Do early infant feeding practices vary by maternal ethnic group?

Breastfeeding, Walking Onset, and Abdominal Obesity Are Determinants of Physical Fitness among Latin American and Spanish Schoolchildren: A Cross-Cultural Study

OBJECTIVE

To comp+are levels of physical fitness between Ecuador and Spain and identify whether breastfeeding period, walking onset, and abdominal obesity are determinants of physical performance in schoolchildren from Ecuador and Spain.

METHODS

a total of 352 schoolchildren (6-12 years old) from Ecuador (n = 176) and Spain (n = 176) joined in this study. Anthropometric measures, socio-demographic characteristics, and physical fitness were evaluated.

RESULTS

Spanish schoolchildren showed better performance in handgrip strength, standing long jump, and 25 m sprint (p = 0.021; p < 0.001; p < 0.001; p < 0.001, respectively). Furthermore, Spanish children showed better cardiorespiratory fitness (p < 0.001) and a higher VO2 max (p = 0.002) with regards to their peers. In addition, children from Ecuador and Spain showed an influence of breastfeeding period (p ranged from <0.001 to 0.043) and walking onset (p ranged from <0.001 to 0.032) on physical performance. Moreover, physical fitness components were protective factors of abdominal obesity in Ecuadorian and Spanish schoolchildren (p ranged from =0.001 to 0.049).

CONCLUSIONS

Our findings revealed the influence of the infancy period and the onset of walking on children's physical performance, highlighting the importance of these factors in motor development during early childhood and also their influence in middle childhood and throughout adulthood.

A cross-sectional study of infant feeding practices in Vietnamese-born mothers living in Australia

BACKGROUND

Infant feeding practices are a key modifiable risk factor for childhood overweight and obesity; and important for lifelong health and wellbeing. Despite the growing Australian immigrant population, it is unclear how infant feeding practices may differ between ethnicities living in Australia. Few studies have examined the infant feeding practices of Vietnamese mothers who migrate and give birth to infants in Australia - termed Vietnamese-born mothers. The aim of this study was to examine differences in infant feeding practices (breastfeeding, formula feeding and complementary feeding (other fluids and solids)) in Vietnamese-born mothers compared with Australian-born mothers living in Australia.

METHOD

This study analysed the Australian National Infant Feeding Survey dataset (2010-11), a large national cross-sectional survey measuring feeding practices of infants aged 0-24 months old. Infant feeding practices of Vietnamese-born mothers (n = 261) and a random sub-sample of Australian-born mothers (n = 261) were compared. Associations between ethnicity and infant feeding practices were examined through logistic and linear regression adjusting for maternal age, socioeconomic status, body mass index (BMI) at start of pregnancy, infant age at survey completion and parity. Compliance with the Australian national infant feeding guidelines was also assessed.

RESULTS

Compliance with infant feeding guidelines was low, with differences in infant feeding practices between groups. At the time of survey completion, when infants were on average 7.2 months old, compared with infants of Australian-born mothers, infants to Vietnamese-born mothers were significantly younger when first exposed to fruit juice (b = -2.41, 95%CI: -4.54- -0.28); less likely to be exposed to solids (AOR: 0.15, 95%CI: 0.05-0.44) and more likely to be exposed to formula milks (AOR: 2.21, 95%CI: 1.10-4.43); toddler milks (AOR: 16.72, 95%CI: 3.11-90.09) and fruit juice (AOR: 2.37, 95%CI: 1.06-5.32) (p < 0.05).

CONCLUSION

Low adherence with breastfeeding (low breastfeeding and high infant formula use) and other fluids (toddler milks and fruit juice) recommendations outlined by the Australian infant feeding guidelines were observed in this group of Vietnamese-born mothers. To optimise feeding and growth in Vietnamese-Australian children, culturally appropriate infant feeding support targeting breastfeeding durations, reducing reliance on infant formula, and reducing inappropriate introduction to other fluids should be the focus of infant feeding promotion within these mothers.

Determinants of rapid infant weight gain: A pooled analysis of seven cohorts

OBJECTIVE

Rapid weight gain (RWG) in infancy is strongly associated with subsequent obesity risk, but little is known about the factors driving RWG. This study explored the child and maternal factors associated with infant RWG.

METHODS

Data from seven Australian and New Zealand cohorts were used (n = 4542). Infant RWG was defined as a change in weight z-score ≥0.67 from birth to age 1 year. Univariable and multivariable logistic regression assessed the association between child and maternal factors and infant RWG in each cohort. Meta-analysis was conducted to obtain pooled effect sizes.

RESULTS

Multivariable analyses revealed boys were more likely to experience RWG (OR 1.42 95% CI 1.22, 1.66) than girls. Higher birth weight in kg (OR 0.09, 95% CI 0.04, 0.20) and gestational age in weeks (OR 0.69, 95% CI 0.48, 0.98) were associated with lower RWG risk. Children who were breastfed for ≥6 months showed lower RWG risk (OR 0.45, 95% CI 0.38, 0.53). Children of native-born versus overseas-born women appeared to have higher RWG risk (OR 1.37, 95% CI 0.99, 1.90). Maternal smoking during pregnancy increased RWG risk (OR 1.60, 95% CI 1.28, 2.01), whereas children who started solids ≥6 months (OR 0.77, 95% CI 0.63, 0.93) and children with siblings (OR 0.68, 95% CI 0.57, 0.81) showed lower RWG risk in univariable analysis, but these associations were attenuated in multivariable analysis. No association was found for maternal age, education, marital status and pre-pregnancy BMI.

CONCLUSION

Maternal country of birth, smoking status, child sex, birth weight, gestational age, infant feeding and parity were potential determinants of infant RWG.

Suriyeli mülteci ve türk kadınlarının perinatal eğilimleri ve obstetrik sonuçları

Aim: The impact of migration on health is far-reaching, making migrant populations particularly vulnerable, fueling health inequalities and resulting in serious implications for global health. The aim of our study to assess antenatal care, pregnancy and neonatal outcomes of Syrian refugee women in Turkiye. Material and Methods: Syrian and Turkish pregnants who delivered between 2013-2019 were recruited and categorized into groups according to maternal age at delivery. First trimester combined test, second trimester triple test, preterm delivery, maternal anemia; neonatal stillbirth, APGAR scores, birth weight and breastfeeding status were assessed. Results: 4992 Syrian and 6846 Turkish pregnants were included. Maternal anemia was higher in Turkish patients in 20-34 and ≥35 groups. First trimester combined test, APGAR scores and birth weights were lower in Syrian women. Preterm rates higher in Turkish patients in only 20-34 age group. Second-trimester triplet tests were only higher in Turkish women in ≥35 age group. Low birth weight was higher in younger Syrian patients. Satisfying breastfeeding results were found in Syrian women. Conclusion: Our study stated that Syrian women are at risk of low birth weight in adolescent and 20-34 age groups and low rates in first trimester combined test in all age groups. However decreased risk of pregnancy complications such as maternal anemia, preterm delivery, cesarean delivery and satisfying breastfeeding results were found in Syrian patients.

Differences in infant feeding practices between Indian-born mothers and Australian-born mothers living in Australia: a cross-sectional study

Background

Immigrant children from low- and middle-income countries (e.g. India) have higher obesity rates than children from high-income countries (e.g. Australia). Infant feeding practices are a key modifiable risk factor to prevent childhood obesity. This study compared infant feeding practices such as breastfeeding, infant formula feeding, timing of introduction to other liquids and solids of Indian-born versus Australian-born mothers living in Australia.

Methods

Data of children aged between 0–24 months from the 2010–2011 Australian National Infant Feeding Survey were analysed. Infant feeding practices between Indian-born mothers (n = 501) and Australian-born mothers (n = 510) were compared. Multiple regression models with adjustments for covariates, such as maternal demographic factors, were conducted.

Results

Compared to infants of Australian-born mothers, infants of Indian-born mothers were breastfed for 2.1 months longer, introduced solids 0.6 months later and water 0.4 months later (p < 0.001). Moreover, infants of Indian-born mothers were 2.7 times more likely to be currently breastfeeding, 70% less likely to currently consume solids and 67% less likely to consume solids before six months (p < 0.001). In contrast, infants of Indian-born mothers were introduced to fruit juice 2.4 months earlier, water-based drinks 2.8 months earlier and cow’s milk 2.0 months earlier than infants of Australian-born mothers (p < 0.001). Additionally, infants of Indian-born mothers were 2.7 times more likely to consume fruit juice (p < 0.001) than the infants of Australian-born mothers.

