Breastmilk and transmission of HIV

The risk of vertical HIV transmission is greatest (20%) during late pregnancy and childbirth. Breast feeding is associated with an additional 14% risk. The risk of infection through breast feeding must be weighed against the dangers posed by artificial feeding. If HIV-positive mothers were to abandon breast feeding without safe alternatives, the resulting infant deaths from diarrhea and respiratory infections could vastly outnumber those from HIV. HIV-infected mothers should be assisted by HIV counselors or health professionals to weigh the risks of both vertical transmission through breast feeding and infections associated with artificial feeding. If an HIV-positive mother has access to adequate breast milk substitutes that she can prepare safely, she should consider artificial feeding. Access to voluntary, confidential HIV testing and counseling is key to any strategy to reduce vertical transmission. Prenatal and obstetric care services aimed at reducing the HIV transmission risk are also essential.     

An enquiry into the attitudes of Muslim Asian mothers regarding infant feeding practices and dental health

Recent studies have highlighted some unfavourable dietary practices among Asian infants in the UK. A number of reasons for such nutritional patterns have been suggested. In the present study, attitudes, beliefs and expectations of 100 first-generation Muslim Asian mothers regarding infant feeding practices were explored through group discussions in their mother tongue.
It was found that mothers generally favoured breast-feeding but lacked knowledge of weaning practices. There was great emphasis on the consumption of milk. The advice from health professionals to discontinue using a feeding bottle by 12 months of age was not considered acceptable. Some mothers thought the change might cause infants to stop drinking milk and that there was little alternative suitable nourishing food available for that age group. The main requirement for infant foods was that they must be halal. Sugar was used either because it ensured that more milk would be consumed, or because it was considered to be intrinsically beneficial. Some mothers fed children on demand, some stated that children chose what they wanted to eat, and that mothers lacked firm control of dietary intake.
Against a background of conflicting advice from health professionals, pressure from in-laws, and the powerful influence of advertising, there is considerable scope for the training of health professionals and for continuing education for families and communities.     

The first weeks of breast feeding

The 2 main causes of the contemporary epidemic of breastfeeding failure appear to be urban life and hospital delivery. In rural areas, the majority of mothers breastfeed successfully. They have much emotional support from experienced women around them, and although some women experience problems, traditional birth attendants are skilled at both preventing and overcoming them. In town, a woman may be surrounded only by young friends as inexperienced as herself and a husband who is impatient of a crying infant. The most obvious solution to any difficulty is a feeding bottle which she can see many modern people using, including some health workers. Hospital delivery contributes to lactation failure by separating the mother and baby to allow them both to "rest," yet mothers who are separated from their babies for even 12 hours stop breastfeeding sooner than mothers who put their baby to the breast immediately after delivery. Possibly the emotional bonding that occurs during the 1st few hours gives a mother the motivation that she needs to persist with breastfeeding when it becomes difficult. In most societies it is customary to let the baby breastfeed immediately, and many traditional birth attendants are aware of how this helps both to stop uterine bleeding and to promote a better flow of milk. In hospitals a baby may be given feeds of formula milk or glucose water, while he/she "waits" for mother's milk to come in. Prelacteal feeds fill a baby's stomach, reduce his/her appetite, and make the baby less willing to suck at the breast. This delays the onset of lactation and increases the dangers of engorgement. If a baby is given his/her prelacteal feeds (or later feeds) from a bottle with a rubber teat, he/she is likely to develop "nipple confusion" and to fail to suck effectively from his/her mother. If hospitals are to be places in which babies may start to feed safely, the staff should let a mother suckle her baby immediately after delivery, and they should let her keep the baby with her and demand feed from the start. The majority of early breastfeeding problems are trivial and are easily if there is someone nearby who knows. Health service administrators should arrange for mothers to have care near home soon after delivery.     

