Early Infant Feeding Practices Research Articles

The relationships between optimal infant feeding practices and child development and attained height at age 2 years and 6-7 years.

Limited evidence exists on the long-term effects of early feeding practices on child growth and development. We examined the relationships between infant feeding practices and child height and development at ages 2 and 6-7 years. We studied 885 mother-child dyads from a randomized controlled trial of preconception supplementation in Vietnam. Early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), breastfeeding (BF) duration and minimum dietary diversity (MDD) were assessed using World Health Organization(WHO) guidelines. Child development was assessed by the Bayley Scales of Infant Development-III at 2 years and the Wechsler Intelligence Scale for Children®-IV at 6-7years. Child height-for-age z-score (HAZ) was calculated from child height and age. Multivariable regression and structural equation models were used in analyses that controlled for confounding. EIBF and EBF at 6monthsoccurred in 52% and 62% of children, respectively. Mean breastfeeding duration was 18 monthsand 83% achieved MDD at 1year. EIBF was associated with motor (β = 0.13, 95% confidence interval [CI]: 0.00, 0.28) and cognitive development at 2years(β = 0.12, 95%CI: -0.01, 0.26), which in turn were positively associated with cognitive development at 6-7years. EBF was directly associated with development at 6-7years (β = 0.21, 95% CI:0.08, 0.34) whereas motor and cognitive development at 2years explained 41%-75% of the relationship between EIBF and development at 6-7years. HAZ at 2years also mediated 70% of the association between MDD at 1year and HAZ at 6-7years. BF duration was not associated with child development and HAZ. Early infant feeding practices, especially EIBF and EBF, have important long-term implications for optimizing child linear growth and cognition as they begin school.

Early Infant Feeding Practices and Associations with Growth in Childhood.

Early infant growth trajectories have been linked to obesity risk. The aim of this study was to examine early infant feeding practices in association with anthropometric measures and risk of overweight/obesity in childhood. A total of 2492 children from Upstate KIDS, a population-based longitudinal cohort, were included for the analysis. Parents reported breastfeeding and complementary food introduction from 4 to 12 months on questionnaires. Weight and height were reported at 2-3 years of age and during later follow-up at 7-9 years of age. Age and sex z-scores were calculated. Linear mixed models were conducted, adjusting for maternal and child sociodemographic factors. Approximately 54% of infants were formula-fed at <5 months of age. Compared to those formula-fed, BMI- (adjusted B, -0.23; 95% CI: -0.42, -0.05) and weight-for-age z-scores (adjusted B, -0.16; -0.28, -0.03) were lower for those exclusively breastfed. Infants breastfed for ≥12 months had a lower risk of being overweight (aRR, 0.33; 0.18, 0.59) at 2-3 years, relative to formula-fed infants. Compared to introduction at <5 months, the introduction of fruits and vegetables between 5 and 8 months was associated with lower risk of obesity at 7-9 years (aRR, 0.45; 0.22, 0.93). The type and duration of breastfeeding and delayed introduction of certain complementary foods was associated with lower childhood BMI.

The multiple factors of suboptimal early feeding practices among infants aged 0-5 months in Indonesia.

