The intergenerational continuity of breastfeeding intention, initiation, and duration: a systematic review

Using the theory of planned behavior model to predict factors influencing breastfeeding behavior among preterm mothers at week 6 postpartum: the mediating effect of breastfeeding intention

Background

Exclusive breastfeeding (EBF) in the first 6 weeks postpartum is key to continued breastfeeding. This study aimed to explore the role of EBF-related predictors (particularly breastfeeding intention) in breastfeeding behavior among preterm mothers at week 6 postpartum based on the theory of planned behavior (TPB).

Methods

A total of 352 mothers of preterm infants were recruited, 340 of whom participated in this study. Prior to discharge, participants completed the Chinese versions of the modified Breastfeeding Attrition Predictive Tool, the Breastfeeding Knowledge Questionnaire (BKQ), the Infant Feeding Intention, and the Edinburgh Postnatal Depression Scale. Responses to the items of the Breastfeeding Behavioral Questionnaire (BBQ) were also collected by telephone at week 6 postpartum. The final analyses included 321 participants who completed the full two-wave data collection.

Results

The fitness indices of the modified TPB model were acceptable. Breastfeeding knowledge and EBF before discharge positively impacted breastfeeding intention, whereas depression had a negative impact. Before discharge, breastfeeding intention fully mediated the impacts of breastfeeding attitude, social and professional support, knowledge, depression, and EBF on breastfeeding behavior and partially mediated the influence of perceived breastfeeding control on breastfeeding behavior.

Conclusion

These findings indicate that TPB accurately predicts breastfeeding behavior among preterm mothers at week 6 postpartum, and breastfeeding intention is key to the above-mentioned EBF-related factors and breastfeeding behavior. The findings underline the need for further longitudinal studies and corresponding interventions for preterm mothers with a high risk of EBF attrition.

Factors Affecting the Breastfeeding Duration of Infants and Young Children in China: A Cross-Sectional Study

Objective: To investigate the factors affecting the duration of continuous breastfeeding of infants within 2 years of age, and to explore intervention strategies that may promote breastfeeding duration in China. Method: A self-made electronic questionnaire was used to investigate the breastfeeding duration of infants, and the influencing factors were collected from three levels of individual, family, and social support. The Kruskal–Wallis rank sum test and the multivariable ordinal logistic regression model were used for data analysis. Subgroup analysis was carried out according to region and parity. Results: A total of 1001 valid samples from 26 provinces across the country were obtained. Among them, 9.9% breastfed for less than 6 months, 38.6% for 6 to 12 months, 31.8% for 12 to 18 months, 6.7% for 18 to 24 months, and 13.1% for more than 24 months. Barriers to sustained breastfeeding included the mother’s age at birth being over 31, education level below junior high, cesarean delivery, and the baby’s first nipple sucking at 2 to 24 h after birth. Factors that promote continued breastfeeding included freelancer or full-time mother, high breastfeeding knowledge score, supporting breastfeeding, baby with low birth weight, first bottle feeding at 4 months and later, first supplementary food at over 6 months old, high family income, the mother’s family and friends supporting breastfeeding, breastfeeding support conditions after returning to work, etc. Conclusion: The breastfeeding duration in China is generally short, and the proportion of mothers breastfeeding until the age of 2 years and above, recommended by WHO, is very low. Multiple factors at the individual, family, and social support levels influence the duration of breastfeeding. It is suggested to improve the current situation by strengthening health education, improving system security, and enhancing social support.

