Infant feeding practices of Anglo American and Asian Indian American mothers

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..

The factors associated with food fussiness in Irish school-aged children

Objective

To establish the factors that determine food fussiness, to explore if child age determines the extent to which these factors influence food fussiness and to identify whether parental neophobia is an independent determinant of food fussiness.

Design

Cross-sectional data from the National Children’s Food Survey (2003–2004). The Children’s Eating Behaviour Questionnaire (CEBQ) assessed eating behaviours in children. The Food Neophobia Scale (FNS) assessed parental food neophobia. Young children were classified as 5–8 years old with older children classified as 9–12 years old.

Setting

Republic of Ireland.

Participants

Nationally representative sample of Irish children aged 5–12 years (n 594).

Results

Parents identifying child’s food preferences as a barrier to providing their child with a healthy diet was significantly associated with increased food fussiness in younger (P<0·001) and older children (P<0·001). Higher levels of parental neophobia were significantly associated with an increase in food fussiness in younger (P<0·05) and older (P<0·001) children. Food advertising as a barrier to providing a healthy diet was inversely associated with food fussiness in younger children (P<0·05). In older children, there was a significant inverse association between child’s BMI and food fussiness (P<0·05), but not to the extent that a difference in weight status was noted. Family mealtimes in older children were associated with significantly lower levels of food fussiness (P<0·05).

Conclusions

Findings from the present study identify that a child’s age does determine the extent to which certain factors influence food fussiness and that parental neophobia is an independent determinant of food fussiness.

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.

The prevalence and determinants of breast-feeding initiation and duration in a sample of women in Ireland

OBJECTIVE

To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and 'any' breast-feeding at 6 weeks in a sample of Irish-national mothers.

DESIGN

This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum.

SETTING

Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin.

SUBJECTS

In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study.

RESULTS

Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47% and 79.6%, respectively. Factors that were significantly (P = 0.000) associated with both breast-feeding initiation and 'any' breast-feeding at 6 weeks included mothers who were >or=35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breast-feeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation.

CONCLUSIONS

Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breast-feeding may prove effective in addressing this cultural barrier.

Family and Cultural Issues in a School Swallowing and Feeding Program

Purpose

This article presents a rationale for speech-language pathologists (SLPs) to provide culturally competent evaluation, diagnostic, and intervention services for children with oral motor, swallowing, and feeding disorders in school settings. There is also a discussion of how changing American public school demographics necessitate the consideration of cultural issues and family-focused approaches to dysphagia services.

Method

This article provides an overview of cultural, religious, and health beliefs of several ethnic groups, as well as information on the dynamics and requirements of cultural competence and family-focused intervention. Ethnographic interviewing is presented as a culturally sensitive diagnostic method. Information on structuring a culturally relevant individualized educational program process is provided. Guidance in the use of interpreters and translators is also offered.

Conclusion

Attention to cultural and family issues in the diagnosis and treatment of dysphagia in a school setting optimizes the opportunities for successful outcomes and better meets the needs of children and families from culturally/linguistically diverse backgrounds.

Infant-Feeding Practices and Beliefs about Complementary Feeding among Low-Income Brazilian Mothers: A Qualitative Study

Background

Breastfeeding and weaning practices are important determinants of growth and development not only in infancy but also later in life.

Objective

To describe infant-feeding practices and beliefs about complementary feeding among low-income Brazilian mothers.

Methods

Qualitative methods included focus group discussions with low-income mothers enrolled in a Family Health/Community Health Workers program in Ceará, Northeast Brazil.

Results

Breastfeeding is widely practiced in this area, and overall, mothers are knowledgeable about the benefits of breastfeeding for their infants and themselves. Practices of prolonged breastfeeding and delayed supplementation of infants with semisolid foods emerged as a problem among very poor women. In addition, the results showed common problems related to complementary feeding practices, such as the early introduction of solid foods and the use of expensive commercial cereals and formula for weaning. Cultural factors and taboos appeared to have an important influence on mothers' infant-feeding practices and eating patterns of their children.

Conclusions

The results have implications for the design of breastfeeding promotion and interventions to improve complementary feeding. Improvements of the national Food Grant Program are also suggested, which are needed by low-income mothers to improve their infant-feeding practices.

On the role of breastfeeding in health promotion and the prevention of allergic diseases

Based on animal models, we specify the major role of different bioactive milk components known to participate significantly in neonatal health promotion and in protection against a large number of infectious diseases and the development of allergies and asthma.

Low-income mothers' decisions regarding when and why to introduce solid foods to their infants: influencing factors

Preventive measures for long-life illnesses such as asthma, obesity, and diabetes can start as early as in infant feeding practices. The American Academy of Pediatrics recommends introducing babies to solid foods, anything other than breast milk or formula, no earlier than 4-6 months of age (Kleinman, 2004). This study's purpose was to assess beliefs and attitudes of mothers enrolled in Medicaid about the introduction of solid foods and other infant feeding behaviors. Six focus groups (N = 23) were conducted with Black and Caucasian mothers with infants under 1 year old. The Theory of Planned Behavior was used as a framework for moderator questions and interpretation of themes. Maternal knowledge about infant feeding, maternal perceptions of applicability of infant feeding guidelines, and manner and type of information useful for infant feeding decisions emerged as themes. Implications of themes for informing an educational program for mothers to delay the introduction of solid foods are discussed.

Parental perceptions of feeding practices in five European countries: an exploratory study

OBJECTIVE

To gain an insight into parental perceptions of infant feeding practices in five European countries.

DESIGN

An exploratory investigation using focus group discussions. Various aspects addressed included social and cultural setting for the consumption of food, infant feeding practice and behaviour, consumer health awareness and sources of information, and attitudes towards a healthy infant diet.

