Sudden infant death syndrome: How much mothers and health professionals know

Background: Behavioral risk factors are associated with sudden infant death syndrome (SIDS). Education about the risk factors of SIDS is important for prevention. Our aim was to determine the knowledge and attitude of parents and health professionals about SIDS. Methods: A total of 174 health professionals and 150 mothers were enrolled in this study. Mothers' data were collected by telephone interview and health‐care professionals were interviewed by the same investigator. Results: Only 39% of mothers were aware of SIDS. Forty‐six percent of the mothers preferred a supine sleeping position for their infant and 16% of the parents were bed‐sharing with their infants. Seventy‐three percent of health professionals selected side, 17% supine and 10% prone sleeping position as the safest sleeping position. Frequencies for awareness of risk factors were: bed‐sharing (75%), soft bedding (70%), pillow use (52%), toys in bed (90%), high room temperature (67%) and smoking (88%). Total knowledge score of health professionals who selected supine sleeping position as the safest was significantly higher (P < 0.001). Conclusion: Most of the mothers were unaware of SIDS and less than half preferred a supine sleeping position for their infant. Only 72% of health professionals recommended a certain sleeping position during family interviews. Health professionals are more often recommending the side sleeping position or prone. Education of families and health professionals for the risk factors of SIDS may reduce the number of deaths from SIDS in Istanbul.     

Determinants of infant feeding choices by Zambian mothers: a mixed quantitative and qualitative study

Choosing an infant feeding mode is complex for human immunodeficiency virus (HIV)-infected African women. We documented infant feeding choices by 811 mothers of infants aged less than 18 months enrolled in the Chilenje Infant Growth, Nutrition and Infection Study of fortified complementary or replacement foods. We also conducted 20 interviews and 4 focus group discussions among women and nurses to explore the issues in depth. Practices of most HIV-infected women did not closely follow national or international guidelines: 26% never initiated breastfeeding, and 55% were not breastfeeding by 6 months post partum. Women of lower socio-economic status and those not meeting criteria for safe replacement feeding were more likely to initiate breastfeeding, to continue longer and to stop at 6 months when provided with free food within the trial. Most HIV-negative women and women of unknown HIV status continued breastfeeding into the infant's second year, indicating limited 'spillover' of infant feeding messages designed for HIV-infected women into the uninfected population. Qualitative work indicated that the main factors affecting HIV-infected women's infant feeding decisions were the cost of formula, the advice of health workers, influence of relatives, stigma and difficulties with using an exclusive feeding mode. Rapidly changing international recommendations confused both mothers and nurses. Many HIV-infected women chose replacement feeding without meeting criteria to do this safely. Women were influenced by health workers but, for several reasons, found it difficult to follow their advice. The recently revised international HIV and infant feeding recommendations may make the counselling process simpler for health workers and makes following their advice easier for HIV-infected women.     

Quality of infant feeding counselling for HIV+ mothers in Brazil: challenges and achievements

AIM: This project aimed to assess the information and counselling on infant feeding in HIV+ mothers. METHODS: A cross-sectional study, based on 118 structured observations of mothers' visits to health professionals (5-8/professional)-in 15 purposively selected HIV/Aids healthcare units in Sao Paulo. RESULTS: The general quality of communication and counselling skills was good: for example, professionals responded to all mothers' questions (98%); kept eye-to-eye contact (82%); encouraged the mother to talk (77.1%). However, the information provided to mothers aimed to help their choices concerning infant feeding was of very poor quality. No mother, for example, was informed about alternatives to formula feeding and the danger of mixed feeding. None was offered the option of using banked breast milk. Only around 20% of mothers were informed about the safe preparation of formula feeding. When counselled by a nutritionist (compared with a paediatrician) more mothers were informed about the correct way to prepare bottle-feeds. No mention was made of cup feeding. CONCLUSION: Although health workers have good communication skills, the information provided to HIV+ mothers is insufficient. Recommending against breast-feeding and providing infant formula may not be enough to achieve safer infant-feeding practices.     

