Maternal knowledge regarding breast feeding and weaning practices

The study assessed the knowledge of mothers of the high income group of urban Baroda, related to breast feeding and weaning. Forty mothers with children aged 4 to 18 months were studied. Knowledge and practices regarding breast feeding and weaning were assessed using pretested questionnaires. Results indicated that only half the mothers breast fed their babies on the first day. Breast feeding was stopped when the child was 3–6 months; top feeding and solid supplements were initiated at 4–6 months. Mainly commercial baby foods were used for weaning.Most mothers avoided ‘dals’ for the child because these were believed to be difficult to digest and produced gas in the child’s stomach. Fifty percent of the mothers were not in favour of feeding the sick child with small frequent meals.     

Maternal restrictive feeding practices for child weight control and associated characteristics

Objective

To identify associations between maternal restrictive feeding practices for child weight control and sociodemographic, behavioral, dietetic, and anthropometric characteristics.

Knowledge and attitude among child development project officers towards breast feeding

A study was conducted to determine the knowledge and attitude about breast feeding (BF) amongst child development project officers (CDPOs) working in Integrated Child Development Services Scheme. A semi structured pretested questionnaire was administered. It was found that majority of respondent had correct knowledge about feeding of colostrum, age of initiation of breast feeding and introduction of semi-solid foods. Majority of CDPOs had the knowledge that consumption of dry fruits, milk and desi ghee would increase that breast milk secretion. The percentage of subjects who were aware that BF should be discontinued if mother is suffering from illness like breast cancer (48%) tuberculosis (57%), malaria (67%) and Diarrhoea (84%). There is need of continuing education of CDPOs for updating their knowledge.     

Infant feeding practices among patients of pediatricians and general practitioners

In an attempt to document the infant feeding practices among patients of pediatricians and general practitioners, a study was carried over a period of one month and data of 10,374 infants were recorded using a pre-printed proforma marked by a simple ‘tick’ for each patient. The results showed: (i) initiation of breastfeeding was delayed in nearly half of the cases beyond 24 hours; (ii) introduction of bottle feeding in more than half of infants by the age of 4 months and (iii) introduction of solid foods later than eight months in almost half of infants. While breastfeeding is practised by 78% of women, only one in five practice exclusive breastfeeding till 4–6 months, and very few avoid bottle feeds. Much education and change in behaviour is needed if optimal benefit of breastfeeding in India is to be realised.     

Infant feeding practices in rural Bangladesh

A longitudinal study was done on the infant feeding practices in a rural area. One hundred and ten infants were followed up from birth to 1 year of age by alternate day home visits, to enquire about the type of food, and frequency of consuming it. It was found that 100% mothers breast-fed their infants from birth to 1 year, almost every day. But, bottles containing various kinds of milk and starchy food were added to 60% of infants diets by 3 months, and 80% by 5 months of age. This additional food was given mostly in diluted form, which was more so in case of tinned milk. Family food such as rice and vegetables were given in 30% and 40% child days respectively from 6 months to 1 year. Rural people withhold protein food and fruits during infancy. It is concluded, that infant feeding practices in our population is improper and mothers should, therefore, be trained and motivated on weaning practices for timely and adequate supplementation to ameliorate the presently observed dietary deficiency and early malnutrition in rural Bangladesh.     

Risk factors for early termination of breast feeding in Brazil

A prospective study was undertaken to identify possible factors related to the duration of breast feeding. Two hundred and thirty-eight mothers who had delivered normal single babies with birth weights greater than 2.5 kg and had initiated breast feeding were randomly selected at the maternity hospital, Hospital de Clinicas de Porto Alegre, Brazil, and followed by mail questionnaires until termination of breast feeding, or until the end of the first year. If no reply was received, telephone contact or home visits were made. The group of mothers who stopped breast feeding prior to the end of the third month was compared with those who extended breast feeding beyond three months with respect to socioeconomic, biological, environmental, medical and psychological factors. The variables with a significant coefficient of association with early termination of breast feeding were maternal education, past experience with breast feeding, help of a maid, help with housework provided by a relative, breast feeding orientation during prenatal care and encouragement from the husband. These factors act simultaneously, with interactions among them.     

