Breast-feeding, Bottle-feeding and Related Factors

ABSTRACT. Infant feeding practices and related factors were studied in a survey of 189 mothers of 4-month-old infants in 1980 and of 151 mothers of 6-month-old infants in 1982. In both groups about 70 % of the mothers commenced with breast-feeding. In 1980, 21 % of the infants were still being breast-fed at the age of 4 months, compared with 32 % in 1982. 26 % of the infants were still being breast-fed at the age of 6 months. The most frequently mentioned reason for not commencing with or discontinuing breast-feeding was 'insufficient milk'. Univariate analyses showed that the educational level of the mother and her smoking habits were significantly related to both the commencement and the duration of breast-feeding in 1980 and 1982. These results were confirmed by multivariate analyses which suggest that well educated, non-smoking mothers are the most successful in breast-feeding their infants.     

Breast-feeding influences thymic size in late infancy

We have previously shown that breast-fed infants have a considerably larger thymus at 4 months than formula-fed infants. The aim of the present study was to investigate whether breast-feeding also influences the thymic size in late infancy. In a cohort of 50 infants, all being partially breast-fed when recruited at 8 months, ultrasound assessment of the thymic index (a volume estimate) was performed at both 8 and 10 months of age. At 10 months the thymic index was significantly higher in those still being breast-fed compared to infants who had stopped breast-feeding between 8 and 10 months of age (P=0.05). This difference became more significant when controlled for the influence of infectious diseases (P=0.03). In infants still breast-fed at 10 months there was a significant correlation between the number of breast-feeds per day and their thymic index (P=0.01). Conclusion The effect of breast-feeding on thymus size is likely to be caused by immune modulating factors in breast milk. Breast milk influences thymic size in late infancy. Received: 20 October 1998 / Accepted: 21 May 1999     

Breast-feeding, gastrointestinal and lower respiratory illness in the first two years

ABSTRACT. The relationships between breast-feeding practices and the rates of gastro-intestinal and lower respiratory illness during the first two years of life were examined for a birth cohort of New Zealand infants. During the first four months, there were significant tendencies for rates of gastro-intestinal illness to decrease with increasing duration of breast feeding. These trends remained significant when the effects of a number of social and familial factors were taken into account. There was no association between duration of breast-feeding and rates of gastro-intestinal illness beyond four months. Prolonged breast-feeding was associated with significantly lower rates of lower respiratory illness during both the first and second years. However, when the effects of social and familial factors were taken into account the apparent associations between duration of breast-feeding and rates of lower respiratory illness became non-significant. The implications of these findings are discussed.     

SUDDEN INFANT DEATH IN COPENHAGEN 1956–1971 II. Social Factors and Morbidity

Abstract. Biering-Sørensen, F., Jørgensen, T. and Hilden, J. (Municipal Agency of Infant Health Visitors, Copenhagen, and Institute of Human Genetics, University of Copenhagen, Copenhagen, Denmark). Sudden infant death in Copenhagen 1956–71. II. Social factors and morbidity. Acta Paediatr Scand, 68: 1, 1979.—131 cases of the Sudden Infant Death Syndrome (SIDS) among infants born in the Municipality of Copenhagen during 1956-71 were analysed on the basis of data collected prospectively by the infant health visitors and abstracted from police reports. Compared with controls, a significantly larger number of SIDS infants had been born out of wedlock, were living only with their mother, had parents in a less secure occupation, lived in more crowded, poor-quality dwellings and districts. The "home standard" was lower among the SIDS families, including a lower standard of infant care, a higher percentage of not keeping the appointments with the infant health visitors, and a lower mental capacity in the mothers; there was no difference with respect to the mother's physical capacity. More congenital malformations and more cases of asphyxia were found among the SIDS infants, and a significantly larger number of the SIDS infants had been admitted to hospital, with a tendency to being kept there longer. It is concluded that a relationship exists between poor social conditions, increased morbidity, and SIDS. At the same time, it is pointed out that during recent years the differences between cases and controls as regards certain of the social parameters studied have decreased.     

