Half Of Infants Research Articles

Breastfeeding and reported morbidity during infancy: findings from the Southampton Women's Survey

A number of studies in developed countries suggest that breastfeeding protects against infections in infancy. However, the choice to breastfeed is often related to maternal characteristics, and many of these studies are limited in the extent to which they can take account of confounding influences. In a prospective birth cohort study, we assessed the relationship between the duration of breastfeeding and the prevalence of lower respiratory tract infections, ear infections and gastrointestinal morbidity during the first year of life in 1764 infants. We considered the duration of all breastfeeding, including mixed feeding. Eighty-one per cent of the infants were breastfed initially, and 25% were breastfed up to 6 months. There were graded decreases in the prevalence of respiratory and gastrointestinal symptoms between birth and 6 months as breastfeeding duration increased; these were robust to adjustment for a number of confounding factors. The adjusted relative risks (95% confidence interval) for infants breastfed for six or more months compared with infants who were never breastfed were 0.72 (0.58-0.89), 0.43 (0.30-0.61) and 0.60 (0.39-0.92) for general respiratory morbidity, diarrhoea and vomiting, respectively. Duration of breastfeeding in the second half of infancy was less strongly related to diagnosed respiratory tract infections and gastrointestinal morbidity, although important benefits of breastfeeding were still seen. Our data provide strong support for a protective role of breastfeeding against respiratory and gastrointestinal infections in infancy. The graded inverse associations with breastfeeding duration suggest that current efforts to promote breastfeeding and increase duration will have important effects in reducing morbidity in infancy.

Sleeping Through the Night: The Consolidation of Self-regulated Sleep Across the First Year of Life

To investigate the consolidation of infants' self-regulated nocturnal sleep over the first year, to determine when infants first sleep through the night from 24:00 to 05:00 hours (criterion 1), for 8 hours (criterion 2), or between 22:00 and 06:00 hours (the family-congruent criterion 3). This was a prospective longitudinal study with repeated measures. Parents of 75 typically developing infants completed sleep diaries for 6 days each month for 12 months. Accuracy of parent reports were assessed by using videosomnography. The largest mean increase (504 minutes) in self-regulated sleep length occurred from 1 to 4 months. The survival function decreased most rapidly (indicating greatest probability of meeting criteria) for criterion 1 at 2 months, criterion 2 at 3 months, and criterion 3 at 4 months. A 50% probability of meeting criteria 1 and 2 occurred at 3 months and at 5 months for criterion 3. The hazard function identified 2 months (criteria 1 and 2) and 3 months (criterion 3) as the most likely ages for sleeping through the night. At 12 months, 11 infants did not meet criteria 1 or 2, whereas 21 failed to meet criterion 3. The most rapid consolidation in infant sleep regulation occurs in the first 4 months. Most infants are sleeping through the night at 2 and 3 months, regardless of the criterion used. The most developmentally and socially valid criterion for sleeping through is from 22:00 to 0:600 hours. At 5 months, more than half of infants are sleeping concurrently with their parents.

618 Significance of Murmurs in Infancy

Aim: To find out the significance of murmurs heard during infancy.Methods: Retrospective audit of all infants with newly heard murmurs referred from April 2007 to October 2009 to cardiac clinics in district general hospital run by a Paediatrician with special expertise in cardiology.Results: Over 30 month period, 246 infants were newly referred for murmurs. No murmurs were heard in clinic in 36% (88/246). Of 158 persistent murmurs, 54 were discharged following normal echocardiogram. Abnormalities excluding Patent Foramen Ovale (PFO) on echocardiogram were found in 91 (58%). These were Ventricular Septal Defect (VSD) 34 (37%), Pulmonary Branch Stenosis 24 (26%), Patent ductus arteriosus (PDA) 7, Atrial Septal Defect 7, PFO & PDA 6, Aortic Stenosis 5, VSD & PDA 1 and Tetralogy of Fallot 2, Pulmonary Stenosis 1, Transposition of great arteries (TGA) 1, Congenitally Corrected TGA 1, Double Outlet Right ventricle 1, Complete Atrio-Ventricular Septal defect 1. 24 of the 91 infants (26%) were referred to the nearest tertiary cardiac centre for further management. Abnormalities in ECG were seen in 20/24 infants. 80 infants with less significant cardiac defects did not require any intervention and were followed up locally.Conclusion: More than half of infants with murmur have a cardiac defect and one-fourth of these defects are significant ones. Asymptomatic infants with persistent murmurs and/or abnormal ECGs should be referred for definitive diagnosis to cardiac clinics. District general hospital clinics with echocardiographic facility provide a good screening place and in reducing the work load of tertiary cardiac centres.

