Patterns and Predictors of Breast Milk Feeding from Birth to Age 4 Months among Primiparous African American Mother–Infant Dyads

The health benefits of breast milk feeding have been well-established, yet disparities exist, with African American mothers having the lowest breast milk feeding rates in the United States. This prospective, longitudinal study examined infant feeding (breast milk and/or infant formula) from birth to age 16 weeks, predictors of any breast milk feeding by age 1 week, and predictors of cessation of any breast milk feeding by ages 3, 8, and 16 weeks among primiparous African American mothers. This secondary analysis included 185 mother–infant dyads from the Sleep SAAF (Strong African American Families) study, a randomized clinical trial testing a responsive parenting vs. child safety control intervention. Mothers reported sociodemographic and psychosocial characteristics at age 1 week and infant feeding practices at ages 1, 3, 8, and 16 weeks. Rates of any breast milk feeding decreased from 66.5% at 1 week to 23.3% at 16 weeks. Bivariate logistic regression models showed that prepregnancy BMI (OR = 1.09), working prepregnancy (OR = 2.25), and food insecurity (OR = 2.49) significantly increased the odds of mothers feeding any breast milk by 1 week, whereas Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation (OR = 0.21) significantly decreased the odds. Bivariate logistic regression models showed that Supplemental Nutrition Assistance Program (SNAP) participation (OR = 2.86) and racial discrimination (OR = 2.14) significantly increased the odds of cessation of any breast milk feeding by 3 weeks. SNAP (OR = 2.33) and WIC (OR = 2.38) participation significantly increased the odds of cessation of any breast milk feeding by 8 weeks, whereas higher prepregnancy BMI (OR = 0.95) decreased the odds. Higher mother’s age (OR = 0.92) significantly decreased the odds of cessation of any breast milk feeding by 16 weeks. The findings can be used to inform targeted interventions to promote mothers feeding any breast milk and help reduce breast milk feeding disparities among African American mothers.     

Who is responsible for artificial feeding? An evaluation

Artificial feeding has been found to be on the increases in India. In this research study, 320 infants who were artificially fed before 6 months of age and attended the child health clinic of the Department of Community Medicine, SKIMS Srinagar, between March and November, 1991, were surveyed. Information was obtained from mothers on personnel who advised artificial feeding by type of medical care unit. The sample of mothers included 59.3% who were illiterate. 52.25% of all mothers were housewives and 43.75% had a middle socioeconomic status, while 31.5% had a low socioeconomic status. 53.75% of the artificially fed babies were born at a hospital, of which 2.5% received intensive care. 46.25% were born at home. 76.87% were first or second births. 3.55% of babies were completely artificially fed from birth; at 3 months, 18.76% were exclusively artificially fed. Mixed feeding of breast and artificial milk was 10.76% at birth and 25.97% by 3 months and 42.10% by 6 months. 51.25% of mothers were advised by pediatricians to use artificial feeding; 24.65% of mothers were advised by general practitioners and 10.31% by paramedical. 40% were advised at private clinics and 26.25% in hospital wards at the time of discharge. 18.12% were advised in outpatient departments, and 15.62% at other health centers, such as immunization clinics, health clinics, or nutrition education centers. 66.25% received recommendations to use tinned milk (Lactogen/Milk-care) and 30%, for cows milk. 45.31% of mothers received advice from pediatricians about tinned milk and 5.93% about cow's milk. 5.93% of infants received advice from general practitioners about tinned milk and 5.31 about cow's milk. Over 80% of mothers were given instructions on the amount of dilution and frequency of feeding. 60.93% of mothers received information on feeding equipment and 56.15% on sterilization of feeding equipment. Only 59.37% and 65.37% were able to understand instructions on equipment and sterilization, respectively. The reasons given by mothers for using artificial feeding were low milk output (49.68%), nonacceptance of breast milk by the baby (22.50%), working mothers (12.18%), and baby illness (8.12%). Mothers attributed infections, colic, and regurgitation to artificial feedings. Clearly, the professional community is not complying with the professional code promoted by the World Health Assembly and Indian legislation in 1986 on not recommending milk formula.     

