Recent advances in breast feeding

Feeding on one side or both sides in a breast-feeding session

BACKGROUND

The aim of the present study was to examine the effects of breast-feeding method (on only one or on two sides in a single feeding session) on growth, sleep duration and sucking period, and stool frequency.

METHODS

Exclusively breast-fed healthy infants, aged 1-6 months, were included in the study during child health follow-up visits. Mothers were given a questionnaire on sleep duration, sucking periods, and stool frequencies of their infants.

RESULTS

The height-for-age and weight-for-age z scores were significantly higher in infants breast-fed from one side during a single session than from both sides (P= 0.002, P < 0.001; respectively). Infants sucking on only one breast in a breast-feeding session defecated significantly less at night (P= 0.005), their maximum sucking periods at night were shorter (P= 0.049).

CONCLUSION

Breast-feeding at one side only during a single breast-feeding session increases growth, decreases stool frequency and the maximum sucking period at night and does not influence the overall sleep pattern.

Tendência do aleitamento materno em município da região centro-sul do estado de São Paulo: 1995-1999-2004

OBJETIVO: Avaliar a situação do aleitamento materno em 2004 no município de Botucatu, SP, e identificar sua tendência nos últimos 10 anos. MÉTODOS: Trata-se de um estudo epidemiológico, no qual foram comparados os resultados de 3 inquéritos populacionais transversais (1995-1999-2004), metodologicamente semelhantes, sobre a situação do aleitamento materno em crianças menores de 12 meses. Os dados foram obtidos em Campanhas de Multivacinação, a partir de questionário contendo um recordatório da alimentação das crianças no dia anterior à pesquisa. Para identificar a tendência dos diferentes tipos de aleitamento (aleitamento materno exclusivo, aleitamento materno predominante e aleitamento materno), foram comparadas as prevalências, segundo faixas etárias selecionadas (0-1 mês, 0-4 meses, 0-6 meses e 0-12 meses), nos 3 inquéritos. Os resultados foram submetidos a teste estatístico (teste z) para verificação das diferenças entre proporções. RESULTADOS: Para as crianças menores de 4 meses, houve aumento progressivo e de grande magnitude (19,1% em 1995 e 36,9% em 2004) do aleitamento materno exclusivo e diminuição do aleitamento materno predominante - diferenças estatisticamente significantes. O mesmo ocorreu para as crianças menores de 6 meses: 13,0% em aleitamento materno exclusivo em 1995, 29,6% em 2004, representando 128,0% de aumento. Com relação ao aleitamento materno, tanto para as crianças menores de 4 meses, quanto para as menores de 6 meses e de 1 ano, houve pequeno aumento de prevalência, mas as diferenças não foram estatisticamente significantes. A duração mediana do aleitamento materno exclusivo aumentou 14 dias (82,0%) e do aleitamento materno 85 dias (50,9%) no período de 10 anos. CONCLUSÃO: Com a elevação expressiva da prevalência de crianças menores de 6 meses em aleitamento materno exclusivo e o aumento da mediana da amamentação exclusiva e da amamentação, pode-se afirmar que a evolução do aleitamento no município foi favorável. Entretanto, a situação em 2004 ainda está distante das recomendações atuais sobre alimentação infantil.

Natural Parenting — Back to Basics in Infant Care

This review examines an age-old approach to parenting recently rediscovered in Western industrialized societies and known by names such as natural parenting, attachment parenting, and instinctive parenting. Its leading principle is utmost sensitivity to the child's innate emotional and physical needs, resulting in extended breastfeeding on demand, extensive infant carrying on the caregiver's body, and cosleeping of infant and parents. The described practices prevailed during the evolutionary history of the human species and reflect the natural, innate rearing style of the human species to which the human infant has biologically adapted over the course of evolution. An overview of research from diverse areas regarding psychological as well as physiological aspects of early care provides evidence for the beneficial effects of natural parenting. Cross-cultural and historical data is cited to reveal the widespread use of the investigated parenting style. It is concluded that the described approach to parenting provides the human infant with an ideal environment for optimal growth both psychologically and physiologically. It is yet to be determined how much departure from this prototype of optimal human parenting is possible without compromising infant and parental wellbeing. The review also invites a critical reevaluation of current Western childrearing practices.

