Feeding practices in infants: a 6-month prospective cohort study]

The aims of this work were to assess timing of complementary feeding in infants and to precise the underlying factors that may cause inappropriate complementary feeding. PATIENTS AND METHODS: A cohort of 167 newborns, born in the same maternity ward during a 6 week-period, was prospectively analyzed. Only healthy neonates were included in the study. A phone questionnaire was filled at 4 and 6 months of age to evaluate modality of complementary feeding. Multivariate analysis (segmentation tree, analyse by multiple correspondence) was used to study factors associated with inappropriate diversification. RESULTS: Out of the 167 neonates included in the study, 132 mothers could be contacted at 4 months and 116 at 6 months of age. Sixty-seven per cent of mothers started breast feeding at birth. Among these, 33% still breastfed -at least partially- at 4 months and 17% at 6 months. Fifty-two percent of mothers started complementary feeding before 4 months, and 24% of infants received gluten at 4 months of age. Multi-gravida mothers, mothers aged more than 35 years old and mothers who gave infant or follow-up formulae before 4 months, started complementary feeding significantly earlier (P<0.05). Infants who were formula fed received more frequently complementary feeding before the age of 4 months than breast fed infants (57% vs 33%, P<0.05). CONCLUSION: Our study showed that half of infants were introduced solid food too early and allowed to identify a population at risk that could benefit from nutritional intervention programs.     

Obstetric and infant feeding practices in Punjab: effect of educational intervention.

A survey of obstetric and infant feeding practices in 100 mothers showed that only 17% infants were exclusively breast fed. Antenatal advice regarding breast feeding was given to only 13%. Sixty eight per cent infants were put to breast 24 hours after delivery. Campaign against bottle feeding was then launched. Fifteen months later, a survey on another 100 mothers showed that 44% infants were exclusively breast-fed, antenatal advice was given to 11% mothers and 60% mothers got active postnatal advice regarding disadvantages of bottle feeds. Incidence of exclusive breast feeding was more in infants who were roomed-in with the mother early, started on breast feeding earlier and whose mothers received antenatal advice. It was concluded that even if the percentage of antenatal advice did not improve, active postnatal campaign directed towards dangers of bottle feeding could increase the prevalence of exclusive breast feeding.     

Artificial vs breast feeding: relation to infant health in a middle class American community

The effects of breast feeding in the early months of life on such clinical phenomena as the rate of weight gain, linear growth, frequency of office visits, phone calls and types of clinical morbidity encountered in office practice during the 1st year of the infant's life were examined. The practice was located in a suburban California residential area. This report is based on observations of 113 consecutive infants seen from birth through the 1st year each with at least 4 well-check visits including the 6-month and 12-month checks. 60 of the infants were started on breast feeding and 53 on artificial feeding. Those 52 of the 60 infants who remained fed primarily at breast for the first 3 months of life and often longer were categorized as wholly breast fed. The other 61 infants were classed as bottle fed. The number and percentage of breast fed infants declined slowing during the first 4 months, and more rapidly thereafter. At 3 months, 46% of the mothers were still breast feeding, at 6 months 27%. The method of feeding during the 1st months of life appeared to exert no influence on weight gain and linear growth, or on the frequency of visits for either well- or sick-checks. During the first 6 months, the boys in both feeding groups gained weight more rapidly than did the similarly fed girls. During the second 6 months, the infants of both sexes, breast or bottle fed, gained at the same rate. Fever, gastrointestinal and respiratory disorders occurred with the same minimal frequency in both feeding groups.     

Socio-cultural factors affecting breast feeding and other infant feeding practices in an urban community.

A study of infant feeding practices was carried out as part of a larger longitudinal study of an urban birth cohort in an area of South Delhi, India. 802 mothers of children over 1 year of age were selected randomly for interview. The study group is considered to be a representative sampling of the economic, cultural, and ethnic groups within the population of all of Delhi. Breast feeding was almost universal but for varying durations. 5.5%, 11.7%, and 22.8% of the children were breast fed for less than 1 month, 2 months, and 6 months respectively. Literate and older mothers tended to breast feed for shorter periods of time. Illiterate mothers, on the other hand, tended to prolong breast feeding unduly. The sex of the infant and the duration of the urban stay of the mother did not seem to affect the duration of breast feeding. Supplementation with liquid feeds, 50% diluted buffalo milk in the majority of cases, was begun rather early but the introduction of semisolids and solids was very often unduly delayed. This was particularly true among illiterate mothers. Thus, it is felt that a concerted effort to educate mothers, especially illiterate and underprivileged mothers, regarding the role of breast feeding and the benefits of supplementation feeding would improve infant nutritional status.     