Optimal early infant feeding practices are critical to ensure adequate nutrition for infants' growth and development. This study aimed to examine the determinants of suboptimal early feeding practices (i.e., delayed initiation of breastfeeding, prelacteal feeding, and non-exclusive breastfeeding) among infants aged 0-5 months in Indonesia. We used data collected in the 2012 and 2017 Indonesia Demographic and Health Surveys. Analyses were conducted using information from 3,198 live-born singleton infants aged 0-5 months. The primary outcomes used were: (1) delayed initiation of breastfeeding in the first hour after birth, (2) prelacteal feeding in the first 3 days, and (3) non-exclusive breastfeeding in the last 24 h preceding the survey. Potential predictors analyzed were categorized into the environmental, household, maternal, pregnancy, delivery, and child characteristics. Logistic regression analyses were performed to identify factors significantly associated with each outcome. Approximately 78,6% of infants aged 0-5 months in Indonesia had at least one of the three suboptimal early infant feeding practices. We found a strong association between the three outcome indicators analyzed. The determinants of delayed initiation of breastfeeding included infants from Sumatera region (adjusted odds ratios (aOR) = 2.02, p < 0.001), infants delivered by Cesarean section (aOR = 2.78, p < 0.001), and in non-health facilities (aOR = 1.53, p = 0.003). The determinants of prelacteal feeding in the first 3 days included infants living in urban areas (aOR = 1.32, p = 0.035), the first birth-ranked infants (aOR = 1.32, p = 0.019), and infants who had delayed initiation of breastfeeding in the first hour of life (aOR = 3.90, p < 0.001). The determinants of non-exclusive breastfeeding in the last 24 h included infants whose mothers worked in non-agricultural fields (aOR = 1.52, p < 0.001), infants delivered by Cesarean section (aOR = 1.33, p = 0.044), and the first birth-ranked infants (aOR = 1.28, p = 0.039). There was a high percentage of infants aged 0-5 months who had suboptimal feeding practices in Indonesia. As we found multiple factors associated with suboptimal early feeding practices among infants, integrated approaches, including health promotion and supportive public policy, are required to ensure infants receive adequate nutrition in the early stages of life.

Delayed secretory activation and low milk production in women with gestational diabetes: a case series

BackgroundGestational diabetes mellitus (GDM) is major pregnancy complication that is associated with short- and long-term consequences for both mother and infant, including increased risk of diabetes later in life. A longer breastfeeding duration has been associated with a reduced risk of diabetes, however, women with GDM are less likely to exclusively breastfeed and have shorter breastfeeding duration. While the timing of breastfeeding initiation and milk removal frequency affects subsequent breastfeeding outcomes, little is known about early infant feeding practices and milk production in women with GDM. This case series offers detailed prospective breastfeeding initiation data, as well as the first report of objective measures of milk production in women with GDM.Case presentationIn this case series, we present the early infant feeding practices of eight women with GDM that gave birth at term gestation. Women recorded the timing of initiation of breastfeeding and secretory activation, as well as their breastfeeding, expression and formula feeding frequencies on postpartum days 1, 7 and 21. Measurement of 24 h milk production volume was performed at 3 weeks postpartum using the test weight method. We observed a delayed first breastfeed (> 1 h) in 6 (75%) cases, formula use in hospital in 5 (63%) cases and delayed secretory activation in 3 (38%) cases. At 3 weeks postpartum, 2 cases had measured milk productions that were insufficient to sustain adequate infant weight gain.ConclusionsOur data suggest that despite early and frequent milk removal, women with GDM are at greater risk of delayed secretory activation and low milk supply. Cohort studies that consider co-morbidities such as obesity are needed to determine the lactation outcomes of women with GDM.

Associations between Cultural Identity, Household Membership and Diet Quality among Native Hawaiian, Pacific Islander, and Filipino Infants in Hawai'i.

Public health efforts to reduce diet-related health disparities experienced by indigenous peoples could be enhanced by efforts to improve complementary infant feeding practices. The latter is possible through interventions informed by cultural determinants. This cross-sectional secondary analysis explored possible determinants of the complementary feeding practices of Native Hawaiian, Pacific Islander, and/or Filipino infants (NHPIF) in Hawaiʻi, ages 3–12 months. The objective was to determine the association between caregiver cultural identity and infant household membership with indicators of infant diet healthfulness. The cultural identities, infant household memberships, early infant feeding practices and additional demographic information (infant age and sex, household income) were assessed via an online questionnaire. Surrogate reporting of the infants’ diets over four days was evaluated using an image-based mobile food record (mFR). Data collected by the mFR were evaluated to derive the World Health Organization’s minimum dietary diversity (MDD) indicator and food group consumption. Data were summarized by descriptive statistics and analyzed using multivariate linear and logistic regressions. Seventy infant participants, ages 3–12 months, and their primary caregivers completed the study. Of these, there were 56 infant participants between the age of 6–12 months. Approximately 10% of infants, ages 6–12 months, met MDD for all four days. Meeting MDD and the number of food groups consumed were significantly associated with age. Caregiver cultural identity, infant household membership and infant sex had non-significant associations with indicators of infant diet quality. Findings inform the influences shaping dietary patterns of Native Hawaiian, Pacific Islander and Filipino infants in Hawaiʻi.

