Timing Of Complementary Feeding Research Articles

Early feeding and nutritional status of Portuguese children in the first 36 months of life: EPACI Portugal 2012-a national representative cross-sectional study.

Early feeding practices have a critical role in the future not only in health but also in modulating eating habits. This study aimed to assess breastfeeding and complementary feeding practices and the nutritional status of Portuguese toddlers aged 0-36 months. EPACI Portugal 2012 is a cross-sectional study of a national representative sample. Trained interviewers collected data about early feeding practices and anthropometrics. Body mass index was classified according to World Health Organization criteria. Frequencies and survival analysis were used to characterize variables. More than 90% of children were initiated breastfeeding, around 20% were exclusively breastfed for six months, and about 20% were breastfed at 12 months while complementary feeding was taking place. Exclusive breastfeeding was determined by maternal prepregnancy body mass index (HR 1.01; 95% CI 1.00, 1.03, P=.03) and low birth weight (HR 1.61; IC 95% 1.21, 2.15, P=.001) of the infants. About 90% were initiated complementary feeding between four and six months, and almost 10% were introduced to cow's milk before 12 months. In the second year of life, 83.2% and 61.6% of toddlers have already consumed nectars and sweet desserts, respectively. About one-third of Portuguese toddlers showed a body mass index z-score >1, and 6.6% were overweight/obese (z-score >2). No association was found between the duration of breastfeeding or timing of complementary feeding and the body mass index z-score in children. Despite the low prevalence of exclusive breastfeeding at six months, Portuguese infants effectively comply with dietary recommendations during the first year of life. The transition to the family diet must be carefully made. There is a high prevalence of Portuguese toddlers at least at overweight risk. The duration of breastfeeding or timing of complementary feeding was not associated with the expression of overweight/obesity.

Dietary Practices of Caregivers to Children Aged 6 to 23 Months at Narok County Referral Hospital, Kenya

In Narok County, Kenya, where the challenge of achieving optimal child nutrition persists, particularly in the context of its arid and semi-arid climate, the prevalence of stunting among children is alarmingly high compared to other regions. Addressing this critical issue necessitates an enhancement of caregivers’ dietary practices. A gap in dietary practices among caregivers of children aged 6 to 23 months extends beyond Narok County to encompass broader regions in Africa, including Kenya. Consequently, this study was designed to establish the dietary practices of caregivers within Narok County for children in this age group. All approvals including ethical clearance from the Kabarak University Research and Ethics Committee (KUREC), a research permit from NACOSTI, and a permit from Narok County Referral Hospital were sought before the commencement of the study. This research adopted a descriptive cross-sectional design and a sample size of 108 children aged 6 to 23 months and caregivers were purposively recruited. Data were analysed using SPSS version 25 and ENASMART soft wares. Findings indicate a variation in dietary practices where 68.5% of children were still breastfeeding at the time of data collection; 88% of children were exclusively breastfed during the first 6 months of age. Cereals were consumed more than four times a week by 85.2% of the children although the majority of them (76.9%) did not meet the minimum dietary score. The overall prevalence of wasting, underweight and stunting was 29.6%,15.7%, and 23.1% respectively. The occurrence of stunting in children was related to dietary practices (χ0.245=2, p-value=0.011). The timing of complementary feeding displayed a moderate positive correlation with WAZ (r=0.305, p=0.001) and WHZ (r=0.047, p=0.627). In conclusion, caregivers’ dietary practices varied across the caregivers and contributed to the nutrition outcome of the children in dietary diversity, food adequacy, and nutrient intake. There need to promote proper responsive feeding practices among caregivers to children of this age group.

Complementary Feeding Practices: Recommendations of Pediatricians for Infants with and without Allergy Risk.