Conclusion

Significant differences exist in infant feeding practices of Indian-born and Australian-born mothers (some health promoting and some potentially obesogenic). The evidence of early introduction of sweetened fluids in infants of Indian-born mothers provides an opportunity to support parents to delay introduction to promote optimal infant growth..

Complementary feeding practices and the associated risk of childhood obesity among ethnic minority groups living in high-income countries: protocol for a systematic review and meta-analysis

INTRODUCTION

Complementary feeding (CF) is defined as the period from when exclusive breast milk and formula are no longer sufficient for meeting the infant's nutritional needs. The CF period occurs from birth to 23 months of age. Though the recommended guidelines for introducing CF is from around 6 months of age, data indicates that some infants are introduced to food earlier than 6 months which can predispose children to obesity and overweight. Obesity in ethnic minority groups (EMG) is higher than their native counterparts and often tracks into adulthood. Hence, our aim was to conduct a systematic review and meta-analysis on the available literature to identify the risk of childhood overweight/obesity associated with CF practices concerning their timing, as well as the frequency and type of CF food introduced. We focused specifically on EMG children living in high-income countries.

METHODS AND ANALYSIS

A methodological literature search surrounding childhood obesity and overweight (COO) risk associated with CF practices will be conducted in May 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. The following academic databases will be methodologically searched: PubMed, EMBASE, PsycINFO, CINAHL, SCOPUS, Cochrane Library and the WHO Global Index Medicus. Three independent researchers will be involved in independent screening and review the included articles based on the predefined inclusion and exclusion criteria. Where conflicts arise during the screening process, it will be resolved through discourse until a consensus is reached. Information on CF practices and anthropometric measurements will be extracted to ascertain the risk of COO. For this study, WHO body mass index for age and sex percentiles, Centers for Disease Control and Prevention classification and other recognised country-specific classifications will be utilised for the outcome.

ETHICS AND DISSEMINATION

Formal ethical approval is not needed as the results will be drawn from currently available published literature. Outcomes of the review will be shared through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42021246029.

Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants

Premature infants are born prior to a critical window of rapid placental nutrient transfer and fetal growth-particularly brain development-that occurs during the third trimester of pregnancy. Subsequently, a large proportion of preterm neonates experience extrauterine growth failure and associated neurodevelopmental impairments. Human milk (maternal or donor breast milk) is the recommended source of enteral nutrition for preterm infants, but requires additional fortification of macronutrient, micronutrient, and energy content to meet the nutritional demands of the preterm infant in attempts at replicating in utero nutrient accretion and growth rates. Traditional standardized fortification practices that add a fixed amount of multicomponent fortifier based on assumed breast milk composition do not take into account the considerable variations in breast milk content or individual neonatal metabolism. Emerging methods of individualized fortification-including targeted and adjusted fortification-show promise in improving postnatal growth and neurodevelopmental outcomes in preterm infants.

Factors Affecting Complementary Feeding of Infants. A Pilot Study Conducted after the Introduction of New Infant Feeding Guidelines in Poland

Adequate nutrition in the first year of life is the key prerequisite for a child’s healthy growth and development. The success of complementary feeding is influenced by various factors, including the family’s socioeconomic status, maternal age, place of residence and educational level, older children and duration of breastfeeding. Modified infant feeding guidelines were introduced in Poland in 2016. The aim of this study was to identify the factors that exert the greatest influence on infant feeding practices in the Polish population. A thorough understanding of maternal factors that are responsible for undesirable feeding practices is required to improve the mothers’ knowledge and to promote healthy feeding practices. This study was carried out in March–June 2018 and between November 2018 and March 2019 in the Region of Lublin in southeastern Poland. The mothers of children aged 9–14 months, who had introduced complementary foods, were invited to the study. A total of 441 mothers agreed to participate, and 289 of them fully and correctly completed the questionnaires. Logistic regression models were developed to assess the association between maternal factors, such as age, educational level and the nutrition knowledge score, and introduction of solid foods. The infant’s sex and birth weight and the mother’s place of residence had no significant influence on the duration of breastfeeding. The mother’s age and educational level, the number of children in the family and maternal nutrition knowledge scores contributed to significant differences in breastfeeding duration. Older mothers (30–34 years vs. 25–29 years, p = 0.001), better educated mothers (university vs. secondary school education p = 0.002) and mothers with one or two children exclusively breastfed their children for longer (17 weeks vs. 11 weeks, p = 0.002) than younger mothers with secondary school education and more than three children. Exclusive formula feeding was significantly correlated with untimely introduction of solid foods compared to exclusive breastfeeding (13 weeks vs. 19.7 weeks, p = 0.001). Mothers with nutrition knowledge scores in the upper tertile were more likely to adapt food consistency to the skills manifested by the child (88%) (OR = 1.88; Cl: 1.53–2.26, p < 0.05) and were less likely to delay the introduction of new foods that required chewing and biting (84%) (OR = 0.22; Cl: 0.09–0.34, p < 0.05) than mothers with nutrition knowledge scores in the bottom tertile. Maternal age, educational level and nutrition knowledge significantly increased the age at which infants were introduced to solid foods and the correct identification of the signs indicative of the child’s readiness to explore new tastes and foods with a new consistency. The above factors contributed to delayed, but not untimely, introduction of complementary foods (6 months of age or later), including gluten.

Growth patterns from birth to overweight at age 5-6 years of children with various backgrounds in socioeconomic status and country of origin: the ABCD study

INTRODUCTION

Children from minority groups are at increased risk of overweight. This study compared BMI growth patterns from birth onwards of boys and girls with overweight at 5-6 years, according to socioeconomic status (SES) and country of origin, in order to gain more insight into the critical periods of growth to overweight.

METHODS

A total of 3714 singletons of the multi-ethnic ABCD study were included. Within children with overweight at age 5-6 years (N = 487, prevalence boys: 11.6%, girls: 14.6%), BMI growth patterns from birth onwards (12.8 serial measurements; SD = 3.1) were compared between children from European (69.4%) and non-European mothers (30.6%), and between children from low (20.8%), mid (37.0%) or high SES (42.2%), based on maternal educational level.

RESULTS

BMI growth to overweight did not differ between children of European or non-European mothers, but it did differ according to maternal SES. Children with overweight in the low and mid SES group had a lower BMI in the first 2 years of life, an earlier adiposity rebound and increased in BMI more rapidly after age 2, resulting in a higher BMI at age 7 years compared to children with overweight in the high SES group [∆BMI (kg/m2 ) between high and low SES: boys 1.43(95%CI:0.16;3.01) and girls 1.91(0.55;3.27)].

CONCLUSION

Children with overweight from low SES have an early adiposity rebound and accelerated growth to a higher BMI at age 5-6 years compared to children with overweight from the high SES group. These results imply that timing of critical periods for overweight development is earlier in children with a low socioeconomic background as compared to other children.

Breastfeeding beliefs and experiences of African immigrant mothers in high-income countries: A systematic review

Breastfeeding provides optimal nutrition for the healthy growth of infants and is associated with reduced risks of infectious diseases, child and adult obesity, type 2 diabetes, and other chronic diseases. Migration has been shown to influence breastfeeding especially among migrants from low-and-middle-income countries. This mixed-methods systematic review aimed to identify, synthesise, and appraise the international literature on the breastfeeding knowledge and experiences of African immigrant mothers residing in high-income countries. MEDLINE, CINAHL, Embase, PsychINFO, Scopus, and Web of Knowledge databases were searched from their inception to February 2019. Grey literature, reference, and citation searches were carried out and relevant journals hand-searched. Data extraction and quality assessment were independently carried out by two reviewers. An integrated mixed-methods approach adopting elements of framework synthesis was used to synthesise findings. The initial searches recovered 8,841 papers, and 35 studies were included in the review. Five concepts emerged from the data: (a) breastfeeding practices, showing that 90% of African mothers initiated breastfeeding; (b) knowledge, beliefs, and attitudes, which were mostly positive but included a desire for bigger babies; (c) influence of socio-demographic, economic, and cultural factors, leading to early supplementation; (d) support system influencing breastfeeding rates and duration; and (e) perception of health professionals who struggled to offer support due to culture and language barriers. African immigrant mothers were positive about breastfeeding and willing to adopt best practice but faced challenges with cultural beliefs and lifestyle changes after migration. African mothers may benefit from more tailored support and information to improve exclusive breastfeeding rates.