A repeated cross-sectional analysis of breastfeeding initiation rates in Ireland for two decades and 10 recommended priorities for improvement

Despite a number of public health and policy-based initiatives, Ireland's national breastfeeding rates are among the lowest globally. Regionally, the Mid-West of Ireland has historically had low breastfeeding initiation rates, and parts of its major urban area such as Limerick City suffer the highest levels of economic deprivation in the country. In that context, this repeated cross-sectional study analysed breastfeeding initiation trends in the Mid-West of Ireland for two decades, from 2001 to 2020 inclusively. Statistical analysis revealed persistently low percentages of women initiating breastfeeding in the region. Time series analyses of the data demonstrated that overall breastfeeding rates are increasing, but continue to be lower than Irish national averages. From these findings and a narrative review of published research, we determined 10 plausible reasons for these consistently low breastfeeding rates. Arising from these, we propose '10 Priorities' to increase the breastfeeding initiation rates in Ireland.

The Influence of a Sister's Breastfeeding Experience on a Mother's Breastfeeding Behavior: Is There an Intragenerational Effect?

Objective: Intergenerational transmission of breastfeeding attitudes and behaviors from mother to daughter are well known, but there is limited research on intragenerational transmission of breastfeeding attitudes or behaviors within families. This study aimed to understand how initiation and duration of breastfeeding are influenced by past breastfeeding experiences of sisters among women in a longitudinal population-based cohort. Methods: Data were obtained on women enrolled in the 1979 National Longitudinal Survey of Youth (NLSY) who had at least one child enrolled in a substudy of cohort members' children. For each mother in the study, we determined whether any of her sisters also enrolled in the main NLSY study had previously breastfed one of their children. Results: Mothers whose sister(s) had prior breastfeeding experience were more likely to breastfeed their first-born child on unadjusted analysis (70% versus 45%, chi-square p < 0.001) and had a longer median of breastfeeding duration (median 14.5 versus 12 weeks, rank-sum p = 0.039). However, on a multivariable analysis accounting for potential confounding by maternal characteristics, infant characteristics, and differences among households, sisters' breastfeeding experience was no longer independently associated with the likelihood of breastfeeding initiation (odds ratio: 1.16; confidence interval [95% CI]: 0.73-1.85; p = 0.520) or the hazard of breastfeeding discontinuation (hazard ratio: 0.96; 95% CI: 0.82-1.12; p = 0.598). Conclusion: After adjusting for socioeconomic characteristics, intragenerational transmission of breastfeeding behavior was negligible among mothers raised in the same household. Other forms of intragenerational transmission (e.g., influence of extended family members) may be more salient influences on women's decision to breastfeed.

Patterns and predictors of exclusive breastfeeding in Chinese Australian mothers: a cross sectional study

BACKGROUND

While exclusive breastfeeding is recommended to 6 months of age, just 15% of mothers in Australia achieve this. The rate appears to be even lower among mothers born in China, where 90% have introduced infant formula by this time. This study aimed to examine infant feeding patterns in the first 12 months of life and the factors associated with exclusive breastfeeding at 4 months of age and infant formula introduction by 1 month of age among Chinese Australian mothers.

METHODS

Chinese Australian women with a child aged 1 to 4 years born in Australia were recruited through social media and asked to complete an online survey. Chinese ethnicity was defined as the mother or her parents having been born in mainland China, Taiwan or Hong Kong. Infant feeding practices since birth and a range of psychosocial and cultural factors were assessed. A total of 289 Chinese Australian mothers completed the survey. The relationships between exposure variables and exclusive breastfeeding at 4 months or infant formula use by 1 month were examined using multivariable logistic regression.

RESULTS

Almost all (93%) mothers initiated breastfeeding, however by 1 month of age exclusive breastfeeding rates reduced to 44%, with a further decline to 33 and 18% at 4 and 6 months respectively. Concurrently, 7% of parents reported infant formula feeding at birth increasing to 55 and 63% at 1 and 6 months of age respectively. The rates of any breastfeeding were 81% at 6 months and 50% at 12 months of age. Breastfeeding intention, self-efficacy and awareness of the infant feeding guidelines were key factors associated with sustained exclusive breastfeeding to 4 months.