To investigate the routine guidance provided by pediatricians concerning the timing of complementary feeding (CF) for both healthy infants and those at a heightened risk of allergies. A total of 233 pediatricians participated in an anonymous online survey that included questions about demographics and recommendations for CF. Specifically, they provided guidance on the types of foods, preparation methods, supplements, time intervals for introducing new foods to infants at low and high allergy risk, and delayed food introductions for high-risk cases. The respondents advised introducing certain foods at specific ages: fruits, starchy non-gluten grains, vegetables, olive oil, and meat were appropriate at 6 months; gluten-rich grains at 7 months; yogurt, hard-boiled eggs, and legumes at 8 months; fish at 8.5 months; and nuts at 9 months. Pediatricians, especially those with less than 15 years of practice, often introduced egg, seafood, gluten-rich grains, legumes, and nuts earlier for high-risk infants. Parenthood and male gender were associated with the earlier introduction of eggs and grains. Greek pediatricians follow a structured food introduction schedule for CF in infants. Interestingly, they tend to delay the introduction of common food allergens and recommend longer intervals between introducing new foods, particularly for high-risk infants. Key Notes: Despite recent evidence-based indications on healthy complementary feeding strategies for infants, discrepancies persist among pediatricians regarding food choices and the order and timing of food introduction, both for healthy infants and those at risk of allergy. Guidance on complementary feeding by pediatricians is influenced by their individual characteristics. Pediatricians tend to delay the introduction of common food allergens and recommend longer intervals between introducing new foods, particularly for high-risk infants.

Timing of complementary feeding for early childhood allergy prevention: An overview of systematic reviews.

To summarise and critically appraise systematic review (SR) evidence on the effects of timing of complementary feeding (CF) on the occurrence of allergic sensitisation and disease. Overview of SRs. AMSTAR-2 and ROBIS were used to assess methodological quality and risk of bias (RoB) of SRs. RoB 2 Tool was used to assess RoB of primary randomised controlled trials (RCTs) (or extracted). The certainty of evidence (CoE) was assessed using GRADE. Findings were synthesised narratively. MEDLINE (via PubMed and Ovid), the Cochrane Library and Web of Science Core Collection (2010 to 27 February 2023). SRs investigating the effects of timing of CF in infants or young children (0-3 years) on risk of developing food allergy (FA), allergic sensitisation, asthma, allergic rhinitis, atopic eczema and adverse events based on RCT evidence. Eleven SRs were included. Only two SRs had low RoB; common issues were failure to report on funding of primary studies and failure to provide a list of excluded trials. Common limitations of included trials were lack of blinding of outcome assessment or detailed trial preregistration, and inadequate handling of high loss to follow up. Primary study overlap was very high for specific FA and slight to moderate for FA in general and other primary outcomes. Introducing specific foods (peanut, cooked egg) early probably reduces the risk of specific FA. Evidence forother allergic outcomes was mostly very uncertain and based on few primary studies. Trials varied regarding timing of CF, nature of complementary foods and population risk, which limited comparability between SRs. For developing guidelines to support decision-making on the timing of CF as a preventive strategy, early introduction of specific foods (i.e. egg and peanut) seems promising and safe, whereas more extensive research is required regarding other allergic outcomes and potential adverse events.

Prevalence of Feeding Problems in Children and Associated Factors-A Cross-Sectional Study among Polish Children Aged 2-7 Years.

The study group consisted of 585 children: 299 boys (51.11%) and 286 girls (48.89%). The study was conducted using a questionnaire-based method, with an indirect survey technique using a web-based form (CAWI). The research tool used was the Montreal Children's Hospital-Pediatric Feeding Program. Groups with the lowest risk feeding problems, risk 0, comprised 445 children (76.06%); group 1, middle difficulties, 59 children (10.08%); group 2, moderate difficulties, 40 children (6.84%); and group 3, most difficulties, 40 children (7.01%). The mean MCH-FS score for the entire study group was calculated and was 37.29 points ± 12.02; for 2 year olds, 35.69 points; for 3 year olds, 37.41 points; for 4 year olds, 38.31 points; for 5 year olds, 38.46 points; for 6 year olds, 37.95 points; and for 7 year olds, 36.06 points. The mean value of the MCH-FS scale for girls was 37.44 points, and for boys, 37.32 points. None of the above parameters correlated with the risk of feeding problems, including age, except with a non-significative tendency to be higher in the youngest age. Breast milk feeding and the time of complementary feeding (CF) in the study group did not influence the risk of feeding problems. Using the full BLW method during CF can protect the child against the occurrence of feeding problems such a food selectivity or picky eating in the future. In our study, children with difficulties during CF, mainly the vomiting reflex, were more likely to develop feeding problems such as food neophobia. Based on our study, we did not observe a correlation between age, gender, and the occurrence of feeding problems, and there was only a non-significant tendency to be higher in the youngest age. However, further research needs to be undertaken to assess how such behaviour affects subsequent feeding difficulties.

