Timing Of Complementary Feeding Research Articles

Starch Consumption Patterns in Infants and Young Children.

The introduction of starch into an infant's diet is an important milestone in the feeding journey. Intestinal maturity and the presence of digestive enzymes are necessary for the physiologic breakdown of starch and other complementary foods. However, little is known about the consumption patterns of starch containing foods during complementary feeding. The 2008 Feeding Infants and Toddlers Study (FITS) is a cross-sectional 24-hour dietary intake survey of a nationally representative sample of infants, toddlers, and preschoolers from birth to 48 months of age. We looked at the age-based prevalence of consumption of starch-containing foods during complementary feeding. We found that about 90% of infants were consuming starch by 6 and 8.9 months, with less than half of infants being exposed to complementary foods from multiple food groups under 6 months. The most common food source of starch was iron-fortified infant cereals, followed by vegetables and fruits. Rice and oats were the most prevalent cereal types, while sweet potatoes, peas and squash were the most commonly consumed starch-containing vegetables. Bananas were the leading starch-containing fruit that was consumed. Around 9 and 11 months, the prevalence of iron-fortified cereals declined and were replaced with lower iron-containing ready-to-eat cereals. There was also a drop in the prevalence of fruit and vegetable consumption once the infant became a toddler. Most bread products consumed by toddlers were not whole grain, but their cereal choices were often whole grain. Other sources of starch were mixed dishes, which contained grains like bread or pasta combined with other types of foods. Starch enters the infant's diet around the time of complementary feeding, though earlier exposure may occur from certain carbohydrate components of infant formula. Most infants are exposed to starch from grains, followed by vegetables and fruits.

The effect of early feeding practices on growth indices and obesity at preschool children from four European countries and UK schoolchildren and adolescents.

Early feeding practices, i.e., any breastfeeding duration and age of introduction of complementary foods, do not appear to be consistently associated with height z-score, overweight/obesity, and body fat mass in preschool children from four European countries and in UK schoolchildren and adolescents. What is known? • Healthy growth and childhood obesity partly originate from early life. What is new? • Breastfeeding duration less than 6months was associated with lower height z-scores in 5-year-old French children, while the opposite was observed in 4-year-old British children. • Introduction of complementary foods earlier than 4months was positively associated with fat mass levels in 5-year-old French children, but not in the other three countries. • Early feeding practices did not appear to be consistently associated with growth and adiposity indices, and as such, no clear influence can be observed.

A Nutrition Education Program in Rural Bangladesh Was Associated with Improved Feeding Practices but Not with Child Growth

Background: Childhood undernutrition is a major public health problem in Bangladesh. Evaluating child nutrition programs is a priority.Objective: The objective of this study was to evaluate a community-based nutrition education program (implemented from 2011 to 2013) aimed at improving infant and young child feeding (IYCF) practices and growth in rural Bangladesh.Methods: A cohort-based evaluation was conducted that included 2400 women (1200 from Karimganj, the intervention subdistrict, and 1200 from Katiadi, the control subdistrict) enrolled at 28-31 wk gestation in 3 waves between January and October 2011. Follow-up occurred at 3, 9, 16, and 24 mo of offspring age. The main outcomes were exclusive breastfeeding (EBF), measured at 3 mo, timing of complementary feeding (CF) initiation and minimum acceptable diet (MAD), measured at 9 mo, and child growth [assessed via length-for-age z score (LAZ) and weight-for-length z score], measured at all follow-ups. The main exposures were subdistrict of residence and wave of enrollment. For IYCF practices as outcome, logistic regressions were used. Generalized estimating equations were used for child growth as outcome.Results: EBF rates at 3 mo remained unchanged between waves 1 and 3 in Karimganj (55.6% compared with 57.3%), but the proportion of infants receiving timely CF initiation and MAD at 9 mo increased significantly (CF: 27.1-54.7%; MAD: 8.4-35.3%). Mean LAZ at 24 mo remained unchanged between waves 1 and 3 in Karimganj (-2.18 compared with -1.98).Conclusions: The program was successful in improving the quality of infant diet at 9 mo and timely CF initiation, but not EBF at 3 mo or LAZ. These findings support the case for implementing simple messages in all programs aimed at improving infant diet, especially in settings in which supplementing overall household diet may not be feasible.