Predictors of Early Introduction of Core and Discretionary Foods in Australian Infants-Results from HSHK Birth Cohort Study

Early introduction of complementary foods can have a detrimental impact on children's long-term health. This study examined the timing and determinants of early introduction of core and discretionary foods among infants in Sydney, Australia. Mothers (n = 1035) from an ongoing population-based birth cohort study were interviewed at 8, 17, 34 and 52 weeks postpartum. The outcome was 'age at which particular core and discretionary food items were first introduced'. Multivariable logistic regression models were used to investigate family and infant-related determinants of early introduction of core (<17 weeks of age) and discretionary foods (<52 weeks of age). Of the 934 mother-infant dyads interviewed, 12% (n = 113) of infants were introduced core foods before 17 weeks of age (median: 22). Mothers working part-time (adjusted odds ratio (OR): 3.42, 95% confidence interval (CI): 1.54-7.62) and those exclusively formula-feeding their babies at four-weeks postpartum (adjusted OR 3.26, 95% CI: 1.99-5.33) were most likely to introduce core foods early. Ninety-five percent (n = 858) of infants were introduced discretionary foods before 52 weeks of age (median: 28). Low socio-economic status was significantly associated with early introduction of discretionary foods (adjusted OR: 3.72, 95% CI: 1.17-11.78). Compliance with infant feeding guidelines related to core foods was better; however, discretionary foods were introduced early in most infants.

Factors Influencing the Age of Complementary Feeding-A Cross-Sectional Study from Two European Countries

The timing of introducing complementary feeding affects nutritional status and children's health. The aim of this study was to determine sociodemographic and birth-related factors associated with the age of introducing complementary foods. This cross-sectional study investigated parents (n = 5815) of children aged 12-36 months from Poland (n = 4065) and Austria (n = 1750) using a single online questionnaire. During the study, detailed data about sociodemographic characteristics, variables related to pregnancy, and early feeding practices were collected. Univariate and multivariate logistic regression models were used to investigate factors associated with the introduction of complementary feeding before 4 completed months, between 4 and 6 months, and after 6 completed months separately for both countries. Complementary foods were introduced before 4 months in 3.0% of infants (2.4% in Poland and 4.3% in Austria), between 4 and 6 months in 65.0% (60.5% in Poland and 75.3% in Austria), and after 6 completed months in 32.1% of infants (37.1% in Poland and 20.4% in Austria). The factors related to earlier introduction of complementary feeding were lower maternal age (in Austria 25-29 years: aOR 2.21 (95% CI 1.06-4.65)) and education level (in Poland and Austria primary and vocational: aOR 14.49 (95% CI 3.73-56.35), aOR 2.13 (95% CI 1.10-4.11), respectively), preterm birth (in Poland and Austria: aOR 10.21 (95% CI 5.73-18.20); aOR 4.45 (95% CI 2.42-8.18), respectively), never breastfeeding (Poland: aOR 2.73 (95% CI 1.29 - 5.76)) and receiving an infant formula after hospital discharge (in both countries: aOR 3.73 (95% CI 2.06-6.75); aOR 3.65 (95% CI 1.87-7.12), respectively). These factors should be taken into account by health professionals in identifying mothers who are least likely to follow nutritional recommendations.

Complementary Feeding Practices for South Asian Young Children Living in High-Income Countries: A Systematic Review

Sub-optimal nutrition among South Asian (SA) children living in high-income countries is a significant problem. High rates of obesity have been observed in this population, and differential complementary feeding practices (CFP) have been highlighted as a key influence. Our aim was to undertake a systematic review of studies assessing CFP in children under two years of age from SA communities living in high-income countries, including dietary diversity, timing, frequency and promotors/barriers. Searches covered January 1990⁻July 2018 using MEDLINE, EMBASE, Global Health, Web of Science, BanglaJOL, OVID Maternity and Infant Care, CINAHL, Cochrane Library, POPLINE and World Health Organisation (WHO) Global Health Library. Eligible studies were primary research on CFP in SA children aged 0⁻2 years. Search terms were "children", "feeding" and "South Asian", and derivatives. Quality appraisal used the Evidence for Policy and Practice Information (EPPI) Weight of Evidence scoring. From 50,713 studies, 13 were extracted with ten from the UK, and one each from the USA, Canada and Singapore. Sub-optimal CFP were found in all studies. All ten studies investigating timing reported complementary feeding (CF) being commenced before six months. Promoters/barriers influencing CFP included income, lack of knowledge, and incorrect advice. This is the first systematic review to evaluate CFP in SA children living in high-income countries and these findings should inform the development of effective interventions for SA infants in these settings.

Ethnic variation in unexplained deaths in infancy, including sudden infant death syndrome (SIDS), England and Wales 2006-2012: national birth cohort study using routine data

BACKGROUND

Unexplained deaths in infancy comprise 'sudden infant death syndrome' (SIDS) and deaths without ascertained cause. They are typically sleep-related, perhaps triggered by unsafe sleep environments. Preterm birth may increase risk, and varies with ethnicity. We aimed to compare ethnic-specific rates of unexplained infant death, explore sociodemographic explanations for ethnic variation, and examine the role of preterm birth.

METHODS

We analysed routine data for 4.6 million live singleton births in England and Wales 2006-2012, including seven non-White ethnic groups ranging in size from 29 313 (Mixed Black-African-White) to 180 265 (Pakistani). We calculated rates, birth-year-adjusted ORs, and effects of further adjustments on the χ² for ethnic variation.

RESULTS

There were 1559 unexplained infant deaths. Crude rates per 1000 live singleton births were as follows: 0.1-0.2 for Indian, Bangladeshi, Pakistani, White Non-British, Black African; 0.4 for White British; 0.6-0.7 for Mixed Black-African-White, Mixed Black-Caribbean-White, Black Caribbean. Birth-year-adjusted ORs relative to White British ranged from 0.38 (95% CI 0.24 to 0.60) for Indian babies to 1.73 (1.21 to 2.47) for Black Caribbean (χ²(10 df)=113.6, p<0.0005). Combined adjustment for parents' marital/registration status and mother's country of birth (UK/non-UK) attenuated the ethnic variation. Adjustments for gestational age at birth, maternal age and area deprivation made little difference.

CONCLUSION

Substantial ethnic disparity in risk of unexplained infant death exists in England and Wales. Apparently not attributable to preterm birth or area deprivation, this may reflect cultural differences in infant care. Further research into infant-care practices in low-risk ethnic groups might enable more effective prevention of such deaths in the general population.

Differences in infant feeding practices between Chinese-born and Australian-born mothers living in Australia: a cross-sectional study

BACKGROUND

Chinese immigrants are the third largest immigrant group in Australia. Recent qualitative evidence from Victorian Maternal and Child Health nurses indicate that infants of Chinese parents commonly have rapid growth trajectories and that high value is placed on rapid growth and having a fatter child; with low breastfeeding rates and overfeeding of infant formula. The aim of this study was to compare infant feeding practices (breastfeeding, infant formula, other liquids, solids) of Chinese-born and Australian-born mothers living in Australia.

METHODS

Using the Australian National Infant Feeding Survey dataset (2010-2011), infant feeding data from Chinese-born mothers (n = 602) were compared with a random sub-sample of Australian-born mothers (n = 602). Group differences on feeding practices were tested using Chi-square or t-tests and the effect of ethnicity on infant feeding behaviours assessed using regression.

RESULTS

Compared to infants of Australian-born mothers, infants of Chinese-born mothers were younger when they first consumed infant formula, water-based drinks and fruit juice and older when they first ate solid foods (p < 0.05). Furthermore, infants of Chinese-born mothers were less likely to have ever had cow's milk (OR: 0.37 95%CI:, 0.18-0.78) and solids (0.41, 0.25-0.68); but were more likely to have ever had infant formula (2.19, 1.32-3.62), water (2.45, 1.55-3.87), toddler milk (3.39, 1.60-7.18), water-based drinks (e.g. cordial, soft drink, tea; 2.48, 1.12-5.49), and fruit juice (4.03, 2.50-6.51). Those ≤4 months of age were more likely to have had water-based drinks (7.77, 1.96-30.77) and fruit juice (3.44, 1.14-10.38) (p < 0.05) compared to infants of Australian-born mothers.

CONCLUSION

Differences in mothers' early infant feeding practices exist between Chinese-born and Australian-born mothers living in Australia. Better understanding these ethnically patterned infant feeding practices is important for identifying key opportunities to promote best nutrition and growth in early life in different ethnic groups within our population.

