Feeding Guidelines Research Articles

Efficacy of Initiating the Right Complementary Feeding at Right Time - Bridge the Knowledge Gap Between Mother and the Caregiver in Bangladesh

Health professionals who have received nutrition training may assist to lower child undernutrition. By regularly advising caregivers on diet, qualified health professionals may specifically help achieve this goal. The risk of undernutrition among children of advised caregivers may be decreased as a result of bettering child-feeding behaviors. From six months of age forward, when breast milk alone is no longer adequate to cover all of their nutritional needs and supplemental feeding should be begun, infants and young children are at an elevated risk of malnutrition. To realize every person's full potential, appropriate nutrition throughout the first two years of life is essential. This time frame is still regarded today as being crucial for fostering healthy development, growth, and development. The health, nutritional status, growth and development of children at this period of life are thus affected by sufficient eating, not only in the short term but also in the medium and long term. For people who look after children throughout this period of life, this document offers complementary feeding (CF) guidelines that are expressed as questions or statements. Examples include when to introduce complementary feedings, when to introduce foods in order, and when to consider how the consistency of foods changes as a child's nervous system matures. Quantities for each meal; inadequate complementary feeding practices; myths and reality of complementary feeding; number of days to assess acceptability and tolerance to new foods; developmental milestones; practice of vegetarianism or baby-led weaning.

Feeding guidelines for night workers. A growing need

Feeding guidelines for night workers. A growing need

Healthcare Providers in Africa Face HIV and AIDS Challenges in Providing Services to a Key Population: Infant and Young Child Feeding

There is agreement on the benefits of exclusive breastfeeding for 6 months and the introduction of appropriate complementary foods at 6 months, followed by continued breastfeeding, for all infants. However, infant, and young child feeding (IYCF) guidelines for HIV-positive mothers have changed on a regular basis since 2000. Considering new HIV treatment guidelines, implementation challenges, and knowledge gaps, this article investigates issues and Evidence related to IYCF for the prevention and care of paediatric HIV in resource-limited settings. The effectiveness of antiretroviral medications (ARVs) in decreasing the incidence of HIV transmission from mother to child prompted WHO to urge countries to support either avoidance or treatment. Significant progress has been made in terms of preserving the lives of moms but also decreasing the spread of HIV among children, but long-term political, financial, and scientific commitment is essential for ensuring effective postnatal HIV prevention programs and providing for the nutritional requirements of HIV-exposed and HIV-infected infants.

More food for thought—For infants, can we pin down the timing of complementary feeding introduction even more?

Pediatricians and child health and nutrition providers are important and trusted sources of information for feeding guidelines for young infants. Although WHO guidelines that recommend exclusive breastfeeding for 6 months of age are the “gold standard” recommendations, the AAP and other guidelines have generally recommended introducing complementary foods “around” the age of 6 months. Of note, these guidelines are based on a wide range of concerns including optimal weight gain, food safety (the avoidance of enteropathogens), and the development of obesity. New research from Hollander et al in this volume of The Journal of Pediatrics provides more data to narrow down this window of opportunity. Compared with infants who received complementary foods at 6 months of age, those who received these at 4 months of age (still within the window of some recommendations), had a substantially higher BMI Z score as well as a higher incidence of obesity at age 10 years (Figure). Another point for closer to 6 months for ideal infant and child health! Article page 102 Timing of Introduction to Solid Food, Growth, and Nutrition Risk in Later ChildhoodThe Journal of PediatricsVol. 240PreviewTo evaluate the relationship between the timing of infant cereal introduction between 4 and 6 months of age and growth and dietary intake in later childhood. Full-Text PDF

Trends and predictors of early initiation, exclusive and continued breast-feeding in Bangladesh (2004-2018): a multilevel analysis of demographic and health survey data.

