The Australian Feeding Infants and Toddler Study (OzFITS 2021): Breastfeeding and Early Feeding Practices

The Australian Feeding Infants and Toddler Study 2021 (OzFITS 2021) is a nationwide survey of Australian caregivers' infant and toddler feeding practices. Here, we describe breastfeeding rates and duration, use of breastmilk substitutes, and introduction of complementary (solid) foods, including common food allergens. Caregivers (n = 1140) were recruited by a digital marketing company and were interviewed using a structured telephone questionnaire to obtain information. Breastfeeding was initiated in 98% of infants, but the duration of exclusive breastfeeding to six months was less than 1%. Nearly 40% of children continued to receive breastmilk beyond one year, with 10% of toddlers receiving breastmilk at two years. One-quarter of infants were introduced to solid foods between 4 to 5 months, and nearly all infants had received solid foods by 7 months. New guidelines encourage the early introduction of potential food allergens to reduce the risk of allergy, and by 12 months, over 90% of children had been given eggs and peanuts. One-third of children received no breastmilk substitutes during their first year. One-third of infants first received breastmilk substitutes following birth and before discharge from the hospital. Of these infants, 30% ceased breastmilk substitute use after discharge. Our findings suggest a high rate of continued breastfeeding with 44% receiving breastmilk beyond 1 year. One approach to increase the duration of exclusive breastfeeding is to reduce breastmilk substitute use while in hospital.

The infant gut resistome is associated with E. coli and early-life exposures

BACKGROUND

The human gut microbiome harbors a collection of bacterial antimicrobial resistance genes (ARGs) known as the resistome. The factors associated with establishment of the resistome in early life are not well understood. We investigated the early-life exposures and taxonomic signatures associated with resistome development over the first year of life in a large, prospective cohort in the United States. Shotgun metagenomic sequencing was used to profile both microbial composition and ARGs in stool samples collected at 6 weeks and 1 year of age from infants enrolled in the New Hampshire Birth Cohort Study. Negative binomial regression and statistical modeling were used to examine infant factors such as sex, delivery mode, feeding method, gestational age, antibiotic exposure, and infant gut microbiome composition in relation to the diversity and relative abundance of ARGs.

RESULTS

Metagenomic sequencing was performed on paired samples from 195 full term (at least 37 weeks' gestation) and 15 late preterm (33-36 weeks' gestation) infants. 6-week samples compared to 1-year samples had 4.37 times (95% CI: 3.54-5.39) the rate of harboring ARGs. The majority of ARGs that were at a greater relative abundance at 6 weeks (chi-squared p < 0.01) worked through the mechanism of antibiotic efflux. The overall relative abundance of the resistome was strongly correlated with Proteobacteria (Spearman correlation = 78.9%) and specifically Escherichia coli (62.2%) relative abundance in the gut microbiome. Among infant characteristics, delivery mode was most strongly associated with the diversity and relative abundance of ARGs. Infants born via cesarean delivery had a trend towards a higher risk of harboring unique ARGs [relative risk = 1.12 (95% CI: 0.97-1.29)] as well as having an increased risk for overall ARG relative abundance [relative risk = 1.43 (95% CI: 1.12-1.84)] at 1 year compared to infants born vaginally.

CONCLUSIONS

Our findings suggest that the developing infant gut resistome may be alterable by early-life exposures. Establishing the extent to which infant characteristics and early-life exposures impact the resistome can ultimately lead to interventions that decrease the transmission of ARGs and thus the risk of antibiotic resistant infections.

Effect of delayed feeding post-hatch on expression of tight junction- and gut barrier-related genes in the small intestine of broiler chickens during neonatal development

