Selected complementary feeding practices and their association with maternal education

Does Mother's Nutritional Knowledge Level Affect Anthropometric Measurements of 0-2 Year Old Infants?

The objective of this study was to investigate the relationship between maternal nutritional knowledge and anthropometric indices in children under 2 years of age. The Infant Nutrition Attitude Scale (IOWA) was administered to all participated mothers. The IOWA was developed to assess women's attitudes toward breastfeeding and their choice of infant feeding method. The IOWA score of mothers who fed their infants only formula and only complementary foods was found to be statistically significantly lower than the IOWA score of mothers who breastfed (p < .05). In summary, the higher the IOWA score, the longer the duration of breastfeeding. No statistically significant correlation was found between the IOWA and infants' anthropometric measurements (p > .05).

Factors associated with early childhood development: results from the Brazilian National Survey on Child Nutrition (ENANI-2019)

Introduction

The full achievement of early childhood development (ECD) is a human right and adhering to the nurturing care framework may facilitate it.

Objective

To evaluate the association between distal and proximal variables and developmental quotient (DQ).

Methods

Data from 14 159 children <5 years were evaluated in the Brazilian National Survey on Child Nutrition. The Survey of Well-being of Young Children-Brazilian version milestones questionnaire was used to evaluate ECD. The developmental age was estimated using the graded response models. DQ was calculated by dividing developmental age by chronological age. The expected age milestones are attained when DQ=1. DQ predictors were defined considering distal and proximal levels/variables using a multiple linear regression model and a hierarchical approach.

Results

The DQ mean was significantly lower among children aged 36-59 months (0.91 (0.88 to 0.93)), boys (1.03 (1.01 to 1.06)) and those from the North region (0.98 (0.93 to 1.04)) compared with children aged 1-35 months (1.18 (1.15 to 1.22)), girls (1.11 (1.08 to 1.13)) and from the Southeast region (1.11 (1.07 to 1.16)). For children aged 1-35 months, DQ was inversely associated with emergency C-section (β=-0.08; p<0.01), consumption of ultra-processed food (β=-0.33; p<0.01), and positively associated with attendance at daycare/school (private: β=0.09; p=0.02 and No: β=0.12; p<0.01). For children aged 36-59 months, attendance to private daycare/school (β=0.08; p<0.01) was positively associated with DQ, and small for gestational age at birth (β=-0.05; p=0.01) and access to public health services (no-primary care) (β=-0.07; p<0.01) were inversely associated with DQ.

Conclusions

Adverse health, nutrition and learning factors predicted the ECD, demonstrating an inequitable environment for Brazilian children. These findings indicate a need for public policies to ensure social and health equity in early childhood.

Effectiveness of Relactation Supportive Program in Sustaining Exclusive Breastfeeding: A Prospective Observational Study

INTRODUCTION

Relactation is the process of re-establishing breastfeeding after stopping or after a period of little breastfeeding. The study aimed to assess the Relactation Supportive Program (RSP)'s efficacy in sustaining breastfeeding and to determine the impact of RSP on breastfeeding initiation, timing, and correlation with the lactation gap.

METHODS

 A prospective observational study was done with 60 infant-mother dyads, aged seven days to 14 weeks who stopped breastfeeding for 6-28 days or never breastfed. Mothers in the RSP group received hands-on guidance on techniques like supplemental feeding methods and nipple stimulation, alongside psychological and emotional support. In the Routine Counseling (RC) group, mothers received counseling about the benefits of breastfeeding, breast milk expression, correct attachment, and motivation for breastfeeding.

RESULTS

In the RSP group, 21 infants achieved and sustained exclusive breastfeeding by six months (p=0.003), compared to 10 in the RC group. RSP initiated lactation earlier (10.04±4.02 days, p=0.002) than the RC group (13.43±3.59 days). Relactation duration was inversely correlated with the lactation gap.

CONCLUSION

RSP significantly promoted earlier and sustained relactation compared to RC alone.

Prevalence and predictors of minimum acceptable diet (MAD) feeding among tribal children aged 6-23 months in India

Minimum acceptable diet (MAD) that combines minimum dietary diversity (MDD) and minimum meal frequency (MMF) is one of the eight core indicators for assessing infant and young child feeding (IYCF) practices for children aged 6-23 months. With low MAD, young children and infants are more susceptible to undernutrition. The study assesses the prevalence and predictors of MAD among tribal children aged 6-23 months in India. Descriptive, bivariate, and multivariate analyzes were performed on data from 6326 tribal children of the National Family Health Survey (2019-21). Stata was used for the analyzes, with a 5% significance level. Only 12% of tribal children were fed with a MAD, while 24% had MDD and 34% MMF. Children aged 18-23 months had a three times higher chance of MAD than their 6-8 months counterparts. Children receiving Integrated Child Development Services (ICDS), children of mothers with ten or more years of schooling, children whose mothers were exposed to mass media, and whose mothers had 4+ antenatal care visits in their last pregnancy had a higher likelihood of MAD. The study concludes that MAD among tribal children aged 6-23 months is unsatisfactory and varies significantly by socio-demographic characteristics, suggesting targeted intervention.

Infant Obesity Prevention Programs for Underrepresented Mothers in a Home Visiting Program: A Qualitative and Community-Engaged Needs Assessment

A qualitative, community-engaged assessment was conducted to identify needs and priorities for infant obesity prevention programs among mothers participating in home visiting programs. Thirty-two stakeholders (i.e., community partners, mothers, home visitors) affiliated with a home visiting program serving low-income families during the prenatal to age three period participated in group level assessment sessions or individual qualitative interviews. Results indicated families face many challenges to obesity prevention particularly in terms of healthy eating. An obesity prevention program can address these challenges by offering realistic feeding options and non-judgmental peer support, improving access to resources, and tailoring program content to individual family needs and preferences. Informational needs, family factors in healthy eating outcomes, and the importance of access and awareness of programs were also noted. To ensure the cultural- and contextual-relevance of infant obesity prevention programs for underserved populations, needs and preferences among community stakeholders and the focal population should be used as a roadmap for intervention development.

Complementary Feeding: Tradition, Innovation and Pitfalls

According to WHO, "complementary feeding (CF) is the process starting when breast milk alone or infant formula alone is no longer sufficient to meet the nutritional requirements of infants, and therefore, other foods and liquids are needed, along with breast human milk or a breastmilk substitute". CF is one of the most important "critical and sensitive periods" in human life: indeed, timing and approaches to solid foods introduction in an infant's nutrition are of utmost importance as potential epigenetic factors from infancy to adulthood. CF is also deeply influenced by each country and single-family traditions, culture, and beliefs. The aim of our narrative review is to analyze traditional CF practices, including innovative and alternative ones that emerged in the last decades, such as baby-led weaning or plant-based weaning, and to evaluate their effects on the risk of developing non-communicable diseases. Moreover, we will discuss pitfalls and misunderstandings that pediatricians frequently have to face when dealing with complementary feeding. Health care professionals must not have prejudices against parents' wishes or traditions about CF; rather, they should support and educate them in case of any alternative CF choice, always pursuing the infant's adequate growth, neuro- and taste development, and the achievement of correct eating behavior as the primary goal.

Risk Factors of Language Delay at Two Years of Corrected Age among Very-Low-Birth-Weight Preterm Infants: A Population-Based Study

Language delays are often underestimated in very-low-birth-weight (VLBW) preterm infants. We aimed to identify the risk factors of language delay at two years of corrected age in this vulnerable population. VLBW infants, who were assessed at two years of corrected age using the Bayley Scale of Infant Development, third edition, were included using a population-based cohort database. Language delay was defined as mild to moderate if the composite score was between 70 and 85 and severe if the score was < 70. Multivariable logistic regression analysis was used to identify the perinatal risk factors associated with language delay. The study comprised 3797 VLBW preterm infants; 678 (18%) had a mild to moderate delay and 235 (6%) had a severe delay. After adjusting for confounding factors, low maternal education level, low maternal socioeconomic status, extremely low birth weight, male sex, and severe intraventricular hemorrhage (IVH) and/or cystic periventricular leukomalacia (PVL) were found to be significantly associated with both mild to moderate and severe delays. Resuscitation at delivery, necrotizing enterocolitis, and patent ductus arteriosus requiring ligation showed significant associations with severe delay. The strongest factors predicting both mild to moderate and severe language delays were the male sex and severe IVH and/or cystic PVL; thus, early targeted intervention is warranted in these populations.