The early initiation of breast-feeding (EIBF) within 1 h of birth, exclusive breast-feeding (EBF) to 6 months and continued breast-feeding (CBF) to 2 years are key infant and young child feeding guidelines promoted globally for optimal child health and development. Using publicly available national survey data from the five most recent, consecutive Bangladesh Demographic and Health Surveys (2004, 2007, 2011, 2014 and 2017-2018), we assessed the trends in these key breast-feeding indicators. Multiple multilevel logistic regression models were built to assess socio-demographic predictors of breast-feeding using the latest 2017-2018 data set. Both EIBF and EBF have increased significantly between 2004 and 2017-2018, from 26 % to 60 % and 36 % to 68 %, respectively, and CBF decreased from 94 % to 85 %. Caesarean section delivery conferred lower EIBF practice (OR = 0·34, 95 % CI 0·27, 0·42) compared with vaginal delivery. Women who were currently working had 32 % lower odds of EBF (OR = 0·68, 95 % CI 0·48, 0·95). Compared with delivery at home, women who delivered in a health facility had 81 % higher odds of EBF (OR = 1·81, 95 % CI 1·25, 2·34). Larger family size (≥5) also predicted EBF (OR = 1·70, 95 % CI 1·21, 2·40). Rural residency was associated with 2·39 (95 % CI 1·32, 4·31) times of higher odds of CBF. Regional variation was also predictive of the various breast-feeding indicators. Although Bangladesh currently exceeds the 2019 global prevalence rates for these three breast-feeding indicators, efforts should be made to continue improving EIBF and EBF and to prevent future decreases in CBF.

The Australian Feeding Infants and Toddlers Study (OzFITS) 2021: Study Design, Methods and Sample Description.

(1) Background: Caregiver feeding practices during the first two years of a child’s life influence nutrition, growth, and development, as well as long term taste preferences and dietary patterns. Suboptimal feeding practices lead to poorer health outcomes, such as obesity, that persist into adulthood. Although the importance of early life nutrition is well-established, there are no Australia-wide surveys of dietary intakes of children under two years of age. The 2021 Australian Feeding Infants and Toddlers Study (OzFITS) aims to fill this gap. This paper describes the methods and study sample of OzFITS 2021. (2) Methods: OzFITS 2021 is a cross-sectional study of children aged 0 to 23.9 months of age and their caregiver across Australia. Data were collected between April 2020 and April 2021. A telephone-based survey was completed with a caregiver to obtain information on child and caregiver characteristics and feeding practices. For exclusively breastfed infants, the number of breastfeeds in a 24 h period was reported. Dietary intakes for mixed fed children were estimated using a one-day food record, with 30% of caregivers completing a second food record on a non-consecutive day. (3) Results: We enrolled 1140 caregiver and child dyads. Of those eligible to complete a food record, 853 (87%) completed the food record. Compared to the Australian population, caregivers were more likely to be university-educated (>75%), married or in a de facto relationship (94%), and have a household income >$100,000/y (60%). (4) Conclusions: OzFITS 2021 is the first national study to examine food and nutrient intake in Australian children aged under 2 years. The study will provide information on breastfeeding rates and duration, use of breast milk substitutes, and timing of solid food introduction. Dietary intake data will allow the comparison of core food groups and discretionary food intake to Australian guidelines and estimate the prevalence of inadequate intake of key nutrients, like iron. Healthcare practitioners and policymakers can use the study findings as a source of evidence to inform the next iteration of infant feeding guidelines.

Implementation of the Addendum Guidelines for Peanut Allergy Prevention by US Allergists, A Survey Conducted by the NIAID, in Collaboration With the AAAAI

