Infant feeding practices and socio-demographic factors in Ottawa-Carleton

Parents of 320 infants 6-18 months of age were interviewed to determine infant feeding practices and socio-demographic factors contributing to parental choices. 76% of women breastfed initially. Social class was directly related to the incidence of breastfeeding. 50% of the women who started breastfeeding continued to do so at 6 months, a figure which is higher than that previously reported in Canada. Although social class was a major determinant in parents' choice of infant feeding, cultural factors were also very important. A higher proportion of mothers who spoke languages other than English or French in the home (including mainly Polish, Italian, Spanish, and East Indian) breastfed their infants than did mothers who spoke French, even though more of them were in the lowest socio-economic group. The reason for the relatively low incidence of breastfeeding by Francophone mothers is unclear.     

Infant feeding in Nigeria: A case study of practices in Ile-Ife community

Infant feeding practices and nutritional status of one hundred and ten infants in urban and rural areas of lle-lfe were investigated. Questionnaires were administered with the nursing mothers as respondents. Information was obtained on breastfeeding pattern, feeding of milk and non-milk supplements, and also health and medical history of the infants. Anthropometric measurements were also conducted on the infants aged between 0-2 years.

Analysis of the data showed that all nursing mothers breastfed their babies within the first three days up to an average of 12 months of life after which milk and non-milk supplements were introduced. Urban mothers were found to introduce milk supplements at an earlier age of life than their rural counterparts with urban infants being better nourished.     

Breastfeeding in Depressed Mother-Infant Dyads

Depressed versus non-depressed mothers were interviewed on their breastfeeding practices and perceptions of their infants' feeding behavior when their infants were eight-months-old. The depressed mothers less often breastfed, they stopped breastfeeding their infants significantly earlier in infancy and they scored lower on a breastfeeding confidence scale. Independent of maternal depression, mothers who breastfed rather than bottle fed their infants had higher confidence levels and rated their infants as less alert and less irritable during feedings.     

Breastfeeding in Depressed Mother-Infant Dyads

Depressed versus non-depressed mothers were interviewed on their breastfeeding practices and perceptions of their infants' feeding behavior when their infants were eight-months-old. The depressed mothers less often breastfed, they stopped breastfeeding their infants significantly earlier in infancy and they scored lower on a breastfeeding confidence scale. Independent of maternal depression, mothers who breastfed rather than bottle fed their infants had higher confidence levels and rated their infants as less alert and less irritable during feedings.     

Knowledge about breastfeeding in mothers of infants with gastroesophageal reflux

Infants with gastroesophageal reflux disease (GERD) who are breastfed have significantly shorter clinical episodes of the condition than artificially fed infants. The purpose of this study was to identify the knowledge about the benefits of breastfeeding in mothers of babies 0-12 months of age with gastroesophageal reflux. A non-probabilistic sample was taken among patients from various private radiological centers. Sixty mothers completed a self-administered questionnaire, with a median age of 26 years and an educational level of 14 years. Seventy one percent breastfed their last baby, but only 18.6% practiced exclusive breastfeeding. The pediatrician suggested formula to 53.3% of the mothers, and 64% of the mothers were told to combine breast milk with vegetables as treatment for the GERD. Inadequate knowledge about the benefits of breastfeeding was exhibited by 27% of the mothers. Mothers of infants with GERD need education on the importance of breastfeeding. Further research is necessary on the factors which impact the duration of breastfeeding in this population.     

Differences in the infant-feeding practices in Urban and Rural Nigeria

This study compared the infant-feeding methods of 378 urban mothers and 356 rural mothers. We collected information by means of a questionnaire. The weights of infants were taken by means of an Avery scale and milk intake was assessed by the test-weighing method. The results showed that all mothers breastfed their children and introduced milk formula or other milks at some stage. All urban mothers had stopped breastfeeding by 12 months, but 27.5% of rural mothers breastfed 1 year or more. A majority of the mothers (87.1% rural and 78.6% urban) reported that they stopped breastfeeding when they thought the child was old enough to stop. And although urban and rural mothers said they started weaning their children for similar reasons, 33.9% of urban mothers weaned their babies within the first 9 months of life compared to 6.7% in the rural area. Urban infants were heavier within the period surveyed. This article includes recommendations for increasing the duration of breastfeeding and improving availability of weaning foods.     

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.     