Trends in Complementary Feeding Indicators and Intake from Specific Food Groups among Children Aged 6-23 Months in Bangladesh

The present study aims to comprehensively analyse trends in complementary feeding indicators (Introduction of solid, semi-solid, and soft foods at 6–8 months (INTRO), Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF) and Minimum Acceptable Diet (MAD)) among children aged 6–23 months in Bangladesh. The study used data from four rounds (2007, 2011, 2014, and 2017–2018) of nationally representative Bangladesh Demographic and Health Surveys (BDHSs). The Cochran–Armitage test was performed to capture the trends in complementary feeding practices and intake from specific food groups. BDHSs are periodically conducted cross-sectional surveys in all seven administrative divisions of Bangladesh. The present analysis was performed among 8116 children (1563 in 2007, 2137 in 2011, 2249 in 2014, and 2167 in 2017–2018) aged 6–23 months. Overall, a decreasing trend was observed in all the complementary feeding indicators except INTRO from 2007 to 2014, but a substantial increase in MDD, MMF and MAD was noted in 2017–2018. A statistically significant reduction in consumption from different food groups such as legumes and nuts (p < 0.001), dairy products (p = 0.001), vitamin-A-rich fruits or vegetables (p < 0.001), and other fruits and vegetables (p < 0.001) was also observed. However, a positive trend was noted in the consumption of grains/roots/tubers (p = 0.027), and meat/fish/egg (p < 0.001). After experiencing a significant decreasing trend during 2007–2014, the recent BDHS indicates improvements in all complementary feeding indicators among young children in Bangladesh, which calls for integrated, multisectoral, and multicomponent interventions to sustain this progress.

Predictors of Age at Juice Introduction and Associations with Subsequent Beverage Intake in Early and Middle Childhood

BACKGROUND

The American Academy of Pediatrics recommends that if parents choose to introduce juice, they wait until ≥12 months, citing concerns of obesity and dental caries.

OBJECTIVES

We sought to identify correlates of early juice introduction (<6 months) and determine whether early introduction establishes a pattern of sugary beverage intake in childhood.

METHODS

Upstate KIDS is a prospective birth cohort study with follow-up through 7 years (n = 4989). The age of juice introduction was assessed from responses on periodic questionnaires from 4-18 months and categorized as <6,  6 to <12, and ≥12 months. Sociodemographic information was reported using vital records or maternal questionnaires. At 24, 30, and 36 months and 7 years, mothers reported their child's regular juice, soda, water, and milk intakes. The analysis was restricted to singletons and 1 randomly selected twin from each pair with information on juice introduction (n = 4067). We assessed associations of sociodemographic correlates with juice introduction using Cox proportional hazard models. The relations of juice introduction with beverage intake were evaluated using Poisson or logistic regression for adjusted risk ratios (aRR) or ORs, adjusting for sociodemographic covariates and total beverage intake.

RESULTS

Of the mothers, 25% and 74% introduced juice prior to 6 and 12 months, respectively. Younger maternal age; black or Hispanic race/ethnicity; lower educational attainment; Special Supplemental Nutrition Program for Women, Infants, and Children participation (yes); smoking during pregnancy; a higher pre-pregnancy BMI; a lower household income; and living in a townhouse/condominium or mobile home were associated with earlier juice introduction. Earlier juice introduction was related to a higher childhood juice intake, any soda intake, and lower water intake, holding total beverage intake constant [aRR, 1.5 (95% CI: 1.3-1.7; P-trend < 0.0001); adjusted OR 1.6 (95% CI: 1.0-2.4; P-trend = 0.01); aRR 0.9 (95% CI: 0.8-0.9; P-trend < 0.0001), respectively].

CONCLUSIONS

Markers of lower socioeconomic status are strongly associated with earlier juice introduction, which, in turn, relates to sugary beverage intake in childhood, potentially replacing water.

Urban-Rural Disparities in the Magnitude and Determinants of Stunting among Children under Five in Tanzania: Based on Tanzania Demographic and Health Surveys 1991-2016

Our study aims to examine the disparity of under-5 child stunting prevalence between urban and rural areas of Tanzania in the past three decades, and to explore factors affecting the rural–urban disparity. Secondary analyses of Tanzania Demographic and Health Surveys (TDHS) data drawn from 1991–1992, 1996, 1999, 2004–2005, 2009–2010, and 2015–2016 surveys were conducted. Under-5 child stunting prevalence was calculated separately for rural and urban children and its decline trends were examined by chi-square tests. Descriptive analyses were used to present the individual-level, household-level, and societal-level characteristics of children, while multivariable logistic regression analyses were performed to examine determinants of stunting in rural and urban areas, respectively. Additive interaction effects were estimated between residence and other covariates. The results showed that total stunting prevalence was declining in Tanzania, but urban–rural disparity has widened since the decline was slower in the rural area. No interaction effect existed between residence and other determinants, and the urban–rural disparity was mainly caused by the discrepancy of the individual-level and household-level factors between rural and urban households. As various types of determinants exist, multisector nutritional intervention strategies are required to address the child stunting problem. Meanwhile, the intervention should focus on targeting vulnerable children, rather than implementing different policies in rural and urban areas.

Complementary Feeding Practices and Parental Pressure to Eat among Spanish Infants and Toddlers: A Cross-Sectional Study

The introduction of complementary foods is a crucial stage in the development and determination of infants’ health status in both the short and longer-term. This study describes complementary feeding practices among infants and toddlers in Spain. Also, relationships among sample characteristics (both parents and their child), feeding practices (timing, type of complementary food), and parental pressure to eat were explored. Cognitive interviewing with 18 parents was used to refine the survey questions. Responses from a national random sample of 630 parents, who were responsible for feeding their infants and toddlers aged 3–18 months, were obtained. Solids, often cereals and/or fruits first, were introduced at a median age of five months. Fish and eggs were introduced around the age of nine and ten months. Almost all children were fed with home-prepared foods at least once per week (93%), and in 36% of the cases, salt was added. Interestingly, higher levels of parental pressure to eat were found in female infants, younger parents, parents with a full-time job, the southern regions of Spain, and in infants who were not fed with home-prepared foods. Our insights underline the importance of clear feeding recommendations that can support health care professionals in promoting effective strategies to improve parental feeding practices.

Perceptions About Lactation Consultant Support, Breastfeeding Experiences and Postpartum Psychosocial Outcomes

INTRODUCTION

Many women seek lactation consultant support in the postpartum period. Lactation consultant support in community or clinical settings is often assumed to extend breastfeeding duration, improve breastfeeding experiences, and be well-received. Few studies have assessed women's perceptions of the support they received, nor have perceptions been examined in relationship to breastfeeding outcomes and maternal well-being. Our objective was to characterize the lactation consultant support women received and examine how women's perceptions about the support related to their breastfeeding outcomes, anxiety and depressive symptoms, and parenting stress.

METHODS

This observational, cross-sectional study examined receipt of postpartum lactation consultant support among 210 US women. Perceptions of lactation consultant support were examined in relation to breastfeeding outcomes, anxiety and depressive symptoms, and parenting stress to explore outcomes of negative versus positive lactation consultant support experiences, using linear and proportional hazards regression.

RESULTS

While overall perceptions of lactation consultant support were positive for most recipients (71%, n = 98), 29% (n = 40) reported negative perceptions of lactation consultant support. Negative perceptions were associated with lower breastfeeding self-efficacy (β =  - 11.7, 95% CI - 17.3, - 6.0), a less successful breastfeeding experience (β =  - 19.5, CI - 27.8, - 11.3), greater general anxiety (β = 6.5, CI 2.1, 10.9), and shorter total duration of milk production (HR = 0.39, 95% CI 0.18, 0.84). Perceptions were not associated with depressive symptoms or parenting stress.

DISCUSSION

Findings highlight the importance of ensuring that postpartum breastfeeding support provided by lactation consultants is perceived as positive by women.

Breastfeeding practices and complementary feeding in Ecuador: implications for localized policy applications and promotion of breastfeeding: a pooled analysis

Background

Best practices in breastfeeding are often not followed despite appropriate levels of knowledge and positive attitudes regarding the benefits of human milk. For many reasons, some women do not initiate breastfeeding, suspend breastfeeding early, or initiate complementary feeding earlier than recommended. Usual measurement methods use large sample surveys at a national scale, which are not well suited for monitoring sub-national differences.

