The transfer of alcohol to human milk. Effects on flavor and the infant's behavior

BACKGROUND. The amount of alcohol ingested by a breast-fed infant is only a small fraction of that consumed by its mother, but even this small amount may have an effect on the infant. We investigated whether the ingestion of alcohol by a lactating woman altered the odor of her milk and whether exposure to a small amount of alcohol in the mother's milk had immediate effects on the behavior of the infant. METHODS. Twelve lactating women and their infants were tested on two days separated by an interval of one week. On each testing day, the mother expressed a small quantity of breast milk and then drank either orange juice or orange juice containing a small quantity of ethanol (0.3 g per kilogram of body weight). Additional milk samples were obtained at fixed intervals after the ingestion of the beverage and analyzed to determine their ethanol content. The samples were also evaluated by a panel of adults to determine whether any difference in the odor of the milk was detectable after alcohol ingestion. The infants were weighed before and after nursing to assess the amount of milk they ingested, and their behavior during breast-feeding was monitored by videotape. RESULTS. Short-term alcohol consumption by lactating women significantly and uniformly increased the perceived intensity of the odor of their milk as assessed by the panel; this increase in the intensity of the odor peaked 30 minutes to 1 hour after the alcohol was consumed and decreased thereafter. The alteration in the odor of the milk closely paralleled the changes in the concentration of ethanol in the milk (mean range, 0 to 6.9 mmol per liter [0 to 32 mg per deciliter]). The infants sucked more frequently during the first minute of feedings after their mothers had consumed alcohol (67.0 +/- 6.5 sucks, as compared with 58.4 +/- 5.9 sucks for feedings after the consumption of the nonalcoholic beverage; P less than 0.05), but they consumed significantly less milk (120.4 +/- 9.5 ml vs. 156.4 +/- 8.2 ml, P less than 0.001) during the testing sessions in which their mothers drank the alcoholic beverage. CONCLUSIONS. Although the mechanisms underlying this reduction in milk intake remain to be elucidated, this study shows that short-term alcohol consumption by nursing mothers has an immediate effect on the sensory characteristics (odor) of their milk and the feeding behavior of their infants.     

Beer,breast feeding,and folklore

Beer consumption by nursing women altered the sensory qualities of their milk and the behavior of their infants during breast-feeding in the short term. The infants consumed significantly less milk during the 4-hr testing sessions in which their mothers drank alcoholic beer compared to when the mothers drank nonalcoholic beer; this decrease in milk intake was not due to a decrease in the number of times the babies fed. Although the infants consumed less of the alcohol-flavored milk, the mothers believed their infants had ingested enough milk, reported that they experienced a letdown during nursing, and felt they had milk remaining in their breasts at the end of the majority of feedings. Moreover, the mothers terminated the feeds the same percentage of time on both testing days. The mechanism by which the consumption of alcoholic beer by lactating women decreases milk intake by their nurslings remains to be determined. © 1993 John Wiley & Sons Inc.     

Olfactory conditioning facilitates diet transition in human infants

We evaluated whether Pavlovian conditioning methods could be used to increase the ingestion of non-preferred solutions by formula-fed human infants. In baseline measures, 5-7 month old infants sucked less frequently and consumed less water than regular formula. During a 3-day olfactory conditioning period, parents placed a small scented disk, the conditioned stimulus, on the rim of their infants' formula bottle at every feeding. Following this training, infants' responses to water were tested when their water bottles had a disk scented with the training odor, a novel odor, or no odor. Infants tested with the training odor sucked more frequently and consumed significantly more water than they had at baseline. Infants tested with no odor or a novel odor consumed water at or below baseline levels. These data demonstrate that olfactory conditioning can be used to enhance ingestion in infants and suggest that such methods may be useful for infants experiencing difficulty when making transitions from one diet to another.     

