Early Supplementary Feeding Research Articles

Promoting and supporting breastfeeding in a protracted emergency setting-Caregivers' and health workers' perceptions from North-East Nigeria.

Breastfeeding (BF) should be protected, promoted, and supported for all infants in humanitarian settings. The re-establishment of exclusive BF is also a central part of the management of acutely malnourished infants under 6 months (<6 m). Médecins Sans Frontières (MSF) runs a nutrition project in Maiduguri, a protracted emergency setting in North-East Nigeria. This study aimed to explore caregivers' (CGs) and health workers' (HWs) perceptions of BF practice, promotion, and support among CGs with infants <6 m in this setting. We conducted a qualitative study using in-depth interviews and focus group discussions combined with non-participant observations. Participants included CGs of young infants enrolled in MSF nutritional programs or who attended health promotion activities in a displacement camp. MSF HWs were involved at different levels in BF promotion and support. Data were collected involving a local translator and analyzed using reflexive thematic analysis directly from audio recordings. Participants described how feeding practices are shaped by family, community, and traditional beliefs. The perception of breastmilk insufficiency was common and led to early supplementary feeding with inexpensive but unsuitable products. Participants often linked insufficient breastmilk production with poor maternal nutrition and stress, in a context shaped by conflict and food insecurity. BF promotion was generally well received but could be improved if tailored to address specific barriers to exclusive BF. Interviewed CGs positively valued BF support received as part of the comprehensive treatment for infant malnutrition. One of the main challenges identified was the length of stay at the facility. Some participants perceived that improvements in BF were at risk of being lost after discharge if CGs lacked an enabling environment for BF. This study corroborates the strong influence of household and contextual factors on the practice, promotion, and support of BF. Despite identified challenges, the provision of BF support contributes to improvements in BF practice and was positively perceived by CGs in the studied setting. Greater attention should be directed toward providing support and follow-up for infants <6 m and their CGs in the community.

The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals.

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1-12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039).Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID. What is Known: • The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants. • In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment. What is New: • This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation. • The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs.

Effects of supplementary feeding on the rumen morphology and bacterial diversity in lambs.

Early supplementary feeding of lambs before weaning is important to meet their nutritional needs, promote the development of rumen and improve performance. To study the effect of early supplementary feeding on rumen development and the microbiota of lambs, 22 Hu lambs were randomly divided into two groups: one group was fed with milk replacer (group C), and the other group was fed with milk replacer and starter (group S). At 28 days, six lambs in each group were slaughtered, and the rumen content and tissue samples were collected for detection and analysis. The starter significantly promoted the length of rumen papilla (P = 0.03), the concentration of acetate, propionate, butyrate and total volatile fatty acids (TVFA) (P < 0.01), which were higher in group S compared with group C. Group C had a higher rumen microbial diversity than group S. The dominant bacteria in the two groups were the same (Bacteroidetes, Firmicutes and Proteobacteria); however, they differed notably at the genus level. The microbial abundance of the two groups was significantly different for 22 species. In group C, the first three dominant bacteria were Bacteroides, Porphyromonas, and Campylobacter, while in group S they were Succinivibrio, unidentified_Prevotellaceae, and unidentified_Lachnospiraceae. Spearman correlation analysis showed that some ruminal bacteria were closely related to internal environmental factors, e.g., the relative abundances of unidentified_Bacteria, Euryarchaeota, Fusobacteria, and Gracilibacteria correlated negatively with acetate, propionate, butyrate, and TVFA (P < 0.05), while the relative abundances of Firmicutes correlated positively with acetate, propionate, butyrate and TVFA (P < 0.05). Bacteroidetes correlated negatively with propionate, butyrate, and TVFA (P < 0.05); Synergistetes correlated negatively with acetate, propionate, and butyrate (P < 0.05); Deinococcus-Thermus correlated negatively with propionate, butyrate, and TVFA (P < 0.05); Spirochaetes correlated negatively with propionate and TVFA (P < 0.05); and Elusimicrobia correlated negatively with propionate and butyrate (P < 0.05). Actinobacteria and Verrucomicrobia correlated positively correlated with NH3-N. In conclusion, supplementary feeding of lambs before weaning promoted the development of rumen tissue morphology and rumen microorganisms.