Social and economic factors influencing intrahousehold food allocation and egg consumption of children in Kaduna State,Nigeria

Adequate intake of high‐quality nutritious foods during infancy and early childhood is critical to achieving optimal growth, cognitive and behavioural development, and economic productivity later in life. Integrating high‐quality and nutrient‐dense animal source foods (ASFs), a major source of protein and micronutrients, into children''s diets is increasingly considered essential to reducing the global burden of malnutrition in low‐ and middle‐income countries. While eggs are an ASF that shows promise for mitigating child undernutrition, interventions promoting egg consumption among children have had mixed results in improving egg intake and child growth outcomes. As part of an evaluation of a demand creation campaign promoting egg consumption, qualitative research was carried out in September 2019 to assess sociocultural and household factors affecting egg intake among young children living in Kaduna State, Nigeria, where a thriving egg industry and childhood stunting rates of 50% exist. Methods included freelisting exercises (11), key informant interviews (11), in‐depth interviews (25) and FGDs (4). Results illuminated cultural rules that restrict egg consumption among children living in low‐income households. These rules and norms reflect social and economic valuations that foster male dominance in household decision‐making and guide food purchasing and intrahousehold food allocation that allow men to consume eggs more regularly. Study results highlight sociocultural considerations when selecting food interventions to address child malnutrition in low‐income contexts. Interventions encouraging increased consumption of ASFs, and specifically eggs in young children, should be informed by formative research to understand sociocultural norms and beliefs guiding egg consumption.     

Epidemiological study of constipation and other gastrointestinal symptoms in 8000 children

AIM: Adult studies indicate that gastrointestinal symptoms vary with sex and socioeconomic status. We examined socioeconomic factors, infant sex, smoking and gastrointestinal symptoms, especially constipation, in 2.5 year-old children. METHODS: This study was part of a prospective cohort study of children born 01.10.97-01.10.99 (the ABIS study; All Babies in Southeast Sweden). Socioeconomic factors, infant sex, smoking were analyzed vs. constipation, diarrhoea, anorexia, abdominal pain, meteorism and vomiting using logistic regression. All data were obtained through questionnaires distributed at infant birth, at 1 and 2.5 years of age. RESULTS: Out of 8341 children, 539 (6.5%) suffered from constipation. In a backward stepwise regression analysis (AOR; and 95% CI AOR = are given within brackets), constipation correlated with low maternal education (1.60; 1.08-2.35), female sex (1.52; 1.23-1.85), living in a large community with >3000 inhabitants (1.35; 1.09-1.64) and having no older siblings (1.28; 1.04-1.59). Smoking during pregnancy was linked to diarrhoea (multivariate analysis: 1.76; 1.02-3.02), anorexia (univariate analysis: 1.43; 1.09-1.87) and meteorism (univariate analysis: 1.58; 1.11-2.27). Adjusting for confounders, paracetamol use was linked to a five-fold increased risk of anorexia (5.12; 1.26-20.70). CONCLUSIONS: This study indicates that socioeconomic status, infant sex and parental smoking, are associated with gastrointestinal symptoms in children.     

Understanding the effects of nutrition‐sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutrition in rural Odisha,India: A mixed‐methods process evaluation

A trial of three nutrition‐sensitive agriculture interventions with participatory videos and women''s group meetings in rural Odisha, India, found improvements in maternal and child dietary diversity, limited effects on agricultural production, and no effects on women and children''s nutritional status. Our process evaluation explored fidelity, reach, and mechanisms behind interventions'' effects. We also examined how context affected implementation, mechanisms, and outcomes. We used data from intervention monitoring systems, review notes, trial surveys, 32 case studies with families (n = 91 family members), and 20 group discussions with women''s group members and intervention workers (n = 181 and 32, respectively). We found that interventions were implemented with high fidelity. Groups reached around half of the mothers of children under 2 years. Videos and meetings increased women''s knowledge, motivation and confidence to suggest or make changes to their diets and agricultural production. Families responded in diverse ways. Many adopted or improved rainfed homestead garden cultivation for consumption, which could explain gains in maternal and child dietary diversity seen in the impact evaluation. Cultivation for income was less common. This was often due to small landholdings, poor access to irrigation and decision‐making dominated by men. Interventions helped change norms about heavy work during pregnancy, but young women with little family support still did considerable work. Women''s ability to shape cultivation, income and workload decisions was strongly influenced by support from male relatives. Future nutrition‐sensitive agriculture interventions could include additional flexibility to address families’ land, water, labour and time constraints, as well as actively engage with spouses and in‐laws.     

Infant feeding and early neonatal jaundice

The feeding patterns and third day serum bilirubin levels were evaluated in 30 newborn infants receiving formula feeds in the neonatal special care unit and in 30 breastfed babies. Initiation of milk feeds were delayed in breast-fed babies and the frequency of feeding was significantly lower than in the formula-fed infants. Supplementary water was given only in the breast-fed group. Serum bilirubin levels were significantly higher in breast-fed infants (9·74±3·17 ml/dl) than those on formula (6·59±3·50 mg/dl), t=3·69, p<0·001). There appeared to be no influence of supplementation with water.     