Sucking behaviors of normal 3-day-old female neonates during a 24-hr period

Feeding behaviors were measured during six feeding sessions distributed throughout a 24-hr period in 10 normal 3-day-old female infants. Infants were individually videotaped during feeding sessions at 13:00, 17:00, 21:00, 01:00, 05:00, and 09:00 hours. Total mealtime, nutritive sucking time, pause time, number of nutritive sucks, and amounnt of nutrient consumed were measured. None of these feeding variables were affected by the time of day an infant was fed. Maternal interactions with their infants such as auditory stimulation, caretaking touches or tender touches were unaffected by the time of a feed. These maternal behaviors did not correlate with any of the feeding variables. These findings suggest that 3-day-old infants experiencing routine nursery care do not express specific day-night feeding differences and that certain maternal behaviors do not influence the infants' feeding pattern.     

Development of atopic disease after early administration of cow milk formula

We prospectively studied the incidence of atopic disease in healthy term infants with a birth weight between -1 and -2 SD who were fed a cow milk formula during the first few days of life. A total of 216 infants were randomized to receive either early feeding with formula before normal breastfeeding was started (n = 112) or "normal feeding" with breastmilk (n = 104). Symptoms of allergy developed in 18% of the infants before 18 months of age in the formula fed group, as compared to 33% in the breastfed group (P less than 0.05). The difference was confined to the group of infants with a history of allergy in two family members. Thus, 11% of the formula-fed infants developed allergy symptoms, as compared to 61% of the control infants (P less than 0.01). Our study implies that early feeding during the first days of life with a cow milk formula, before the introduction of breastmilk, may reduce the incidence of allergy symptoms before 18 months of age in infants with a family history of allergy.     

Short-term effect of partially hydrolyzed formula on the prevention of development of atopic dermatitis in infants at high risk

This short-term, prospective study was aimed to assess the effects of partially hydrolyzed formula (PHF) on the prevention of the development of atopic dermatitis in infants at high risk. The infants of parents with allergy symptoms and serum total IgE over 200 kU/L were divided into 3 groups by their feeding patterns: PHF group (n=15), standard formula (SF) group (n=32), and breast milk (BM) group (n=22). No allergenic food was given during the study period of 6 months, and breastfeeding mothers avoided egg ingestion. Their atopic symptoms were monitored every 2 months. The cumulative incidence and prevalence of atopic dermatitis at the age of 6 months were significantly less in the PHF group than in the SF group (47% vs. 78%, p<0.05; 20% vs. 59%, p<0.05). Those rates of the PHF group were also less than those of the BM group, but they were not statistically significant. There was no difference in the onset age and disease severity. These results suggest that early feeding of PHF to infants at high risk has a short-term preventive effect on the development of atopic dermatitis during the first 6 months of life. Long-term preventive effects should be evaluated.     

Maternal alcohol use during breast-feeding and infant mental and motor development at one year

The detrimental effects of maternal drinking during pregnancy on fetal health have been documented. The consequences for infants of maternal drinking during breast-feeding are unknown, but research in animals suggests that the infant could be affected by exposure to alcohol through the mother's milk. In a study of 400 infants born to members of a health maintenance organization, we investigated the relation of the mother's use of alcohol during breast-feeding to the infant's development at one year of age. Mental development, as measured by the Bayley Mental Development Index (MDI), was unrelated to maternal drinking during breast-feeding. However, motor development, as measured by the Psychomotor Development Index (PDI), was significantly lower in infants exposed regularly to alcohol in breast milk (after alcohol exposure during gestation was controlled for), with a dose-response relation (P for linear trend, 0.006). The infants of breast-feeding mothers who had at least one drink daily had a mean PDI score of 98, whereas the infants exposed to less alcohol in breast milk had a mean PDI score of 103 (95 percent confidence interval for the difference of the two means, 1.2 to 9.8). The effect was more pronounced when mothers who supplemented breast-feeding with formula were excluded from the analysis. The association persisted even after we controlled for more than 100 potentially confounding variables, including smoking and other drug use during pregnancy and in the postpartum period. We conclude that ethanol ingested through breast milk has a slight but significant detrimental effect on motor development, but not mental development, in breast-fed infants.     