Quick Herpes Test for Women in Labor to Help Prevent Transmission to Newborns

Half of infants who acquire herpes simplex virus (HSV) perinatally have central nervous system involvement, with mortality and rates of neurologic

Iron intake and iron status in breastfed infants during the first year of life

Breastfed infants may be at particular risk for iron deficiency because breast milk is low in iron. In a secondary analysis of data from a complementary feeding trial, indicators of iron status were examined, with particular focus on the development of iron status in those infants who were fully breastfed during the first 4 months of life. In this retrospective analysis of data from a randomized controlled trial infants were stratified according to their predominant milk diet during the first 4 months of life, a subgroup of breastfed infants (group BM, n=53) were compared with a subgroup of infants fed (iron-fortified) formula (group F, n=23). Dietary iron intake and indicators of iron status were analysed at 4 months of age (during the full milk feeding period), and during the complementary feeding period at 7 and 10 months of age. Iron intake was low in the BM group, ranging below the Dietary Reference Intakes throughout the complementary feeding period, with the (estimated) bioavailable iron intake only just achieving the reference requirements. At 4 months, iron deficiency (ID, Ferritin <12.0 ng/mL) was observed in 3 infants in the BM group and in 1 infant in the F group; no infant developed iron deficiency anaemia (IDA, ID and Hb <10.5 g/dl). At 7 and at 10 months of age, iron status was adequate in all infants of the F group. In the BM group, at 7 (10) months of age, ID was diagnosed in 10 (11) infants and IDA was found in 2 (1) infants. Healthy infants, fully breastfed at 4 months of age, demonstrated ID in about 21% and IDA in up to 6% during the second half of infancy while fed according to the paediatric dietary guidelines. This finding supports the recommendation that supplementation with bioavailable iron via complementary foods should be started early (4-6 months of age) in order to prevent iron deficiency during infancy.

Morbidity among infants in South India: A longitudinal study

To study the incidence and types of morbidity in the first year of life in a birth cohort, a longitudinal study. This study was undertaken in northern part of Karnataka state in India. Birth cohort consisted of all the children born during first six months of the study period. They were assessed at the time of enrollment and monthly follow up was done till they attained one yr of age. Out of the 194 newborns, 46.4% were boys and 53.6% were girls. 24.8% of newborns were of low birth weight and 5.1% were preterm. Four (2.1%) had congenital anomalies and 2.5% developed birth asphyxia. Diarrhea (10.8%) and skin diseases (8.2%) were the commonest morbidities in the neonatal period. The incidence of morbidity was 3.28 per infant per yr. It was more among boys and in the second half of infancy. Commonest morbidities during infancy were respiratory tract infection (62.4%), diarrhea 42.8% and skin diseases (21.6%). Incidence of disease in infancy highlights the need to improve and plan health programmes.