Methods

In order to understand how local infant feeding practices could influence policy and promotion practices, we apply data pooling methodology to analyse breastfeeding patterns in different Ecuadorian settings: Cumbayá parish, located near Quito, the Ecuadorian capital; the city of Macas and rural surroundings in the Amazon basin province of Morona Santiago; and the province of Galapagos. Surveys were conducted independently between August 2017 and August 2018; while they are representative of each respective setting, sampling designs and survey methods differ, but the same demographic information and data based on standard breastfeeding indicators established by the World Health Organization (WHO) were collected. In order to account for differences in the different settings, the design effect of each survey was considered in the analysis.

Results

Significant differences were found in breastfeeding practices between the suburban Cumbayá parish near Quito and Galapagos on one hand, and urban and rural parts of Morona Santiago, on the other. The rates of early breastfeeding initiation and age-appropriate breastfeeding are significantly higher in urban and rural Morona Santiago then in Cumbayá or Galapagos, while the rate of exclusive breastfeeding is highest in rural parts of Morona Santiago. No significant differences were found in complementary feeding practices between Cumbayá and Galapagos, but there are with urban and rural Morona Santiago. Initiation of breastfeeding in the first hour after birth occurs in only 36.2% of cases in Cumbayá but in 75.4% of cases in urban Morona.

Conclusions

Differences among regions reflect specific opportunities and barriers to practices related to promoting optimal infant health and nutrition. Consequently, regional or local conditions that often are not apparent in national-level data should orient policies and promotion activities in specific populations.

The Use of Added Salt and Sugar in the Diet of Polish and Austrian Toddlers. Associated Factors and Dietary Patterns, Feeding and Maternal Practices

Children aged <2 years should not be given meals with the addition of salt and sugar due to health risks and to promote healthier dietary habits. The aims of this study were: to assess the prevalence of the use of added salt (AS), sugar (ASu) and both salt and sugar (AS&Su) in the diets of Polish and Austrian toddlers aged 12-24 and 25-36 months; to explore the sociodemographic and early nutritional factors associated with the use of AS and ASu; to investigate the difference in dietary habits and maternal concerns about toddlers' eating regarding the use of AS and ASu in toddlers' diet. This cross-sectional anonymous study was conducted in 5893 mothers of children aged 12-36 months, recruited through social media in 2017-2019. The questionnaire consisted of questions about sociodemographics, early feeding practices and current children's nutrition (e.g., use of AS and ASu, food frequency questionnaire). Multivariate logistic regression and cluster analyses were applied. Austrian mothers more often used AS than mothers from Poland (at 2 years old: 74.8% vs. 52.8%; at 3 years old 87.4% vs. 74.4%, p ≤ 0.001), however Polish mothers were more prone to use ASu (at 2 years old: 34.7% vs. 27.7%; at 3 years old: 59.0% vs. 45.8%, p ≤ 0.001). In younger toddlers (12-24 months), the odds of using of AS, ASu, and AS&Su increased with toddlers' age, when the mother was a multipara, was not currently breastfeeding, or had exclusively breastfed for 4-5 months. This risk decreased when older toddlers (25-36 months) were introduced to solids by baby-led weaning (BLW). Toddlers from both countries who consumed meals with AS or ASu more often a followed Western-like dietary pattern. Our study emphasizes the need for parental nutritional education when beginning to introduce solid foods.

Maternal depression is associated with child undernutrition: A cross-sectional study in Ethiopia

Child undernutrition is widespread in low- and middle-income countries (LMIC) and is associated with health and economic losses. Undernutrition is estimated to contribute to 3.1 million deaths per year in children less than 5 years of age. A complex causal and contextual factors contributing to child undernutrition have been assessed, but maternal depression, which could contribute to child undernutrition by interfering with the mother's child caring practice and ability, has been received little attention. The objective of this study was to assess the association between maternal postpartum depression symptoms and infant (5-10 months of age) stunting in northern Ethiopia. A community-based cross-sectional study was conducted among mother-infant pairs (n = 232) between March and April 2018. Through interviewer-administrated questionnaire, information on sociodemographic variables were collected, and maternal depression symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS≥13). Infants' length and weight were measured and converted to length and weight for age Z scores using the WHO growth standards. Breastfeeding was a norm, but the adequacy of complementary feeding practice was sub-optimal. Only 25% of the infants met the minimum meal frequency (MMF), less than 10% met the minimum dietary diversity (MMD; 9%) or minimum acceptable diet (7%). Maternal depression was prevalent (22.8%) and was significantly associated with inappropriate complementary feeding and stunting (P < .05). Improving complementary feeding practices is central to preventing stunting in this and other settings. However, such efforts should integrate interventions that address maternal depression to improve child feeding and caring practices to effectively prevent stunting.

Trends and factors associated with complementary feeding practices in Ethiopia from 2005 to 2016

Introducing appropriate complementary feeding at 6 months of age is crucial for the optimal growth and development of an infant. In Ethiopia, however, no previous national‐level studies have examined the trends and associated factors of complementary feeding practices. The aim of this study is to investigate the trends and determinants of complementary feeding practices in Ethiopia from 2005 to 2016. The study was conducted using the Ethiopia Demographic and Health Survey (EDHS) data for 2005 (N = 2,520), 2011 (N = 2,850), and 2016 (N = 2,864). Percentage point changes in complementary feeding indicators were estimated to examine the trends over the EDHS years. Multivariate logistic regression was used to examine the association between socioeconomic, demographic, health service, and community‐level factors and (a) the introduction of complementary foods, (b) minimum dietary diversity (MDD), (c) minimum meal frequency (MMF), and (d) minimum acceptable diet (MAD). The proportion of mothers who met MDD increased from 6.3% to 13.5% (p < .001), and MAD increased from 4.1% to 7.1% (p = .003) from 2005 to 2016. Improvements in the introduction of complementary foods (from 50.3% to 59.5%, p = .051) and MMF (from 41.3% to 43.6%, p = .288) were not statistically significant. Maternal education and occupation were associated with the introduction of complementary foods, MDD, MMF, and MAD. Higher partner education and frequent antenatal visits were associated with MDD and MAD. Children whose mothers listened to the radio had higher odds of MDD, MMF, and MAD. Our analysis of the EDHS suggests that the proportion of MDD and MAD were unacceptably low. Interventions aiming to improve complementary feeding practices in Ethiopia should also target mothers with low education, antenatal service usage, and media exposure.

Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries

OBJECTIVE

To determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs).

DESIGN

Meta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data.

DATA SOURCES

We searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study.

ANALYSES

Linear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses.

RESULTS

We retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (-0.24 to -0.05) and 0.23 SD (-0.42 to -0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from -0.18 to -0.10 SDs.

CONCLUSIONS

Differential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children.

Maternal predictors of infant beverage consumption: results from the Nurture cohort study

OBJECTIVE

The goal of the present study was to estimate prevalence and maternal risk factors for infant beverage consumption.

DESIGN

Observational birth cohort.

SETTING

Central North Carolina, USA.

PARTICIPANTS

Mothers 20-36 weeks pregnant were surveyed every 3 months through their infant's first year (n 666) on their sociodemographics and infant's consumption frequency of 100 % fruit and vegetable juices and sugar-sweetened-beverages (SSB). Repeated-measure models, using a compound symmetry covariance structure, were used to assess the association of sociodemographic and maternal predictors with introducing juice and SSB separately and explored interaction terms with time to determine how the effects of the predictors change over time.

RESULTS

On average, mothers were 28 years old, 72 % were non-Hispanic Black and 59 % were low-income. We found time by race, income, education, maternal age and breast-feeding duration interactions for both juice and SSB consumption. At approximately 6-7 months of age through 12 months of age, being Black, having a lower income (≤$US 20 000 v. >$US 20 000 per year) and education (less than high-school degree v. high-school degree or higher), being younger (<26 years v. ≥26 years) and breast-feeding for fewer than 26 weeks were each associated with introduction of both juice and SSB consumption.

CONCLUSIONS

Future efforts are needed to raise awareness on the importance of national recommendations of limiting juice and SSB for infants, together with decreasing disparities in unhealthy beverage intake early in life.