To assess peanut feeding guideline implementation by US allergists who manage infants with food allergies.US allergists within the American Academy of Allergy, Asthma, and Immunology database.This was a cross-sectional survey conducted electronically between September and October 2018. The survey consisted of 31 questions, of which 4 were used to screen out those who were not practicing, did not see infants ≤12 months old, did not manage food allergy, and were not board certified. The survey was performed ∼21 months after the guidelines were published and ∼3 and one-half years after publication of the Learning Early About Peanut Allergy (LEAP) study.Over 3200 surveys were delivered by e-mail. There was a return rate of 29% (n = 825), of which 789 were completed enough for analysis. Nearly all respondents (99%) advised parents on peanut allergy prevention and performed in vitro or in vivo testing for peanut-specific immunoglobulin E. Nearly all strongly agreed (69%) or agreed (28%) that early introduction was effective in preventing peanut allergy. A total of 97% were aware of the guidelines. Of those, 65% reported rare deviation from the guidelines, and 34% reported partial implementation. The deviations reported erred on the side of caution, not nonchalance. Three clinical scenarios of severe eczema and a positive skin-prick test (SPT) result to peanut were described and included in the survey. Respondents fully adhered to the guidelines when the diameter of the peanut SPT was small (0–2 mm; 75.4%) or large (≥8 mm; 78%). Somewhat fewer (68.6%) fully adhered when the peanut SPT was 3 to 7 mm diameter. Only 44% fully adhered to the guidelines in all 3 scenarios. As compared with older allergists (≥31 years since med school graduation), younger allergists (0–10 years since graduation) were more likely to use the guidelines as published (P = .012), perform graded oral peanut challenges (P < .0001), perform single dose in-office challenges (P = .0012), strongly agree that early peanut introduction conferred protection against the development of allergy (P = .0003), and have read the full guideline (P = .0008). Older respondents were more likely to desire more training on the guidelines (P = .001) and report that conducting graded challenges (P = .0008) and reimbursement (P < .0001) were barriers to implementation. Allergists in academic institutions were more aligned with the younger allergists but identified a lack of clinic time as a barrier to implementation (P < .0001). In contrast, nonacademically affiliated allergists were more likely to identify concern about allergic reactions (P < .0001) and legal liability (P < .0001) as barriers.Most allergists are aware of and implement guidelines regarding early introduction of peanut, but barriers to full implementation remain.One can look at these results as good news that so many allergists generally adhered to the guidelines ∼21 months after publication or as bad news that so many more did not. Because the LEAP study was published 2 years before the guidelines, many allergists had already started to adjust practices by the time the guidelines were published. I will say the glass is half full because implementation of these guidelines was much faster than implementation of guidelines for asthma care when the first expert panel report was published 30 years ago. One weakness of this study published in 2020 is that the survey was conducted 2 years before publication. The results might differ by now, but how? Guidelines are just that: advice based on scientific principles. They are not rules or laws, so they must be open to interpretation and adjustment as knowledge evolves and experience grows. Finally, as someone who graduated from medical school 38 years ago, I found it interesting that older allergists were less likely to follow the guidelines than those who were more recently trained. Might it be because their greater experience made them interpret the nuances of the guidelines differently? Or might it be that greater efforts should be made to target older and nonacademically affiliated allergists when new guidelines are published? If either of those or any other explanation is correct, I would not extrapolate from peanut allergy and allergists to other guidelines or specialties.

Māori first foods: a Māori centred approach to understanding infant complementary feeding practices within Māori whānau

ABSTRACT This study sought to explore infant complementary feeding practices among Māori whānau and the extent to which they may be informed by traditional and culturally specific practices, knowledge, personal beliefs and values. This study also endeavoured to explore how these practices, values and beliefs may have changed across time and between generations. Māori-centred qualitative methods were used within a theoretical framework of Kaupapa Māori and socioecological theories. Semi-structured interviews were conducted and analysed using Braun & Clarke’s method of thematic analysis to uncover key themes and a new theory for understanding infant feeding among Māori whānau. The themes and theories identified through this project suggest that infant complementary feeding is believed to be a natural and instinctive process for Māori whānau, one that is undergoing a process of decolonisation across generations. These theories indicate that Te Ao Māori centred living, grounded in mātauranga Māori is integral to infant feeding values and practices within Māori whānau. It is also clear that many Māori parents desire more culturally relevant infant nutrition information and support. Our findings should inform future updates to infant complementary feeding guidelines within Aotearoa New Zealand, as well as developments in infant nutrition information and support.

Supporting Feeding of Late Preterm Infants in the Hospital: A Quality Improvement Project.

Feeding difficulty is the most common cause of delayed hospital discharge and readmission of late preterm infants. Frequent and adequate feedings from birth are protective against dehydration, hypoglycemia, and jaundice. The National Perinatal Association's feeding guidelines provide the foundation for late preterm infant standards of care. Feeding at least every 3 hours promotes nutritional status and neurologic development. One feeding assessment every 12 hours during the hospital stay can ensure quality of infant feeding. At a large urban hospital, medical record reviews were completed to evaluate nursing care practices consistent with the hospital's late preterm infant care standard policy. Feeding frequency and nurse assessment of feeding effectiveness were far below acceptable targets. A quality improvement team was formed to address inconsistency with expected practice. The project included an investigation using the define, design, implement, and sustain method of quality improvement. Parent education, nurse education, and visual cues were developed to sustain enhanced nursing practice. Late preterm infants who received feedings at least every 3 hours increased from 2.5% (1 of 40) to 27% (11 of 40); (M = 0.275, SD = 0.446), p = 0.001. Documented breastfeeding assessments increased from 2% (5 of 264) to 8% (10 of 126), p = 0.001. Documented bottle-feeding assessments increased from 15% (39 of 264) to 31% (53 of 172), p < 0.001. Intervention time was cut short due to reprioritization of efforts in response to the COVID-19 pandemic. Interventions and implementation of this process improvement is easy to replicate through attainable and sustainable goals directed toward improved outcomes for late preterm infants.

