Feeding Guidelines Research Articles

Translating new evidence into clinical practice: a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa

ObjectivesWe report the effectiveness of a mentoring approach to improve health workers’ (HWs’) knowledge, attitudes and confidence with counselling on HIV and infant feeding.DesignQuasi-experimental controlled before–after study.SettingRandomly selected primary healthcare...

Psychosocial Experiences of HIV-Positive Women of African Descent in the Cultural Context of Infant Feeding: A Three-Country Comparative Analyses.

Infant feeding among mothers of African descent living with Human Immunodeficiency Virus (HIV) is a critical practice that is influenced by policies, cultural expectations, and the resultant psychosocial state of the mother. Hence, this paper draws insights from a broader infant feeding study. It provides insights into how guidelines on infant feeding practices, cultural expectations, migration, or geographic status intersect to influence the psychosocial experiences of mothers living with HIV. We compared psychosocial experiences of Black mothers of African descent living with HIV in Nigeria versus those in high-income countries (Canada and USA), in the context of contrasting national infant feeding guidelines, cultural beliefs about breastfeeding, and geographic locations. Survey was conducted in venue-based convenience samples in two comparative groups: (Ottawa, Canada and Miami-FL, USA combined [n = 290]), and (Port Harcourt, Nigeria [n = 400]). Using independent samples t-statistics, we compared the means and distributions of six psychosocial attributes between Black mothers in two distinct: Infant feeding groups (IFGs), cultural, and geographical contexts at p < 0.05. Psychosocial attributes, such as discrimination and stigma, were greater in women who exclusively formula feed (EFF) than in women who exclusively breastfeed (EBF) at p < 0.01. Heightened vigilance, discrimination, and stigma scores were greater in women whose infant feeding practices were informed by cultural beliefs (CBs) compared to those not informed by CBs at p < 0.001. Discrimination and stigma scores were greater among mothers in Canada and the USA than in Nigeria at p < 0.001. Heightened vigilance and perceived stress scores were less among women in Canada and the USA than in Nigeria at p < 0.001. The guidelines on infant feeding practices for mothers with HIV should consider cultural expectations and migration/locational status of mothers.

Compliance with Feeding Guidelines in COVID+ Patients

Describe compliance with feeding recommendations for COVID+ patients at three urban hospitals.

The future of Cochrane Neonatal

The future of Cochrane Neonatal

Social Determinants of Breastfeeding Preferences among Black Mothers Living with HIV in Two North American Cities.

The study is motivated by the need to understand the social determinants of breastfeeding attitudes among HIV-positive African, Caribbean, and Black (ACB) mothers. To address the central issue identified in this study, analysis was conducted with datasets from two North American cities, where unique country-specific guidelines complicate infant feeding discourse, decisions, and practices for HIV-positive mothers. These national infant feeding guidelines in Canada and the US present a source of conflict and tension for ACB mothers as they try to navigate the spaces between contradictory cultural expectations and national guidelines. Analyses in this paper were drawn from a broader mixed methods study guided by a community-based participatory research (CBPR) approach to examine infant feeding practices among HIV-positive Black mothers in three countries. The survey were distributed through Qualtrics and SPSS was used for data cleaning and analysis. Results revealed a direct correlation between social determinants and breastfeeding attitude. Country of residence, relatives’ opinion, healthcare providers’ advice and HIV-related stigma had statistically significant association with breastfeeding attitude. While the two countries’ guidelines, which recommend exclusive formula feeding, are cardinal in preventing vertical transmission, they can also be a source of stress. We recommend due consideration of the cultural contexts of women’s lives in infant feeding guidelines, to ensure inclusion of diverse women.

Knowledge, Attitude and Practice Survey of the Recommended Infant Feeding Guidelines for HIV Positive Mothers by Primary Health Care Workers in Uyo, Nigeria