The gut not only plays a key role in digestion and absorption of nutrients but also forms a physical barrier and first line of defense between the host and the luminal environment. A functional gut barrier (mucus and epithelial cells with tight junctions [TJ]) is essential for optimal health and efficient production in poultry. In current broiler system, chicks are deprived of food and water up to 72 h due to uneven hatching, hatchery procedures, and transportation. Post-hatch feed delay results in lower BW, higher FCR and mortality, and delayed post-hatch gut development. Little is known about the effects of early neonatal development and delayed feeding immediately post-hatch on gut barrier function in chickens. Therefore, the aim of the present study was to characterize the expression pattern of gut barrier-related and TJ-related genes in the small intestine of broiler chickens during early development and delay in access to feed. Newly hatched chicks received feed and water immediately after hatch or were subjected to 48 h delayed access to feed to mimic commercial hatchery setting and operations. Birds were sampled (n = 6) at -48, 0, 4, 24, 48, 72, 96, 144, 192, 240, 288, and 336 h post-hatch. Jejunum and ileum were collected, cleaned of digesta, and snap-frozen in liquid nitrogen or fixed in paraformaldehyde. The relative mRNA levels of gut barrier- and TJ-related protein genes were measured by quantitative PCR and analyzed by 2-way ANOVA. In both tissues, changes (P < 0.05) in gene expression pattern of gut barrier-related and TJ-related genes were detected due to delayed access to feed post-hatch and/or development. In general, expression of TJ-related genes was downregulated while mRNA levels of gut barrier-related genes were upregulated during development. Histological differences and changes in mucin staining due to age and treatment were observed. These results suggest that delayed access to feed post-hatch may affect TJ structure and/or function and therefore gut barrier function and overall health of the chicken small intestine.

Impact of Cognition and Handfeeding Assistance on Nutritional Intake for Nursing Home Residents

In nursing homes (NHs), residents are at risk for malnutrition and weight loss. The purpose of this secondary data analysis was to examine the impact of resident cognitive status and level of feeding assistance provided by NH staff on resident's daily nutritional intake and body weight. As part of a large, multisite clinical trial (N = 786), residents with and without dementia were examined according to level of feeding assistance required during mealtimes (independent, set-up only, needs help eating) over a 21-day period. Outcomes analyzed were percent of meal intake by meal type (breakfast, lunch, dinner) and overall daily intake (meals + snacks/supplements). Residents with dementia who required meal set-up assistance had significantly lower meal intake for all three meals. Residents without dementia requiring meal set-up assistance experienced significantly lower intake for breakfast and dinner, but not lunch. When snacks and supplements were offered between meals, residents with dementia consumed approximately 163 additional calories/day, and residents without dementia consumed approximately 156 additional calories/day. This study adds new evidence that residents at greatest risk for low intake are those who are only provided set-up assistance for meals and/or have cognitive impairment.

How feeding garden birds has changed the pecking order

Bird feeding in gardens has increased over the past 40 years and, as Georgina Mills explains, this has had a huge impact on the diversity of birds visiting UK gardens.

Feeding Style and a Child's Body Mass Index

INTRODUCTION

Early onset pediatric obesity has become a major health concern in the United States. A key contributing factor to early onset childhood is socialization to the eating and mealtime environment. Maternal feeding styles play an integral role in how children are socialized to the eating and mealtime environment.

METHOD

The study utilized a descriptive correlational research design. The sample was 126 mother/child dyads recruited from a southeastern Michigan Head Start program. Each mother completed a research packet.

RESULTS

Results indicated that maternal beliefs such as nutritional belief and belief about the child's eating style were significantly associated with maternal feeding style. Maternal behaviors were associated with maternal feeding styles.

DISCUSSION

Overall, the study provides a description of maternal beliefs and behaviors related to the body weight status of a preschool-aged child.

Age at Introduction to Solid Foods and Child Obesity at 6 Years

BACKGROUND

Epidemiological evidence suggests that timing of introduction of solid foods may be associated with subsequent obesity, and the association may vary by whether an infant is breastfed or formula-fed.

METHODS

We included 1181 infants who participated in the Infant Feeding Practices Study II (IFPS II) and the Year 6 Follow Up (Y6FU) study. Data from IFPS II were used to calculate the primary exposure and timing of solid food introduction (<4, 4-<6, and ≥6 months), and data from Y6FU were used to calculate the primary outcome and obesity at 6 years of age (BMI ≥95th percentile). We used multivariable logistic regression to assess the association between timing of the introduction of solids and obesity at 6 years and test whether this association was modified by breastfeeding duration (breastfed for 4 months vs. not).

RESULTS

Prevalence of obesity in our sample was 12.0%. The odds of obesity was higher among infants introduced to solids <4 months compared to those introduced at 4-<6 months (odds ratio [OR] = 1.66; 95% CI, 1.15, 2.40) in unadjusted analysis; however, this relationship was no longer significant after adjustment for covariates (OR = 1.18; 95% CI, 0.79, 1.77). Introduction of solids ≥6 months was not associated with obesity. We found no interaction between breastfeeding duration and early solid food introduction and subsequent obesity.

CONCLUSIONS

Timing of introduction of solid foods was not associated with child obesity at 6 years in this sample. Given the inconsistency in findings with other studies, further studies in larger populations may be needed.