Do Early Infant Feeding Practices and Modifiable Household Behaviors Contribute to Age-Specific Interindividual Variations in Infant Linear Growth? Evidence from a Birth Cohort in Dhaka, Bangladesh

ABSTRACTBackgroundCauses of infant linear growth faltering in low-income settings remain poorly understood. Identifying age-specific risk factors in observational studies might be influenced by statistical model selection.ObjectivesTo estimate associations of selected household factors and infant feeding behaviors within discrete age intervals with interval-specific changes in length-for-age z-scores (LAZs) or attained LAZ, using 5 statistical approaches.MethodsData from a birth cohort in Dhaka, Bangladesh (n = 1157) were analyzed. Multivariable-adjusted associations of infant feeding patterns or household factors with conditional LAZ (cLAZ) were estimated for 5 intervals in infancy. Two alternative approaches were used to estimate differences in interval changes in LAZ, and differences in end-interval attained LAZ and RRs of stunting (LAZ < −2) were estimated.ResultsLAZ was symmetrically distributed with mean ± SD = −0.95 ± 1.02 at birth and −1.00 ± 1.04 at 12 mo. Compared with exclusively breastfed infants, partial breastfeeding (difference in cLAZ: −0.11; 95% CI: −0.20, −0.02) or no breastfeeding (−0.30; 95% CI: −0.54, −0.07) were associated with slower growth from 0 to 3 mo. However, associations were not sustained beyond 6 mo. Modifiable household factors (smoking, water treatment, soap at handwashing station) were not associated with infant growth, attained size, or stunting. Alternative statistical approaches yielded mostly similar results as conditional growth models.ConclusionsThe entire infant LAZ distribution was shifted down, indicating that length deficits were mostly caused by ubiquitous or community-level factors. Early-infant feeding practices explained minimal variation in early growth, and associations were not sustained to 12 mo of age. Statistical model choice did not substantially alter the conclusions. Modifications of household hygiene, smoking, or early infant feeding practices would be unlikely to improve infant linear growth in Bangladesh or other settings where growth faltering is widespread.

Early Infant Feeding Practices Among Mothers of Southeast Nigeria

Background: The promotion of optimal infant feeding practices is the most cost-effective of all interventions to reduce infant mortality. In spite of the recommendation of the WHO for optimal breastfeeding practices, several studies in Nigeria on early infant feeding practices have indicated a need for continuous auditing of feeding practices among mothers to make improvements. Objective: This study evaluated the early infant feeding practices of mothers and associated factors. Methods: A cross-sectional, descriptive, multi-centre, questionnaire-based survey was conducted among 2,287 mother-infant pairs in 13 Baby Friendly Hospitals in Southeast Nigeria. Results: The rate of early initiation of breastfeeding [EIBF] within the first one hour of birth was 22.9%, while the exclusive breastfeeding [EBF] rate was 39.3%. The main deterrent to EBF was early introduction of water [94.0%], formula [40.9%] and complementary feeds [85.7%]. There was a statistically significant difference [p<0.001] between the nutritional status of the exclusively breastfed infants and those non-exclusively breastfed, with moderate underweight, and severe underweight malnutrition in the non-exclusively breastfed group. Sociodemographic factors associated with EBF were infant’s birth order [p<0.001], maternal age [p=0.010], mother’s and spouse’s education [p<0.001 and p<0.001], mother’s and spouse’s occupation [p<0.001 and p<0.001]. Conclusion: Policies and measures to promote hospital deliveries targeting all mothers, with special focus on the poor, rural, working, and primiparous mothers, should become a top priority to improve the rate of EIBF. Promotion of EBF with emphasis on the dangers of early introduction of water, formula and complementary feeding should be intensified.