Breastfeeding and complementary feeding practices in a Swaziland population

Before construction of the Maguga Dam near Pigs Peak in Swaziland commenced, a baseline cross-sectional study was conducted to assess the nutritional status of the population a part of a health status survey. In this article we report the breastfeeding and complementary feeding practices of children younger than two years of age. The study population consisted of people living in three areas, which are likely to be affected by the construction of the Maguga Dam in Swaziland, and two areas approximately 150km away, which were selected because of socio-economic and demographic similarities. The initiation rate of breastfeeding was high, and most of the children were breastfeed for at least 12 months. Sixty percent of infants were introduced to solid foods at the age of 4-6 months. Maize meal porridge was the solid food introduced first to more than 80% of the infants. Approximately two months lapsed before the next solid food was introduced. Although only a small percentage (9.4%) of the mothers used formula milk, less than half of these mothers followed the correct mixing proportions (one scoop formula on 25ml water). When breast milk and solid foods were given during the same feeding session, approximately one third of the mothers gave breast milk first and then the solid foods. This study showed that the initiation and duration of breastfeeding are not a problem in this population residing in Swaziland. The complementary feeding practices of concern were the age of introducing solid foods (28.2% before 4 months and 11.8% after 6 months), the lapse of 2 months before the next solid food was introduced, and the order of feeding breast milk and solids, and the incorrect mixing of formula milk.     

Predictors of treatment use among foster mothers in an attachment-based intervention program

The current study examined predictors of treatment use among 56 foster mothers who participated in an attachment-based intervention program for foster infants. Foster mothers' levels of treatment use were coded at early, middle, and late phases of the intervention program. Foster mothers' states of mind with regard to attachment predicted their understanding of the intervention session concepts. Specifically, autonomous foster mothers showed higher levels of understanding at the start of the intervention program, when compared with non-autonomous foster mothers. State of mind with regard to attachment also predicted foster mothers' levels of reflective functioning during the intervention sessions. Autonomous foster mothers showed higher levels of reflective functioning at early, middle, and late stages of the intervention program, when compared with non-autonomous foster mothers. The relevance of these findings for both treatment effectiveness and treatment delivery is discussed.     

71例病理新生儿母乳再喂养情况调查

目的:探讨因病理原因短期断母乳的新生儿再恢复母乳喂养的可能性以及一些影响因素。方法:对71例因患病而住院,短期与母亲隔离,病愈后出院的新生儿母乳喂养情况进行了上门调查,并分析影响母乳喂养的因素。结果:2个月内母乳喂养率为 67.6％,4个月内母乳喂养率为 54.9％,6个月时母乳喂养率只有 31％,4月内时的纯母乳喂养率为 8.5%。影响母乳再喂养的原因主要是母乳缺乏,其次是母亲、家庭对母乳喂养缺乏足够的认识和信心,其他原因有母婴患病、母亲白天上班有时间冲突等。结论:病理新生儿短期断母乳后仍可恢复母乳喂养。出院后继续哺乳宣教、采取促进乳汁分泌的措施是提高母乳喂养的关键。     

Response of bonnet macaque dyads to an acute foraging task under different motivational conditions.

To explore behavioral patterns in bonnet macaque mother-infant dyads under environmental challenge, the motivation of infants to contact their mothers during a 1-hr foraging period was manipulated in two ways. First, sessions were given in which the infants were separated from their mothers for 3 hr prior to the foraging period. Second, sessions were given in which the infants were allowed access to food prior to the foraging period, thereby presumably reducing their motivation to separate from mother to seek food for themselves during the foraging period. Neither manipulation resulted in heightened conflict within the dyads. Separation of the infants prior to the foraging period did result, in general, in mothers forfeiting foraging task engagement to attend to their infants. The extent to which a mother exhibited this pattern correlated with her level of foraging effectiveness.     