Relationship between Silent Gastroesophageal Reflux and Food Sensitization in Infants and Young Children with Recurrent Wheezing

It is known that early childhood wheezing associated with sensitization to allergens, including food, has an increased risk of developing asthma later during school age. Gastroesophageal reflux (GER) is well known to be associated with asthma. The purpose of this study was to determine whether there is an association between silent GER and food sensitization in infants and young children with recurrent wheezing. Eighty-five infants or young children with recurrent wheezing, and no gastrointestinal symptoms, underwent 24 hr esophageal pH monitoring, as well as total serum IgE and specific IgE testing for eggs and milk. Among the 85 subjects, 48.2% had significant GER. There was no significant difference in the GER between atopic and non-atopic recurrent wheezers (41.7% and 50.8%, respectively). The sensitization rate to food (eggs or milk) was 12.2% and 20.5% in the GER and non-GER groups, respectively and showed no statistically significant difference between the two groups (P=0.34). In conclusion, about half of infants and young children with recurrent wheezing and no gastrointestinal symptoms have silent GER. The silent GER may not contribute to food sensitization in infants and young children with recurrent wheezing.

Gendered perceptions on infant feeding in Eastern Uganda: continued need for exclusive breastfeeding support

BackgroundIn resource-poor settings, HIV positive mothers are recommended to choose between 'Exclusive breastfeeding' (EBF) or 'Exclusive replacement feeding' (ERF). Acceptability, Feasibility, Affordability, Sustainability and Safety (AFASS) has been the World Health Organization (WHO)'s a priori criteria for ERF the last ten years. 'AFASS' has become a mere acronym among many workers in the field of prevention of mother-to-child transmission of HIV, PMTCT. Thereby, non-breastfeeding has been suggested irrespective of social norms. EBF for the first half of infancy is associated with huge health benefits for children in areas where infant mortality is high. But, even if EBF has been recommended for a decade, few mothers are practicing it. We set out to understand fathers' and mothers' infant feeding perceptions and the degree to which EBF and ERF were 'AFASS.'MethodsEight focus groups with 81 informants provided information for inductive content analysis. Four groups were held by men among men and four groups by women among women in Mbale District, Eastern Uganda.ResultsTwo study questions emerged: How are the different feeding options understood and accepted? And, what are men's and women's responsibilities related to infant feeding? A mother's commitment to breastfeed and the husband's commitment to provide for the family came out strongly. Not breastfeeding a newborn was seen as dangerous and as unacceptable, except in cases of maternal illness. Men argued that not breastfeeding could entail sanctions by kin or in court. But, in general, both men and women regarded EBF as 'not enough' or even 'harmful.' Among men, not giving supplements to breast milk was associated with poverty and men's failure as providers. Women emphasised lack of time, exhaustion, poverty and hunger as factors for limited breast milk production. Although women had attended antenatal teaching they expressed a need to know more. Most men felt left out from health education.ConclusionBreastfeeding was the expected way to feed the baby, but even with existing knowledge among mothers, EBF was generally perceived as impossible. ERF was overall negatively sanctioned. Greater culture-sensitivity in programs promoting safer infant feeding in general and in HIV-contexts in particular is urgently needed, and male involvement is imperative.Trial RegistrationThe study was part of formative studies for the ongoing study PROMISE EBF registered at http://clinicaltrials.gov (NCT00397150).

Treatment Outcomes for Culturally and Linguistically Diverse Early Intervention Populations

Abstract Research indicates that close to half of infants, toddlers and preschool children enrolled in early intervention programs funded by the Individuals with Disabilities Education Act have a communication disorder. In addition, a substantial number of children, particularly in the infant and toddler population, are from culturally and linguistically diverse backgrounds. Audiologists and speech-language pathologists are charged with providing culturally-competent, evidence-based services to all clients. Given the federal, state, and local demand for accountability in practices, clinicians need guidance on treatment outcomes pertaining to the culturally and linguistically diverse early intervention populations with communication disorders.