Breast-feeding and human immunodeficiency virus

Breast-feeding provides nutritional, immunological, and psychological benefits. It protects children from mortality and morbidity associated with diarrheal diseases, pneumonia and other infections. Breast feeding has also been shown to prolong the interval between births and thereby improve child survival and maternal health. However, studies suggest that in certain populations, breast feeding may account for nearly 14% of perinatal human immunodeficiency virus type 1 (HIV-1) transmission. It is therefore important that the risk of HIV-1 infection through breast feeding be weighed against the morbidity and mortality associated with bottle feeding. This paper discusses the literature dealing with breast feeding in women with HIV-1 infection. Specifically, the review addresses the issues surrounding infant mortality in areas of different HIV-1 prevalence where breast-feeding or bottle-feeding may be employed. Analysis suggests that the benefits of breast-feeding or bottle-feeding may be employed. Analysis suggests that the benefits of breastfeeding can substantially outweigh the putative risk of HIV-1 transmission unless the prevalence of HIV-1 infection is high or the difference in mortality between breast-fed and bottle-fed infants is very low.     

Support and Variation, the Needs of the Breast-Feeding Woman

A basic pattern for human beings is the support given to the mother during delivery and for a period postpartum. One function of this universally recognized need is to assure the success of breast-feeding. The position of the supportive person—the doula— who works with the mother during this period is examined in this presentation. The quantitative difference in the amount of support needed by different women during this period is discussed. In the United States the role of the father is changing dramatically. Men are present at the birth of their children and are expressing more tenderness towards their wife and children. The possibility of such change of role for Japan is of concern. Studies of over 200 cultures have shown the enormous variety m patterns of care for the mother during and after delivery. The author suggests that each mother has a unique rhythm of her own and that sensitivity to each individual woman's needs might enrich her first experiences with her child.     

A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcome

Aims: To estimate the incidence and clinical characteristics in hospital admissions due to dehydration or undernutrition and their laboratory evaluation and treatment outcome in exclusively breastfed infants.
Methods: All hospital admissions during the first 3 months of life assessed by the Dutch Paediatric Surveillance Unit (DPSU) between mid 2003 and mid 2005.
Results: Nationwide 158 cases reported, correspond to an incidence of 58/y/100 000 breastfed infants; it is lower for severe dehydration at risk for hypernatraemia; 20/y/100 000. Sixty-five per cent of cases were <2 weeks old, their median weight loss was 9.3% and median age at admission 5 days; Serum sodium value was measured in only 12% of all cases. Insufficient volume intake and inadequate growth were most frequently reported (61% and 41%). Lethargy, jaundice or clinical dehydration was scored in 11–25%, seizures or shock in 3%. A breast pump at home was used in only 31%. In the hospital breast pumps were available (82%) as lactation consultants (73%). For treatment 65% was offered formula, in 30% by nasogastric drip. Most admissions lasted up to 3 days, all recovered fully and 33% were breastfed exclusively at discharge.
Conclusion: The incidence of severe dehydration in the Netherlands is relatively low. With extended use of breast pumps at home it could be lower. To prevent complications, we recommend applying a reference weight chart, a full clinical examination and more extensive screening of serum sodium and glucose.     

Social and behaviour change communication to improve child feeding practices in Ethiopia

Social and behaviour change communication (SBCC) interventions can positively affect optimal nutritional practices. This study evaluated the added value of a virtual facilitator tool to an enhanced community conversation (ECC) programme to improve infant and young child feeding (IYCF) practice among children under the Growth through Nutrition Activity programme in Ethiopia. The study used a quasi‐experimental design with a control group. Pregnant and/or lactating women were the study population for both study groups. The intervention (ECC + VF) group received all the same components as the control group but had the addition of in‐person ECC meetings supplemented with audio‐recorded virtual facilitators (VF) sessions designed to complement the monthly meeting lesson or topic. A difference in difference analysis was employed using generalized linear mixed model (GLMM) in Stata version 15.0 (Stata Corporation, College Station, TX). A p‐value of less than or equal to 0.05 was considered significant for all tests. Accordingly, a 13.6% change in iron folic acid (IFA) intake for 3 months and above was observed in the intervention group. Even though not statistically significant, large to moderate positive changes in child minimum diet diversity (20%), minimum acceptable diet (18%) and women diet diversity (7.9%) were observed in the intervention group. This study identified the use of virtual facilitators as a modality to transmit standard nutrition messages during ECC programmes for optimal IYCF practices. The findings strengthen the notion that using a combination of SBCC approaches has advantage over a single method in improving important nutritional practices.     

