Early Food Introduction Research Articles

Food allergies in children - a brief literature review

Objective: to identify the main acute and chronic consequences of childhood food allergy. Data source: This is an integrative literature review produced in sequential steps, which selected 20 articles. It was carried out from the search of scientific studies published on the topic in the platforms: Scientific Eletronic Library Online (SciELO) and PubMed, in the month of October 2022. The articles were searched using the Health Science Descriptors (DeCS/MeSH) in Portuguese and English: food hypersensitivity, child, pediatrics, combining them with the Boolean operator "AND". Data Synthesis: The mechanisms of food intolerance, allergies related to early food introduction, main complications and impacts of food allergies in children, and induction of tolerance to adequate diet were discussed. Conclusion: It is concluded that the main acute and chronic consequences of childhood food allergy are diverse, including cutaneous, gastrointestinal tract and even systemic reactions. It is important to emphasize the need for the continuity of public policies for exclusive breastfeeding, since the lack of this represents the main triggering factor for childhood food allergies. Conclusion: We conclude that the main acute and chronic consequences of childhood food allergy are diverse, including cutaneous, gastrointestinal tract, and even systemic reactions. It is important to emphasize the need for the continuity of public policies for exclusive breastfeeding, since the lack of this represents the main triggering factor for childhood food allergies.

Australian Infant Food Allergy Emergency Presentations Following Updated Early Food Introduction Guidelines

The Australasian Society of Clinical Immunology and Allergy food allergy prevention guidelines were updated in 2016 to recommend home introduction of allergenic foods actively in the first year of life, including to infants at high risk of allergy. An important consideration for parents and providers is whether this practice increases food allergy reactions or anaphylaxis. We aimed to determine whether the 2016 update of food allergy prevention guidelines was associated with an increase in food allergy or anaphylaxis emergency department (ED) presentations. We obtained hospital electronic medical records for infants aged 4 to 12 months who attended the Royal Children's Hospital Melbourne ED in 2015 or in 2018 with a presenting problem or an encounter diagnosis of food allergy or anaphylaxis. Emergency department presentations owing to food allergy increased from 1.0% (95% CI, 0.85-1.23) in 2015 to 1.4% (95% CI, 1.22-1.67) in 2018 (P= .006). There was no increase in the number of anaphylaxis presentations (28 in 2015 and 22 in 2018) or peanut anaphylaxis presentations (three in 2015 and three in 2018). Overall, the proportion of food allergy presentations attributed to IgE-mediated food allergy was similar (82.1% in 2015 and 84.1% in 2018), whereas peanut allergy presentations increased slightly, although not statically significantly, from 14.6% to 21.2% (P= .09). Food protein-induced enterocolitis syndrome ED presentations were five in 2015 (4.3%) and 12 in 2018(7.6%), although not statistically significant (P= .25). Changes to food allergy prevention guidelines recommending the earlier introduction of allergenic food may have led to a small increase in ED presentations for food allergy but not anaphylaxis.

Investigating Key Determinants of Childhood Diarrheal Incidence among Patients at Hoima Regional Referral Hospital, Western Uganda

This study aimed to analyze the determinants impacting diarrhea incidence among children under five at Hoima Regional Referral Hospital, Western Uganda. Through a cross-sectional investigation, quantitative data was collected via self-administered and investigator-led questionnaires utilizing digital tools such as Google Sheets for both online and offline data collection. From a randomized sample of 323 caregivers selected through convenience sampling, a diarrhea prevalence of 27.3% among children under five was observed at the time of data collection as reported by caregivers. Among the children studied, 136 (43.7%) were male, and 175 (56.3%) were female. The average age of the participants was 2 years with a standard deviation of 1.25 years. The analysis revealed higher rates of diarrhea among children aged 1 and 3 years, constituting 24 (28%) cases in each group, followed by 20 cases (24%) in the 2-year-old group. Additionally, 12 (14%) cases were reported in children aged 6- 11 months, while only 5 (6%) cases were found in 4-year-olds out of the total 85 reported cases of diarrhea. Regarding breastfeeding practices, 11 (3.7%) children were breastfed 1-3 times a day, 77 (26.1%) were breastfed 3-5 times, 150 (50.8%) were breastfed 5-7 times, 34 (11.5%) were breastfed 7-9 times, and 23 (7.8%) were breastfed more than 9 times a day. The introduction of supplementary food varied with 25 (8.0%) initiated at 3-4 months, 80 (25.7%) at 5-6 months, and the majority, 181 (58.2%), introduced to supplementary food after 6 months. The study highlighted maternal occupation influencing weaning practices; 152 (48.9%) of mothers who weaned their children at 2 years were self-employed, followed by 56 (18.0%) engaged in casual labor and 36 (11.6%) in civil service. Merely 6 (1.9%) civil servant mothers, 47 (15.1%) self-employed, and 14 (4.5%) casual laborers practiced weaning at three years of age. The elevated prevalence of diarrhea (27.3%) was associated with factors such as health-seeking behavior, early introduction of supplementary foods, premature weaning, and breastfeeding frequency. Notably, exclusive breastfeeding practices were scarce, with mothers introducing other foods early and weaning their children prematurely. Keywords: Diarrhoea, Children under five, Breastfeeding, Weaning, Supplementary foods.