Factors associated with the duration of breast feeding in a privileged society

130 highly motivated middle class women were interviewed 1 year after delivery to investigate the factors associated with successful breast feeding. 82% breast fed for 6 months or longer and 62% did not introduce solids before 4 months. The most common reason for weaning before 6 months was an insufficient milk supply. Weaning before 6 months was closely associated with a delay of more than 2 hours in the first suckling or an instrumental delivery. Insufficient milk was associated with an absence of the ‘let down’ reflex. The results suggest that breast feeding for 6 months or more and the introduction of solids after at least 3 months are feasible for most British mothers and babies.     

Does breastfeeding method influence infant weight gain?

OBJECTIVE: To compare the effect of traditional and "baby-led" breastfeeding advice on early infant weight gain and exclusive breastfeeding rates. DESIGN: Longitudinal cohort study: part prospective, part retrospective. SETTING: One UK general practice. PARTICIPANTS: 63 exclusively breastfed infants in two cohorts: 32 babies born before and 31 babies born after a change in breastfeeding advice. INTERVENTION: A change from baby-led to traditional breastfeeding advice. MAIN OUTCOME MEASURES: Primary analysis: comparison of the effectiveness of the intervention (ie, weight gain expressed as standard deviation score gain (SDSG) between birth and 6-8 weeks) and exclusive breastfeeding rates between babies whose mothers received traditional advice and those whose mothers received baby-led advice. Secondary analysis: relevance of feed length (ie, weight gain expressed as SDSG between birth and 6-8 weeks in babies feeding for 10 min or less from the first breast and those feeding for longer than 10 min). RESULTS: The two groups were equivalent with respect to birth weight, gestational age, and parity. Primary outcome: babies whose mothers received the traditional advice were more likely to be exclusively breast fed up to 12 weeks (log rank chi2 = 9.68, p = 0.002) and gained more weight up to 6-8 weeks than those given baby-led advice (mean SDSG 0.41 (95% CI 0.13 to 0.69) vs -0.23 (95% CI -0.72 to 0.27)). Secondary outcome: irrespective of feeding advice given, babies feeding for 10 min or less from the first breast gained more weight by 6-8 weeks than babies feeding for longer than 10 min (mean SDSG 0.42 (95% CI 0.11 to 0.73) vs -0.19 (95% CI -0.64 to 0.26)). CONCLUSIONS: In this study, traditional breastfeeding advice resulted in increased weight gain and increased exclusive breastfeeding rates compared with baby-led advice. Exclusively breastfed babies who had shorter feeds (10 min or less from the first breast) gained more weight.     

Breast feeding and weaning practices among urban Muslims of district Lucknow.

Data on 73 Moslem women living in an urban area of District Lucknow, India were analyzed to determine duration and frequency of breast feeding, child spacing, and their beliefs about advantages and disadvantages of breast feeding. Physicians attended 78.9% of the deliveries. Nurse-midwives and trained traditional birth attendants delivered the remaining infants. The woman had a average 5.9 children. All women breast fed their infants from day 1. The mothers were more likely to breast feed sons longer than daughters (24.9 months vs. 21.3 months). Median breast feeding duration was 22.4 months compared with 23.8 months for Moslem women in Bangladesh. It declined with parity except for the 1st child which was 23 months and the 5th child which was 17 months (26.7 months for parity 2, 25.6 for parity 3, 14.8 for parity 4, and 11 for parity 6). Infants 3 months old received more feeds each day than those 3 months old (7.5 vs. 5.3). 50% of mothers who breast fed for 12-17 months had a 2-year birth interval and those who breast fed for 2 years had an interval of about 4 years. While 100% of the noneducated mothers and 72.7% of the educated mothers knew that breast feeding maintains a child's health only 36.3% of educated mothers and none of the noneducated mothers knew that it conferred immunity. Mothers began giving their infants other liquids at a mean of 1.4 months. These liquids were water, diluted milk, toned milk, barley water, and pulse's water. The average age for introduction of solid foods (rice, kheer, porridge, bread, biscuits, boiled eggs, egg yolks, bananas, pudding, curd, and wheat) was 8.2 months.     