Impact of the Great East Japan Earthquake on feeding methods and newborn growth at 1 month postpartum: results from the Fukushima Health Management Survey

This study examined the effects of three disasters (the Great East Japan Earthquake of March 11, 2011, followed by a tsunami and the Fukushima Daiichi Nuclear Power Plant accident) on feeding methods and growth in infants born after the disasters. Using results from the Fukushima Health Management Survey, Soso District (the affected area where the damaged nuclear power plant is located) and Aizu District (a less-affected area located farthest from the plant) were compared. In this study, newborn and maternal background characteristics were examined, as well as feeding methods, and other factors for newborn growth at the first postpartum examination for 1706 newborns born after the disaster in the affected (n = 836) and less-affected (n = 870) areas. Postpartum examinations took place 1 month after birth. Feeding method trends were examined, and multivariate regression analyses were used to investigate effects on newborn mass gain. There were no significant differences in background characteristics among newborns in these areas. When birth dates were divided into four periods to assess trends, no significant change in the exclusive breastfeeding rate was found, while the exclusive formula-feeding rate was significantly different across time periods in the affected area (p = 0.02). Multivariate analyses revealed no significant independent associations of maternal depression and change in medical facilities (possible disaster effects) with other newborn growth factors in either area. No area differences in newborn growth at the first postpartum examination or in exclusive breastfeeding rates were found during any period. Exclusive formula-feeding rates varied across time periods in the affected, but not in the less-affected area. It is concluded that effective guidance to promote breast-feeding and prevent exclusive use of formula is important for women in post-disaster circumstances.

Exploring the infant feeding practices of immigrant women in the North West of England: a case study of asylum seekers and refugees in Liverpool and Manchester

Little is known about the infant feeding experiences of refugees residing in the UK. To enable successful health promotion for this population, such experiences must be understood. The study aimed to gain an understanding of infant feeding practices among a group of UK-based refugee mothers. Objectives were to explore mothers' perceptions and influences of infant feeding practices, to explore challenges faced by mothers in feeding their infants and to identify concerns and experiences of health care professionals with regard to caring for them. Fifteen semi-structured interviews and two focus group discussions with refugee mothers and five semi-structured interviews with health care providers were conducted in 2012. A framework approach was used to identify main themes. Overall mothers were dissatisfied with their infant feeding outcomes. A preference to exclusively breastfeed was often not achieved. Most resorted to using formula feed, perceiving that this was primarily due to a lack of support. Mothers who were positive to human immunodeficiency virus followed the UK guidelines of exclusively formula feeding for 6 months, but struggled with guilt of not being able to breastfeed. All mothers unable to exclusively breastfeed experienced a sense of loss. Lack of wider support services coupled with complex lifestyles appeared to create challenges in providing infant feeding support. The results highlight a need for an intensified response to facilitate these mothers to maintain their preferred infant feeding choices, or when required, to support them in the adoption of a new method. Using experienced refugee mothers to guide newer mothers, and integrating health and social care, would be positive starting points.

Determinants of suboptimal complementary feeding practices among children aged 6-23 months in four anglophone West African countries

Suboptimal complementary feeding practices have a detrimental impact on a child's growth, health and development in the first two years of life. They lead to child malnutrition, which contributes to the high prevalence of stunting (38%) and underweight (28%) reported for children <5 years of age in Sub-Saharan Africa. This study analysed complementary feeding practices in four anglophone West African countries (Ghana, Liberia, Nigeria and Sierra Leone) using the most recent Demographic and Health Surveys. The study covered 12 623 children aged 6-23 months from four anglophone West African countries (Ghana: 822 children: Liberia: 1458 children, Nigeria: 8786 children and Sierra Leone: 1557 children). Four complementary feeding indicators were examined against a set of individual-, household- and community-level factors, using multiple regression analysis. Multivariate analyses found that lack of post-natal contacts with health workers, maternal illiteracy and geographical region were common determinants of delayed introduction of solid, semi-solid or soft foods across all four countries. Predictors for minimum dietary diversity, minimum meal frequency and minimum acceptable diet included children aged 6-11 months, administrative/geographical region, poorer household income and limited access to media. The authors recommend that the four anglophone West African countries studied should prioritise efforts to improve complementary feeding practices in order to reduce child morbidity and mortality. Interventional studies on complementary feeding should target those from poor and illiterate households.

