Early Complementary Feeding Research Articles

Advancement in Texture in Early Complementary Feeding and the Relevance to Developmental Outcomes.

A child's transition to independent eating is a protracted process that progresses over the course of many years. Although major health agencies, such as the World Health Organization, now offer clear guidance when to begin introducing solids, advice about how to safely transition to progressively challenging foods is varied and comes from a staggering number of sources. The resulting conflicting views have promoted parental confusion and anxiety about what foods are appropriate and when to advance to new textures. Efforts to develop science-based recommendations for complementary feeding include research on the development of chewing motor skills. Chewing development is an essential aspect of feeding readiness that is often overlooked by agencies developing recommendations for complementary feeding, and little is known about the development of chewing motor skills and how children learn to accommodate foods with varying textures. Such information is essential for designing developmentally appropriate foods, minimizing food aversions, providing caregivers science-based guidance regarding the safety and appropriateness of new foods, and identifying children at risk for choking or feeding impairments.

Factors Influencing Mothers to Initiate Early Complementary Feeding in Darjeeling, West Bengal

Factors Influencing Mothers to Initiate Early Complementary Feeding in Darjeeling, West Bengal

Conflict or congruence? Maternal and infant-centric factors associated with shorter exclusive breastfeeding durations among the Tsimane

Six months of exclusive breastfeeding (EBF) is considered optimal for infant health, though globally most infants begin complementary feeding (CF) earlier—including among populations that practice prolonged breastfeeding. Two frameworks for understanding patterns of early CF emerge in the literature. In the first, maternal and infant needs trade-off, as “maternal-centric” factors—related to time and energy demands, reproductive investment, cultural influences, and structural barriers— favor supplanting breastfeeding with earlier and increased CF. A second framework considers that “infant-centric” factors—related to infant energetic needs—favor CF before six months to supplement breastfeeding.We apply these two frameworks in examining early CF among the Tsimane—a high-fertility, high-mortality, forager-horticulturalist population residing in the Bolivian Amazon. Data were collected from a mixed-longitudinal sample of 161 Tsimane mother-infant pairs from August 2012–April 2013. Tsimane mothers generally reported introducing CF because of perceived infant needs. However, CF is introduced with continued intensive breastfeeding, and generally coupled with premastication. Risks of earlier CF relative to the minimum hazard (estimated at 5 births) were elevated for lower and higher parity mothers, but were significantly greater only after 9 births. Seventeen percent of mothers reported introducing CF because of low milk supply. Introducing CF because of low milk was most common from 0 to 3 months of age and among higher parity mothers, which may reflect physiological constraints. Maternal reproductive trade-offs and perceived infant needs may help explain the low prevalence of EBF to six months among other populations in which breastfeeding is not structurally or culturally constrained.

The timing of complementary feeding in preterm infants and the effect on overweight: study protocol for a systematic review.

BackgroundIn term infants, there is evidence that early complementary feeding is a risk factor for childhood obesity. Therefore, timely introduction of complementary feeding during infancy is necessary. The World Health Organization (WHO) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) both developed recommendations for the start of complementary feeding for term-born infants. However, these guidelines cannot be directly translated to preterm infants. Recent literature looking at the introduction of complementary feeding in preterm infants gives contrasting information. Given these contrasting reports on the introduction of solid foods in premature born infants, a systematic review is needed. The primary objective of this study is to analyze the effect of the time starting complementary feeding on overweight (including obesity) in preterm infants.MethodsAn electronic systematic literature search with pre-defined terms will be conducted in Cochrane, PubMed, EMBASE, Web of Science, Scopus, and CINAHL. There will be no restriction for time period. Primarily, data from randomized controlled trials (RCTs) will be included in this systematic review. Search terms will include preterm infants, complementary feeding, overweight, and their synonyms. Article selection, including risk of bias assessment, will be performed by three reviewers independently. Body mass index standard deviation score (BMI-SDS or BMI-Z-score) will be used to compare studies. The consistency of results across the studies will influence the decision whether or not to combine results in a meta-analysis. Studies that cannot be included in the meta-analysis will be described in a narrative analysis.DiscussionThis systematic review will give an overview of the existing knowledge on the timing of complementary feeding in preterm infants and the effect on overweight. It will form a basis for future guidelines for complementary feeding for preterm infants.Systematic review registrationPROSPERO CRD42015014215Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0324-3) contains supplementary material, which is available to authorized users.