The challenges of preventing food allergy: Lessons learned from LEAP and EAT

OBJECTIVE

To highlight challenges associated with this novel preventive strategy.

DATA SOURCES

The Learning Early About Peanuts (LEAP) and Enquiring About Tolerance (EAT) Studies, with reference to other oral tolerance induction studies.

STUDY SELECTIONS

Randomized clinial trials seeking to prevent food allergy through allergen introduction in infancy.

RESULTS

Oral tolerance induction programs that use a regimen of consumption of 2 g/week of protein are effective in preventing peanut and egg allergy. LEAP findings suggest oral tolerance induction is allergen specific. Adding peanut and other common food allergens (egg, fish, sesame, milk) to the infant diet has no adverse nutritional or growth effects and does not increase rates of food allergy. Breastfeeding rates are not adversely affected by these interventions. In the Western world, nonwhite children have the highest risk of food allergy, but their families are the least likely to participate in oral tolerance induction programs.

CONCLUSION

Many challenges must be overcome to implement successful food allergy prevention strategies. Allergy testing of high-risk infants (those with moderate to severe eczema and/or egg allergy) before commencing oral tolerance induction is desirable, but access is not universal. Dietary interventions would ideally be implemented in infancy before allergic sensitization and allergy occur, using a program that provides protection against multiple common allergens. Further research and consensus with regard to food preparations, target populations, dosing regimens, and preparations and clearly defined adherence are now required.

Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: A systematic review

BACKGROUND

Childhood obesity is a global public health challenge. Parental feeding practices, such as responsive feeding, are implicated in the etiology of childhood obesity.

PURPOSE

This systematic review aimed to examine of effects of healthcare professional-delivered early feeding interventions, on parental feeding practices, dietary intake, and weight outcomes for children up to 2 years. The role of responsive feeding interventions was also specifically examined.

METHODS

Databases searched included: CINAHL, the Cochrane Library, EMBASE, Medline, PubMed, PsycINFO, and Maternity and Infant Care.

INCLUSION CRITERIA

participants are parents of children ≤2 years; intervention includes focus on early child feeding to prevent overweight and obesity; intervention delivered by healthcare professionals.

RESULTS

Sixteen papers, representing 10 trials, met inclusion criteria for review. Six interventions included responsive feeding components. Interventions demonstrated inconsistent effects on feeding practices, dietary intake, and weight outcomes. Findings suggest some reductions in pressure to eat and infant consumption of non-core beverages. Responsive feeding based interventions demonstrate greater improvements in feeding approaches, and weight outcomes.

CONCLUSIONS

The findings of this review highlight the importance of incorporating responsive feeding in healthcare professional delivered early feeding interventions to prevent childhood obesity. Observed inconsistencies across trials may be explained by methodological limitations.

Contested moral landscapes: Negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the U.S. and the U.K

Recent public health breastfeeding promotion efforts have galvanized media debates about breastfeeding in wealthy, Euro-American settings. A growing body of research demonstrates that while breastfeeding is increasingly viewed as important for health, mothers continue to face significant structural and cultural barriers. Concerns have been raised about the moralizing aspects of breastfeeding promotion and its detrimental effects on those who do not breastfeed. Far less, however, is known about the moral experiences of those who pursue breastfeeding. This study draws together research on breastmilk sharing (2012-2016) and nighttime breastfeeding from the U.S. (2006-2009), and long-term breastfeeding from the U.K. (2008-2009) from three ethnographic projects to address this gap. Comparative analysis of these cases reveals that while breastfeeding is considered ideal infant nutrition, aspects of its practice continue to evoke physical and moral danger, even when these practices are implemented to facilitate breastfeeding. Breastmilk sharing to maintain exclusive breastmilk feeding, nighttime breastfeeding and bedsharing to facilitate breastfeeding, and breastfeeding beyond the accepted duration are considered unnecessary, unhealthy, harmful or even deadly. The sexual connotations of breastfeeding enhance the morally threatening qualities of these practices. The cessation of these "problematic" breastfeeding practices and their replacement with formula-feeding or other foods is viewed as a way to restore the normative social and moral order. Mothers manage the stigmatization of these breastfeeding practices through secrecy and avoidance of health professionals and others who might judge them, often leading to social isolation. Our findings highlight the divide between perceptions of the ideal of breastfeeding and its actual practice and point to the contested moral status of breastfeeding in the U.S. and the U.K. Further comparative ethnographic research is needed to illuminate the lived social and moral experiences of breastfeeding, and inform initiatives to normalize and support its practice without stigmatizing parents who do not breastfeed.

Infant and young child feeding practices differ by ethnicity of Vietnamese mothers

Background

Limited studies have examined ethnic variation in breastfeeding and complementary feeding practices in developing countries. This study investigated ethnic variation in feeding practices in mothers with children 0–23 months old in Vietnam.

Methods

We used data on 1875 women who came from the ethnic majority, Kinh (n = 989, randomly sampled from 9875 surveyed Kinh mothers, 10 % from each province) and three ethnic minorities: E De-Mnong (n = 309), Thai-Muong (n = 229) and Tay-Nung (n = 348). Ethnic minorities were compared with the Kinh group using logistic regression model.

Results

Prevalence of breastfeeding initiation within an hour of birth was 69 % in Thai-Muong, but ~50 % in other ethnicities. In logistic regression, the prevalence of breastfeeding within one hour was lower in Tay-Nung (OR: 0.54; 95 % CI: 0.38, 0.77) than the majority Kinh. Prevalence of exclusive breastfeeding under 6 months was 18, 10, 17, and 33 % in Kinh, Thai-Muong, Tay-Nung, and E De-Mnong, respectively; compared to the majority Kinh, the prevalence was lower in Thai-Muong (OR: 0.42; 95 % CI: 0.25, 0.71) and higher in E De-Mnong (OR: 1.99; 95 % CI: 1.04, 3.82). Overall prevalence of bottle feeding in Thai-Muong and E De-Mnong (~20 %) was lower than in Kinh (~33 %): Thai-Muong (OR: 0.50; 95 % CI: 0.37, 0.68) and E De-Mnong (OR: 0.69; 95 % CI: 0.50, 0.95). Compared with Kinh (75 %), fewer ethnic minority children received minimum acceptable diets (33 % in Thai-Muong, 46 % in E De-Mnong, and 52 % in Tay-Nung; P < 0.05). Prevalence of minimum acceptable diet (met both dietary frequency and diversity) was lower in Thai-Muong (OR: 0.23; 95 % CI: 0.11, 0.46), Tay-Nung (OR: 0.52; 95 % CI: 0.39, 0.69), and E De-Mnong (OR: 0.55; 95 % CI: 0.33, 0.89) than the majority Kinh.

Conclusions

Breastfeeding practices were suboptimal and differed by ethnicity, which suggests need for tailored interventions at multiple levels to address ethnic-specific challenges and norms. Complementary feeding practices were less optimal among ethnic minorities compared to Kinh, which suggests need for broad intervention including improved food availability, accessibility, and security.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-0995-8) contains supplementary material, which is available to authorized users.

Bangladeshi women's experiences of infant feeding in the London Borough of Tower Hamlets

This study examined the main factors that influence Bangladeshi women living in London's decisions to partially breastfeed their children, including the influence of older women within the community. Fifty-seven women of Bangladeshi origin living in the London Borough of Tower Hamlets took part in seven discussion groups between April and June 2013. Five groups were held with women of child-bearing age and two groups with older women in the community. A further eight younger women and three older women took part in one-on-one interviews. Interviews were also carried out with eight local health care workers, including public health specialists, peer support workers, breastfeeding coordinators and a health visitor. The influences on women's infant feeding choices can be understood through a 'socio-ecological model', including public health policy; diverse cultural influences from Bangladesh, London and the Bangladeshi community in London; and the impacts of migration and religious and family beliefs. The women's commitment to breastfeeding was mediated through the complexity of their everyday lives. The tension between what was 'best' and what was 'possible' leads them not only to partially breastfeed but also to sustain partial breastfeeding in a way not seen in other socio-cultural groups in the United Kingdom.