Contribution of commercial infant products and fortified staple foods to nutrient intake at ages 6, 12, and 18 months in a cohort of children from a low socio-economic community in South Africa

Fortification of two staple foods, maize meal and wheat flour (bread), is mandatory, and commercial infant products are widely available in South Africa. Using a 24-hr recall, we determined the contribution of these foods towards nutrient intakes at ages 6 (n = 715), 12 (n = 446), and 18 (n = 213) months in a cohort of children in a peri-urban community, North West province. On the day of recall, commercial infant products were consumed by 83% of children at 6 months, 46% at 12 months, and 15% at 18 months; fortified staples were consumed by 23%, 81%, and 96%, respectively. For consumers thereof, commercial infant products contributed 33% energy and 94% iron intakes at 6 months and 27% energy and 56% iron intakes at 12 months; nutrient densities of the complementary diet was higher than for nonconsumers for most micronutrients. For consumers of fortified staples, energy contribution thereof was 11% at 6 months versus 29% at 18 months; at 18 months, fortified staples contributed >30% of iron, zinc, vitamin A, thiamine, niacin, vitamin B6, and folate; at 12 months, nutrient densities of the complementary diet were higher for zinc, folate, and vitamin B6 but lower for calcium, iron, vitamin A, niacin, and vitamin C than nonconsumers. At ages 12 and 18 months, ~75% of children had low calcium intakes. At 12 months, 51.4% of consumers versus 25.0% (P = 0.005) of nonconsumers of fortified staples had adequate intakes (>EAR) for all eight fortificant nutrients. However, despite fortification, nutrient gaps remain.

The Early Introduction of Complementary (Solid) Foods: A Prospective Cohort Study of Infants in Chengdu, China

The objective of this study was to document the types of foods introduced to infants before six months of age and identify factors associated with their early introduction. A prospective cohort study of infant feeding for the first six months after birth was undertaken in the city of Chengdu, PR China. The participants were 845 mothers who delivered their infants in hospitals in Chengdu. Mothers were interviewed within 15 days of giving birth and were followed up with for six months. The outcome measures were the introduction of complementary foods to infants within four and six months postpartum. Complementary foods are defined as any food, whether manufactured or locally prepared, used as a complement to breast milk or infant formula. In this study the emphasis was on solids and not liquid foods. More than 94% of the infants were given complementary foods (semi-solid or solid foods) before the age of six months and 10% by four months. The most commonly introduced food was infant cereal, which was given to three quarters of the infants by six months. Multivariate analysis showed that maternal education level was a significant factor affecting the introduction of complementary foods before four months, adjusted odds ratio 2.983 (1.232–7.219), with the more educated mothers introducing complementary foods earlier. More antenatal and postnatal health promotion efforts are required to highlight the benefits of introducing solid foods later than is the current practice in Chengdu, at or close to six months of age. Further education is also required for training health professionals including pediatricians, midwives, and community health staff.

Prospective associations of age at complementary feeding and exclusive breastfeeding duration with body mass index at 5-6 years within different risk groups

BACKGROUND

Children with overweight or obesity are at risk for developing obesity in adulthood. Certain maternal characteristics, such as ethnicity, education, body mass index (BMI) or neighbourhood, are determinants for childhood overweight risk. There are large variations in how mothers differing in these characteristics feed their infants. Therefore, associations of age at complementary feeding, exclusive breast feeding duration with childhood overweight may differ in these groups. Understanding these associations would be essential to develop overweight prevention strategies.

OBJECTIVES

The objective of this study is to study the associations of age at complementary feeding, exclusive breastfeeding duration with BMI-standard deviation score (SDS) at 5-6 years within risk groups.

METHODS

Using data from the Amsterdam Born Children and their Development study, a population-based birth cohort (n = 4495), we formed groups of children at varying risk of overweight according to maternal characteristics of ethnicity, education, pre-pregnancy BMI and neighbourhood. Linear and logistic regression analyses were conducted.

RESULTS

Complementary feeding after 5 months of age was associated with lower BMI-SDS in children of mothers of Dutch ethnicity (B: -0.12; 95% CI: -0.21, -0.04), medium-level education (-0.19; -0.30, -0.08), normal BMI (-0.08; -0.16, -0.01) and high-risk neighbourhood (-0.16; -0.29, -0.02). Compared with exclusive breastfeeding for <3 months, exclusive breastfeeding for ≥6 months was associated with lower BMI-SDS in groups of medium-level education (-0.28; 0.44, -0.11), normal BMI (-0.18; -0.29, -0.08) and medium-risk (-0.18; -0.33, -0.04) and high-risk (-0.22; -0.42, -0.02) neighbourhoods.

CONCLUSIONS

Associations between infant feeding practices and childhood BMI may differ between risk groups, implying that overweight prevention strategies should be group-specific.

Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under

BACKGROUND

Although complementary feeding is a universal practice, the methods and manner in which it is practiced vary between cultures, individuals and socioeconomic classes. The period of complementary feeding is a critical time of transition in the life of an infant, and inappropriate complementary feeding practices, with their associated adverse health consequences, remain a significant global public health problem. Educational interventions are widely acknowledged as effective in promoting public health strategy, and those aimed at improving complementary feeding practices provide information about proper complementary feeding practices to caregivers of infants/children. It is therefore important to summarise evidence on the effectiveness of educational interventions to improve the complementary feeding practices of caregivers of infants.

OBJECTIVES

To assess the effectiveness of educational interventions for improving the complementary feeding (weaning) practices of primary caregivers of children of complementary feeding age, and related health and growth outcomes in infants.

SEARCH METHODS

In November 2017, we searched CENTRAL, MEDLINE, Embase, 10 other databases and two trials registers. We also searched the reference lists of relevant studies and reviews to identify any additional studies. We did not limit the searches by date, language or publication status.

SELECTION CRITERIA

Randomised controlled trials (RCTs), comparing educational interventions to no intervention, usual practice, or educational interventions provided in conjunction with another intervention, so long as the educational intervention was only available in the experimental group and the adjunctive intervention was available to the control group. Study participants included caregivers of infants aged 4 to 24 months undergoing complementary feeding. Pregnant women who were expected to give birth and commence complementary feeding during the period of the study were also included.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data on participants, settings, interventions, methodology and outcomes using a specifically-developed and piloted data extraction form. We calculated risk ratios (RR) and 95% confidence intervals (CIs) for dichotomous data, and mean differences (MD) and 95% CIs for continuous data. Where data permitted, we conducted a meta-analysis using a random-effects model. We assessed the included studies for risk of bias and also assessed the quality of evidence using the GRADE approach.

MAIN RESULTS

We included 23 studies (from 35 reports) with a total of 11,170 caregiver-infant pairs who were randomly assigned to receive an educational intervention delivered to the caregiver or usual care. Nineteen of the included studies were community-based studies while four were facility-based studies. In addition, 13 of the included studies were cluster-randomised while the others were individually randomised. Generally, the interventions were focused on the introduction of complementary feeding at the appropriate time, the types and amount of complementary foods to be fed to infants, and hygiene. Using the GRADE criteria, we assessed the quality of the evidence as moderate, mostly due to inadequate allocation concealment and insufficient blinding.Educational interventions led to improvements in complementary feeding practices for age at introduction of complementary foods (average RR 0.88, 95% CI 0.83 to 0.94; 4 studies, 1738 children; moderate-quality evidence) and hygiene practices (average RR 1.38, 95% CI 1.23 to 1.55; 4 studies, 2029 participants; moderate-quality evidence). For duration of exclusive breastfeeding, pooled results were compatible with both a reduction and an increase in the outcome (average RR 1.58, 95% CI 0.77 to 3.22; 3 studies, 1544 children; very low-quality evidence). There was limited (low to very low-quality) evidence of an effect for all growth outcomes.Quality of evidenceThere is moderate to very low-quality evidence that educational interventions can improve complementary feeding practices but insufficient evidence to conclude that it impacts growth outcomes.

AUTHORS' CONCLUSIONS

Overall, we found evidence that education improves complementary feeding practices.

Intimate partner violence and breastfeeding practices: a systematic review of observational studies

OBJECTIVE

To review the association between intimate partner violence and breastfeeding practices in the literature.

DATA SOURCES

The search was carried out in five databases, including MEDLINE, LILACS, SCOPUS, PsycoINFO, and Science Direct. The search strategy was carried out in February 2017. The authors included original studies with observational design, which investigated forms of intimate partner violence (including emotional, physical, and/or sexual) and breastfeeding practices. The quality of the studies was assessed based on the bias susceptibility through criteria specifically developed for this review.