Patterns and determinants of breastfeeding and complementary feeding practices over the first year of life in a rural Gambian population

Background: Although breastfeeding is common in The Gambia, high rates of undernutrition in children under five highlight the importance of understanding drivers of particular feeding patterns in this environment, especially early introduction of non-breast milk foods (NBMFs). The country’s marked seasonality, which is associated with annual food insecurity and heavy maternal workload, may influence breastfeeding patterns; however, longitudinal assessments of infant diet in relationship to such factors are limited. We aimed to characterize infant breastfeeding patterns and timing of introduction of local complementary foods in a rural Gambian population across the first twelve months of life. Potential environmental and sociodemographic predictors of exclusive breastfeeding (EBF) duration were explored in order to identify factors that may influence infant feeding decisions in this population. Methods: Data from dietary questionnaires (administered every ten days until 12 months of age) collected as a part of the Hormonal and Epigenetic Regulators of Growth study (2013-2018) were used to calculate EBF duration in a subsample of 194 mother-infant pairs. Socioeconomic questionnaires and Principal Component Analysis were used to calculate household sociodemographic position (SEP). Multiple linear regression analyses were used to investigate potential predictors of EBF duration, including seasonality, SEP, and maternal and infant factors. Results: Mean age at introduction of food or liquid other than maternal milk was five months (±1.5). At twelve months, 98.7% of infants continue to receive some maternal milk. Being born in May significantly predicted shorter EBF duration by -1.68 months (95% CIs: -2.52, -0.84mo; P<.0001). SEP, maternal parity, and infant sex were non-significant predictors of EBF duration. Conclusions: Maternal milk is a vital component of infant diet across the first twelve months of life in this population. Earlier introduction of NBMFs coincides with the annual period where maternal agricultural workload intensifies in this region, though additional investigation is warranted.

The Effectiveness of Early Food Introduction in Preventing Childhood Allergic Diseases: Protocol for a Systematic Review and Meta-Analysis.

Allergic diseases affect around 40% of the pediatric population worldwide. The coexistence of asthma, allergic rhinitis, eczema, and food allergy renders allergy treatment and prevention challenging. Infant feeding strategies recommend avoiding allergenic foods to prevent allergy development and anaphylaxis. However, recent evidence suggests that early consumption of food allergens during weaning in infants aged 4-6 months could result in food tolerance, thus reducing the risk of developing allergies. The aim of this study is to systematically review and carry out a meta-analysis of evidence on the outcome of early food introduction for preventing childhood allergic diseases. We will conduct a systematic review of interventions through a comprehensive search of various databases including PubMed, Embase, Scopus, CENTRAL, PsycINFO, CINAHL, and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to the latest available studies in 2023. We will include randomized controlled trials (RCTs), cluster RCTs, non-RCTs, and other observational studies that assess the effect of early food introduction to prevent childhood allergic diseases. Primary outcomes will include measures related to the effect of childhood allergic diseases (ie, asthma, allergic rhinitis, eczema, and food allergy). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines will be followed for study selection. All data will be extracted using a standardized data extraction form and the quality of the studies will be assessed using the Cochrane Risk of Bias tool. A summary of findings table will be generated for the following outcomes: (1) total number of allergic diseases, (2) rate of sensitization, (3) total number of adverse events, (4) improvement of health-related quality of life, and (5) all-cause mortality. Descriptive and meta-analyses will be performed using a random-effects model in Review Manager (Cochrane). Heterogeneity among selected studies will be assessed using the I2 statistic and explored through meta-regression and subgroup analyses. Data collection is expected to start in June 2023. The results acquired from this study will contribute to the existing literature and harmonize recommendations for infant feeding with regard to the prevention of childhood allergic diseases. PROSPERO CRD42021256776; https://tinyurl.com/4j272y8a. PRR1-10.2196/46816.