Initiation of breast-feeding practice and associated factors among mothers who have infants less than 12 months of age in Debre Tabor Town, North West Ethiopia, 2021: A multicenter community-based cross-sectional study

Introductioninitiation of breastfeeding is crucial in preventing newborn deaths and influences childhood nutrition. There was limited updated evidence regarding early initiation of breast-feeding practice and associated factors among the target population in the study area. ObjectiveTo assess initiation of breastfeeding practice and its associated factors among mothers who have infants less than six months of age in, North West Ethiopia, 2020. MethodsThe Community based quantitative cross-sectional study was conducted among 405 respondents in the stud area, then data would be entered and analyzed by using SPSS version 20 statistical packages. Bivariate and multivariable logistic regression model analysis would be done. Odds ratio with 95% confidence was computed to determine the level of significance-value less than 0.05 considered as significant. ResultThis study showed that 94.7% of mothers in Debre Tabor Town practiced initiation of breastfeeding for their infants within the Less Than 12 Months of age. In multivariable analysis I n f a n t S e x, Female [AOR (95% CI) = 0.068 (0.002, 1.659), and Age of Mother 20–24 years [AOR (95% CI) = 2.33 (0.030, 17.12)], 25–29 years ((AOR = 8.20 [(95% CI: 12.212, 22.189]), and 30–34 years (AOR = 4.48 [95% CI: 0.463, 15.478], Assists (Attend) during delivery, Doctor (AOR = 0.644 [95% CI: 0.041, 10.138]) and Encourage BF by religious father (AOR = 6.669 [(95% CI: 4.27, 8.895]) were remained significantly associated with the outcome variable with at 95% CI and P- value of <0.05. Conclusionand Recommendation: The prevalence of EIBF among mother-infant pairs of less than 12 months in debre tabor town, Northwest, Ethiopia, was found to be high as compared to national and global infant and young child feeding guidelines. However; it shows improvement as compared with some previous studies in Ethiopia. I n f a n t s e x, age of mother, assists during delivery, and encourage BF by religious father were factors associated with outcome in the stud area.

Management of erosive tooth wear

Erosive tooth wear is an oral health problem that worries clinicians and researchers worldwide. The aim of this study is to describe, through a literature review, the erosive tooth wear management. This problem is a challenge for dental surgeons, especially when it reaches more advanced stages, which can cause loss of dental and aesthetic function, as well as generate hypersensitivity to the patient. To prevent the progression of this problem focusing into preventive measures, such as guidelines for feeding and oral hygiene, the dental surgeon must perform early diagnosis to minimize erosive tooth wear damage.

Effect of Left and Right Semi-Elevated Side-Lying Positions on Feeding Performance of Preterm Infants

ObjectiveTo determine the effect of right and left semi-elevated side-lying positions on the feeding performance and skills of bottle-fed preterm infants. DesignA single-group, crossover experimental study. SettingsLevel 3 NICU of a training and research hospital in Istanbul. ParticipantsA total of 60 preterm infants born at 24 to 36 6/7 weeks gestation. MethodsWe collected data using an infant information form, feeding observation form, and the Turkish version of the Early Feeding Skills Assessment (EFS-Turkish). For each infant, we collected data for two feeds: one in the right and one in the left semi-elevated side-lying position. ResultsWe found no difference between the right and left semi-elevated side-lying positions in the volume or percentage of food taken (p = .582 and p = .625, respectively), feeding duration (p = .901), or feeding efficiency (p = .423). We observed no significant differences between feedings in the left and right semi-elevated side-lying positions in mean EFS-Turkish total score (p = .251) or subscale scores (p > .05). ConclusionNeonatal nurses can feed preterm infants in both directions of the semi-elevated side-lying position when following evidence-based feeding guidelines.

Breastfeeding Insufficiencies: Common and Preventable Harm to Neonates.