The success of breast feeding

Breastfeeding is a natural and unique system of supply and demand, which best serves both the mother and baby. It is not difficult; it is the attitudes toward breastfeeding that have created problems. Breastfeeding is an art that can be learned, and its skills can and should be made available to every mother who plans to breastfeed. Each mother requires individual teaching in the practicalities of breastfeeding to suit her particular needs and to achieve successful breastfeeding. Regard is paid to the mother's physique and the shape and size of her breasts so that the infant may be correctly positioned. This helps to prevent the development of sore nipples. Breastfeeding ought to be initiated as soon as practical after birth. Demand feeding should continue, taking into account the size and maturity of the baby. The duration of the feeds can be determined by the baby. Rigid timing of feeds leads to reduced efficiency of lactation, and the tension of "clock watching" makes for a fractious baby. Midwives and health workers should assess whether a baby is thrivinge without making the mother anxious by test weighing. A baby is not necessarily hungry when he/she cries, and mothers can be encouraged to assess their babies' needs. Once the basic physiology of breastfeeding has been explained, mothers are their own best therapists. Their need is for a calm individual to sit with them for the duration of an early feed, encouraging them to assess the situation and allowing them time to relax and adjust to their new role. Stress or anxiety in a mother can inhibit the "let down" reflex which releases the milk as the baby feeds. So anxiety results in a hungry baby and a mother who believes she cannot produce sufficient milk. Many mothers have found the continuity of 1 adviser on infant feeding a great support. On returning home this link is maintained over the telphone, where this is available. Often the query may appear minor to the health worker, but to the mother it may help her on the road to successful breastfeeding. Owing to a general lack of public facilities in British towns where mothers can breastfeed, the mothers must delay or cut short their outings in order to breastfeed at home. This added pressure can impede the "let down" reflex. The breastfeeding mother who works is under similar pressures. Possibly recognition of the problem, understanding that there is a maternal desire to breastfeed, and encouraging the mother to succeed, attitudes as professionals and as members of society can be improved.     

What choice in infant feeding methods?

Despite concerted efforts to encourage breast-feeding, one-third of women in the UK choose to formula feed from the onset, and 75% mothers are using formula by four months. Yet these mothers are often denied information on an appropriate formula to use, how to prepare formula correctly or how to sterilise and store bottles of formula or expressed breast milk. This is partly because of a deliberate policy by some health professionals and partly because of the regulations restricting manufacturers from communicating with the public. The author argues that parents are entitled to information on all aspects of infant feeding and infant nutrition, not solely on breast-feeding. Not to provide this may mean infants are put at risk by inappropriate use of breast-milk substitutes and poor hygiene practices in preparing feeds. There should be appropriate collaboration between health professionals, health promotion specialists, Government and the formula manufacturers to ensure a more balanced and realistic approach.     

The influence of health education on breast feedingpractices in Benin City, Nigeria

Many mothers from developing countries including Nigeria are introducing their babies to artificial milk feeding early in life. This is probably due to the rapidly increasing female education whereby working mothers had to go back to work 6–8 weeks after delivery.In this study, only 31·4% of the mothers wholly breast fed their babies at confinement in spite of the health educational activities of breast feeding practices during antenatal clinic (A.N.C.) attendances. Breast feeding declined rapidly after discharge from hospital, and artificial milk feeding was well established at 6–8 weeks, post confinement, for socio—economic reasons.It is suggested that for these working mothers, bottle-feeding practices should be welldemonstrated to them so as to minimize the ill effects that ignorance and malutilization of the artificial milk may cause. For the non-working mothers, health educational activities on the advantages of breast feeding and breast milk should be continuous and continuing.     

我国5城市已婚育龄妇女母乳喂养影响因素分析

目的 :了解城市居民中母乳喂养状况及其影响因素。方法 :以“计划生育问卷调查”的方式 ,对广州等 5城市已婚育龄妇女进行抽样调查 ,以寿命表法等统计方法进行分析。结果 :5城市妇女产后母乳喂养率为 94 .5 7%。平均母乳喂养时间 8.0 1月 ,4个月后继续母乳喂养率为 6 1.0 3%。母亲文化程度高者、初产婴儿产后母乳喂养率高。但继续母乳喂养率 ,受母亲生理及自身文化程度等社会心理特征和家庭多种因素的影响。结论 :母乳喂养受母亲、家庭和社会的多种因素的影响 ,应有针对性地加强产妇出院后继续母乳喂养的宣教工作     