Determinan yang Berhubungan dengan Pemberian MP-ASI Dini pada Bayi Usia 0-6 Bulan

SDKI (2012) said the distribution of MP-ASI early age in Indonesia: 0-1 months of 49,3%, at the age 2-3 month of 51%, and age 4-5 months of 73%. If complementary feeding given at the age of under six months, digestive system of infants have not having enzymes to digest food, digestion and kidney worked havier, can lead cough, diarrhea, colic, and allergic.The lowest percentage of the scope breastfeeding exclusive was at Puskesmas Rumbai Pesisir, about 37,27 %. This study was to know factors that deals with the provision of premature complementary feeding on children aged 6-0 months in the work area of Puskesmas Rumbai Pesisir Pekanbaru. This study was analytic design cross sectional. Population were all the mother who have a baby aged 6-0 months, total population were 1135 people, and 92 as total sample. Data were analyzed by test chi-square (α<0,05). Results were obtained the majority of respondents knowledgeable good 67 people (72,8%), educated low as many as 68 people (73,9%), does not work as many as 69 people (75%) and family income high 53 people (57,6%). Statistical tests chi-square revealed that there were relation between knowledge and education with the premature complementary feeding. And there was no related between work and family income with give premature complementary feeding. Expected health workers can cooperate with healthcare and community figures in providing information or tutoring directed regarding the provision of complementary feeding time.

Infant feeding and child fussy eating: The Generation R Study

Fussy/picky eating – i.e. consistently avoiding certain foods – is common in childhood and can be worrisome for parents. Repeated exposure to various flavors as occurs in breastmilk and early exposure to complementary feeding may increase food acceptance and thereby decrease fussy eating. This study examines the associations between infant feeding and child fussy eating in 4779 participants of Generation R, a Dutch population-based cohort. Breastfeeding initiation and continuation, and timing of complementary feeding were assessed by questionnaires at 2, 6, and 12 months. The food fussiness scale of the Children's Eating Behaviour Questionnaire was administered at 4 years. Linear regression analyses were performed, adjusted for confounders. Children who were never breastfed did not differ in fussy eating frequency from children breastfed for 6 months or longer. However, children who were breastfed for less than 2 months had a 0.70 points higher food fussiness sum-score (95%CI:0.27; 1.12) than children breastfed for 6 months or longer. An earlier introduction of vegetables was associated with less fussy eating behavior (p-for-trend:0.005). Particularly children who were introduced to vegetables between 4 and 5 months had a 0.60 point lower food fussiness score (95%CI: 1.06;-0.15) than children introduced to vegetables after 6 months. An early introduction to fruits or any solids was not significantly related to fussy eating, although the effect estimates were in the same direction as for introducing vegetables early. Results suggest that breastfeeding does not predict fussy eating. However, introducing vegetables into a child's diet before 5 months might be protective against fussy eating, although future research should account for parents' own fussy eating.

Knowledge, attitude and practices regarding complementary feeding among mothers of children 6 to 24 months of age in Konaseema region

Background: Complementary feeding is the introduction of semisolid or solid food in infant who is on breast feeding, when mother’s milk is no longer enough to meet the nutritional needs. Understanding the social beliefs, knowledge, attitude and practices about complementary feeding among mothers is an important step prior to designing an intervention strategy to prevent malnutrition in children. Aim of the study was to assess the knowledge, attitude and practices regarding complementary feeding among mothers and its effect on growth of the child.Methods: Prospective study including 500 mothers with children between 6 to 24 months of age in KIMS, from December 2014 to November 2015. Results: Mean age of knowledge regarding complementary feeding in mothers was 8.01 months. Most of the mothers 307/500 (61.4%) started complementary feeding because of insufficient milk, 183/500 (36.6%) mothers started complementary feeding as they felt the child required more milk, 30/500 (6%) mothers started complementary feeding as the child was sick and not drinking milk. There is significant positive correlation between age of complementary feeding and malnutrition in first 2 years of life.Conclusions: Mother’s knowledge regarding timing of complementary feeding is inadequate and practices are inappropriate. Majority of them are not aware of the current recommendations. It is essential to give accurate information and education about complementary feeding to prevent malnutrition and improve the health status of children.