CONCLUSIONS

While Chinese Australian mothers had comparable exclusive breastfeeding rates at 6 months to the general Australian population, twice as many had introduced infant formula by 1 month of age. There is an urgent need to support Chinese Australian mothers in the perinatal period to strengthen their knowledge, intention and confidence to delay early introduction of infant formula and promote exclusive breastfeeding in the early postpartum period.

Intergenerational breastfeeding practices among parents and children: 1993 Pelotas (Brazil) birth cohort

The objective of this study was to investigate intergenerational breastfeeding practices according to parental sex and age at delivery in the 1993 Pelotas (Brazil) birth cohort study. This is a prospective birth cohort study, and at the 22‐year follow‐up, a substudy with all children of the cohort members who had become parents was conducted (93Cohort‐II). First generation breastfeeding data were collected at 3 months and 4‐year‐old follow‐ups. In the 93Cohort‐II, parents answered a questionnaire about their children's breastfeeding practices. Adjusted Tobit and Poisson regression models with robust variance were applied to estimate the association between predominant parental breastfeeding duration and exclusive breastfeeding duration of the children at 3 and 6 months. Out of 3,810 cohort participants, 955 (25%) had delivered at least one live‐born infant, and 1,222 children were assessed. Fifty‐four percent of parents were ≤19 years old. Direct effects of predominant parental breastfeeding duration on exclusive breastfeeding duration of their children were only observed when data were stratified by parental age: children born to parents aged ≥20 years old and who were predominantly breastfed for at least 3 months presented higher exclusive breastfeeding duration and higher prevalence of being exclusively breastfed for at least 3 months. When analyses were stratified by mothers and fathers, the result remained significant only among mothers. Longer predominant breastfeeding duration in the first generation was associated with longer exclusive breastfeeding duration in the second generation, but only among older mothers. Education and social support surrounding breastfeeding should be intensified among fathers and younger parents to create a positive environment supportive of breastfeeding.

Individual breastfeeding support with contingent incentives for low-income mothers in the USA: the 'BOOST (Breastfeeding Onset & Onward with Support Tools)' randomised controlled trial protocol

INTRODUCTION

National breastfeeding rates have improved in recent years, however, disparities exist by socioeconomic and psychosocial factors. Suboptimal breastfeeding overburdens the society by increasing healthcare costs. Existing breastfeeding supports including education and peer support have not been sufficient in sustaining breastfeeding rates especially among low-income women. The preliminary outcomes of contingent incentives for breastfeeding in addition to existing support show promising effects in sustaining breastfeeding among mothers in the Special Supplemental Nutrition Programme for women, infants and children (WIC).

METHODS AND ANALYSIS

This trial uses a parallel randomised controlled trial. This trial is conducted at two sites in separate states in the USA. Mothers who were enrolled in WIC and initiated breastfeeding are eligible. Participants (n=168) are randomised into one of the two study groups: (1) standard care control (SC) group consisting of WIC breastfeeding services plus home-based individual support or (2) SC plus breastfeeding incentives (SC +BFI) contingent on demonstrating successful breastfeeding. All participants receive standard breastfeeding services from WIC, home-based individual support and assessments. Participants in SC receive financial compensation based on the number of completed monthly home visits, paid in a lump sum at the end of the 6-month intervention period. Participants in SC +BFI receive an escalating magnitude of financial incentives contingent on observed breastfeeding, paid monthly during the intervention period, as well as bonus incentives for selecting full breastfeeding food packages at WIC. The primary hypothesis is that monthly incentives contingent on breastfeeding in SC +BFI will significantly increase rates of any breastfeeding compared with SC. The primary outcome is the rate of any breastfeeding over 12 months. Randomisation is completed in an automated electronic system. Staff conducting home visits for support and assessments are blinded to study groups.

ETHICS AND DISSEMINATION

The Advarra Institutional Review Board has approved the study protocol (Pro00033168). Findings will be disseminated to our participants, scientific communities, public health officials and any other interested community members.