Feeding Practices and Dietary Diversity in the First Year of Life: PreventADALL, a Scandinavian Randomized Controlled Trial and Birth Cohort Study

BackgroundBreastmik is considered the optimal source of nutrition in early infancy. However, recommendations and practices for when and how complementary food should be introduced in the first year of life vary worldwide. Early introduction of allergenic foods may prevent food allergies, but if early food introduction influences infant feeding practices is less known. ObjectivesWe sought to assess infant feeding practices in the first year of life and to determine if early interventional food introduction influences breastfeeding and dietary diversity. MethodsDietary intake was assessed in infants from the population-based clinical trial Preventing Atopic Dermatitis and ALLergies (PreventADALL) in children study. A total of 2397 infants were cluster-randomized at birth into 4 different groups: 1) control, 2) skin intervention, 3) introduction to 4 allergenic foods between 3 and 4 mo of age: peanut, cow milk, wheat, and egg, as small tastings until 6 mo, and 4) combined skin and food interventions. Dietary data were available from at least one of the 3-, 6-, 9-, and 12-mo questionnaires in 2059 infants. In the present analysis, groups 1 and 2 constitute the No Food Intervention group, whereas groups 3 and 4 constitute the Food Intervention group.We used the log-rank test and Cox regression to assess the impact of food intervention on age of breastfeeding cessation. Mixed effects logistic regression was used to compare dietary diversity, defined as the number of food categories consumed, between intervention groups. ResultsAt 3, 6, 9, and 12 mo, 95%, 88%, 67%, and 51% were breastfed, respectively, and breastfeeding duration was not affected by the food intervention. In the No Food Intervention group, mean age of complementary food introduction was 18.3 wk (confidence interval [CI]: 18.1, 18.5). In the Food Intervention group, the dietary diversity score was 1.39 units (CI: 1.16, 1.62) higher at 9 mo (P < 0.001) and 0.7 units (CI: 0.5, 0.9) higher at 12 mo (P < 0.001) compared to the No Food Intervention group. ConclusionsEarly food intervention did not affect breastfeeding rates and increased dietary diversity at 9 and 12 mo.

Early Introduction of Allergenic Foods in Infants and Children

Immunoglobulin E-mediated food allergies are a concerning health problem affecting 5.5% of children and 6% of adults in the United States. Nine foods cause 90% of food allergies, with milk, eggs, and peanuts most often linked to food allergies in infants and children. Prevention strategies have shifted from avoidance of foods to the early introduction of high allergenic foods. Evidence supports that the early introduction of peanuts can reduce food allergies. United States guidelines promote the optimal times for the introduction of high-allergen foods. Future research is required to ensure evidence-based best practices for patients and families.

The future of food allergy: Challenging existing paradigms of clinical practice.

The field of food allergy has seen tremendous change over the past 5-10 years with seminal studies redefining our approach to prevention and management and novel testing modalities in the horizon. Early introduction of allergenic foods is now recommended, challenging the previous paradigm of restrictive avoidance. The management of food allergy has shifted from a passive avoidance approach to active interventions that aim to provide protection from accidental exposures, decrease allergic reaction severity and improve the quality of life of food-allergic patients and their families. Additionally, novel diagnostic tools are making their way into clinical practice with the goal to reduce the need for food challenges and assist physicians in the-often complex-diagnostic process. With all the new developments and available choices for diagnosis, prevention and therapy, shared decision-making has become a key part of medical consultation, enabling patients to make the right choice for them, based on their values and preferences. Communication with patients has also become more complex over time, as patients are seeking advice online and through social media, but the information found online may be outdated, incorrect, or lacking in context. The role of the allergist has evolved to embrace all the above exciting developments and provide patients with the optimal care that fits their needs. In this review, we discuss recent developments as well as the evolution of the field of food allergy in the next decade.