Expressing yourself: A feminist analysis of talk around expressing breast milk

Recent feminist analyses, particularly from those working within a poststructuralist framework, have highlighted a number of historically located and contradictory socio-cultural constructions and practices which women are faced with when negotiating infant feeding, especially breastfeeding, within contemporary western contexts. However, there has been little explicit analysis of the practice of expressing breast milk. The aim of this article is to explore the embodied practice of expressing breast milk. This is done by analysing, from a feminist poststructuralist perspective, discourse surrounding expressing breast milk in sixteen first time mothers' accounts of early infant feeding. Participants were recruited from a hospital in the South Midlands of England. The data are drawn from the first phase of a larger longitudinal study, during which mothers kept an audio diary about their breastfeeding experiences for seven days following discharge from hospital, and then took part in a follow-up interview. Key themes identified are expressing breast milk as (i) a way of managing pain whilst still feeding breast milk; (ii) a solution to the inefficiencies of the maternal body; (iii) enhancing or disrupting the ‘bonding process’; (iv) a way of managing feeding in public; and (v) a way to negotiate some independence and manage the demands of breastfeeding. Links between these and broader historical and socio-cultural constructions and practices are discussed. This analysis expands current feminist theorising around how women actively create the ‘good maternal body’. As constructed by the participants, expressing breast milk appears to be largely a way of aligning subjectivity with cultural ideologies of motherhood. Moreover, breastfeeding discourses and practices available to mothers are not limitless and processes of power restrict the possibilities for women in relation to infant feeding.     

Infant feeding practices and maternal dietary intake among Latino immigrants in California

Mothers of 8–16-month-old infants were surveyed to examine infant feeding practices and maternal dietary intake associated with increased years of residency by Mexican immigrant families (n = 1093 mother–infant pairs). Mothers were recruited from San Diego and Contra Costa counties in California during 1992–93. Twenty-nine percent of Mexican mothers living in the United States for <6 years breastfed their infants exclusively for at least 16 weeks; only 20% of mothers living in the United States between 6 and 15 years and 17% of mothers residing in the United States for over 15 years engaged in exclusive breastfeeding. Neither breastfeeding duration nor the introduction of solids differed by years of residency. In contrast, maternal dietary intake varied markedly. Second generation mothers and those living in the United States the longest had significantly higher intakes of vegetables, low fat milk, salty snacks, animal protein, and cereals. Beyond early caregiving practices, the influence of years of residency on the diets of toddlers is less than that of the mothers.     

Breast-feeding counselling in a diarrhoeal disease hospital.

Lactation counsellors were trained to advise mothers of partially breast-fed infants who were admitted to hospital because of diarrhoea, so that they could start exclusive breast-feeding during their hospital stay. Infants (n = 250) up to 12 weeks of age were randomized to intervention and control groups. Mothers in the intervention group were individually advised by the counsellors while mothers in the control group received only routine group health education. During follow-up at home by the counsellors a week later, only the mothers in the intervention group were counselled. All the mothers were evaluated for infant feeding practices at home two weeks after discharge. Among the 125 mother-infant pairs in each group, 60% of mothers in the intervention group were breast-feeding exclusively at discharge compared with only 6% in the control group (P < 0.001); two weeks later, these rates rose to 75% and 8% in the intervention and control groups, respectively (P < 0.001). However, 49% of mothers in the control group reverted back to bottle-feeding compared with 12% in the intervention group (P < 0.001). Thus, individual counselling had a positive impact on mothers to start exclusive breast-feeding during hospitalization and to continue the practice at home. Maternal and child health facilities should include lactation counselling as an integral part of their programme to improve infant feeding practices.     

Breastmilk and transmission of HIV

The risk of vertical HIV transmission is greatest (20%) during late pregnancy and childbirth. Breast feeding is associated with an additional 14% risk. The risk of infection through breast feeding must be weighed against the dangers posed by artificial feeding. If HIV-positive mothers were to abandon breast feeding without safe alternatives, the resulting infant deaths from diarrhea and respiratory infections could vastly outnumber those from HIV. HIV-infected mothers should be assisted by HIV counselors or health professionals to weigh the risks of both vertical transmission through breast feeding and infections associated with artificial feeding. If an HIV-positive mother has access to adequate breast milk substitutes that she can prepare safely, she should consider artificial feeding. Access to voluntary, confidential HIV testing and counseling is key to any strategy to reduce vertical transmission. Prenatal and obstetric care services aimed at reducing the HIV transmission risk are also essential.     