Background: Safe and appropriate feeding is a key intervention that can prevent mother to child transmission of HIV. This study aimed at determining the level of knowledge, attitude and current practice of primary health care (PHC) workers in Uyo of the recommended infant feeding guidelines for infants of HIV-infected mothers.&#x0D; Methodology: This was an analytical cross-sectional study carried out among 130 primary health care workers in 15 PHCs in Uyo metropolis, Akwa Ibom State, Nigeria. Data was collected using self-administered questionnaires in English and analyzed using the Statistical Package for Social Sciences (SPSS) version 25.0.&#x0D; Results: Nineteen (14.6%) and 111 (85.4%) respondents had a fair and poor level of knowledge of MTCT of HIV and infant feeding options respectively. One hundred and six (81.5%) and 100 (76.9%) respondents had received training on PMTCT of HIV and infant feeding counselling for HIV-infected mothers respectively. The majority of respondents exhibited positive attitude regarding infant feeding options for HIV exposed babies. One hundred and twenty (92.3%) considered it correct for an HIV-infected woman to breastfeed her baby and 125 (96.2%) considered breast milk alone adequate food for babies in the first 6 months of life. Predictor of negative attitude was lack of training on infant feeding counseling (OR 15, P=0.02, 95%CI 1.64-138.07). Most 107 (82.3%) cited exclusive breastfeeding with introduction of complementary feeds at 6 months as the most common method accepted by their clients.&#x0D; Conclusion: Gaps in the knowledge of PHC workers in Uyo on MTCT and Infant feeding options and practice were identified which can be addressed by qualitative training, effective monitoring and supportive supervision.

P12 Evaluation of energy and protein intake in neonates using SCAMP regimen

AimsOur neonatal unit recently updated their parenteral and enteral feeding guideline and started using a standardised parenteral nutrition regimen (SCAMP).1The aim of this study was to observe the amount of energy and protein that was being delivered to patients using the SCAMP regimen and to evaluate whether it met the recommendations made by ESGPHAN in terms of energy and protein intake.2MethodsA data collection form was designed using Excel. Patients were identified using BadgerNet digital software. All required patient parameters were recorded from Badgernet. Data was anonymised and the Excel spreadsheet was password protected. A single investigator collected data over a 28 day period in October/November 2018. Only patients on the SCAMP regimen were included in the study. Patient data was collected from first day of SCAMP regimen until baby was discharged, or ceased parenteral nutrition.Results22 patients were identified for inclusion in the study. Of these, 17/22 (77%) weighed &lt; 1 kg.Majority of babies (20/22; 91%) were aged &lt; 31 weeks corrected gestational age when SCAMP was initiated.Majority of babies were on the SCAMP regimen due to prematurity; 4/22 (18%) had a surgical condition, that required PN to be initiated.1 patient had a complex congenital cardiac anomaly.Average length of time babies remained on SCAMP was 19 days (range 5–28 days).Majority of babies were enterally fed using breastmilk. Some babies were on alternative formula feeds.Mean amount of energy delivered to each patient was calculated. The amount of energy delivered increased daily over the first week, and by day 10 of life had reached the target range (110–135 kcal/kg/day). Recommended energy intake was then maintained for the rest of the 28–day study period.Target amount of protein intake varied for babies weighing &lt;1 kg and &gt;1 kg. For babies &lt;1 kg, a gradual increase occurred over the first 5 days of life. Recommended protein intake was met between days 5–10 of life, then there was a gradual decline.For babies weighing between 1–1.8 kg, the recommended protein intake was achieved within 24–48 hours. Higher than recommended amounts of protein were being delivered between days 5–10 of life. Mean protein intake remained within ESPGHAN recommendations (3.5–4 g/kg/day) during weeks 3 and 4 of life.The results are encouraging and demonstrate that neonates are managing to achieve the recommended amounts of energy intake from day 10 of life.LimitationsThis study focused solely on energy and protein intake – it did not include observations of growth. Future studies should consider looking at more patient-focused outcomes.ConclusionsSCAMP regimen is delivering the recommended amounts of energy for babies on the neonatal unit – target levels are achieved by day 10 of life.Future work should focus on observing growth in babies on SCAMPEarlier introduction of breast–milk fortifier may be helpful to increase protein intake in babies &lt; 1 kg – potential benefits need to be evaluated against risk of adverse effects.ReferencesMorgan C, Herwitker S, Badhawi I, et al. SCAMP: standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care. BMC Pediatrics 2011;11:53.Koletzo B, Goulet O, Hunt J, et al. Guidelines on paediatric parenteral nutrition of the European society of paediatric gastroenterology, hepatology and nutrition (ESPGHAN) and the European society for clinical nutrition and metabolism (ESPEN), supported by the European society of paediatric research (ESPR). J Pediatr Gastroenterol Nutr 2005;41 (Suppl 2):S1–87.