The Relationship between the Timing of Complementary Feeding and Maternal Knowledge of Responsive Feeding and the Incidence of Stunting in Children Aged 6-24 Months

In 2021, the prevalence of stunting among toddlers in Wani Primary Health Care (Puskesmas) was still high at 18.2%. Delayed introduction of complementary feeding (MP-ASI) and inappropriate feeding practices, such as lack of responsive feeding, contribute to the occurrence of stunting. The objective of this study was to investigate the relationship between the timing of MP-ASI introduction and maternal knowledge of responsive feeding with the occurrence of stunting among children aged 6 to 24 months. This research employed a cross-sectional design using quantitative analytic observational methods. Simple random sampling was used to select the sample, and data were collected through questionnaire surveys from 126 mothers with children between the ages of 6 and 24 months. The study was conducted in the communities of Nupa Bomba, Bale, and Wani Lumbumpetigo, all located within the working area of Wani Primary Health Care. The results showed that 80.2% of the timing of MP-ASI introduction was inappropriate, and 62.7% of the mothers had insufficient knowledge of responsive feeding. The chi-square test revealed a significant association between the timing of MP-ASI introduction and the occurrence of stunting (p value = 0.047, OR = 0.290), as well as between the occurrence of stunting and maternal knowledge of responsive feeding (p value = 0.008, OR = 0.298). In conclusion, there is a relationship between the occurrence of stunting and the timing of MP-ASI introduction, as well as maternal knowledge of responsive feeding. It is recommended to enhance parental knowledge and attitudes and prevent stunting by providing nutrition education through counseling on proper complementary feeding and responsible childcare practices. This study highlights the importance of improving education and support for mothers to prevent stunting.

Quality of systematic reviews on timing of complementary feeding for early childhood allergy prevention

BackgroundOnly rigorously prepared analyses can provide the highest level of evidence to inform decision-making. Several recent systematic reviews (SRs) examined the hypothesis that the early introduction of specific allergenic complementary foods (CFs) to infants may lead to a lower incidence of one or more allergic outcomes. However, the methodological rigour and quality of reporting of SRs in this area has not yet been systematically evaluated.MethodsWe comprehensively searched PubMed, Medline (Ovid), and Web of Science Core Collection on 13th January 2022, using a pre-specified and tested search syntax for SRs with RCT evidence on the early introduction of allergenic CFs as a means for allergy prevention in infants and children. We examined the quality and risk of bias (RoB) using AMSTAR-2 and ROBIS tools, examined adherence to the Preferred Reporting Items for SRs and Meta-Analyses (PRISMA), and checked whether certainty of the evidence was assessed.ResultsTwelve SRs were included. Application of both tools resulted in similar overall judgements in terms of direction and extent for nine of the 12 SRs. Nine SRs were found to be of critically low to low quality according to AMSTAR-2 and to be at high RoB according to ROBIS. One SR received a moderate quality rating (AMSTAR-2) and high RoB rating (ROBIS). However, for two SRs, judgements between AMSTAR-2 and ROBIS were at stark variance. Only two SRs fully adhered to the PRISMA checklist. Six SRs evaluated the certainty of the body of RCT evidence. Several SRs failed to consider unpublished studies either by an explicit a priori exclusion or by inadequate search strategies.ConclusionsWell-conducted SRs are important for decision-making and informing guideline development, the quality of their methodology should therefore be considered. The methodological rigour and the reporting quality of SRs on the timing of CF for allergy prevention must be improved.Registrationhttps://osf.io/7cs4b.