Iron status and infant feeding practices in an urban ambulatory center

The relationship of infant feeding practices to iron status was examined in a group of 280 infants, 9 to 12 months of age, attending a "well-baby" clinic. Of this group, 7.6% were found to be iron depleted, 19.7% were iron deficient without anemia, and 8.2% were iron deficient with anemia. The incidence of iron-deficiency anemia was significantly greater in the black infants than the white infants (14.3% v 2.7%). The introduction of whole cow's milk into the diet had occurred prior to 6 months of age in 29.2% of the infants, and 62.1% of these infants had laboratory evidence of nutritional iron inadequacy, as contrasted with only 21.8% of those with iron deficiencies fed cow's milk after 6 months of age. Of the 21 infants with iron-deficiency anemia, 19 (90.5%) had been fed whole cow's milk prior to 6 months of age. Iron deficiency remains a nutritional problem for infants in an urban setting and is largely a result of the early introduction of whole cow's milk into the diet.     

Maternal knowledge of infant feeding guidelines and label reading behaviours in a population of new mothers in San Francisco, California

The objective of this study was to evaluate the relationship between maternal nutrition knowledge and maternal socio-demographics including participation in the Special Supplemental Women, Infants and Children's (WIC) Program. A cross-sectional study of new mothers at two San Francisco hospitals was conducted using some of the American Academy of Pediatrics' guidelines in a structured questionnaire to assess maternal nutritional knowledge. Maternal nutritional attitudes towards product nutrient labels were also assessed in a questionnaire format. Logistic regression models were used to evaluate the odds of having high maternal nutrition knowledge and of infrequently reading nutrition labels. In multivariate logistic regression models, higher maternal nutrition knowledge (defined as answering all four nutrition questions correctly) was associated with higher income levels defined as ≥$25 000/year, odds ratio (OR) 10.03 95% confidence interval (CI) (1.51–66.74), and in linear models, higher nutritional knowledge was associated with having more children ( P  < 0.01), a higher income ( P  = 0.01) and not being a WIC participant ( P  < 0.01). Mothers with higher incomes were also more likely to read product nutritional labels OR 4.24, 95% CI (1.24–14.51), compared with mothers with lower incomes as were mothers with higher education levels OR 3.32, 95% CI (1.28–8.63). In San Francisco, lower income mothers are at greatest risk for low maternal nutrition knowledge and not reading product nutritional labels. Higher household income was independently associated with increased maternal nutrition knowledge and likelihood of reading nutritional labels. More comprehensive interventions need to target low-income mothers including current WIC participants to help close the nutritional advantages gap conferred by income and education.     

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.     

Dairy intensification,mothers and children: an exploration of infant and young child feeding practices among rural dairy farmers in Kenya

Agricultural strategies such as dairy intensification have potential to improve human nutrition through increased household food security. Increasing dairy productivity could also adversely affect infant and young child feeding (IYCF) practices because of increased maternal stress, demands on maternal time, and beliefs about the timing and appropriate types of complementary foods. Yet, few studies have looked rigorously at how interventions can affect young children (0–60 months). The study explores, within the context of rural dairy farming in Kenya, the relationship between level of household dairy production and selected IYCF practices using a mixed‐methods approach. Six focus group discussions with women involved in dairy farming investigated their attitudes towards breastfeeding, introduction of complementary foods and child diets. Ninety‐two households involved in three levels of dairy production with at least one child 0–60 months participated in a household survey. Quantitative results indicated that women from higher dairy producing households were more likely to introduce cow's milk to infants before they reached 6 months than women from households not producing any dairy. Themes from the focus group discussions demonstrated that women were familiar with exclusive breastfeeding recommendations, but indicated a preference for mixed feeding of infants. Evidence from this study can inform nutrition education programmes targeted to farmers participating in dairy interventions in rural, low‐income settings to minimise potential harm to the nutritional status of children.     