High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

PurposeInfants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness.ConclusionGuidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

Recommendations on Complementary Food Introduction Among Pediatric Practitioners

The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend waiting 3 to 5 days between the introduction of new complementary foods (solid foods introduced to infants <12 months of age), yet with advances in the understanding of infant food diversity, the guidance that pediatric practitioners are providing to parents is unclear. To characterize pediatric practitioner recommendations regarding complementary food introduction and waiting periods between introducing new foods. In this survey study, a 23-item electronic survey on complementary food introduction among infants was administered to pediatric health care professionals from February 1 to April 30, 2019. Responses were described among the total sample and compared among subgroups. Survey invitations were emailed to 2215 members of the Illinois Chapter of the American Academy of Pediatrics and the national American Academy of Pediatrics' Council on Early Childhood. Participants were required to be primary medical practitioners, such as physicians, resident physicians, or nurse practitioners, providing pediatric care to infants 12 months or younger. The main outcome measures were recommendations on age of complementary food introduction and waiting periods between the introduction of new foods. Categorical survey items were reported as numbers (percentages) and 95% CIs. Means (SDs) were used to describe continuous survey items. The survey was sent to 2215 practitioners and completed by 604 (response rate, 27.3%). Of these respondents, 41 were excluded because they did not provide care for infants or pediatric patients. The final analyses included responses from 563 surveys. Of these, 454 pediatricians (80.6%), 85 resident physicians (15.1%), and 20 nurse practitioners (3.6%) completed the survey. Only 217 practitioners (38.6%; 95% CI, 34.1%-44.6%) recommended waiting 3 days or longer between food introduction; 259 practitioners (66.3%; 95% CI, 61.4%-70.8%) recommended waiting that amount of time for infants at risk for food allergy development (P = .02). A total of 264 practitioners (46.9%; 95% CI, 42.8%-51.0%) recommended infant cereal as the first food, and 226 practitioners (40.1%; 95% CI, 36.1%-44.2%) did not recommend a specific order. A total of 268 practitioners (47.6%; 95% CI, 43.5%-51.7%) recommended food introduction at 6 months for exclusively breastfed (EBF) infants, and 193 (34.3%; 95% CI, 30.5%-38.3%) recommended food introduction at 6 months for non-EBF infants (P < .001); 179 practitioners (31.8%; 95% CI, 28.1%-35.8%) recommended food introduction at 4 months for EBF infants, and 239 practitioners (42.5%; 95% CI, 38.4%-46.6%) recommended food introduction at 4 months for non-EBF infants (P < .001). A need for additional training on complementary food introduction was reported by 310 practitioners (55.1%; 95% CI, 50.9%-59.1%). In this survey study, most pediatric practitioners did not counsel families to wait 3 days or longer between introducing foods unless infants were at risk for food allergy development. The findings suggest that the current recommendation limits infant food diversity and may delay early peanut introduction. Because the approach to food allergy prevention has changed, a reevaluation of published feeding guidelines may be necessary.

Gastric residual volume measurement in British neonatal intensive care units: a survey of practice

ObjectiveDespite little evidence, the practice of routine gastric residual volume (GRV) measurement to guide enteral feeding in neonatal units is widespread. Due to increased interest in this practice, and to...

Primary Prevention of Allergic Diseases: The Role of Early Exposure to Cow's Milk Formula.

The burden of atopic disorders is continuously worsening worldwide, especially in childhood. Therefore, risk factors and preventive measures have been called into question. The age when infants introduce complementary foods, varies greatly according to traditional habits, clinical practice recommendations, and breastfeeding duration. It is still debated the impact of early exposure to cow's milk on the increase of allergic diseases, mainly food allergy, and atopic dermatitis. Many factors may play a role in this potential link, such as genetic variation, parental atopy, infant feeding regimens. Recent evidences suggest that the early introduction of complementary foods (up to 6 months of age), including cow's milk, could prevent the development of food allergies. So, several countries included this new approach into feeding guidelines. Our review will focus on the influence of early exposure to cow's milk formula on the development of allergic diseases. Some trials found that cow's milk supplementation in the first days of life could even increase the development of IgE sensitization and food allergies. Other trials did not show any efficacy on prevention of allergic disorders. Further studies are needed to understand the prospective for allergy prevention related to optimal timing of cow's milk formula introduction.