TRIAL REGISTRATION NUMBER

NCT03964454.

Exclusive Breastfeeding Duration and its Effect on the Health of the Children in Iran, a Meta Analysis

PROBLEM

Given the importance of exclusive breastfeeding (EB) duration on growth and to maintain health in children, we decided to systematically review the existing research on EB duration and its effect on the health of 2- to 5-year-old children in Iran.

ELIGIBILITY CRITERIA

A systematic literature search was conducted in the Database of Abstracts of Reviews of Effects (DARE), Google Scholar, PubMed, Psyc INFO, Thomson Reuters, Cochrane, and Medical Library (MedLib) to detect appropriate studies (1994 to 2016). Outcomes of mean, mean difference, and proportions were pooled.

SAMPLE

In this meta-analysis, 38 studies met the eligibility criteria.

RESULTS

The pooled mean of EB was calculated as 4.1 months (CI 95%: 3.2, 4.99). The meta prevalence of EB up to 4 months and 5 to 6 months was estimated 65.0% (CI 95%: 54.0, 77.0) and 54% (CI 95%: 46.0, 62.0) respectively. Based on studies conducted over the years from 1994 to 2016, an increasing trend of EB was found in infants up to 4 months (p ≤ 0.0001). Among children with anemia and respiratory diseases EB until 5 to 6 months was more common than in healthy children (CI 95%; 1.1, 2.11, and 1.01, 1.47 respectively).

CONCLUSION

The duration of EB (4.1 months) was equal to the lower limit recommended by the World Health Organization (WHO). Overall, the duration of EB until 5 to 6 months is sufficient if the child's iron intake is well-monitored.

IMPLICATION

Monitoring of the implementation of recent guidelines or even modification of the duration period of the iron administration is potentially necessary.

Sala cuna como facilitador de lactancia materna. Experiencia de madres en la región de la Araucania, Chile

Introducción. Existe una baja prevalencia de lactancia materna en menores de 2 años en Chile; por ello, en las salas cuna (SC), donde permanecen los niños de mayor vulnerabilidad social, se debe apoyar esta práctica.Objetivo. Conocer la experiencia de lactancia en madres de niños que asisten a SC de la Fundación Integra.Materiales y métodos. Investigación cualitativa desde la teoría fundamentada. Se realizaron 12 entrevistas en profundidad a madres que consintieron su participación y fueron derivadas de un estudio preliminar que identificó el tipo de alimentación recibido por sus hijos. Se hizo un análisis inductivo de los datos y entre los criterios de rigor estuvo la triangulación por investigador y la confirmabilidad de los resultados del estudio por las participantes.Resultados. Existen obstaculizadores de la lactancia como dificultades para salir del trabajo y asistir a la SC para amamantar, baja producción láctea y elección voluntaria de destete. Como facilitadores destacan la red familiar y el apoyo de la pareja. La SC es reconocida como la institución que brinda cuidado y seguridad al hijo.Conclusión. Es relevante el papel que cumple el personal de las SC en la mantención de la lactancia. Las madres del sistema público de salud deberían ser informadas de las facilidades existentes en estos establecimientos.

A priori choice of neuraxial labour analgesia and breastfeeding initiation success: a community-based cohort study in an Italian baby-friendly hospital

OBJECTIVE

To investigate whether the nature of the decision about receiving neuraxial labour analgesia is associated with breastfeeding initiation success (BIS), defined as exclusive breastfeeding until discharge associated with postnatal weight loss <7% at 60 hours from birth.

DESIGN

Single-centre community-based cohort study.

SETTING

An Italian baby-friendly hospital, from 1 July 2011 to 22 September 2015.

PARTICIPANTS

Inclusion criteria: women vaginally delivering singleton cephalic newborns and willing to breastfeed.