Human Immunodeficiency Virus type 1 infection and breast milk

Major questions are whether mothers infected with the Human Immunodeficiency Virus type 1 (HIV-1) transmit the virus through breast milk and the magnitude of the additional transmission risk. The demonstration of a dose-response effect is an epidemiological method to demonstrate causality. Thus, a study was carried out by the Italian Register for HIV Infection in Children on 961 children of known infection status. Duration of breast-feeding was considered as the level of exposure in 168 ever breastfed children. Results showed that duration of practice significantly increased the risk of transmission. The adjusted infection odds ratio for one day of breast- versus exclusive formula-feeding was 1.19 with narrow confidence limits (1.10–1.28). In a second study by the Register on 556 children of known infection status and derived prospectively, an infection odds ratio of 2.55 (confidence interval: 1.03–6.37) was calculated in breast- versus exclusively formula-fed children. Several lines of evidence, including the above-mentioned data from the Italian Register for HIV Infection in Children, showed a contribution of breast-feeding to mother-to-child HIV-1 transmission. Thus, this practice is now discouraged in HIV-1 infected mothers living in industrialized societies where formula feeding is practical and attainable. Mode of feeding was known in 2183 children enrolled in the Register and born to HIV-1 infected mothers since 1981. It could be observed that feeding habits of at-risk infants changed in Italy in the middle 1980s, when a large majority of subjects was identified at birth. However, women infected exclusively by the sexual route are often unconscious of being infected or even being at risk from infection and consequently their children are less frequently identified at birth than are children of women with a history of intravenous drug use. In industrialized areas, the former children remain at risk from milk-borne HIV-1 infection.     

Infantile colic: occurrence and risk factors

The purpose of this work was to study the appearance of infantile colic and gas discomfort and to learn whether these problems are associated with factors in the child's social environment, allergic symptoms, or feeding. The study was made retrospectively by means of a questionnaire which was sent to mothers of every tenth child aged 14 to 38 months in Turku, Finland. Forty percent of the children, as many boys as girls, had colic or gas problems in early infancy, so severe in 20% that drug therapy was used. First born children in the family more often had colic and gas problems than did subsequent children. Siblings of colicky children had colic and gas problems more often than did siblings of the children who had no colic or gas problems. Neither family history or symptoms of allergy, duration of breast-feeding, mother's consumption of plain cow's milk during lactation, nor the age of introduction of cow's milk to the child were associated with the occurrence of colic. Children with colic grew as well as children without. However, their night sleep was more often disturbed by awakenings than the night sleep of children without colic or gas problems in early infancy.     

Prelacteal feeds and breast-feeding problems

A recent WHO sponsored study observed that health establishments in some developing countries tend to discourage breast-feeding. In order to determine the factors responsible for it, perinatal infant feeding-related experiences of 210 mother child pairs delivered in five different locales in Benin City, Nigeria, were investigated. It was found that while the participants were similar in relevant backgrounds and had generally similar experiences in the five delivery locales, those of two of the hospitals started bottle-feeding significantly earlier. They had more problems with breast-feeding and breast-fed their babies for shorter durations. These observations were found to be related to the practice of the so-called “pre-lacteal feeds” in the two hospital maternities.     

Factors adversely associated with breast feeding in New Zealand

Control data from 1529 infants studied in a multicentre case-control study of sudden infant death in New Zealand were analysed to identify factors that might hinder the establishment and duration of breast feeding. Although 1300 infants (85%) were exclusively breast-fed at discharge from the obstetric hospital, this fell to 940 (61%) by 4 weeks. Logistic regression was used to identify factors that might adversely influence breast feeding ‘at discharge’,‘at 4 weeks’ and the overall ‘duration’ of breast feeding. When adjusted for confounding factors, not exclusive breast feeding ‘at discharge’ was significantly associated with: twin pregnancy, being a Pacific Islander, mother not bedsharing, subsequent dummy use, birthweight less than 2500g, heavy maternal smoking, not attending antenatal classes and mother less than 20 years old at first pregnancy. Mothers smoking more than 20 cigarettes a day were nearly twice as likeiy to not exclusively breast feed on discharge compared to those who did not smoke. A ‘dose response’ was apparent with the heaviest smokers having the least likelihood of establishing exclusive breast feeding. Being exclusively breast-fed at discharge but not ‘at 4 weeks’ was associated with: twin pregnancy, admission to a neonatal intensive care unit, subsequent dummy use and not being married. A shorter overall ‘duration’ of breast feeding was associated with maternal smoking, subsequent dummy use, mother not bedsharing, twin pregnancy, mother less than 20 years old at first pregnancy, low occupational status and not attending antenatal classes. These effects persisted when social and demographic factors, including birthweight, were taken into account. This study showed that 31% of New Zealand women had smoked during their pregnancy. A concerted effort to achieve smokefree pregnancies would not only directly improve the health of mother and child but may enhance both the initiation and duration of breast feeding. The influence on the duration of breast feeding of both dummy usage and the mother sharing the bed with her infant needs to be explored further, as a causal relationship cannot be established from these data.