Breastfeeding practices and associated factors among children under 24 months of age in Timor-Leste

OBJECTIVE: To describe breastfeeding practices and to assess the sociodemographic factors associated with selected breastfeeding indicators. DESIGN AND SETTING: The 2003 Demographic and Health Survey was a multi-stage cluster sample survey of 4320 households from four different geographic areas in Timor-Leste. SUBJECTS: A total of 2162 children aged 0-23 months. RESULTS: A high proportion (97.6%) of infants had been ever breastfed, but only 46.1% had initiated breastfeeding within the first hour of birth. Seventy-eight percent of children <24 months were currently breastfed, 30.7% of infants <6 months were exclusively breastfed and 12.5% of infants <12 months were bottle-fed. A high proportion of infants of 6-9 months (82.0%) were receiving complementary food in addition to breast milk. Multivariate analysis revealed that exclusive breastfeeding was significantly lower in the rural west region (odds ratio (OR)=3.15) compared to the urban region, and among those from richest households (OR=1.90) compared to poorest. Mothers with primary education were significantly more likely to exclusively breastfeed than mothers with no education (OR=0.62). Increasing age of the infant was associated with significantly less current (OR=1.23) and exclusive (OR=1.35) breastfeeding. Continuation of breastfeeding at the end of the first year was significantly lower in non-working mothers (OR=1.58) compared to working mothers, and among infants born in health-care facilities (OR=2.16) than those born at home. CONCLUSIONS: Breastfeeding practices in Timor-Leste were satisfactory, except the exclusive breastfeeding at 6 months. However, more socioeconomically privileged groups demonstrated a poorer breastfeeding performance than disadvantaged groups. Further breastfeeding promotion programmes are needed across all population groups, and should include health-care providers and maternity institutions.     

Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study

OBJECTIVE: To determine the association of different feeding patterns for infants (exclusive breastfeeding, predominant breastfeeding, partial breastfeeding and no breastfeeding) with mortality and hospital admissions during the first half of infancy. METHODS: This paper is based on a secondary analysis of data from a multicentre randomized controlled trial on immunization-linked vitamin A supplementation. Altogether, 9424 infants and their mothers (2919 in Ghana, 4000 in India and 2505 in Peru) were enrolled when infants were 18-42 days old in two urban slums in New Delhi, India, a periurban shanty town in Lima, Peru, and 37 villages in the Kintampo district of Ghana. Mother-infant pairs were visited at home every 4 weeks from the time the infant received the first dose of oral polio vaccine and diphtheria-pertussis-tetanus at the age of 6 weeks in Ghana and India and at the age of 10 weeks in Peru. At each visit, mothers were queried about what they had offered their infant to eat or drink during the past week. Information was also collected on hospital admissions and deaths occurring between the ages of 6 weeks and 6 months. The main outcome measures were all-cause mortality, diarrhoea-specific mortality, mortality caused by acute lower respiratory infections, and hospital admissions. FINDINGS: There was no significant difference in the risk of death between children who were exclusively breastfed and those who were predominantly breastfed (adjusted hazard ratio (HR) = 1.46; 95% confidence interval (CI) = 0.75-2.86). Non-breastfed infants had a higher risk of dying when compared with those who had been predominantly breastfed (HR = 10.5; 95% CI = 5.0-22.0; P < 0.001) as did partially breastfed infants (HR = 2.46; 95% CI = 1.44-4.18; P = 0.001). CONCLUSION: There are two major implications of these findings. First, the extremely high risks of infant mortality associated with not being breastfed need to be taken into account when informing HIV-infected mothers about options for feeding their infants. Second, our finding that the risks of death are similar for infants who are predominantly breastfed and those who are exclusively breastfed suggests that in settings where rates of predominant breastfeeding are already high, promotion efforts should focus on sustaining these high rates rather than on attempting to achieve a shift from predominant breastfeeding to exclusive breastfeeding.     

Breastfeeding Duration, Social and Occupational Characteristics of Mothers in the French ‘EDEN Mother–Child’ Cohort

Socio-demographic characteristics of mothers have been associated with exclusive breastfeeding duration, but little is known about the association with maternal full- and part-time employment and return to work in European countries. To study the associations between breastfeeding, any and almost exclusive (infants receiving breast milk as their only milk) breastfeeding, at 4 months of infant’s age and the socio-demographic and occupational characteristics of mothers. We used the EDEN mother–child cohort, a prospective study of 2002 singleton pregnant women in two French university hospitals. We selected all mothers (n = 1,339) who were breastfeeding at discharge from the maternity unit. Data on feeding practices were collected at the maternity unit and by postal questionnaires at 4, 8 and 12 months after the birth. Among infants breastfed at discharge, 93 % were still receiving any breastfeeding (83 % almost exclusive breastfeeding) at the 3rd completed week of life, 78 % (63 %) at the 1st completed month, and 42 % (20 %) at the 4th completed month. Time of return to work was a major predictor for stopping breastfeeding: the sooner the mothers returned to work, the less they breastfed their babies at 4 months of infant’s age, independently of full-time or part-time employment. The association was stronger for almost exclusive breastfeeding mothers than for any breastfeeding ones. In a society where breastfeeding is not the norm, women may have difficulties combining work and breastfeeding. Specific actions need to be developed and assessed among mothers who return to work and among employers.     

