Another look at cow milk in the second 6 months of life

Infant feeding practices and associated factors through the first 9 months of life in Bavaria, Germany

OBJECTIVES

To investigate infant feeding and breast-feeding practices during the first 9 months of life in Bavaria, Germany, in relation to recommendations and to identify factors associated with early feeding of semisolid food.

MATERIALS AND METHODS

Data from 3103 infants throughout Bavaria, Germany, were collected in a prospective cohort study. Questionnaires were administered at the age of 6 days, and 2, 4, 6, and 9 months.

RESULTS

There was a considerable variety concerning the time when complementary feeding was introduced. Only 16.4% of the infants ate solid/semisolid food before the age of 5 months. Most of the infants received as their first solid food a mash of vegetable, meat, and potato. Compared to national guidelines fluids were introduced early. More than 37% of the breast-fed infants received additional fluids/formula. The strongest risk factor associated with complementary feeding before the fifth month was breast-feeding duration of less than 4 months (any breast-feeding) with an odds ratio of 8.57 (95% confidence interval 6.16-11.94). Other factors were low level of education, young age of the mother, smoking habit of the mother, and mother not being born in Germany.

CONCLUSIONS

Further improvements in nutrition of infants may be achieved in 2 ways: promotion of breast-feeding according to current recommendations and better counselling on the correct timing of introduction of semisolid food-especially for parents of not- or short-time breast-fed babies and focused on young mothers with low levels of education.

Feeding practices of infants through the first year of life in Italy

AIM

To investigate infant feeding practices through the first year of life in Italy, and to identify factors associated with the duration of breastfeeding and early introduction of solid foods.

METHODS

Structured phone interviews on feeding practices were conducted with 2450 Italian-speaking mothers randomly selected among women who delivered a healthy-term singleton infant in November 1999 in Italy. Interviews were performed 30 d after delivery and when the infants were aged 3, 6, 9 and 12 mo. Type of breastfeeding was classified according to the WHO criteria.

RESULTS

Breastfeeding started in 91.1% of infants. At the age of 6 and 12 mo, respectively, 46.8% and 11.8% of the infants was still breastfed, 68.4% and 27.7% received formula, and 18.3% and 65.2% were given cow's milk. Solids were introduced at the mean age of 4.3 mo (range 1.6-6.5 mo). Introduction of solids occurred before age 3 and 4 mo in 5.6% and 34.2% of infants, respectively. The first solids introduced were fruit (73.1%) and cereals (63.9%). The main factors (negatively) associated with the duration of breastfeeding were pacifier use (p < 0.0001), early introduction of formula (p < 0.0001), lower mother's age (p < 0.01) and early introduction of solids (p = 0.05). Factors (negatively) associated with the introduction of solids foods before the age of 3 mo were mother not having breastfed (p < 0.01), early introduction of formula (p < 0.01), lower infant bodyweight at the age of 1 mo (p = 0.05) and mother smoking (p = 0.05).

CONCLUSION

The duration of breastfeeding in Italy is still inadequate, as well as compliance with international recommendations for timing of introduction of complementary foods. National guidelines, public messages and educational campaigns should be promoted in Italy.

Treatment of iron deficiency anemia and associated protein-losing enteropathy in children

PURPOSE

The aims of this study were to evaluate the response of oral iron treatment in children with iron deficiency anemia (IDA) fed whole cow's milk (WCM) or soy formula; to compare the incidence of fecal blood loss in infants fed WCM and soy formula; and to evaluate the incidence and relation of protein-losing enteropathy (PLE) and IDA by testing serum albumin, fecal blood loss, and fecal alpha1-antitrypsin (alpha1AT).

METHODS

Twenty-four children with nutritional IDA were randomly assigned to receive either 16 oz WCM or soy formula daily. Both groups were treated with daily therapeutic oral iron during 12 weeks. Stool specimens for hemoglobin losses were collected at weeks 0, 3, 6, and 12. Levels of serum albumin and fecal alpha1AT were tested at diagnosis and when IDA was corrected.

RESULTS

Anemia was corrected in 21 of the 24 children by week 6 or 12. Median fecal hemoglobin losses were not increased in either group at diagnosis or during treatment. Seven of 24 children had PLE at diagnosis with elevated fecal alpha1AT levels of 72 to 381 mg/dL that returned to normal after correction of IDA. Their initial fecal alpha1AT levels averaged 170 mg/ dL at diagnosis and 21 mg/dL after the IDA was corrected. Excessive WCM intake of 30 oz/day or more was present in 63% of the infants.

CONCLUSIONS

Treatment of nutritional IDA with oral iron was just as effective with a limited quantity of either WCM or soy formula. Fecal hemoglobin losses were uncommon and did not differ in children at diagnosis or during treatment of IDA. PLE associated with IDA resolves when the IDA is corrected, but differences between children fed WCM or soy formula could not be detected.

Filling the gap: weaning practices of children aged 0-2 years in western metropolitan Melbourne

OBJECTIVE

To investigate weaning practices of children aged 0-2 years in Melbourne's western metropolitan region (WMR).

METHODOLOGY

The study group comprised children aged 0-2 years attending six maternal and child health centres in the City of Brimbank in Melbourne's WMR. One hundred and nineteen parents were asked to complete a questionnaire about their child. Interpreters were used as required. In total, 115 questionnaires were completed representing a response rate of 97%. All maternal and child health nurses working in the target region were asked to complete a questionnaire. Of these, five were selected randomly to participate in follow-up indepth interviews. Weaning was defined as the addition of food/fluids other than breast milk or formula.

RESULTS

The mean age for the introduction of solids was 4.3 months. Of the children already introduced to solids, 67% had commenced between 4 and 6 months whilst 29% of the infants were taking solids by 3 months of age. Of the children already having juice, 85% had done so by the age of 6 months. The mean age for the introduction of cow's milk as the main drink was 10.7 months (S.D. 2.8). For English speaking families the mean age was 11.3 months (S.D. 1.8) whilst for families speaking languages other than English the mean age was 9.7 months (S.D. 4.1).

CONCLUSIONS

Most parents in this group were following the recommended guidelines for weaning. Some parents had poor knowledge of appropriate weaning time, use of fruit juice and introduction of cow's milk as the main drink. Additional information and education is required in these areas. Further investigation is required in relation to use of cow's milk and ethnicity.