Calcium homeostasis in the first days of life in relation to feeding

Determinations of serum calcium (Ca), phosphorus (P), magnesium (Mg), calcitonin (CT) and parathyroid hormone (PTH) were carried out in full term newborn infants during the first 168h of life. The infants were randomly assigned to two different diets: glucose and breast feeding (BF) only or early formula feeding (F). The Ca serum levels decreased from birth to the 24th h; after that time they increased until the 72nd h. The values of serum Ca at the 48th and 72nd h were significantly lower in the F than in the BF group. In contrast, the P serum levels increased from birth to the 48th h and then they decreased; the values of serum P at the 48th h were significantly higher in F than in the BF group. The CT serum levels increased from birth to the 24th h and then they decreased. No difference between the F and BF groups was found during the first 48 h, while at the 72nd h the F group demonstrated significantly higher values of serum CT. PTH serum levels also increased from birth to the 24th h with significantly higher values at the 72nd h in the F group. The results of this investigation demonstrate that the difference in feeding in the first hours of life affects the calcium homeostasis and the secretion of hormones involved in the regulation of serum Ca levels.Abbreviations CT calcitonin - PTH parathyroid hormone - BF breast feeding - F early formula feeding - RIA radio-immunoassay     

Immediate newborn care practices delay thermoregulation and breastfeeding initiation

Aim: A deadly nosocomial outbreak in a Philippine hospital drew nationwide attention to neonatal sepsis. Together with specific infection control measures, interventions that protect newborns against infection‐related mortality include drying, skin‐to‐skin contact, delayed cord clamping, breastfeeding initiation and delayed bathing. This evaluation characterized hospital care in the first hours of life with the intent to drive policy change, strategic planning and hospital reform. Methods: Trained physicians observed 481 consecutive deliveries in 51 hospitals using a standardized tool to record practices and timing of immediate newborn care procedures. Results: Drying, weighing, eye care and vitamin K injections were performed in more than 90% of newborns. Only 9.6% were allowed skin‐to‐skin contact. Interventions were inappropriately sequenced, e.g. immediate cord clamping (median 12 sec), delayed drying (96.5%) and early bathing (90.0%). While 68.2% were put to the breast, they were separated two minutes later. Unnecessary suctioning was performed in 94.9%. Doctors trained in neonatal resuscitation were 2.5 (1.1–5.7) times more likely to unnecessarily suction vigorous newborns. Two per cent died and 5.7% developed sepsis/pneumonia. Conclusions: This minute‐by‐minute observational assessment revealed that performance and timing of immediate newborn care interventions are below WHO standards and deprive newborns of basic protections against infection and death.     

Index for measuring child feeding practices

Objective The present investigation was undertaken with the objective of creating an Infant and Child Feeding Index (ICFI) from a set of complementary feeding (CF) practices and to determine its association with growth of infants and young children (6-23months). Methods A semi-structured interview schedule was used to collect information for 204 children from one large slum (n=104) and two private pediatric clinics (n=100) of urban Vadodara. Results Results revealed that about half (50.5%) of the children were stunted Ht for Age Z score (HAZ<-2SD), nearly one-fourth (25.5%) were underweight Wt for Age Z score (WAZ<-2SD), but wasting (WHZ Wt for Ht Z score<-2SD) was low (3%). Significant associations were revealed between almost all positive CF practices and nutritional status of the children as measured by HAZ and WAZ (p<0.01), but not with WHZ. Good associations were revealed between ICFI and HAZ and WAZ, but not with WHZ. On multivariate analysis of factors affecting the HAZ, WAZ and WHZ scores, ICFI was not found to be significant whereas maternal education was the most significant factor, which was also found to be associated significantly with ICFI. Conclusion It is concluded that the composite index in its present form can reflect the CF practices more holistically than just one or few behaviors studied separately. More research is needed in the direction of constituting a composite index which can then be used for research, monitoring, evaluation and much needed advocacy for complementary feeding.     