Maternal education and the incidence and duration of breast feeding: a prospective study

INTRODUCTION: Duration of breast feeding and factors possibly affecting duration were studied in a population of 2174 newborn infants, with gestational age of >37 weeks, who were born in the Department of Obstetrics and Gynaecology at the University of Florence Hospital between November 15, 1997, and November 14, 1998. PATIENTS AND METHODS: Nine hundred mothers agreed to participate in the study. Five questionnaires were completed at the end of the 1st, 3rd, 6th, 9th, and 12th postpartum month. These dealt with infant feeding practices, including breast feeding during the previous week. Breast feeding duration was defined as short (1 month); medium-short (>1 month-<3 months); medium (>3-<6 months); medium-long (>6-<9 months), and long (>9 months). RESULTS: The authors found that 76.3%, 64.7%, 42.3%, 26.4%, and 17% of mothers were still breast feeding at 1, 3, 6, 9, and 12 months after delivery, respectively. The multivariate analysis of the correspondence shows that lack of breast feeding is associated with a birth weight of less than 3000 g, a low level of maternal education, and maternal profession as a housewife or blue collar worker in the commercial sector. A period of breast feeding defined as short or medium-short is associated with mothers who smoke, primiparous mothers, and absence of maternal allergy. The survival curves highlight how the single factor of smoking is an element that leads to a significant difference in the duration of breast feeding. The multiple Cox regression analysis shows a significant negative influence associated with birth weight of less than 3000 g, maternal smoking, and first parity. Above all, among low-birth-weight infants of mothers who smoke, there is a strong correlation with a shorter duration of breast feeding. DISCUSSION: There is still a need for programs that support and encourage breast feeding, focusing particularly on mothers with a low level of education who give birth to a low-weight infant, primiparous mothers, and smokers.     

Breast milk feeding and cognitive ability at 7-8 years

OBJECTIVE: To examine the association between duration of breast milk feeding and cognitive ability at 7-8 years in a birth cohort of very low birthweight infants. DESIGN: 280 survivors from a national birth cohort of 413 New Zealand very low birthweight infants born in 1986 were assessed at age 7-8 years on measures of verbal and performance intelligence quotient (IQ) using the WISC-R. At the same time mothers were questioned as to whether they had elected to provide expressed breast milk at birth and the total duration of breast milk feeding. RESULTS: Some 73% of mothers provided expressed breast milk and 37% breast fed for four months or longer. Increasing duration of breast milk feeding was associated with increases in both verbal IQ (p < 0.001) and performance IQ (p < 0.05): children breast fed for eight months or longer had mean (SD) verbal IQ scores that were 10.2 (0.56) points higher and performance IQ scores that were 6.2 (0.35) points higher than children who did not receive breast milk. These differences were substantially reduced after control for selection factors associated with receipt of breast milk. Nevertheless, even after control for confounding, there remained a significant (p < 0.05) association between duration of breast milk feeding and verbal IQ: children breast fed for eight months or longer had adjusted mean (SD) verbal IQ scores that were 6 (0.36) points higher than the scores of those who did not receive breast milk. CONCLUSIONS: These findings add to a growing body of evidence to suggest that breast milk feeding may have small long term benefits for child cognitive development.     

Breast milk feeding rates of mothers of multiples compared to mothers of singletons.

OBJECTIVE: Over 3% of infants born annually in the United States are from a multiple gestation pregnancy, yet there is little data published about the feeding practices of their mothers. The objectives of this study were to determine and compare the rates of breast milk feeding of mothers of multiples and mothers of singletons. METHODS: Stratified random sampling (n = 686) on the basis of plurality of pregnancy and gestational age at delivery was performed on a 1999 birth certificate database in the greater Cincinnati area. We collected information about infant feeding during the first 6 months of life using a retrospective, self-administered questionnaire and phone interview from mothers of term singletons (TS), preterm singletons (PS), term multiples (TM), and preterm multiples (PM). Data were analyzed using chi-square and logistic or multiple regression. RESULTS: We obtained feeding information from 346 mothers (n = 81 TS, 80 PS, 90 TM, and 95 PM). By 3 days postpartum, PM provided breast milk less often than all other groups: TS = 69%, PS = 66%, TM = 73%, PM = 57% (P =.035). Among mothers who initiated breast milk feeding, the geometric mean duration of at least some breast milk feeding was significantly shorter for PM than for all other groups: TS = 23 weeks, PS = 19 weeks, TM = 24 weeks, and PM = 12 weeks (P =.002). CONCLUSIONS: Further evaluation of the potential causes for the lower breast milk feeding rates among PM is needed to develop effective intervention strategies and increase the number of preterm multiple gestation infants receiving breast milk.     