Factors Associated with the Early Introduction of Complementary Feeding in Saudi Arabia.

Mothers’ instigation of complementary feeding before their infant reaches 6 months old risks shortening their breastfeeding duration, and high morbidity and mortality for their child. Complementary feeding practices require further investigation in Saudi Arabia. The present study aims to evaluate complementary feeding practices, and to establish which factors are associated with the early introduction of complementary feeding in the Saudi Arabian context. Cross-sectional research was conducted with 632 mothers of infants aged between 4 and 24 months attending five primary health care centers (PHCCs) between July and December 2015 in Saudi Arabia. Data on participants’ socio-demographic characteristics and complementary feeding practices were collected via structured questionnaires. A regression analysis identified the factors associated with the early introduction of solid foods, defined as before 17 weeks. 62.5% of the study’s infants received solid foods before reaching 17 weeks old. The maternal factors at higher risk of early introduction of solids were: younger age; Saudi nationality; shorter education; employment within 6 months post-birth; caesareans; not breastfeeding fully for six weeks post-birth, and living in low-income households. Complementary feeding prior to 6 months postpartum was common in Saudi Arabia. Public health interventions are needed to reduce early complementary feeding, focusing on mothers at highest risk of giving solids too early.

A review of infant and young child feeding practice in hospital and the home in KwaZulu-Natal Midlands

Background: Malnutrition remains a major health burden globally. To date the focus in South Africa has been on exclusive breastfeeding from birth to 6 months, with less attention on feeding of the infants beyond 6 months.Objectives: To describe infant and young child feeding practices at home and in hospital in KwaZulu-Natal Midlands, South Africa, and determine if feeding practices conform to national feeding policies. No statistical correlation was done.Methodology: A descriptive study, using structured questionnaires for mothers of infants and young children up to the age of five years, and healthcare professionals in state hospitals, was conducted in 2011 in 12 hospitals in the KwaZulu-Natal Midlands, South Africa.Results: Seventy-six percent (76%) of infants were ever exclusively breastfed with just 36% being exclusively breastfed beyond three months. Complementary feeds were commenced in 84% of infants younger than 6 months of age. Age-specific meals were provided for children below 2 years (93%) and for participants above 2 years (78%). Approximately 61% of infants and children between 6 and 24 months received more than three cups of milk per day in hospital with only 26% of children between 2 to 5 years receiving any milk. Majority of children (48%) aged 2 to 5 years received only one snack per day, which is suboptimal.Conclusion: Feeding messages focus on breastfeeding. Breastfeeding rates have improved in this region since 2003, but exclusive breastfeeding is of limited duration. Early complementary feeding is a problem in the Midlands. This study has identified that age-specific feeding of infants and young children is not recognised in state hospitals, due to the inadequate frequency of feeding. There is a discrepancy between intention and practice among healthcare professionals in feeding infants and young children. Feeding messages have to expand beyond breastfeeding and complementary feeding, with ongoing training of healthcare professionals in this field.