EXCLUSION CRITERIA

women who delivered in uterus-dead fetuses, were single or requested but did not receive neuraxial analgesia. Overall, 775 out of the 3628 enrolled women received neuraxial analgesia.

RESULTS

Compared with women who tried to cope with labour pain, those who decided a priori to receive neuraxial analgesia had less BIS (planned vaginal birth: 2121/3421 (62.0%), vs 102/207 (49.3%; p<0.001; risk difference (RD), 12.7%); actual vaginal birth: 1924/2994 (64.3%), vs 93/189 (49.2%; p<0.001; RD, 15.1%)). Multivariable analyses with antelabour-only confounders confirmed both associations (planned vaginal birth: relative risk (RR), 0.65; 95% CI, 0.48 to 0.87; actual vaginal birth: RR, 0.59; 95% CI, 0.43 to 0.80). Although women who requested analgesia as a last resort had less BIS than did those successfully coping with labour pain in the bivariable analyses (planned vaginal birth: 1804/2853 (63.2%), vs 317/568 (55.8%; p=0.001; RD, 7.4%); actual vaginal birth: 1665/2546 (65.4%), vs 259/448 (57.8%; p=0.002; RD, 7.6%)), multivariable analyses with either antelabour-only or peripartum confounders did not confirm these associations (planned vaginal birth: RR, 0.99; 95% CI, 0.80 to 1.23; actual vaginal birth: RR, 0.90; 95% CI, 0.69 to 1.16).

CONCLUSIONS

Compared with trying to cope with labour pain, a priori choice of neuraxial analgesia is negatively associated with BIS. Conversely, compared with having successfully coped with pain, requesting neuraxial analgesia as a last resort is not negatively associated with BIS.

Predictors of breastfeeding duration in a predominantly Māori population in New Zealand

Background

Although breastfeeding duration in New Zealand’s indigenous Māori is shorter than in non-Māori, we know little about barriers or motivators of breastfeeding in this community. The aim of this analysis was to identify predictors for extended duration of breastfeeding amongst participants drawn from predominantly Māori communities in regional Hawke’s Bay.

Methods

Mother/baby dyads were recruited from two midwifery practices serving predominantly Māori women in mostly deprived areas, for a randomised controlled trial comparing the risks and benefits of an indigenous sleeping device (wahakura) and a bassinet. Questionnaires were administered at baseline (pregnancy) and at one, three and six months postnatal. Several questions relating to breastfeeding and factors associated with breastfeeding were included. The data from both groups were pooled to examine predictors of breastfeeding duration.

Results

Māori comprised 70.5% of the 197 participants recruited. The median time infants were fully breastfed was eight weeks and Māori women were more likely to breastfeed for a shorter duration than New Zealand European women with an odds-ratio (OR) of 0.45 (95% CI 0.24, 0.85). The key predictors for extended duration of breastfeeding were the strong support of the mother’s partner (OR = 3.64, 95% CI 1.76, 7.55) or her mother for breastfeeding (OR = 2.47, 95% CI 1.27, 4.82), longer intended duration of maternal breastfeeding (OR = 1.02, 95% CI 1.00, 1.03) and being an older mother (OR = 1.07, 95% CI 1.02, 1.12). The key predictors for shorter duration of breastfeeding were pacifier use (OR = 0.28, 95% CI 0.17, 0.46), daily cigarette smoking (OR = 0.51, 95% CI 0.37, 0.69), alcohol use (OR = 0.54, 95% CI 0.31, 0.93) and living in a more deprived area (OR 0.40, 95% CI 0.22, 0.72).

Conclusions

Breastfeeding duration in this group of mainly Māori women was shorter than the national average. Increasing the duration of breastfeeding by these mothers could be further facilitated by ante and postnatal education involving their own mothers and their partners in the support of breastfeeding and by addressing pacifier use, smoking and alcohol use.