Associations of Complementary Feeding Practice History and Protein Adequacy Level with Childhood Stunting in the Working Area of Puskesmas Bantaran in Probolinggo Regency

Stunting is often associated with too early complementary feeding time and inadequate protein intake. The purpose of this study was to analyze the relationship between the practice of complementary feeding and the level of protein adequacy with the incidence of stunting in toddlers in the working area of Puskesmas Bantaran Probolinggo regency, East Java. Research used observational analytic with retrospective case control design. The sample were 22 stunted group and 22 non-stunted control group who met the inclusion criteria, and taken by simple random sampling. The sample was a stunting locus village toddler in the working area of Puskesmas Bantaran, Probolinggo Regency with mother as respondents. Data collection instruments included questionnaires of characteristic, SQ-FFQ to assess protein adequacy, and microtoise to measure height. Analysis using Chi-Square and Spearman test. The results showed that stunted toddlers get inappropriate complementary feeding (81.8%) and deficit of protein intake (81.8%). Non-stunted toddlers get the right complementary feeding practices (63.6%) and adequate protein intake (59.1%). There is a relationship between the practice of complementary feeding (p=0.002, OR=7.87) and the level of protein adequacy (p=0.005, OR=6.5) with the incidence of stunting in toddlers. The conclusion of this study is that toddlers with improper complementary feeding practices are 7.87 times higher risk of stunting and toddlers with adequate levels of protein deficit are 6.5 times higher risk of stunting. Mothers should be able to increase the amount of protein intake and proper complementary feeding.

KNOWLEDGE AND PRACTICES OF CHILD CAREGIVERS IN FEEDING CHILDREN AGED 6−36 MONTHS AT THE NUTRITIONAL CLINIC OF CHILDREN'S HOSPITAL 1, HO CHI MINH CITY

Aims: To determine the caregivers' knowledge of complementary feeding timing and the practices of breastfeeding and feeding children. Methods: A cross-sectional study was carried out from January 2022 to March 2022 on 256 caregivers of children aged 6-36 months who visited the Nutritional Clinic of Children's Hospital 1, HoChiMinh City, Vietnam. Face-to-face interviews with caregivers were applied to collect data by questionnaire. Results: More than half of caregivers did not have the proper knowledge about the timing of complementary feeding. The correct knowledge about when to feed children with powder, porridge, and rice was respectively 70.3, 29.7, and 7.4%. The rate of breastfed children was 23.0%. The rate of children using bottles with artificial nipples was 60.8%. The children fed four food groups during the weaning period accounted for 62.1%. Conclusions: The study indicates the limitations in knowledge and practices of breastfeeding and complementary feeding in caregivers. It is necessary to continue promoting communication measures to guide the child's feeding during the complementary feeding period.

An online survey of dietary quality during complementary feeding; associations with maternal feeding self-efficacy and adherence to dietary recommendations

BackgroundParents are the gatekeepers of nutrition in early life and their feeding practices form children’s dietary behaviours. Although maternal characteristics have been associated with certain feeding practices, their relationship with overall quality of complementary feeding diets has not been explored. This study aimed to: assess dietary quality in complementary feeding age; explore its association with maternal and child characteristics; and evaluate the association between complementary feeding practices and child weight.MethodsAn online cross-sectional survey captured data from a self-selected sample of mothers living in the UK with a healthy full-term child in complementary feeding age. A total of 466 mothers completed a questionnaire on their complementary feeding practices, demographics, anthropometrics, rates of maternal food neophobia, feeding self-efficacy, social support, postnatal depression and infant temperament. Dietary quality was assessed using the Complementary Feeding Utility Index (CFUI). Children were classified into underweight, normal weight, overweight and obese.ResultsMajority of participants reported high levels of dietary quality as determined by a mean CFUI score of 80%. High dietary quality was associated with reliance on the NHS recommendation on timing of complementary feeding and maternal self-efficacy in promoting a healthy diet and limiting non-recommended foods. Responsive feeding, longer breastfeeding duration, frequent exposure to fruits and to a high variety of protein-rich animal foods were significantly associated with lighter child weight status. Consumption of sweetened drinks and delayed introduction of lumpy foods were associated with heavier child weight status.ConclusionsThis study provided an evaluation of dietary quality in complementary feeding in a UK sample of children and explored its relationship with maternal and child attributes. Increasing understanding of the current complementary feeding recommendations and strengthening maternal feeding self-efficacy may be key for healthcare professionals and researchers to improving complementary feeding practices.