陕西部分农村母亲婴幼儿喂养知信行现况调查

目的:了解农村婴幼儿喂养现状,为进一步干预提供依据。方法:采用定量方法利用自编问卷对陕西泾阳县6个乡的311名儿童母亲进行现况调查;采用定性方法组织12名儿童母亲进行专题小组讨论,了解影响母亲喂养行为的因素。使用中位数、均数、标准差、频数、卡方检验等方法分析定量资料;使用分类归纳法分析定性资料。结果:定量调查显示,88.4%的母亲认为婴儿6个月内纯母乳喂养好,但6个月内纯母乳喂养率为55.3%;44.4%的母亲了解正确添加辅食的时间,但适时添加辅食率为26.1%;分别有92.9%、97.4%、76.2%的母亲认为应该每天给6个月及以上的孩子吃鸡蛋、蔬菜或肉类,但每周给6个月及以上的孩子添加6次及以上鸡蛋的比例为38.9%、蔬菜47.9%;给7个月及以上孩子每周添加1次以上肉类的比例只有21.6%。定性结果表明,没有坚持纯母乳喂养的母亲主要是自认为母乳不足而过早加辅食;过晚添加辅食的母亲主要是认为8个月以下的孩子对乳类以外的食物难以消化;不给孩子添加肉类食物的母亲主要是认为孩子1岁牙长好了才能消化肉类。结论:6个月婴儿纯母乳喂养率和适时添加辅食率低于同期其他农村地区水平,辅食种类单调,动物性食物摄入明显不足。建议加强对妇幼保健人员的培训,更新相关知识,提高健康教育技能;开发适合农村家长的科普书报、杂志等健康教育材料。     

剖宫产儿与母乳喂养的探讨

目的：探讨不同哺乳方式对剖宫产母婴的影响。方法：随机将83例剖宫产患者分为两组,研究组42例剖宫产患者术后实行早吸吮,早接触,24小时母婴同室,纯母乳喂养,对照组41例新生儿娩出后按手术产儿常规住婴儿室,3天内人工喂养不抱母乳,产后72小时后每天抱喂母乳5次,并辅助人工喂养。结果：研究组产妇无1例产后出血发生,产后24小时内平均出血量较对照组少125ml,产后第2天子宫复旧较对照组佳,下奶时间较对照组平均早14小时,经统计学处理差异有显著性（P＜0．005）。研究组新生儿产后第1、2天尿量少于对照组,提示新生儿有轻度脱水现象,但新生儿肺炎、腹泻、鹅口疮、臀红等疾病发病率及新生儿死亡率明显低于对照组,经统计学处理差异有显著性（P＜0．005）。结论：在医护人员的帮助下对剖宫产产妇实行早吸吮,早接触,24小时母婴同室,坚持母乳喂养可促进子宫复旧,减少产后出血,提早产妇下奶时间,降低新生儿发病率及死亡率。     

The response of mothers to health education and the incidence of gastro-enteritis among their babies in Ile-Ife,Nigeria

The study was carried out among 100 nursing mothers attending infant welfare clinics in order to evaluate their behavioural response to methods of hygiene taught to them about their babies' feeding utensils by health workers.The respondents studied were those with children whose ages ranged between 0 and 12 months, irrespective of birth order.One major purpose of organizing educational talks and of demonstrating food preparations and hygiene is to reduce and possibly prevent the prevalence of intestinal infections, especially during the transition from breast to bottle feeding and to the use of solids.Therefore, the incidence of gastro-enteritis among babies who attended the clinic was investigated.In the analysis of their behavioural response, consideration was given to the environmental conditions under which respondents lived.The response of the mothers was positive to health education. There was a significant difference in the incidence of diarrhoea among babies at the 1% level after exposure of their mothers to health education.     

Infant-feeding practices of mothers of known HIV status in Lusaka,Zambia

BACKGROUND: Between 25 and 44% of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) occurs through breastfeeding. As a result, feeding guidelines for infants of HIV-infected mothers are being formulated in many resource-poor countries. The impact of introducing these guidelines on mothers' actual feeding practices has not previously been examined. Infant-feeding practices of mothers of known HIV status who should have received advice during pre- and post-test HIV counselling were assessed and compared with those of uninfected mothers. METHODS: Mothers of infants aged 2-12 months, 55 HIV-infected and 85 HIV-uninfected, were recruited from the HIV Family Support Unit in Lusaka, Zambia. HIV status was known to 121 of these mothers, who had all received pre- and post-test HIV counselling. Feeding practices were determined by verbal questionnaire. RESULTS: All mothers breastfed but only 35% of infants below 4 months were exclusively breastfed (received breast milk only). HIV-infected mothers introduced fluids and weaned their infants significantly earlier than HIV-uninfected mothers (p = 0.03 and p = 0.002, respectively). Infants of HIV-infected mothers had significantly lower weight for age Z (WAZ) scores indicating poorer nutritional or health status (p = 0.004). Commercial formula milk and cow's milk were used by 36 mothers as breast milk substitutes, and were introduced at a median age of 2.5 months. Thirteen mothers gave cow's milk, and no mother added water to cow's milk (as recommended), with two adding sugar and four adding salt. CONCLUSION: Infant-feeding practices of HIV-infected mothers differed significantly from HIV-uninfected mothers, and this may contribute to their poorer growth. Paradoxically these mothers feeding practice could be putting these infants at greater risk of both non-HIV-related morbidity and HIV transmission, as early introduction of foods other than breast milk may increase MTCT.     