Breast milk in low birth weight babies

Two hundred low birth weight babies weighing less than 1.8 kg. were studied to evaluate the impact of breast feeding versus top feeding. There was significantly less mortality in the breast fed group as compared with the top fed group (23% vs 47%, P<007). This was true whether the data was analysed for gestational age. or birth weight, although statistical significance was not achieved in some groups, due to small numbers. The rate of infection was lower in the breast fed as compared with the top fed group (35% vs 54%, P<0.001). The cure rate from infection was also higher in the breast fed group (P<001). In the breast fed group the weight gain occurred earlier, although by the 3rd week it was marginally greater in the top fed group.     

Effect of perinatal motivation on breastfeeding in educated mothers

100 mothers were observed in 1972 in a study of perinatal motivation and its affects on the choice of breast feeding. Each subject was approached in the perinatal period and was given information outlining the importance of breast feeding and the adverse effects of artificial feeding. The subjects were then visited on the day of delivery, the day of discharge, the 10th day after delivery, the 20th day after delivery and at the end of each month for 3 months. A control group of mothers who were not motivated were also observed. Although most of the mothers believed breast feeding to be desirable, very few understood the benefits of breast feeding and the problems associated with artificial feeding. Only 20 of the subjects, before motivation, understood that breast milk was a complete food. Out of the 100 mothers who were motivated, 96% breast fed their babies for 3 months following all instructions. The percentage of mothers who breast fed their babies in the control group was 40%. The method of motivation may not be viable on a national level despite its success in this study. A general awareness of breast feeding must lay the backdrop for changes on a national scale.     

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.     

Breast milk and breast feeding in very low birthweight infants.

The feeding of 17 babies weighing less than 1500 g was examined retrospectively. 12 babies started breast feeding at a mean weight of 1324 g and 10 of them were fully breast fed by a mean weight of 1600 g. Their weight gains were comparable with bottle-fed babies receiving expressed breast milk. Practical aspects of breast feeding were considered to be: a knowledgeable maternal and nursing attitude, close mother and baby contact, early expression of breast milk, and early suckling. The increased incidence of breast feeding by mothers of both low birthweight and term babies ensures regular supplies of fresh breast milk. Therefore, sterilisation or storage of breast milk there is unnecessary.     

Breast feeding pattern in urban infants in Chandigarh

The pattern of breast feeding and the factors which determine the practice was assessed in 670 mothers from urban areas of Chandigarh. Unsupplemented breast milk was administered to only 36.6 percent babies until 4 months of age. Women from lower socio economic class, uneducated and poorly educated mothers were more successful than those from the upper socio economic class or with higher education (P=<0.01). The success rate of breast feeding was higher amongst babies born at home (50.0%) as compared to those born in the hospital (32.3%). Similarly, higher proportion of male infants were successfully breast fed (40.3%) as compared to females (31.6%). Amongst the weaned infants in more than 60 percent, breast feeding was discontinued before 1 month of age. The main reason for failure of successful breast feeding was insufficient milk. Promotional efforts for unsupplemented breast feeding should consider some of the above factors for their success.     

Maternal attitude and practices in initiation of newborn feeding

The present study highlights the need for due emphasis on initiation of breast feeding of newborn infants over other traditional prelacteal newborn feeds. Knowledge, attitudes and newborn feeding practices amongst 702 mothers with urban background was recorded. Though 83.5% of mothers had attended the antenatal clinics, only 13.24% had been given breast feeding advice at the antenatal clinics. It is a cause of concern that only 26.35% had initiated the feeding by breast milk and only 16% had given colostrum. A large number of newborns were fed with finger tips and other unhygienic methods. However, most (95.01%) mothers had started breast feeding their newborns before discharge from hospital.     

