Breast-feeding

The pediatrician plays a crucial role in the success of breast-feeding by providing well-researched, practical advice and support to the lactating woman, beginning in the prenatal period and continuing until total weaning. The pediatrician can provide much needed support and affirmation when the mother is sabotaged by well-meaning friends and relatives who are misinformed about the value or techniques of breast-feeding. Mothers state that their pediatrician is the most important member of the support team but also the one most apt to obstruct success with inappropriate advice. An understanding of lactation as a physiologic process will provide a sound basis for anticipatory guidance.     

Breast-feeding, bottle-feeding and related factors. The Leiden Pre-School Children Study

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 multiples

Human breast milk is the best nutrition for human infants. Its advantages over the milk of other species, such as cows, include both a reduced risk for infections, allergies and chronic diseases, together with the full nutritional requirements for growth and development. Breast-feeding is as important for multiples as for singletons. Despite the advantages, multiples receive less breast-feeding than singletons. Common reasons for not breast-feeding multiples include the fear of not fulfilling the infants' needs and the difficulty of coping with the demands on the mother's time. In addition, many multiples are delivered prematurely and by Caesarean section. Maternal pain and discomfort together with anxiety over the infants' condition are not conducive to successful breast-feeding. During lactation, the mother needs to add calories to her daily diet. It has been recommended to add approximately 500–600 kcal/day for each infant. Thus, between eating, nursing and sleeping, life is very busy for the mother of multiples. However, there is evidence that, with appropriate nutrition, one mother can nourish more than one infant. Also, simultaneous breast-feeding can save much time. Combined efforts of parents, close family, friends and the medical team can help to make either full or partial breast-feeding of multiples possible. However, when breast-feeding is not possible, health care workers need to carefully avoid judgmental approaches that may induce feelings of guilt.     

Breast-feeding and Social Factors

ABSTRACT. Information about every tenth child aged 14 to 38 months was collected by means of a questionnaire in Turku, Finland in March, 1983. This paper reports on duration of breastfeeding and its relation to social factors. The average duration of breast-feeding was 5.7 months. Length of breast-feeding was unaffected by sex, number of siblings, and birth order among siblings. The socioeconomic status of the father was associated with duration of breastfeeding: children in high status families were breast-fed longer than children in low status families. Mothers with occupations in the health service, education, and the social sector breast-fed longer than mothers in other occupations. Mothers who were working at the time of the study had breast-fed longer than housewives. For further promotion of breast-feeding, information must be made more effective in the lower social groups and among fathers.     

Breast-feeding and intestinal parasites

The extent of intestinal parasitic infection was determined using 4 methods of fecal examination in 400 Gabonese infants aged 0.5 to 24 months (86 exclusively and 151 partially breast-fed and 163 artificially fed) and in 170 of their mothers in an African urban community. Parasitic prevalence was the same in the stools of the mothers from the 3 infant groups, providing evidence for the same level of exposure to parasites in all infants. Exclusively and partially breast-fed infants excreted parasites in numbers significantly lower than artificially fed infants of the same ages, during the first and the second years of life. This antiparasitic activity of human milk concerned mostly Giardia and ascaris, was not exclusively due to a decreased exposure to parasites in breast-fed infants and did not seem exclusively antibody-mediated; the role of lipids is possible.     

Breast-feeding and diarrheal morbidity

This study used a unique longitudinal survey of more than 3000 mother-infant pairs observed from pregnancy through infancy. The sample is representative of infants from the Cebu region of the Philippines. The sequencing of breast-feeding and diarrheal morbidity events was carefully examined in a longitudinal analysis which allowed for the examination of age-specific effects of feeding patterns. Because the work controlled for a wide range of environmental causes of diarrhea, the results can be generalized to other populations with some confidence. The addition to the breast-milk diet of even water, teas, and other nonnutritive liquids doubled or tripled the likelihood of diarrhea. Supplementation of breast-feeding with additional nutritive foods or liquids further increased significantly the risk of diarrhea; most benefits of breast-feeding alone or in combination with nutritive foods/liquids became small during the second half of infancy. Benefits of breast-feeding were slightly greater in urban environments.     

Breast-feeding in Bangkok, Thailand: Current status, maternal knowledge, attitude and social support

BACKGROUND: The promotion of breast-feeding is one of the essential interventions for reduction of infant mortality and improving infant development worldwide. The aim of the present study was to examine the current status of infant feeding and the influences of suspected family sociodemographic characteristics and social support as well as maternal knowledge, attitudes and behaviours in infant feeding since the Baby-Friendly Hospital Initiative was launched in Thailand. METHODS: A total of 221 mother-infant pairs were randomly drawn from six health care centers in Bangkok from 20 April to 1 May 1998. Health care staff, using a structured questionnaire, interviewed the mothers in the health care centers. RESULTS: Most sampled mothers believed that breast milk was the best food for their infants and knew that breast milk had many advantages for infants, mothers and families. Ninety-five percent of mothers breast-fed their infants up to 3 months postpartum, but the prevalence of exclusive breast-feeding was relatively low (62.4%). Multiple logistic regression analyses revealed that the following factors independently increased the risk of mixed or formula feeding during the first 3 months of life: (i) mothers with a full-time job; (ii) grandmothers and other people as the main child caretakers; (iii) mothers who did not have an antenatal plan of exclusive breast-feeding; and (iv) newborns' non-exclusive breast-feeding in hospitals after birth. However, the mother being a housewife, mother as the main child caretaker, an antenatal plan of exclusive breast-feeding and exclusive breast-feeding in hospital were more likely to improve exclusive breast-feeding. CONCLUSION: The prevalence of exclusive breast-feeding was relatively low. Antenatal plans for exclusive breast-feeding and newborn feeding type in hospital after birth may play key roles in the duration of exclusive breast-feeding. These findings suggest the importance of strengthening implementation of the Baby-Friendly Hospital policy and prenatal health education regarding breast-feeding.