OBESITY IN CHILDREN: NEW PREVENTION CONCEPTS AND APPROACHES. LITERATURE REVIEW

The review presents modern concepts of the obesity origins in children and adults. We substantiate the point of view of antenatal origin of obesity caused by malnutrition of a woman during pregnancy and also consider the possibility of influence of infant and young child nutrition on the development of obesity in the future. New opportunities for obesity prevention should be aimed at optimizing women's nutrition before and during childbearing, supporting breastfeeding, observing the timing of complementary feeding and adequate feeding of children after one year of age.

The timing of complementary feeding in preterm infants and the effect on overweight: study protocol for a systematic review.

BackgroundIn term infants, there is evidence that early complementary feeding is a risk factor for childhood obesity. Therefore, timely introduction of complementary feeding during infancy is necessary. The World Health Organization (WHO) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) both developed recommendations for the start of complementary feeding for term-born infants. However, these guidelines cannot be directly translated to preterm infants. Recent literature looking at the introduction of complementary feeding in preterm infants gives contrasting information. Given these contrasting reports on the introduction of solid foods in premature born infants, a systematic review is needed. The primary objective of this study is to analyze the effect of the time starting complementary feeding on overweight (including obesity) in preterm infants.MethodsAn electronic systematic literature search with pre-defined terms will be conducted in Cochrane, PubMed, EMBASE, Web of Science, Scopus, and CINAHL. There will be no restriction for time period. Primarily, data from randomized controlled trials (RCTs) will be included in this systematic review. Search terms will include preterm infants, complementary feeding, overweight, and their synonyms. Article selection, including risk of bias assessment, will be performed by three reviewers independently. Body mass index standard deviation score (BMI-SDS or BMI-Z-score) will be used to compare studies. The consistency of results across the studies will influence the decision whether or not to combine results in a meta-analysis. Studies that cannot be included in the meta-analysis will be described in a narrative analysis.DiscussionThis systematic review will give an overview of the existing knowledge on the timing of complementary feeding in preterm infants and the effect on overweight. It will form a basis for future guidelines for complementary feeding for preterm infants.Systematic review registrationPROSPERO CRD42015014215Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0324-3) contains supplementary material, which is available to authorized users.

Maternal weight status, diet, and supplement use as determinants of breastfeeding and complementary feeding: a systematic review and meta-analysis.

Infant feeding practices are influenced by maternal factors. The aim of this review is to examine the associations between maternal weight status or dietary characteristics and breastfeeding or complementary feeding. A systematic literature search of the Embase, Cochrane Library, Google Scholar, MEDLINE, PubMed, and Web of Science databases was performed. Interventional and cohort studies in healthy mothers and infants that reported on maternal weight status, diet, or supplement use were selected. Outcomes assessed included delayed onset of lactogenesis; initiation, exclusivity, duration, and cessation of breastfeeding; and timing of complementary feeding. Eighty-one studies were included. Maternal underweight, diet, and supplement use were not associated with infant feeding practices. Obese women had a relative risk of failure to initiate breastfeeding (risk ratio [RR] = 1.23; 95%CI, 1.03-1.47) and a delayed onset of lactogenesis (RR = 2.06; 95%CI, 1.18-3.61). The RR for breastfeeding cessation was 1.11 (95%CI, 1.07-1.15) per increase in category of body mass index. Prevention of obesity in women of reproductive age, as well as counseling of obese women after delivery, could be targeted to improve infant feeding practices.

Complementary feeding practices in rural areas of Telangana: A hospital based, cross-sectional, descriptive study

Background: Introduction of semi solid/solid food i.e., complementary feeding time is very vulnerable period during infancy. To prevent malnutrition knowledge of optimal feeding practices is essential for mothers. Objective: To study currently existing complementary feeding practices and assess the knowledge and practice gap. Study design: Hospital based, cross-sectional, descriptive study. Setting: In a tertiary care teaching hospital of rural Telangana. Participants: Total 220 mothers with children in the age group of 6-23 months of age. Methods: Participants were randomly selected after informed consent. Data regarding currently following complementary feeding practices was collected in the predesigned, semi-structured questionnaire and analyzed. Results: Only 40.9% of mothers initiated complementary feeding at the recommended age. Although age appropriate quantity of food was received by 66.4% of subjects only 25.5% subjects were receiving at recommended frequency. 77.7% of mothers were giving home made preparations. Diversity of feeds was observed in 23% of children. Conclusions: As there is increasing evidence for the positive impact of feeding counseling on energy and nutrient intake and growth in children of less than two years, changes in individual’s behavior, supplemental interventions will be needed. Effective nutrition actions do exist but should be implemented on a sufficiently large scale to reduce the burden of malnutrition.