Infant Feeding Practices in A Well Baby Clinic of A Tertiary Hospital in North Kerala

Authors Dr Kavitha Pavithran, Dr Anil kumar Aalinkeel, Dr Ravikumar Payora Department of Pediatrics, A.C.M.E Pariyaram, Kannur. Kerala Corresponding Author Dr Kavitha Pavithran Department of Pediatrics, A.C.M.E Pariyaram, Kannur. Kerala. 670503 Email: kavashu@gmail.com Phone: 9446454969 ABSTRACT Aim and objective: To study the infant feeding practices among mothers accompanying infants in a well baby clinic. To evaluate the association between educational status and religion of mother and the feeding practice. Methods: A clinic based cross-sectional descriptive study among mothers accompanying infants for immunization and check up during a period of six months. Data was collected using a pre tested questionnaire Results: A total of 432 mothers and their infants were enrolled in the study. 19.8% of infants were given prelacteal feeds. All the babies received colostrum. 92.5% were initiated breast feeding within one hour after delivery. 97% of the mothers practiced breast feeding on demand. 72% of babies who were less than 6 months of age were exclusively breast fed. Among babies older than 6 months 71.6% were started on early complementary feeding and 2.1% of them were not on complementary feeding. Early initiation of breast feeding was significantly more in mothers with higher educational status. Exclusive breast feeding was less and artificial feeds usage was more in mothers with higher educational status. Religion also showed significant association with type and time of first feed. Conclusion: Despite higher rate of early initiation of breast feeding, colostrum feeding and demand feeding, exclusive breast feeding was comparatively low. Early initiation of complementary feeding was also noted. Knowledge and practice of infant feeding varied with religion and educational status of the mother

Strategy for obesity prevention among school-age children (literature review)

Obesity is one of major threats to people health and life. It increases risk of many diseases, including type 2 diabetes, heart disease, arthritis, and several cancers. This is a serious problem for the Russian Federation. Half of adults in our country are considered to be overweight or obese. However, to assess objectively the prevalence of this pathology in children is very difficult. At present in Russia there is no single universally accepted system for child anthropometry. Several studies in Russian regions found that about 10% of children were overweight and obese. Main risk factors of obesity in intrauterine and perinatal periods: mother smoking during pregnancy, child accelerated weight gain during the first months of life, formula feeding and early complementary feeding. In older children main risk factors are high-calorie foods, lack of exercise and sedative behaviour. International expert community has defined preventive strategies that will support elimination of child obesity. These strategies include implementation of child development assessment system with body mass index measurement in accordance with the World Health Organization guidelines; training primary pediatricians on using this assessment system and effective obesity prevention counseling; and school-based obesity prevention programs. Physicians and teachers must understand how important obesity prevention for child health. Health and education stakeholders should actively support these preventive measures and ensure universal access to physical exercises and healthy diet in schools. Alfa-Endo Program will assist all these initiatives.

Maternal knowledge and attitudes in relation to complementary feeding initiation in rural Bangladesh

Inappropriate complementary feeding (CF) practices are common in Bangladesh. To identify predictors of the timing of introduction of solid/semi‐solid/soft foods (CF initiation) in rural Bangladesh, we prospectively interviewed 2073 pregnant women at 28 weeks' pregnancy and at postnatal months 3 and 9. We assessed CF knowledge and attitudes at the 3 mo visit. CF initiation was characterized as early (蠄4 mo), timely (5‐6 mo) or late (蠅7 mo), based on maternal recall at the 9 mo visit. We used polytomous logistic regression, adjusted for SES, infant gender, maternal age, literacy and parity. Timely CF initiation was referent.
 CF initiation was early for 7%, timely for 49%, and late for 44% of infants. Only 19% of mothers knew the recommended CF initiation age. Knowledge and attitudes tertiles were 0 – 7, 8 – 9, and 10 – 15, and 19 – 29, 30, and 31 – 39, respectively. Mothers with the lowest knowledge tertile were more likely to initiate early CF compared to those with the highest tertile (aOR = 0.6, 95% CI: 0.3 – 0.9). Mothers with the highest attitudes tertile were more likely to initiate late CF compared to those with the lowest tertile (aOR = 1.3, 95% CI: 1.0 – 1.6). Multiparous mothers were significantly less likely to initiate timely CF compared to those with 1 child (early vs. timely aOR = 1.9; 95% CI: 1.2, 3.1; late vs. timely aOR = 1.3, 95% CI: 1.0, 1.7). SES, infant gender, maternal age and literacy were not associated with age at CF initiation.
 Efforts discouraging early CF initiation have been successful but late introduction of foods is still widely prevalent in Bangladesh. Interventions to improve infant nutrition need to promote timely CF initiation.