How do parents access, appraise, and apply health information on early childhood allergy prevention? A focus group and interview study.

When parents want to make health-related decisions for their child, they need to be able to handle health information from a potentially endless range of sources. Early childhood allergy prevention (ECAP) is a good example: recommendations have shifted from allergen avoidance to early introduction of allergenic foods. We investigated how parents of children under 3 years old access, appraise and apply health information about ECAP, and their respective needs and preferences. We conducted 23 focus groups and 24 interviews with 114 parents of children with varied risk for allergies. The recruitment strategy and a topic guide were co-designed with the target group and professionals from public health, education, and medicine. Data were mostly collected via video calls, recorded and then transcribed verbatim. Content analysis according to Kuckartz was performed using MAXQDA and findings are presented as a descriptive overview. Parents most frequently referred to family members, friends, and other parents as sources of ECAP information, as well as healthcare professionals (HCPs), particularly pediatricians. Parents said that they exchanged experiences and practices with their peers, while relying on HCPs for guidance on decision-making. When searching for information online, they infrequently recalled the sources used and were rarely aware of providers of "good" health information. While parents often reported trying to identify the authors of information to appraise its reliability, they said they did not undertake more comprehensive information quality checks. The choice and presentation of ECAP information was frequently criticized by all parent groups; in particular, parents of at-risk children or with a manifested allergy were often dissatisfied with HCP consultations, and hence did not straightforwardly apply advice. Though many trusted their HCPs, parents often reported taking preventive measures based on their own intuition. One suggestion to react upon the many criticisms expressed by parents regarding who and how provides ECAP information is to integrate central ECAP recommendations into regular child care counseling by HCPs-provided that feasible ways for doing so are identified. This would assist disease prevention, as parents without specific concerns are often unaware of the ECAP dimension of issues such as nutrition.

Skin care interventions and early complementary food introduction for the prevention of atopic dermatitis in infants

аtopic dermatitis and food allergy are common diseases that usually begin in early childhood and can occur together in the same individuals. The aim of this study was to assess the significance of interventions such as skin care products for the skin barrier improvement, breastfeeding and early complementary foods introduction for the primary prevention of atopic dermatitis and food allergy in infants by building logistic regression models. We performed a survey of 97 parents of children. The survey was conducted with the help of Google forms and distributed on the Internet. Method of building and analysing logistic regression models was used to analyse the association of the risk of atopic dermatitis in children with the factor characteristics. Characteristics were as follows: "Skin care 1: application moisturizers to the infant's skin", "Skin care 2: bathing infants with water containing moisturizing substances or moisturizing oils", "Skin care 3: usage of less soap, bathing the child less often", "paternal history of atopy", "duration of breastfeeding less than 1 year", "early introduction of supplementary food (up to the 6th month of life)". We obtained the following results: 42.2% of respondents reported about the application of moisturizing cream, parents of 16.5% of children were using moisturizing oil for bathing the child, 12.4% of parents used less soap and bathed the child less often, 28.9% reported that they were not using any interventions. It was established that when applying care method 1, namely applying moisturizing agents to the infant’s skin, the risk of developing atopic dermatitis increases, OR=12.8 (95% CI 3.89 - 42.3) (p&lt;0.0001). When constructing a three-factor logistic regression model for predicting the risk of food allergy, no dependence was found between the development of food allergy and the presence of allergic diseases in parents, the period of introduction of complementary foods, and the duration of breastfeeding. Thus, this study did not reveal the protective role of skin care products, breastfeeding, and early introduction of complementary foods for the development of atopic dermatitis and food allergies in children. Multivariate analysis showed that atopic dermatitis is associated with emollients application to the infant’s skin. The use of moisturizing creams for the treatment of already existing atopic dermatitis or the path of percutaneous sensitization to allergens could have influenced the data.