Knowledge of complementary feed and its effect on the child nutrition

Introduction: Introduction of semisolid food in an infant who is on liquid diet is known as complementary feeding. When breast milk is no longer enough to meet the nutritional needs of the infant, complementary feeding should be started. Methods: 500 mothers with children 6-24 months of age attending OPD in Mc Gann were interviewed. Data was collected using a self-administered, semi-structured questionnaire with the mothers regarding knowledge, attitude, and practices of complementary feeding Results: Knowledge, attitude and practices were assessed in 500 mothers. The mean age of complementary feeding was 8.24 ± 2.79 months. Only few had correct information from health personnel. 23% of mothers started complementary feeding at 6 months of age. 21.6% of mothers used commercial foods. Male child, illiterate mothers, low socio-economic group and rural mothers tend to wean late (p 0.05). 34.1%, 34.5% and 23.8% of children were under weight, stunted and wasted respectively. There was significant association between delayed complementary feeding and malnutrition of the child. Conclusion: There is lack of knowledge in mothers regarding complementary feeding, there has to be proper recommendation about timing of complementary feeding. Mean age of complementary feeding was delayed due to improper information, false beliefs and attitudes, illiteracy, low socio-economic status and rural mothers, thus leading to malnutrition of the child. Hence, mothers should be educated properly regarding complementary feeding, foods, preparation and practice to prevent malnutrition and improve the health status of the children.

How well do WHO complementary feeding indicators relate to nutritional status of children aged 6-23 months in rural Northern Ghana?

BackgroundThough the World Health Organization (WHO) recommended Infant and Young Child Feeding (IYCF) indicators have been in use, little is known about their association with child nutritional status. The objective of this study was to explore the relationship between IYCF indicators (timing of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet) and child growth indicators.MethodsA community-based cross-sectional survey was carried out in November 2013. The study population comprised mothers/primary caregivers and their children selected using a two-stage cluster sampling procedure.ResultsOf the 1984 children aged 6–23 months; 58.2 % met the minimum meal frequency, 34.8 % received minimum dietary diversity (≥4 food groups), 27.8 % had received minimum acceptable diet and only 15.7 % received appropriate complementary feeding. With respect to nutritional status, 20.5 %, 11.5 % and 21.1 % of the study population were stunted, wasted and underweight respectively.Multiple logistic regression analysis revealed that compared to children who were introduced to complementary feeding either late or early, children who started complementary feeding at six months of age were 25 % protected from chronic malnutrition (AOR = 0.75, CI = 0.50 - 0.95, P = 0.02). It was found that children whose mothers attended antenatal care (ANC) at least 4 times were 34 % protected [AOR 0.66; 95 % CI (0.50 - 0.88)] against stunted growth compared to children born to mothers who attended ANC less than 4 times. Children from households with high household wealth index were 51 % protected [AOR 0.49; 95 % CI (0.26 - 0.94)] against chronic malnutrition compared to children from households with low household wealth index.After adjusting for potential confounders, there was a significant positive association between appropriate complementary feeding index and mean WLZ (β = 0.10, p = 0.005) but was not associated with mean LAZ.ConclusionsThe WHO IYCF indicators better explain weight-for-length Z-scores than length-for-age Z-scores of young children in rural Northern Ghana. Furthermore, a composite indicator comprising timely introduction of solid, semi-solid or soft foods at 6 months, minimum meal frequency, and minimum dietary diversity better explains weight-for-length Z-scores than each of the single indicators.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2494-7) contains supplementary material, which is available to authorized users.

Developing a novel tool to assess liking and wanting in infants at the time of complementary feeding – The Feeding Infants: Behaviour and Facial Expression Coding System (FIBFECS)