Insufficient milk intake in breastfed neonates is common, frequently missed, and causes preventable hospitalizations for jaundice/hyperbilirubinemia, hypernatremia/dehydration, and hypoglycemia - accounting for most U.S. neonatal readmissions. These and other consequences of neonatal starvation and deprivation may substantially contribute to fully preventable morbidity and mortality in previously healthy neonates worldwide. Previous advanced civilizations recognized this problem of breastfeeding insufficiencies and had an infrastructure to solve it: Wetnursing, shared nursing, and prelacteal feeding traditions used to be well-organized and widespread.Modern societies accidentally destroyed that infrastructure. Then, modern reformers missing a few generations of direct knowledge transmission about safe breastfeeding invented a new, historically anomalous conception of breastfeeding defined in terms of exclusivity. As that new intervention has become increasingly widespread, so too have researchers widely reported associated possible harms of the longer neonatal starvation/deprivation and later infant under-nutrition periods that it creates when breastfeeding is insufficient. Early insufficient nutrition/hydration has possible long-term effects including neurodevelopmental consequences such as attention deficit hyperactivity disorder, autism, cerebral palsy, cognitive and developmental delay, epilepsy, hearing impairment, kernicterus, language disorder, mood disorders, lower IQ, and specific learning disorder.Current early infant feeding guidelines conflict with the available evidence. Recent reform efforts have tended to focus on using more technology and measurement to harm fewer neonates instead of proposing the indicated paradigm shift in early infant feeding to prevent more harm. The scientific evidence is already sufficient to mandate application of the precautionary principle to feed neonates early, adequate, and often milk before mothers’ milk comes in and whenever signs of hunger persist, mitigating possible risks including death or disability. In most contexts, the formula is the best supplementary milk for infants at risk from breastfeeding insufficiencies. National-level reviews of scientific evidence, health policy, and research methods and ethics are needed to initiate the early infant feeding paradigm shift that the data already support. Policy experiments and related legislative initiatives might also contribute to the shift, as insurers might decline or be required by law to decline reimbursing hospitals for costs of this type of preventable hospitalization, which otherwise generates profit.

Improved recipes provide better complementary feeding in young children: findings of community-based trials in Bangladesh.

In Bangladesh, only 34% of children receive minimum acceptable diets as complementary foods (CF) for appropriate age while the rest of them remain at the risk of growth faltering, micronutrient deficiency, compromised cognitive development, and increased morbidity and mortality. The purpose of the study was to develop nutritious recipes for complementary feeding and provide necessary guidelines for improving complementary feeding practices for doctors, nutritionist and caregivers. This qualitative study including a baseline survey and Trials of Improved Practices of recipes (TIPs) was conducted on families having 6-23 months old children selected by Multi-stage random sampling methods from 2010 to 2012 throughout seven divisions of Bangladesh. Thirty-five food recipes were developed from local food items based on the 'WHO indicators to assess the adequacy of CF practices' for the TIP. Thirty (30) cooked recipes were analyzed for 10 nutrients in an accredited laboratory in Bangladesh. The baseline survey found that energy density of local recipes was low and did not have the required diversity, adequacy, and nutrient density according to IYCF indicators established by WHO. The TIPs found that 28 recipes out of the 35 recipes were most acceptable by both mothers and children. A manual of improved complementary food recipes and a complementary feeding guideline has been developed with calculation of dietary diversity scores, energy and nutrient density. This report will provide evidence-based practical knowledge for training and serve as nutrition education tool for nutrition practitioners, policy makers, and academicians.

Exploring Innovations in Human Milk Analysis in the Neonatal Intensive Care Unit: A Survey of the United States.