Need to optimise infant feeding counselling: A cross-sectional survey among HIV-positive mothers in Eastern Uganda

Background  

The choice of infant feeding method is important for HIV-positive mothers in order to optimise the chance of survival of their infants and to minimise the risk of HIV transmission. The aim of this study was to investigate feeding practices, including breastfeeding, in the context of PMTCT for infants and children under two years of age born to HIV-positive mothers in Uganda.     

The use of video support for infant feeding after hospital discharge: a study in remote and rural Scotland

This study assesses the feasibility and acceptability of future infant feeding video support after hospital discharge, and investigates general views on the potential of other communication technology in a remote and rural area of Scotland. Mixed survey and qualitative methods were used. A consecutive sample of 403 women were given a questionnaire at discharge from post-natal wards and 91 responded. From the respondents, 20 volunteers were purposively selected for in-depth semi-structured telephone interviews 6–8 weeks after birth. Results demonstrated that two-thirds of survey respondents had access to video communication technology, and 86% supported the availability of an infant feeding video link to the National Health Service, dependent on reassurance that it would be timely, maintain continuity of care and be available from home any time of day or night. However, less than 25% of the survey respondents stated that they would definitely or probably use video via mobile or Internet for advice on breastfeeding problems. When provided with four common post-natal scenarios, the majority preferred face-to-face, followed by telephone support. Rural respondents had reservations about the potential impact of video support on existing face-to-face services, and concerns were raised about ensuring privacy and security. There was no evidence to suggest that support for video link varied depending upon feeding method or experience. No single technology solution suited all women; therefore, any innovations should take account of difference in preference and be multifaceted in terms of encompassing a range of means of communication.     

Understanding infant feeding beliefs, practices and preferred nutrition education and health provider approaches: an exploratory study with Somali mothers in the USA

The objective of this study was to explore Somali mothers' beliefs and practices around infant feeding and education, towards developing a culturally informed infant nutrition curriculum for health providers. Four focus groups were conducted to explore: (1) beliefs about infant feeding, hunger and ideal weight; (2) feeding practices; (3) nutrition education approaches; and (4) provider/mother interactions. Thirty-seven Somali mother participants identified the following themes within these topics: (1) strategies for assessing hunger, satiety and when to feed; shared beliefs that plump babies are healthy, leading to worry about infant weight; (2) context of breast milk adequacy, difficulties breastfeeding and environmental and cultural barriers to breastfeeding, leading to nearly universal early supplementation with formula; (3) preferred education approaches include provider visits with interpreters, Somali language educational materials and advice from older, experienced family members; and (4) desired health provider skills include: listening, explaining, empathy, addressing specific concerns, repeating important information, offering preventive advice and sufficient visit time. This study presents knowledge about Somali beliefs and practices that can directly guide discussions with these families. Given that these infants appear on a trajectory towards obesity, influencing infant feeding practices in the Somali community is a good upstream approach to preventing obesity. These findings will underpin a new infant nutrition curriculum for health providers.     

Child-care and feeding practices of urban middle class working and non-working Indonesian mothers: a qualitative study of the socio-economic and cultural environment

The double-burden problem of malnutrition in many developing countries is occurring against a backdrop of complex changes in the socio-economic and cultural environment. One such change is the increasing rate of female employment, a change that has attracted researchers to explore the possible relationships between maternal employment and child nutritional status. The present study employs a qualitative approach to explore the socio-economic and cultural environments that may influence child-care practices in families of working and non-working mothers with children of different nutritional status and types of domestic caregiver. It was conducted in Depok, a satellite city of Jakarta, Indonesia, and was designed as a case study involving 26 middle class families. The children were categorized as underweight, normal weight and obese, and caregivers were grouped as family and domestic paid caregivers. Twenty-six mothers and 18 caregivers were interviewed. Data were analysed by the constant comparative approach. The study identified five emerging themes, consisting of reason for working and not working, support for mother and caregivers, decision maker on child food, maternal self-confidence and access to resources. It confirmed that mothers and caregivers need support and adequate resources to perform child-care practices regardless of the child nutritional and maternal working status. Further research is required into how Indonesian mothers across a range of socio-economic strata can have increased options for quality child-care arrangements and support with child feeding. Additionally, this paper discussed the importance of enhanced dissemination of health information addressing both child underweight and obesity problems.     

