Infant Feeding Experiences Research Articles

Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (Capability, Opportunity, Motivation-Behaviour) model

BackgroundHealth behaviours during pregnancy and the early years of life have been proven to affect long term health, resulting in investment in interventions. However, interventions often have low levels of completion and limited effectiveness. Consequently, it is increasingly important for interventions to be based on both behaviour change theories and techniques, and the accounts of pregnant women. This study engaged with pregnant women from deprived communities, to understand their subjective experiences of health in pregnancy.MethodsThe study adopted a women-centred ethos and recruited a purposive sample of ten pregnant women, who lived in deprived areas and were on low incomes. Participants engaged with three creative techniques of visual data production (timelines, collaging and dyad sandboxing), followed by elicitation interviews. One participant only engaged in the initial activity and interview, resulting in a total of 28 elicitation interviews. This in-depth qualitative approach was designed to enable a nuanced account of the participants’ thoughts, everyday experiences and social relationships. Data were deductively coded for alcohol, smoking and infant feeding and then mapped to the COM-B model (Capability, Opportunity, Motivation – Behaviour).ResultsFive participants had experience of smoking during pregnancy, four had consumed alcohol during pregnancy, and all participants, except one who had exclusively formula fed her child, disclosed a range of infant feeding experiences and intentions for their current pregnancies. Considerable variation was identified between the drivers of behaviour around infant feeding and that related to abstinence from tobacco and alcohol during pregnancy. Overall, knowledge and confidence (psychological capability), the role of partners (social opportunity) and support from services to overcome physical challenges (environmental opportunity) were reported to impact on (reflective) motivation, and thus women’s behaviour. The role of the public in creating and reinforcing stigma (social opportunity) was also noted in relation to all three behaviours.ConclusionsWhen designing new interventions to improve maternal health behaviours it is important to consider the accounts of pregnant women. Acknowledging pregnant women’s subjective experiences and the challenges they face in negotiating acceptable forms of motherhood, can contribute to informed policy and practice, which can engage rather than isolate potential user groups.

Undetectable = Untransmissible: Unpacking HIV Risk and Transmission Concerns for Women Living With HIV

To explore some of the questions and concerns of women living with HIV regarding the broad application of U=U to their lives, ICASO commissioned a Community Brief on U=U for women living with HIV. Launched in September 2018 at the National AIDS Conference in Australia, this brief was written by a team of women living with HIV and was guided by a global community advisory committee, also made up by women living with HIV. Together they collected stories from over 65 women living with HIV from around the world and held two community consultations at the International AIDS Conference in Amsterdam in July 2018 to refine and test the content and construction of the brief. In particular, this global brief focused upon capturing the voices of women living with HIV and contains quotes of over 20 women from every region in the world. Their voices illuminate the intensely personal experiences of pregnancy, motherhood and infant feeding as well as some of the nuances around sexuality.

Breastfeeding performance in Afar regional state, northeastern Ethiopia: a cross sectional study

BackgroundIn Ethiopia fewer than 20% of infants aged less than six months are appropriately fed. This study aimed to identify predictors of poor breastfeeding performance among mother-infant pairs in Samara-Logia city administration, Afar Regional State, Ethiopia.MethodsFive hundred and seventy six mothers of infants aged less than six months were recruited to participate in face-to-face structured interviews at their home. Infant feeding practices were measured by breastfeeding performance index (BPI). Infants who scored 0–3 BPI were classified as achieving ‘Low BPI’, 4–5 as ‘Medium BPI’, and 6–7 scores as ‘High BPI’. A pre-tested instrument was used to assess demographic characteristics of mothers and their experiences of infant feeding. EpiData version 3.02 was used to enter, clean and code the data. Then, data were analyzed using SPSS version 20.ResultsFive hundred thirty six (93.1%) of the study mothers had ever breastfed their infants. About 83% [95% CI: 80.0, 86.0%] of infants had achieved low or medium BPI scores. Being older than 34 years [AOR: 4.55; 95% CI (1.33, 15.73)], having an infant aged 4–5 months [AOR: 2.49; 95% CI (1.08, 5.76)], giving birth at home [AOR: 4.25; 95% CI (1.37, 13.23)] or by caesarean section [AOR: 8.00; 95% CI (2.78, 23.09)] and receiving advice on proper infant feeding practices at postnatal checkup [AOR:0.28; 95% CI (0.13,0.59)] were independent predictors of low/medium BPI scores.ConclusionThis study revealed that nearly eight in ten infants aged less than six months achieved low/medium BPI scores. Being older than 34 years, having an infant aged 4–5 months, giving birth at home or by caesarean section and lack of advice on proper infant feeding practices were associated with higher odds of low/medium BPI scores.