Psychometric Assessment and Precision Remodeling of the Iowa Infant Feeding Attitude Scale to Improve Clinical Use and Efficacy Among Prenatal Women in Canada

BACKGROUND

The 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has been widely used to assess maternal attitudes toward infant feeding and to predict breastfeeding intention. The IIFAS has been validated among prenatal women located in Newfoundland and Labrador in Canada, although its length may prove challenging to complete in a clinical setting. Research aim: The authors aimed to reduce the number of items from the original 17-item IIFAS scale while maintaining reliability and validity.

METHODS

A nonexperimental cross-sectional design was used among 1,283 women in their third trimester residing in Newfoundland and Labrador. Data were collected from August 2011 to June 2016. An exploratory factor analysis using principal component analysis was performed to explore the underlying structure of the IIFAS. The internal consistency of both the 17-item and reduced version was assessed using Cronbach's alpha and item-total correlation. The area under the curve and linear regression model were used to assess predictive validity of intention to breastfeed.

RESULTS

Our findings revealed that a 13-item IIFAS (Cronbach's α = .870) had relatively similar internal consistency to the original IIFAS (Cronbach's α = .868). Three themes were extracted from the factor analysis, resulting in the removal of four items. The reduced scale demonstrated an excellent ability to predict breastfeeding intention (area under the curve = 0.914).

CONCLUSION

The reduced 13-item version of the IIFAS is a psychometrically sound instrument that maintains its accuracy and validity when measuring maternal feeding attitudes during pregnancy and can be more time efficient in clinical settings compared with the 17-item IIFAS.

Maternal intention to exclusively breast feed among mainland Chinese mothers: A cross-sectional study

OBJECTIVE

to examine postpartum maternal recall of their intentions to exclusively breast feed among breastfeeding women and identify its predictors.

DESIGN AND SETTING

a cross-sectional descriptive study was conducted in a regional teaching hospital at Guangzhou, China between April 1 and July 14, 2014.

PARTICIPANTS

571 mothers who were within four days after delivery were recruited to the study.

MEASUREMENTS

data were collected by four research assistants with maternal intention to breast feed data sheet, the Network Support for Breastfeeding Scale (NSBS), and a socio-demographic data sheet.

FINDINGS

greater than half of the mothers (69.5%) intended to exclusively breast feed. The logistic regression analysis revealed six variables which predicted postpartum maternal recall of their intentions to exclusively breast feed. They were support from husband, being breast-fed as an infant, previous breast feeding experience, attending antenatal breast feeding class, time of decision to breast feed, and the rating of the importance of my baby's health.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

health care professionals could develop strategies to enhance mothers' intention to exclusively breast feed, such as providing antenatal breast feeding class on internet, a strong focus on the benefits of exclusive breast feeding on the baby's health in the education programme, and more efforts directed toward educating school-aged children and adolescents to modify societal perceptions of what are considered normal infant feeding. Mothers' husband could be encouraged in supporting exclusive breast feeding.

Attitudes and Expectations in the Intergenerational Transmission of Breastfeeding: A Phenomenological Study

BACKGROUND

The socially constructed meanings of breastfeeding that have been passed from generation to generation by grandmothers produce continuities and discontinuities in the practices of breastfeeding. Research aim: The aim of this study is to explore the objectives and positioning of women today with respect to their role as future grandmothers, based on their experiences with breastfeeding. That is, what role do future grandmothers wish to have in the lives of their breastfeeding daughters and grandchildren?

METHODS

A qualitative study with interpretative phenomenological analysis was conducted based on the philosophy of Martin Heidegger, using a sample of unstructured interviews from 20 women in Madrid. The data were analyzed using the steps of interpretative phenomenological analysis.

RESULTS

Among the women who desired to have a supportive role for their future breastfeeding daughters and daughters-in-law, three emergent themes were identified that aimed at being supportive but remaining flexible and respecting their autonomy: "I'll give you what I didn't have," "the well-being of my daughter/daughter-in-law," and "seeking professional help." Two additional themes were identified that show the desire of these women to be present during this stage of family development and the lifecycle: "my role in the family" and "continuing to share."