SUMMARY OF DATA

The study included 12 original articles (10 cross-sectional, one case-control, and one cohort study) carried out in different countries. The forms of intimate partner violence observed were emotional, physical, and/or sexual. Breastfeeding was investigated by different tools and only assessed children between 2 days and 6 months of life. Of the 12 studies included in this review, eight found a lower breastfeeding intention, breastfeeding initiation, and exclusive breastfeeding during the first six months of the child's life, and a higher likelihood of early termination of exclusive breastfeeding among women living at home where violence was present. The quality varied between the studies and six were classified as having low bias susceptibility based on the assessed items.

CONCLUSIONS

Intimate partner violence is associated with inadequate breastfeeding practices of children aged 2 days to 6 months of life.

Responsive Feeding-Play (Resfeed-Play) Intervention on Children Aged 6-24 Months with Malnutrition

Introduction: Toddlers are at risk to health problems, one of which is malnutrition. One of the important determinants to toddlers’ growth is nutrition. Giving solid foods to toddlers can be done by active/responsive feeding combined with the method that best suits the stage of playing toddlers. This paper aimed to provide an overview of the intervention of Resfeed-Play as a form of community nursing intervention on 32 children aged 6-24 months with malnutrition. Implementation of the intervention Resfeed-Play was performed in families and in society in nutrition support activities.Methods: The method was quasi-experimental with one group pre-post-test design. The inclusion sample criterion was family with toddlers who suffered from malnutrition.Results: The results of evaluation of Resfeed-Play shows an increase in knowledge (24.2%), attitude and skills by 30.3% and 42.4%, respectively. After intervention of six months, the mean weight gain for toddler was 0.95Kg. Based on paired sample t-test, the weight gain is significant with a P value of 0.001 (P <0.05). Resfeed-Play intervention can increase body weight in toddlers and can address the problems of malnutrition in children under five.Conclusion: Based on the results of this study, Resfeed-Play intervention is recommended to increase community empowerment through positive activities such as post-activity nutrition in order to prevent and mitigate the problem of malnutrition in toddlers.

Introduction of inappropriate complementary feeding in the first year of life and associated factors in children with low socioeconomic status

The study aimed to identify factors associated with the introduction of inappropriate complementary feeding in the first year of life in children living in municipalities (counties) with low socioeconomic statusl. This was a cross-sectional multicenter study in 1,567 children 12 to 59 months of age in 48 municipalities participating in the Brazil Without Poverty plan in the South of Brazil. A structured questionnaire was applied to the children's parents to obtain socio-demographic information and the age at which inappropriate complementary foods were introduced for the first time in complementary feeding. Prevalence of introduction of sugar before four months of age was 35.5% (n = 497; 95%CI: 33.1-38.0). The prevalence rates for the introduction of cookies/crackers, creamy yogurt, and jelly before six months of age were 20.4% (n = 287; 95%CI: 18.3-22.3), 24.8% (n = 349; 95%CI: 22.4-27.1), and 13.8% (n = 192; 95%CI: 12.0-15.7), respectively. Associations were identified between low maternal schooling (PR = 1.25; 95%CI: 1.03-1.51) and low monthly family income (PR = 1.22; CI95%: 1.01-1.48) and the introduction of inappropriate complementary feeding. The study identified the introduction of inappropriate complementary feeding in the first year of life among children in municipalities with high socioeconomic vulnerability in the South of Brazil, associated with low maternal schooling and low monthly family income.

Use of infant formula in the ELFE study: The association with social and health-related factors

Breastfeeding is recommended until 6 months of age, but a wide range of infant formula is available for nonbreastfed or partially breastfed infants. Our aim was to describe infant formula selection and to examine social- and health-related factors associated with this selection. Analyses were based on 13,291 infants from the French national birth cohort Etude Longitudinale Française depuis l'Enfance. Infant diet was assessed at Month 2 by phone interview and monthly from Months 3 to 10 via internet/paper questionnaires. Infant formulas were categorized in 6 groups: extensively or partially hydrolysed, regular with or without prebiotics/probiotics, and thickened with or without prebiotics/probiotics. Associations between type of infant formula used at 2 months and family or infant characteristics were assessed by multinomial logistic regressions. At Month 2, 58.1% of formula-fed infants were fed with formula enriched in prebiotics/probiotics, 31.5% with thickened formula, and 1.4% with extensively hydrolysed formula. The proportion of formula-fed infants increased regularly, but the type of infant formula used was fairly stable between 2 and 10 months. At Month 2, extensively hydrolysed formulas were more likely to be used in infants with diarrhoea or regurgitation problems. Partially hydrolysed formulas were more often used in families with high income, with a history of allergy, or with infants with regurgitation issues. Thickened formulas were used more with boys, preterm infants, infants with regurgitation issues, or in cases of early maternal return to work. The main factors related to the selection of infant formula were family and infant health-related ones.

Iodine status and associations with feeding practices and psychomotor milestone development in six-month-old South African infants

Iodine is important for normal growth and psychomotor development. While infants below 6 months of age receive iodine from breast milk or fortified infant formula, the introduction of complementary foods poses a serious risk for deteriorating iodine status. This cross-sectional analysis assessed the iodine status of six-month-old South African infants and explored its associations with feeding practices and psychomotor milestone development. Iodine concentrations were measured in infant (n = 386) and maternal (n = 371) urine (urinary iodine concentration [UIC]), and in breast milk (n = 257 [breast milk iodine concentrations]). Feeding practices and psychomotor milestone development were assessed in all infants. The median (25th-75th percentile) UIC in infants was 345 (213-596) μg/L and was significantly lower in stunted (302 [195-504] μg/L) than non-stunted (366 [225-641] μg/L) infants. Only 6.7% of infants were deficient. Maternal UIC (128 [81-216] μg/L; rs  = 0.218, p < 0.001) and breast milk iodine concentrations (170 [110-270] μg/kg; rs  = 0.447, p < 0.0001) were associated with infant UIC. Most infants (72%) were breastfed and tended to have higher UIC than non-breastfed infants (p = 0.074). Almost all infants (95%) consumed semi-solid or solid foods, with commercial infant cereals (60%) and jarred infant foods (20%) being the most common solid foods first introduced. Infants who reported to consume commercial infant cereals ≥4 days weekly had significantly higher UIC (372 [225-637] μg/L) than those reported to consume commercial infant cereals seldom or never (308 [200-517] μg/L; p = 0.023). No associations between infant UIC and psychomotor developmental scores were observed. Our results suggest that iodine intake in the studied six-month-old infants was adequate. Iodine in breast milk and commercial infant cereals potentially contributed to this adequate intake.

Determinants of infant and young child feeding practices by mothers in two rural districts of Sindh, Pakistan: a cross-sectional survey

BACKGROUND

Infant and young child feeding (IYCF) practices during the first two years of life are important for the growth and development of a child. The aim of this study was to assess IYCF practices and its associated factors in two rural districts of Pakistan.

METHODS

A cross-sectional study was conducted in two rural districts of Sindh province, Pakistan as part of a stunting prevention project between May and August 2014. A standard questionnaire on IYCF practices recommended by World Health Organization was used to collect information from 2013 mothers who had a child aged between 0 and 23 months.

RESULTS

Only 49% of mothers initiated breastfeeding within one hour of birth. Thirty-seven percent of mothers exclusively breastfed their infants for six months. Seventy-percent mothers introduced complementary feeding at 6-8 months of age. Eighty-two percent of mothers continued breastfeeding for at least one year and 75% for at least two years of age. IYCF practices were not significantly different for boys and girls in the study area. Being an employed mother (AOR 2.14; 95% CI 1.02, 4.51) was positively associated with the early initiation of breastfeeding. Children who were born at a health facility (AOR 0.65; 95% CI 0.50, 0.84) and were aged six to eleven months (AOR 0.70; 95% CI 0.54, 0.90) were less likely to be have an early initiation of breastfeeding. Mothers aged 25 to 29 years (AOR 1.83; 95% CI 1.05, 3.18), being literate (AOR 1.79; 95% CI 1.15, 2.78), and higher income (AOR 10.6; 95% CI 4.40, 25.30) were more likely to have an improved dietary diversity. Being an employed mother (AOR 2.18; 95% CI 1.77, 4.03) and higher income were more likely to have minimum acceptable diet (AOR 9.7; 95% CI 4.33, 21.71).