Growth charts and the assessment of infant feeding practices in the western world and in developing countries

Changes during the past ten years in infant feeding practices are described and it is demonstrated that with the growing popularity of breast feeding, plus the later addition of solids, dietary energy intakes are substantially lower than they were. These dietary changes would appear to be associated with alterations in the detailed pattern of growth. When exclusively breast-fed, babies, if anything, grow more quickly than growth standard rates, but after 3-4 months a relative deceleration in growth velocity becomes apparent. The anthropometric and dietary findings are discussed in relation to the use of growth charts for the assessment of the adequacy of infant feeding practices in the western world and especially in the Third World. A reanalysis of data indicates that diet-related growth faltering probably does not occur in many developing country situations until later than would be suggested by growth standards currently in use.     

喂养习惯与婴儿出生后前6个月按身长体质量增加的相关性

目的 探讨导致婴儿出生早期生长过快,尤其是按身长体质量增长过快的相关喂养习惯,包括婴儿的喂养方式、喂养环境以及喂养者的一般情况和喂养行为等,方法以上海市控江社区医疗服务中心常规健康体检的200例足月、单胎、正常出生体质量的健康5～6月龄婴儿及其主要喂养者作为研究对象.有关婴儿喂养习惯的调查问卷,包括婴儿喂养模式、喂养环境、以及喂养者的行为等,由研究小组成员在现场对婴儿的主要喂养者进行一对一调查.记录婴儿的出生体质最,并在婴儿6月龄时测量其体质量和身长.结果 200例婴儿中有70例超重(BAZ>+1),占35%.男婴超重多于女婴(40.0%对30.9%,x2=1.798,P=0.180).超重婴儿和体质量正常婴儿的出生体质量一致(3.30±0.35 kg对3.35±0.32 kg,t=1.010,P=0.314),6月龄时两组婴儿的身长也一致(67.64±2.10 cm对67.91±1.97cm,t=0.896,P=0.371).超重婴儿在出生后前6个月内按身长体质量增加速度明显快于正常体质量婴儿,6月龄时超重婴儿的体质量以及BMI显著高于正常体质量婴儿(9.16±0.67对7.94±0.64,t=12.324,P<0.01;19.86±1.24对17.41±0.80,t=14.953,P<0.01).两组婴儿中纯母乳喂养时间至少4个月,6月龄时持续母乳喂养、辅助食品稠厚度和喂养次数差异无统计学意义(x2=0.723～2.701,P均>0.05).祖父母在上海婴儿的喂养照料中扮演着重要的角色,39.0%的婴儿完全由祖父母承担喂养和照料的责任,而23.0%的婴儿则由父母与祖父母共同承担.两组婴儿的主要喂养者、喂养者学历、婴儿喂养知识掌握差异无统计学意义(x2=0.175、0.446,t=0.949,P均>0.05).超重婴儿喂养者的喂养速度明显快于正常体质量婴儿(Z=2.753,P<0.01),超重婴儿喂养者在喂养过程中与婴儿的语言交流明显较少(Z=2.932,P<0.01).在超重婴儿中,喂养者的过度喂养行为与超重婴儿的BAZ呈显著正相关(r=0.281,P<0.05).结论 上海婴儿出生早期按身长体质量增长过快与某些婴儿喂养习惯相关.婴儿出生后前6个月按身长体质量增加过快是否会增加儿章期肥胖的风险值得进一步观察和研究.     

会宁地区437名婴幼儿喂养方式调查

目的：该研究通过调查经济不发达的会宁地区婴幼儿早期喂养方式,明确相关影响因素,以便为有针对性干预提供基础资料。方法：参考地域、经济因素,采用分层整群抽样法以会宁地区7个乡镇的437名婴幼儿为调查对象,通过抚养人利用统一调查表记录儿童出生24个月内母乳喂养及辅食添加情况,同时用膳食频率法收集调查对象上一年的营养素补充剂的摄入情况。结果：调查对象出生6个月内基本纯母乳喂养率、混合喂养率、人工喂养率分别为45.3%,40.5%和14.2%。最为突出的问题是辅食添加不合理,主要表现为添加不及时。配方奶粉添加最早,平均添加时间为6.4个月,畜禽肉类添加最迟,平均添加时间为17.2个月。谷类、蔬菜水果类和蛋类添加较多,而鱼虾等水产品添加较少。营养素补充剂应用尚不普遍,在选用营养素补充剂时,城镇抚养人主要是根据医生的建议,农村抚养人主要根据家人的经验,且受电视、广告等媒体的影响较大。结论：会宁地区婴幼儿早期喂养方式存在较多不合理之处。应通过营养教育,提高婴幼儿抚养人的营养知识水平,以改善不合理的喂养方式。［中国当代儿科杂志,2009,11（6）：460-463］     