‘People try and police your behaviour’: the impact of surveillance on mothers and grandmothers’ perceptions and experiences of infant feeding

Pregnancy and motherhood are increasingly subjected to surveillance. Research has highlighted that public breastfeeding is difficult to navigate within existing constructs of acceptable femininity, but at the same time, mothers who formula feed are often located within discourses of the failed maternal subject. This article draws on intergenerational research with six mother/grandmother pairs from marginalised urban Welsh locales, which involved elicitation interviews around the everyday artefacts that participants presented to symbolise their experiences of motherhood and infant care. We examine the negotiation of acceptable motherhood in relation to the intrusive policing of lifestyle choices, consumption and infant feeding from family, friends and strangers. The article argues that the moral maze of surveyed motherhood renders infant feeding a challenging, and challenged, space for women.

What Do Women Lose if They Are Prevented From Meeting Their Breastfeeding Goals?

This article explores the complex issue of breastfeeding and maternal mental health. Many women stop breastfeeding before they are ready, often leading to feelings of anxiety, guilt, and anger. Critics of breastfeeding promotion blame breastfeeding advocates for this impact, claiming that if the focus were merely on feeding the baby, with all methods equally valued and supported, maternal mental health would be protected. Established health impacts of infant feeding aside, this argument fails to account for the importance of maternal breastfeeding goals, or the physical and emotional rewards breastfeeding can bring. Although some women will take comfort in the message that what matters most is that the baby is fed, others view such suggestions as a lack of recognition of their wishes and the loss that they feel, exacerbating their grief and frustration. The purpose of this article is to highlight the importance of recognizing and valuing women’s individual breastfeeding goals, and not dismissing or invalidating their experience if they do not meet these by telling them that they do not matter. To move forward, we must recognize the impact of all infant feeding experiences, consider the impact of public messaging, and work to support more women to meet their goals.

Breastfeeding self-efficacy and breastmilk feeding for moderate and late preterm infants in the Family Integrated Care trial: a mixed methods protocol

BackgroundBreastmilk is the ideal nutrition for preterm infants. Yet, breastmilk feeding rates among preterm infants are substantially lower than those of full-term infants. Barriers incurred through hospital care practices as well as the physical environment of the neonatal intensive care unit (NICU) can result in physical and emotional separation of infants from their parents, posing a substantial risk to establishing and maintaining breastfeeding. Additionally, current practitioner-focused care provision in the NICU can result in decreased breastfeeding self-efficacy (BSE), which is predictive of breastfeeding rates in mothers of preterm infants at 6 weeks postpartum.MethodsFamily Integrated Care (FICare) integrates and supports parents to actively participate in the care of their infant while in the NICU. Nested within the broader FICare trial, we will conduct an explanatory sequential mixed methods study to investigate if FICare improves maternal BSE and rates of breastmilk feeding in moderate and late preterm infants at discharge from the NICU. In phase 1, we will calculate the mean difference between admission and discharge BSE scores for the intervention group. Mothers who score in the top and bottom 20th percentile of change scores will be invited to participate in a semi-structured telephone interview exploring maternal experiences with infant feeding in the NICU. We will conduct inductive thematic analysis to identify and describe the facilitators and barriers of FICare on maternal feeding experiences. Once data saturation is achieved and themes have been established, phase 2 will revisit the quantitative data to determine whether FICare was impactful on BSE and breastmilk feeding rates. Findings from the qualitative and quantitative phases will be integrated to determine how infant feeding experiences on FICare units work to improve or detract from maternal BSE and rates of breastmilk feeding.DiscussionFICare may help to improve maternal BSE and rates of breastmilk feeding in moderate and late preterm infants. Improved breastmilk feeding outcomes can have a substantial impact on overall infant health, developmental outcomes, and maternal-infant bonding and will help to improve long-term health outcomes for moderate and late preterm infants.Trial registration(NCT02879799). Registered May 27, 2016 protocol version June 9, 2016 Version 2.