Faecal Short-chain Fatty Acid and Early Introduction of Foods in the First 200 Days of Infant’s Life in the District of Abidjan (Ivory Coast)

Dosage of short chain fatty acids (SCFAs) according to food diet showed that the content of acetate was high in newborn feaces. Infants receiving food supplements have a complex and diverse gut microbiota. Moreover, the results show that infants from poor districts have an abundant concentration of SCFAs in their faeces compared to those living in places with a relatively high standard of living. Among infants receiving milk, the highest proportion of SCFA is acetate in breastfed infants (BF) at a rate of 15.025 ± 2.23 μmol/g, followed by propionate in infants receiving mixed feeding (BF+FF), at a rate of 13.58 ± 1.03 μmol/g and butyrate in infants taking mixed feeding at a rate of 0.32 ± 0.72 μmol/g. However, among infants starting early diet diversification, acetate is higher in infants receiving milk formula and diet diversification (FF+FD) with a concentration of 25.4 ± 0 μmol/g, followed by propionate (2.36 ± 0 μmol/g) in infants receiving mixed feeding (BF+FF) and butyrate in those fed with (BF+FD). Partial breastfeeding is associated with a higher proportion of acetate, butyrate and propionate. The study of the correlation between the different SCFAs produced and the ASV (Variants of Microbial Amplicon Sequences) of the intestinal community of the child, shows that acetate is positively correlated with Bifidobacterium and negatively with Streptococcus and Escherichia-Shigella. Propionate is positively correlated with Bifido bacterium and negatively with Escherichia-Shigella. Similarly, butyrate is positively correlated with Bifidobacterium and negatively with Escherichia-Shigella.

Resident perspectives on early allergenic food introduction

The changing guidelines on introduction of allergenic foods over the past decade have left some providers and trainees confused on how to best counsel patients. Much of this counseling occurs during pediatric well visits by primary care providers. We aimed to describe barriers that resident physicians in the primary care setting face in counseling patients on early allergenic food introduction.

Food-induced Anaphylaxis In Infants Following Early Introduction Guidelines And Recommendations

Guidelines for prevention of peanut allergy (i.e. early introduction of age-appropriate peanut-containing food) in US were published in January 2017 and soon followed by recommendations for early introduction of other foods also. We sought to determine changes in infant anaphylaxis thereafter.

Food Protein Induced Enterocolitis Syndrome: A Culprit Food Analysis

Food protein induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy. We investigated trigger foods and clinical presentation of patients with FPIES, before and after the 2015 early food introduction initiative, and hypothesized there would be a change in culprit foods.

Prevalence of iron deficiency anemia in hospitalized infants

Iron is vital, as it is essential for many metabolic processes, including oxygen transport, electron transport, DNA synthesis and repair. Iron balance in the body is regulated carefully so that iron losses are compensated by sufficient iron absorption. Iron deficiency is a common cause of anemia and is typically due to insufficient intake, poor absorption or overt or occult blood loss. The World Health Organization has recognized iron deficiency anemia as the most common nutritional deficiency in the world with 30% of the population being affected. This study was conducted to estimate the prevalence of iron deficiency anemia in 152 hospitalized infants between 1-12 months old. Iron deficiency anemia resulted highly prevalent in this age group, 45% of infants had Hemoglobin level &lt;10g/dl. Despite nutrition, there are other social-economic factors that play a role in the high prevalence of iron deficiency anemia in infants. Conclusively it is stated that, as iron deficiency impairs neurologic development and growth in infants, an adequate clinical attention and evaluation should be directed towards it. Routine screening starting at 9 to 12 months is recommended to help preventing the development of anemia. It is also important adequate weaning and early introduction of iron-rich foods, 4-6 months of age.

The clinical and immunological basis of early food introduction in food allergy prevention.

IgE-mediated food allergy has an estimated prevalence of 6%-10% in developed countries. Allergen avoidance has long been the main focus in the prevention of food allergy and late solid food introduction after 6-12 months of age was recommended in high-risk infants. However, the rising prevalence of food allergy despite delayed exposure to allergens and the observations that IgE-mediated sensitization to food products could even occur before the introduction of solid foods resulted in a shift towards early solid food introduction as an attempt to prevent IgE-mediated food allergy. Since then, many trials focused on the clinical outcome of early allergen introduction and overall seem to point to a protective effect on the development of IgE-mediated food allergies. For non-IgE-mediated diseases of food allergy, evidence of early food introduction seems less clear. Moreover, data on the underlying immunological processes in early food introduction is lacking. The goal of this review is to summarize the available data of immunological changes in early food introduction to prevent IgE and non-IgE mediated food allergy.