Evaluation of paladai cup feeding in breast-fed preterm infants compared with bottle feeding

This pilot study developed an appropriate procedure to evaluate the paladai cup compared to bottle feeding in preterm infants, using weighed napkins and video analysis to assess amount of spillage, volume consumed, time taken and physiological stability. Paladai results demonstrated increased spillage, increased feed times with more stress cues.     

Maternal correlates of maternal child feeding practices: a systematic review

Establishing healthy eating habits early in life is one important strategy to combat childhood obesity. Given that early maternal child feeding practices have been linked to child food intake and weight, identifying the maternal correlates of maternal child feeding practices is important in order to understand the determinants of childhood obesity; this was the overall aim of the current review. Academic databases were searched for studies examining the relationship between maternal child feeding practices and parenting, personal characteristics and psychopathology of mothers with preschoolers. Papers were limited to those published in English, between January 2000 and June 2012. Only studies with mothers of normally developing children between the ages of 2 and 6 years were included. There were no restrictions regarding the inclusion of maternal nationality or socioeconomic status (SES). Seventeen eligible studies were sourced. Information on the aim, sample, measures and findings of these was summarised into tables. The findings of this review support a relationship between maternal controlling parenting, general and eating psychopathology, and SES and maternal child feeding practices. The main methodological issues of the studies reviewed included inconsistency in measures of maternal variables across studies and cross‐sectional designs. We conclude that the maternal correlates associated with maternal child feeding practices are complex, and the pathways by which maternal correlates impact these feeding practices require further investigation.     

Child feeding practices and concerns: Thematic content analysis of Thai virtual communities

Parents'' child feeding practices are influenced not only by family but also by a broader circle of networks, including online groups. Peer‐to‐peer platforms such as Facebook groups facilitate a learning environment and may influence the transmission of user‐generated content into practice. These digital data not only benefit participants but also offer new opportunities for researchers to study related phenomena. Therefore, this study employs thematic content analysis to investigate peer‐exchanging discourse conveyed in Facebook peer‐support groups in children''s diets in Thailand. To identify the area of interest, we classified and quantified the initial posts and investigated the relationship between initial posts'' contents and community engagement. Thematic analysis was used to qualitatively describe the peer‐exchanging content that responded to the initial posts. Of the five approved Facebook groups, 200 initial posts with their 1964 comments were extracted anonymously. Results revealed that Facebook groups devoted to diets for children have become a platform for Thai parents to seek informational and emotional support. The top‐ranked initial posts were related to requesting knowledge and skills about age‐appropriate food and meal preparation. Parents have also expressed anxiety about feeding and tension related to food fussiness which created the need for emotional support. Age‐appropriate feeding, homemade baby foods, concerns about food seasonings and food allergy awareness were observable within online groups. However, a shift from traditional child feeding practices to new ideas created cultural gaps which lead to arguments in some families. Understanding these views would help guide to address parental concerns better.     

Supplementary feeding in the maternity ward shortens the duration of breast feeding

In a prospective study, feeding routines of a maternity unit and the subsequent feeding patterns of 521 newborns were analysed. During the stay in the maternity unit, 69% of newborns were exclusively breast fed and 1% received only donor's milk from the milk bank and/or formula. Nine percent received their mothers' milk by bottle at least once and 21% received one or more supplementary feedings with donor's milk from the milk bank. One-quarter of the children received supplementary feeds on the third day of life, the indications for this being birth weight less than 3.0 kg, maternal diabetes or gestational diabetes, “insufficient amounts” of milk or fussiness. At three months, 65% were being exclusively breast fed and 15% partially breast fed. In a multiple logistic regression analysis, the potential determinants (neonatal feeding, maternal characteristics, characteristics of the delivery and the child) for the duration of breast feeding were included. The adjusted relative risk (estimated as odds ratios, OR) of not being breast fed at three months was associated with maternal age (< 25 years, OR 4.2), maternal smoking (OR 4.0), neonatal feeding (supplements given, OR 3.9) and initial weight loss (10% or more, OR 2.8). Thus the administration of supplementary donor's milk or formula during the early neonatal period was associated with an increased risk of a short duration for breast feeding, even after adjustment for a number of potential confounders.     

