. WHO/UNICEF IYCF indicators, anthropometry and household socio‐economic status were available for 441 children <24 months. Stunting, wasting, and underweight prevalence (2) prevalence was 6%. In survey‐design‐adjusted analyses, 52% of mothers of 0‐ to 5‐month olds reported exclusive breastfeeding (EBF), with EBF less common for girls than boys (OR: 0.2 [95% CI: 0.1–0.9]). Although 61% of children were breastfed at 2 years and 75% of children >6 months met a minimum daily meal frequency, only 18% of children 6–23 months met minimum dietary diversity. IYCF was unassociated with risk of stunting, wasting, or underweight, possibly due to relatively low prevalence of anthropometric failure and small sample size. However, currently‐breastfed children were less often overweight [OR: ~0.1 (95% upper limit ≤1.0)]. Neither breastfeeding nor most complementary feeding practices differed by socio‐economic status, but children in the highest two fifth of a wealth index had 7.8 (1.3–46.9) and 5.3 (1.1–25.2) times greater odds than children in the lowest fifth of meeting minimum dietary diversity criteria. Low rates of EBF, given possible protection of breastfeeding against overweight, and inadequate dietary diversity offer evidence to guide future program interventions to improve nutritional status of young children.     

Effect of nutrition education of mothers on infant feeding practices

Objective : To assess current infant feeding practices (IFP) in a relocated slum, to identity the lacunae, to outline, implement, and evaluate the gain in awareness and IFP followed by mothers.Methods. Thirty–five mothers of infants aged 5–19 months were interviewed. Based on lacunae, Nutrition Education (NE) was imparted to mothers over two months. Tools used were individual counseling, participatory learning methods, positive deviance and early adopters approach aided with existing information education communication materials. Monthly weight and length of infants was also taken. Awareness and practices on infant feeding (IF) were reviewed at mid and post NE.Results. Areas of concern at baseline were (i) discarding colostrum (77.0%), (ii) feeding prelacteals (80.0%), (iii) initiation of breast-feeding (BF) after 3 days (54.3%), (iv) absence of exclusive breast-feeding (86.3%), (v) delayed complementary feeding (CF) and (vi) feeding CF grossly inadequate in quality, quantity, frequency and consistency. Post NE results revealed an improved awareness about IF amongst the mothers. An improvement was seen in variety, quantity and consistency of CF fed. Active feeding behaviours were adopted (6.6% pre-NE vs 66.6% post-NE). Early adopters (24%) served as motivators. Weight for age and weight for length showed improvement.Conclusion : NE programs of shorter duration using a ‘communication mix’ of channels with repeated reinforcement can bring about improvement not only in awareness but also in IFP.