CONCLUSION

IYCF practices were below the acceptable level and associated with maternal age, maternal illiteracy, unemployment, and poor household wealth status. Emphasis should be given to improve maternal literacy and reduction in poverty to improve IYCF practices.

Factors associated with sugar intake and sugar sources in European children from 1 to 8 years of age

BACKGROUND/OBJECTIVES

The World Health Organization recommends to limit intake of free sugars to 5% of total energy per day because of the great impact of high sugar intake on body fat deposition, adiposity and dental caries. However, little data exist about total intake and sources of sugar in European children. Therefore, this paper aims to describe sugar intake and dietary sugar sources and associated factors.

SUBJECTS/METHODS

Three-day weighed dietary records were obtained at eight time points from children 1 to 8 years of age (n=995) in five European countries. Food items were classified into subgroups according to food composition. Linear mixed models were used to examine associated factors.

RESULTS

Total sugar intake increased from 65 g/day (30.0% of energy intake (E%)) at 12 months of age to 83 g/day (20.9 E%) at 96 months of age. Around 80% of children's sugar intake was derived from the following sources: milk and dairy products, fruits and fruit products, confectionary and sugar sweetened beverages (SSB). Total sugar intake and dietary sugar sources varied significantly by country of residence. Boys had a significantly (P=0.003) higher total sugar consumption than girls.SSB consumption was significantly higher in children from young mothers while sugar intake from fruit products was lower in children from mothers with lower educational status and those with higher birth order.

CONCLUSIONS

Sugar intake in our population was lower than in other studies. Total sugar intake was associated with country of residence and gender, while dietary sugar sources varied by country of residence, maternal age, education and birth order.

Feeding Mode of Australian Infants in the First 12 Months of Life

BACKGROUND

In 2011, Australia published a set of 6 population-level indicators assessing breastfeeding, formula use, and the introduction of soft/semisolid/solid foods.

OBJECTIVES

This study aimed to report the feeding practices of Australian infants against these indicators and determine the predictors of early breastfeeding cessation and introduction of solids.

METHODS

Mother-infant dyads (N = 1470) were recruited postnatally in 2 Australian capital cities and regional areas of 1 state between February 2008 and March 2009. Demographic and feeding intention data were collected by self-completed questionnaire at infant birth, with feeding practices (current feeding mode, age of breastfeeding cessation, age of formula and/or solids introduction) reported when the infant was between 4 and 7 months of age, and around 13 months of age. Multiple logistic regression was used to determine the predictors of breastfeeding cessation and solids introduction.

RESULTS

Although initiation of breastfeeding was almost universal (93.3%), less than half of the infants were breastfed to 6 months (41.7%) and 33.3% were receiving solids by 4 months. Women who were socially disadvantaged, younger, less educated, unpartnered, primiparous, and/or overweight were most likely to have ceased breastfeeding before 6 months of age, and younger and/or less educated women were most likely to have introduced solid food by 4 months of age. Not producing adequate milk was the most common reason provided for cessation of breastfeeding.

CONCLUSION

The feeding behaviors of Australian infants in the first 12 months fall well short of recommendations. Women need anticipatory guidance as to the indicators of breastfeeding success and the tendency of women to doubt the adequacy of their breast milk supply warrants further investigation.

Infant Dietary Exposures to Sweetness and Fattiness Increase during the First Year of Life and Are Associated with Feeding Practices

BACKGROUND

Taste is a strong determinant of food intake. Previous research has suggested that early taste exposures could influence preferences and later eating behavior, but little is known about the factors related to this.

OBJECTIVES

The aims of this study were to describe infants' exposure to sweetness and fattiness and to examine whether maternal and infant characteristics and feeding practices are related to these exposures in participants from the OPALINE [Observatoire des Préférences Alimentaires du Nourrisson et de l'Enfant (Observatory of Infant and Child Food Preferences)] cohort study.

METHODS

Food consumption frequency was assessed with a 7-d food record completed monthly over the first year. Dietary taste exposure was defined by the consumption frequency of each food multiplied by the intensity of its taste, summed over all foods. The daily sweetness exposure (SweetExp) and fattiness exposure (FatExp) were calculated at 3-6, 7-9, and 10-12 mo of age for 268 infants from complementary feeding initiation (CFI) to 12 mo. Associations between taste exposure and potential factors were tested by multiple linear regressions.

RESULTS

Both FatExp and SweetExp increased from 3-6 mo to 10-12 mo (mean ± SD: 7.5 ± 2.3 to 12.2 ± 2.5 and 6.8 ± 2.8 to 14.7 ± 4.1, respectively). Breastfeeding duration ≥6 mo was associated with higher SweetExp at all ages, with a decreasing β [β (95% CI): 2.6 (1.8; 3.4) at 3-6 mo and 1.3 (0.1; 2.4) at 10-12 mo]. CFI at <6 mo was associated with higher SweetExp at all ages but with higher FatExp only at 3-6 mo. Higher SweetExp and FatExp were associated with a higher use of all complementary food types. Boys were more likely to be exposed to SweetExp at 10-12 mo and to FatExp at 3-6 mo and 10-12 mo than were girls. Maternal higher education attainment and return to work after 6 mo were linked with higher FatExp and higher FatExp and SweetExp, respectively.

CONCLUSION

SweetExp and FatExp increased from CFI until 12 mo and were associated with feeding practices in OPALINE infants. Studying early taste exposure longitudinally should provide new insights regarding the development of food preferences.

Introduction of complementary foods with respect to French guidelines: description and associated socio-economic factors in a nationwide birth cohort (Epifane survey)

We described the introduction of complementary food (ICF) during the first year of life and identify associations observed with maternal and infant characteristics. We studied 3368 children included in the Epifane cohort, France, 2012. Maternal and infant characteristics and age at introduction of 28 complementary foods were collected at birth and at 1, 4, 8 and 12 months. Kaplan-Meier plots were used to represent probabilities of ICF. A score was used as tertiles in multinomial logistic regression to identify maternal and infant factors associated with ICF agreement with French recommendations. Median age of ICF was 152 days. While 12.6% of infants received complementary food before the age of 4 months, 95% of them were introduced after 7 months. Recommendations were generally followed, except for eggs and added fats, introduced in only 23.2% and 53.1% of 1-year-old infants, respectively. Factors significantly associated with the first ICF score tertile (low agreement with recommendations) vs. third tertile were as follows: maternal age 18-24 years (OR = 2.24 [1.49-3.35]) or 25-29 years (OR = 1.57 [1.21-2.04]), education less than or equal to high school graduation (OR = 1.94[1.51-2.48]), birthplace in France (OR = 2.13 [1.41-3.21]), three or more children (OR = 1.70 [1.15-2.51]), no follow-up antenatal classes (OR = 1.58 [1.22-2.04]), unemployment before and after pregnancy (OR = 1.64 [1.04-2.59]), unemployment before pregnancy and return to work within 12 months (OR = 2.06 [1.05-4.02]), no breastfeeding (OR = 2.08 [1.55-2.79]) or lasting <28 days (OR = 1.68 [1.22-2.31]) or 1-4 months (OR = 1.45 [1.08-1.96]). Recommendations concerning complementary food were generally followed. However, guidelines should be clarified and adapted to families who have difficulties in adopting them.

Parental timing of allergenic food introduction in urban and suburban populations

BACKGROUND

Recommendations on timing for introduction of allergenic foods in an infant diet have changed twice during the past decade. How families with different demographic characteristics implement the change has not been studied in the United States.

OBJECTIVE

To compare the age of introduction of allergenic foods between an urban Medicaid-based population and a suburban private insurance-based population in Cincinnati, Ohio.

METHODS

Two hundred parent surveys were distributed at well-child checkups between 4 and 36 months of age. Data were analyzed using distribution mapping to determine the difference in the age of introduction of infant formula, infant solids, whole cow's milk, eggs, peanut, and fish. Random forest analysis was used to determine the most important factors affecting the age of introduction for both populations.

RESULTS

There was no statistically significant difference in the age of infant solid introduction, but urban populations introduced allergenic foods earlier than suburban populations, with a statistically significant difference in the age of introduction of infant formula, whole cow's milk, eggs, peanut, and fish. The most important factor for the timing of all food introductions was the recommended age of introduction from health care professionals.