Breast feeding promotion in an urban and a rural Jamaican hospital

Breast feeding promotion has been a national priority in Jamaica since the mid-1970s. Despite this effort, breast feeding rates have continued to decline there, especially in urban areas. Studies of the role of health professionals in promoting breast feeding have shown that specific practices encourage breast feeding, while others discourage it. In the context of declining breast feeding in a nation committed to promoting it, the goal of this study was to explore the relationship between specific health professional practices, mothers' breast feeding, and mothers' knowledge of breast feeding in rural and urban Jamaica. To accomplish this goal, a structured interview was administered to 113 mothers of infants age 0-6 months at one urban (n = 62) and one rural (n = 51) hospital, regarding (1) physician and nurse practices known to affect breast feeding, (2) mothers' own breast feeding practices, and (3) mothers knowledge of breast feeding issues. Physician and nurse visits were also directly observed to confirm responses given to the questionnaire and to assess the resources devoted to teaching mothers about breast feeding. While extensive lectures, posters and pamphlets promoting breast feeding were provided for mothers at the urban hospital, far fewer educational resources were available for mothers at the rural hospital. Overall, however, health professional practices discouraging breast feeding were observed more frequently at the urban hospital than at the rural hospital, whereas practices promoting breast feeding were more common at the rural hospital. At the rural hospital, mothers' breast feeding practices more closely approximated recommendations than at the urban hospital.(ABSTRACT TRUNCATED AT 250 WORDS)     

Carotenoid composition and content of legumes, tubers and roots by HPLC

A survey was carried out in the district of Kemaman, Terengganu, Malaysia to study infant feeding practices in rural and semi-urban communities. A total of 593 mothers were interviewed and their socio-demographic information recorded. Data on infant feeding practices were collected from mothers who had children up to 15 months of age. Among breast-feeding mothers (n =157), 42.0 % fed their babies for less than 3 months and 58.0% bottle fed for more than 6 months. Sixteen children were found to be fed on sweetened condensed milk with 62.5% of them for the first 3 months. Among those who breast fed their babies, 40.1% were found to have bottle fed at one time or another. The majority of breast feeding mothers belonged to the groups having incomplete primary schooling or completed primary education only and household income below RM600 per month. A substantial number of breast fed babies were given weaning foods in the form of porridge mixture (rice + egg, rice + vegetables, rice + meat, rice+ fish and cereals) between the age of 0 - 3 months. The findings of this study concluded that although breast-feeding is widely practiced, however, their duration has dwindled, and early introduction of solid foods is widespread.     

Do Maternal Factors and Milk Expression Patterns Affect the Composition of Donor Human Milk?

A primary role of Human Milk Banks (HMBs) is to provide human milk (HM) for preterm infants and to support the mothers of these infants as they establish their own milk supply. A better understanding of the variation in the energy and macronutrients contents of donor human milk (DHM) potentiates targeted nutrition for preterm babies. Therefore, the aim of this study was to assess the variability of energy and macronutrients content in DHM and to investigate the impact of maternal factors and feeding practices on the nutritional value of DHM. The study involved 49 donors registered in the HMB in the Holy Family Hospital in Warsaw, Poland. Samples from each donor were pooled within a maximum of two weeks. The composition of DHM, including energy content, protein, fat, and carbohydrate concentrations, was analyzed using the Miris Human Milk Analyzer. The analyses were performed before the pasteurization process. The mean time of milk donation to HMB was 13.2 ± 6.0 weeks. There were no significant differences in energy and macronutrients contents of DHM in the beginning and at the end of milk donation to HMB, however, HM fat concentration was positively correlated with afternoon feedings (r = 0.289, p = 0.044). The method of feeding (breastfeeding vs. feeding only expressed milk) also did not impact the nutritional value of DHM. Future research for the DHM should include a further cross-sectional observational study with the collection of detailed donor information and characteristics of milk expression and feeding practices to further evaluate the pooling processes and the effect on DHM composition.     

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.     