SETTING

Focus group participants were recruited from centres in five countries, Germany, Italy, Scotland, Spain and Sweden, with three focus groups being conducted in each centre.

SUBJECTS

A total of 108 parents with infants up to the age of 12 months participated in focus group discussions across these centres.

METHODS

Focus groups were conducted with participants from centres in five countries.

RESULTS

The majority of parents in this study chose to initiate breastfeeding and prepare infant food at home. Parents did not strictly adhere to infant feeding guidelines when introducing complementary foods into their infant's diets. There were cross-cultural differences in sources of information on infant feeding practice with the paediatrician in Germany, Italy and Spain. The health visitor in Scotland and the child welfare clinics in Sweden were the most popular sources.

CONCLUSIONS

A number of cultural differences and similarities in attitudes towards infant feeding practice were revealed. This makes European wide approaches to promoting healthy infant feeding difficult as different infant feeding practices are influenced not only by parental perceptions but also by advice from health professionals and feeding guidelines. Further data need to be available on parents' attitudes and beliefs towards infant feeding practice to investigate further the rationale for differing beliefs and attitudes towards infant feeding practice.

SPONSORSHIP

EU Fifth Framework QLRT 2002 02606.

Grandmothers' influence on child care

OBJECTIVE

This paper compares child care-giving and child's nutritional status among rural families where grandmothers were present and those where grandmothers were absent.

METHODS

From 27 villages in rural Vadodara, four were randomly selected and all the families (n=31) with children (3-24 months) where grandmothers were present (GMP) were compared with 39 families where grandmothers were absent (GMA). Semi structured questionnaires were used to assess beliefs-practices of mothers and grandmothers regarding breastfeeding and complementary feeding (BF-CF). Nutrient intake of the children and nutritional status were measured using standard procedures.

RESULTS

Some deleterious practices were present in a similar proportion of both GMP and GMA groups: giving prelacteals, delaying initiation of BF, exclusive breastfeeding < 3 months and delaying initiation of CF. Favorable practices present in significantly more GMP were: active feeding and use of anganwadi services. Grandmother's help enabled mother to practice more care-giving behaviors. However, children in both the groups had low calorie intake

CONCLUSION

Role of family members in childcare and the benefits of including them in interventions to improve child survival, health and nutrition status need to be further researched.

The religious and cultural bases for breastfeeding practices among the Hindus

In Hindu communities, breastfeeding is nearly universal and continues for most children beyond infancy. This review examines the religious and cultural basis for the contemporary breastfeeding practices amongst the Hindu. Practices at the time of birth and feeding rituals like prelacteal feeds, importance and timing of complementary feeds, and protections for the breastfeeding mother are examined from the published medical literature and available religious texts. Hindu Vedic literature and ancient ayurvedic texts underscore the importance of breastfeeding in the Hindu society. Although almost every Hindu child gets some breastfeeding, exclusive breastfeeding for the recommended duration and early initiation of breastfeeding are not that common. As birth of a baby is a celebration for family and society, breastfeeding is strongly influenced by cultural and religious ceremonies. In today's context, although women may receive guidance from health care professionals, relatives--especially grandmothers--have an important influence on breastfeeding practices.

Insulin resistance syndrome (metabolic syndrome) and obesity in Asian Indians: evidence and implications

OBJECTIVES

This review describes prevalence, determinants, and possible pathophysiologic mechanisms and suggests management and research directions for insulin resistance syndrome (metabolic syndrome) in Asian Indians.

METHOD

We reviewed the topic using the terms Asian Indians, Asians, South Asians, and Indians coupled with the terms insulin resistance, hyperinsulinemia, metabolic syndrome, and obesity from the databases Pubmed (National Library of Medicine, Bethesda, MD, USA) and Current Contents (Institute for Scientific Information, Thomson Scientific, Philadelphia, PA, USA) and from non-indexed publications of the medical research and governmental institutions in India.

RESULTS

Asian Indians have a high prevalence of insulin resistance syndrome that may underlie their greater than normal tendency to develop diabetes mellitus and early atherosclerosis. Important reasons could be their excess body fat and adverse body fat patterning including abdominal adiposity even when the body mass index is within the currently defined normal limits. Some of these features have been reported at birth and childhood. Whether Asian Indians also have tendency to develop insulin resistance de novo, independent of total or regional adiposity, needs further investigation. Underlying genetic tendency or early-life adverse events may contribute to such a phenotype, but lifestyle factors alone or modulated by inherited factors appear to play an important role because obesity and dyslipidemia become worse with urbanization and migration. Systemic stress may contribute to insulin resistance syndrome in the intra-country and inter-country migrant Asian Indians.

CONCLUSIONS

High prevalences of excess body fat, adverse body fat patterning, hypertriglyceridemia, and insulin resistance beginning at a young age have been consistently recorded in Asian Indians irrespective of their geographic locations. These data suggest that primary prevention strategies should be initiated early in this ethnic group.

Mothers' sources of information about feeding their children ages 2 months to 54 months

The purpose of this study was to determine sources and types of information about child feeding practices that were received by 62 mothers with children aged 2 to 54 months. Each mother participated in 10 or 11 in-home interviews. Data analyses included chi-square testing for differences in information sources over time and content analyses to develop information themes. As sources, citations for professionals and magazines decreased, with no significant changes for relatives over time. After 24 months, newspapers, television, and friends were reported more frequently than earlier. Mothers reported multiple and concurrent information sources over time. Thus, nutrition educators have concurrent and multiple opportunities to disseminate nutrition information.