Prevalence, and early childhood caries risk indicators in preschool children in suburban Nigeria

BACKGROUND

Early Childhood Caries (ECC) is defined as the presence of caries lesion in an primary tooth in children below the age of 71 months. It is a significant public health problem with consequences for the growth and development of affected children. The objective of this study was to determine the prevalence and ECC risk indicators in a suburban population in Nigeria.

METHODS

The data of 497 children aged 6 months to 71 months who were recruited through a household survey conducted in Ile-Ife, Nigeria was analysed for prevalence of ECC and risk indicators. Information on children's ages, sex, socioeconomic status, tooth brushing habits, sugary snacks consumption, use of fluoridated toothpaste, birth rank, infant-feeding practices, breastfeeding practices, maternal age at childbirth, and maternal knowledge of oral health was obtained. Children's oral hygiene and caries status was also determined. Risk factors associated with ECC were determined using logistic regression analysis.

RESULTS

Thirty-three (6.6%) children had ECC. Four (0.8%) had severe ECC. The four risk indicators for ECC were the child's gender, mothers' knowledge of oral health, consumption of sugary snacks in between meals more than three times a day, and the child's oral hygiene status. Females (PR: -0.06; 95% CI: -0.01- -0.01; p = 0.02), and children with mothers who had good knowledge of oral health (PR: -0.06; 95% CI: -0.11--0.008; p = 0.02) were less likely to have ECC. Children who consumed sugary snacks in between meals three times a day or more (PR: 0.05; CI: 0.003 - 0.01; P = 0.04) and children with fair oral hygiene (PR: 0.05; 95% CI: 0.005-0.10; p = 0.03) were more likely to have ECC.

CONCLUSIONS

The prevalence of ECC in the study population was low. Promoting good oral hygiene practices and enhancing mothers' knowledge of oral health may help reduce further, the risk for ECC in the study population.

Prevalence and reasons for introducing infants early to solid foods: variations by milk feeding type

OBJECTIVE

To examine the prevalence of, and mothers' self-reported reasons for, introducing solid foods to infants earlier than recommended (aged <4 months) and the variation in reasons for early introduction by milk feeding type.

METHODS

The study included 1334 mothers who participated in the national longitudinal Infant Feeding Practices Study II (2005-2007). Monthly 7-day food-frequency questions throughout infancy were used to determine infant age at solid food introduction and to classify infant's milk feeding at introduction as breast milk only, formula only, or mixed. Reasons for introducing solid foods at age <4 months were assessed through maternal responses to a list of 12 potential reasons. Analyses included descriptive statistics and multivariable logistic regression.

RESULTS

Overall, 40.4% of mothers introduced solid foods before age 4 months. Prevalence varied by milk feeding type (24.3%, 52.7%, and 50.2% for breastfed, formula-fed, and mixed-fed infants, respectively). The most commonly cited reasons for early introduction of solid food were as follows: "My baby was old enough," "My baby seemed hungry," "I wanted to feed my baby something in addition to breast milk or formula," "My baby wanted the food I ate," "A doctor or other health care professional said my baby should begin eating solid food," and "It would help my baby sleep longer at night." Four of these reasons varied by milk feeding type.

CONCLUSIONS

Our findings highlight the high prevalence of early introduction of solids and provide details on why mothers introduced solid foods early.

[Intervention for family feeding methods for nursling between 6 to 24 months in Zhouqu]

OBJECTIVE

To analyze the change of family feeding methods after nutrition intervention for nurslings between 6 to 24 months in Zhouqu .

METHOD

Choose 252 nurslings in basic survey and 239 in final survey by PPS sampling and obtain the change of feeding methods by questionnaire.

RESULTS

After the one year's intervention, the rate of pure breast feeding increases from 26.98% to 39.33%, the rate of breast feeding in one hour after the baby delivered increases from 17.06% to 38.09%. The rate of feeding formula powder increases from 27.28% to 61.51% and the status of feeding vegetable meat and bean are improved. The rate for early complementary feeding for special kings of food decreased.

CONCLUSION

After the one year's intervention, the feeding methods improves in total, but there are still some problems. It isrequired to enhance intervention and formulate and implement a kind of reasonable intervention method to attach the objective of scientific feeding for nurslings.

[Correlation between feeding index and growth development of 6-36 month-old infants in two counties of western China by applying multiple correspondence analysis]

OBJECTIVE

To explore the correlation between feeding index and growth development status of infants from two counties of western China by applying the method of multiple correspondence analysis.