Timing of Complementary Feeding, Growth, and Risk of Non-Communicable Diseases: Systematic Review and Meta-Analysis.

No consensus currently exists on the appropriate age for the introduction of complementary feeding (CF). In this paper, a systematic review is conducted that investigates the effects of starting CF in breastfed and formula-fed infants at 4, 4–6, or 6 months of age (i) on growth at 12 months of age, (ii) on the development of overweight/obesity at 3–6 years of age, (iii) on iron status, and (iv) on the risk of developing (later in life) type 2 diabetes mellitus (DM2) and hypertension. An extensive literature search identified seven studies that evaluated the effects of the introduction of CF at the ages in question. No statistically significant differences related to the age at which CF is started were observed in breastfed or formula-fed infants in terms of the following: iron status, weight, length, and body mass index Z-scores (zBMI) at 12 months, and development of overweight/obesity at 3 years. No studies were found specifically focused on the age range for CF introduction and risk of DM2 and hypertension. Introducing CF before 6 months in healthy term-born infants living in developed countries is essentially useless, as human milk (HM) and formulas are nutritionally adequate up to 6 months of age.

Association of early feeding practices with dietary patterns of 7-year-olds from the birth cohort Generation XXI

Early feeding practices have been related to child's body mass index (BMI), however, their role in establishing dietary patterns is less well understood. The aim of this study was to examine the association of parent-reported early feeding practices (breastfeeding duration, type of foods and timing of complementary feeding) and dietary patterns identified at age 7 to explain BMI z-scores at 10 years of age. Participants were children from the Generation XXI cohort, evaluated at 4, 7 and 10 years of age (n = 3673). At 7 years-old, dietary intake was assessed with a validated food-frequency questionnaire. Two dietary patterns were previously derived: “Energy-dense foods” (higher in energy-dense foods, and lower in vegetable soup, significantly associated with BMI z-score at 10 years-old, and the “Fish-based” dietary pattern (higher in fish consumption and low in energy-dense foods). Adjusted sex-stratified associations were estimated by generalized linear models. Boys and girls who were never breastfed or were breastfed for a very short duration had lower scores in the “Fish-based” dietary pattern, compared to those with longer breastfeeding durations (Boys: β = −0.219; 95%CI: 0.361; −0.077; Girls: β = −0.223; 95%CI: 0.358; −0.088). No significant associations between breastfeeding and the “Energy-dense foods” dietary pattern were found. Boys and girls who were offered cereals as a first food during complementary feeding, in comparison with soup, presented lower scores in the “Energy-dense foods” dietary pattern (Boys: β = −0.183; 95%CI: 0.292; −0.074; Girls: β = −0.155; 95%CI: 0.259; −0.050), but only girls presented higher scores in the ‘Fish-based’ dietary pattern (β = 0.137; 95%CI: 0.006; 0.267). The age of introduction of complementary feeding was not significantly associated with the dietary patterns. Parents should be supported in their infant feeding decisions, given the potential effects of breastfeeding duration and first foods at complementary feeding on shaping longer term dietary patterns of young children.

Knowledge and practice of nursing mother`s regarding complementary feeding

Complementary feeding is the systemic process of introduction of semisolid or solid food in infant at the right time in addition to mother’s milk in order to provide needed nutrition to the baby. A cross sectional study was conducted from January to December, 2020 to assess the level of knowledge and practice of nursing mothers regarding complementary feeding. Total 177 nursing mother were selected purposively and interviewed with a pre-tested semi-structured questionnaire. Face to face interview was conducted to collect data. P-value less than 0.05 were set as statistically significant. The knowledge and practice score were categorized into good (≥70%), satisfactory (50 to 70%), and poor (≤50%). Out of 177 respondents, majority 109(61.6%) had satisfactory knowledge regarding complementary feeding, 33(18.6%) had good knowledge and rest of them 35(19.8%) had poor knowledge regarding complementary feeding among the nursing mother. On the other hand 62.7% respondents had poor Practices, 24.9% had satisfactory practices and 12.4% had good practices regarding complementary feeding among the nursing mothers. There was highly significant association between knowledge and practice of complementary feeding (p <.000). Nursing mother’s knowledge regarding complementary feeding time was inadequate and practices were inappropriate. . It is the responsibility of health professionals to pass on the current information about proper infant feeding to mothers/care takers for promoting the healthy complementary feeding of the breastfeed child.