Infant Appetite Traits and Early Infant Feeding Practices in Low-Income Hispanic Families

Abstract Objectives This study examined the association of infant appetite traits and exclusive breastfeeding (EBF), BF intensity, early introduction of complementary foods/liquids and 100% fruit juice consumption among Hispanic infants during the first year of life. Methods This study is a cross-sectional analysis of data collected from the “Starting Early Program" randomized controlled obesity prevention trial of low-income, Hispanic mother-child pairs (n = 533). Four infant appetite traits including Food Responsiveness (FR), Enjoyment of Food (EF), Satiety Responsiveness (SR), and Slowness in Eating (SE) were assessed using the Baby Eating Behavior Questionnaire. Each appetite trait was based on a 5-point Likert frequency scale. Infant feeding measures were collected using 24-hour recall methodology and survey based on the Infant Feeding Practices Study II. Linear and logistic regressions assessed the associations between appetite traits and infant feeding practices, specifically 1) EBF, 2) BF intensity (% of daily milk consumption that is breast milk), 3) early introduction to complementary foods/liquids defined as receiving prior to infant age 4 months, and 4) Any 100% fruit juice consumption at age 10 months. Results Of the 473 children with both appetite and infant feeding measures, 48% were male with mean birth weight of 3.4 kg. After adjusting for confounders, infants with higher SE scores had higher odds of EBF duration (≥3 months) (OR = 1.7, P &amp;lt; 0.001), and higher odds of having medium (20% ≤ score ≤ 80%) and high (&amp;gt;80%) BF intensity (OR = 1.8, P = 0.002; OR = 2.5, P &amp;lt; 0.001), compared to infants with lower SE scores. Infants with higher SE and SR were less likely to receive early complementary foods/liquids (OR = 0.59, P = 0.026; OR = 0.51, P = 0.009). Infants with higher EF were more likely to consume any 100% fruit juice at age 10 months (OR = 1.7, P = 0.047). The other appetite traits were not significantly related to infant feeding measures. Conclusions Higher SE was associated with greater EBF and BF intensity. Infants with higher SE and SR were less likely to have early introduction to complementary foods/liquids. Infants with higher EF were more likely to have juice at 10 months. Appetite traits are associated with potentially obesogenic feeding practices and may represent a target for early life infant feeding interventions. Funding Sources USDA AFRI.

Early infant feeding practices in Ireland; current and secular analyses of infant feeding in two prospective birth cohort studies

AbstractRecognised as the optimum infant feeding method, breastfeeding affords substantial health benefits to mother and infant. Exclusive breastfeeding is recommended to 6 months, with continuation thereafter. In Ireland, data indicates that 60% breastfeed to any extent at hospital discharge and 40% do so at 3 months. However, nationally collected data is limited in detail, particularly with regard to breastfeeding continuation. The ongoing Cork-based COMBINE birth cohort study recruited 456 participants between 2015 and 2017. Through interviewer-led questionnaires, research midwives collected feeding data at hospital discharge, 1, 2, 4, 6 and 9 months of age. Infant feeding was classed as breast (breastmilk as main milk source), combination (both breastmilk and infant formula daily) or infant formula only feeding. Adherence to the World Health Organisation (WHO) recommendation to exclusively breastfeed (breastmilk only, no infant formula, supplementary fluids or solid foods) was examined longitudinally. To explore secular changes, breastfeeding rates in COMBINE were compared to the BASELINE birth cohort study, which recruited participants (n = 2116) between 2008 and 2011 in the same setting. In COMBINE, 75% of mothers provided any breastmilk (breast or combination) at hospital discharge, of whom 44% breastfed only. Two-fifths (40%), one-third (33%) and one-quarter (24%) breastfed at 1, 4 and 6 months, respectively. Combination feeding of breastmilk and infant formula was prevalent at discharge (31%) and 1 month (20%). Advice from healthcare professionals (31%) and concern baby was hungry (30%) were commonly reported reasons for this practice and throughout the study, mothers who combination fed were more likely to stop breastfeeding altogether than those who breastfed (all P &lt; 0.001). Infant formula only feeding increased from 25% at discharge to 40% at 1 month, 49% at 2 months and 74% at 9 months. Half (45%) of mothers who breastfed did so for less than 4 months and insufficient milk/growth faltering was the most commonly cited reason for cessation (27%). The rate of WHO-defined exclusive breastfeeding was 40% from birth to discharge, 22% to 1 month, 15% to 4 months and 2% to 6 months. The breastfeeding (breastmilk as main milk source) rate at discharge did not differ between our two birth cohorts (44 vs. 40%, P = 0.23), but was significantly higher in COMBINE compared to BASELINE at 2 (36 vs. 27%) and 6 (24 vs. 12%) months (both P &lt; 0.05). While these data provide evidence of some progress towards longer breastfeeding durations, there remains much scope to improve infant feeding practices in Ireland.