Growth and Body Composition of Peruvian Infants in a Periurban Setting

Previous growth studies of Peruvian children have featured high stunting rates and limited information about body composition. We aimed to characterize anthropometric measures of Peruvian infants 0 to 12 months of age in relation to the international growth references and biological, environmental, and socioeconomic factors. Infants (n = 232) were followed longitudinally from birth through 12 months of age from a prenatal zinc supplementation trial conducted in Lima, Peru, between 1995 and 1997. Anthropometric measures of growth and body composition were obtained at enrollment from mothers and monthly through 1 year of age from infants. Weekly morbidity and dietary intake surveillance was carried out during the second half of infancy. The prevalence rates of stunting, underweight, and wasting did not exceed 4% based on the World Health Organization growth references. Infants of mothers from high-altitude regions had larger chest circumference (p = .006) and greater length (p = .06) by 12 months. Significant predictors of growth and body composition throughout infancy were age, sex, anthropometric measurements at birth, breastfeeding, maternal anthropometric measurements, primiparity, prevalence of diarrhea among children, and the altitude of the region of maternal origin. No associations were found for maternal education, asset ownership, or sanitation and hygiene factors. Peruvian infants in this urban setting had lower rates of stunting than expected. Proximal and familial conditions influenced growth throughout infancy.

Maternal, Infant, and Household Factors Are Associated with Breast-Feeding Trajectories during Infants’ First 6 Months of Life in Matlab, Bangladesh ,

Women’s breast-feeding patterns are complex, and existing definitions of breast-feeding behavior do not capture this complexity adequately. We used results from a prior qualitative study to define trajectories for feeding during the first half of infancy, and then examined household-, maternal-, and infant-level determinants of these trajectories using logistic regression analysis. The 1472 women in the study cohort lived in rural Bangladesh and were participants in the Maternal and Infant Nutrition Intervention in Matlab trial. The 3 infant feeding trajectories included women who fed only breast milk and water [full breast-feeding trajectory (FBT)]; offered mixed feeding continuously when their babies were 0–4 mo old [continuous mixed feeding trajectory (CMFT)]; and practiced any other type of breast-feeding [intermittent feeding trajectory (IFT)], which was the normative feeding behavior in this community. In adjusted regression models, women who lived in rural areas [odds ratio (OR), 2.1; 95% CI, 1.2, 3.4], came from the poorest households (OR, 3.4; 95% CI, 1.5, 7.7), and offered prelacteal (OR, 1.7; 95% CI, 1.0–2.7) were more likely to be in the FBT. Women from the richest households (OR, 1.6; 95% CI, 1.1, 2.6), employed mothers (OR, 1.7; 95% CI, 1.1, 2.6), and older mothers (OR, 1.02; 95% CI, 1.0, 1.1) were more likely to be in the CMFT, and women with higher birth-weight infants (OR, 0.6; 95% CI, 0.4–0.8) were less likely to be in the CMFT. Thus, these trajectories were associated with distinct groups of women and these results provide information useful for developing interventions to improve breast-feeding practices.

Effects of Maternal Zinc Supplementation on Pregnancy and Lactation Outcomes

Observational studies in human populations suggest that maternal zinc deficiency during pregnancy may cause adverse pregnancy outcomes for the mother and fetus. Therefore, we reviewed the current evidence from studies of zinc supplementation, with or without other micronutrients, during pregnancy and lactation to assess its impact on maternal, fetal, and infant health. A meta-analysis of supplementation trials indicates a 14% reduction in premature delivery among zinc-supplemented women. Most studies found no significant impact of maternal zinc supplementation on infant birthweight, but a subset of studies conducted in underweight or zinc-deficient women suggests that there may be a positive effect of zinc supplementation in such women. However, the number of relevant studies is limited, and more information is needed to confirm these observations. The results for other pregnancy outcomes are inconsistent, and the number of available studies is small. Likewise, the impact of maternal zinc supplementation during pregnancy on infant postnatal growth and risk of infection is variable, and few studies are available. Thus, more research will be needed to allow definitive conclusions to be drawn, especially for the second half of infancy and later childhood. Studies found no adverse effects of maternal zinc supplementation on iron status during pregnancy. More information is required on other potential adverse effects, particularly with regard to a possible modifying effect of preexisting maternal zinc status. In view of the possible benefits of zinc supplementation for reducing the risk of premature delivery, the possible positive impact of zinc supplementation on infant birthweight among undernourished women, and the lack of reported adverse effects, zinc should be included in maternal supplements given during pregnancy in populations at risk for zinc deficiency.