Patterns and predictors of exclusive breastfeeding in Chinese Australian mothers: a cross sectional study

BackgroundWhile exclusive breastfeeding is recommended to 6 months of age, just 15% of mothers in Australia achieve this. The rate appears to be even lower among mothers born in China, where 90% have introduced infant formula by this time. This study aimed to examine infant feeding patterns in the first 12 months of life and the factors associated with exclusive breastfeeding at 4 months of age and infant formula introduction by 1 month of age among Chinese Australian mothers.MethodsChinese Australian women with a child aged 1 to 4 years born in Australia were recruited through social media and asked to complete an online survey. Chinese ethnicity was defined as the mother or her parents having been born in mainland China, Taiwan or Hong Kong. Infant feeding practices since birth and a range of psychosocial and cultural factors were assessed. A total of 289 Chinese Australian mothers completed the survey. The relationships between exposure variables and exclusive breastfeeding at 4 months or infant formula use by 1 month were examined using multivariable logistic regression.ResultsAlmost all (93%) mothers initiated breastfeeding, however by 1 month of age exclusive breastfeeding rates reduced to 44%, with a further decline to 33 and 18% at 4 and 6 months respectively. Concurrently, 7% of parents reported infant formula feeding at birth increasing to 55 and 63% at 1 and 6 months of age respectively. The rates of any breastfeeding were 81% at 6 months and 50% at 12 months of age. Breastfeeding intention, self-efficacy and awareness of the infant feeding guidelines were key factors associated with sustained exclusive breastfeeding to 4 months.ConclusionsWhile Chinese Australian mothers had comparable exclusive breastfeeding rates at 6 months to the general Australian population, twice as many had introduced infant formula by 1 month of age. There is an urgent need to support Chinese Australian mothers in the perinatal period to strengthen their knowledge, intention and confidence to delay early introduction of infant formula and promote exclusive breastfeeding in the early postpartum period.

HOW TO OPTIMIZE INFANT FEEDING PRACTICES

Introduction. Obesity is one of the most important non-communicable epidemics of the 21st century. Rapid weight gain during first year of life is considered as a risk factor for childhood and adolescence obesity. Pediatricians play a central role in shaping healthy diets and combating the childhood obesity epidemic. It is necessary to optimize the teaching of child nutrition in the undergraduate and postgraduate studies, first and foremost, this concerns breastfeeding.Purpose of the study: optimization of infant feeding practices by updating the content of continuing medical education for physicians to improve their parental counseling skills.Materials and methods of research. A voluntary, anonymous survey of 40 primary care physicians on their infant feeding recommendations was conducted by random sampling. With the help of Google Forms, doctors were asked to answer 20 online survey questions. The prevalence of self-reported physician recommendations has been compared with current Guidelines for Infants and Young Toddler (2017) and parental self-reported responses, which reflects existing infant feeding practices.Results of the study and their discussion. It has been found that physicians spend an average of 15-20 minutes on counseling about breastfeeding, complementary foods or assessment and correction of feeding in the second part of the first year of life. Only 27.5% of doctors did not have difficulties in counseling parents. According to doctors, enhancement of counseling algorithms (42.5%) and printed material for parents (55%) could help to improve parental counseling practices. The main recommendations of doctors on breastfeeding, the timing of complementary feeding and the general list of supplementary foods are modern and have a significant impact on the practice of breastfeeding. In doing so, evidence-based recommendations provided by Feeding Guidelines for Infants and Young Toddler (2017) regarding iron-rich foods, potential high-allergenic foods, non-recommended foods, and responsive feeding have proven to be new to some physicians.Conclusion. In order to optimize the practice of breastfeeding, it is necessary to improve the training of pediatricians and family doctors during undergraduate studies and continuing postgraduate education. In the undergraduate program, greater emphasis should be placed on developing such competencies as effective communication of physicians with parents, and the elements of breastfeeding counseling and responsive breastfeeding may be included in the list of objective structured clinical exam skills. Continuing postgraduate physician education provides for continuous updating of knowledge as updated evidence-based recommendations emerge. The Feeding Guidelines for Infants and Young Toddler (2017) can now be offered as a prototype for national infant and toddler feeding guidelines, and the information contained therein is being disseminated.