METHODS

Two sample counties were randomly selected from the ones that satisfied the research conditions in Shaanxi province and Chongqing in western China. In the study, 472 premature/low birth weight infants (PLBW) and 461 normal term infants (NT) of 6-36 months from the two counties were investigated from September 2010 to November 2010. The SPSS 19.0 software was applied to analyze the data using general statistical analysis and multiple correspondence analysis.

RESULTS

In the two counties of western China, the proportion of infants with feeding index at the medium level was the highest, which was between 50% and 60%. In the PLBW group and the NT group, the proportion of low level of feeding index among 6-9 month-old infants was the highest, and the proportion was 33.3% for the PLBW group and 29.4% for the NT group. For both the PLBW group and the NT group, the distribution of feeding index among the different age groups showed significant difference (P<0.05).Among the infants with low level of feeding index, the growth development of the PLBW lay behind that of the NT. We could see a catching-up trend of the PLBW with medium or good level of feeding index, but their growth development index was still at a lower level than that of the NT with the same level of feeding condition. Through multiple correspondence analyses, the outcomes of PLBW corresponded and strongly correlated with low level of feeding index, low level of growth development index, mother's low education degree and low annual family income. And the outcomes of NT corresponded and strongly correlated with medium/good level of feeding index, medium level of growth development status, mother's medium/high education degree and medium/high level of annual family income.

CONCLUSION

There are good correspondence correlations at different hierarchical levels of the infants' group, feeding index, growth development index and family factors in the two counties of western China. Multiple correspondence analysis could directly reveal the correlation among several variables, which is a suitable method for categorical data. The result can be illustrated directly through a two-dimensional graph and could provide the suggestion of feeding practice for different infants in western rural China.

Early childhood caries and feeding practices in kindergarten children

OBJECTIVE

To determine the prevalence and severity of early childhood caries (ECC) and its relation to feeding practices in Syria.

METHOD AND MATERIALS

A total of 400 children aged 3 to 5 years (mean age ± SD, 4.2 ± 0.5) were screened from 20 randomly selected kindergartens in Latakia, Syria. Dental examinations were carried out by a specialist in pediatric dentistry using DMFT and DMFS indices and an ECC scoring system. Information regarding feeding practices during early childhood was also collected.

RESULTS

Caries was seen in 70% of the children, with a total mean DMFT value of 4.25 ± 4.2 per child. The mean values increased from 2.4 ± 3.2 DMFT at age 3 to 5.6 ± 4.9 at age 5 (4.1 ± 6.3 and 12.8 ± 12.0 DMFS, respectively). Age and feeding practices showed statistically significant associations with caries (P < .001). The mean DMFT in the bottlefed children was 5.33 ± 4.6 compared with only 3.27 ± 3.5 in predominantly breastfed children. Forty-eight percent of the children had ECC, and 24% showed a severe degree with carious defects and open caries lesions. A significantly higher prevalence and severity of ECC was observed in children who were bottlefed (z-statistic, -2.1; P = .036) compared with breastfed children.

CONCLUSION

In addition to a high prevalence of caries and ECC in preschool children, bottlefeeding led to even higher caries rates in Syria. Since the caries was largely untreated, preventive and restorative dental programs should be implemented.

Longitudinal changes of bone ultrasound measurements in healthy infants during the first year of life: influence of gender and type of feeding

There is evidence suggesting that early events in life may predispose the adult to osteoporosis. We assessed bone status by quantitative ultrasonography in healthy neonates, and we report the changes occurring during the first year of life, according to the type of early feeding. We measured the speed of sound (SOS) of the left tibia in 116 full-term infants (0-9 days of age) and in their mothers (21-42 years of age). SOS values did not correlate with gestational age of the study subjects (r = 0.08) or anthropometric measurements. The SOS measurements of the mothers did not correlate with those of their children (r = 0.01). Fifty-seven infants had SOS measurements performed at 4 and 12 months. Twenty-five infants were exclusively breast-fed, 12 received formula milk from birth, and 20 received human and formula milk. SOS measurements at 4 months were comparable with those at baseline, whereas at 12 months they were significantly higher. No effect of type of feeding was observed, indicating that SOS changes may be independent of the type of early diet.