Jejunal inflammatory cytokines, barrier proteins and microbiome-metabolome responses to early supplementary feeding of Bamei suckling piglets

BackgroundDietary intervention has been reported to improve intestinal health. The intestinal microbiota of newborn animals plays a fundamental role in the development of intestinal function and the innate immune system. However, little is currently known about dietary interventions in the gut microbiota and barrier function of livestock, especially suckling Bamei piglets. To this end, we studied the effect of early dietary supplementation on intestinal bacterial communities and intestinal barrier function in piglets.Results10 purebred Bamei sows were randomly allocated into two groups. In group one, the piglets received a supplementary milk replacer on day 7 of age, whereas the other control group was allowed sow’s milk alone. At 21 days, 18 and 17, respectively, piglets in each group of average weight were randomly selected and sacrificed. Tissue and digesta samples were collected from the jejunum to evaluate differences in the microbiome-metabolome and the mRNA expression of inflammatory cytokines (TLR4, TNFα and IL-8) and barrier proteins (ZO-1, Occludin and Claudin-1). Sequencing of 16S rRNA revealed that ES improved the gut microbiome composition of Bamei suckling piglets. The relative abundances of some bacterial species such as Lactobacillales, Romboutsia, Actinobacillus, Bacteroides were significantly reduced in the ES group. Metabolomics analysis indicated that 23 compounds were enriched and 35 compounds decreased in the ES group. And correlation analysis demonstrated that some gut bacterial genera were highly correlated with altered gut microbiota-related metabolites. Meanwhile, ES of Bamei suckling piglets altered the gene expression of inflammatory cytokine and barrier protein in the jejunum.ConclusionsIn summary, these results provide important insights on the relationships between jejunal microbiota and related metabolites, and jejunal barrier function during the early life of Bamei suckling piglets.

Efektivitas lembar balik dan leaflet terhadap pengetahuan ibu hamil tentang pemberian makanan pendamping ASI (MP-ASI)

Background: Breast milk contains all the nutrients a baby needs in the first six months after birth. Provision of MP-ASI before children aged six months is not recommended, because it can increase the likelihood of contamination and increase the risk of disease, especially diarrhea. Many factors are related to early breastfeeding. These factors include knowledge. Based on data obtained from the Baiturrahman Health Center in 2018, the total coverage of k4 was 871 with 909 infants and those who received exclusive breastfeeding were 191 (42.54%) and the rest were given complementary feeding.Objectives: To determine the effectiveness of flipcharts and leaflets on the knowledge of pregnant women about complementary feeding in the work area of the Baiturrahman Health Center in Banda Aceh City in 2019.Methods: : this study uses a quasy-experimental design, the research design used is the pre and post test two gruop design. The population in this study were all pregnant women in the Baiturrahman Community Health Center in Banda Aceh City, with a purposive sampling technique of 15 people. Analysis of the data in this study used the T-Paired test.Results: The results showed that the effect of flipcharts was more effective on increasing maternal knowledge about complementary foods after counseling (p = 0.002), compared to the effect of using leaflets (p = 0.016) on increasing maternal knowledge about complementary foods after counselingConclusions and Recommendations: It is hoped that this research can be a reference for researchers in conducting this research and can provide information about complementary feeding, so as to reduce the number of early supplementary feeding and increase the rate of exclusive breastfeeding.

Longitudinal development of the gut microbiota in healthy and diarrheic piglets induced by age-related dietary changes.