Factors Associated with the Stunting in Toddlers in the Work Area of Tikson Raya Public Health Center

Background: Stunting often called stunted or short, is a condition of failure to thrive due to chronic malnutrition and psychosocial stimulation and exposure to repeated infections in the First 1000 Days of Life (from fetus to child aged 2 years). Objective: The purpose of this study was to determine the factors associated with the incidence of stunting in the working area of the Tikson Raya Public Health Center, Banggai Laut District. The quantitative study with a case-control research design was applied. The number of samples used was 90 people with the Stratified Random Sampling technique. The data was collected by a questionnaire and analyzed by using univariate, bivariate, and multivariate analysis. Results: An association between breastfeeding (p=0.009), the timing of complementary feeding (p=0.009), history of infectious disease (p=0.001), basic health practices (p=0.000), environmental sanitation hygiene (p=0.000), knowledge of maternal nutrition (p = 0.000) with the incidence of stunting in the working area of the Tikson Raya Public Health Center, Banggai Laut District. The environmental sanitation hygiene variable was identified as the most related to the value of OR = 17.367. Conclusion: Exclusive breastfeeding, complementary breastfeeding, infectious diseases, basic health practices, environmental sanitation, and knowledge of maternal nutrition are associated with the incidence of stunting in toddlers in the working area of Tikson Raya Public Health Center, Banggai Laut District.

Timing of food introduction to the infant diet and risk of food allergy: a systematic review and Meta-analysis

Objective: To evaluate the relationship between the timing of complementary feeding for infants and the occurrence of food allergy. Methods: The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang Data database were searched for randomized controlled trials (RCTs) about the effects of early introduction of complementary foods in infants on the occurrence of food allergy. Papers published from the establishment of the databases to December 31, 2019 were extracted. The quality of the selected literature was evaluated using the risk-of-bias (ROB) tools in the Cochrane Handbook, and the RevMan 5.3 software was used for meta-analysis. For the complementary food analyzed in a few reports in literature, a systematic review was conducted. Results: A total of 8 RCTs were extracted, and the systematic review and Meta-analysis were carried out according to food types. The results of Meta-analysis showed that compared with late introduction (after 6 months of age), early introduction (before 6 months of age) of eggs (RR=0.60, 95%CI 0.46-0.79) could reduce the risk of egg allergy in infants. The subgroup analysis of the six studies about eggs demonstrated that in infants with a prior or family history of allergic diseases, the introduction of eggs before 6 months of age was associated with reduced risk of egg allergy (RR=0.55, 95%CI 0.40-0.75), and the introduction of raw eggs (RR=0.67, 95%CI 0.49-0.93) and small amount of eggs (equivalent to weekly protein 0-4 g) (RR=0.55, 95%CI 0.36-0.85) before 6 months of age were also associated with reduced risk of egg allergy. In addition, egg supplementation during 4-6 months of age reduced the occurrence of egg allergy compared with supplementation before 4 months of age (RR=0.58, 95%CI 0.43-0.78). The systematic review found no conclusive relationship between early peanut introduction and peanut allergy, nor the correlation between early cow's milk protein introduction and cow's milk protein allergy (P>0.05). Conclusion: Early introduction (before 6 months of age) of eggs in infants' complementary foods can prevent infant egg allergy, but the limitations of the study need to be considered.