Determinants of infant nutrition status in rural farming households before and after harvest.

Infant and young child feeding (IYCF) practices determine infant growth, development and health. Despite global recommendations for exclusive breastfeeding until 6months, adherence rates are low worldwide for different reasons, largely dependent on environment. In low-income countries, inappropriate IYCF leads to poor nutrition status. This study examined IYCF practices and nutrition outcomes in rural farming households in Tanzania before and after harvest. Mothers and their infants were recruited from two regions in Tanzania. Demographics, health status, IYCF practices, anthropometrics and haemoglobin were measured; preharvest and postharvest. Regression analysis modelled the relationship between IYCF and nutrition outcomes. Despite high rates of breastfeeding a large proportion did not meet early initiation of breastfeeding and minimum acceptable diet standards. Undernutrition was high with 30-40% of infants classified as stunted depending on season, and the majority (81%) were anaemic. Early initiation of breastfeeding was associated with higher Length-for-age z-score and weight-for-age z-score and lower risk of stunting and underweight (p<0.05). The introduction of fluids other than breast milk in the first 3days after birth was associated with lower weight-for-age z-score and increased underweight (p<0.05). Maternal age and height were strongly and positively associated with child anthropometrics. Findings confirm the importance of early infant feeding practices for growth and development and emphasize the significance of mother's nutrition status in relation to infant health. Future interventions should focus on improving maternal nutrition status before, during and after pregnancy as well as educating and supporting mothers to adopt appropriate infant feeding including breastfeeding practices for the prevention of undernutrition.

Infant Feeding and Cardiovascular Disease: A multi-staged analysis from global to country data

Background: Death from cardiovascular disease (CVD) is the leading cause of death globally and in particular in the Eastern Mediterranean region (EMR). The relationship between early feeding practices and CVD remains to be fully established.&#x0D; Aim: To examine the relationship between early infant feeding practices as risk factors of death from CVD with a focus on high blood pressure (HBP) in the 22 countries of the EMR.&#x0D; Methods: First: global and regional data were compiled for deaths from CVD, HBP, nutritional deficiencies. Second: data from the EMR countries were compiled for adult obesity, high cholesterol (HC) and blood sugar (HBS) and pollution. Countries from the EMR were divided into high and low risk by HBP and biochemical data. Third: deaths from wasting, stunting, non-exclusive and discontinued breastfeeding and nutritional deficiencies including anemia, vitamin A deficiency, low bone mineral density and Zinc deficiency, were compared in both groups. Fourth: a small scale in-depth study (SSIDS) was conducted for 32 breastfed and 28 non-breastfed mother-child pairs under-five years of age. HBP and high density lipoproteins (HDL) and low density lipoproteins (LDL) and highly sensitive C-reactive protein (HsCRP) were measured.&#x0D; Findings: Nine EMR countries were identified as high risk for CVD with HBP, obesity, HC and HBS and pollution. Deaths from nutritional deficiencies and feeding practices were higher in this group. In the SSIDS, HsCPR was significantly lower in mothers and children who were breastfed and HDL significantly higher in children introduced foods after 6 months of age.&#x0D; Conclusions: Optimal infant feeding practices contribute directly and indirectly to reducing deaths from CVD.