Diarrhea is one of the most common enteric diseases in young piglets. Diverse factors such as an unstable gut microenvironment, immature intestinal immune system, early supplementary feeding, and weaning often induce dysfunction of gut microbiota, thus leading to a continuing high incidence of diarrhea in piglets. However, few studies have characterized the gut microbiota of diarrheic piglets following changes in diet and during the development of intestinal physiology. In this study, we used 16S rRNA gene sequencing to analyze the dynamic establishment of fecal microbiota in six healthy piglets in response to age‐related changes in the diet: sow‐reared, early supplementary creep‐feeding (sow‐reared + starter diet), and weaning (solid nursery diet). We compared the gut microbiota of these six healthy piglets with those of diarrheic piglets during each of the three dietary stages (n = 10 sow‐reared, n = 10 early supplementary creep‐feeding, and n = 5 weaning). We found that weaning (solid nursery feeding) was the primary factor leading to dynamic colonization by microbiota in healthy piglets, and diarrhea primarily affected the microbial communities of piglets before weaning. Healthy piglets showed a continuous decrease in Lactobacillus and Escherichia, as well as a gradual increase in Prevotella with the transition to solid food. An altered relationship between Prevotella and Escherichia may be the main cause of diarrhea in preweaned piglets, whereas reduced numbers of Bacteroides, Ruminococcus, Bulleidia, and Treponema that are responsible for the digestion and utilization of solid feeds may be related to the onset of postweaning piglet diarrhea. The Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) functional analysis indicated that a reduction in genes involved in carbohydrate metabolism induced by intestinal dysbacteriosis in diarrheic piglets was one of the major causes of diarrhea at the three dietary stages. These findings provide insights into developing an intervention strategy for better management of diarrhea in piglets.

Early supplementary feeding in rural Malawi: Constraints and motivations

Early supplementary feeding in rural Malawi: Constraints and motivations

ALEITAMENTO MATERNO EXCLUSIVO E ALIMENTAÇÃO COMPLEMENTAR ENTRE MENORES DE UM ANO EM RIBEIRÃO DAS NEVES-MG

Objective : The study aimed to identify the rate of exclusive breastfeeding and complementary feeding of children aged under one year in the city of Ribeirao das Neves-MG, Brazil. Material and methods : Research conducted in 10 municipal primary health units, with data collected through a questionnaire with 55 questions to be completed by the parents/carers of children under one year, who attended the vaccine room in the study period. A total of 353 questionnaires were distributed to the health units. Data analysis comprised the association of variables with exclusive breastfeeding based on asymptotic and exact Pearson’s chi-square tests and exact Pearson’s chi-square tests with the study variables. Results : The exclusive breastfeeding rate in the city was 30%, requiring development of activities, programs or services to promote, support and advise on breastfeeding. The variables that have correlation with the low breastfeeding rate in the municipality were the use of bottle and child’s age. We identified early supplementary feeding and use of foods not recommended for the child’s age, practice that can be linked to cultural factors. Conclusion : Early introduction of foods not recommended for age favors early weaning and the establishment of unhealthy dietary habits in adulthood. Data suggest that the multidisciplinary team should be prepared to meet the individual needs of mother and child when monitoring and evaluating breastfeeding or supplementary feeding. DOI: http://dx.doi.org/10.12957/demetra.2015.13479