Control of intake by human-milk-fed infants: relationships between feeding size and interval

Diurnal feeding behavior of 24 exclusively breast-fed infants was examined at 2, 4, 6, 8, and 12 weeks to assess whether milk intake at a feeding was related to previous (preprandial) or subsequent (postprandial) intervals between feedings. Amount of human milk consumed per feeding and intervals between feedings were measured over a 72-hr period. Correlation analyses revealed that volume of milk ingested at a feeding (meal size) was positively related to preprandial interval at all 5 ages (r = 0.39-0.47, p less than 0.0001). Meal size was likewise related, but not as strongly, to postprandial interval at 4 of the 5 time points examined (r = 0.17-0.25, p less than 0.01). Results of the correlational analyses revealed clear, consistent preprandial correlations, providing evidence for a reactive type feeding pattern among the solely breast-fed infants. Postprandial correlations, possibly reflect an anticipatory feeding pattern, were present but remained consistently low over the 3 months examined, providing little evidence of a developmental shift. This study provides a preliminary foundation for future longitudinal studies that address the regulation of food intake among infants.     

Bovine β-1actoglobulin in human milk from atopic and non-atopic mothers. Relationship to maternal intake of homogenized and unhomogenized milk

Human milk samples (n = 300) were collected during a 3-week period from 10 healthy mothers and from 10 atopic mothers, all with healthy, solely breast-fed infants. The milk samples were analysed by an enzyme-linked immunosorbent assay (ELISA) for the content of bovine beta-lactoglobulin (BLG). In a cross-over design the atopic and non-atopic mothers alternated their intake of milk between homogenized and unhomogenized milk each week. On day 7, in each week, consecutive milk samples were taken before and 4, 8, 12 and 24 hr after a single ingestion of 500 ml of homogenized or unhomogenized milk. Detectable amounts of BLG (0.9-150 micrograms/l, median value 4.2 micrograms/l) were measured in 19/20 of the mothers (95%), in 9 of 10 atopic mothers and in all 10 of 10 non-atopic mothers. No correlation was found between the type of milk preparation (homogenized or unhomogenized) and the presence of BLG or the level of BLG in human milk. A great intra-individual and inter-individual variation of BLG level was found, and no relationship was observed between BLG levels and atopic status of the mothers. The interval between ingestion of 500 ml of milk and the maximal concentration of BLG on milk-free diet varied between 4 and 24 hr, median value 8 hr. The presence of BLG in human milk is a common finding in both atopic and non-atopic mothers.     

Lack of IgA antibody response in secretions of rat dams during long-term ovalbumin feeding. Induction of systemic tolerance in pups but not in adult rats

Antigen uptake, serum and secretory immune response was studied in rat dams fed pellets substituted with ovalbumin during three consecutive pregnancies and lactation periods. The concentration of ovalbumin was somewhat higher in milk than in serum, and both serum and milk concentrations showed a parallel decrease with feeding time. IgA antibodies did not develop in the milk during the 7-month feeding period and no antibody response could be detected in saliva or bile. By the time of the first lactation about half of the dams had developed low titres of IgG antibodies in serum and milk and the number of IgG responders, as well as the mean antibody titre, increased with each lactation. Also when injected directly into the Peyer's patches ovalbumin induced solely IgG antibodies in the milk, while immunization with ferritin in addition resulted in both IgA and IgM antibodies in the milk against ferritin. The presence or absence of immunological tolerance to ovalbumin was examined in three groups of rats: (1) dams which had been fed ovalbumin-substituted pellets for one pregnancy and the first 14 days of the lactation period, i.e. for approximately 5 weeks altogether; (2) pups that were born by and kept together with these mothers, and (3) pups that were born by and kept together with mothers that were fed ovalbumin-substituted pellets during the pregnancy and until weaning at day 21 (altogether for 6 weeks). The rat dams in group 1 were not tolerant to a subcutaneous injection of ovalbumin 4 weeks after the termination of feeding with ovalbumin-substituted food.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sweet and sour preferences during childhood: role of early experiences