Celiac Disease Prevention

Celiac disease (CD) is a common autoimmune disorder induced by ingestion of gluten in genetically susceptible individuals. Despite the prerequisite for a genetic predisposition, only a minority of the 40% of the Caucasian population that has this genetic predisposition develops the disease. Thus, environmental and/or lifestyle factors play a causal role in the development of CD. The incidence of CD has increased over the last half-century, resulting in rising interest in identifying risk factors for CD to enable primary prevention. Early infant feeding practices have been suggested as one of the factors influencing the risk of CD in genetically susceptible individuals. However, recent large prospective studies have shown that neither the timing of gluten introduction nor the duration or maintenance of breastfeeding influence the risk of CD. Also, other environmental influences have been investigated as potential risk factors, but have not led to primary prevention strategies. Secondary prevention is possible through early diagnosis and treatment. Since CD is significantly underdiagnosed and a large proportion of CD patients are asymptomatic at the time of diagnosis, secondary prevention will not identify all CD patients, as long as mass screening has not been introduced. As following a gluten-free diet is a major challenge, tertiary prevention strategies are discussed as well.

Infant feeding nutrition policies in Australian early childhood education and care services: a content and qualitative analysis

Early infant feeding practices are a critical part of education and care programs within Early Childhood Education and Care (ECEC) settings. With an increasing number of children attending ECEC services from a young age, adherence to best practice infant feeding will improve long-term health outcomes. This paper uses inductive and deductive thematic analysis informed by Social Cognitive Theory and inductive content analysis, to describe Australian infant feeding nutrition ECEC policy environments. Key Australian ECEC policy documents were analysed, revealing the invisibility of infants generally, and infant feeding specifically, in current quality standards. This was followed by analysis of 28 nutrition or infant feeding policies from 19 centre- and home-based ECEC services impacting over 1500 children in Queensland Australia. Five key themes characterising the content of service policies impacting infant feeding emerged: documentation, values, curriculum and pedagogy, supportive environments, and working in partnerships with parents. Service policies are required by legislation and set the foundation for a safe, supportive environment for infant feeding. The lack of infant feeding practice examples and invisibility of infants in legislation increase ambiguity, and health and safety risks. Opportunities exist to adopt separate infant feeding policies which will assist the provision of quality practice for the short-term and long-term optimal health of infants in ECEC settings.

Uncovering the barriers to exclusive breastfeeding for mothers living in Dhaka\u2019s slums: a mixed method study

BackgroundDespite the substantial impact on child and maternal health, breastfeeding practices for infants remain at the suboptimum level in Bangladesh. Yet the understanding of why these practices are suboptimal, especially surrounding urban slum dwelling mothers, is unclear. The purpose of this study was to assess early infant feeding practices, examine associations with maternal factors, and uncover the facilitators and barriers to early feeding practices in selected slums of Dhaka, Bangladesh.MethodsA mixed method study was conducted from June to September 2016 using both quantitative and qualitative methods among mothers with children under the age of 6 months. The survey included 342 mother-infant pairs and 18 in-depth interviews were conducted. Univariate and multiple logistic regression was used to determine status of early infant feeding practices and factors associated with exclusive breastfeeding (EBF) within the previous 24 h. Transcripts were coded to uncover the facilitators and barriers surrounding early infant feeding practices.ResultsSixty four percent (220/342) of mothers initiated breastfeeding within 1 h, 96.5% (330/342) reported feeding colostrum, and 36.3% (124/342) infants were EBF in the last 24 h. After adjusting for child gender, maternal age, education, diet and household income; infant’s age (adjusted odds ratio (AOR) for 61–120 days 6.42; 95% CI 3.42, 12.1; AOR for 121–180 days 45.6; 95% CI 18.33, 113.45), prelacteal feeding (AOR 2.53; 95% CI 1.14, 4.58), lack of planning for EBF during pregnancy (AOR 4.06; 95% CI 1.09, 15.12) and infants delivered by cesarean section (AOR 2.76; 95% CI 1.34, 5.67) were negatively associated with EBF. During the 18 interviews, eight mothers reported a cesarean delivery and none of these mothers initiated breastfeeding within 1 h or exclusively breastfed. Moreover, all eight mothers gave their infants prelacteal feeds.ConclusionsThe status of early infant feeding practices in Dhaka’s slums was poor. The negative impact of cesarean section on all early infant feeding practices was evident in both quantitative and qualitative analysis.