Supplementary Infant Feeding and Growth

To the Editor: International recommendations discourage feeding infants anything other than breast milk for the first 6 months of life1,2—in part, because of concern that supplementation would reduce a mother’s breast milk supply as a consequence of reduced suckling. Conversely, perceived “insufficient milk” is commonly reported by mothers throughout the world3–6 as a reason for early supplementary feeding or discontinuation of breastfeeding. In a recent commentary in EPIDEMIOLOGY, Kramer and colleagues reflect on a “formidable obstacle to causal inference”3(p. 793) regarding infant feeding: do differences in infant feeding behaviors cause differences in infant growth or do growth patterns instead affect infant feeding choices (“reverse causality”3,7)? Detailed prospective data with which to address these questions are rare. A study from Argentina provides some insights. Five hundred mothers who planned to breastfeed for 9 months, with no supplementary feeding for 4 months, were enrolled.8 Here, we consider the patterns of supplementation (milk or other foods) during the infants’ first 4 months of life (which was the duration of unsupplemented breastfeeding recommended at the time this study was conducted). The Table presents infant weight gain in relation to timing of supplementation, using the notation in the directed acyclic graph depicted by Kramer et al3 (eFigure, https://links.lww.com/EDE/A763; Kramer’s Figure 4). One-third of mothers who were observed at 4 months had already begun supplementation. For each month, weight velocity during the period leading up to the follow-up visit (which occurred at time j + 1) was highest for infants who were not yet supplemented, somewhat lower for those who had begun supplementation before this interval (before time j), lower still for those who began supplementation during this interval (j to j + 1), and lowest for those who began supplementation at the time of this visit.TABLE: Number of Subjects, Mean Daily Infant Weight Velocity Since Previous Follow-up Visit, and Percentage of Mothers Reporting Decreased Milk Production,a by Month and Timing of Supplementary Feeding (Described According to the DAG in the Article by Kramer et al3; see eFigure, http://links.lww.com/EDE/A763)At time j + 1, mothers who had begun supplementing before time j reported the highest percentages of perceived decreased milk production—presumably because supplementary foods had been providing some of the infants’ nutritional needs for at least 1 month. Once supplementation began, the reported daily breastfeeding frequency and average duration per feeding both declined, suggesting that these mothers were producing less milk. Of concern is the observation that, more than a month after supplementation had begun, these infants continued to grow more slowly than unsupplemented infants. Among mothers who began supplementing at time j + 1, maternal reports about decreased milk production expressed at that visit—as well as the slowest infant growth of the 4 groups—clearly preceded supplementation. (International recommendations1,2 instead encourage more frequent breastfeeding to stimulate the milk supply.) For mothers who began supplementing during the interval j to j + 1, we cannot be sure which mechanism is at work. However, we do know that at the previous visit (time j) few of these mothers had reported decreased milk production, and infant weight velocity had been relatively high. These results suggest that, for at least some of these mothers, the decision to begin supplements between these two visits was not prompted by perceived decreased milk production or slow weight gain but rather led to these problems. Among mothers who had not begun supplementation, very few reported that milk production was “unsatisfactory” (Table). These infants had the highest weight velocity. One limitation of our study is the small sample sizes in the three supplementing groups, due in part to study attrition; thus, confidence intervals are broad and overlapping. Nonetheless, similar patterns in all 4 months lend credence to these results. Analyses of larger data sets are warranted to explore the longitudinal associations of mothers’ reports of insufficient milk, supplementary feeding of young infants, and infant weight gain. Margaret F. McCann FHI360 Durham, NC, [email protected] Angel Victor Moggia Department of Obstetrics School of Medicine Buenos Aires University Buenos Aires, Argentina

Early supplementary feeding among central African foragers and farmers: A biocultural approach

The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for six months, yet this recommendation has proven difficult to implement. Here, we examine the nature of and influences on early supplementation (ES) in light of current evidence regarding evolved human caregiving patterns (cooperative breeding). We utilize a biocultural approach, which takes into consideration that infant feeding is influenced by an array of evolutionary, physiological, structural, ecological, and cultural factors. The research is cross-cultural, conducted among the Aka foragers and Ngandu farmers in the Central African Republic. We explore emic perspectives of ES as well as infant characteristics and socioecological factors that, when combined with evidence of human care patterns, offers a more holistic understanding of early infant feeding. We employ a mixed-methods approach, utilizing qualitative interview and quantitative focal-follow behavioral observation data, collected from 2009 to 2012. Results indicate that foragers introduce ES earlier than farmers; nevertheless, only a small proportion of Ngandu mothers EBF. Maternal and non-maternal caregiver ES patterns are predicted by different factors. Maternal ES is associated with infant age, while non-maternal ES is associated with maternal labor activities and the infant's caregiving network. Non-maternal ES, but not maternal ES, reduces breastfeeding. Results suggest that neither subsistence ecology nor maternal labor patterns fully explain the timing of ES. However, cooperative caregiving, infant mortality risk, and cultural models of caregiving offer insights into why foragers commence ES so early. We discuss the implications of ES on weaning age, inter-birth intervals, and fertility. Throughout our evolutionary history and today, non-maternal caregivers were and are essential participants in childcare and provisioning, yet are rarely viewed as active participants in early infant feeding. Consideration of evolved caregiving patterns and the role of others in feeding practice will enhance public health outreach.