Avaliação dos conhecimentos de equipes do Programa de Saúde da Família sobre o manejo do aleitamento materno em um município da região metropolitana de São Paulo

OBJETIVOS: avaliar os conhecimentos e a capacitação de equipes do Programa de Saúde da Família (PSF) para o desenvolvimento de ações de incentivo ao aleitamento materno (AM) no município de Francisco Morato, São Paulo. MÉTODOS: um questionário contendo questões sobre características dos profissionais, sensibilização para o trabalho de incentivo à amamentação, conhecimentos sobre manejo do AM, capacitação em AM e organização das ações de incentivo à amamentação foi aplicado a 61 profissionais do PSF do município, selecionados por amostragem aleatória estratificada. RESULTADOS: 45,9% dos entrevistados citaram o AM como uma das ações prioritárias desenvolvidas para saúde da criança; 98,4% reconheceram a importância e as vantagens do AM para a dupla mãe-bebê; 96,7% recomendam o AM exclusivo até seis meses de vida; 24,6% orientam as mães a continuarem o AM até os dois anos; 88,5% orientam sobre pega e posicionamento da mamada, sendo que 38,9% fazem a orientação de forma satisfatória; quanto à ordenha manual, 21,4% orientam satisfatoriamente. CONCLUSÕES: os entrevistados estão sensibilizados quanto à importância do AM e têm conhecimentos teóricos sobre o tema, mas apresentam dificuldades para a resolução de questões práticas sobre o manejo da amamentação, o que pode interferir de forma negativa no trabalho desenvolvido de apoio às mães lactantes.

Human milk, breastfeeding, and transmission of human immunodeficiency virus type 1 in the United States. American Academy of Pediatrics Committee on Pediatric AIDS

Transmission of human immunodeficiency virus type 1 (HIV-1) through breastfeeding has been conclusively demonstrated. The risk of such transmission has been quantified, the timing has been clarified, and certain risk factors for breastfeeding transmission have been identified. In areas where infant formula is accessible, affordable, safe, and sustainable, avoidance of breastfeeding has represented one of the main components of mother-to-child HIV-1 transmission prevention efforts for many years. In areas where affordable and safe alternatives to breastfeeding may not be available, interventions to prevent breastfeeding transmission are being investigated. Complete avoidance of breastfeeding by HIV-1-infected women has been recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention and remains the only means by which prevention of breastfeeding transmission of HIV-1 can be absolutely ensured. This technical report summarizes the information available regarding breastfeeding transmission of HIV-1.

How exclusive is exclusive breastfeeding? A comparison of data since birth with current status data

BACKGROUND

There is no accepted and widely used indicator for exclusive breastfeeding since birth. Indeed, the difference between 'current status' data on exclusive breastfeeding and data on 'exclusive breastfeeding since birth' is rarely recognized. We used data from a longitudinal study to examine this issue.

METHODS

A descriptive longitudinal, prospective study design was used in which 506 mother-infant pairs were included. The mothers completed daily recordings on infant feeding during the first nine months after birth. A research assistant conducted fortnightly home visits with structured interviews. The resulting data on breastfeeding patterns are presented in two different ways: analysis of 'current status' data based on a single 24-hour recording of infant feeding at 2, 4 and 6 months of age, and analysis of data 'since birth', i.e. data on infant feeding for every day, starting from birth until the ages of 2, 4 and 6 months.

RESULTS

A wide discrepancy between the results obtained from the two analyses was found. The difference in the exclusive breastfeeding rate was over 40 percentage points at both 2 and 4 months of age (92% versus 51% at 2 months and 73% versus 30% at 4 months) and 9 percentage points at 6 months (11% versus 1.8%).

CONCLUSIONS

Current status indicators based on a 24-hour period may be inadequate and even misleading for many purposes. We propose that in many studies an indicator called 'exclusive breastfeeding since birth' could be added.