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

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

Barriers to exclusive breast-feeding in Indonesian hospitals: a qualitative study of early infant feeding practices.

Although initiating breast-feeding is common in Indonesia, rates of exclusive breast-feeding are low. Our objective was to identify early barriers to exclusive breast-feeding in Indonesian hospitals. Qualitative. Semi-structured interviews were conducted in April-June 2015. The data were analysed using thematic analysis. Indonesian provinces of Jakarta, Banten and West Java. Fifty-four participants including public health officials, hospital administrators, health-care professionals and parents. Five themes were identified as contributing to low rates of early exclusive breast-feeding in Indonesian hospitals: (i) quality and quantity of breast-feeding education; (ii) marketing and influence of infant formula manufacturers; (iii) hospital infrastructure; (iv) policy, legislation and protocols; and (v) perceived need for infant formula supplementation. Participants noted that providers and mothers receive inadequate or incorrect education regarding breast-feeding; manufacturers promote infant formula use both inside and outside hospitals; constraints in physical space and hospital design interfere with early breast-feeding; legislation and protocols designed to promote breast-feeding are inconsistently enforced and implemented; and providers and mothers often believe infant formula is necessary to promote infant health. All participants identified numerous barriers to early exclusive breast-feeding that related to more than one identified theme. Our study identified important barriers to early exclusive breast-feeding in Indonesian hospitals, finding that participants consistently reported multifaceted barriers to early exclusive breast-feeding. Future research should examine whether system-level interventions such the Baby-Friendly Hospital Initiative might improve rates of exclusive breast-feeding by improving breast-feeding education, reducing manufacturer influence, modifying existing infrastructure and providing tools needed for protocols and counselling.

Differences in infant feeding practices between Chinese-born and Australian-born mothers living in Australia: a cross-sectional study

BackgroundChinese immigrants are the third largest immigrant group in Australia. Recent qualitative evidence from Victorian Maternal and Child Health nurses indicate that infants of Chinese parents commonly have rapid growth trajectories and that high value is placed on rapid growth and having a fatter child; with low breastfeeding rates and overfeeding of infant formula. The aim of this study was to compare infant feeding practices (breastfeeding, infant formula, other liquids, solids) of Chinese-born and Australian-born mothers living in Australia.MethodsUsing the Australian National Infant Feeding Survey dataset (2010–2011), infant feeding data from Chinese-born mothers (n = 602) were compared with a random sub-sample of Australian-born mothers (n = 602). Group differences on feeding practices were tested using Chi-square or t-tests and the effect of ethnicity on infant feeding behaviours assessed using regression.ResultsCompared to infants of Australian-born mothers, infants of Chinese-born mothers were younger when they first consumed infant formula, water-based drinks and fruit juice and older when they first ate solid foods (p < 0.05). Furthermore, infants of Chinese-born mothers were less likely to have ever had cow’s milk (OR: 0.37 95%CI:, 0.18–0.78) and solids (0.41, 0.25–0.68); but were more likely to have ever had infant formula (2.19, 1.32–3.62), water (2.45, 1.55–3.87), toddler milk (3.39, 1.60–7.18), water-based drinks (e.g. cordial, soft drink, tea; 2.48, 1.12–5.49), and fruit juice (4.03, 2.50–6.51). Those ≤4 months of age were more likely to have had water-based drinks (7.77, 1.96–30.77) and fruit juice (3.44, 1.14–10.38) (p < 0.05) compared to infants of Australian-born mothers.ConclusionDifferences in mothers’ early infant feeding practices exist between Chinese-born and Australian-born mothers living in Australia. Better understanding these ethnically patterned infant feeding practices is important for identifying key opportunities to promote best nutrition and growth in early life in different ethnic groups within our population.