‘It is me who eats, to nourish him’: a mixed‐method study of breastfeeding in post‐earthquake Haiti

In Haiti, initiation of breastfeeding is high, but early mixed feeding is the norm. In a situation of crisis, mothers' worries about insufficiency of breast milk, disruption of social networks and free unmonitored distribution of breast milk substitutes impact feeding practices. This study was conducted to explore the attitudes, practices and understandings of breastfeeding in the post-earthquake situation in Haiti. A mixed-method study was conducted in Léogâne, Haiti, a town close to the epicentre of the 2010 earthquake. In a household survey, 1131 mothers of children under 24 months were interviewed about feeding practices. In the quantitative component, we conducted 25 in-depth interviews and seven focus group discussions with mothers, grandmothers, traditional birth attendants, fathers and health care professionals. Mothers described breastfeeding as a challenging responsibility to ensure the infants' health. They understood breast milk as a dynamic substance, the quality of which would deteriorate if the mother's diet was poor or if the mother was afflicted with a psychosocial condition called move san or colere, 'bad blood'. To protect the child in these situations, early supplementary feeding is introduced. Only 20% of informants exclusively breastfed infants under 6 months. Because of a lack of confidence in the quality of breast milk, Haitian mothers tend to wean children earlier. The abiding concerns of Haitian mothers over the quality of their breast milk suggest a number of ways - such as dietary advice - that post-earthquake aid agencies could enhance breastfeeding support.

Relação entre introdução precoce de alimentos, condições socioeconômicas familiares e doenças respiratórias

Objective: To assess the characteristics of early supplementary feeding and socioeconomic and demographic characteristics of families of children aged 0-59 m...

Stability, Predictive Validity, and Sensitivity of Mental and Motor Development Scales and Pre-School Cognitive Tests among Low-Income Children in Developing Countries

This paper documents the stability, predictive power, and sensitivity of mental and motor development scales and pre-school cognitive tests in the context of economically impoverished populations in low-income countries. Stability and predictive power comprise forecasting; stability includes repeated measures using the same test, whereas predictive power includes different tests. Sensitivity is the track record of the test in discriminating among groups of children exposed to different nutritional interventions. Psychometric data from three longitudinal studies of the assessment of the impact of early supplementary feeding on child development were used. Two studies were conducted in West Java, Indonesia, and the third study was carried out in El Oriente, Guatemala. Repeated measures allowed for the calculation of stability and predictive correlation coefficients. the mental development scales administered up to about 18 months had modest stability but no predictive power. This trend changed during the second year of life as the strength of the stability and predictive power increased. the pre-school tests were good predictors of a child's enrollment and school achievement. the findings on infant scales and pre-school tests agree with what has been reported in other populations in industrialized countries. There is no reason to believe that the developmental risk of the subjects that were assessed in each of the three target studies strengthens the psychometric attributes that were evaluated.

Fertility and Mode of Subsistence: A Phylogenetic Analysis

Des debats recents sur la dependance de la demographie humaine vis-a-vis des modes de subsistance offrent de nouvelles pistes de reflexion pour les anthropologues et les archeologues qui travaillent sur les relations entre l'environnement naturel et les strategies de reproduction familiale, ou encore sur les origines de l'agriculture. Les AA. presentent les resultats d'une analyse synthetique prenant en compte diverses societes (a partir de sources bibliographiques) afin d'isoler les effets phylogenetiques en comparant uniquement les differences entre fertilite et mode de subsistance parmi les societes traditionnelles culturellement voisines (classification par aire geographique qui prend en compte l'ensemble du monde). L'etude quantitative mesure les degres de dependance selon la typologie des modes de subsistance representes majoritairement parmi chaque societe traditionnelle.

A Reconceptualization of the Effects of Undernutrition on Children's Biological, Psychosocial, and Behavioral Development and commentaries

A Reconceptualization of the Effects of Undernutrition on Children's Biological, Psychosocial, and Behavioral Development and commentaries

Early Supplementary Feeding, Child Development, and Health Policy

We carried out a meta-analysis of six field studies that assessed the effects of supplementary feeding on infants’ performance on mental and motor development scales— conducted in nutritionally at-risk populations in Colombia, Guatemala, Indonesia, Jamaica, Taiwan, and the United States—which showed that early high energy and protein supplementary feeding has a beneficial effect on motor development in young infants (8–15 months old) and on both motor and mental development in older infants (1824 months old) who are nutritionally at risk. These findings provide justification for food assistance programmes targeted to young at-risk children. However, positive findings in field studies do not guarantee that similar results will be achieved by large-scale programmes, as complex bureaucracies and inadequate infrastructure are often obstacles to success.