IntroductionConsumption of foods is determined in part by how much a food is liked. However, assessing liking in infants is difficult. Research with infants has often relied on indirect measures such as intake or subjective ratings from mothers. Therefore the aim of the present research was to devise a tool adapted from existing techniques which can directly and systematically measure liking in infants during the weaning period. MethodA tool was developed by extracting items from previous studies. In all, 13 items were generated, which included 6 behaviours reflecting avoidance and approach: turning away, arching back, pushing spoon away, crying/fussy, leaning forward and rate of acceptance; also 7 facial expressions thought to reflect affective response; brow lowered, inner brow raised, squinting, nose wrinkling, upper lip raised, lip corners down and gaping. An e-training manual was developed with a certification test to train coders. The coding tool is based on coding the first 9 spoonfuls for each infant. 63 videos were coded by 4 raters, each video was coded by at least 2 different coders. For each spoonful the absence or presence of each item was recorded; for rate of acceptance, a four point scale was used. ResultsIn the certification test most cues were high in agreement for all coders. Factor analysis indicated two dimensions, one which largely captured gross behaviours and the second featuring a cluster of facial expressions. Internal consistencies of the overall scale and the behaviour and facial expression subscales were acceptable as indicated by Cronbach’s alpha >0.7. Intra-class correlation indicated moderate to high inter-rater reliability and test–retest reliability for most of the cues. Spearman correlations indicated significant associations of the total number of negative behaviours with rate of acceptance and overall facial expressions. Rejection behaviours corresponded with a low rate of food acceptance and a high rate of negative facial expressions. Two parameters occurred less frequently and did not appear to provide any further discriminatory ability, namely leaning forward and crying/fussiness, these can be removed from the scale for future use. ConclusionsThe Feeding Infants: Behaviour and Facial Expression Coding System (FIBFECS) is structurally valid and reliable for use by trained coders and those who are researching infant eating behaviour. The two factor structure of the tool suggests that the facial expression subscale reflects liking and the behaviour subscale wanting. The tool could also be adapted for mothers and professionals to detect liking and wanting through facial expression and behavioural cues respectively.

Application and validation of the Feeding Infants: Behaviour and Facial Expression Coding System (FIBFECS) to assess liking and wanting in infants at the time of complementary feeding

IntroductionThe aim of this study was to validate a novel tool developed to measure liking and wanting in infants during the weaning period. The Feeding Infants: Behaviour and Facial Expression Coding System (FIBFECS; Hetherington et al., 2016) is an evidence based video coding tool, consisting of 13 items. There are 6 measures of avoidance/approach behaviours (turns head away, arches back, pushes spoon away, crying/fussy, leaning forward and rate of acceptance) to assess wanting and 7 facial expressions (brow lowered, inner brow raised, squinting, nose wrinkling, lip corners down, upper lip raised and gaping) to assess liking. Lower scores on the total scale indicated greater wanting and/or liking. The tool was applied to a recent randomized control trial (Hetherington et al., 2015). Method36 mother–infant dyads took part in the study and were randomised to the intervention or the control group. Infants were filmed on two occasions whilst eating a generally liked vegetable (carrots) and less preferred vegetable (green bean). 72 video extracts were coded by 4 trained researchers with adequate certification scores, each video was coded by at least two coders. Items and scales were tested for discrimination ((1) intervention vs control; (2) liked vs disliked vegetable) and construct validity (correlation with intake and liking assessed by mother and researcher). ResultsVery good discrimination (p<0.001) was obtained for carrots vs green bean for the total score and total negative facial expressions and rejection behaviours (p=0.003). Discrimination for the intervention vs control groups was only obtained for the total rejections and the rate of acceptance (p<0.05). The FIBFECS subscales had good construct validity as these were significantly correlated with intake and liking ratings (p<0.01). Items such as crying/fussy and leaning forward were removed from the scale as well as inner brow raised, squinting and lip corners down, as these do not correlate with other variables. Their removal did not affect the integrity of the scale. The rate of acceptance parameter was found to have potential as a short method to measure wanting in infants. ConclusionThe present study has demonstrated that the FIBFECS can be used to identify liking and wanting independent of subjective ratings from mothers and researchers, therefore, this tool can be used widely in the study of infant responses to novel foods at the time of weaning. There is potential to develop the tool for infants beyond the period of complementary feeding and to assist in identifying fussy eating in the early stages of development.