CONCLUSION

There is a difference between urban and suburban populations in the timing of introduction of allergenic foods but not in other infant solid foods. The reliance on physician recommendation for both populations supports the need for education and guidance to health care professionals on up-to-date guidance and recommendations.

Determinants of infant and young child feeding practices in Rupandehi, Nepal

Background

Undernutrition is a major problem in Nepal and meeting the minimum dietary standard is essential for growth and development of young children. Continuous monitoring of such practices is important to inform policy and program formulation. This study aimed to assess complementary feeding practices, and associated factors in Western Nepal.

Methods

This was a cross-sectional study conducted in Rupandehi district of Western Nepal. Face-to-face interviews were conducted among 178 mothers of young children aged 6–23 months using a structured questionnaire and data on complementary feeding practices. These practices were reported as frequency distribution and the factors associated were ascertained using multiple logistic regression.

Results

Only 57 % of mothers initiated complementary feeding at the age of 6 months. While the proportion of young children receiving minimum meal frequency was reasonably high (84 %), meal diversity (35 %) and minimum acceptable diet (33 %) remained low. Maternal education and having had their children’s growth monitored were independently associated with receiving minimum acceptable diet.

Conclusion

Few infants and young children received the recommended infant and young children feeding practices. Implementing health promotion programs that educate and enhance the skills of mothers should be a priority for future nutrition interventions.

Types of Infant Formulas Consumed in the United States

We examined consumption of different types of infant formula (eg, cow's milk, soy, gentle/lactose-reduced, and specialty) and regular milk among a nationally representative sample of 1864 infants, 0 to 12 months old, from the National Health and Nutrition Examination Survey, 2003-2010. Among the 81% of infants who were fed formula or regular milk, 69% consumed cow's milk formula, 12% consumed soy formula, 5% consumed gentle/ lactose-reduced formulas, 6% consumed specialty formulas, and 13% consumed regular milk products. There were differences by household education and income in the percentage of infants consuming cow's milk formula and regular milk products. The majority of infants in the United States who were fed formula or regular milk consumed cow's milk formula (69%), with lower percentages receiving soy, specialty, gentle/sensitive, or lactose-free/reduced formulas. Contrary to national recommendations, 13% of infants younger than 1 year consumed regular milk, and the percentage varied by household education and income levels.

Preventing Obesity Across Generations: Evidence for Early Life Intervention

To prevent the intergenerational transfer of obesity and end the current epidemic, interventions are needed across the early life stages, from preconception to prenatal to infancy through the age of 2 years. The foundation for obesity is laid in early life by actions and interactions passed from parent to child that have long-lasting biologic and behavioral consequences. The purpose of this paper is to examine the best evidence about (a) factors in parents and offspring that promote obesity during the early life stages, (b) the social determinants and dimensions of obesity in early life, (c) promising and effective interventions for preventing obesity in early life, and (d) opportunities for future research into strategies to disrupt the intergenerational cycle of obesity that begins early in life. The pathway for halting the intergenerational obesity epidemic requires the discovery and development of evidence-based interventions that can act across multiple dimensions of influence on early life.

The timing of solid introduction in an 'obesogenic' environment: a narrative review of the evidence and methodological issues

OBJECTIVE

To evaluate the evidence for association between obesity risk outcomes >12 months of age and timing of solid introduction in healthy term infants in developed countries, the large majority of whom are not exclusively breastfed to six months of age.

METHODS

Studies included were published 1990 to March 2013.

RESULTS

Twenty-six papers with weight status or obesity prevalence outcomes were identified. Studies were predominantly cohort design, most with important methodological limitations. Ten studies reported a positive association. Of these, only two were large, good-quality studies and both examined the outcome of early (<4 months) introduction of solids. None of the four good-quality studies that directly evaluated current guidelines provided evidence of any clinically relevant protective effect of solid introduction from 4-5 versus ≥6 months of age.

CONCLUSION

The introduction of solids prior to 4 months of age may result in increased risk of childhood obesity but there is little evidence of adverse weight status outcomes associated with introducing solids at 4-6 rather than at six months.

IMPLICATIONS

More and better quality evidence is required to inform guidelines on the 'when, what and how' of complementary feeding.

Tools for teen moms to reduce infant obesity: a randomized clinical trial

BACKGROUND

Unhealthy infant feeding practices, such as a combination of formula feeding and early introduction of solids may lead to rapid or excessive weight gain in early infancy. Adolescent mothers' feeding behaviors are most directly related to infant weight gain in the first year of life. Compared to adult mothers, adolescent mothers are less knowledgeable, less responsive, more controlling, and less skilled in infant feeding, which interferes with infants' healthy growth. The Tools for Teen Moms trial aims to compare the effect of a social media intervention for low-income adolescent, first-time mothers of infants 2 months of age or younger, versus standard care on infant weight, maternal responsiveness, and feeding style and practices. The intervention is conducted during the infant's first four months of life to promote healthy transition to solids during their first year. Tools for Teen Moms is an intervention delivered via a social media platform that actively engages and coaches low-income adolescent mothers in infant-centered feeding to reduce rapid/excessive infant weight gain in the first six months of life.

METHODS/DESIGN

We describe our study protocol for a randomized control trial with an anticipated sample of 100 low-income African- American and Caucasian adolescent, first-time mothers of infants. Participants are recruited through Maternal-Infant Health Programs in four counties in Michigan, USA. Participants are randomly assigned to the intervention or the control group. The intervention provides infant feeding information to mothers via a web-based application, and includes daily behavioral challenges, text message reminders, discussion forums, and website information as a comprehensive social media strategy over 6 weeks. Participants continue to receive usual care during the intervention. Main maternal outcomes include: (a) maternal responsiveness, (b) feeding style, and (c) feeding practices. The primary infant outcome is infant weight. Data collection occurs at baseline, and when the baby is 3 and 6 months old.

DISCUSSION

Expected outcomes will address the effectiveness of the social media intervention in helping teen mothers develop healthy infant feeding practices that contribute to reducing the risk of early onset childhood obesity.

TRIAL REGISTRATION

Clinical Trials.Gov NCT02244424, June 24, 2014.

Maternal eating disorder and infant diet. A latent class analysis based on the Norwegian Mother and Child Cohort Study (MoBa)

Knowledge of infant diet and feeding practices among children of mothers with eating disorders is essential to promote healthy eating in these children. This study compared the dietary patterns of 6-month-old children of mothers with anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified-purging subtype, to the diet of children of mothers with no eating disorders (reference group). The study was based on 53,879 mothers in the Norwegian Mother and Child Cohort Study (MoBa). Latent class analysis (LCA) was used to identify discrete latent classes of infant diet based on the mothers' responses to questions about 16 food items. LCA identified five classes, characterized by primarily homemade vegetarian food (4% of infants), homemade traditional food (8%), commercial cereals (35%), commercial jarred baby food (39%), and a mix of all food groups (11%). The association between latent dietary classes and maternal eating disorders were estimated by multinomial logistic regression. Infants of mothers with bulimia nervosa had a lower probability of being in the homemade traditional food class compared to the commercial jarred baby food class, than the referent (O.R. 0.59; 95% CI 0.36-0.99). Infants of mothers with binge eating disorder had a lower probability of being in the homemade vegetarian class compared to the commercial jarred baby food class (O.R. 0.77; 95% CI 0.60-0.99), but only before adjusting for relevant confounders. Anorexia nervosa and eating disorder not otherwise specified-purging subtype were not statistically significantly associated with any of the dietary classes. These results suggest that maternal eating disorders may to some extent influence the child's diet at 6 months; however, the extent to which these differences influence child health and development remains an area for further inquiry.

Predictors for early introduction of solid food among Danish mothers and infants: an observational study

Background

Early introduction of complementary feeding may interfere with breastfeeding and the infant’s self-controlled appetite resulting in increased growth. The aim of the present study was to investigate predictors for early introduction of solid food.

Methods

In an observational study Danish mothers filled in a self-administered questionnaire approximately six months after birth. The questionnaire included questions about factors related to the infant, the mother, attachment and feeding known to influence time for introduction of solid food. The study population consisted of 4503 infants. Data were analysed using ordered logistic regression models. Outcome variable was time for introduction to solid food.