Attitudes,beliefs and social norms regarding infant and young child feeding among Nigerian mothers,fathers and grandmothers across time

Infant and young child feeding (IYCF) interventions in low-resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant type and shifts over time in attitudes, beliefs and social norms related to breastfeeding and dietary diversity (DD). Overall, across time points, we found more discrepancies in attitudes, beliefs and social norms for early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) among different participant types than for DD. Although most participants agreed EIBF and EBF are good practices, mothers believed this more strongly than fathers and grandmothers; however, at endline, a shift towards acceptance of EIBF and EBF appeared among fathers and grandmothers. Across time points, all participant types acknowledged the nutritional and health benefits of green leafy vegetables and animal-source foods but described various barriers to feeding them to children. Across time points, all participant types also highlighted the importance of health workers and antenatal visits as important sources of IYCF knowledge and facilitators to following recommended practices. Insights from this study highlight the importance of including key influencers of IYCF practices in qualitative research.     

The nutritional status and feeding practices among sick urban pre-school children admitted to a major hospital in Accra, Ghana

In a prospective study of 652 sick pre-school children only 33% were found to be adequately nourished. Among the malnourished, 54.3% had first degree malnutrition while 32.3% and 13.4% had second and third degree malnutrition respectively. The majority of malnourished children (72.4%) had undernutrition: kwashiorkor (14.2%), marasmus 7.3%) and marasmic kwashiorkor (6.1%) was relatively less common. Furthermore, 58% of the underweight children were stunted, indicating malnutrition of some considerable duration. Malnutrition was essentially of postnatal origin and closely related to a high incidence of malnutrition-associated illnesses: diarrhoea (74%), measles (51%) and intestinal parasites (54%). Though breast feeding was universal and of adequate duration, milk production was mostly inadequate because of too early supplementation with low-energy cereal gruels with little or no protein-enrichment. The majority of children came from low socio-economic homes (61%) with mostly illiterate or semi-literate mothers. It is essential that newer methods of teaching be employed in the health education of these unfortunate mothers. Health institutions other than well-baby clinics need to have integrated units for nutritional and immunization surveillance and also for serving as avenues for the supply of free supplementary food items to children with poor weight gain, especially those from poor homes. Clinical Nutrition Units are needed to ensure that inpatients receive nutrients sufficient for continuing and catch-up growth.     

A comparison of infant and toddler feeding practices of mothers with and without histories of eating disorders

This preliminary study surveyed the feeding practices of mothers with eating disorder histories through evaluation of mothers' reported feeding styles, child diet composition and restrictive special approaches to feeding. For this non‐randomised cohort study, 25 mothers with eating disorder histories and 25 mothers with no history of an eating disorder with children ages 6–36 months were selected such that the groups were similar based on child age group and child sex. Mothers were compared on self‐reported feeding style using the Infant Feeding Styles Questionnaire and on child diet composition and special feeding approaches using a modified version of the Toddler Diet Questionnaire from the Women, Infants, and Children program. Mothers with eating disorder histories scored lower on the restrictive feeding style subscale than controls. No significant differences were detected between groups in child diet including the percentage of mothers who breastfed, duration of breastfeeding, age at solid food introduction, daily number of meals or snacks or daily frequency of consumption of fruits, vegetables or protein foods. Mothers with eating disorder histories were more likely to report taking a restrictive special approach to feeding such as limiting processed foods or feeding organic foods only. Although mothers with eating disorder histories may not differ greatly from control mothers in terms of child diet composition (smaller effects may not have been detected due to limited sample size), they may be more likely to take restrictive special approaches to feeding which mirror dietary rules common in individuals with eating disorders.