We investigated the effects of early experience on sweet and sour preferences in children. Eighty-three children were divided into four groups based on the type of formula fed during infancy and age. By using a forced-choice, sip-and-swallow procedure, we determined the level of sweetness and sourness preferred in juice. Children who were fed protein hydrolysate formulas, which have a distinctive sour and bitter taste and unpleasant odor, preferred higher levels of citric acid in juice when compared to older children who were fed similar formulas. No such difference was observed between the groups for sweet preference. However, the level of sweetness preferred in juice was related to the sugar content of the child's favorite cereal and whether the mother routinely added sugar to their foods. These data illustrate the wide variety of experiential factors that can influence flavor preferences during childhood.     

Effects of Immigration on Infant Feeding Practices in an Inner City,Low Socioeconomic Community

ObjectiveInfant feeding practices have been shown to differ between immigrants and non-immigrants in the United States. Our study characterizes feeding practices of infants of immigrant versus American-born mothers followed in an inner city Pediatric continuity clinic serving predominantly low socioeconomic status families.MethodsA survey was given to 102 parents of infants ranging from 12 to 15 months of age who attended the clinic. Parents were asked about their country of origin, ethnic background and time since immigration to the US. They were also asked about their breastfeeding and early infant feeding practices. Statistical significance was estimated using chi-squared tests.ResultsNot only were breastfeeding rates higher among immigrant mothers compared to American-born mothers (88% vs. 63%, p-value 0.008) but they introduced commercially available baby food less frequently (37% vs. 52%, p-value 0.03) and rarely fed their infants fast food (22% vs. 50%, p-value<0.001). Moreover, breast feeding rates decreased with duration of residence in the United States. 53% of immigrant mothers who have been in the United States for less than 5 years breastfed for over 6 months versus 22% of immigrant mothers who resided more than 5 years in the United States (p-value 0.02). The vast majority of immigrant mothers who switched to formula did so because they felt their milk production was insufficient (93%) whereas the vast majority of American-born mothers stopped breastfeeding because they perceived it to be painful (64%, p value 0.001).ConclusionsInfant feeding practices differ between immigrant and American-born mothers and the differences diminish the longer the mothers reside in the United States. These differences stem from differences in cultural perceptions of breastfeeding. Therefore, in educating mothers about infant feeding, physicians should strongly consider cultural and ethnic factors.     

Infant sex predicts breast milk energy content

During human evolutionary history, and for many around the world, breast milk is the primary source of nutritional energy for infants. Variation in breast milk quality might logically have important effects on infant health, growth, and development, yet the sources of this variation remain largely unelucidated. We quantified nutrient and energy content of breast milk from 25 healthy, well‐nourished Massachusetts mothers with infants aged 2–5 months. We examined several potential sources of variation in milk quality, particularly feeding patterns, infant sex, and maternal breast growth during pregnancy. After controlling for time since last feeding, a known correlate of milk composition, we found that mothers of male infants produced milk that had 25% greater energy content than mothers of female infants (P < 0.001). Change in maternal bra cup size during pregnancy was associated with 16.17 kcal/100 ml greater energy content of milk (P = 0.009), but was not significant after taking infant sex into account. Greater nutritional investment in sons may account for the greater observed growth rates in male compared to female infants. Am. J. Hum. Biol. 2010. © 2009 Wiley‐Liss, Inc.     

Is ingestion of milk-associated bacteria by premature infants fed raw human milk controlled by routine bacteriologic screening?