Infant- and young child-feeding practices in Bankura district, West Bengal, India

A community-based, cross-sectional descriptive study was conducted during June-July 2008 to assess the infant- and young child-feeding (IYCF) practices in Bankura district, West Bengal, India. In total, 647 children aged less than two years selected through revised 40-cluster sampling using the indicators of the Integrated Management of Neonatal and Childhood Illness (IMNCI) and World Health Organization. The proportions of infants with early initiation of breastfeeding (13.6%) and exclusive breastfeeding under six months (57.1%) and infants who received complementary feeding at the age of 6-8 months (55.7%) were low. Appropriate feeding as per the IMNCI protocol was significantly less among infants aged 6-11 months (15.2%) and children aged 12-23 months (8.7%) compared to infants aged less than six months (57.1%), which could be attributable to low frequency and amount of complementary feeding. The main problems revealed from the study were late initiation of breastfeeding, low rates of exclusive breastfeeding, and inappropriate complementary feeding practices.

Human milk pumping rates of mothers of singletons and mothers of multiples

Rates of breastfeeding are increasing, but the methods by which human milk is fed to infants is not well described. Using a retrospective survey design, the authors collected information about infant feeding from mothers of term, preterm, singleton, and multiple-gestation infants (n=346). Human milk feeding methods were characterized as solely at the breast, pumped only, or a combination. Sixty-eight percent of mothers in the study fed their infants at least some human milk; 77% of these mothers reported pumping milk. There was no difference in the percentage of pumping based on multiple gestation or length of pregnancy. Feeding human milk solely at the breast at early postpartum time points was associated with longer durations of human milk feeding overall. More research is needed to better understand why mothers choose pumping over direct human milk feedings and to evaluate the health outcomes associated with this practice.

Infant botulism in the age of botulism immune globulin

Infant botulism causes acute bulbar dysfunction, weakness, and respiratory failure in infants living in endemic regions of the United States. Until Food and Drug Administration approval of botulism immune globulin (BIG) in October 2003, management of infant botulism had changed little since the 1970s. Currently, IV therapy with BIG is advised to shorten the duration and diminish the potential complications of the disorder. This review describes two decades of experience with infant botulism and provides a contemporary perspective on the role and benefit of BIG.

Identification of errors and factors associated with errors in data from electronic swine feeders1

Electronic swine feeders are used to automatically measure individual feed intake on group-housed pigs, but the resulting data contain errors caused by feeder malfunctions and animal-feeder interactions. The objectives of this study were to 1) develop criteria to identify errors in data from an electronic feeder that is predominant in the United States; 2) evaluate the frequency of errors in data from three consecutive experiments using the same feeders; and 3) identify factors associated with errors. Across experiments, data included 1,878,321 feed intake records (visits) on 1,721 pigs and 124 pens. Sixteen criteria were developed to detect errors in seven variables related to feed trough weights and times. Logistic regression was used to identify factors associated with the presence or absence of each error type in identified visits (visits where the feeder recognized a transponder) using a model that included the fixed effects of replicate, sex, linear and quadratic effects of day on test, and random effects of feeder within replicate, pig within feeder within replicate, test day within replicate, and week within feeder within replicate. Frequencies of error types in identified visits varied considerably within and between experiments. Errors in feed trough weights were more frequent than errors in time. Percentage of identified visits and of daily feed intake records with at least one error ranged from 4.3 to 18.7% and from 17.2 to 50.0%, respectively, and decreased from the first to the last experiment, reflecting the increasing ability of the managers to operate the feeders. Replicate, sex, test day, feeder within replicate, pig, and day within replicate affected the number of errors that occurred, but their effect varied among error types. Week-to-week variation within a feeder and replicate had the largest effect on number of errors, which was likely associated with feeder management. Results indicate that the frequency of errors in data from electronic swine feeders is substantial, but visits with errors can be identified and their frequency can be decreased by proper feeder management.

Are infant feeding options that are recommended for mothers with HIV acceptable, feasible, affordable, sustainable and safe? Pregnant women's perspectives

OBJECTIVE

To investigate pregnant women's views on infant feeding options recommended for HIV-infected women.

DESIGN

A structured interview survey complemented with focus group discussions.

SETTING

Antenatal clinics in Moshi urban and rural districts of Tanzania.

SUBJECTS

Five hundred pregnant women participated in the interview survey and 46 pregnant women participated in six focus group discussions.

RESULTS

Participating women reported that they would change to an alternative infant feeding method if they were found to be HIV-infected and were advised to do so. Cow's milk was regarded as the most feasible infant feeding method for local HIV-infected mothers. Infant feeding formula was regarded as too costly, but if recommended by health workers and distributed free of charge, the majority of the women (82%) were confident that they would then choose this option. In the focus group discussions, women were less optimistic and expressed great concern for the social consequences of not breast-feeding. The safety of exclusive breast-feeding was questioned. Less common infant feeding methods, such as expressed heat-treated breast milk and wet-nursing, were not regarded as viable options. Several social barriers to replacement feeding were identified in the focus group discussions, including possible lack of support from partner and potential negative reactions from the community.

