Randomised trial of different rates of feeding in acute diarrhoea.

OBJECTIVE: To compare the effect of different feeding frequencies on the speed of recovery from diarrhoea. METHODS: A randomised, non-blinded trial provided 0.452 MJ/kg/day as either 6 or 12 feeds of cows' milk each day to 262 hospitalised male infants aged 3-12 months with acute diarrhoea. Stool frequency, stool weight, body weight, and diarrhoea complications were monitored until recovery or for 14 days. RESULTS: A proportional hazards regression model controlling for age, diarrhoea aetiology, and severity of dehydration on admission revealed that the frequently fed group had a significantly shorter duration of diarrhoea (hazards ratio, 1.29; 95% confidence interval, 1.002 to 1.653). Frequently fed infants had a significantly greater weight gain and significantly lower faecal frequency and faecal weight. CONCLUSIONS: Breast feeding remains the preferred method of feeding infants with acute diarrhoea, but feeding cows' milk to adequately nourished infants with acute diarrhoea is safe and is more rapidly effective if provided in frequent feeds with low energy loads.     

Differences in the pattern of milk intake between breast and bottle fed infants

Two hundred and nine 6-day-old healthy term infants were test weighed either during bottle feeding (n = 77) or breast feeding (n = 132). Cross-sectional data collection avoided repeated interruptions of individual feeds. Bottle fed infants (fed ad libitum) and breast fed infants consumed a similar feed volume (respectively, 67 ± 2 ml versus 75 ±6 ml, mean ±S.E.M.) over a similar period of time (mean 25 min); yet the pattern of milk flow during feeding was significantly different in the two groups. In bottle fed infants, there was a linear pattern of milk intake over the first 10 min of feeding, by which time 81% of the feed has been consumed, contrasting with a biphasic intake pattern in breast fed infants in whom a total 84% of the feed was consumed either in the first 4 min or between 15 and 19 min after the start of the feed. It is speculated that these differences in the pattern of milk intake could influence the physiological responses to feeding and might account for differences between breast and bottle fed infants in gut hormonal responses to milk feeds.     

Randomised trial of different rates of feeding in acute diarrhoea

OBJECTIVE—To compare the effect of different feeding frequencies on the speed of recovery from diarrhoea.
METHODS—A randomised, non-blinded trial provided 0.452 MJ/kg/day as either 6 or 12 feeds of cows'' milk each day to 262 hospitalised male infants aged 3-12 months with acute diarrhoea. Stool frequency, stool weight, body weight, and diarrhoea complications were monitored until recovery or for 14days.
RESULTS—A proportional hazards regression model controlling for age, diarrhoea aetiology, and severity of dehydration on admission revealed that the frequently fed group had a significantly shorter duration of diarrhoea (hazards ratio, 1.29; 95% confidence interval, 1.002 to 1.653). Frequently fed infants had a significantly greater weight gain and significantly lower faecal frequency and faecal weight.
CONCLUSIONS—Breast feeding remains the preferred method of feeding infants with acute diarrhoea, but feeding cows'' milk to adequately nourished infants with acute diarrhoea is safe and is more rapidly effective if provided in frequent feeds with low energy loads.
     

A study of infant growth in relation to the type of feeding

A total of 133 breast fed newborn babies, and 106 bottle fed babies, were selected and studied prospectively. Details taken of feeding practices have shown that by 5–7 wk of age bottle feeds had been introduced in about 50% of breast fed babies. Entirely breast fed babies received their first solid food later than breast-and-bottle fed or entirely bottle fed babies when such babies were in social class I, II or III, but in social class IV and V entirely breast fed babies were weaned at a similar age to those in the other two groups of babies. In the first 5–7 wk of life there was a significant negative correlation between the increase in skinfold thickness and the skinfold thickness at birth. The study has also shown that the present practice of feeding babies modified milks retards weight gain and the increase in subcutaneous fat in male babies.     