Personal Infant Feeding Experiences of Postpartum Nurses Affect How They Provide Breastfeeding Support

ObjectiveTo describe the experiences of postpartum nurses when feeding their own infants and explore how these experiences influence the breastfeeding support they provide to new mothers. DesignQualitative research with interviews using dialogic data generation and analysis. SettingLarge academic women and children’s hospital in the Southern United States. ParticipantsNine postpartum nurses who gave birth and breastfed or mixed-fed infants at any time in the past. MethodsIndividual, semistructured, face-to-face interviews. ResultsParticipants described breastfeeding experiences similar to those of other women: some were positive, some negative. Most participants reported that they received less breastfeeding support than they needed during the maternity hospitalization. They attributed this to the fact that they were nurses. The infant feeding experiences of participants led them to promote breastfeeding in a more personal way and establish deeper connections with the mothers in their care. The practice of all participants changed because of their desire to prevent other mothers from experiencing the physical or psychological pain they experienced with breastfeeding. ConclusionPersonal infant feeding experiences shaped the breastfeeding practice of participants in unique and unpredictable ways. Nurses may benefit from increased breastfeeding education and support during their own maternity hospitalizations. Additionally, the inclusion of reflective narrative processes in breastfeeding education could encourage nurses to explore their personal, empirical, and clinical knowledge and construct an approach to breastfeeding practice that integrates these sources of information.

\u201cI beg you\u2026breastfeed the baby, things changed\u201d: infant feeding experiences among Ugandan mothers living with HIV in the context of evolving guidelines to prevent postnatal transmission

BackgroundFor women living with HIV (WLWH) in low- and middle-income countries, World Health Organization (WHO) infant feeding guidelines now recommend exclusive breastfeeding until six months followed by mixed feeding until 24 months, alongside lifelong maternal antiretroviral therapy (ART). These recommendations represent the sixth major revision to WHO infant feeding guidelines since 1992. We explored how WLWH in rural Uganda make infant feeding decisions in light of evolving recommendations.MethodsWe conducted semi-structured interviews with 20 postpartum Ugandan WLWH accessing ART, who reported pregnancy < 2 years prior to recruitment. Interviews were conducted between February–August 2014 with babies born between March 2012–October 2013, over which time, the regional HIV treatment clinic recommended lifelong ART for all pregnant and breastfeeding women (Option B+). Content analysis was used to identify major themes. Infant feeding experiences was an emergent theme. NVivo 10 software was used to organize analyses.ResultsAmong 20 women, median age was 33 years [IQR: 28–35], number of livebirths was 3 [IQR: 2–5], years on ART was 2.3 [IQR: 1.5–5.1], and 95% were virally suppressed. Data revealed that women valued opportunities to reduce postnatal transmission. However, women made infant feeding choices that differed from recommendations due to: (1) perception of conflicting recommendations regarding infant feeding; (2) fear of prolonged infant HIV exposure through breastfeeding; and (3) social and structural constraints shaping infant feeding decision-making.ConclusionsWLWH face layered challenges navigating evolving infant feeding recommendations. Further research is needed to examine guidance and decision-making on infant feeding choices to improve postpartum experiences and outcomes. Improved communication about changes to recommendations is needed for WLWH, their partners, community members, and healthcare providers.

Men's views and experiences of infant feeding: A qualitative systematic review.

Although the advantages of breastfeeding are well documented, rates for breastfeeding often fall short of international and national targets. Increasing attention has been paid to the role of men in infant feeding, but a lot of the research about men has been elicited from women, rather than from men themselves. To explore these issues further, a systematic review of the qualitative research on infant feeding was carried out, focusing specifically on men's own views and experiences. Evidence was identified by searching electronic databases (CINAL, Cochrane, PubMed, and Scopus), manually searching citations, and by searching the grey literature. Studies were included in the review if they discussed men's views and experiences of infant feeding and if they reported primary qualitative data. Twenty research papers were included in the review, and each study was summarised and then analysed thematically to produce a synthesis. Five major analytical themes were identified: men's knowledge of infant feeding; men's perceptions of their role in infant feeding; positive views on breastfeeding; negative views on breastfeeding; and men's experiences of health promotion and support. The review concludes by highlighting that although men can play an important role in supporting women, they do not have a significant role in infant feeding decisions.

Parental experiences and perceptions of infant complementary feeding: a qualitative evidence synthesis.

Interventions to prevent childhood obesity increasingly focus on infant feeding, but demonstrate inconsistent effects. A comprehensive qualitative evidence synthesis is essential to better understand feeding behaviours and inform intervention development. The aim of this study is to synthesize evidence on perceptions and experiences of infant feeding and complementary feeding recommendations. Databases CINAHL, EMBASE, MEDLINE, PsycINFO, Academic Search Complete, SocIndex and Maternity and Infant Care were searched from inception to May 2017. Eligible studies examined parents' experiences of complementary feeding of children (<2years). Data were synthesized using thematic synthesis. Twenty-five studies met inclusion criteria for review. Four key themes emerged. 'Guidelines and advice' highlights variety and inconsistencies between sources of complementary feeding information. 'Stage of weaning' describes infant feeding as a process involving different stages. 'Knowing and trying' outlines parents' engagement in feeding approaches based on instinct, prior experience or trial and error. 'Daily life' highlights problematic cost and time constraints for parents. Parents predominantly understand and want to engage in healthy feeding processes. Consideration of infant feeding as a process that changes over time is necessary to support parents. Provision of clear, consistent information and guidance from trusted sources on when, what and how to feed is also essential.

Human Milk Provision Experiences, Goals, and Outcomes for Teen Mothers with Low-Birth-Weight Infants in the Neonatal Intensive Care Unit.

Breastfeeding rates are virtually unknown for teen mothers whose low-birth-weight (LBW; <2500 gm) infants are hospitalized in the neonatal intensive care unit (NICU). The objective was to examine the infant feeding experiences, goals, and outcomes of teen mothers of LBW infants. We conducted a multimethod study using a qualitative research design, survey, and infant medical records. The primary data source was individual interviews conducted with teen mothers of LBW infants hospitalized in a tertiary NICU. Content analysis and descriptive statistics were used for data analysis. All 15 teen mothers (12 black, 3 Hispanic) wanted what was best for their infants and initiated lactation by breast pump. However, maintaining lactation was challenging and the following barriers were identified: fear of being judged; body image issues; influence of the maternal grandmother; and disorganized thought processes about combining pumping with returning to school or work. Despite these barriers, 50% of the teen mothers met their goals for human milk provision at NICU discharge. Most of the teen mothers' lactation barriers reflected their adolescent developmental stage. Potential interventions are identified and include focus groups with teen mothers and maternal grandmothers and lactation support by NICU-based teen breastfeeding peer counselors.

Providing the best medicine: adopting a systematic approach to identifying and using evidence to support breastfeeding and breastmilk feeding in neonatal units in Scotland

BackgroundThe breastmilk feeding of premature babies is of great importance to public health, and it provides the optimum nutrition. Yet the difficulties experienced by mothers who have preterm babies are compounded by anxiety and loss because staff may be unable to fully support parents owing to time pressures, established models of care, and limited training opportunities. To inform the 2016 Scottish Government-led review of maternity and neonatal services, we aimed to summarise evidence about effective interventions to support breastmilk feeding in neonatal units and, drawing on findings from qualitative papers, to describe the infant feeding experiences of parents of babies in neonatal units and the views of staff. MethodsWe searched Medline, Embase, Web of Science, and Cochrane databases to identify systematic reviews published in English between Nov 1, 2010, and April 1, 2014, using the keywords neonatal/intensive care, KMC, kangaroo mother care, low birth weight, premature, breastfeeding, and breast milk. We searched CINAHL and MIDIRS using the same criteria to identify qualitative papers that explored the infant feeding experiences of both parents and neonatal staff. FindingsEight systematic reviews and 17 qualitative publications were identified. Synthesis of systematic review level evidence indicated the effectiveness of interventions including kangaroo mother care, mother's breastmilk, and donor human milk for protecting the infant against necrotising enterocolitis and promoting neurodevelopment and growth. Thematic analysis of the qualitative studies emphasised the importance of attending to the experiences of parents, who had to deal with the impact of premature delivery and the neonatal unit environment, and of developing coping strategies to help them respond to the unpredictability of their baby's health-related feeding issues. Findings from staff indicated that they needed to feel in control, relying on technology and efficiently using time to maximise the health of babies in the neonatal unit in the midst of uncertainty. InterpretationEvidence about the infant feeding experiences of parents and staff in neonatal units (with evidence related to effective interventions for promoting breastmilk feeding) has enhanced the timely partnership between colleagues from NHS Health Scotland and the Scottish Government to influence policy and practice. This evidence has informed the national review of maternity and neonatal provision in Scotland and will be jointly disseminated throughout Scotland. FundingNone.

Infant Feeding Decision-Making and the Influences of Social Support Persons Among First-Time African American Mothers.

Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Objective The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusions for Practice Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation.

Factors Associated with Recurrent Infant Feeding Practices in Subsequent Births.

Previous breastfeeding experience has been associated with subsequent infant feeding practices. However, few longitudinal studies have investigated formula-only feeding patterns or the full range of potentially associated characteristics. This study aimed to determine the recurrence of infant feeding practices and maternal, birthing, and infant characteristics associated with recurrent formula-only feeding and changes between exclusive breastfeeding and formula-only feeding across subsequent births. We conducted a population-based record-linkage study of 317 027 mothers, with a term singleton live-birth in 2007-2011, New South Wales, Australia. Infant feeding patterns were described using sequential birth pairs. For mothers with a first and second birth, robust Poisson regression was used to investigate the association between maternal, birthing, and infant characteristics and infant feeding patterns. Combined relative risks (RRs) were calculated for selected maternal characteristics. Across 69 994 sequential birth pairs, the recurrence rate of formula-only feeding was 71%, and 92% for exclusive breastfeeding. Maternal characteristics < 25 years old, being Australian born or single, smoking during pregnancy, and living in lower socioeconomic areas were most strongly associated with repeat formula-only feeding (RR, 22.1; 95% confidence interval [CI], 18.6-26.3), changing from exclusive breastfeeding to formula-only feeding (RR, 9.0; 95% CI, 7.4-10.7), and being less likely to change from formula-only feeding to exclusive breastfeeding (RR, 0.47; 95% CI, 0.38-0.59). Infant feeding practices were strongly recurrent, highlighting the importance of successful breastfeeding for first-time mothers. Additional support for young mothers from disadvantaged backgrounds accounting for infant feeding history, experiences, and common barriers could improve recurrent exclusive breastfeeding and positively affect infant and maternal health.

Family experiences of infant and young child feeding in lower-income countries: protocol for a systematic review of qualitative studies.

BackgroundInfant and young child feeding practices, including breastfeeding and complementary feeding of children under 2 years old, are crucially influenced by parent and family perceptions and experiences. Given the urgent need to improve nutrition of young children in low- and low-middle-income countries, both for reduction of morbidity and mortality in childhood and for future health outcomes, we propose to systematically review and synthesize available qualitative data specifically related to infant and young child feeding practices of parents and families in these settings, which may provide greater insights into barriers and facilitators to recommended feeding practices.Methods/designThe proposed study will systematically review existing qualitative research reporting infant and young child feeding practices from low- and low-middle-income settings. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement will be used for reporting the stages of the review and dissemination. The search period will include all studies published from 2006 to 2016. The study selection process will follow established and recommended guidelines for reviews, and quality assessment will be conducted in two phases using critical appraisal and subsequently a confidence in findings approach derived from Grading of Recommendations, Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative (GRADE-CERQual). A full synthesis of the studies identified by the review will begin with thematic analysis and be followed by an interpretive approach to provide actionable information on the topic.DiscussionThe findings will provide insight into the barriers and facilitators related to behavior that may hinder or enable implementation of interventions aimed at improving infant and young child feeding practices in lower-income settings.Systematic review registrationPROSPERO CRD42016035677Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0292-7) contains supplementary material, which is available to authorized users.

Pediatric Feeding in Infants With Pierre Robin Sequence Following Mandibular Distraction Osteogenesis

Pierre Robin sequence (PRS) causes anomalies that can include micrognathia, cleft palate, and glossoptosis. At birth, infants typically present with a small mandible (micrognathia) which displaces the tongue posteriorly and causes breathing difficulties due to airway obstruction. A large, U-shaped cleft palate is often associated with this condition and the combined phenotype can be seen in isolation or in conjunction with a syndrome. In the neonatal period, management of PRS focuses on airway obstruction and feeding through conservative positioning techniques that are often successful. However, infants that do not respond to conservative measures require surgical intervention such as tongue-lip adhesion, tracheostomy, or mandibular distraction osteogenesis (MDO) to manage their airway. While each of these surgical procedures have been used effectively, the process of MDO has become the definitive technique to surgically correct the airway obstruction in PRS by lengthening the mandible, which also brings the tongue forward and out of the airway. Feeding intervention is directly related to the resolution of micrognathia which in turn advances the tongue base anteriorly, resolving the glossoptosis and airway obstruction. The infant's feeding experience, including pre-surgery and post-surgery considerations, are discussed.

Understanding the importance of collecting qualitative data creatively.

Understanding the importance of collecting qualitative data creatively.

Ethics of Care and Urban Aboriginal and Torres Strait Islander Breastfeeding beyond Three Months

Background: Although early cessation of breastfeeding is common in Australia, as in other industrialised nations, higher proportions of Indigenous mothers cease breastfeeding in the first three months in comparison with other Australian mothers.Methods: Twenty urban Aboriginal and Torres Strait Islander mothers of infants aged 3 to12 months participated in in-depth, semistructured interviews which explored the mothers' experiences of infant feeding, and the advice and support they received from health professionals. Data were analysed thematically, using an ethics of care lens.Results: Three themes arising from the data are presented here: the impact of care on breastfeeding trajectories, relational support, and mother-centred care. Professional care was found to have a strong influence on breastfeeding initiation and duration. Caring relationships with health professionals which prioritise continuity of care and attention to mothers' and infants' specific needs build mothers' trust in their health carers and their own capacities to breastfeed and in turn facilitate positive breastfeeding outcomes. Mother-centred care in hospital, during clinic follow-up, home visits or phone calls facilitates timely identification of mothers' feeding doubts or problems and initiation of solutions to breastfeeding problems. Empathic mother-centred infant feeding care is especially important for mothers with limited support at home.Conclusion: In this research we saw that when health professionals working with urban Aboriginal and Torres Strait Islander mothers demonstrate an ethic of care, which is characterised by culturally safe, mother-centred, relational support, they can positively influence breastfeeding initiation and duration beyond three months. To support urban Indigenous mothers to breastfeed, policy and services need to embrace relational, mother-centred care.

Infant Feeding in Newfoundland and Labrador, Canada: Perceptions and Experiences of Maternal Grandmothers.

The purpose of this study was to examine the primary factors that influenced grandmothers' choices of infant feeding and to explore the role that grandmothers feel they played in their daughters' choices about infant feeding. Twenty-two maternal grandmothers who bottle fed their children and whose daughters also bottle fed their babies were recruited to participate in 4 focus groups and/or 2 interviews. Using the constant comparative method of data analysis, 3 themes emerged that described how grandmothers felt about their infant feeding experiences: "powerlessness," "modesty," and "ambivalence." These themes and their implications are discussed in this article.

Portuguese Experiences of Artificial Infant Feeding in the Late Eighteenth Century

Infant feeding is an explanatory factor of infant mortality levels in historical populations. The bacteriological revolution in the early 1870s changed medical science and technologies in terms of food production and ways in which infant populations were fed. Even before that change, however, connections between food and child health were being discussed in both the medical literature and political institutions. How foundlings were fed was a crucial issue in pre-industrial Europe. At that time, increasing foundling numbers and difficulties in providing wet nursing, due to the shortage of suitable women and financial constraints, forced the authorities to take action to keep infant mortality levels under control. This article shows evidence of dry nursing strategies and practices in Portugal in the late eighteenth century. It explores the relationship between political and healthcare institutions, medical knowledge and the living conditions of the infant population and, more specifically, discusses the use of artificial feeding in Portugal and the intervention of authorities such as the Intendant-General of Police, Diogo Inácio de Pina Manique, and his experiments with animal milk.