Association of Breastfeeding Intensity and Bottle-Emptying Behaviors at Early Infancy With Infants' Risk for Excess Weight at Late Infancy

Our goal was to test the hypothesis that infants who were breastfed more intensively during early infancy (< or = 6 months) will be less likely to have excess weight during late infancy (> 6 months) and to examine the independent impact of infant-initiated bottle emptying and mothers' encouragement of bottle emptying on infants' risk for excess weight. The sample consisted of 1896 mothers who participated in postpartum surveys of the Infant Feeding Practice Study II and who provided at least 1 weight measurement of their infants during the second half of infancy. We used multiple logistic regression models to assess the association between infants' risks for excess weight during the second half of infancy and 3 self-reported feeding practices during the first half of infancy after adjusting for a series of sociodemographic characteristics. The early feeding practices examined included the percentage of all milk feedings in which infants consumed breast milk (breastfeeding intensity), the frequency of bottle feedings in which infants initiated bottle emptying, and the frequency of bottle feedings in which mothers encouraged bottle emptying. Infants fed with low (< 20% of milk feeds being breast milk) and medium (20%-80%) breastfeeding intensity in the first half of infancy were at least 2 times more likely to have excess weight during the second half of infancy than those breastfed at high intensity (> 80%). Infants who often emptied bottles in early infancy were 69% more likely than those who rarely emptied bottles to have excess weight during late infancy. However, mothers' encouragement of bottle emptying was negatively associated with their infants' risk for excess weight during the second half of infancy. Infants' risk for excess weight during late infancy was negatively associated with breastfeeding intensity but positively associated with infant-initiated bottle emptying during early infancy. These findings not only provide evidence for the potential risk of not breastfeeding or breastfeeding at a low intensity in development of childhood obesity, but they also suggest that infant-initiated bottle emptying may be an independent risk factor as well.

Complementary Feeding Practices And Nutrient Intake From Habitual Complementary Foods Of Infants And Children Aged 6-18 Months Old In Lusaka, Zambia

Poor quality complementary foods with low nutrient density and inappropriate feeding practices have been identified among the major causes of malnutrition in young children. In many developing countries, complementary foods are introduced too early or too late and the quality and quantity of the foods are insufficient, leading to a great risk of nutritional deficiencies during the second half of infancy. Most of the habitually used complementary foods in developing countries are unfortified cerealbased gruels characterised by low energy and nutrient density and are often inadequate in iron, zinc and pyridoxine and in some populations may be deficient in riboflavin, niacin, calcium, thiamine, folate, ascorbic acid and vitamin A. The aim of this study was to establish current complementary feeding practices of mothers/caretakers living in a medium income urban community in Lusaka, Zambia. The study was the first phase of a larger study designed to develop improved complementary foods based on already-in-use cereals and legumes for the improvement of infant health in urban settings characterised by high HIV prevalence. Complementary feeding practices and nutrient intakes of children 6-18 months old in Lusaka were assessed by qualitative and quantitative methods. Themes generated from three focus group discussions (9 health workers, 7 mothers and 8 fathers) were used to design a semi-structured questionnaire to interview 34 mothers, 20 of whom were observed for 12 hours at home and their infant's dietary intake measured by 12-h weighed food record and 24-h recall, (assuming medium breast milk intake). The results showed that although mothers had wide knowledge of optimal infant feeding, actual practices were constrained by food cost, maternal HIV status and time availability. Compared with the recommended daily allowance (RDA) at 6-8, 9-11 and 12-18 months of age, the daily nutrient intakes were 88%, 121% and 94% for energy; 33%, 52% and 59% for iron and 30%, 33% and 38% for calcium, respectively. Fortification of complementary foods is necessary to meet infants' needs for iron and calcium. Keywords : Complementary feeding, infants, iron, Zambia. AJFAND Vol. 8 (1) 2008 pp. 28-47

Sex differences in prevalence of anaemia and iron deficiency in infancy in a large multi-country trial in South-East Asia