CONCLUSION

Future research on infant feeding options should include the broader cultural context and the psychological stress that HIV-infected women face when choosing infant feeding methods.

Feeding, artificial sucking habits, and malocclusions in 3-year-old girls in different regions of the world

PURPOSE

The way babies and young children are reared is important to their health and development. Extensive breast-feeding has also been shown to reduce the development of artificial sucking habits like digit or pacifier-sucking. The aim of this study was to determine feeding methods, artificial sucking habits, and the presence of malocclusions in 3-year-old girls living in different regions of the world.

METHODS

Children from the following countries were involved in the present study: (1) Brazil (Porto Alegre); (2) Japan (Niigata); (3) Mexico (Mexico City); (4) Norway (Oslo); (5) Sweden (Falköping); (6) Turkey (Istanbul); (7) and the United States (Iowa City, Iowa). During the interview and examination, the following variables were evaluated and registered: (1) breastfeeding and bottle-feeding; (2) duration and frequency; (3) sucking habits; (4) posterior and anterior crossbites; and (5) other malocclusions/normal occlusion.

RESULTS

The prevalence of breast-feeding was very high in all groups, ranging between 78% and 98%. The prevalence of bottle-feeding in the different areas was also high. Except for Iowa City, the prevalence of digit-sucking was relatively low. Pacifier-sucking is fairly popular in most areas, with the exception of Niigata. The prevalence of normal occlusion in different cities ranged from 38% to 98%.

CONCLUSIONS

There are considerable differences in feeding, as well as artificial sucking habits, in different areas of the world and at different periods.

Comparison of Feeding Among Multiple Birth Infants

Mothers of multiples who choose to feed their infants breast milk are faced with a seemingly overwhelming set of circumstances. Since mothers of multiples could potentially feed their infants differing proportions of breast milk, current methods of obtaining breastfeeding data for mothers of singletons may not adequately describe the breastfeeding behaviors of mothers of twins and triplets. The goal of our study was to determine the proportion of breast milk each infant of a multiple set was fed over a six-month period and compare the feeding regimens of sibling infants. Results of this retrospective study based on maternal reports indicated that there was almost complete agreement in the proportion of breast milk fed to siblings born from the same pregnancy, regardless of stratification based on gestational age, plurality, or location of the infants (hospital vs. home). The Pearson correlation coefficient for duration of breast-milk feeding between sibling twins was 0.99 (p < .0001); among sibling triplets the values were .97, .98 and .99 (p < .0001). A better understanding of the process by which twins and triplets are fed breast milk sets the stage for future research and can ultimately lead to the development of strategies to increase breast-milk feeding rates for multiple birth children.

Field evaluation of capsaicin as a rodent aversion agent for poultry feed

Developing additional techniques for reducing animal feed contamination by rodents and controlling rodent populations is critical to efforts aimed at reducing the occurrence of Salmonella spp infection on poultry farms. Capsaicin, a compound found in chili peppers of the genus Capsicum, produces a burning sensation in the mouth of mammals and is used effectively as an animal deterrent for some pest species. Applied to poultry feed, capsaicin may be effective as an aversive agent to deter rodent feeding and enhance acceptability of rodenticide baits. We tested capsaicin-treated poultry diets (2000 and 3000 Scoville Heat Units, SHU) in no-choice feeding trials at four active New York farms in the winter of 1997-1998. At all farms, consumption of the 2000 SHU diet by rodents (Norway rats, Rattus norvegicus (Berk), and house mice, Mus musculus L) was significantly less than consumption of a control diet. Consumption of the 3000 SHU diet by rodents was significantly less than consumption of a control diet at three of the four farms. Overall, consumption of treated diets was 58-97% and 55-98% less than consumption of the control diet, for the 2000 and 3000 SHU diets, respectively. These reductions appeared to be related closely to the availability of alternative feed sources at these farms. Two-choice feeding trials involving a rodenticide bait (0.05 g kg(-1) brodifacoum) and the 3000 SHU diet demonstrated that Norway rats preferred the rodenticide to the capsaicin-treated poultry feed. Overall, rodenticide bait acceptance was high (95.6%) when offered simultaneously with capsaicin-treated poultry feed. Although poultry managers must utilize several techniques to manage rodent pests, the use of capsaicin-treated diets to reduce feed losses and increase rodenticide bait acceptance appears promising. Use of capsaicin-treated feed on poultry farms may substantially reduce feed contamination by rodents and ultimately the incidence of Salmonella infection in poultry.