Infant-feeding practices of mothers of known HIV status in Lusaka,Zambia

BACKGROUND: Between 25 and 44% of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) occurs through breastfeeding. As a result, feeding guidelines for infants of HIV-infected mothers are being formulated in many resource-poor countries. The impact of introducing these guidelines on mothers' actual feeding practices has not previously been examined. Infant-feeding practices of mothers of known HIV status who should have received advice during pre- and post-test HIV counselling were assessed and compared with those of uninfected mothers. METHODS: Mothers of infants aged 2-12 months, 55 HIV-infected and 85 HIV-uninfected, were recruited from the HIV Family Support Unit in Lusaka, Zambia. HIV status was known to 121 of these mothers, who had all received pre- and post-test HIV counselling. Feeding practices were determined by verbal questionnaire. RESULTS: All mothers breastfed but only 35% of infants below 4 months were exclusively breastfed (received breast milk only). HIV-infected mothers introduced fluids and weaned their infants significantly earlier than HIV-uninfected mothers (p = 0.03 and p = 0.002, respectively). Infants of HIV-infected mothers had significantly lower weight for age Z (WAZ) scores indicating poorer nutritional or health status (p = 0.004). Commercial formula milk and cow's milk were used by 36 mothers as breast milk substitutes, and were introduced at a median age of 2.5 months. Thirteen mothers gave cow's milk, and no mother added water to cow's milk (as recommended), with two adding sugar and four adding salt. CONCLUSION: Infant-feeding practices of HIV-infected mothers differed significantly from HIV-uninfected mothers, and this may contribute to their poorer growth. Paradoxically these mothers feeding practice could be putting these infants at greater risk of both non-HIV-related morbidity and HIV transmission, as early introduction of foods other than breast milk may increase MTCT.     

Lessons from the polybrominated diphenyl ethers (PBDEs): precautionary principle,primary prevention,and the value of community-based body-burden monitoring using breast milk

Levels of chemicals in humans (body burdens) are useful indicators of environmental quality and of community health. Chemical body burdens are easily monitored using breast milk samples collected from first-time mothers (primiparae) with infants 2-8 weeks of age. Currently, there is no body-burden monitoring program using breast milk in the United States, although ad hoc systems operate successfully in several European countries. In this article we describe the value of such monitoring and important considerations of how it might be accomplished, drawing from our experiences with pilot monitoring projects. Breast milk has several advantages as a sampling matrix: It is simple and noninvasive, with samples collected by the mother. It monitors body burdens in reproductive-age women and it estimates in utero and nursing-infant exposures, all important to community health. Time-trend data from breast milk monitoring serve as a warning system that identifies chemicals whose body burdens and human exposures are increasing. Time trends also serve as a report card on how well past regulatory actions have reduced environmental chemical exposures. Body-burden monitoring using breast milk should include educational programs that encourage breast-feeding. Finally, and most important, clean breast milk matters to people and leads to primary prevention--the limiting of chemical exposures. We illustrate these advantages with polybrominated diphenyl ethers (PBDEs), a formerly obscure group of brominated flame retardants that rose to prominence and were regulated in Sweden when residue levels were found to be rapidly increasing in breast milk. A community-based body-burden monitoring program using breast milk could be set up in the United States in collaboration with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC has a large number of lactating first-time mothers: It has 6,000 clinics nationwide and serves almost half (47%) the infants born in the United States. Educational programs (e.g., those run by WIC) are needed that encourage breast-feeding, especially in lower-income communities where breast-feeding rates are low and where breast-feeding may help protect the infant from the effects of environmental chemical exposures. Education is also needed about reducing chemical body burdens. A body-burden monitoring program would provide valuable data on time trends, background levels, and community hot spots in need of mitigation and follow-up health studies; develop analytic methods for new chemicals of concern; and archive breast milk samples for future analyses of other agents.     

婴儿血铅与母亲血铅和乳铅等因素的相关性研究

目的了解婴儿血铅与母亲血铅和乳铅等因素的相关关系,为防治儿童铅中毒提供参考依据。方法2002年11至12月,采用石墨炉原子吸收光谱法,测定厦门市177名0～11个月的婴儿及其母亲的血铅,并对小儿出生情况及其母亲、家庭环境等相关因素进行问卷调查。结果177例婴儿血铅的几何均值为(0.37±0.15)μmol/L,范围为0.12～1.36μmol/L,≥0.48μmol/L者46例(占25.99%);母亲血铅的均值为(0.50±0.14)μmol/L,范围为0.21～2.38μmol/L;177例中有160例为母乳喂养儿,其中105例采集出乳汁,乳铅的几何均值为(0.17±0.08)μmol/L,婴儿血铅与母亲的血铅和乳铅密切相关,表明母体的铅可以通过乳汁影响到婴儿血铅水平。旧商业区婴儿的血铅、婴儿母亲乳铅水平均高于其他地区,婴儿血铅水平主要与母亲血铅、婴儿月龄和母亲在职等呈正相关关系,而与母亲身高等因素呈负相关关系。结论母乳喂养儿的血铅水平除了与母亲血铅水平相关外,还与乳铅密切相关,因此在婴儿喂养方式的选择和家庭抚育行为方面须引起重视。     