Economic issues in the prevention of vertical transmission of HIV

In the absence of interventions, 20% of infants born to women infected with HIV acquire infection from their mother at or before delivery. A further 15% are infected through breast feeding. Prenatal testing for HIV allows infected women to be reliably identified so that they can receive antiretroviral therapy and, in countries with safe water supplies, be advised not to breast feed. These and other interventions can reduce the risk of transmission to 5% or less. Economic evaluations of prenatal testing for HIV are reviewed and compared in this article, and future research priorities outlined. These studies set the costs of testing and intervention against the averted lifetime costs of paediatric infection, and generate estimates of the HIV prevalence threshold above which there would be a net cost saving, or calculate the cost per life-year saved given a particular prevalence. In the developed world, prenatal testing has been adopted in many countries, and recent economic analyses broadly support this. Future research is likely to focus on the incremental benefits of different antiretroviral regimens in lowering transmission rates still further, with or without elective caesarean section, and the possibility that some may lead to adverse effects in uninfected infants exposed to them in utero. Some earlier assessments in resource-poor settings concluded that prenatal testing was unaffordable or of doubtful cost effectiveness. This negative conclusion appears to be the result of very low estimates of the lifetime costs of paediatric HIV infection, together with developed world conceptions of pre-test counselling. The demonstration that nevirapine reduces transmission risk at a low cost has transformed the outlook, and there is hope that antiretrovirals can act prophylactically to prevent infection of the breast-fed child. However, to achieve a sustained reduction in vertical transmission there may be a need to evaluate the need for a strengthened infrastructure to deliver prenatal HIV testing and treatment, as well as programmes to reduce HIV incidence in adults.

Breastfeeding patterns in relation to thumb sucking and pacifier use

OBJECTIVES

To analyze the influence of thumb sucking and pacifier use on breastfeeding patterns in exclusively breastfed infants, on the duration of exclusive breastfeeding, and on the total breastfeeding duration.

STUDY DESIGN

Descriptive, longitudinal, prospective study.

SETTING

The subjects were recruited from a population of 15 189 infants born in the maternity ward at the University Hospital, Uppsala, Sweden between May 1989 and December 1992.

STUDY POPULATION

506 mother-infant pairs.

METHODS

Daily recordings by the mothers on infant feeding from the first week after delivery through the duration of the study. Fortnightly home visits with structured interviews by a research assistant.

RESULTS

Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours, shorter duration of exclusive breastfeeding, and shorter total breastfeeding duration compared with no pacifier use. These associations were not found for thumb sucking. The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use. Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration.

CONCLUSIONS

More frequent use of a pacifier was associated with shorter breastfeeding duration, even among a group of mothers who were highly motivated to breastfeed. breastfeeding duration, breastfeeding pattern, exclusive breastfeeding, pacifier use, thumb sucking.

The relationship between infant feeding practices and diarrhoeal infections

To determine the relationship between infant feeding practices and diarrhoeal infections, a descriptive survey was conducted on infants aged between 6 and 12 months of age. A guided interview was conducted with 105 mothers of infants who attended the health facilities of Mbabane, Swaziland. The results showed that breast feeding was routinely practised by the majority of mothers, although exclusive breast feeding was very low. Supplementary feeds in the form of formula or solids were introduced by the majority of respondents within the first 3 months of life. Infants who were given colostrum and breast milk had fewer diarrhoeal attacks. Other factors, for example education and cultural factors, influenced the feeding practices and number of diarrhoeal attacks. It is recommended that breast feeding should be promoted as an important intervention in the control of diarrhoea.

[Assessing breastfeeding status in an urban area of southeastern Brazil: use of a simplified method]

INTRODUCTION

The diagnosis of breastfeeding status in populations is necessary to define aims and to evaluate support and promotion programs related to this practice. Thus, the feasibility of undertaking such a diagnosis concomitantly with the National Multivaccination Campaign, was tested.

METHOD

A simplified questionnaire was used (3 yes/no questions) to study the present feeding of 1,550 children under 1 year old (91.8% coverage) who attended the vaccination venues in August 19th, 1995. The medians and frequencies from three patterns of breastfeeding were calculated by probit analysis technique.

RESULTS

The medians were: exclusive breastfeeding = 17 days (IC: 4.6-28.7); complete breastfeeding = 64 days (IC: 53.0-74.5) and breastfeeding = 167 days (IC: 153.7-182.2). The good adjustment of three patterns was attested by R2 values and by Kolmogorov-Smirnov tests (p < 0.05).

CONCLUSIONS

The results confirmed the need for this program in the city. The simplified methodology was found to be available and is recommended for breastfeeding trend management and for studies on the impact resulting from intervention.