Early Infant Feeding Practices as Possible Risk Factors for Immunoglobulin E-Mediated Food Allergies in Kuwait.

Objective Early feeding and infant exposures have been suggested as potential risk factors for immunoglobulin E- (IgE-) mediated food allergy (FA). We aimed to evaluate the association between IgE-mediated FA in children and early exposures including the child's nutritional status, breastfeeding and its duration, the age at which the solid food was first introduced, antibiotic exposure during the first year of life, and the child's vitamin D status during infancy. Design A case-control study. Setting and Subjects Children aged 0–13 years were recruited from pediatric allergy and immunology clinics (PAICs) located at major government hospitals in Kuwait (total FA cases: n = 100; boys = 67%), and healthy controls (n = 100, boys 55%) were recruited from various vaccination units at primary healthcare centers. Results Cow's milk allergy was the most common type of FA. FA status was independently associated with the early exposures of exclusive breastfeeding (aOR = 15.55 (3.26–74.19), p = 0.001), vitamin D deficiency or insufficiency during infancy (aOR = 5.42 (1.92–15.30), p = 0.001), and antibiotic exposure during the first year of life (aOR = 5.00 (1.58–15.84), p = 0.006). Conclusions FA is highly prevalent among children in Kuwait, and our data indicate that early nutrition-related and antibiotic exposures are associated with FA risk.

A multifaceted approach towards interpreting early life experience and infant feeding practices in the ancient Atacama Desert, Northern Chile

AbstractInterpreting early life experience in the past is of considerable interest to archaeologists, yet remains fraught with difficulty. Children are sensitive barometers of population health in general. In addition, infant feeding practices, and stresses experienced during infancy and childhood, have important effects on adult health and demographic changes. Understanding how diet and physiological stress interact is therefore of significance, but most bony indicators of stress have non‐specific etiologies that cannot be tied to events during childhood. The recent advent of incremental isotopic techniques means we now have the potential to identify periods of stress and dietary change during childhood through changes to stable carbon and nitrogen isotopic ratios during tissue formation. Being able to establish these individual weaning trajectories allows us to consider individuality in past weaning choices, giving the bioarchaeologist a more nuanced picture of the past. Here, we investigate whether combining paleopathological and isotopic data can give insight into the synergy between infant feeding and stress. We present a case study of a 5‐year‐old child from an early agricultural period archaeological site in the northern Atacama Desert, Chile. We show that, despite physiological stress likely affecting isotopic ratios in this individual, a weaning curve is visible and the interpretation of weaning behaviour is possible. In addition, we suggest that there is isotopic evidence for a micronutrient deficient weaning diet that may be correlated with bony evidence for pathology.

Milk feeding and first complementary foods during the first year of life in the TEDDY study.

The aim was to describe milk feeding patterns and first weaning foods during the first year of life in a large prospective birth cohort of infants with increased genetic risk for Type 1 diabetes (T1D) recruited in 4 different countries: the United States, Finland, Germany, and Sweden. All enrolled children with dietary information (n=8,673) were included in the analyses; 1,307 (15%) children who dropped out before the first birthday were excluded from some analyses. Supplementary milk feeding in the first 3days of life was common in all the four countries, although the type of the supplementary milk differed by country and by maternal T1D. Donated human milk was commonly used only in Finland. In all the countries, the most common first supplementary food was cow's milk-based infant formula, especially among offspring of mothers with T1D. The use of specific types of infant formulas differed notably by country: Extensively hydrolysed formulas were most used in Finland, partially hydrolysed ones in the United States and in Germany, and soy formulas only in the United States. Infant formulas commonly included probiotics, prebiotics, and starches. During the first year of life, most of the infants received conventional cow's milk. Overall, milk feeding during the first 3days of life and thereafter until the first birthday differed markedly by maternal T1D status and across countries. These descriptive data may be useful in understanding early infant feeding practices and in planning potential interventions, which affect infant feeding.