Breastfeeding practices in relation to country of origin among women living in Denmark: a population-based study

The objective of this study was to describe breastfeeding practices and to compare the risk of suboptimal breastfeeding of women living in Denmark according to country of origin, and further to examine how socio-economic position and duration of stay in the country affected this risk. Information on breastfeeding of 42,420 infants born 2002–2009 and living in eighteen selected Danish municipalities was collected from the Danish Health Visitor’s Child Health Database. The data was linked with data on maternal socio-demographic information from Danish population-covering registries. Suboptimal breastfeeding was defined as <4 months of full breastfeeding as described by the Danish Health and Medicines Authority. We used logistic regression to model the crude associations between suboptimal breastfeeding and country of origin, and taking maternal age and parity, and a variety of parental socio-economic measures into account. Suboptimal breastfeeding was more frequent among non-Western migrant women than among women of Danish origin. Women who were descendants of Turkish and Pakistani immigrants had a higher risk of suboptimal breastfeeding as compared to the group of women who had migrated from the same countries, suggesting that acculturation did not favor breastfeeding. For all but the group of women who had migrated from Pakistan, adjustment for socio-demographic indicators (age, parity, education, attachment to labour market, and income) eliminated the increased risk of suboptimal breastfeeding. There was no evidence for differences in the breastfeeding support provided at hospital level according to migrant status. Suboptimal breastfeeding was more frequent among women who were non-Nordic migrants and descendants of migrants than among women with Danish origin.

Breast-feeding and complementary feeding practices in the first 6 months of life among Norwegian-Somali and Norwegian-Iraqi infants: the InnBaKost survey

OBJECTIVE

To examine breast-feeding and complementary feeding practices during the first 6 months of life among Norwegian infants of Somali and Iraqi family origin.

DESIGN

A cross-sectional survey was performed during March 2013-February 2014. Data were collected using a semi-quantitative FFQ adapted from the second Norwegian national dietary survey among infants in 2006-2007.

SETTING

Somali-born and Iraqi-born mothers living in eastern Norway were invited to participate.

SUBJECTS

One hundred and seven mothers/infants of Somali origin and eighty mothers/infants of Iraqi origin participated.

RESULTS

Breast-feeding was almost universally initiated after birth. Only 7 % of Norwegian-Somali and 10 % of Norwegian-Iraqi infants were exclusively breast-fed at 4 months of age. By 1 month of age, water had been introduced to 30 % of Norwegian-Somali and 26 % of Norwegian-Iraqi infants, and infant formula to 44 % and 34 %, respectively. Fifty-four per cent of Norwegian-Somali and 68 % of Norwegian-Iraqi infants had been introduced to solid or semi-solid foods at 4 months of age. Breast-feeding at 6 months of age was more common among Norwegian-Somali infants (79 %) compared with Norwegian-Iraqi infants (58 %; P=0·001). Multivariate analyses indicated no significant factors associated with exclusive breast-feeding at 3·5 months of age. Factors positively associated with breast-feeding at 6 months were country of origin (Somalia) and parity (>2).

CONCLUSIONS

Breast-feeding initiation was common among Iraqi-born and Somali-born mothers, but the exclusive breast-feeding period was shorter than recommended in both groups. The study suggests that there is a need for new culture-specific approaches to support exclusive breast-feeding and complementary feeding practices among foreign-born mothers living in Norway.

Ethnic differences in dietary intake at age 12 and 18 months: the Born in Bradford 1000 Study

OBJECTIVE

To compare the intake of key indicator foods at age 12 months and 18 months between infants of Pakistani and White British origin.

DESIGN

Logistic regression was used to model associations between ethnicity and consumption of key indicator foods defined by high or low energy density using an FFQ at age 12 and 18 months.

SETTING

Born in Bradford 1000 study, Bradford, UK.

SUBJECTS

Infants (n 1259; 38 % White British, 49 % Pakistani), mean age 12·7 (sd 1·0) months and toddlers (n 1257; 37 % White British, 49 % Pakistani), mean age 18·7 (sd1·0) months.

RESULTS

At 12 months, Pakistani infants consumed more commercial sweet baby meals than White British infants, with greater odds for being above average consumers (adjusted OR (AOR)=1·90; 95 % CI 1·40, 2·56), more chips/roast potatoes (AOR=2·75; 95 % CI 2·09, 3·62), less processed meat products (AOR=0·11; 95 % CI 0·08, 0·15), more fruit (AOR=2·20; 95 % CI 1·70, 2·85) and more sugar-sweetened drinks (AOR=1·68; 95 % CI 1·29, 2·18). At 18 months these differences persisted, with Pakistani infants consuming more commercial sweet baby meals (AOR=4·57; 95 % CI 2·49, 8·39), more chips/roast potato shapes (AOR=2·26; 95 % CI 1·50, 3·43), more fruit (AOR=1·40; 95 % CI 1·08, 1·81), more sugar-sweetened drinks (AOR=2·03; 95 % CI 1·53, 2·70), more pure fruit juice (AOR=1·82; 95 % CI 1·40, 2·35), more water (AOR=3·24; 95 % CI 2·46, 4·25) and less processed meat (AOR=0·10; 95 % CI 0·06, 0·15) than White British infants.

CONCLUSIONS

Dietary intake during infancy and the early toddlerhood period is associated with ethnicity, suggesting the importance of early and culturally adapted interventions aimed at establishing healthy eating behaviours.

The role of early life factors in the development of ethnic differences in growth and overweight in preschool children: a prospective birth cohort

BACKGROUND

Ethnic differences in childhood and adulthood are known, but ethnic differences in preschool overweight and associated factors are less studied. We assessed ethnic differences in pre-school age overweight, and studied the mediating role of early life factors in this association. Furthermore, we assessed body mass index (BMI) z-score development from birth to age 4 years to study ethnic-specific differences in BMI z-score trajectory.

METHODS

We used data on 4581 children participating in a birth cohort who were born between 2002 and 2006 in Rotterdam, the Netherlands. Child's ethnicity was defined according to country of birth of the parents. Weight and length/height was repeatedly measured between 1 and 45 months of age. Overweight at age 4 years was defined according to cut-off points for BMI from the international obesity task force. We performed logistic regression to obtain independent estimates of the association between ethnicity and preschool-age overweight, and to assess the mediating role of early life risk factors. Mixed models were used to describe BMI-z development for each ethnic group from birth to preschool age.

RESULTS

Relative to native Dutch children, non-Dutch children were more likely to be overweight at age 4 years, except for Surinamese-Hindustani children. Socio-demographic factors, parental BMI, and infant weight change in the first 6 months after birth reduced associations. After full adjustment, Turkish (OR: 2.02, 95% CI: 1.34-3.04) and Antillean/Surinamese Creole (OR: 1.78, 95% CI: 1.06-3.02) children were still more likely to be overweight at age 4 years.

CONCLUSION

Ethnic differences on the prevalence of overweight in preschool children can be partially explained by maternal educational level, parental overweight and early infant weight change. These may be possible targets to reduce ethnic inequalities in preschool age overweight.

Ethnic differences in infant feeding practices and their relationship with BMI at 3 years of age - results from the Born in Bradford birth cohort study

The present study aimed to explore previously unreported ethnic differences in infant feeding practices during the introduction of solid foods, accounting for maternal and birth factors, and to determine whether these feeding patterns are associated with BMI at 3 years of age. An observational study using Poisson regression was carried out to investigate the relationship between ethnicity and infant feeding practices and linear regression was used to investigate the relationship between feeding practices and BMI at 3 years of age in a subsample of 1327 infants in Bradford. It was found that compared with White British mothers, mothers of Other ethnicities were less likely to replace breast milk with formula milk before introducing solid foods (adjusted relative risk (RR) - Pakistani: 0·76 (95 % CI 0·64, 0·91), Other South Asian: 0·58 (95 % CI 0·39, 0·86), and Other ethnicities: 0·50 (95 % CI 0·34, 0·73)). Pakistani and Other South Asian mothers were less likely to introduce solid foods early ( < 17 weeks) (adjusted RR - Pakistani: 0·92 (95 % CI 0·87, 0·96) and Other South Asian: 0·87 (95 % CI 0·81, 0·93)). Other South Asian mothers and mothers of Other ethnicities were more likely to continue breast-feeding after introducing solid foods (adjusted RR - 1·72 (95 % CI 1·29, 2·29) and 2·12 (95 % CI 1·60, 2·81), respectively). Pakistani and Other South Asian infants were more likely to be fed sweetened foods (adjusted RR - 1·18 (95 % CI 1·13, 1·23) and 1·19 (95 % CI 1·10, 1·28), respectively) and Pakistani infants were more likely to consume sweetened drinks (adjusted RR 1·72 (95 % CI 1·15, 2·57)). No association between infant feeding practices and BMI at 3 years was observed. Although ethnic differences in infant feeding practices were found, there was no association with BMI at 3 years of age. Interventions targeting infant feeding practices need to consider ethnicity to identify which populations are failing to follow recommendations.