Feeding of infants and young children in tsunami affected villages in Pondicherry

The study was conducted to identify the problems related to feeding of children post tsunami in four villages in Pondicherry. Data were collected from 100 randomly chosen families who had an infant or a young child below 3 years of age during Tsunami. Informants were the mothers. In the population studied, 30% mothers did not exclusively breast feed for 6 months; 58% bottle fed their children and 51% fed their infants with commercial formula. The occurrence of diarrhea was three times higher among children who were fed with free breast milk substitutes (BMS) than in those who were not fed with the same. Those populations, wherein a pre-existing tradition of artificial feeding is present, infants are at further risk during a crisis situation like Tsunami. Breast feeding practices need strengthening even in routine conditions to tackle a disaster rather than intervention after the disaster.     

Relation of breast versus bottle feeding to hospitalization for gastroenteritis in a middle-class U.S. population

In an effort to determine the relation of breast versus bottle feeding to hospitalization for gastroenteritis, children hospitalized for gastroenteritis at the Kaiser-Permanente Medical Center in California were compared with a larger normal population of children discharged from the Center's nursery, for incidence of breast feeding. All infants under 12 months of age admitted to the hospital with acute gastroenteritis between January 1, 1973 and December 31, 1975 were identified. All infants had an acute onset of diarrhea and weight loss, some with vomiting. Variable degrees of clinical dehydration also occurred. 107 infants were admitted during the period of study. The type of feeding--breast or bottle--was obtained from the patients' admission history, nursery records, outpatient clinic charts, or by direct contact with parents. Of the 197 patients admitted with acute gastroenteritis during the study period, only 1 was being breast fed at the time of admission. 40 infants were under 6 months of age. Breast feeding accounted for 28 percent of the infant-months in the 0-6 month age group. The lower than predicted incidence of acute gastroenteritis in the breast fed infants was statistically significant. Although about 1/3 of the bottle fed infants had started breast feeding at birth, all had been switched to the bottle at least 1 month prior to hospitalization. The study data strongly indicate that breast feeding plays a major role in protection against intestinal infections.     

Infant feeding in the second 6 months of life related to iron status: an observational study.

OBJECTIVE: To investigate the relationship between iron status in infancy and type of milk and weaning solids consumed. DESIGN: An observational cohort study. SETTING: 928 term infants from the Avon Longitudinal Study of Parents and Children in 1993-94. METHODS: Haemoglobin and ferritin concentrations at 8 and 12 months were assessed in relation to type and quantity of milk intake at 8 months. RESULTS: By WHO criteria, 22.7% of the infants were anaemic at 8 months and 18.1% at 12 months. More breast--than formula-fed infants were anaemic at 8 and 12 months. Cows' milk as the main drink was associated with increased anaemia at 12 months and low ferritin at 8 and 12 months. No association was found between any nutrients and haemoglobin concentrations. Protein and non-haem iron intakes were positively associated with ferritin concentrations and calcium intake negatively. This effect was more marked in infants being fed cows' milk. More than 25% of infants in the breast milk and cows' milk groups and 41% of infants having >6 breast feeds per day had iron intakes below the lower reference nutrient intake. Feeding cows' milk or formula above 600 ml or >6 breast feeds per day was associated with lower intakes of solids. CONCLUSIONS: Both breast and cows' milk feeding were associated with higher levels of anaemia. Satisfactory iron intake from solids in later infancy is more likely if formula intake is <600 ml per day and breast feeds are limited to <6 feeds per day. Cows' milk should be strongly discouraged as a main drink before 12 months.     

SUPPLEMENTARY FEEDING AND JAUNDICE IN NEWBORNS

ABSTRACT. In a survey it was found that the majority of full-term breast fed infants receive supplementary feeds of water, dextrose solution or infant formula during the first few days of life. Breast fed babies receiving water or dextrose supplements had higher plasma bilirubins on the sixth day of life than bottle fed infants. Supplementation with water or dextrose did not reduce the hyperbilirubinaemia of term, breast fed infants. Since it may prejudice the establishment of breast feeding, we suggest that the practice is abandoned.     