Dissimilarities across age groups in the associations between complementary feeding practices and child growth: Evidence from rural Togo

Adequate complementary feeding (CF) practices are essential for achieving optimal growth but challenging to measure comprehensively. This paper describes CF practices in 2,034 children aged 6–23 months and investigates their relationships with length‐for‐age z‐score (LAZ) and stunting, using cross‐sectional data collected from May to July 2014 in rural Northern Togo. The World Health Organization infant and young child feeding indicators were computed, along with ancillary indicators on feeding style and timing of introduction of complementary foods. The associations between those indicators and children's LAZ and stunting were assessed using linear and logistic regressions after stratification by age group and adjustment for children, maternal, and household characteristics. CF practices were suboptimal, and their associations with child's growth varied across indicators and age groups. In children aged 6–11 months, reaching the minimum dietary diversity and the minimum acceptable diet was associated with higher LAZ (p < .05). In 18‐ to 23‐month‐old children, only the consumption of iron‐rich food was associated with both LAZ (p = .02) and stunting (p = .05). The late introduction of family foods was associated with higher odds of being stunted and lower LAZ in children aged 12–17 months (p < .001). The untimely introduction of porridge was associated with higher odds of stunting in children aged 9–23 months (p < .05). Unexpectedly, helping the child to eat was negatively associated with linear growth in all age groups. These findings nurture the ongoing process of review of the World Health Organization infant and young child feeding indicators showing that, in their current version, they hardly capture the links between CF and child's growth at different ages.     

Age during breast feeding and timely suckling

A cross sectional study of 398 mothers and infants was conducted to assess the age at first breast feeding, and its determinants,in Shimla. We found that the timely first suckling rate was 0.10 in urban group and 0.11 in rural group. The median age at initiation of breast feeding was five hours among urban cases and four hours among rural cases. Most of the infants were breast fed by the age of 24 hours which is a positive sign and is higher than previous studies. Absence of definite trendvs mother’s education may be due to other factors. A community-based educational programme to promote early breast feeding is required, along with training on lactation management counselling for health workers. This will help in achieving healthy child development through prevention of childhood malnutrition.     

Prospective associations between parental feeding practices and children's oral processing behaviours

Previous research demonstrated that faster eating rates are linked with increased intake of energy during a meal. Here, we examined whether within‐meal parental feeding practices show cross‐sectional and prospective associations with children's oral processing behaviours and whether the previously demonstrated association between faster eating rates and higher energy intakes varies by parental feeding practices. A subset (n = 155) of children and their mothers from the Growing Up in Singapore Towards healthy Outcomes cohort participated in an ad libitum meal at age 4.5 years. Children's oral processing behaviours (eating rate, bite size, chews per gram, oral exposure time, and meal duration) and parental feeding practices (autonomy‐supporting and coercive prompts, restrictions, hurrying, and slowing) were recorded during the meal. Subsequently, 94 of the children participated in a follow‐up meal without their mothers at age 6 years. Parental feeding practices were not consistently associated with child oral processing behaviours overall. However, exploratory post hoc analyses revealed some sex differences. The mothers of girls with faster eating rates, larger bite sizes, and fewer chews were more likely to use hurrying, slowing, and restrictions, but similar associations were not observed among boys. Children who had the most problematic eating style and were eating fast and for long experienced more restrictions, instructions to slow down, and prompts. Faster eating rates were linked with the highest energy intakes if children were additionally prompted to eat. Prospective analyses showed that children who were more often prompted using coercive techniques and less frequently hurried at age 4.5 years had faster eating rates at 6 years and a larger increase in eating rates between ages 4.5 and 6 years but did not consume more energy. Although the direction of these associations cannot be assumed, these exploratory analyses suggest sex differences in the associations between feeding practices and oral processing behaviours and highlight the potential role of parents in the development of children's oral processing behaviours.