A tendência da prática da amamentação no Brasil nas décadas de 70 e 80

A prática da amamentação sofreu um declínio em todo o mundo, levando a conseqüências desastrosas para a saúde das crianças e suas mães. A partir da década de 70 iniciou-se um verdadeiro movimento mundial para o retorno à amamentação, sendo que no Brasil, estudos realizados em algumas cidades indicam o possível sucesso deste movimento no País. Este estudo teve por objetivo descrever a trajetória recente do aleitamento materno no Brasil, em diferentes estratos populacionais, compa-rando duas pesquisas nacionais (ENDEF/75 e PNSN/89). Empregou-se a análise de probitos, que permite estimar freqüências da amamentação a partir de regressões lineares ponderadas, utilizando o teste de aderência de Kolmogorov-Smirnov para verificar a adequação dos modelos obtidos. Verificou-se uma expansão considerável da prática da amamentação no País. Esta tedência ocorreu em todos os estratos da população, porém o aumento da prática da amamentação foi mais acentuado na área urbana, na região Centro-Sul do país, entre as mulheres de maior poder aquisitivo e de maior escolaridade.

Successful breast feeding in spite of early mother-baby separation for neonatal care

OBJECTIVE

To study the effects on breast feeding duration of mother-baby separation after birth, owing to full-term babies' care in a neonatal unit for a maximum of six days.

DESIGN

Retrospective review of medical records and telephone interviews with mothers.

SETTING

A level II and III NICU in a University Hospital.

PARTICIPANTS

148 mother-baby pairs in a separated group and 3516 in a comparison group.

MAIN OUTCOME MEASURES

Breast feeding success is defined as the duration of exclusive and partial breast feeding.

FINDINGS

There were no differences in breast feeding duration between babies in the separated group and the comparison group. More than 70% of the babies in both groups were breast fed exclusively after two months and more than 50% for more than four months. In the separated group delays in physical contact, first suckling and regular breast feeding, and duration of separation were not associated with shorter duration of breast feeding. Mixed feeding, both breast and bottle at the time of discharge from hospital, and baby diagnosis of hypoglycaemia had a negative impact. Maternal level of education was also associated with the breast feeding outcome.

CONCLUSIONS

Although every possible effort should be made to avoid mother-baby separation, women can be reassured that separation, because of their or the baby's medical condition during the first days after birth, need not be considered an obstacle to successful breast feeding.

A study of breast feeding rates at a large Australian obstetric hospital

A prospective breast feeding survey in a large obstetric hospital was carried out from 1988 to 1991. For each year, a sample of women were interviewed following delivery and data was collected which included the method of feeding, patient status (public or private patients), age, parity, (including previous breast feeding experience), marital status, country of birth and the number of babies. The mother's feeding method after delivery and on discharge from hospital were recorded. Women who were breast feeding on discharge were interviewed at 3 months. When putting the figures for the 4 years together, the breast feeding commencement rate was 88%, the breast feeding rate on discharge was 80% and the breast feeding rate at 3 months was between 51% and 57%. Factors found to be affecting the breast feeding rate at 3 months included patient status, age and parity. Problems experienced by the mothers after discharge from hospital included nipple pain, nipple trauma and mastitis. Private patients reported a significantly higher rate of mastitis than public patients.

Factors that influence the choice of infant feeding

To consider some of the many factors that influence the choice to initiate and continue breast-feeding.

CONCLUSION

There is increasing recognition of the nutritional value and related health outcomes of breast-fed infants. Further research is essential to appraise the medical and social determinants of infant feeding practices, particularly the early discontinutation of breast-feeding. Paediatricians are in an ideal position to foster, encourage and support such research and to accept a wider role in advocacy of the infant's right to obtain optimal nutrition.

Infant demand and milk supply. Part 2: The short-term control of milk synthesis in lactating women

In this second part of our two-part commentary, milk production and milk synthesis are defined and the methods that may be used in their measurement are briefly reviewed. In particular, the rationale for the development of breast volume measurement techniques is described. We review our studies which have employed breast volume measurement techniques and propose a model for the short-term control of milk synthesis in lactating women. According to this model, the breast responds to the degree to which the infant empties the breast at each breastfeed. The frequency of milk removal may not directly affect the rate of milk synthesis except as a function of the mother's ability to store milk.