Breast milk vitamin B-12 concentrations in Guatemalan women are correlated with maternal but not infant vitamin B-12 status at 12 months postpartum

In our previous studies, one-third of lactating Guatemalan women, infants, and children had deficient or marginal serum vitamin B-12 concentrations. Relationships among maternal and infant status and breast milk vitamin B-12, however, have not, to our knowledge, been investigated in such populations. Our purpose was to measure breast milk vitamin B-12 in Guatemalan women with a range of serum vitamin B-12 concentrations and explore associations between milk vitamin B-12 concentrations and maternal and infant vitamin B-12 intake and status. Participants were 183 mother-infant pairs breastfeeding at 12 mo postpartum. Exclusion criteria included mother <17 y, infant <11.5 or >12.5 mo, multiple birth, reported health problems in mother or infant, and mother pregnant >3 mo. Data collected on mothers and infants included anthropometry, serum and breast milk vitamin B-12, and dietary vitamin B-12. Serum vitamin B-12 concentrations indicated deficiency (<150 pmol/L) in 35% of mothers and 27% of infants and marginal status (150-220 pmol/L) in 35% of mothers and 17% of infants. In a multiple regression analysis, breast milk vitamin B-12 concentration was associated (P < 0.05) with both maternal vitamin B-12 intake (r = 0.26) and maternal serum vitamin B-12 (r = 0.30). Controlling for the number of breastfeeds per day and vitamin B-12 intake from complementary foods, infant serum vitamin B-12 was associated with maternal serum vitamin B-12 (r = 0.31; P < 0.001) but not breast milk vitamin B-12, implicating a long-term effect of pregnancy status on infant vitamin B-12 status at 12 mo postpartum.     

Beliefs and practices in infant feeding among the Wagogo of Chigongwe (Dodoma rural district), Tanzania. I. Breastfeeding

Fieldwork conducted in 1989-91 among the Wagogo, a semipastoral people in central Tanzania, documented the cultural and social contexts of infant nutrition. 120 breast-feeding mothers were observed extensively and 291 mothers of 322 children attending a health center were interviewed. In this setting, repeated pregnancy and lactation are natural conditions for all adult women. Breast milk is perceived as an essential source of nutrition, energy, vigor, and strength. Lactation failure does not occur in this society. All infants nurse within a few hours of delivery and receive colostrum. The infant remains with the mother night and day, even when she is working in the fields. Breast feeding is on demand, generally in response to crying, and lasts for 2-3 years. Any changes in the quality of breast milk are viewed as associated with maternal disease or witchcraft due to jealousy. "Bad" milk is believed to cause diarrhea and withheld from the infant. In many cases, milk in one breast is perceived as bad and that breast is no longer used for feeding. Sexual intercourse is prohibited during lactation, and women who become pregnant before weaning are shamed. The progressive weakening of the child associated with the cessation of breast feeding at the time of a new pregnancy is viewed as a consequence of the breach of sexual taboos ant not recognized as malnutrition.     

Early termination of breastfeeding among Philippine urban poor

The research objective was to identify factors that caused mothers to terminate breastfeeding prematurely, i.e., before the infant reached his or her 1st birthday. Nursing for at least 1 year was a minimum goal of health authorities in the area of this research. The study was conducted in 2 urban poor areas and in 2 fringe squatter settlements of Cebu City, a metropolitan area of 500,000 people in the central Philippines. The data were collected by 2 women field workers. The 130 participants, who were within 3 months of delivery, pre- or postpartum were recruited in 1979. They were visited in their homes once a month by the worker who weighed the mother and the baby, inquired about their diets, and recorded breastfeeding experiences and plans. Special attention was given to any problems the mothers were having that might interfere with continued nursing. Other than encouraging mothers to use the local health center, workers did not intervene to support breastfeeding. The mothers were followed for at least the crucial 1st 6 months. Many were followed for a year or more. Of those who agreed to participate prior to delivery, and who composed 1/3 of the total group, some 95% initiated breastfeeding. Of the 3 who did not, 2 tried to nurse but gave up when the newborn showed persistent diarrhea. Between 10-20% of babies were on a mixed diet of breast and bottle feeding, some beginning as early as the 1st month when mothers returned to part-time work. Other mothers, feeling that the babies were not getting enough to eat, added bottles regularly. This pattern did not necessarily lead to the early termination of breastfeeding. With the exception of 2 instances when mothers decided that their babies were big enough to get along without breast milk, the mothers were forced by circumstances as they perceived them to wean the child. Almost all the terminations were abrupt, with the mother continuing to have an adequate supply of milk. The insufficient milk situation reported by 9 mothers is an exception. In most cases, stopping was a crisis, because the mothers felt that to continue would endanger the child while to stop would sacrifice the benefits of breastfeeding. The major reasons for early termination are discussed: diarrhea, insufficient milk, returning to work, mother sick or pregnant, infant refuses the breast or is not growing, and milk is salty or not good.     