Food choking hazards in children

OBJECTIVES

To review the literature on pediatric food choking risks, with the long-term goal of supporting legislation regulating the production, labeling, and distribution of high-risk foods.

METHODS

A PubMed search (Keywords: choking, obstruction, asphyxiation, foreign body, food) was conducted in July-September 2010 with publication dates ranging from 1966 to 2010.

STUDY SELECTION

Articles related to pediatric foreign body aspiration (FBA) were selected by three independent reviewers. 1145 articles were initially identified. Abstracts were then screened utilizing a tool designed to isolate relevant pediatric choking events; this tool helped to only select abstracts which presented data on patients younger than 18 years of age who had choked on food items. Through this, a total of 72 pertinent articles were isolated (55 observational studies, 17 case reports/series).

DATA EXTRACTION

For each study, patient age, sex, foreign body location, presenting signs and symptoms, utility of radiographic studies, and type of foreign body detected in the majority of study participants were determined. A "majority" of patients for each study was predetermined arbitrarily to be 2/3 of the studied population.

RESULTS

The majority of patients in each observational study was determined to be: male (87% of all studies) and age <5 years (95% of all studies). Aspirated foreign bodies were mostly detected in the right main bronchus foreign body (72% of all studies), and there were abnormal radiographic signs (81% of all studies) at the time of evaluation. Food-object foreign bodies were the most frequent factors associated with choking (94% of all studies).

CONCLUSION

Childhood aspiration of food-objects is a significant public health issue. Although there is substantial legislation regulating non-food items that pose a choking hazard, equivalent guidelines do not exist for high-risk foods. Our study identifies and confirms several risk factors for pediatric FBA events. In doing so, it echoes the concerns and suggestions of various groups in supporting the development of legislation which may reduce the incidence of food-object aspiration.

Informing the 'early years' agenda in Scotland: understanding infant feeding patterns using linked datasets

BACKGROUND

Providing infants with the 'best possible start in life' is a priority for the Scottish Government. This is reflected in policy and health promotion strategies to increase breast feeding, which gives the best source of nutrients for healthy infant growth and development. However, the rate of breast feeding in Scotland remains one of the lowest in Europe. Information is needed to provide a better understanding of infant feeding and its impact on child health. This paper describes the development of a unique population-wide resource created to explore infant feeding and child health in Scotland.

METHODS

Descriptive and multivariate analyses of linked routine/administrative maternal and infant health records for 731,595 infants born in Scotland between 1997 and 2009.

RESULTS

A linked dataset was created containing a wide range of background, parental, maternal, birth and health service characteristics for a representative sample of infants born in Scotland over the study period. There was high coverage and completeness of infant feeding and other demographic, maternal and infant records. The results confirmed the importance of an enabling environment--cultural, family, health service and other maternal and infant health-related factors--in increasing the likelihood to breast feed.

CONCLUSIONS

Using the linked dataset, it was possible to investigate the determinants of breast feeding for a representative sample of Scottish infants born between 1997 and 2009. The linked dataset is an important resource that has potential uses in research, policy design and targeting intervention programmes.

Factors associated with breastfeeding in England: an analysis by primary care trust

OBJECTIVES

To identify the sociodemographic factors associated with variation in area-based breastfeeding in England; to calculate the predicted breastfeeding rates adjusted for sociodemographic variations.

DESIGN

Ecological analysis of routine data using random effects logistic regression.

SETTING

All 151 primary care trusts (PCTs) in England 2010-2011.

OUTCOME MEASURES

PCT level data on breastfeeding: initiation, any and exclusive breastfeeding at 6-8 weeks.

RESULTS

There was considerable variation in breastfeeding across PCTs (breastfeeding initiation mean 72%, range 39-93%; any breastfeeding at 6-8 weeks mean 45%, range 19-83%; exclusive breastfeeding at 6-8 weeks mean 32%, range 14-58%), with London PCTs reporting markedly higher rates. Maternal age was strongly associated with area-based breastfeeding, with a 4-6% increase in odds of breastfeeding associated with a unit increase in the percentage of older mothers. Outside London, the proportion of the local population from a Black and Minority Ethnic (BME) background, compared with those from a White British background, was associated with higher breastfeeding (1-3% increase in odds per unit increase in the proportion from a BME background). Area-based deprivation was associated with reduced odds of breastfeeding (21-32% reduced odds comparing most deprived quintile to least deprived quintile). Weaker associations were observed between sociodemographic factors and breastfeeding in London PCTs. Very few PCTs reported breastfeeding figures substantially above or below the national average, having adjusted for variations in sociodemographic factors.

CONCLUSIONS

Our results show striking associations between sociodemographic factors and breastfeeding at the area level, with much of the variation in breastfeeding rates explained by the sociodemographic profile. The sociodemographic context of breastfeeding is clearly important at the area level as well as the individual level. Our findings can be used to inform decision-making relating to local priorities and service provision.

Factors associated with the timing of introduction of complementary feeding: the Generation R Study

BACKGROUND/OBJECTIVES

Many parents do not follow recommendations for the timing of introduction of complementary feeding. The aim of this study was to identify determinants associated with the timing of introduction of complementary feeding in a multiethnic birth cohort.

SUBJECTS/METHODS

Subjects were 3561 mothers and infants participating in a prospective cohort study. The timing of introduction of complementary feeding and maternal and infant characteristics were obtained by parent-derived questionnaires. Regression analyses were performed to identify determinants for the timing of introduction of complementary feeding (<3, 3-6 and ≥ 6 months).

RESULTS

In total, 62% of infants were introduced to complementary feeding before the age of 6 months. Determinants for very early (<3 months) introduction were being a single parent and infant day care attendance. Determinants for early (3-6 months) introduction were young maternal age, multiple parities, no infant family history of asthma, atopy and no infant history of allergy to cow's milk. Determinants for both very early and early introduction were low educational level and not fully breastfeeding for 4 months. Maternal educational level was only significantly associated with the timing of introduction in mothers of Western origin.

CONCLUSIONS

This study confirmed determinants for the timing of introduction of complementary feeding that have been identified by previous studies, which may be appropriate targets for education and guidance. Moreover, mothers whose infants attend day care and have a family history of asthma, atopy or allergy to cow's milk may need guidance to follow infant feeding recommendations.

Contradictions and conflict: a meta-ethnographic study of migrant women's experiences of breastfeeding in a new country

Background

Studies report mixed findings about rates of both exclusive and partial breastfeeding amongst women who are migrants or refugees in high income countries. It is important to understand the beliefs and experiences that impact on migrant and refugee women’s infant feeding decisions in order to appropriately support women to breastfeed in a new country. The aim of this paper is to report the findings of a meta-ethnographic study that explored migrant and refugee women’s experiences and practices related to breastfeeding in a new country.

Methods

CINAHL, MEDLINE, PubMed, SCOPUS and the Cochrane Library with Full Text databases were searched for the period January 2000 to May 2012. Out of 2355 papers retrieved 11 met the inclusion criteria. A meta-ethnographic synthesis was undertaken using the analytic strategies and theme synthesis techniques of reciprocal translation and refutational investigation. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool.

Results

Eight qualitative studies and three studies reporting both qualitative and quantitative data were included and one overarching theme emerged: ‘Breastfeeding in a new country: facing contradictions and conflict’. This theme comprised four sub-themes ‘Mother’s milk is best’; ‘Contradictions and conflict in breastfeeding practices’; ‘Producing breast milk requires energy and good health’; and ‘The dominant role of female relatives’. Migrant women who valued, but did not have access to, traditional postpartum practices, were more likely to cease breastfeeding. Women reported a clash between their individual beliefs and practices and the dominant practices in the new country, and also a tension with family members either in the country of origin or in the new country.

Conclusion

Migrant women experience tensions in their breastfeeding experience and require support from professionals who can sensitively address their individual needs. Strategies to engage grandmothers in educational opportunities may offer a novel approach to breastfeeding support.