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.     

Infant Feeding Practices in Sydney 1976–77

Allen, Jane, and Heywood, P. F. (1979). Aust. Paediatr. J. , 15, 113–117. Infant feeding practices in Sydney 1976–77. This study reports the results of a survey of infant feeding practices carried out in the Sydney metropolitan area. The sample, 250 children under 12 months of age was stratified by age and sex of infant and parity of mother. Infants were selected from six obstetric hospitals in different geographical locations. The number of children chosen from each hospital was proportional to its contribution to total births. Whilst approximately 80% of mothers attempted breast feeding, only 20% of infants were breast fed at 3 months of age. A high proportion of mothers introduced bottle feeding in the first month of life. Seventy-two percent of mothers had introduced fluids, other than feeding milks, in the first month of life. Forty-six percent had introduced solids, predominantly cereal, by the end of the second month of life. The primary reason for introducing bottle feeding was "unsuccessful breast feed ing" and for cessation of lactation was "low milk supply".     

Type of milk feeding affects hematological parameters and serum lipid profile in Japanese infants

Background: Type and volume of infant feeding determines infant growth, hematological parameters, and serum lipids. Methods: Study subjects consisted of 103 infants who were born vaginally at term, with birthweight >2200 g. Milk feeding amount, type, and anthropometry were measured at 1 and 6 months. Hematological tests and serum lipid profile were assessed at 1 and 6 months. Thirty‐four infants were breast‐fed and 36 were formula‐fed at 6 months. Results: Breast‐fed infants demonstrated similar growth patterns compared with partially breast‐fed or formula‐fed infants, despite the lower milk intake. Infants with higher breast milk intake at 6 months, however, tended to have lower hemoglobin levels. In contrast, higher formula intake at 6 months was related to lower serum total cholesterol. Conclusions: Japanese breast‐fed infants were more likely to be anemic at 6 months, while formula‐fed infants were likely to have low serum lipid levels. Iron‐fortified infant foods may be useful to prevent anemia in breast‐fed infants. Fat quality of infant formulas should be improved to enhance lipid status of formula‐fed infants.     

Clinical and biochemical assessment of a modified evaporated milk for infant feeding

A clinical and biochemical evaluation has been made of a new milk formula, Modified Carnation milk (MCM), based on cows' milk but with the mineral content and concentration of caloric nutrients altered to make it correspond more closely to human milk. MCM produced higher plasma calcium and magnesium concentrations in 6-day-old infants than those produced by unmodified evaporated and dried milks, achieving concentrations closer to those of breast milk. Plasma free amino acid concentrations in MCM-fed infants are nearer breast-fed values than those in unmodified milk-fed infants where higher individual plasma amino acid concentrations persist during the first 3 months. MCM-fed infants had low plasma urea concentrations and lower urine osmolalities at 6 days, 3 weeks, 6 weeks, 3 months, and 6 months than infants fed on the evaporated and dried milks, and similar plasma urea and urine osmolalities to those of breast-fed infants. MCM is likely to be superior to unmodified evaporated and dried milks in preventing convulsions of the hypocalcaemic/hypomagnesaemic/hyperphosphataemic type, and seems less likely to cause hypertonic dehydration. MCM is easily prepared, readily accepted by babies, and appears to be nutritionally adequate for the feeding of term infants.     

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.     

Infant feeding in the second 6 months of life related to iron status: an observational study

Objective

To investigate the relationship between iron status in infancy and type of milk and weaning solids consumed.

Design

An observational cohort study.

Setting

928 term infants from the Avon Longitudinal Study of Parents and Children in 1993–94.

Methods

Haemoglobin and ferritin concentrations at 8 and 12 months were assessed in relation to type and quantity of milk intake at 8 months.