Breast feeding,breast milk and AIDS

In response to concerns that breast milk can transmit human immunodeficiency virus (HIV) infection, the International Planned Parenthood Federation (IPPF) Acquired Immunodeficiency Syndrome (AIDS) Prevention Unit has developed a series of recommendations. A total of 5 infants have reportedly become infected as a result of breastfeeding when their mothers became infected with HIV in the immediate postpartum period. However, there are even more cases in which women in similar circumstances breastfed their infants and HIV infection was not transmitted. The infectivity of breast milk is probably dependent on factors such as the frequency or timing of appearance of HIV in breast milk, the viral titer, the mother's nutritional and immunologic status, maternal exposure to other viruses, parity, and the integrity of mucosal barriers. In addition, there are possible protective effects of breastfeeding, including reduction of the incidence and severity of diarrhea and gastrointestinal infection; reduction of the infection load and possible protection against the progression of HIV-related diseases; and the essential immunologic, nutritional, childspacing, and emotional benefits to the child. For all these reasons, it is recommended that breastfeeding by the biologic mother should be the feeding method of choice regardless of her HIV antibody status. If the mother cannot breastfeed, the use of pooled or alternative sources of human milk should be considered. In addition, further research is required to determine whether antibody in breast milk is protective and the factors that affect secretion of HIV in breast milk.     

Frequency of isolation of enterotoxigenic staphylococci from milk of nursing mothers in Kaduna, Nigeria.

Milk samples from 251 nursing mothers were screened for enterotoxigenic staphylococci. The incidence of staphylococci in milk samples was 71.3%. Two hundred and sixteen strains were isolated from 179 mothers. Eighty-six (39.8%) of the 216 strains were found to be toxigenic. Enterotoxin type A (SEA) predominated, with 41 strains (19.0%) elaborating it. Twenty-one strains (9.7%) produced enterotoxin B (SEB) while only eight (3.7%) produced enterotoxin C (SEC). Ten strains (4.6%) produced all three types. Enterotoxigenic strains usually produced coagulase, thermonuclease and alpha haemolysin. In this series breast-feeding alone was more common than combined breast and bottle feeding, especially among mothers less than 30 years old. The incidence of reported infantile diarrhoea decreased with increasing age of the mother. Of 16 babies with diarrhoea, 10 (62.5%) had mothers whose milk yielded staphylococci. Six of these were toxigenic. Although no direct relationship between enterotoxigenic staphylococci in the milk of nursing mothers and infantile diarrhoea could be demonstrated, these findings reveal a potential health risk to these infants.     

Infant feeding fractices within white and Asian Communities in inner-city Leeds

A structured questionnaire was devised in order to ascertain infant feeding practices. Multi-lingual interviewers visited the homes of 127 Caucasian and 184 Asian families with infants aged 6–24 months, in inner-city Leeds. The Asian families interviewed were from four-defined communities; Bangladeshis, Pakistanis, Punjabis and Gujaratis.
When compared with asian mothers, Caucasian mothers were more likely to breast-feed, and demonstrated a more positive approach to their chosen feeding pattern whether breast or bottle. Few differences in feeding practices were noted between the distinct Asian groups despite inter-group variations in English language ability, family size and duration of residence in Britain. Most of the Asian infants were still drinking from a feeding bottle at the age of 2 years, and two-thirds of the milk feeds were sweetened. In contrast, the majority of white Caucasian infants were no longer using a feeding bottle at 12 months of age, although one-third drank milk swetened, The mothers interviewed claimed that health professionals had advised them to add items to the milk, and to use vitamin fruit juices.
The feeding practices reported have clear implications for dental health, particularly among the Asain children. There is an urgent need for effective health education initiatives by health advisers based on a thorough evaluation of cultural differences in attitudes and practices     

Mercury in breast milk – A health hazard for infants in gold mining areas?