Can early life interventions prevent food allergies?

The incidence of food allergies is increasing all over the world. Prevention strategies intend to reduce food sensitization risk and subsequent allergies. In this review, we will discuss the recent data concerning different geographic regions for the prevention of food allergies in children. This review provides recommendations for the prevention of food allergies based on the recent data available in the PUBMED database in English (up to December 2022). The best strategy to prevent food allergies is regarded as the early introduction of allergenic foods to an infant`s diet. A healthy and diverse diet is recommended for infants and their mothers, in accordance with the family`s eating habits and regional food culture, rather than avoiding certain foods or using supplements. Avoiding common food allergens in the maternal diet during pregnancy and/or breastfeeding is not recommended. Exclusive breastfeeding is generally recommended for all mothers for at least 6 months. There is no specific association between exclusive breastfeeding and the primary prevention of any specific food allergy. Where a breastmilk substitute is needed, the best alternative should be chosen according to the infant`s nutritional needs. There is no substantial evidence to support the use of hydrolyzed or soy formula in infancy against food allergies or sensitization. Feeding patterns in infancy play an important role in the risk of developing food allergies. Existing strategies to prevent allergies are relatively ineffective and further research is needed to figure out strategies for food allergy prevention, particularly in high-risk infants.

IMPACT OF EARLY PEANUT INTRODUCTION GUIDELINES ON INFANT TREE NUT ALLERGY TESTING

<h3>Introduction</h3> Tree nut allergy, like peanut allergy, is a common cause of severe food allergic reactions. The impact of the 2017 early peanut introduction guidelines on tree nut allergy testing in infants has not been well studied. <h3>Methods</h3> We performed a retrospective cohort study of infants less than age 1 year with Kaiser Permanente Northern California insurance coverage and had food-specific sIgE testing from January 2015 to December 2020. Our outcome of interest was sIgE testing rates for the following tree nuts: almond, Brazil nut, cashew, hazelnut, pecan, pistachio, and walnut. <h3>Results</h3> Among 3340 infants undergoing food-specific sIgE testing, the sIgE testing rates (per 1000 infants) increased for all tree nuts studied from 2015 to 2020 (p<0.001, Figure). Year-to-year analysis showed that sIgE testing rates increased for most tree nuts from 2017 to 2018 following publication of the early peanut introduction guidelines: almond (p=0.001), Brazil nut (p=0.001), hazelnut (p=0.001), pecan (p=0.004), and pistachio (p=0.002). sIgE testing rates for cashew and walnut also trended upward but decreased significantly from 2018 to 2019 following removal of a food allergy screening panel containing both nuts (p=0.01 for cashew, p=0.035 for walnut). <h3>Conclusion</h3> Infant sIgE testing rates increased significantly for all tree nuts following the 2017 early peanut introduction guidelines and decreased for selected tree nuts following removal of a food allergy screening panel. More studies are needed to assess the utility of tree nut sIgE testing in infants and the impact of early food introduction on tree nut allergy prevalence.

Oral Tolerance Induction-Opportunities and Mechanisms.

Oral tolerance is the active absence of response to food allergens, which involves complex mechanisms in the gut-associated lymphoid tissue. Food allergy results from the disruption of such tolerance or the absence of its establishment in the first place. It follows allergic sensitization with the production of allergen-specific IgE and results from the degranulation of basophils and mast cells on subsequent exposure to the allergen. Oral tolerance induction has been explored in the contexts of prevention and treatment of food allergy. Early introduction of allergenic foods (i.e., egg and peanut) in the diet of infants, before allergic sensitization occurs (i.e., via inflamed skin affected with eczema) has shown to be beneficial. Guidelines have changed to recommend the introduction of these allergenic foods by 6 months of age. For food allergic individuals, oral tolerance induction has been attempted using allergen-specific immunotherapy, which involves the administration of an allergen, modified or not, through various possible routes, including oral, sublingual, epicutaneous, and subcutaneous, with or without concomitant administration of antibody-based biologics. Further research into the immune mechanisms of food allergy and oral tolerance can lead to the identification of novel targets to suppress the food allergic response and reverse the current food allergy epidemic.

Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study.

The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.