How feasible is Baby-led Weaning as an approach to infant feeding? A review of the evidence

Baby-Led Weaning (BLW) is an alternative method for introducing complementary foods to infants in which the infant feeds themselves hand-held foods instead of being spoon-fed by an adult. The BLW infant also shares family food and mealtimes and is offered milk (ideally breast milk) on demand until they self-wean. Anecdotal evidence suggests that many parents are choosing this method instead of conventional spoon-feeding of purées. Observational studies suggest that BLW may encourage improved eating patterns and lead to a healthier body weight, although it is not yet clear whether these associations are causal. This review evaluates the literature with respect to the prerequisites for BLW, which we have defined as beginning complementary foods at six months (for safety reasons), and exclusive breastfeeding to six months (to align with WHO infant feeding guidelines); the gross and oral motor skills required for successful and safe self-feeding of whole foods from six months; and the practicalities of family meals and continued breastfeeding on demand. Baby-Led Weaning will not suit all infants and families, but it is probably achievable for most. However, ultimately, the feasibility of BLW as an approach to infant feeding can only be determined in a randomized controlled trial. Given the popularity of BLW amongst parents, such a study is urgently needed.

Randomized controlled trial of 4 compared with 6 mo of exclusive breastfeeding in Iceland: differences in breast-milk intake by stable-isotope probe

BACKGROUND

The WHO recommends exclusive breastfeeding (EBF) for 6 mo after birth. However, the time at which breast milk ceases to provide adequate energy and nutrition, requiring the introduction of complementary foods, remains unclear. Most studies that investigated this issue were observational and potentially confounded by variability in social circumstances or infant growth.

OBJECTIVE

We hypothesized that EBF infants would consume more breast milk at age 6 mo than infants receiving breast milk and complementary foods.

DESIGN

We measured anthropometric outcomes, body composition, and breast-milk intake at age 6 mo in infants who were randomly assigned at age 4 mo either to 6-mo EBF or to the introduction of complementary foods with continued breastfeeding. We recruited 119 infants from health centers in Reykjavik and neighboring municipalities in Iceland. In 100 infants who completed the protocol (50/group), breast-milk intake was measured by using stable isotopes, and complementary food intakes were weighed over 3 d in the complementary feeding (CF) group.

RESULTS

Breast-milk intake was 83 g/d (95% CI: 19, 148 g/d) greater in EBF (mean ± SD: 901 ± 158 g/d) than in CF (818 ± 166 g/d) infants and was equivalent to 56 kcal/d; CF infants obtained 63 ± 52 kcal/d from complementary foods. Estimated total energy intakes were similar (EBF: 560 ± 98 kcal/d; CF: 571 ± 97 kcal/d). Secondary outcomes (anthropometric outcomes, body composition) did not differ significantly between groups.

CONCLUSIONS

On a group basis, EBF to age 6 mo did not compromise infant growth or body composition, and energy intake at age 6 mo was comparable to that in CF infants whose energy intake was not constrained by maternal breast-milk output.

Systematic review and meta-analysis of randomized controlled trials evaluating primary care-based interventions to promote breastfeeding in low-income women

BACKGROUND

Given the benefits of breastfeeding (BF), health care institutions recommend that a child should be breastfed for the first 6 months of its life. However, differences between social groups as regards BF behaviour are very prevalent.

OBJECTIVES

To identify effective programmes that can be implemented by GPs to promote BF in low-income women.

METHODS

A review of the literature was based on the Medline, Cochrane and Public Health databases (1985-2009), using index terms relating to BF, general medicine and social inequalities in health. Randomized controlled trials were included in our analysis. Two people independently selected which studies would be used by rating the quality of the articles. The results of these studies were presented in raw form and in terms of a pooled relative risk.

RESULTS

We analysed 10 studies (of the 343 articles originally selected) involving a population of 1445 'mother and child' pairs. The studies that assessed ways of encouraging the initiation of any form of BF showed that educational programmes are effective [relative risk (RR) for starting BF, 1.46, 95% confidence interval (CI): 1.03-2.08]. As regards the studies that involved ways to encourage mothers to continue BF, the programmes used showed significant success rates after 3-month postpartum (RR: 1.15, 95% CI: 1.01-1.30). The successful programmes usually involved multiple 'short' follow-up appointments (<20 to 30 minutes).

CONCLUSIONS

Educational programmes delivered in the context of ongoing personal contact with a health professional are effective in promoting BF in low-income women.

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 and educational achievement at age 5

Our aim was to investigate whether the duration of breastfeeding, at all or exclusively, is associated with educational achievement at age 5. We used data from a prospective, population-based UK cohort study, the Millennium Cohort Study (MCS). 5489 children from White ethnic background born at term in 2000-2001, attending school in England in 2006, were included in our analyses. Educational achievement was measured using the Foundation Stage Profile (FSP), a statutory assessment undertaken by teachers at the end of the child's first school year. Breastfeeding duration was ascertained from interviews with the mother when the child was 9 months old. We used modified Poisson's regression to model the association of breastfeeding duration with having reached a good level of achievement overall (≥78 overall points and ≥6 in 'personal, social and emotional development' and 'communication, language and literacy' points) and in specific areas (≥6 points) of development. Children who had been breastfed for up to 2 months were more likely to have reached a good level of overall achievement [adjusted rate ratio (RR): 1.09, 95% confidence interval (CI): 1.01, 1.19] than never breastfed children. This association was more marked in children breastfed for 2-4 months (adjusted RR: 1.17, 95% CI: 1.07, 1.29) and in those breastfed for longer than 4 months (adjusted RR: 1.16, 95% CI: 1.07, 1.26). The associations of exclusive breastfeeding with the educational achievement were similar. Our findings suggest that longer duration of breastfeeding, at all or exclusively, is associated with better educational achievement at age 5.

Association of socioeconomic position with maternal pregnancy and infant health outcomes in birth cohort studies from Brazil and the UK

BACKGROUND

Socioeconomic inequalities in health outcomes are dynamic and vary over time. Differences between countries can provide useful insights into the causes of health inequalities. The study aims to compare the associations between two measures of socioeconomic position (SEP)-maternal education and family income-and maternal and infant health outcomes between ALSPAC and Pelotas cohorts.

METHODS

Birth cohort studies were started in Avon, UK, in 1991 (ALSPAC) and in the city of Pelotas, Brazil, in 1982, 1993 and 2004. Maternal outcomes included smoking during pregnancy, caesarean section and delivery not attended by a doctor. Infant outcomes were preterm birth, intra-uterine growth restriction (IUGR) and breast feeding for <3 months. The relative index of inequality was used for each measure of SEP so that results were comparable between cohorts.

RESULTS

An inverse association (higher prevalence among the poorest and less educated) was observed for almost all outcomes, with the exception of caesarean sections where a positive association was found. Stronger income-related inequalities for smoking and education-related inequalities for breast feeding were found in the ALSPAC study. However, greater inequalities in caesarean section and education-related inequalities in preterm birth were observed in the Pelotas cohorts.

CONCLUSIONS

Mothers and infants have more adverse health outcomes if they are from poorer and less well-educated socioeconomic backgrounds in both Brazil and the UK. However, our findings demonstrate the dynamic nature of the association between SEP and health outcomes. Examining differential socioeconomic patterning of maternal and infant health outcomes might help understanding of mechanisms underlying such inequalities.

Midwifery factors associated with successful breastfeeding

BACKGROUND

It is well recognized that breast milk is the best form of nutrition for babies. However, many women do not breastfeed or give up soon after birth. Some report feeling unsupported in the post-natal period and many stop breastfeeding earlier than they would have wished. This study aimed to estimate the separate effects of midwifery factors in the overall context of sociodemographic and clinical influences on breastfeeding.

METHODS

Data from a national survey conducted in England in 2006 were used. Questionnaires were sent to a random sample of 4800 new mothers (63% response rate). Questions relating to infant feeding allowed calculation of rates of initiation of breastfeeding and rates of exclusive and any breastfeeding in the first few days and at 3 months. Univariate analyses were carried out to estimate the associations between sociodemographic, clinical and midwifery factors and breastfeeding. Logistic regression was used to estimate the specific effects of midwifery factors, while adjusting for other significant variables.

RESULTS

The most powerful explanatory factor was antenatal feeding intention. Maternal age, absence of clinical problems in the baby and a short post-natal stay were important in the early days. At 3 months, breastfeeding was associated with sociodemographic and intrapartum factors. At all stages, breastfeeding was significantly associated with either receiving consistent advice, practical help and/or active support and encouragement from midwives.

CONCLUSIONS

The antenatal decision about infant feeding is the most powerful predictor of infant feeding behaviour. Some sociodemographic and clinical factors are also important influences on breastfeeding. However, after adjusting for these, midwifery factors are still influential.