EARLY SUPPLEMENTARY FEEDING AND COGNITION: A RETROSPECTIVE COMMENT

Monographs of the Society for Research in Child DevelopmentVolume 58, Issue 7 p. 111-115 EARLY SUPPLEMENTARY FEEDING AND COGNITION: A RETROSPECTIVE COMMENT Nevin S. Scrimshaw, Nevin S. ScrimshawSearch for more papers by this author Nevin S. Scrimshaw, Nevin S. ScrimshawSearch for more papers by this author First published: September 1993 https://doi.org/10.1111/j.1540-5834.1993.tb00430.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume58, Issue7September 1993Pages 111-115 RelatedInformation

Early Supplementary Feeding and Cognition: Effects over Two Decades

The study reported in this Monograph of the effects of early supplementary feeding on cognition included two data collection periods: a longitudinal investigation spanning the years 1969-1977 and a cross-sectional follow-up carried out in 1988-1989. The study was conducted in four rural villages in Guatemala and compared the differential effects of exposure in childhood (0-7 years) to an Atole supplement (11.5 g of protein; 163 kcal) or a Fresco supplement (59 kcal) on performance on a battery of psychoeducational and information-processing tests in adolescence and young adulthood (11-24 years). In this report, particular attention is given to a cohort of subjects who were exposed to the supplement prenatally and during at least the first 2 years of postnatal life. Data on this subsample are contrasted with those on a cohort of subjects who received the supplement only after 24 months of life. The Monograph also reports results from an analysis of the supplementation effects in infancy and early childhood. Consistent differences between groups on the psychoeducational tests were observed. Adolescents from Atole villages scored significantly higher on tests of knowledge, numeracy, reading, and vocabulary than Fresco subjects. Atole was also associated with a faster reaction time in information-processing tasks. Significant interactions helped identify two groups who benefited more from the Atole treatment: those at the lowest levels of socioeconomic status and those who attained the highest levels of primary schooling. The consistent differences in test performance established in the follow-up assessment contrast sharply with the few and less pronounced between-group differences observed in the infancy and preschool periods. After close scrutiny of alternative hypotheses, it is concluded that nutritional differences provide the strongest explanation for the test performance differences observed in the follow-up between the subjects exposed to the Atole and those exposed to the Fresco supplement.

Weaning practices and breast-feeding duration in Northern Thailand.

Current infant feeding guidelines recommend exclusive breast-feeding until the infant is about 4 months old to reduce the risks of early termination of breast-feeding, undernutrition and infection. In many societies, however, supplementary foods are given well before 4 months of age. The present paper describes weaning practices, factors associated with early supplementation and the effects of supplementation on duration of breast-feeding in a random sample of sixty northern Thai breast-fed infants studied prospectively from birth to 2 years of age. Composition of supplementary foods, energy and protein intake from supplements and changes in the supplementary diet with increasing infant age are also described. Rice-based foods were given from soon after birth; 81% of the sample had received supplements by 6 weeks of age. Early supplementary feeding was significantly associated with rural residence, large household size, maternal employment in agriculture and maternal age. Girls and infants with lower birth weights tended to be supplemented earlier. Despite early feeding of supplements, breast-feeding was prolonged, with median duration of 12 months. Early introduction of supplements and quantity of supplements consumed in the first 3 months were not associated with duration of breast-feeding. However, mothers who gave infant formula as the first supplementary food stopped breast-feeding slightly earlier, as did younger mothers living in households with more children.

About the causes of hypogalactia in women

Natural feeding in the first year of life is of great importance for the normal physical development of the child, the correct formation of his psycho-emotional sphere. At present, despite the success in studying various nutritional formulas for artificial feeding, all domestic and foreign pediatricians recognize the benefits of breastfeeding and are its ardent supporters. However, the number of children who receive early supplementary feeding and are transferred to artificial feeding is still high. The main reason for the transfer of infants to artificial feeding is hypogalactia - reduced secretory ability of the mammary glands. It is important to study the causes of hypogalactia, the development of effective methods for its prevention and treatment.