INFANT FEEDING PRACTICES: THE CASE OF HMONG WOMEN IN AUSTRALIA

I discuss infant feeding beliefs and practices among Hmong women in Melbourne, focusing particularly on changed patterns that have occurred since their settlement in Australia. Traditionally, Hmong women breastfeed their newborn infants. Most women can breastfeed successfully in their homeland. However, since their settlement in a new country, some women have changed to bottlefeeding. Reasons given include the need to study English and seek employment, the availability of infant formula, insufficient milk, and their concern about the health and well-being of the infants. Hmong women either choose breast- or bottlefeeding based on what they think is best for their babies; their clear intention is to have children who will be healthy and thrive. Understanding of women's beliefs and practices relating to feeding is essential in creating a breastfeeding campaign. More importantly, the information will assist health professionals to support mothers in their choice of a feeding method, whether it be breast or bottle.     

Early introduction of solid foods among urban African-American participants in WIC

OBJECTIVE: To compare infant feeding practices among low-income, urban, African-American women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with current recommendations for infant feeding. DESIGN: Longitudinal follow-up of women and their infants who participated in a WIC-based breast-feeding promotion project. Women enrolled prenatally at or before 24 weeks of gestation were followed up until 16 weeks postpartum. SUBJECTS/SETTING: Two hundred seventeen African-American WIC participants in an urban area. METHODS: Data related to infant feeding practices were collected by interviewers who used a structured questionnaire to determine when nonmilk liquids or solids were introduced to the infant. Reported practices were compared with current recommendations. STATISTICAL ANALYSIS PERFORMED: Contingency table analysis, including chi 2 tests, and multivariate analysis using logistic regression. RESULTS: By 7 to 10 days postpartum, approximately a third of infants were receiving some nonmilk liquids or solids; this escalated to 77% by 8 weeks and 93% by 16 weeks postpartum. Women breast-feeding exclusively (i.e., not adding nonmilk liquids or solids) were least likely, and women providing mixed feeding (breast milk and formula) were more likely, than women feeding formula exclusively to introduce nonmilk liquids and solids at each data collection time period. APPLICATIONS/CONCLUSIONS: WIC participants who receive instruction about infant feeding nutrition are no more likely than mothers who do not participate in WIC to follow infant feeding guidelines recommended by the American Academy of Pediatrics in regard to the time when solids should be introduced to infants' diet. Our findings suggest the need for WIC to implement more powerful and innovative educational and motivational strategies to help mothers delay the introduction of nonmilk liquids and solid foods until their infants are 4 to 6 months old, as recommended.     

Marketing Breastfeeding—Reversing Corporate Influence on Infant Feeding Practices

Breast milk is the gold standard for infant nutrition and the only necessary food for the first 6 months of an infant's life. Infant formula is deficient and inferior to breast milk in meeting infants' nutritional needs. The infant formula industry has contributed to low rates of breastfeeding through various methods of marketing and advertising infant formula. Today, in New York City, although the majority of mothers initiate breastfeeding (approximately 85%), a minority of infants is breastfed exclusively at 8 weeks postpartum (approximately 25%). The article reviews the practices of the formula industry and the impact of these practices. It then presents the strategic approach taken by the NYC Department of Health and Mental Hygiene and its partners to change hospital practices and educate health care providers and the public on the benefits of breast milk, and provides lessons learned from these efforts to make breastfeeding the normative and usual method of infant feeding in New York City.     

Infant feeding practices: the case of Hmong women in Australia

I discuss infant feeding beliefs and practices among Hmong women in Melbourne, focusing particularly on changed patterns that have occurred since their settlement in Australia. Traditionally, Hmong women breastfeed their newborn infants. Most women can breastfeed successfully in their homeland. However, since their settlement in a new country, some women have changed to bottlefeeding. Reasons given include the need to study English and seek employment, the availability of infant formula, insufficient milk, and their concern about the health and well-being of the infants. Hmong women either choose breast- or bottlefeeding based on what they think is best for their babies; their clear intention is to have children who will be healthy and thrive. Understanding of women's beliefs and practices relating to feeding is essential in creating a breastfeeding campaign. More importantly, the information will assist health professionals to support mothers in their choice of a feeding method, whether it be breast or bottle.     

新会县农村妇女哺乳情况调查

<正> 母乳是婴儿最佳的食物,它适应新生儿的需要并对乳儿的生长发育有重要的影响。在当前的条件下,哺乳的情况如何,单独以母乳哺育其营养供给能维持多长时间,以及哺乳的影响因素等,都需要了解,以利于推动计划生育工作与促进千万母亲与婴儿的健康。 本调查在广东新会县农村,该地距广州100公里,农业以粮食作物与经济作物为主,还有渔业和其他副业生产,妇女普遍参加农业劳动、手工业劳动或兼有手工业劳动,其生活习惯和经济状况在本地区中有一定的代表性。