CONCLUSION

Future grandmothers desire to be involved in their daughters and daughters-in-law breastfeeding experience through flexibility and support and with the use of specialized and personalized professional help. In addition, future grandmothers desire to be valued and included in the vital process of breastfeeding.

Impact of intervention on breastfeeding outcomes and determinants based on theory of planned behavior

BACKGROUND

Breastfeeding knowledge, attitude, subjective norm, and perceived control are significant determinants of breastfeeding, according to the theory of planned behavior (TPB). However, evidence concerning the effectiveness of the TPB-based intervention in breastfeeding promotion is sparse. Meanwhile, the changes of these determinants with time have not been examined in previous studies.

AIM

To investigate the effectiveness of the TPB-based intervention program in improving exclusive breastfeeding, and the interaction of time and intervention on these determinants of breastfeeding.

METHODS

285 primiparous mothers were included, with 157 mothers in the experimental group and 128 mothers in the control group. The experimental group received the TPB-based intervention program delivered during 6 weeks postpartum, while both the experimental and control groups received the standard obstetric care.

FINDINGS

Scores of breastfeeding knowledge, attitude and breastfeeding control increased with time from baseline to 6 weeks postpartum, while breastfeeding subjective norm decreased at 6 weeks both in the experimental and the control groups. Besides, scores of the four determinants were significantly higher in the experimental group than these in the control group at 3days and 6 weeks, except for breastfeeding control at 6 weeks, which resulted in the higher exclusive breastfeeding rates at 3days and 6 weeks in the experimental group than the control group.

DISCUSSION AND CONCLUSIONS

The TPB-based intervention was effective in promoting exclusive breastfeeding during 6 weeks postpartum. Future interventions are recommended to adjust intervention strategies with time, and give more focus on providing continued breastfeeding support after discharge.

Breast-feeding and malocclusions: The quality and level of evidence on the Internet for the public

BACKGROUND

The authors sought to assess the quality of information on the Internet for laypeople regarding the effect of breast-feeding on malocclusions and to determine the levels of evidence of the articles cited to support the information.

METHODS

The first author (E.J.D.) entered a key word term, "breast-feeding and crooked teeth," and a natural language term, "does breast-feeding protect against crooked teeth," into 4 search engines. The author performed consecutive sampling of every Web site until 5 Web sites were identified that fulfilled the inclusion criteria per search engine, per search term, producing 40 Web sites for evaluation. The author assessed quality using the LIDA instrument and determined the levels of evidence of the cited articles according to the Joanna Briggs Institute Levels of Evidence.

RESULTS

The author determined that the quality of the Web sites was moderate, represented by a median overall LIDA score of 73%. The author identified only 2 high-quality Web sites. Nearly one-half of the Web sites cited a combined total of 10 scientific articles to support their content, and these ranged from moderate to very low levels of evidence.

CONCLUSIONS

The authors found the quality of freely available information on the Internet for laypeople about the protective effect of breast-feeding against malocclusions to be moderate and that the evidence base cited to support the content ranged from moderate to very low levels of evidence.

PRACTICAL IMPLICATIONS

Increasingly, patients are seeking health information online, although not all information is credible. Dental heath care practitioners should regularly review their practices' Web sites to ensure that they are accessible and that the content is usable, reliable, and up-to-date, particularly as new, higher-level evidence becomes available.

High education and increased parity are associated with breast-feeding initiation and duration among Australian women

OBJECTIVE

Breast-feeding is associated with positive maternal and infant health and development outcomes. To assist identifying women less likely to meet infant nutritional guidelines, we investigated the role of socio-economic position and parity on initiation of and sustaining breast-feeding for at least 6 months.

DESIGN

Prospective cohort study.

SETTING

Australia.

SUBJECTS

Parous women from the Australian Longitudinal Study on Women's Health (born 1973-78), with self-reported reproductive and breast-feeding history (N 4777).

RESULTS

While 89 % of women (83 % of infants) had ever breast-fed, only 60 % of infants were breast-fed for at least 6 months. Multiparous women were more likely to breast-feed their first child (~90 % v. ~71 % of primiparous women), and women who breast-fed their first child were more likely to breast-feed subsequent children. Women with a low education (adjusted OR (95 % CI): 2·09 (1·67, 2·62)) or a very low-educated parent (1·47 (1·16, 1·88)) had increased odds of not initiating breast-feeding with their first or subsequent children. While fewer women initiated breast-feeding with their youngest child, this was most pronounced among high-educated women. While ~60 % of women breast-fed their first, second and third child for at least 6 months, low-educated women (first child, adjusted OR (95 % CI): 2·19 (1·79, 2·68)) and women with a very low (1·82 (1·49, 2·22)) or low-educated parent (1·69 (1·33, 2·14)) had increased odds of not breast-feeding for at least 6 months.

CONCLUSIONS

A greater understanding of barriers to initiating and sustaining breast-feeding, some of which are socio-economic-specific, may assist in reducing inequalities in infant breast-feeding.

Physiological mechanisms, behavioral and psychological factors influencing the transfer of milk from mothers to their young

This article is part of a Special Issue "Parental Care".Producing milk to support the growth of their young is a central element of maternal care in mammals. In spite of the facts that ecological constraints influence nursing frequency, length of time until weaning and the composition of milk, there is considerable similarity in the anatomy and physiology of milk production and delivery across mammalian species. Here we provide an overview of cross species variation in nursing patterns and milk composition as well as the mechanisms underlying mammary gland development, milk production and letdown. Not all women breastfeed their infants, thus in later sections we review studies of factors that facilitate or impede the initiation and duration of breastfeeding. The results of these investigations suggest that the decisions to initiate and maintain breastfeeding are influenced by an array of personal, social and biological factors. Finally, studies comparing the development of breastfed and formula fed infants as well as those investigating associations between breastfeeding, maternal health and mother/infant interaction are reviewed. Leading health agencies including the World Health Organization and CDC advocate breastfeeding for at least the first 6months postpartum. To achieve these rates will require not only institutional support but also a focus on individual mother/infant dyads and their experience.

Predictors of impaired breastfeeding initiation and maintenance in a diverse sample: what is important?

PURPOSE

This study aimed to investigate socio-demographic, medical and psychological factors that have an impact on breastfeeding.

METHODS

Questionnaires were administered to 330 women prenatally (TI third trimester) and postpartum (TII 3-4 days, TIII 4 months). Medical data were collected from the hospital records. Self-reported data on initiation and maintenance of breastfeeding was collected simultaneously. Primary endpoint was breastfeeding initiation and maintenance. Data analyses were performed using Spearman's ρ correlations between breastfeeding and other study variables and generalized multiple ordinal logistic regression analysis.

RESULTS

Neonatal admission to the NICU, high BMI, cesarean section, difficulties with breastfeeding initiation and high maternal state anxiety were the strongest predictors of impaired breastfeeding initiation, explaining together 50 % of variance. After 4 months, the strongest predictors of impaired maintenance of breastfeeding were maternal smoking, a high BMI and a history of postpartum anxiety disorder, explaining 30 % of variance.

CONCLUSIONS

Successful initiation and maintenance of breast feeding is a multifactorial process. Our results underline the need of interdisciplinary approaches to optimise breastfeeding outcomes by demonstrating the equality of medical and psychological variables. Whereas practices on maternity wards are crucial for optimal initiation, continuous lifestyle modifying and supporting approaches are essential for breastfeeding maintenance. Healthcare providers can also significantly influence breastfeeding initiation and maintenance by counselling on the importance of maternal BMI.