Infant formula, tea, and water supplementation of latino infants at 4-6 weeks postpartum

The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months-of-age. The authors examined prevalence and risk factors for use of infant formulas, water, and teas at 4-6 weeks in Latino infants in the San Francisco Bay Area, a group at high risk for future obesity. They recruited a cohort of pregnant Latina women (N = 201). Infant dietary recall and postpartum depressive symptoms were assessed at 4-6 weeks. The authors found that 105 women (53.1%) were feeding infant formulas and 48 (25.4%) were supplementing with tea or water. Of those providing water or tea, 60.0% were providing daily supplementation. In multivariate analyses, risk for infant supplementation with water or tea was associated with postpartum depressive symptoms (relative risk, 1.8; 95% confidence interval, 1.1-3.0), cesarean delivery (relative risk, 1.9; 95% confidence interval, 1.3-2.9), and infant formula use (relative risk, 1.3; 95% confidence interval, 1.1-1.6). Early supplementation with water or teas and infant formulas should be discouraged in Latinos, given the high frequency observed in this population.

UK-born ethnic minority women and their experiences of feeding their newborn infant

OBJECTIVE

to explore the factors that impact on UK-born ethnic minority women's experiences of and decisions around feeding their infant.

DESIGN

in-depth semi-structured interviews.

PARTICIPANTS

34 UK-born women of Black African, Black Caribbean, Pakistani, Bangladeshi, Indian and Irish parentage and 30 health-care professionals.

SETTING

women and health-care professionals were recruited primarily from hospitals serving large numbers of ethnic minority women in London and Birmingham.

FINDINGS AND CONCLUSIONS

despite being aware of the benefits of exclusive breast feeding, many women chose to feed their infant with formula. The main barriers to breast feeding were the perceived difficulties of breast feeding, a family preference for formula feed, and embarrassment about breast feeding in front of others. Reports from women of South Asian parentage, particularly those who lived with an extended family, suggested that their intentions to breast feed were compromised by the context of their family life. The lack of privacy in these households and grandparental pressure appeared to be key issues. Unlike other participants, Irish women reported an intention to feed their infant with formula before giving birth. The key facilitators to breast feeding were the self-confidence and determination of women and the supportive role of health-care professionals.

IMPLICATIONS FOR PRACTICE

these findings point to common but also culturally specific mechanisms that may hinder both the initiation and maintenance of breast feeding in UK-born ethnic minority women. They signal potential benefits from the inclusion of family members in breast-feeding support programmes.

Caregiver- vs infant-oriented feeding: a model of infant-feeding strategies among special supplemental nutrition program for women, infants, and children participants in rural east Tennessee

The aim of this project was to collect data from focus-group participants to inform the future development of region-specific educational strategies to modify infant-feeding practices that may predispose children to obesity. Infant-feeding perceptions and practices were collected from participants of the Special Supplemental Nutrition Program for Women, Infants, and Children, through recorded focus groups, in two East Tennessee counties. Focus groups replaced the participants' required, prescheduled nutrition-education classes for participants with infants younger than 6 months of age. Twenty-nine focus groups were convened and recorded, reaching a total of 109 participants. Results of this series of focus groups indicate that the Special Supplemental Nutrition Program for Women, Infants, and Children population in rural East Tennessee was similar to populations elsewhere in terms of early solid-food introduction, frequent switching of formula, and sources of and valuation of infant-feeding advice. However, this population seemed to be different in the magnitude at which they introduce infant cereal early (primarily as an addition to the bottle). For this reason, interventions designed to reduce inappropriate infant-feeding behaviors in this population should focus on early introduction of solid food (especially infant cereal) first. In addition to these findings, a model of infant-feeding strategy development based on caregiver-orientation (framed within parenting styles) is presented and discussed.

Region of birth, income and breastfeeding in a Swedish county

AIM

To study the relationship between maternal region of birth, disposable income and breastfeeding initiation and duration.

METHODS

The study population consisted of 12,197 term born, singleton infants, born 1997-2001 in the county of Uppsala. Data on breastfeeding at 1 week, 6 months and 12 months were collected from the register of statistics of the Child Health Care Unit in Uppsala and socioeconomic indicators from Swedish national registers. Multivariate analysis was conducted using Cox regression.

RESULTS

No influence of disposable income or region of birth on breastfeeding initiation was observed. Breastfeeding rates at 6 months were lower for mothers with disposable incomes in quartile 1-3 compared with mothers with the highest incomes in quartile 4 (hazard ratios (HRs) 0.88-0.90, adjusted HRs 0.92). The breastfeeding rates at 12 months were higher for mothers born in all regions compared with mothers born in Sweden (HRs 1.25-2.45, adjusted HRs 1.20-2.14).

CONCLUSIONS

The findings in the present study show that disposable income is a strong predictor for breastfeeding at 6 months in the Swedish context. Region of birth of the mother predicted long term breastfeeding, > or =12 months. This calls for professionals in the maternity and child health care to pay extra attention to breastfeeding in low-income mothers in all ethnic groups.

Are starting and continuing breastfeeding related to educational background? The generation R study

OBJECTIVE

To assess the effect of a woman's educational level on starting and continuing breastfeeding and to assess the role of sociodemographic, lifestyle-related, psychosocial, and birth characteristics in this association.

METHODS

We used the data of 2914 participants in a population-based prospective cohort study. Information on educational level, breastfeeding, sociodemographic (maternal age, single parenthood, parity, job status), lifestyle-related (BMI, smoking, alcohol use), psychosocial (whether the pregnancy was planned, stress), and birth (gestational age, birth weight, cesarean delivery, place and type of delivery) characteristics were obtained between pregnancy and 12 months postpartum. Odds ratios and 95% confidence intervals of starting and continuing breastfeeding for educational level were obtained by logistic regression, adjusted for each group of covariates and for all covariates simultaneously.

RESULTS

Of 1031 highest-educated mothers, 985 (95.5%) started breastfeeding; the percentage was 73.1% (255 of 349) in the lowest-educated mothers. At 6 months, 39.3% (405 of 1031) of highest-educated mothers and 15.2% (53 of 349) of lowest-educated mothers were still breastfeeding. Educationally related differences were present in starting breastfeeding and the continuation of breastfeeding until 2 months but not in breastfeeding continuation between 2 and 6 months. Lifestyle-related and birth characteristics attenuated the association between educational level and breastfeeding, but the association was hardly affected by sociodemographic and psychosocial characteristics.

CONCLUSIONS

Decisions to breastfeed were underlain by differences in educational background. The underlying pathways require further research. For the time being, interventions on promoting breastfeeding should start early in pregnancy and should increase their focus on low-educated women.

Ethnicity of children with homozygous c.985A>G medium-chain acyl-CoA dehydrogenase deficiency: findings from screening approximately 1.1 million newborn infants

OBJECTIVES

It has been suggested that homozygous c.985A>G medium-chain acyl-CoA dehydrogenase deficiency (MCADD) is a disease of White ethnic origin but little is known regarding its ethnic distribution. We estimated ethnic-specific homozygous c.985A>G MCADD birth prevalence from a large-scale UK newborn screening study.

METHODS

Homozygous c.985A>G MCADD cases were ascertained in six English newborn screening centres between 1 March 2004 and 28 February 2007 by screening approximately 1.1 million newborns using tandem mass spectrometry analysis of underivatised blood spot samples to quantitate octanoylcarnitine (C8). Follow-up biochemistry and mutation analyses for cases (mean triplicate C8 value >/=0.5 micromol/L) were reviewed to confirm diagnosis. Ethnicity was ascertained from clinician report and denominators from 2001 UK Census estimates of ethnic group of children less than one year.

RESULTS

Sixty-four infants were c.985A>G MCADD homozygotes (overall prevalence 5.8 per 100,000 live births; 95% CI 4.4-7.2). Sixty (93%) were White, two (3%) were mixed/other and two were of unknown ethnic origin. No Asian or Black homozygotes were identified. Proportions of White, mixed/other, Asian and Black births in screening regions were estimated, yielding homozygous c.985A>G MCADD birth prevalence of 6.9 per 100,000 (95% CI 5.2-8.8) in White, and 95% CI estimates of 0-2.7 per 100,000 in Asian and 0-5.8 in Black populations. The c.985A>G carrier frequency in the White group was estimated at one in 65 (95% CI 1/74, 1/61) under Hardy-Weinberg conditions.

CONCLUSION

c.985A>G homozygous MCADD is not found in Black and Asian ethnic groups that have been screened at birth in England. This is consistent with the earlier published observations suggesting that MCADD due to the c.985A>G mutation is a disease of White ethnic origin.