Virtually supported home peanut introduction during COVID-19 for at-risk infants

Virtually supported home peanut introduction during COVID-19 for at-risk infants

The optimal period for changing the feeding regime of mono-sex male Nile tilapia (Oreochromis niloticus)

There has been a lack of information reported on the appropriate period required to replace an original feed formula with a new feed for most fish species. In the current study, a feed containing high protein (HP) was replaced in daily increments of 12.5, 20 and 25% with low protein (LP) feed for mono-sex male Nile tilapia (3.68 ± 0.03 g initial weight) over a nine-week experimental period and the results compared with a control treatment continually fed with the HP feed. At the end of the feeding trial, the body weight, length and specific growth rate did not differ for fish fed with the 20 and 25% replacement levels (P > 0.05), while significantly decreased values were observed for the 12.5% replacement group. The feed conversion ratio was superior for fish receiving the 12.5 and 25% replacement levels, while the protein efficiency ratio showed no differences across all the dietary treatments. Changing the feeding regime had no significant effects on the specific activities of protein- and carbohydrate-digesting enzymes, while significantly lower lipase specific activity was observed for the control group fish. The RNA and RNA/protein ratio were highest in the fish receiving the 25% replacement level, followed by the 12.5 and 20% groups, with the control group lowest, while the protein concentration was lower than the control group at all replacement levels. The amounts of flesh proteins did not differ among all the dietary treatments, nor did the carcass moisture, crude protein or ash, while the crude lipid was higher in all the fish receiving the LP feed. The findings from the current study suggest that the optimal level for replacing the original feed formula with a new feed is 25% per day, which should be used as a practical feeding guideline for mono-sex male Nile tilapia.

Non-Adherence to WHO Recommendations Regarding Infant Feeding Practices Results in Dilemma of Malnourishment: A Community-Based Prospective Cohort Study Conducted in Karachi, Pakistan

BackgroundThe prevalence of chronic malnutrition and its associated morbid outcomes has been a significant cause of health loss globally, affecting millions of children hampering their mental, physical, social, and immune system development. World Health Organization's (WHO) recommendations presenting infant feeding guidelines have largely controlled this burden. However, developing countries including Pakistan have failed to promote these guidelines and still succumb to a huge burden of morbidity and mortality secondary to malnourishment among infants.MethodologyOur study is a prospective cohort including 300 infants without predisposing congenital anomaly, followed from 6 months to 18 months of age. The primary outcome involved was classifying patients as malnourished based on anthropometric measurements, assessing the prevalence of co-morbidities and comparison of results in compliance with WHO guidelines.ResultsA total of 276 infants were included and the rest were lost to follow-up. Stratification on socioeconomic status was done; 53% of infants were diagnosed as malnourished, either due to stunted growth, underweight, or both. The odds of development of malnourishment based on non-adherence to WHO guidelines on breastfeeding were 2.87 (p=0.001). The incidence of morbid complications was higher in the malnourished group, including gastrointestinal and respiratory tract infections.ConclusionThe implementation of WHO recommendations on infant feeding techniques can prove to be a pivotal instrument to control the soaring index of morbidities and mortalities associated with malnourishment. A strong focus on parental education and awareness among masses is required for its promulgation and controlling the infant health burden linked to this preventable condition.

Infant and Child Diets of Hunter-Fisher-Gatherer Societies: A Systematic Review

Abstract Objectives To identify key changes in child diets during the transition to agriculture by synthesizing evidence on 1) infant and child hunter-fisher-gatherer diets to identify common elements of an evolutionary child diet and 2) early agricultural groups. Methods We searched five databases (Academic Search Complete via EBSCO, Anthropology Plus via EBSCO, Medline via PubMed, Scopus, and SocIndex with Full Text via EBSCO). Childhood was defined as children 10 years or younger. Early agriculture was defined as cultivation activities during the Neolithic or regional Neolithic equivalent era (e.g., Woodland Period), to account for the variation in the transition to agriculture. Studies examining hominins from the following species were eligible: Homo erectus/Homo ergaster, Homo neanderthalensis, Homo heidelbergensis, and Homo sapiens. We included peer-reviewed papers of qualitative, quantitative, and mixed methods on infant and childhood diets for groups whose primary subsistence method was hunting, fishing, or gathering or groups who were transitioning to early agriculture. Title and abstract reviews were conducted in Rayyan QCRI by two blinded authors. Discrepancies were reviewed by a third author. Full text review was also blinded. We scored studies with the Mixed Methods Appraisal Tool (2018), and we synthesized evidence using a narrative synthesis with sub-group analysis as appropriate. Results The publications covered a range of subsistence groups and study types (e.g., ethnography, isotopic analysis). Groups from Africa, Asia, Europe, North America and South America were represented, and time periods ranged from the Mesolithic Era to present. Our analysis indicated a significant shift in child diet accompanying the shift to agriculture. Hunter-gatherer-fisher children had more varied diets with a larger proportion of animal-source foods during and after the complementary feeding period compared to early agricultural groups. Conclusions Early agricultural diets, similar to current child dietary patterns, have diverged from the diets of hunter-fisher-gatherer children in important ways. These differences could offer insight into child feeding guidelines today. Funding Sources This project was internally funded by the E3 Nutrition Lab at Washington University in St. Louis.