Introduction: Human milk (HM) is the ideal enteral feeding for nearly all infants and offers unique benefits to the very low birthweight (VLBW) infant population. It is a challenge to meet the high nutrient requirements of VLBW infants due to the known variability of HM composition. Human milk analysis (HMA) assesses the composition of HM and allows for individualized fortification. Due to recent U.S. Food and Drug Administration (FDA) approval, it has relatively recent availability for clinical use in the US.Aim: To identify current practices of HMA and individualized fortification in neonatal intensive care units (NICUs) across the United States (US) and to inform future translational research efforts implementing this nutrition management method.Methods: An institutional review board (IRB) approved survey was created and collected data on the following subjects such as NICU demographics, feeding practices, HM usage, HM fortification practices, and HMA practices. It was distributed from 10/30–12/21/2020 via online pediatric nutrition groups and listservs selected to reach the intended audience of NICU dietitians and other clinical staff. Each response was assessed prior to inclusion, and descriptive analysis was performed.Results: About 225 survey responses were recorded during the survey period with 119 entries included in the analysis. This represented 36 states and Washington D.C., primarily from level III and IV NICUs. HMA was reported in 11.8% of responding NICUs. The most commonly owned technology for HMA is the Creamatocrit Plus TM (EKF Diagnostics), followed by the HM Analyzer by Miris (Uppsala, Sweden). In NICUs practicing HMA, 84.6% are doing so clinically.Discussion: Feeding guidelines and fortification of HM remain standard of care, and interest in HMA was common in this survey. Despite the interest, very few NICUs are performing HMA and individualized fortification. Barriers identified include determining who should receive individualized fortification and how often, collecting a representative sample, and the cost and personnel required.Conclusions: Human milk analysis and individualized fortification are emerging practices within NICUs in the US. Few are using it in the clinical setting with large variation in execution among respondents and many logistical concerns regarding implementation. Future research may be beneficial to evaluate how practices change as HMA and individualized fortification gain popularity and become more commonly used in the clinical setting.

Primary Health Care Intervention Reduces Added Sugars Consumption During Childhood

ObjectiveTo investigate the effectiveness of a training program for health workers regarding infant feeding practices to reduce sugar consumption in children. DesignA cluster randomized trial was conducted at 20 health centers in southern Brazil randomly assigned to an intervention (n = 9) or control (n = 11) group. ParticipantsThe 715 pregnant women enrolled were assessed when their children were aged 6 months, 3 years, and 6 years. InterventionA training session for primary care workers based on the Brazilian National Guidelines for Children. Main Outcome MeasureMothers were asked when sugar was first offered to children. Added sugars intake was obtained from dietary recalls. AnalysisThe effectiveness of the intervention was modeled using generalized estimation equations and Poisson regression with robust variance. ResultsChildren attending intervention health centers had a 27% reduced risk of sugar introduction before 4 months of age (relative risk, 0.73; 95% confidence interval [CI], 0.61-0.87) as well as lower added sugars consumption (difference, −6.36 g/d; 95% CI, −11.49 to −1.23) and total daily energy intake (difference, −116.90 kcal/d; 95% CI, −222.41 to −11.40) at 3 years of age. Conclusions and ImplicationsHealth care worker training in infant feeding guidelines may be an effective intervention to delay the introduction of added sugars and lower the subsequent intake of added sugars in infants and toddlers.

CE: Monitoring Adult Patients for Intolerance to Gastric Tube Feedings.

Gastric tube feeding is a common and valuable intervention for patients in a variety of care settings. While tube feeding can save the lives of patients for whom oral feeding isn't possible, intolerance to tube feeding is a potential complication. This article discusses risk factors for feeding intolerance; the assessment of signs and symptoms of feeding intolerance; the various means of assessing gastric emptying, including the practice of monitoring gastric residual volume (GRV); the controversy surrounding GRV monitoring in assessing feeding tolerance; and the special considerations for monitoring feeding tolerance in acutely and critically ill adults with coronavirus disease 2019. The author, a nurse researcher with extensive experience in the area of enteral feeding, briefly summarizes recommendations and guidelines for enteral feeding published by national and international health care organizations between 2015 and 2020, and offers her perspective on best nursing practices for monitoring food tolerance in adults.

Impact of a \u201cvegetables first\u201d approach to complementary feeding on later intake and liking of vegetables in infants: a study protocol for a randomised controlled trial