Racial Differences in the Prevalence of Corneal Arcus

A random sample of 300 employees from the working population of a sugar estate in Trinidad was examined to determine the racial prevalence of corneal arcus and its relationship to blood pressure and serum cholesterol. The higher frequency of corneal arcus in Indians and Negroes, as compared with Europeans, is shown and is especially marked in the earlier decades. Of Indian men, 48% between 20 to 29 and 74% between 30 to 39 years of age showed corneal arcus. Of Negro men, 67% between 20 to 29 and 78% between 30 to 39 showed it. No correlation was found between the presence of corneal arcus and raised serum cholesterol levels or diastolic hypertension. It would appear that premature corneal arcus in the Indian and Negro is probably without significance.     

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.     

The epidemiology of breastfeeding cessation in sub-urban Lagos, Nigeria

Two hundred and forty mothers in a sub-urban community in Lagos were studied. Respondents were women who had children 0 -- 24 months of age. They were largely married women of low educational and socioeconomic background. Breastfeeding is commonly practised in this community. Nearly all the mothers (92.4%) breastfed for longer than six months and a large proportion (71.5%) breastfed up to 12 months. The proportion of male infants who were breastfed for longer than 12 months was higher than that of the female infants (75% vs. 67%) although the difference was not statistically significant (X² = 1.77, p=0.279). Older mothers (#lt35 years) tended to breastfeed for slightly longer period than their younger counterparts. There was a significant inverse association between mothers' level of education and the duration of breastfeeding (p = .035). The major reason for stopping breastfeeding as given by 62 percent (149 mothers) was that the child was old enough. The next important reason for stopping breast feeding was that the mother had to resume work. The “insufficient milk syndrome” as reported from many cultures of developed and developing countries of the world has not yet affected the Nigerian suburban women and was not an important reason for stopping breastfeeding.     

Verbreitung, Dauer und zeitlicher Trend des Stillens in Deutschland

Breast milk is the most natural and best type of nutrition for almost all infants. Moreover, breastfeeding is associated with health benefits for mother and child: breast milk supports the development of the infant and protects it against diseases; the health benefits for the mothers also extend beyond the period after birth. Therefore, the WHO recommends exclusive breastfeeding for at least six months. Until now, no representative data on the breastfeeding rate have been available in Germany. The KiGGS results show an increase in the breastfeeding rate from 1986 to 2005. Across all age groups studied, 76.7 % (95 % CI: 75.2 %-78.1 %) of the children were ever breastfed. The rate of ever-breastfed children was significantly lower in mothers from socially disadvantaged population groups, children of mothers who had smoked during pregnancy or in situations with problems after birth. Children with migration background were more frequently ever-breastfed than children without migration background. The average duration of breastfeeding was - across all age-groups - 6.9 months (95 % CI: 6.8-7.0); the duration of full breastfeeding was 4.6 months (95 % CI: 4.5-4.7) on average. 22.4 % (95 % CI: 21.4 %-23.5 %) of all children from the KiGGS study population were exclusively breastfed for a period of six months. The results emphasises the necessity to further promote breastfeeding, especially to support the socially disadvantaged, and most of all to encourage a positive attitude towards breastfeeding in the society.     

Breastfeeding patterns and energy adequacy

To analyze caloric adequacy in infant feeding six months of age or under, the volume of breast milk consumed was estimated through a regression equation as proposed by Drewett. Energy adequacy was estimated according to World Health Organization guidelines for developing countries and the recommended daily allowance of the Food and Nutrition Board. A cross-sectional analysis was conducted on data from a cohort of 118 infants in a neighborhood around a health center in Campinas, S?o Paulo, Brazil, with home interviews by trained students. Data were gathered on social and demographic characteristics, infant feeding patterns, duration of breastfeeding, frequency of feedings, and age when breast milk substitutes were introduced. On average, weaning began early, with a 2.7-month median duration of exclusive breastfeeding. Mean breast milk volume was estimated (from frequency of feeding) as 561.0 ml, 558.9 ml and 565.5 ml for children in exclusive, predominant, and supplemented breastfeeding, respectively. Mean energy consumption was adequate for all exclusively breastfed children regardless of age and above the recommended level for infants with supplemented breastfeeding and those already weaned.     

母乳喂养预防儿童肥胖及其机制的研究进展

母乳喂养是预防儿童肥胖的保护因素,经过母乳喂养的婴儿在儿童期较少发生肥胖或超重;母乳喂养的持续时间与儿童肥胖或超重的发病率存在一定的负相关.母乳喂养预防肥胖的机制包括:母乳中的特殊成分如瘦素、多不饱和脂肪酸以及婴儿体内的胰岛素对婴儿的营养代谢起"营养程序化"和"代谢印记"作用;母乳喂养行为使所涉及的乳母和婴儿双方共同建立起良好的能量摄入调节机制,对婴儿今后能量摄入起调控作用.     