Results

By WHO criteria, 22.7% of the infants were anaemic at 8 months and 18.1% at 12 months. More breast‐ than formula‐fed infants were anaemic at 8 and 12 months. Cows'' milk as the main drink was associated with increased anaemia at 12 months and low ferritin at 8 and 12 months. No association was found between any nutrients and haemoglobin concentrations. Protein and non‐haem iron intakes were positively associated with ferritin concentrations and calcium intake negatively. This effect was more marked in infants being fed cows'' milk. More than 25% of infants in the breast milk and cows'' milk groups and 41% of infants having >6 breast feeds per day had iron intakes below the lower reference nutrient intake. Feeding cows'' milk or formula above 600 ml or >6 breast feeds per day was associated with lower intakes of solids.

Conclusions

Both breast and cows'' milk feeding were associated with higher levels of anaemia. Satisfactory iron intake from solids in later infancy is more likely if formula intake is <600 ml per day and breast feeds are limited to <6 feeds per day. Cows'' milk should be strongly discouraged as a main drink before 12 months.     

How protective is breast feeding against diarrhoeal disease in infants in 1990s England? A case-control study.

AIMS: To assess the effect of several measures of infant feeding on diarrhoeal disease, and whether these effects vary according to markers of social deprivation. METHODS: Case-control study of diarrhoeal disease cases presenting to 34 general practices in England. Controls were stratified on age group, area deprivation index for the practice, and whether or not the practice was in London. Data were available on 304 infants (167 cases and 137 controls). RESULTS: After adjustment for confounders, breast feeding was associated with significantly less diarrhoeal disease. Associations were striking even in infants aged > or = 6 months. They did not vary by social class, but were greater in those living in rented council accommodation and in more crowded households. The effect of receiving no breast milk was stronger in more deprived areas than in less deprived areas. The effect of not receiving exclusive breast milk was stronger in more deprived areas than in less deprived areas. In formula fed infants, there was significantly more diarrhoeal disease in those not sterilising bottles/teats with steam or chemicals. The protective effect of breast feeding did not persist beyond two months after breast feeding had stopped. CONCLUSIONS: Breast feeding protects against diarrhoeal disease in infants in England although the degree of protection may vary across infants and wear off after breast feeding cessation. Education about the benefits of breast feeding and the risks of inadequate sterilisation should be targeted at carers in deprived areas or households.     

Infantile diarrhoea due to water complementation of breast and bottle feeding.

This study investigated the prevalence of unusual infant feeding practices among 204 mothers of infants aged 1-12 months, who were admitted with acute diarrhoea to the only two national hospitals in Kuwait. Ninety per cent of the mothers boiled water to prepare a powdered milk formula, but only 15% boiled water for drinking. Thirty nine infants (19%) were admitted more than once. Better family state in terms of socioeconomic class, maternal education, and breast feeding gave some protection against re-admission, though this was not significant. It seems that the condition of drinking water is an important cause of diarrhoea and hence of re-admission. The number of re-admissions was twice as high among infants drinking unboiled (unfiltered or mineral) water than among those drinking boiled or unboiled but filtered water. Breast feeding is protective if no extra water is given.     

Clinical and biochemical assessment of a modified evaporated milk for infant feeding.

A clinical and biochemical evaluation has been made of a new milk formula, Modified Carnation milk (MCM), based on cows'' milk but with the mineral content and concentration of caloric nutrients altered to make it correspond more closely to human milk. MCM produced higher plasma calcium and magnesium concentrations in 6-day-old infants than those produced by unmodified evaporated and dried milks, achieving concentrations closer to those of breast milk. Plasma free amino acid concentrations in MCM-fed infants are nearer breast-fed values than those in unmodified milk-fed infants where higher individual plasma amino acid concentrations persist during the first 3 months. MCM-fed infants had low plasma urea concentrations and lower urine osmolalities at 6 days, 3 weeks, 6 weeks, 3 months, and 6 months than infants fed on the evaporated and dried milks, and similar plasma urea and urine osmolalities to those of breast-fed infants. MCM is likely to be superior to unmodified evaporated and dried milks in preventing convulsions of the hypocalcaemic/hypomagnesaemic/hyperphosphataemic type, and seems less likely to cause hypertonic dehydration. MCM is easily prepared, readily accepted by babies, and appears to be nutritionally adequate for the feeding of term infants.     