Reasons for Early or Late Initiation of Complementary Feeding: A Study in Pokhara

Complementary feeding is introduced into an infant’s diet at 6 months of age because at this age breast milk alone cannot adequately meet the child’s nutritional requirement for their optimal health. This study has been undertaken to assess mothers’ timely introduction of complementary feeding and to determine reasons for its early or delayed initiation. This was a cross sectional hospital based study conducted in Manipal Teaching Hospital, on 700 mothers from October 2013 to October 2014. Data was collected by face to face interview using a structured questionnaire. The mothers' understanding of the recommended time to start complementary feeding, and their actual practiced timing of complementary feeding was inquired. Where applicable, reason for early or late introduction to complementary feeding was determined. Out of the 700 mothers sampled, 544 (77.7%) knew that complementary feeding should be started at 6 months of age but only 359 (50%) were found to be practicing it. The most common cited reasons for early introduction of foods/liquids before the age of 6 months were as follows: “I did not have enough breast milk” (37.1%), “I had to return to my job” (15.1%), and “Relatives said that I should give my baby something other than breast milk” (8.3%). In order to improve infant feeding practices, there is a need for anticipatory guidance for the management of common breastfeeding difficulties. Also, considerations and strategies allowing more flexible working conditions such as improved maternity leave provisions may help mothers remain at home with their infants for longer, alleviating the need for early weaning.

Complementary Feeding and Childhood Adiposity in Preschool-Aged Children in a Large Chinese Cohort

To examine the association between the timing and type of complementary feeding and childhood adiposity in Mainland China. During 1999-2009, 97 424 singletons were enrolled in the Jiaxing Birth Cohort, a population-based prospective cohort study in Southeast China. Of these children, 43 848 children provided complementary diet information and other anthropometric measurements at 1, 3, and 6 months of age and were followed up until 4-5 years of age. Obesity and overweight were identified as body mass index (BMI)-for-age z-score (SD) ≥2 and between 1 and 2, respectively. Among 40 510 children in the statistical analysis, 3.18% were overweight and 64.8% were fed complementary food before 3 months of age. Early introduction of complementary foods was associated with greater BMI z-score (P-trend < .001) and higher risk of overweight (P-trend = .033). Compared with introduction of complementary foods between 4-6 months of age, before 3 months of age of introduction was associated with 11% greater risk of overweight (OR 1.11, 95% CI 1.03-1.19). No significant association between timing of complementary feeding and obesity was observed. Fish liver oil was the major type of complementary food associated with adiposity. Early introduction of fish liver oil was associated with greater BMI z-score (P < .001) and greater risk of overweight (P-trend = .004). Early introduction of fish liver oil is associated with greater childhood BMI and risk of overweight in Chinese children at 4-5 years of age.

Faktor risiko stunting pada anak umur 6-24 bulan di kecamatan Penanggalan kota Subulussalam provinsi Aceh

Background : Aceh is one of the province in Indonesia with high prevalence of stunting that is 39% compared withnational 35,6%. Subulussalam has a highly proportion of stunting.Objective : This study was aimed to analyze the risk factors for stunting among children between 6-24 months old.Methods : The design was case-control study, the subjects were children between 6-24 months with 55 stunted and 55normal. The subjects chosen by consecutive sampling. The risk factors were education levels and employment of parent,family income, suffering from diarrhea and URTI, energy and protein intake, height of the parent, birth weight,exclusive breastfeeding, the time of complementary feeding, parenting style and source of clean water. Data analysisusing the odds ratio with 95% confidence interval and regression analysis.Results : The risk factors for stunting were low income of family (OR=8,5, 95%CI: 2,68-26,89), suffering from diarrhea(OR=5,04, 95%CI: 1,84-13,81) and URTI (OR=5,71, 95%CI: 1,95-16,67), inadequate of energy (OR=3,09, 95%CI:1,02-9,39) and protein intake (OR=5,54, 95%CI: 2,43-12,63), short stature of the parent (OR=11,13, 95%CI: 4,37-28,3), low birth weight (OR=3,26, 95%CI: 1,46-7,31), not exclusively breastfeeding (OR=6,54, 95%CI: 2,84-15,06),giving complementary feeding too early (OR=6,54, 95%CI: 2,84-15,06), and poor parenting style of feeding practices(OR=4,59, 95%CI: 2,05-10,25), child hygiene practices (OR=3,26, 95%CI: 1,46-7,31) and treatment of childrenpractices (OR=2,46, 95%CI: 1,13-5,34). Regression analysis showed that the dominant risk factor for stunting wasshort stature of the parent (OR=13,16, 95%CI: 3,72-46,52).Conclusions : The dominant risk factor for stunting was short stature of the parent.

The influence of early feeding practices on healthy diet variety score among pre-school children in four European birth cohorts.