Health and growth of infants breastfed by Norplant contraceptive implants users: a six-year follow-up study

The objective of the study was to evaluate safety to infants whose mothers used Norplant levonorgestrel implants during breastfeeding. A nonrandomized clinical trial design was used. Participants were 220 and 222 healthy breastfed infants of mothers initiating use of Norplant or T-Cu IUD, respectively, at 55 days to 60 days postpartum. Infants were followed from birth through age 6 years. Breastfeeding pattern, infant growth, and disease events were recorded monthly in the first year, three-monthly in the second, and annually thereafter. Most mothers continued use of Norplant (96.4%) and T-Cu (94.1%) during lactation, and 2140 months of infant exposure to levonorgestrel were accumulated. Breastfeeding pattern and infants growth, from admission through age 6 years, were similar in both groups. In the first year, breastfed infants in the Norplant group had higher incidence rates (p < 0.05) of mild episodes of respiratory infections (adjusted RR 1.17, CI 1.08-1.27), skin conditions (adjusted RR 1.46, CI 1.20-1.79), and eye infections (unadjusted RR 1.49, CI 1.03-2.18) than the control group. Later on, a higher proportion of infants in the T-Cu group showed neurological conditions. Although breastfeeding patterns and infant growth is not affected by Norplant use during lactation, the effect on infants' health of steroidal contraception should be further evaluated.     

Optimal duration of exclusive breastfeeding: what is the evidence to support current recommendations?

Before 2001, the World Health Organization (WHO) recommended that infants be exclusively breastfed for 4-6 mo with the introduction of complementary foods (any fluid or food other than breast milk) thereafter. In 2001, after a systematic review and expert consultation, this advice was changed, and exclusive breastfeeding is now recommended for the first 6 mo of life. The systematic review commissioned by the WHO compared infant and maternal outcomes for exclusive breastfeeding for 3-4 mo versus 6 mo. That review concluded that infants exclusively breastfed for 6 mo experienced less morbidity from gastrointestinal infection and showed no deficits in growth but that large randomized trials are required to rule out small adverse effects on growth and the development of iron deficiency in susceptible infants. Others have raised concerns that the evidence is insufficient to confidently recommend exclusive breastfeeding for 6 mo for infants in developed countries, that breast milk may not meet the full energy requirements of the average infant at 6 mo of age, and that estimates of the proportion of exclusively breastfed infants at risk of specific nutritional deficiencies are not available. Additionally, virtually no data are available to form evidence-based recommendations for the introduction of solids in formula-fed infants. Given increasing evidence that early nutrition and growth have effects on both short- and longer-term health, it is vital that this issue be investigated in high-quality randomized studies. Meanwhile, the consequences of the WHO recommendation should be monitored in different settings to assess compliance and record and act on adverse events. The policy should then be reviewed in the context of new data to formulate evidence-based recommendations.     

A review of recent developments in the use of moderately hydrolyzed whey formulae in infant nutrition

The best nutritional option for newborn infants is mother’s milk. However, some infants may not be exclusively breastfed during the first months of life, potentially leading to a reduction in overall health status and the early onset of allergic diseases in some infants. Food allergies play a major role in the pathogenesis of atopic diseases, and therefore dietary intervention during early infancy is an important strategy in preventing such illnesses. An ideal prevention program should avoid food sensitization while inducing oral tolerance to food protein allergens during the first few months of life, provide adequate nutrition, be acceptable to both parent and infant, and cost effective. Infant formulae that contain unmodified cow’s milk proteins may produce sensitization, and there is now widespread agreement that cow’s milk formulae (CMF) should be avoided in infants with a presumed risk of atopic disease. If exclusive breastfeeding during the first months of life is not possible, mother’s milk must be replaced or supplemented by an infant formula during the first 4 to 6 months of life. Today, all nutritional bodies recommend a hypoallergenic hydrolyzed formula in non- or partially breastfed infants with an elevated allergic risk. Both extensively (eHF) and moderately (pHF) hydrolyzed formulae are used in allergy prevention nutrition. The pHF formulae, first introduced in 1985, are more palatable and less expensive than most eHF formulae, and their low residual content of allergens suggests that they may induce oral tolerance without sensitization. The recent literature on pHF demonstrates reductions in short- and long-term incidences of atopic diseases in high-risk infants fed pHF when compared with CMF, with no negative effects on infant growth. Recently published randomized studies comparing pHF with eHF produced no conclusive results to demonstrate a preference between pHF or eHF in early allergy prevention. In an unselected infant population, an allergen-reduced nutrition program resulted in improvements in overall health status during the intervention period, and fewer skin problems from birth to 2 years of age, when compared with controls.