BackgroundVegetables as first complementary foods for infants may programme taste preferences that lead to improved vegetable intake in children. Yet few studies have investigated the impact of a ”vegetables first” approach to complementary feeding, especially in New Zealand. The purpose of this randomised control trial is to investigate the effect of starting complementary feeding with vegetables only on infants’ later intake and liking of vegetables, compared to those starting with fruit and vegetables.Methods/designOne-hundred and twenty mother-infant pairs living in Auckland, New Zealand, will be randomised to receive either vegetables only (intervention) or fruit and vegetables (control) for 28 days, starting from the first day of complementary feeding at around 4–6 months of age. Infants will be presented with a brassica (broccoli), followed by a green leafy vegetable (spinach) and sweet fruit (pear) at 9 months of age. The primary outcome measures of intake of each food will be assessed using a weighed food diary. Secondary outcome measures of overall intake, liking and wanting of vegetables will be assessed using a food frequency questionnaire, liking tool and video coding tool, respectively, at 9, 12, and 24 months of age. Infant growth and iron status will be assessed as part of health screening and monitoring at baseline, post intervention and 9 months of age. Other biological samples to be collected include infant stool samples, vitamin D (mother and infant), iron status (mother), and mothers’ diet.DiscussionThis randomised, controlled trial will be the first to our knowledge to investigate a “vegetables first” approach to complementary feeding on infants’ liking and intake of vegetables in New Zealand. Comparison against standard practice (fruit and vegetables as first foods) should complement other trials underway, such as the Baby’s First Bites and Nordic OTIS trial. Results may contribute to the evidence supporting complementary feeding guidelines in New Zealand and worldwide.Trial registrationAustralian New Zealand Clinical Trial Registry ACTRN12619000737134. Registered on 16 May 2019.

Human immunodeficiency virus-positive women's perspectives on breastfeeding with antiretrovirals: A qualitative evidence synthesis.

Human immunodeficiency virus (HIV)‐positive women can breastfeed with minimal risk of mother‐to‐child transmission if taking antiretrovirals. Guidelines surrounding infant feeding for HIV‐positive women have evolved several times over the last two decades. Our review aimed to explore perspectives of breastfeeding with antiretrovirals from HIV‐positive women since the World Health Organization (2010) infant feeding and antiretroviral guidelines. HIV‐positive pregnant and postnatal women from all countries/settings were eligible. HIV‐positive women were either on an antiretroviral regimen at the time of the study, previously on an antiretroviral regimen, not initiated on a regimen yet, or enrolled in prevention of mother‐to‐child transmission (PMTCT) care. Quality assessment of all included studies were conducted. Four databases (CINAHL, EMBASE, MEDLINE and PsycINFO) were searched for studies conducted from January 2010 to October 2020. Nine papers were included in the review, of which two presented findings from the same study. Five analytical themes were developed via thematic synthesis: (1) awareness of breastfeeding with antiretrovirals, (2) turmoil of emotions, (3) coping mechanisms, (4) the intertwining of secret, stigma and support and (5) support needed. Support from family and health care professionals and coping approaches were important to overcome stigma and the emotional challenges of breastfeeding with antiretrovirals. Health care professionals should be familiar with the most updated national and local guidance surrounding infant feeding and antiretrovirals. Further research into interventions to encourage HIV‐positive women to adhere and commit to lifelong antiretroviral treatment (Option B+) for breastfeeding is required.

An index measuring adherence to New Zealand Infant Feeding Guidelines has convergent validity with maternal socio-demographic and health behaviours and with children's body size.

Using data from a nationally generalisable birth cohort, we aimed to: (i) describe the cohort's adherence to national evidence-based dietary guidelines using an Infant Feeding Index (IFI) and (ii) assess the IFI's convergent construct validity, by exploring associations with antenatal maternal socio-demographic and health behaviours and with child overweight/obesity and central adiposity at age 54 months. Data were from the Growing Up in New Zealand cohort (n 6343). The IFI scores ranged from zero to twelve points, with twelve representing full adherence to the guidelines. Overweight/obesity was defined by BMI-for-age (based on the WHO Growth Standards). Central adiposity was defined as waist-to-height ratio > 90th percentile. Associations were tested using multiple linear regression and Poisson regression with robust variance (risk ratios, 95 % CI). Mean IFI score was 8·2 (sd 2·1). Maternal characteristics explained 29·1 % of variation in the IFI score. Maternal age, education and smoking had the strongest independent relationships with IFI scores. Compared with children in the highest IFI tertile, girls in the lowest and middle tertiles were more likely to be overweight/obese (1·46, 1·03, 2·06 and 1·56, 1·09, 2·23, respectively) and boys in the lowest tertile were more likely to have central adiposity (1·53, 1·02, 2·30) at age 54 months. Most infants fell short of meeting national Infant Feeding Guidelines. The associations between IFI score and maternal characteristics, and children's overweight/obesity/central adiposity, were in the expected directions and confirm the IFI's convergent construct validity.