Abstract
The WHO recommends exclusive breastfeeding for the first 6 months of life. However, the transition of the infants' diet to partial breastfeeding with the addition of animal milks and/or solids typically occurs earlier than this. Here, we explored factors associated with the timing of an early transition to partial breastfeeding across seven sites of a birth cohort study in which twice weekly information on infant feeding practices was collected. Infant (size, sex, illness and temperament), maternal (age, education, parity and depressive symptoms), breastfeeding initiation practices (time of initiation, colostrum and pre‐lacteal feeding) and household factors (food security, crowding, assets, income and resources) were considered. Three consecutive caregiver reports of feeding animal milks and/or solids (over a 10‐day period) were characterized as a transition to partial breastfeeding, and Cox proportional hazard models with time (in days) to partial breastfeeding were used to evaluate associations with both fixed and time‐varying characteristics. Overall, 1470 infants were included in this analysis. Median age of transition to partial breastfeeding ranged from 59 days (South Africa and Tanzania) to 178 days (Bangladesh). Overall, higher weight‐for‐length z‐scores were associated with later transitions to partial breastfeeding, as were food insecurity, and infant cough in the past 30 days. Maternal depressive symptoms (evaluated amongst 1227 infants from six sites) were associated with an earlier transition to partial breastfeeding. Relative thinness or heaviness within each site was related to breastfeeding transitions, as opposed to absolute z‐scores. Further research is needed to understand relationships between local perceptions of infant body size and decisions about breastfeeding.
Highlights
The World Health Organization (WHO) recommends that infants are exclusively breastfed for 6 months (Kramer & Kakuma, 2012; Victora et al, 2016; World Health Organization [WHO], 2003); according to national surveys, only 37% of infants less than 6 months of age in low- and middle-income countries (LMIC) are exclusively breastfed (Victora et al, 2016)
Mothers and other caregivers may transition to partial breastfeeding before 6 months for a variety of reasons, including factors related to the child, the mother and other contextual factors outside of the home including cultural norms (Kavle et al, 2017; Scott et al, 2009)
We considered the report of feeding animal milks and/or solids on three consecutive visits prior to 6 months to indicate a transition to partial breastfeeding
Summary
The World Health Organization (WHO) recommends that infants are exclusively breastfed for 6 months (Kramer & Kakuma, 2012; Victora et al, 2016; World Health Organization [WHO], 2003); according to national surveys, only 37% of infants less than 6 months of age in low- and middle-income countries (LMIC) are exclusively breastfed (Victora et al, 2016). Mothers and other caregivers may transition to partial breastfeeding before 6 months for a variety of reasons, including factors related to the child (size, growth, morbidity and their behaviours [fussiness, appearing ready for foods]), the mother (age, education, parity, socioeconomic status, food security, depression, working outside of the home, perceived insufficient milk) and other contextual factors outside of the home including cultural norms (Kavle et al, 2017; Scott et al, 2009). The primary goal of the study was to describe the relationships amongst enteric infections, diet, gut function, and growth and development.
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