Early childhood caries and risk factors in Jordan

OBJECTIVE

To describe the prevalence of dental caries among Jordanian preschool children and risk factors for caries.

DESIGN

Preschool children aged 1 to 5 years from randomly selected nurseries and kindergartens in Amman were surveyed in September 2001. A questionnaire to investigate factors that might have affected dental caries level was completed by parents. Dental caries was diagnosed as recommended by the World Health Organization.

RESULTS

The mean dmft scores at 1, 2, 3, 4, and 5 years were 0.19, 1.15, 1.7, 2.13, and 3.22 respectively. Overall, 52% of children were caries-free. Caries level was significantly related to feeding practices, snacking habits, oral health practices and pattern of dental visiting as well as to socio-economic background, parents, education level and awareness.

CONCLUSION

The dental caries level was slightly higher than that of children in industrialised countries but lower than that of children in the neighbouring Arab countries. However, the early caries development seen in children from the lower socio-economic classes, because they are at high risk for caries in Jordan, reinforces the need for preventive programmes before eruption of the teeth. Access to dental care must be improved to enable any preventive strategies to be implemented.

A matched cohort study of feeding practice guidelines for infants weighing less than 1,500 g

PURPOSE

To evaluate the efficacy and safety of clinical practice guidelines (CPG) for the nutritional management of infants weighing < 1,500 g.

SUBJECTS

Infants weighing < 1,500 g (n = 200) admitted to the NICU who had no major congenital anomalies were enrolled.

DESIGN AND METHODS

A before-and-after matched cohort study was conducted during 1996/1997 and 1998/1999 enrolling infants in a Standard Practice (SP) group and CPG group, respectively. Weight-stratified CPG were introduced between these 2 study periods. Data on the first 100 babies who could be matched for birth weight and gestational age were analyzed. Data collection continued until full feedings were established and tolerated for 48 hours or the infant was discharged from the hospital, whichever came first.

PRIMARY OUTCOME MEASURE

Of the 200 infants in the study (median gestational age 28 weeks), 142 infants attained full feedings. The median time to full feedings was 15 days in both groups, and a paired sample t test showed no significant difference between the 2 groups (P = 0.35).

PRINCIPAL RESULTS

No statistically significant differences in the age of feeding commencement, number of feeding interruptions, days on total parenteral nutrition, days to regain birth weight, age at discharge, incidence of sepsis, necrotizing enterocolitis, or use of erythromycin were found.

CONCLUSIONS

The CPG was a safe alternative to standardize nutritional practices in the NICU. The lack of differences between groups shown in this study is likely related to gut immaturity limiting the infant's response to changes in feeding practices, inconsistent use of the guidelines, confounding factors, the small sample size, or the similarity between SP and the CPG.

The impact of infant feeding patterns on infection and diarrheal disease due to enterotoxigenic Escherichia coli

OBJECTIVE

Determine the impact of dietary risk factors on patterns of infection by heat labile toxin-producing Escherichia coli (LT-ETEC).

MATERIALS AND METHODS

Ninety-eight infants were followed from birth for one year in Guadalajara, Mexico, beginning in august of 1986. Stool and breast milk samples were collected weekly from infants and their mothers, respectively. Mothers were also interviewed on a weekly basis regarding the health of the infants. Parametric hazard models were fit to durations of different LT-ETEC disease states determined through the analysis of stools. The child's consumption of supplemental foods and liquids as well as specific levels of LT-ETEC-specific breast milk antibodies were included in each model as time-varying covariates.

RESULTS

The hazard of LT-ETEC asymptomatic infection increased 400 percent among children who received oats gruel (hazard rate = 4.01; 95% CI 2.77-5.24). The duration of infection was reduced if the child had had a previous LT-ETEC diarrheal episode (2.12; 95% CI 1.74-2.49) but was prolonged if the child consumed herbal teas (0.53; 95% CI 0.27-0.7). Herbal teas and high LT-ETEC-specific breast milk antibody levels each reduced the hazard of symptomatic infection by ninety percent. Symptomatic episodes became asymptomatic more rapidly if a child was given rice water.

CONCLUSIONS

Specific weaning foods increase the risk of infection. Breastmilk antibodies and liquid infusions reduce diarrheal disease and infection duration.