Results

Almost all of the included infants 4386 (97%) initiated breastfeeding. At weeks 16, 17–25, 25+, 330 infants (7%); 2923 (65%); and 1250 (28%), respectively had been introduced to solid food. Full breastfeeding at five weeks was the most influential predictor for later introduction of solid food (OR = 2.52 CI: 1.93-3.28). Among infant factors male gender, increased gestational age at birth, and higher birth weight were found to be statistically significant predictors. Among maternal factors, lower maternal age, higher BMI, and being primipara were significant predictors, and among attachment factors mother’s reported perception of the infant as being temperamental, and not recognising early infant cues of hunger were significant predictors for earlier introduction of solid food. Supplementary analyses of interactions between the predictors showed that the association of maternal perceived infant temperament on early introduction was restricted to primiparae, that the mother’s pre-pregnancy BMI had no impact if the infant was fully breastfed at week five, and that birth weight was only associated if the mother had reported early uncertainty in recognising infant’s cues of hunger.

Conclusions

Breastfeeding was the single most powerful indicator for preventing early introduction to solid food. Modifiable predictors pointed to the importance of supporting breastfeeding and educating primipara and mothers with low birth weight infants to be able to read and respond to their infants’ cues to prevent early introduction to solid food.

Poor dietary diversity and low nutrient density of the complementary diet for 6- to 24-month-old children in urban and rural KwaZulu-Natal, South Africa

Infants and toddlers have high nutritional requirements relative to body size but consume small amounts of food and therefore need nutrient-dense complementary foods. A cross-sectional study included children aged 6-24 months, stratified in three age categories (6-11 months, 12-17 months and 18-24 months) and randomly selected from an urban (n = 158) and a rural (n = 158) area, both of low socio-economic status, in the KwaZulu-Natal Province of South Africa. Dietary diversity and nutrient density of the complementary diet (excluding breast milk and formula milk) based on a repeated 24-h dietary recall was assessed. For breastfeeding children, nutrient density of the complementary diet was adequate for protein, vitamin A and vitamin C; and inadequate for 100% of children for zinc, for >80% of children for calcium, iron and niacin; and between 60% and 80% of children for vitamin B6 and riboflavin. Urban/rural differences in density for animal and plant protein, cholesterol and fibre occurred in 18-24-month-old children. Fewer than 25% of children consumed ≥4 food groups, with no urban/rural differences. Higher dietary diversity was associated with higher nutrient density for protein and several of the micronutrients including calcium, iron and zinc. The poor nutrient density for key micronutrients can probably be ascribed to lack of dietary variety, and little impact of mandatory fortification of maize meal/wheat flour on infants/toddlers' diet. Targeted strategies are needed to enable mothers to feed their children a more varied diet.

Short report: premastication in rural Gabon--a cross-sectional survey

Premastication-defined as pre-chewing of food for infants by their caregiver-is a common feeding practice in various societies. To date the impact of premastication on children's health including the potential for transmission of infectious diseases is not well understood. Since there are no epidemiologic data on premastication from resource poor regions in Central Africa, we investigated the epidemiology and demographic variables associated with premastication in Central Africa. Between 2011 and 2012, mothers were interviewed about child feeding behaviors in three rural communities in Gabon. A quarter (n = 20, 24%) of 82 participants stated to perform premastication regularly. Despite the small sample size, our study provides first baseline data for the epidemiology of premastication in Central Africa, indicating that this feeding practice is common in rural communities.

Introducing solids and water to Australian infants

BACKGROUND

Recommendations for the introduction of solids and fluids to an infant's diet have changed over the past decade. Since these changes, there has been minimal research to determine patterns in the introduction of foods and fluids to infants.

METHODS

This retrospective cohort study surveyed mothers who birthed in Queensland, Australia, from February 1 to May 31, 2010, around 4 months postpartum. Frequencies of foods and fluids given to infants at 4, 8, 13, and 17 weeks were described. Logistic regression determined associations between infant feeding practices, the introduction of other foods and fluids at 17 weeks, and sociodemographic characteristics.

RESULTS

Response rate was 35.8%. At 17 weeks, 68% of infants were breastfed and 33% exclusively breastfed. Solids and water had been introduced in 8.6% and 35.0% of infants, respectively. The introduction of solids by 17 weeks was associated with younger maternal age and the infant being given water and infant formula at 4 weeks. The infant being given water at 17 weeks was associated with younger maternal age, the infant being given infant formula at 4 weeks, level of education, relative socioeconomic disadvantage, parity, and birth facility.

CONCLUSION

Over the past decade, there has been a significant reduction in the proportion of infants in Australia who have been given solids by 17 weeks. Sociodemographic characteristics and formula feeding practices at 4 weeks were associated with the introduction of solids and water by 17 weeks. Further research should examine these barriers to improve compliance with current infant feeding recommendations.

An online survey of knowledge of the weaning guidelines, advice from health visitors and other factors that influence weaning timing in UK mothers

The UK weaning guidelines recommend the introduction of solid food at or around 6 months. The evidence suggests that knowledge of the guidelines is high, although only a small minority of parents wait until 6 months to wean. The aim of this study was to assess understanding of the UK weaning guidelines in a sample of UK parents and investigate the associations of this understanding with weaning timing, and in comparison to other influencing factors. This study conducted an online survey of UK parents. Eligible participants had weaned a child since the introduction of the current guidelines. Of 3607 participants, 86% accurately understood the guidelines. Eighty-seven per cent of health visitors were reported to have advised weaning at or around 6 months. Knowledge of the guidelines was associated with later weaning (independently of demographic factors) (P < 0.001) but did not ensure compliance: 80% of mothers who weaned before 24 weeks and 65% who weaned before 17 weeks were aware of the guidelines. Younger mothers (P < 0.001), those receiving benefits (P < 0.001), those educated only to 16 (P < 0.001) and minority ethnic groups (P < 0.001) had lower levels of awareness. Poor understanding of the guidelines was the most reliable predictor of early weaning (P = 0.021) together with young maternal age (P = 0.014). Following the baby-led weaning approach was the most reliable predictor of those weaning at 26 weeks, together with the Internet being the most influential source of advice. Understanding of the current weaning guidelines is high and is a key independent predictor of weaning age in this population.

Sociodemographic determinants of early weaning: a Finnish birth cohort study in infants with human leucocyte antigen-conferred susceptibility to type 1 diabetes

OBJECTIVE

To assess the most important sociodemographic determinants of age at introduction of complementary foods in infancy.

DESIGN

A prospective birth cohort with increased risk of type 1 diabetes, recruited between 1996 and 2004. The families completed at home a follow-up form on the age at introduction of new foods and, for each clinic visit, a structured dietary questionnaire with 3 d food records.

SETTING

Data from the Type 1 Diabetes Prediction and Prevention (DIPP) Project, Finland.

SUBJECTS

A cohort of 5991 infants (77 % of those invited) belonging to the DIPP Nutrition Study.

RESULTS

Sixty-three per cent of the infants were introduced to complementary foods, including infant formula, before the age of 4 months. The median age at introduction of infant formula was 1·5 months (range 0-18 months) and that of the first other complementary food 3·5 months (range 0·7-8 months). All sociodemographic and lifestyle factors studied were associated with the age at introduction of infant formula and/or first other complementary food. Female sex of the infant, being born in the southern region of Finland, living in a rural municipality, the presence of siblings, the mother or the father being a high-school graduate, high maternal professional education and maternal non-smoking during pregnancy predicted later introduction of complementary foods.

CONCLUSIONS

Compliance was relatively poor with the current recommendations for the age of introducing complementary foods. Small-sized young families with less well-educated parents were most prone to introduce complementary foods early.

Breastfeeding duration in relation to child care arrangement and participation in the special supplemental nutrition program for women, infants, and children

This study was conducted to examine associations among breastfeeding duration, child care arrangement, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The authors analyzed the nationally representative sample of infants born in 2001 who were enrolled in the Early Childhood Longitudinal Study-Birth Cohort (9 months). They estimated the risks of short breastfeeding duration (< 6 months of age) among infants according to the child care arrangement and WIC participation (n = 7515). Approximately 50% of US infants were enrolled in WIC, and 47% received child care on a regular basis. Both WIC participation and child care use were independently associated with short breastfeeding duration. Compared to those under parental care, WIC participants under relative care were more likely to discontinue breastfeeding before the age of 6 months. A breastfeeding support program targeted toward relative care users may be useful for WIC participants.