The present study examined whether maternal diet and early infant feeding experiences relating to being breast-fed and complementary feeding influence the range of healthy foods consumed in later childhood. Data from four European birth cohorts were studied. Healthy Plate Variety Score (HPVS) was calculated using FFQ. HPVS assesses the variety of healthy foods consumed within and across the five main food groups. The weighted numbers of servings consumed of each food group were summed; the maximum score was 5. Associations between infant feeding experiences, maternal diet and the HPVS were tested using generalized linear models and adjusted for appropriate confounders. The British Avon Longitudinal Study of Parents and Children (ALSPAC), the French Etude des Déterminants pre et postnatals de la santé et du développement de L'Enfant study (EDEN), the Portuguese Generation XXI Birth Cohort and the Greek EuroPrevall cohort. Pre-school children and their mothers. The mean HPVS for each of the cohorts ranged from 2.3 to 3.8, indicating that the majority of children were not eating a full variety of healthy foods. Never being breast-fed or being breast-fed for a short duration was associated with lower HPVS at 2, 3 and 4 years of age in all cohorts. There was no consistent association between the timing of complementary feeding and HPVS. Mother's HPVS was strongly positively associated with child's HPVS but did not greatly attenuate the relationship with breast-feeding duration. Results suggest that being breast-fed for a short duration is associated with pre-school children eating a lower variety of healthy foods.

The effectiveness of the WHO training course on complementary feeding counseling in a primary care setting, Ismailia, Egypt

The adequacy and timing of complementary feeding of the breastfed child are critical for optimal child growth and development.Considerable efforts have been made to improve complementary feeding in the first 2 years of life. One of them was the WHO complementary feeding counseling course (CFC). To evaluate the effectiveness of the WHO CFC on knowledge and counseling abilities of primary healthcare physicians; on caretaker's knowledge and adherence to physicians' recommendations and their feeding practices; and on children's growth. A single-blinded randomized-controlled study was carried out in 40 primary healthcare centers divided into matched pairs according to their location, either in rural or urban areas, and training of the selected physicians on integrated management of childhood illness. One center from each pair was selected randomly for its physician to receive CFC training in nutrition counseling and the matched center was selected as a control. Forty primary healthcare center physicians and 480 mother-child (6-18 months) pairs were included in the study. The mother-child pairs recruited were visited at home within 2 weeks, 90, and 180 days after the initial consultation with trained health workers. Special questionnaires were used to collect information on healthcare providers' knowledge of nutrition counseling and practice (counseling skills); maternal knowledge of basic nutrition-counseling recommendations, maternal compliance with the recommended feeding practice; child dietary intake; and gains in weight and length. CFC-trained physicians were more likely to engage in nutrition counseling and to deliver more appropriate advice. This was reflected in improvements in maternal recall of complementary feeding messages, which were higher in the intervention group compared with the control group. Six months after the consultation, children in the intervention group had significantly greater weight gains compared with the control group (0.96 vs. 0.78 kg; P=0.038). Children in the intervention group, who were 12-18 months of age at the time of recruitment, had significantly less faltering in length gain compared with the control group (height/age Z-score; 0.23 vs. 0.04; P=0.004). Nutrition counseling training improved counseling abilities of primary healthcare physicians and led to improvements in mothers' knowledge and practices of complementary feeding. In turn, this led to improved growth of children. We recommend wide and regular utilization of the CFC course to improve the knowledge and skills of health workers who provide counseling to mothers for complementary feeding.

Timing of complementary feeding and the risk of atopic eczema

To find out whether there was an association between when complementary feeding was introduced and the appearance of atopic eczema in children with a family history of allergy. This prospective study followed 256 mother and child pairs until the child was four-years-old. Repeated skin prick testing was performed and a clinical diagnosis of eczema made by a physician. The mothers kept a continuous diary about the introduction of complementary feeding. To control the possible reverse causation of delaying complementary food introduction due to presumed child allergy, parental suspicions of allergic reactions were recorded. The introduction of cereals and fish after seven-months-of-age was associated with an increased risk of atopic eczema. However, when the parents' suspicions that their child might be exhibiting symptoms of allergic disease were taken into account, this effect was no longer significant. We found no evidence that the timing of the introduction of complementary feeding increased the risk of atopic eczema in a high-risk cohort, when parental suspicions were taken into account. Therefore, it seems that families with a history of allergy can safely comply with current feeding recommendations, although confirmation in further studies is warranted.