Breast-feeding can be a source of mercury exposure for infants. The main concern up to now is methyl-mercury exposure of women at child-bearing age. Certain fish species have high levels of methyl-mercury leading to consumer's advisory guidelines in regard of fish consumption to protect infants from mercury exposure passing through breast milk. Little is known about the transfer of inorganic mercury passing through breast milk to infants. Epidemiological studies showed negative health effects of inorganic mercury in gold mining areas. Small-scale gold miners use mercury to extract the gold from the ore. Environmental and health assessments of gold mining areas in Indonesia, Tanzania and Zimbabwe showed a high exposure with inorganic mercury in these gold mining areas, and a negative health impact of the exposure to the miners and the communities. This paper reports about the analysis and the results of 46 breast milk samples collected from mercury-exposed mothers. The median level of 1.87mug/l is fairly high compared to other results from literature. Some breast milk samples showed very high levels of mercury (up to 149mug/l). Fourteen of the 46 breast milk samples exceed 4mug/l which is considered to be a "high" level. US EPA recommends a "Reference Dose" of 0.3mug inorganic mercury/kg body weight/day [United States Environmental Protection Agency, 1997. Volume V: Health Effects of Mercury and Mercury Compounds. Study Report EPA-452/R-97-007: US EPA]. Twenty-two of the 46 children from these gold mining areas had a higher calculated total mercury uptake. The highest calculated daily mercury uptake of 127mug exceeds by far the recommended maximum uptake of inorganic mercury. Further systematic research of mercury in breast milk from small-scale gold mining areas is needed to increase the knowledge about the bio-transfer of mercury from mercury vapour-exposed mothers passing through breast milk to the breast-fed infant.     

Fragile beginnings: identification and treatment of postpartum disorders.

The transition to parenthood has long been recognized as a normal developmental crisis. However, 7 percent to 10 percent of all new mothers experience serious postpartum disorders that lie beyond the realm of the common "maternity blues." Postpartum depression and psychosis are hormonally based psychiatric illnesses that pose risks to the new mother and the family system. Too often, they are misdiagnosed as exclusively psychological and are undertreated by health care professionals. Early detection, assessment, and treatment are critical for the health and safety of both mother and child. Aggressive treatment may include individual and family therapy as well as medication. Women at particular risk for these illnesses should be identified during pregnancy. Efforts also should be made to prevent recurrence after subsequent deliveries.     

The quiet revolution: breastfeeding transformed with the use of breast pumps

A quiet revolution has been taking place in the feeding of US infants in the form of women using electric breast pumps. This revolution in milk expression may be a boon for both mothers and infants if more infants are fed human milk or if they receive human milk for a longer period. Milk expression may also be problematic for mothers, and it may be particularly problematic for infants if they are fed too much, fed milk of an inappropriate composition, or fed milk that is contaminated. As a result, the time has come to determine the prevalence of exclusive and periodic breast milk expression and the consequences of these behaviors for the health of mothers and their infants.     

Infant feeding practices in a poor district of Santo Domingo

During August-December 1989, in the Dominican Republic, local health promoters interviewed 103 primary caretakers and took anthropometric measurements from 103 children aged 3 years and under during home visits in three poor neighborhoods of Los Alcarrizos (Alto de Chavon, Barrio Landia, and Pueblo Nuevo) to examine infant feeding practices. 95% of the mothers had started breast feeding. The median duration of breast feeding was 7.5 months. Almost 33% had quit breast feeding by 3 months. Perception of insufficient milk was the leading reason for early discontinuation of exclusive breast feeding. The local pharmacies in all three communities offered powdered milk. About 25% of mothers began using breast milk substitutes within the first week. A non-infant formula milk powder was the most commonly used breast milk substitute. 30% of mothers stored prepared milk for later feeds, as long as half a day. Only 13% of households had a refrigerator. The most frequently used first weaning foods were orange juice, lime juice, and beans. 76% of mothers had used or were currently using baby bottles. 95% of them reported washing the bottle in boiling water. The median age of introducing the baby bottle was 3 days. Only 44% of mother covered prepared food during storage. The most commonly eaten foods among children aged at least 1 year were milk, beans, rice, and citrus fruits. Yet the children did not eat all these foods daily. 18% of 1-2 year olds and 13% of 2-3 year olds did not eat meats and alternatives regularly. 7% of 1-2 year olds and 10% of 2-3 year olds did not eat fruits and vegetables regularly. 4% of 1-2 year olds and 3% of 2-3 year olds did not eat breads and cereals regularly. About 14% of all children were not consuming any milk at the time of the survey. These findings will be used to refine nutrition education programs in the district to make them more effective.