A PROSPECTIVE STUDY OF INDIVIDUAL COURSES OF BREAST FEEDING

Abstract. A prospective study of the course of breast feeding was carried out in 75 randomly selected women. Weekly interviews were performed from the day after delivery until the termination of breast feeding, but in no case for longer than 6 months. In each case a detailed analysis was made of the factors leading to transient lactation crises or to complete cessation of breast feeding. A second group of 71 mothers, also randomly selected, was interviewed in retrospect only, 6 months after delivery, and served as controls. Twenty-four weeks after delivery 47% of the mothers in the weekly interview group were still breast feeding. The corresponding figure in the control group was 38%. In both groups only few mothers terminated lactation for medical reasons, while about one fourth stopped for some other reason and about one half because of a combination of factors. Brief case reports are presented to illustrate how varying the factors were that threatened breast feeding.     

A prospective study of individual courses of breast feeding.

A prospective study of the course of breast feeding was carried out in 75 randomly selected women. Weekly interviews were performed from the day after delivery until the termination of breast feeding, but in no case for longer than 6 months. In each case a detailed analysis was made of the factors leading to transient lactation crises or to complete cessation of breast feeding. A second group of 71 mothers, also randomly selected, was interviewed in retrospect only, 6 months after delivery, and served as controls. Twenty-four weeks after delivery 47% of the mothers in the weekly interview group were still breast feeding. The corresponding figure in the control group was 38%. In both groups only few mothers terminated lactation for medical reasons, while about one fourth stopped for some other reason and about one half because of a combination of factors. Brief case reports are presented to illustrate how varying the factors were that threatened breast feeding.     

Cigarette smoke exposure and development of infants throughout the first year of life: influence of passive smoking and nursing on cotinine levels in breast milk and infant''s urine

The effects of smoke exposure via mothers' milk and/or via passive smoking during the first year of life were investigated in a prospective longitudinal matched-pair study. The somatic and mental development of 69 infants whose mothers smoked more than five cigarettes per day throughout pregnancy and continued smoking after childbirth were compared with 69 children of non-smoking mothers. At birth, mean body weight of neonates from smoking mothers was significantly lower than the weight of neonates from non-smoking mothers. This weight difference between the two groups was no longer significant in infants at 12 months of age. With the methods employed by the authors, neither psychomotor nor mental development was affected by smoke exposure during pregnancy and early infancy. Infections of the lower respiratory tract were more frequent in the children of smoking mothers. These mothers weaned their babies earlier than non-smokers, but the different feeding behaviour did not influence any of the clinical parameters that were investigated in this study. In order to evaluate the extent of smoke exposure, cotinine was measured in children's urine and in breast milk once a month throughout the first year of life. Cotinine in the urine was significantly dependent on feeding behaviour: infants breast fed showed concentrations 10-fold higher than those who were bottle fed. Cotinine excretion in urine of infants from smoking mothers, who were not breast fed (nicotine exposure via passive smoking only) was even higher than that of adult passive smokers. If infants from smoking mothers were breast fed, their urinary cotinine excretion was in the range of adult smokers.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Copenhagen cohort study on infant nutrition and growth: duration of breast feeding and influencing factors

Michaelsen KF, Larsen PS, Thomsen BL, Samuelson G. The Copenhagen cohort study on infant nutrition and growth: duration of breast feeding and influencing factors. Acta Pædiatr 1994;83:565–71. Stockholm. ISSN 0803–5253
Duration of breast feeding was studied in 249 randomly chosen, healthy, term infants of Danish origin of which 80.7% participated. Breast feeding was initiated by 99.5% of the mothers. At 3, 6 and 9 months, 71%, 52% and 33%, respectively, were still breast feeding. Only 1 infant (0.5%) was exclusively breast fed beyond 7 months of age. In a Cox multiple regression analysis of factors influencing duration of breast feeding, we found a positive association with maternal education ( p < 0.001) and age ( p = 0.02) and a negative association with the amount of formula given at the maternity ward ( p < 0.001). Six months after delivery, 79% of the mothers with higher school education ( 12 years) were still breast feeding, compared to 29% with a low school education ( 9 years). There is still a need for an increased effort to support mothers in breast feeding, focusing particularly on younger mothers with short school education. Formula supplements during the first days of life, given to 73% of the infants, were associated with a shorter duration of breast feeding and should be discouraged.