To evaluate effects of Fe supplementation and sex on the prevalence of anaemia and Fe status in infants in South-East Asia, biochemical data from four parallel, randomized, double-blind trials with Fe and/or Zn supplementation in infants (n 2452) in Indonesia, Thailand and Vietnam was pooled. At recruitment (5 months of age), Hb concentrations were slightly but significantly lower in boy infants compared with girl infants (108.7 g/l v. 111.4 g/l, P = 0.04). At 11 months of age, boy infants not receiving Fe had significantly lower Hb (106.2 g/l v. 111.0 g/l, P < 0.001) and lower serum ferritin concentrations (14.3 microg/l v. 21.1 g/l, P < 0.001) than girl infants not receiving Fe. Consequently, boy infants had a relative risk of 1.6 (95% CI 1.3, 2.1) to be anaemic, and of 3.3 (95% CI 2.1, 5.0) for having Fe deficiency anaemia compared with girl infants. Fe supplementation significantly increased Hb concentrations in both boys and girls. There was no sex difference in Fe status in infants receiving Fe for 6 months. This study shows that the markedly higher risk for anaemia and Fe deficiency indicates higher Fe requirements in boy than in girl infants. In South-East Asia, standard infant feeding practices do not provide sufficient Fe to meet requirements of infants, especially boys. Current daily recommended intake for Fe in infancy is the same for boy and girl infants however. Our findings suggest that in especially the second half of infancy, Fe requirements for boy infants are approximately 0.9 mg/d higher than for girl infants.

Fat intake and metabolism in Swedish and Italian infants

The purpose of the study was to compare fat intake and metabolism between two infant populations from Sweden and Italy given breast milk or similar infant formulas, but different weaning foods. Nutrient intake and fat metabolism were studied prospectively from 3–12 mo in 68 Swedish and 46 Italian healthy infants, breastfed or given similar infant formulas in combination with Swedish or Mediterranean weaning foods. Although nutrient intake and fat metabolism were similar at 6 mo, fat intake was lower at 12 mo in the Italian than in the Swedish formula group (p < 0.001). At 6 and 12 mo, higher dietary ratios of monounsaturated to saturated fatty acids (p < 0.01 and p < 0.001, respectively), and monounsaturated to polyunsaturated fatty acids (p < 0.05, p < 0.001) were found in the Italian than in the Swedish formula group. Total cholesterol and apolipoprotein B were lower at 6 mo (p < 0.01) in Italian breastfed infants than in Swedish ones. Lower concentrations at 6 and 12 mo of total cholesterol (p < 0.05, p < 0.05, respectively), apolipoprotein B (p < 0.05, p<0.01) and triglycerides (p< 0.001, p<0.01), and of apolipoprotein A1 (p < 0.01) at 12 mo, were found in the Italian formula group than in the Swedish one. In conclusion, plasma total cholesterol, apolipoprotein B and triglycerides were found to be lower in Italian infants than in Swedish infants during the second half of infancy. These findings may partly result from differences in fat compositions between Swedish and Mediterranean weaning diets and in total fat intake in late infancy. Differences in duration of breastfeeding and possibly in breast milk composition may also have influenced our results.

Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO international growth reference: implications for child health programmes

To compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards ('the WHO standards') and the National Center for Health Statistics (NCHS)/WHO international growth reference ('the NCHS reference'), and discuss implications for child health programmes. Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives. Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe. Respectively 4787, 10 381 and 226 infants and children. Healthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%. The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations.