A qualitative analysis of factors influencing infant and young children feeding perceptions and practices, of working mothers, in London Borough of Ealing

Introduction: Optimum infant feeding practices, during the first 1000 days of life, are essential for children's health and development. The World Health Organization (WHO) recommends putting the infant to the breast within the first hour of life, and exclusively breastfeeding for six months. If every infant was exclusively breastfed 823,000 infant deaths could be avoided annually. Despite this fact only 41% of infants worldwide are exclusively breastfed. The Global Nutrition Target 5 seeks to increase this figure to 50% by 2025. In the UK, although there is widespread knowledge on the benefits of breastfeeding, with 81% mothers initiating breastfeeding, only 24% are exclusively breastfeeding at 6 weeks. By six months only 1% of mothers are still exclusively breastfeeding. This is the lowest rate in Europe. This research aimed to explore the infant feeding practices and perceptions of a small group of working mothers, with children under the age of five, in the London Borough of Ealing.
 Methodology: This study applied a qualitative methodology to gain a deeper understanding of factors influencing infant and young child feeding practices in a small group of working women. Two gatekeepers were used to recruit 14 participants through a mixture of convenience and snowball sampling. All mothers included were working and living in the Ealing Borough of London with children under five. Methods utilised for data collection included online interviews and open-ended surveys. Data were analysed using an inductive thematic approach, identifying four themes and eleven sub themes from the participants.
 Results: The study identified that mothers sought information on infant feeding from online sources, printed books, family and friends, and educational classes. However, most mothers expressed the need to have more information on different feeding methods and childbirth in general. Mothers highlighted that the main factors influencing their decision on how to feed their baby included the need to develop a strong connection with their baby, nutritional benefits for the infant and general knowledge about the benefits of breastfeeding. Most participants reported that they started breastfeeding at birth. Six mothers exclusively breastfed their baby until six months, followed by the introduction of complementary foods. Three of these mothers continued to breastfeed until nine months. Five mothers started formula feeding within two months due to personal challenges such as lack of support, perceived lack of milk supply and anatomical challenges such as tongue-tied infants. Mothers did not find work as a major barrier to breastfeeding.
 Conclusions: Increased information and support on all aspects of infant feeding could help the UK achieve their 2025 target. The timing of complementary feeding and clear advice on where to seek nutrition support could be included in an English Infant Feeding Strategy, like the strategy implemented in Scotland. More discussion on the small size of an infant’s stomach could reduce early breastfeeding cessation due to perceptions around lack of milk.

Household Food Security and Nutritional Status of Under-Five-Year Children: A Case Study of Nepal

Background: Food security refers to accessing to desirable, nutritious, and healthy foods to live a healthy and productive life. Household food insecurity is an underlying cause of malnutrition in children. In this study, the household food security and its influence on the nutritional status of under-five year children were investigated.
 Methods: A cross-sectional analytical study was conducted from August to November 2019 in Syangja district of Nepal. Of six rural municipalities of the district, Phedikhola Rural Municipality was selected using the lottery method. We found 905 eligible households that have an under-five year child. A total of 289 children entered the study after considering the 40% overall prevalence rate of malnutrition among children under five years of age. Data were collected proportionately from each ward considering the health status and anthropometric measurements of children and household food security using a structured interview schedule and the Household Food Insecurity Access Scale. Descriptive statistics and chi-square tests were applied to assess the situation and determine the association.
 Results: Food insecurity was observed in more than half (52.3%) of the households. Food insecurity was associated (P < 0.001) with the socioeconomic status of the family. Prevalence of stunting (height-for-age), underweight, and wasting (weight-for-height) in children were 28.7%, 20.0%, and 13.9%, respectively. Food security, exclusive breastfeeding, and initiation time of complementary feeding were significantly associated with wasting and underweight (P < 0.05).
 Conclusion: Food insecurity and under-five year malnutrition were highly frequent in the study areas. The improvement of educational, occupational, and economic conditions of the households may be a solution to this problem.

Parental considerations during complementary feeding in higher income countries: a systematic review of qualitative evidence.

Worldwide data suggest a clash between parental complementary feeding practices and recommendations. Understanding the circumstances under which parents form their feeding practices is a crucial step to improve such practices. This paper aimed to systematically review the existing qualitative literature and synthesise the factors that parents take into consideration in relation to complementary feeding. A systematic review was undertaken. Four electronic databases were searched for qualitative studies published after 2001 exploring parental experiences during complementary feeding. A framework that included authors' outcomes of interest was used to extract and synthesise study findings. The Standards for Reporting Qualitative Research were used to critically assess the included studies. Upper-middle- and high-income countries. Parents with a child below the age of 3 years. A total of forty-seven studies met the eligibility criteria and were included in this systematic review. The themes were organised into three main categories: (1) factors related to introduction of complementary foods; (2) factors related to the type of complementary foods and (3) factors related to both timing and type. The selected literature highlights: prevalent baby cues that prompt parents to introduce solid foods; parents' views on the recommended timing of complementary feeding; factors that drive the choice of complementary foods and perceived value in advice received from health professionals and grandmothers. This systematic review indicates factors that can be barriers to complying with the complementary feeding guidelines, and therefore, its findings are pertinent to improving parental feeding practices through intervention studies and through infant feeding education in a primary care setting.

HUBUNGAN MOTIVASI DAN PEKERJAAN IBU DENGAN PEMBERIAN MAKANAN PENDAMPING AIR SUSU IBU (MP-ASI) DINI PADA BAYI DI BAWAH USIA 6 BULAN

Complementary feeding of breastmilk to infants aged less than 6 months can cause health problems such as constipation, diarrhea and allergies. It will have an impact on the nutritional status of the infant. The purpose of this study was to determine the relationship between motivation and mother occupation with complementary feeding of breastmilk to infants under the age of 6 months in Naga Beralih village the work area of Community Health centre Kampar Utara in 2020. This type of research was analytic with cross sectional design. The population of this research was mothers who have infants aged 0-6 months in Naga Beralih village, the working area of Community Health centre Kampar Utara, totaling 41 people. Data collection tools in this study used a questionnaire. Data analysis in this study used univariate and bivariate analysis with chi square. The results showed that most of the respondents have high motivation in giving complementary breastfeeding, most of the respondents work, most of the respondents give complementary foods to infant under the age of 6 months. There was a relationship of motivation with complementary feeding with p value of 0.001. There was a work relationship with the provision of complementary feeding under the age of 6 months in Naga Beralih village the work area of Community Health centre Kampar Utara in 2020 with a p value of 0.002. For health workers, in order to increase education about the importance of complementary breastfeeding by forming classes for infants and toddlers to provide information and demonstrations, especially regarding the amount of complementary breastfeeding, types of food and timing of complementary feeding.

Etiological factors of severe acute malnutrition and impact of nutrition rehabilitation centre: a prospective observational study from Bhavnagar

Background: Severe acute malnutrition (SAM) causes almost half of childhood deaths in children <5 years in developing countries. In India, as National Family Health Survey (NFHS), prevalence of SAM has increased from 6.4 in NFHS-3 (2005-2006) to 7.5% in NFHS-4 (2015-1016); [5.8 to 9.5% Gujarat]. The aim of study was to determine the etiological factors and outcome of SAM and the benefit of nutrition rehabilitation centre (NRC) among 6 months to 5 years children at the Pediatrics, NRC ward, Sir T. General Hospital.Methods: A prospective observational study of 151 SAM children over nine months. Etiological factors were determined by history and relevant investigations, exclude other systemic disorders. Therapeutic nutrition was provided for 14 days. Cases were followed up two weekly for 2 months by monitoring weight after NRC admission.Results: Association was found between Small for gestational age (64.9%), joint family (59.6%) and low birth spacing (59.6%) as etiological factors leading to SAM. 81.5% children gained weight during 14 days NRC stay. Weight gain was noted at follow-up. Defaulter rate increased from 9.9% at discharge to 28.5% at 2 months follow-up. Weight was static for 9% children. 34.4% children were from rural area and 65.6% from urban area. 23.8% children had received pre lacteal feed. Timing of complementary feeding was incorrect in 29%. There were no deaths.Conclusions: Small for gestational age, joint family, low birth spacing, and incorrect feeding practices and urban residence were etiological factors. NRC stay (defaulter rate 26%), produced weight gain in SAM children.