Introduction of Complementary Foods and Inadequate Dietary Habits in Infants Under 12 Months of Age in Three Regions of Brazil

Abstract Objectives The objective of this study was to describe the dietary patterns of Brazilian infants from birth to 12 mo of age and to assess their adherence to feeding guidelines. Methods A cross-sectional random sample of infants aged 0–11.9 mo (n = 216) was identified in three census regions of Brazil (Northeast, Southeast, and South). In-person interviewers asked caregivers about breastfeeding practices and duration and timing of introduction of solid foods. Prevalence was estimated for specific age groups. Results were weighted to be representative of the infant population in Brazil. Results Almost 80% of the infants below 6 mo of age were ever breastfed. The percentage of infants that were currently breastfeeding decreased from birth through the age of 12 mo. Breastfeeding rates (i.e., currently breastfeeding) were 76.9% for infants 0–2.9 mo, 70.4% for those 3–5.9 mo and 50.5% for infants 6–11.9 mo. Early introduction of complementary foods was identified. Cow's milk was consumed by 12.4% of infants consumed cow's milk at 4–5.9 mo, and 51.6% were receiving cow's milk at 6–11.9 mo. Approximately 25% of 4–5.9 mo olds were consuming juice, and by 6–11.9 mo, 79.2% were consuming juice. On the other hand, 47.5% of 6–11.9 mo olds were consuming iron-fortified infant cereal and 70.8% were consuming meat. Conclusions We identified some feeding practices during early infancy among Brazilian infants that do not meet governmental recommendations. These include early introduction of cow's milk and consumption of fruit juices before one year of age. Funding Sources Supported by Nestle Research, Lausanne Switzerland.

Are the Nutrient and Textural Properties of Australian Commercial Infant and Toddler Foods Consistent with Infant Feeding Advice?

Abstract Objectives Australian Infant Feeding Guidelines recommend first foods be iron rich with no added sugars and that nutrient poor discretionary foods be avoided. They also encourage exposing infants to a variety of foods and flavours with increasingly complex textures. Here, we compare nutritional and textural properties of commercially available infant and toddler foods with established guidelines. Methods Infant and toddler food products available as of August 2019 were identified by searching for ‘baby food’ on retailer websites and by location in the ‘baby food’ section of major supermarket chains (Coles, Woolworths, Aldi and Foodland) in Adelaide, South Australia. Manufacturer websites were cross checked to identify all available products. Nutrient composition of foods was obtained from the nutrient information panel on the product label, manufacturer or retailer websites. In total, 446 products from 17 brands were reviewed, which accounted for over 90% of the market share. Results Most products were poor sources of iron, and 80% of first foods were fruit-based. Half of all products were purees in squeeze pouches and one third of all products were discretionary foods. The nutritional content of many products was inconsistent with guidelines, being low in iron, sweet, smooth in consistency, or classified as discretionary. Conclusions Reformulation of products is warranted to improve iron content, particularly in mixed main dishes, expand the range of vegetable only foods, and textural variety. Greater regulatory oversight and front of package labelling are needed to better inform parents and caregivers. Frequent consumption of commercial baby foods low in iron may increase risk of iron deficiency. Excessive consumption of purees via squeeze pouches may also have implications for overweight and obesity risk. Funding Sources There are no funding sources to declare for this research.

Content and Quality of Infant Feeding Smartphone Apps: Five-Year Update on a Systematic Search and Evaluation.

BackgroundParents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality.ObjectiveThis study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers.MethodsThe Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information.ResultsA total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps’ engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers.ConclusionsThe quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council’s Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources.