Infant Feeding Recommendations Research Articles

From Guidelines to Practice: A Programmatic Model for Implementation of the Updated Infant Feeding Recommendations for People Living with HIV.

From Guidelines to Practice: A Programmatic Model for Implementation of the Updated Infant Feeding Recommendations for People Living with HIV.

Minimum acceptable diet and associated factors among 6–23 months old children enrolled in outpatient therapeutic program in the Tulla district, Sidama region, Ethiopia: a community-based cross-sectional study

BackgroundImproving the minimum acceptable diet (MAD) is essential for ensuring optimal growth and development of children, as well as preventing malnutrition and its consequences. Previous studies in Ethiopia have focused on the magnitude and determinants of a minimum acceptable diet. However, much emphasis was not given to minimum acceptable diet and its associated factors among 6–23 months old children enrolled in Outpatient therapeutic programs (OTP), particularly, in the study area. This study determines the minimum acceptable diet and associated factors among 6–23-month-old children enrolled in OTP.MethodsA community-based cross-sectional study was conducted among 346 randomly selected mothers with children aged 6–23 months who were admitted to the OTP. The data were collected using interviewer-administered structured questionnaires. The data were entered, cleaned, coded into Epidata version 4.6, and exported to SPSS version 26 for further analysis. Multivariate logistic regression was used to assess the determinants of MAD.ResultsThe overall prevalence of minimum Acceptable diet among children aged 6–23 months enrolled to OTP was 14.5% (95% CI: 12.02-19%). The odds of MAD were 1.9 times higher among children aged 18–23 months compared to children aged 6–11 months (AOR = 1.9, 95% CI ((1.2 3.9). The odds of MAD were 2.9times higher in children whose mothers had a good knowledge on recommended feeding (AOR = 2.9, 95% CI (1.2, 6.35). Mothers who had no formal education were 81% less likely to provide minimum acceptable diets for their children compared to their counterpart.(AOR = 1.94, 95% CI = 1.24, 4.19).ConclusionThe practice of a minimum acceptable diet is inadequate. Nutrition education should be emphasized to improve the mothers’ nutrition knowledge regarding infant and young child feeding recommendations, to support mothers in overcoming barriers to feeding their children with adequate diets, and to foster complementary feeding practices for malnourished children.

Infant Feeding for Persons Living With and at Risk for HIV in the United States: Clinical Report.

Pediatricians and pediatric health care professionals caring for infants born to people living with and at risk for HIV infection are likely to be involved in providing guidance on recommended infant feeding practices. Care team members need to be aware of the HIV transmission risk from breastfeeding and the recommendations for feeding infants with perinatal HIV exposure in the United States. The risk of HIV transmission via breastfeeding from a parent with HIV who is receiving antiretroviral treatment (ART) and is virally suppressed is estimated to be less than 1%. The American Academy of Pediatrics recommends that for people with HIV in the United States, avoidance of breastfeeding is the only infant feeding option with 0% risk of HIV transmission. However, people with HIV may express a desire to breastfeed, and pediatricians should be prepared to offer a family-centered, nonjudgmental, harm reduction approach to support people with HIV on ART with sustained viral suppression below 50 copies per mL who desire to breastfeed. Pediatric health care professionals who counsel people with HIV who are not on ART or who are on ART but without viral suppression should recommend against breastfeeding. Pediatric health care professionals should recommend HIV testing for all pregnant persons and HIV preexposure prophylaxis to pregnant or breastfeeding persons who test negative for HIV but are at high risk of HIV acquisition.

Healthcare professionals and commercial milk formula recommendations in the urban Mexican context.

Breastfeeding (BF) is considered an essential component of optimal care for child health and development. In the past two decades, global data have shown improvements in some, but not all, BF indicators. Despite these positive changes sales and per capita intake of commercial milk formula (CMF) have increased globally. The CMF industry invests millions of dollars in marketing, which targets families and healthcare professionals (HCP). In Mexico, more than half of the mothers (53%) who feed their infants with CMF chose their Brand on the recommendation of HCP. Understanding the reasons behind the current recommendations for the use of CMF by HCP is important for the design of BF interventions. The primary objective of this study was to explore Mexican HCP' beliefs, attitudes, perceptions, and practices about early infant feeding practices, and reasons for recommending CMF. The secondary objective was to explore pregnant women and mother's perceptions of the infant feeding recommendations they received from HCP, and of the factors that influenced their infant feeding decisions. The study was based on a secondary qualitative data analysis of a WHO/UNICEF multi-country study. We analyzed focus group discussions (FGDs) and in-depth interviews (IDIs) from Mexico. Data were collected through convenience sampling in Mexico City and Guadalajara. HCP (n = 34) analysis was based on IDIs, and pregnant women or mothers of children 0-18 months (n = 74) on FGDs and IDIs. Through a thematic analysis, we identified the socioecology of BF and triangulated HCP and women's accounts. HCP, pregnant women, and mothers recognized that several factors might have influenced their infant feeding decisions including healthcare facilities' policies and maternal work conditions. Although HCP believed that BF is the best way to feed newborns and young children, they routinely recommended CMF. On the other hand, pregnant women and mothers had a strong belief that BF is the best way to feed their babies. However, when women sought support from HCP, the latter often recommended switching to CMF. This study highlights the discordance between HCP perceptions and mothers' experiences of HCP recommendations about infant feeding. Our findings support a national call for policy actions.

Prevalence of diarrhoea with different feeding methods and water used among infants under two years: A cross-sectional study in Hodeida city, Yemen, 2021

Objectives: Diarrhoea is a significant cause of morbidity and mortality among children under 2 years old in low- and middle-income countries, including Yemen. This study investigated the association between feeding practices, water used and the prevalence of diarrhoea in infants under two in Hodeida City, Yemen. Material and Methods: The study employed a cross-sectional design, gathering data on infant feeding methods and the prevalence of diarrhoea. The sample consisted of 360 mothers or caregivers of children under the age of 2 years. Data were collected from a sex medical centre in rural and urban Hodeida City, Yemen. The data were analysed, and logistic regression was applied to obtain the odds ratio (OR) of association. Results: Results showed significant associations between feeding practices, water type and diarrhoea prevalence. Dropper users had twice the odds of diarrhoea versus spoon/cup users (OR 2.0, 95% confidence interval [CI] 1.2–3.4). Boiled water users had half the odds of diarrhoea compared to tap water users (OR 0.5, 95% CI 0.3–0.8) and purified water users (OR 0.3, 95% CI 0.2–0.6). Infants given bottles later had 1.2 times higher odds of diarrhoea (OR 1.2, 95% CI 1.0–1.5). Conclusion: These findings highlight the importance of appropriate feeding practices and water sources in reducing the risk of diarrhoea in infants under two in Yemen. They may have significant implications for public health policies and infant feeding recommendations in Yemen and other similar settings.

Feasibility, acceptability and lessons learned from an infant feeding intervention trial among women living with HIV in western Kenya

BackgroundThe World Health Organization recommends mothers breastfeed exclusively for the first six months of their infant’s life. However, women living with HIV in low resource settings face many barriers to recommended infant feeding practices such as fear of HIV transmission and perceived milk insufficiency. Moreover, current support for breastfeeding in this context is often insufficient to overcome these barriers. To support women’s infant feeding experience, we tested a personalized infant feeding support program among perinatal women living with HIV in Kenya.MethodsSupporting Healthy Mothers is a theory and evidence-based multilevel intervention designed to address the mental health burden associated with financial and food insecurity and provide personalized support for optimal infant feeding postpartum. As part of the Supporting Healthy Mothers intervention feasibility trial, between February 23, 2022 and November 9, 2022, twenty mothers received five personalized infant feeding support sessions delivered by a local professional lactation specialist from pregnancy until three months postpartum. Through detailed observations of these sessions, clinical notes and repeated team discussions, we aimed to describe and provide a limited evaluation of these sessions. We identified the strengths and limitations of the lactation support sessions as well as areas for future development.ResultsParticipation in the sessions was high and at three months postpartum all participants reported exclusive breastfeeding as recommended despite experiencing a myriad of challenges. Having face-to-face and frequent early postpartum sessions, being available to field participant concerns between sessions and measuring infant weights at each session were key strengths. Continuing sessions beyond three months postpartum and incorporating family planning and general maternal health counseling topics would enhance these supportive sessions.ConclusionsThe personalized professional infant feeding support sessions were highly acceptable and feasible to implement. In-person sessions, in a clinic setting provided opportunities to evaluate and adjust breastfeeding technique and led to successful exclusive breastfeeding practice. Future interventions should consider integrating with other perinatal care services and offering support on demand and immediately postpartum.Trial registrationSupporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, posted on February 2, 2022. Identifiers: NCT05219552 Unique Protocol ID: K23MH116807.

The Effectiveness of Early Food Introduction in Preventing Childhood Allergic Diseases: Protocol for a Systematic Review and Meta-Analysis.

Allergic diseases affect around 40% of the pediatric population worldwide. The coexistence of asthma, allergic rhinitis, eczema, and food allergy renders allergy treatment and prevention challenging. Infant feeding strategies recommend avoiding allergenic foods to prevent allergy development and anaphylaxis. However, recent evidence suggests that early consumption of food allergens during weaning in infants aged 4-6 months could result in food tolerance, thus reducing the risk of developing allergies. The aim of this study is to systematically review and carry out a meta-analysis of evidence on the outcome of early food introduction for preventing childhood allergic diseases. We will conduct a systematic review of interventions through a comprehensive search of various databases including PubMed, Embase, Scopus, CENTRAL, PsycINFO, CINAHL, and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to the latest available studies in 2023. We will include randomized controlled trials (RCTs), cluster RCTs, non-RCTs, and other observational studies that assess the effect of early food introduction to prevent childhood allergic diseases. Primary outcomes will include measures related to the effect of childhood allergic diseases (ie, asthma, allergic rhinitis, eczema, and food allergy). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines will be followed for study selection. All data will be extracted using a standardized data extraction form and the quality of the studies will be assessed using the Cochrane Risk of Bias tool. A summary of findings table will be generated for the following outcomes: (1) total number of allergic diseases, (2) rate of sensitization, (3) total number of adverse events, (4) improvement of health-related quality of life, and (5) all-cause mortality. Descriptive and meta-analyses will be performed using a random-effects model in Review Manager (Cochrane). Heterogeneity among selected studies will be assessed using the I2 statistic and explored through meta-regression and subgroup analyses. Data collection is expected to start in June 2023. The results acquired from this study will contribute to the existing literature and harmonize recommendations for infant feeding with regard to the prevention of childhood allergic diseases. PROSPERO CRD42021256776; https://tinyurl.com/4j272y8a. PRR1-10.2196/46816.

Survey on human milk feeding and enteral feeding practices for very-low-birth-weight infants in NICUs in China Neonatal Network

BackgroundThe breastfeeding rate in China is lower than that in many other countries and the extent of adoption of the “Feeding Recommendations for Preterm Infants and Low Birth Weight Infants” guideline in NICUs remains unclear.MethodA web-based survey about the current status of human milk feeding and enteral feeding practices at NICUs was sent to all China Neonatal Network’s cooperation units on September 7, 2021, and the respondents were given a month to send their responses.ResultsAll sixty NICUs responded to the survey, the reply rate was 100%. All units encouraged breastfeeding and provided regular breastfeeding education. Thirty-six units (60.0%) had a dedicated breastfeeding/pumping room, 55 (91.7%) provided kangaroo care, 20 (33.3%) had family rooms, and 33 (55.0%) routinely provided family integrated care. Twenty hospitals (33.3%) had their own human milk banks, and only 13 (21.7%) used donor human milk. Eight units (13.3%) did not have written standard nutrition management guidelines for infants with body weight < 1500 g. Most units initiated minimal enteral nutrition with mother’s milk for infants with birth weight ˂1500 g within 24 h after birth. Fifty NICUs (83.3%) increased the volume of enteral feeding at 10–20 ml/kg daily. Thirty-one NICUs (51.7%) assessed gastric residual content before every feeding session. Forty-one NICUs (68.3%) did not change the course of enteral nutrition management during drug treatment for patent ductus arteriosus, and 29 NICUs (48.3%) instated NPO for 1 or 2 feeds during blood transfusion.ConclusionThere were significant differences in human milk feeding and enteral feeding strategies between the NICUs in CHNN, but also similarities. The data obtained would be useful in the establishment of national enteral feeding guidelines for preterm infants and quality improvement of cooperation at the national level.

Canadian Pediatric & Perinatal HIV/AIDS Research Group consensus recommendations for infant feeding in the HIV context.

Providing comprehensive infant feeding guidance to families affected by HIV is complex and requires a multidisciplinary approach. While exclusive formula feeding remains the preferred recommendation for infants born to women living with HIV (WLWH) in high-income countries, a more nuanced approach that may include the option of breastfeeding under certain circumstances is emerging in many resource-rich countries. The Canadian Pediatric & Perinatal HIV/AIDS Research Group (CPARG) hosted a Canadian Institute of Health Research-funded meeting in 2016 to develop consensus among multidisciplinary providers around counselling and recommendations for infant feeding. After presentations by adult and paediatric health care providers, basic scientists, and community-based researchers, a subgroup drafted summary evidence-informed recommendations. Along with revisions among CPARG members, a community review was performed by a convenience sample of WLWH who had given birth in the past 5 years from Ontario and Quebec. A legal review was also conducted to ensure understanding of the criminalization potential and concern of HIV transmission and exposure. The Canadian consensus guidelines continue to support formula feeding as the preferred method of infant feeding as it eliminates any residual risk of postnatal vertical transmission. Formula should be made available for all infants born to mothers living with HIV for their first year of life. A comprehensive approach to counselling WLWH is outlined to assist providers to effectively counsel on current evidence to ensure WLWH are fully informed in their decision making. For women meeting criteria to and elect to breastfeed, frequent maternal virologic monitoring and follow-up is required of both mother and infant. Antiretroviral prophylaxis and monitoring are recommended for breastfed infants. The community review highlighted the importance of other supports and counselling needed for implementing effective formula feeding, aside from access to formula. The legal review provided clarifying language around child protection services involvement and the need to provide referral to legal resources or information upon request. Surveillance systems to monitor for cases of breastmilk transmission should be in place to improve gaps in care and develop further knowledge in this area. The Canadian infant feeding consensus guideline is designed to inform and enable better care for WLWH and their babies. Ongoing evaluation of these guidelines as new evidence emerges will be important.

Forming the Perception of WIC Infant Feeding Recommendations: A Qualitative Study.

Nearly half of newborns in the United States are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Promoting breastfeeding is a programmatic priority, although formula vouchers are provided for those who do not exclusively breastfeed. Previous literature suggests that participant perception of WIC's breastfeeding recommendations is a significant factor predicting breastfeeding initiation, duration, and exclusivity outcomes. However, little is known about how participants' perceptions of WIC's breastfeeding recommendations are formed. To address this knowledge gap, we conducted a qualitative pilot study in Nevada, interviewing 10 postpartum WIC mothers and 12 WIC staff who had interacted with participants regarding infant feeding. Results showed participants and staff reported various perceptions of what WIC recommends, the factors that contribute to these perceptions, and how these perceptions affect breastfeeding practices. Respondents also described that WIC has a negative legacy as the "free formula program," and that environmental factors, such as the recent formula recall, have had an impact on participants' infant feeding practices. More effective public campaigns and programmatic strategies are needed to target participants' prenatal self-efficacy and to communicate the availability of skilled lactation support in the early postpartum period to improve participants' perceptions of WIC's position on breastfeeding.

Современные принципы организации питания у поздних недоношенных новорожденных

Neonates born between 34 0/7 and 36 6/7 weeks of gestation are considered late preterm (LPT) and constitute the largest group of all preterm infants. The rate of morbidity and mortality, as well as the frequency of repeated hospitalizations among LPT infants are significantly higher compared to full-term infants, which is explained by immaturity due to the lack of a critical period of their intrauterine growth and development. Fairly common they face nutritional problems leading to adverse immediate and long-term outcomes. Until recently, the lack of clear feeding recommendations for LPT infants determined the use of individual approaches to optimize their nutrition. The annual increase in the number of LPT infants has prompted the accumulation of new scientific information concerning both the anatomical and physiological characteristics and principles of development of these children in general and specific problems, including those related to nutrition. Comprehensive support and appropriate breastfeeding are the cornerstone of adequate nutrition for LPT infants. Depending on factors such as gestational age, birth weight, and comorbidities, it is often necessary to increase nutritional support, including the use of breast milk fortifiers, nutrientenriched formulas, and parenteral nutrition prescription. The process of achieving normal nutritional status in LPT infants can be complicated by episodes of hypoglycemia and prolonged jaundice, delay in postnatal growth and development, which requires a special approach. This review highlights the most common problems of nutritional management of LPT infants and provides current recommendations for optimal feeding of this group of preterm infants. Key words: late preterm infant, nutritional requirements, breastfeeding, donor milk, specialized formula, breast milk fortifiers, hypoglycemia, hyperbilirubinemia

Discrepancies in infant feeding recommendations between grandmothers and healthcare providers in rural Mexico

BackgroundInfant feeding practices are rapidly changing within rural areas in Mexico, including indigenous communities. The aim of this study was to compare infant feeding recommendations between grandmothers and healthcare providers, to better understand the factors that may influence these practices within these communities. This study builds on research that recognizes the legacy of colonization as an ongoing process that impacts the lives of people through many pathways, including the substandard healthcare systems available to them.MethodsQualitative study based on secondary data analysis from interviews and focus groups guided by a socioecological framework conducted in 2018 in two rural, Indigenous communities in Central Mexico. Participants were purposively selected mothers (n = 25), grandmothers (n = 11), and healthcare providers (n = 24) who offered care to children up to two years of age and/or their mothers. Data were coded and thematically analyzed to contrast the different perspectives of infant feeding recommendations and practices between mother, grandmothers, and healthcare providers.ResultsGrandmothers and healthcare providers differed in their beliefs regarding appropriate timing to introduce non-milk foods and duration of breastfeeding. Compared to grandmothers, healthcare providers tended to believe that their recommendations were superior to those from people in the communities and expressed stereotypes reflected in negative attitudes towards mothers who did not follow their recommendations. Grandmothers often passed down advice from previous generations and their own experiences with infant feeding but were also open to learning from healthcare providers through government programs and sharing their knowledge with their daughters and other women. Given the contradictory recommendations from grandmothers and healthcare providers, mothers often were unsure which advice to follow.ConclusionsThere are important differences between grandmothers and healthcare providers regarding infant feeding recommendations. Healthcare providers may perceive their recommendations as superior given the neocolonial structures of the medical system. Public health policies are needed to address the different recommendations mothers receive from different sources, by harmonizing them and following an evidence-informed approach. Breastfeeding programs need to value and to seek the participation of grandmothers.

The Role of Nutrition in the Prevention and Management of Neonatal Jaundice in Ghana

Despite the well-established importance of nutrition in health and wellness, nutrition’s involvement in the management and prevention of neonatal jaundice varies greatly from one guideline to another, to the extent that some guidelines do not include the role of nutrition in the prevention and management of neonatal jaundice. In addition, mothers typically translate their nutrition knowledge into the care of their babies. Hence, it is prudent for mothers to have the requisite knowledge needed to prevent any health condition, including neonatal jaundice. This study, therefore, sought to investigate and consolidate practices that elucidate the role nutrition plays in the prevention and management of neonatal jaundice in Ghana. The study was a multi-center nested, case-control study involving 120 cases and 120 controls of neonates in three referral hospitals in Ghana. Assessment of nutrition knowledge showed that with regards to the WHO (2004 &amp; 2017) infant feeding recommendations, mothers of babies with neonatal jaundice had a higher nutrition score than mothers with healthy babies. During treatment of neonatal jaundice, babies were mostly fed breastmilk only, and, in a few cases, extra fluids were given if the baby is not exclusively breastfed or there is a risk of dehydration during phototherapy. No probiotic supplements were given, and micronutrient supplementation may or may not be given, depending on the prevailing health conditions of the neonate. It is recommended that further assessment should be carried out to identify the effectiveness of the nutrition education given during antenatal and postnatal education sessions at hospitals, clinics, and health centers. Keywords Breastfeeding, Malnutrition, Neonatal jaundice, nutrition education, World Health Organisation (WHO).

Maternal Experiences with Discussing Complementary Feeding in Primary Care.

Complementary feeding practices promote healthy eating habits and food preferences later in life. Little is known about how US pediatricians communicate infant feeding practices to caregivers or how caregivers respond to this information. The purpose of this study is to explore mothers’ experiences and perceptions of the complementary feeding recommendations they receive in primary care settings. English- and Spanish-speaking mothers of infants were recruited from Special Supplemental Nutrition for Women, Infants, and Children offices in Rhode Island, US, and snowball sampling. Semi-structured telephone interviews were conducted to investigate mothers’ discussions with pediatricians about complementary feeding and their overall impressions of wellness visits. Thematic analysis was informed by the Fundamentals of Care theoretical framework. The mean age of the sample (n = 13) was 30.5 years and 62% self-identified as Latina. Four themes emerged from the analysis: (1) wellness visits are mostly positive experiences, (2) not all infant feeding recommendations are easy to follow, (3) alternative sources of infant feeding recommendations can be just as helpful, and (4) there is room for improvement at wellness visits. Improving the content, delivery, and cultural relevance of infant feeding recommendations in primary care settings with more specific and tailored information may promote adherence to evidence-based practices.

Effect of Unlimited Two-Way Texting on Maternal Self-Efficacy Toward Successful Adherence to the 2020-2025 Dietary Guidelines’ Infant Feeding Recommendations

Describe the effect of a two-way texting and video blog program with Registered Dietitian/Lactation Consultant on self-efficacy towards timely and best early feeding practices among new mothers during COVID.

Pathways linking social support, self-efficacy, and exclusive breastfeeding among women in northern Uganda

ABSTRACT Despite improvements in infant feeding practices over the past two decades, the prevalence of exclusive breastfeeding (EBF) is below global targets. Social support can create an enabling environment for recommended infant feeding practices such as EBF, but the types of social support most important for sustained EBF and their potential mechanisms of action have not been thoroughly characterized. We therefore aimed to assess the relationship between EBF-specific social support, EBF self-efficacy, and EBF at 1 and 3 months among postpartum women in northern Uganda. Women (n = 238, 36.2% living with HIV) were recruited during pregnancy. EBF, social support, and EBF self-efficacy were assessed at 1 and 3 months postpartum. Path analysis was used to assess relationships between these factors. Most mothers exclusively breastfed to 1 (80.8%) and 3 months postpartum (62.9%). EBF-specific, but not general, social support differed by EBF status. EBF-specific social support was associated with higher odds of EBF, which was almost fully mediated by EBF self-efficacy. That is, there was evidence that social support primarily influences EBF through its association with self-efficacy. In sum, EBF-specific social support and self-efficacy likely promote EBF and are modifiable factors that can be intervened upon.

Experiences of young Australian mothers with infant feeding

BackgroundDespite the overwhelming evidence of health and other benefits of breastfeeding and recommendations to breastfeed by peak health bodies, breastfeeding rates are significantly lower than recommended in Australia and globally. Young mothers are identified as being at high risk of not breastfeeding their infants according to infant feeding recommendations. This study aimed to gain an in-depth understanding of young Australian mothers’ experiences of infant feeding, and to explore the factors which facilitated or hindered adherence to recommended breastfeeding practices.MethodsPurposive and snowball sampling were used to recruit young mothers in Australia (n = 17) aged 18–25 years who had given birth to their first child within the last two years. Data were collected through semi-structured interviews via online videoconferencing. Interviews were audio-recorded, transcribed verbatim, coded, and subsequently analysed. Thematic analysis was conducted using Quirkos, a qualitative data management and analysis software.ResultsFour major themes were identified: Breastfeeding is challenging; Feeling judged about infant feeding choices; Experiences with breastfeeding support; and Experiences and views on breastfeeding education. Most mothers reported experiencing breastfeeding challenges, particularly those arising from lactation difficulties, yet many were able to overcome these challenges through their determination to breastfeed. Many mothers expressed perceiving judgement from others for breastfeeding in public. Some mothers who were bottle feeding their infants, whether with expressed breast milk or infant formula, felt that they were being judged for using a bottle. Many mothers reported professional, partner, family, and peer support as critical facilitators to the continuation of breastfeeding. Most mothers shared positive experiences of attending breastfeeding education sessions, but indicated the need for community education to reduce judgement toward mothers’ infant feeding decisions.ConclusionsThe barriers and enablers to infant feeding experienced by young mothers are similar to those experienced by mothers of all ages. Young mothers experience significant breastfeeding challenges and need support from partner, family, peers, and professionals to continue breastfeeding in line with recommendations. Breastfeeding campaigns to support young mothers should be aimed at the wider community to increase awareness of breastfeeding challenges, reduce stigma associated with breastfeeding in public, and to support mothers in their infant feeding decisions.

Fruit Juice and Sugar-Sweetened Beverage Related Knowledge and Feeding Practices Among Parents of Infants and Young Toddlers

ObjectivesCurrent infant and young child feeding recommendations include a focus on sugar-containing beverages (SCBs). The American Academy of Pediatrics recommends delaying the introduction of fruit juice (FJ) until after age 12 months and limiting toddler consumption to 4 ounces/day, and the U.S. Dietary Guidelines advise avoiding sugar-sweetened beverages (SSBs) prior to age 2 years. Well-Child Visits (WCV) provide an opportunity to educate parents and promote recommended feeding practices. We aimed to describe the SCB-related knowledge and feeding practices of a sample of parents and the potential for using short videos during WCVs to provide early feeding related education.MethodsA convenience sample of parents attending 4–15 month WCVs at a busy metro area clinic in Georgia completed a self-administered survey to assess their infant/young toddler feeding practices and their knowledge of SCB-related feeding recommendations. A sub-sample also reported on their perceptions of a 3-minute educational video viewed during the visit.ResultsRespondents (n = 105) were primarily women (87%), non-Hispanic/Latino (93%), and Black/African-American (95%). Some parents: 12% and 77% respectively, believed it OK to give infants FJ before 6 months and 12 months of age; 6% reported introducing FJ before 4 months. Among those with children ≥ 12 months (12–18 months; n = 36), 81% reported having given them FJ before 12 months; 25% reported giving them > 4 ounces FJ/day; and 56% had already given their child SSBs. Age of FJ introduction was not modified by presence of older sibling or age of parent. Few (5%) parents were aware of any expert recommendation related to FJ consumption. Most parents who viewed an education video during the WCV (n = 47) reported being able to focus on (74%), enjoy (85%), and learn something (83%) from it; 96% liked the video length, 74% felt watching it was a good use of their time, 45% perceived a change in their thinking after viewing the video.ConclusionsOur findings demonstrate that consumption of FJ among infants and SSBs among young toddlers is common, that parents are unaware of expert recommendations related to FJ consumption, and short videos present an opportunity to support parent education efforts during WCVs.Funding SourcesThe Global Center for Diabetes Translation Research, pilot grant program.

Ethical Considerations for Hospital-Based Infant Feeding Support

I applied a systematic ethical decision-making approach to evaluate how health care professionals in hospital settings should provide infant feeding support after childbirth. Human milk is recommended as the optimal source of nutrition for infants because of the health benefits it provides for infants and their lactating parents. However, health consequences of insufficient oral intake in infants and psychological distress in the lactating parent may occur when infant feeding does not go according to plan. Infant feeding support should be provided in a way that is objective, sensitive, individualized, equitable, and supportive of autonomy and avoids harm. I provide recommendations for ethical infant feeding support that can be applied by individual health care professionals and on postpartum units in hospitals.

Infant feeding practices and its associated factors among HIV positive mothers attending public health institutions at Gondar Town, Northwest Ethiopia, 2019: An institutional based cross-sectional study

IntroductionFour out of ten infants born become infected with the human immunodeficiency virus during pregnancy, childbirth and breastfeeding in developing countries. Several factors are responsible for these, including practising mixed feeding that contributes to mother-to-child transmission and is unpreventable. Besides, it can cause diarrhoea, pneumonia and malnutrition, leading to morbidity and mortality. ObjectivesThis study aimed to assessinfant feeding practices and associated factors among human immunodeficiency virus-positive mothers attending public health institutions in Gondar Town. MethodsAn institutional-based cross-sectional study was conducted. A census method was employed. Data were collected by using a structured questionnaire. The data were entered by Epi Info version 7 and analyzed with SPSS version 20. The data were analyzed by using binary logistic regression. Those variables with a P-value of ≤ 0.05 were considered significantly associated with infant feeding practice. ResultThe overall infant feeding practice was 94 % [95CI (91.4–96.3)]. Being in the age category of 18–24 years [AOR = 2.34,95 % CI(1.26–10.56)], rural residence [AOR = 8.08, 95 %CI (2.45–21.62)], having social support [AOR = 1.82, 95 %CI (1.43–6.55)], disclosing HIV status [AOR = 4.67, 95 %CI (1.67–20.88)], having no pregnancy-related problem [AOR = 2.61, 95 %CI(1.23–7.96)] were significantly associated. Conclusion and recommendationIn the current study, recommended infant feedingpracticeswereoptimal. Age, place of residence, social support, disclosure of HIV status, and absence of pregnancy-related problems during pregnancy were significantly associated with outcome variables. Mothers should follow recommended infant feeding practices andpayspecialattentiontourbandwellers.