Expressed human milk is often used to feed premature infants. Raw milk contains bacteria which may be a source of infection. Milk banks have developed screening programs which combine periodic quantitative milk cultures with arbitrary rules specifying limits of bacterial concentration. It is unknown whether such programs succeed in preventing infants from being fed milk containing bacteria. At the Health Sciences Centre (Winnipeg, Manitoba, Canada), milk is screened once weekly. When a woman's milk is found to have excess bacteria, it is discarded only if she is an unrelated donor (as opposed to an infant's mother). To assess the effectiveness of this screening program, we determined the frequency at which infants fed raw human milk were exposed to milk-associated bacteria and compared the bacterial contents of donor and maternal milk. From February 1986 to April 1987, all human milk fed to 98 premature infants during the first 2 weeks of feeding (n = 10,128 feeds) was cultured quantitatively. Among study infants, 100% were exposed at least once to coagulase-negative staphylococci, 41% were exposed to Staphylococcus aureus, and 64% were exposed to gram-negative bacilli. The proportions of feeds containing bacteria and the quantities (log10 CFU [mean +/- standard deviation]) ingested per positive feed were: 39% and 5.9 +/- 0.5 for coagulase-negative staphylococci; 2.4% and 5.1 +/- 1.0 for S. aureus; and 5.2% and 4.8 +/- 1.1 for gram-negative bacilli. There were no adverse events attributable to ingestion of milk-associated bacteria. Milk coagulase-negative staphylococcal isolates were multiply antibiotic susceptible, whereas infant isolates were antibiotic resistant. Donor milk was significantly less likely than maternal milk to contain coagulase-negative staphylococcal species in any quantity (40 versus 93% of samples, respectively [P < 0.001]) or in concentrations exceeding 10(8) CFU/liter (3 versus 27% of samples, respectively [P < 0.0001]). There was no difference between milk from either source in terms of S. aureus or gram-negative bacterial content (4 to 6%). These results suggest that the Health Sciences Centre screening program is effective in limiting the number of harmless coagulase-negative staphylococcal species but has no impact on the quantity of potentially pathogenic bacteria ingested by premature infants. Implications for screening donor milk are discussed.     

Allomaternal vocal behavior in squirrel monkeys.

Three groups of squirrel monkeys, containing 1-3 infants (N = 7) and 4 adult females each, were observed weekly for the first 12 weeks of the infants' lives. Infants received approximately 100 vocalizations, mostly "caregiver" calls, per waking hour from their mothers and the other adult females with whom they were housed (allomothers). Mothers vocalized very little to their own infants during the first few weeks of life, when infants remain on the mother's back full-time. Instead, allomothers (who were often carrying their own dependent infants) vocalized copiously to others' very young infants. Infants responded vocally to these allomaternal caregiver calls as early as Day 1 but were less responsive to mothers. When infants began leaving the mothers' backs, mothers' rates of calling increased five-fold as they used caregiver calls to retrieve separated infants. Early vocalizing to infants involves them in their first social exchanges and is probably performed by allomothers rather than mothers because the infant rides dorsally in this genus.     

The impact of swaddling upon breastfeeding: A critical review

Introduction

Many parents swaddle their infants to promote sleep and reduce night-waking, however lack of definitive evidence about the pros and cons of swaddling when breastfeeding hinders postnatal recommendations regarding this infant care practice. This review critically examines research conducted on the impact of swaddling upon breastfeeding.

Methods

Only two recent studies on swaddling outcomes have reported infant feed-type, therefore the purpose of this paper is to consider the known effects of swaddling on breastfeeding babies and their mothers. We interpret the existing literature on swaddling in terms of impact on breastfeeding physiology and behaviour during the immediate post-natal period, and as infancy progresses.

Results

Infants swaddled immediately after birth show a delay in initial breastfeeding, less successful suckling at the breast, reduced intake of breastmilk and greater weight loss compared to un-swaddled babies. Swaddling visually obscures feeding cues and reduces crying, thereby eliminating two key feeding prompts typically used by parents/carers.

Conclusions

As swaddled babies cry less, and are fed less frequently than un-swaddled babies some clinical trials position swaddling as a ‘novel weight regulation tool’ to combat obesity. However, in the case of breastfed babies, by reducing feed frequency swaddling may impede maternal milk production and thereby infant growth.