Effect of morbidity on change in mid-upper arm circumference in children under five years of age A COHORT STUDY IN PURWOREJO, CENTRAL JAVA, INDONESIA

The objective of this study were to find out the effect of morbidity (diarrhoeal diseases /DD & acute respiratory infection/ARI) on mid-upper arm circumference (MUAC) in children uner five years of age and to evaluate the impact of potential confounding and effect modifying factors on association between morbidity and MUAC development i.e. socioeconomic status, living area and breast feeding. A cohort study was carried out to follow morbidity and MUAC development from February 1996 to January 1997, including home visits and examinations every 3 months, totally four times. Data were collected through interviews and MUAC was measured using standard non-stretchable plastic tape. This analysis was performed on 2708 individuals (45.3% of the total sample), where complete morbidity and MUAC information was available, DD and ARI prevalence was highest in the second half of infancy. The overall period prevalence of DD and ARI was 1.4 and 9.9%, respectively. There was a small, but significant negative effect of diarrhoea on change in MUAC among infants below one year in the rural area, less so in the urban area. In older children there was no association between morbidity and MUAC velocity. There was a small positive association between maternal education and MUAC development in both age groups. Diarrhoeal diseases, showed a negative influence on MUAC development in infancy. However, in this study MUAC development from 12 months and onwards was not influenced by the load of illness. MUAC seems to be less sensitive in reflecting the morbidity history of the child, as compared to other anthropometric measurements.

Differences in weaning practice, food and nutrient intake between breast‐ and formula‐fed 4‐month‐old infants in England

Breastfed infants may grow more slowly in the second half of infancy than formula-fed infants, differences in weaning practice may contribute. Dietary intakes of 4-month-old infants have been investigated cross-sectionally. Diet was assessed using a structured 1-day un-weighed dietary record in 852 white singletons (72% of those invited) from a random sub-sample of infants taking part in Avon Longitudinal Study of Parents and Children. Nutrient intakes of formula-fed infants were compared by sex and with UK reference values. Estimated mean energy and nutrient intakes, mean bodyweight and daily quantities of food consumed were compared by weaning practice. In formula-fed infants mean energy intakes and intakes of most nutrients were adequate. There were significant differences in intakes of most nutrients by weaning practice; however, mean energy intake and body weight of breastfed infants was similar to formula-fed infants. Infants given formula milk were less likely to consume vegetables and fruit, and more likely to consume commercial infant drinks, compared with infants who were breastfed. In breastfed infants breast milk intake was lower if solids were given (905 g versus 818 g; P = 0.01); however, nutrient intake was not compromised. In formula-fed infants milk intake was not different in those having solids compared to those having milk only (810 g versus 795 g; P = 0.649). Differences in weaning practice and patterns of food consumption were seen between breast- and formula-fed infants, these may contribute to later growth differences.

The Infant Gastroesophageal Reflux Questionnaire Revised: Development and Validation as an Evaluative Instrument

Gastroesophageal reflux disease (GERD) is frequently experienced by infants, and disease-specific measures are needed to evaluate treatment benefits. We revised the Infant Gastroesophageal Reflux Questionnaire (I-GERQ) on the basis of information from parents of infants with GERD and physicians and subjected it to a psychometric evaluation. A 3-week, multi-country observational study of 185 caregivers of infants younger than 18 months with GERD and 93 caregivers of control infants was conducted. Caregivers completed the I-GERQ-R weekly and recorded symptoms in a Daily Diary. Caregivers and physicians rated global disease severity and change in overall GERD symptoms. Slightly more than half of infants were male with a mean age of 6.7 months, and most infants had been diagnosed with GERD for a little more than 2 months (mean, 66.7 days). Internal consistency reliability for the I-GERQ-R ranged from 0.86 to 0.87, and test-retest reliability was 0.85. Construct validity was demonstrated by significant differences between cases and controls on all item scores (all P<.01) and the total score (P<.0001), correlations with relevant Daily Diary symptoms, and both physician-rated (P<.05) and caregiver-rated disease severity (P<.05). Mean baseline to 3-week I-GERQ-R change scores for those infants whose caregivers reported improvement was -5.7 compared with -0.3 for those whose caregivers reported worse/same (P<.001). Physician ratings of change resulted in similar findings, with mean changes of -5.7 for those rated improved and -0.1 for those rated as worse/same (P<.0001). This study demonstrated the I-GERQ-R is a reliable, valid, and clinically responsive measure of infant GERD symptoms.