Quality of the Early Infant Diet across the Eight Low and Middle Income Countries from the Malnutrition and Enteric Disease (MAL‐ED) Study

We explored breastfeeding practices and the quality of the early complementary feeding from birth to eight months of age according to WHO core indicators across the eight sites in South Asia (Bangladesh, India, Nepal and Pakistan), Africa (South Africa, Tanzania) and Latin America (Brazil, Peru). We prospectively follow up cohorts of ~200 mother‐newborn dyads at each site. We categorized exclusive breastfeeding and the quality of the complementary feeding utilizing the WHO Core Indicators by twice weekly surveillance visits and monthly food frequency survey. Overall, 2145 children were enrolled across eight sites. By six months of age, exclusive breastfeeding rates ranged from 1 to 4% in India, Nepal, Brazil, and Peru to 10.3% in Bangladesh. No children in Pakistan, South Africa, or Tanzania were EBF for their entire first six months of life. Only Brazil had acceptable minimum diet diversity (72.2%), acceptable diet (70.5%), meal frequency (90%) and consumption of iron rich foods (71%), while in all sites it ranged from 4‐15%, 0‐14%, 11‐95% and 3‐44%, respectively. Exclusive breastfeeding in the first 6 months and quality of complementary foods at 6‐8 months of age were heterogeneous and sub‐optimal in most of the sites.

Portugues

Complementary feeding (CF) should be started from 6 months of the infant's life, which is, along with breastfeeding, reducing child mortality. This study aimed to describe the knowledge about the introduction of healthy CF of pregnant women and mothers of infants <3 months enrolled in the Municipal Program to Fight Malnutrition - Pregnant women, at the Coordination of the Technical Area of ​​Food and Nutrition - Catan/Macae-RJ. A descriptive study of primary basis, conducted in April/2013, with pregnant women and mothers of infants <3 months enrolled in the Municipal Program to Fight Malnutrition - Pregnant women who agreed to participate and signed an informed consent. Health PET scholarship holders, on the day of delivery of the benefit, conducted interviews using a structured form. We interviewed 21 pregnant women, representing 53% of the clientele. About 50% were 20-30 years old; 57.1% had <1 minimum wage (MW); 47.6% had incomplete primary education. Regarding knowledge about the beginning of the introduction of CF, 81% answered correctly that it must be from the sixth month of life, and 61.9% reported that they should be offered two baby foods of fruit and 1 salty, while maintaining breastfeeding. The family income was moderately and negatively associated with early CF (rs = -0.56, p <0.01). Younger mothers believe that infant feeding needs fixed and rigid schedules between the meals (rs = 0.43, p <0.05), contrary to the recommendation. We conclude that some responses indicated unknowns about the foods and preparations that must be offered on complementary feeding.

Factors Associated with Early Initiation of Complementary Feeding in Bishoftu Town, Oromia, Ethiopia

Background: Early initiation of complementary feeding which was widely documented in many countries exposed infants to increased risk of morbidity and mortality. The purpose of this study was to assess the prevalence of early initiation of complementary feeding and associated factors in Bishoftu Town, Oromia, Ethiopia. Methods: An institutional based cross-sectional study design was conducted from January-February 2015 among 422 mothers of infant aged less than 6 months selected from four public health facilities. Prevalence of early initiation of complementary feeding was determined using “recall since birth” method. Multi-variable logistic regression analysis was employed to control confounders in determining association between early initiation of complementary feeding and selected independent variables. Adjusted Odds Ratio (AOR), 95% Confidence Interval (CI) and P < 0.05 were used to claim statistical significance. Results: The prevalence of early initiation of complementary feeding was 32.9% (137/416, 95% CI: 28.0, 37.0). The odd of mothers with delayed initiation of Breastfeeding was 4.76 times higher to expose their child to early complementary feeding than women who initiated breastfeeding within one hour after delivery with AOR 4.76 (95% CI; 2.48-9.13, P value < 0.001). This finding was a little higher than estimates of other studies. The odds of house wife mothers and mothers who delivered at health institution had 64% and 74% lower risk to early initiate complementary feeding than employed and home delivered mothers with AOR 0.34 (95% CI; 0.21, 0.55) and AOR 0.26 (95% CI; 0.08, 0.89), respectively. The odd of mothers who lacked knowledge on the duration of optimum breastfeeding duration was 3.91 times higher to practice early initiation of complementary feeding than who correctly knew it with AOR 3.91 (95%; 2.33, 6.54, P-value 0.001). Conclusions: Almost one third of mothers initiated early initiation of complementary feeding at four months of their child’s age. Encouraging all mothers to initiate breastfeeding within an hour, providing counseling service on recommended six-month duration of exclusive breastfeeding was recommended.

Adherence to infant-feeding choices by HIV-infected mothers at a Nigerian tertiary hospital: the pre-“rapid advice” experience

Objectives: The study examined adherence to infant-feeding choices made by human immunodeficiency virus (HIV)-infected mothers at a Nigerian tertiary hospital prior to implementation of the “rapid advice” guideline, i.e. the revised World Health Organisation principles and recommendations on infant feeding in the context of HIV.Design: This was a longitudinal descriptive study.Subjects and settings: The study was conducted on mother-infant pairs recruited from the prevention of mother-to-child transmission (PMTCT) of HIV programme of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Final analyses included 142 mother-infant pairs.Outcome measures: Adherence to a prenatal infant-feeding choice and the infant’s HIV status at six months of age were determined.Results: On enrolment, 73% (n = 103) of the mothers chose exclusive formula feeding (EFF), and 28% (n = 39) exclusive breastfeeding (EBF) for the first six months of life. Of the mothers who chose EBF, the actual practice of EBF declined from 88% at two weeks to 21% at six months, while EFF with correctly reconstituted infant formula decreased from 55% to 8% over the same period. The proportion of mothers who switched over to early complementary feeding increased from 8% at six weeks to 80% at six months in the EBF group, and 2% at two weeks to 92% at six months in the EFF group. Major reasons for nonadherence to their initial choice were fear of the mother-to-child transmission (MTCT) of HIV (65%) and non-affordability of the formula (97%) in the EBF and EFF groups, respectively. Factors significantly associated with adherence to their initial choice included having individual prenatal infant-feeding counselling sessions, being married, having a small number of children, being of higher socio-economic status and the mother’s educational status. However, only socio-economic status remained significant after logistic regression analysis was applied. The total MTCT of HIV rate was 1% at six months.Conclusion: Adherence to either EFF or EBF in this study was low, owing to early breastfeeding cessation and the inability to sustain EFF.

Complementary feeding patterns in the first year of life in the city of Rio de Janeiro, Brazil: time trends from 1998 to 2008.

This study aimed to analyze time trends in complementary feeding practices among children under one year of age in the city of Rio de Janeiro, Brazil, from 1998 to 2008. Based on comparable questions on food consumption in five surveys conducted in representative randomized samples of children in 1998 (n=3,762), 2000 (n=3,670), 2003 (n=4,305), 2006 (n=3,686), and 2008 (n=2,621), 16 complementary feeding indicators were constructed. The percentage frequency of all indicators was estimated for each year of the study. Linear trend analyses were also conducted by means of multivariate regression models. All indicators of early complementary feeding decreased from 1998 to 2008. In the 6-11.9 month age group, there was a significant downward trend in the proportion of children receiving food with adequate consistency for their age, consumption of iron-rich foods, and overall adequacy of the diet. A significant upward trend in fruit consumption was observed. There was a decrease in the early complementary feeding, and generally a worsening of complementary feeding practices in children aged 6-11.9 months in Rio de Janeiro during the period studied.

Early infant feeding and childhood adiposity (391.3)

The purpose of this study was to examine the role of early childhood feeding practices on childhood obesity. The specific aims were to examine the relationship between infant feeding and age of introduction of complementary foods, and childhood adiposity. This was a cross‐sectional study of 4 to 6 years old children and their mothers. Infant feeding and timing of introduction of complementary foods were reported by the mother. Child adiposity was assessed via the BOD POD Pediatric Option. Participants were mostly Caucasians (88.9%), female (66.7%) and average age was 4.9±0.8 years. About 41% of the children were breastfeed exclusively (EBF) for at least 4 months, while complementary foods were introduced as early as 6 weeks of age. There was no statistically significant relationship between infant feeding practice and adiposity or age of introduction to complementary foods and adiposity, although children who were mixed fed weighed about 1 kg heavier and had about 3% less body fat than their (EBF) counterparts. Children introduced to early complementary feeding (&lt;4 months) weighed more and had slightly higher percent body fat. There was, however, a significant, positive correlation between the mother’s pre‐pregnancy BMI and the birth weight of the child (P=.009) and the child’s current weight (P=.031). Our findings suggest in‐utero and other external factors besides the child’s diet may be contributing to childhood obesity.Grant Funding Source: Hatch ‐ GEO00701

A study of early complementary feeding determinants in the Republic of Ireland based on a cross-sectional analysis of the Growing Up in Ireland infant cohort.

Early complementary feeding has been shown to increase the risk of overweight, obesity and chronic diseases later in life. Poor compliance with current guidelines on complementary feeding has been reported by Irish studies. The aim of the present paper is to identify predictors of early complementary feeding in order to help health professionals target population groups in greater need of dietary intervention as well as to provide effective advice. Cross-sectional analysis of the national, longitudinal Growing Up in Ireland study. Data were derived from the first wave (2007-2008) of the Growing Up in Ireland infant cohort. A cohort of mothers (n 11 134) from the Republic of Ireland, interviewed when their infants were 9 months of age. Of the infants, 1469 (13·5 %) had been regularly taking solids in the period between 12 and 16 weeks; this percentage increased to 47·0 % of the sample in the period between 16 and 20 weeks. Timing of formula feeding commencement, high maternal BMI and choosing a relative as the infant's minder were strongly associated with early introduction of solids both in bivariate and multivariate analysis. Those infants who started formula feeding at >4 months were 88·4% less likely to be introduced to solids early compared with those who started at <2 months (OR = 0·116; 95% CI 0·072, 0·186; P < 0·001). The results demonstrate that biological, social and behavioural aspects exert an important role in infant feeding practices. These findings are relevant to the design of policies and intervention programmes aimed at educating parents.

Early Initiation of Complementary Feeding and Associated Factors among 6 Months to 2 Years Young Children, in Kamba Woreda, South West Ethiopia: A Community ?Based Cross - Sectional Study

Background: Inadequate and inappropriate complementary feeding are major factors contributing to excess morbidity and mortality in young children in low resource settings. The early introduction of complementary feeds before the age of six months can lead to displacement of breast milk and increased risk of infections such as diarrhea, which further contributes to weight loss and malnutrition. Therefore the objective of this study is to assess early initiation of Complementary feeding and associated factors, in Kamba Woreda, South West Ethiopia. Methods: a community based cross sectional study was conducted in Kamba woreda, Gamo Gofa Zone, South West Ethiopia. The study was conducted on 562 mothers who have young child from 6 months to 2 years from December 2013 to January 2014 by using pre tested structured questioners. Univariate, bivariate and multivariate analysis was conducted by SPSS version 20. Results: From all respondents 59.6% started complementary feeding before six months. Age of mothers those who are in age group ≥30, AOR 2.60(1.07 - 6.35) years, Education level those who have no formal education AOR 2.76(1.63 - 4.69), occupational of mothers those who work as daily worker AOR 3.06(1.03 - 9.12)and Private work activity(merchant, farmers) AOR 2.39(1.61-3.53), Mothers who have no post natal follow up for their child in Health service AOR( 1.64(1.05 - 2.55) were significantly associated factors for early initiation of complementary feeding in the study area. Conclusion and Recommendation: - A relatively high proportion of mothers start early complementary feeding, despite what is recommended in the national and global infant and young child feeding guidelines. Maternal age, educational statues ,occupational statues, mothers who has no PNC, and mothers who encountered medical illness at post natal period were significant predictors for early initiation of complementary feeding.

Exclusive Breastfeeding, Complementary Feeding, and Food Choices in UK Infants

Limited data exist that explore the association between exclusive breastfeeding and dietary behaviors related to key food choices in later infancy. This study aimed to examine the relationship between exclusive breastfeeding at 3 months with age of starting complementary feeding and key complementary feeding data collected at 8 to 10 months. Secondary data analysis was performed on the UK Infant Feeding Survey 2005. After adjusting for maternal characteristics, exclusive breastfeeding for 3 months, compared to mixed or formula feeding, was positively associated with giving homemade infant foods (adjusted odds ratio [AOR] = 1.41; 95% confidence interval [CI], 1.19-1.66), vegetables (AOR = 1.46; 95% CI, 1.25-1.72), fruits (AOR = 1.73; 95% CI, 1.42-2.11), and fresh foods frequently (AOR = 2.24; 95% CI, 1.41-3.56) at 8 to 10 months of age. Conversely, exclusive breastfeeding for 3 months, compared to mixed or formula feeding, was negatively associated with very early complementary feeding (AOR = 0.35; 95% CI, 0.30-0.42) and giving the following foods at 8 to 10 months of age: baby food from jar (AOR = 0.78; 95% CI, 0.66-0.92), powdered baby food (AOR = 0.73; 95% CI, 0.57-0.94), canned baby food (AOR = 0.48; 95% CI, 0.32-0.71), and ready-made bought meals (AOR = 0.67; 95% CI, 0.57-0.78). Exclusively breastfeeding for 3 months compared to mixed or formula feeding was positively associated with the introduction of complementary feeding after 4 months and giving infants fruits, vegetables, and homemade infant foods frequently at 8 to 10 months.

Factors Associated with Breastfeeding Duration

Factors associated with breastfeeding need to be explored in the northwest of China. This study aimed to measure the full duration of breastfeeding and identify factors associated with breastfeeding in Shihezi City in Northwest China. A prospective cohort study was undertaken to obtain details of child feeding practices using structured questionnaires in 2007-2010. Before discharge from hospitals, 681 mothers were randomly recruited and interviewed in maternity units for breastfeeding. After discharge, the mothers were contacted by telephone at monthly intervals within the first 6 months and then at 2-month intervals until discontinuation of breastfeeding. The breastfeeding initiation rate was 95.9%. The breastfeeding rates then declined to 69.6% at 6 months, 29.7% at 12 months, and 2.3% at 24 months. The median duration of "any breastfeeding" was 9 months. The exclusive breastfeeding rate was low because of the high rate of prelacteal and early complementary feeding. Cox regression analyses revealed that mothers who had preterm babies believed that breast milk could not meet infants' needs and intended to breastfeed for less than 6 months, and mothers with late onset of lactogenesis II and whose parents lived in Xinjiang were more likely to stop breastfeeding. Younger maternal age, employment, and suffering from illness were also associated with a shorter duration of breastfeeding. The duration of "exclusive" and "any breastfeeding" was below the Chinese and World Health Organization breastfeeding goals. Shorter duration of breastfeeding was associated with having grandparents residing within the same province, maternal age, illness and employment, gestational age, and delayed onset of lactogenesis.

Baby-friendly hospitals: only the better, but not the best

We read with great interest the article by Samuel et al.1 The authors found that in spite of being delivered in a baby-friendly hospital (BFH) early complementary feeding (CF) was observed at home. Based on their findings, they suggested home- and community-oriented approaches to improve exclusive breast feeding rates. There are few points in the article that need to be commented.