Growth and milk intake of normal infants.

The growth of 94 normal term infants was studied from birth to 6 months. 33 infants were breast fed and the others randomly allocated to one of 3 bottle feeds--Cow and Gate V formula, Baby Milk Plus, and Premium. The weight, length, and head growth velocities were similar in all 4 groups. The infants fed Cow and Gate V formula consumed a larger volume of feed at 3 months than the infants fed the 2 other formulae despite a slower weight gain. It is suggested that this is related to loss of calories in unabsorbed fat. The weight gains of all 4 groups in this study were considerably less than infants fed unmodified milks and early solids, studied in the same region several years later.     

“Breastfeeding” but not at the breast: Mothers' descriptions of providing pumped human milk to their infants via other containers and caregivers

As pumping has become more prevalent among American women, pumped human milk (HM) is on the rise in their infants' diets in place of some or all feeding at the breast. We aimed to fill a gap in knowledge about mothers' motivations, practices and perceptions related to pumping, and about mothers' and other caregivers' motivations, practices, and perceptions related to feeding pumped HM. Results related to providing pumped HM are reported here, and results related to pumping are reported elsewhere. We conducted in‐depth, semi‐structured interviews among a diverse sample of mothers whose infants were fed pumped HM (n = 20), following each up to 1 year postpartum. Data were analyzed using thematic analysis with Atlas.ti. Nearly all mothers felt bottles were necessary to meet infant HM‐feeding goals. Nearly all pumped HM was fed by other caregivers because mothers typically preferred and prioritized feeding at the breast for convenience and maintaining their milk supply. Infants were bottle‐fed HM for several reasons that changed over time, such as mother's absence, latch difficulty, or desire to share the burden and bonding of feeding. Feeding practices differed between feeds from bottles versus at the breast; some infants were bottle‐fed on schedules but fed at the breast on demand. Mothers' methods for storing, transporting, and preparing HM varied substantially and included practices associated with loss of nutrients and microbial contamination. Mothers' reasons for bottle‐feeding HM may affect how much their infants are bottle‐fed. Consumption of pumped HM may not provide the same benefits to infants as feeding at the breast. These findings highlight important avenues for future research into the relationships between bottle‐feeding HM and infant health, growth, and developmental outcomes.     

CHANGES IN HAIR ZINC AND COPPER CONCENTRATIONS OF BREAST FED AND BOTTLE FED INFANTS DURING THE FIRST SIX MONTHS

ABSTRACT. A longitudinal study of 35 full term breast fed (20 males and 15 females; mean birthweight = 3540 g) and 25 full term bottle fed infants (14 males and 11 females; mean birthweight = 3466 g) was carried out to compare the effect of method of feeding on hair zinc and copper concentrations. Hair samples were collected at 30±2, 90±4 and 180±4 days of age and analysed for zinc and copper by instrumental neutron activation procedures. Mean daily zinc and copper intakes were calculated at monthly intervals using three day diet records and test weigh data for the breast fed group. Only the male bottle fed infants showed a significant decline in hair zinc concentration ( p <0.01) during the six-month study period. These results support the suggestion that male infants have a higher requirement for zinc than females in early infancy. No comparable systematic decline in hair zinc levels was evident in the female bottle fed infants or the male and female breast fed infants. The absence of any fall in hair zinc concentrations in the breast fed infants, despite their significantly lower ( p <0.01) dietary zinc intakes compared to the bottle fed group, is attributed to the superior bioavailability of zinc from breast milk. Hair copper levels rose during the first three months in both groups, subsequently declining between 3-6 months. These changes were not significantly related to sex or method of milk feeding, but are associated with the redistribution of copper which occurs during early infancy.