Associations between Breastfeeding and Maternal Responsiveness: A Systematic Review of the Literature

Mother-infant feeding interactions in mothers with and without eating disorder history: Results of a structured observational study

BACKGROUND

A growing body of evidence suggests that children of mothers with eating disorders (EDs) have a greater risk of early feeding problems. Recognizing and reacting adequately to the infant's signals during feeding is crucial for the child's development of internal and external regulatory mechanisms of food intake. Parental EDs might affect this ability. Therefore, we investigated the quality of mother-infant interactions during feeding using video recording and a structured coding system.

METHODS

The data of this pilot study was collected in a prospective cohort study investigating the influence of maternal EDs on child outcomes. Twenty women with ED history and 31 control women were videotaped while feeding their infant during a main meal at ten months postpartum. The mother-infant interactions were evaluated by two raters using the Chatoor Feeding Scale. We assessed birth outcomes, the mother's ED and depression status, breastfeeding practices, infant feeding problems and infant temperament by maternal self-report.

RESULTS

Mothers with and without ED history scored very similar on the Feeding Scale, however mothers from the control group experienced more struggle for control with their infants during feeding (p = 0.046) and made more negative comments about the infant's food intake (p = 0.010). Mothers with ED history were more concerned about infant feeding at three months postpartum and reported significantly more problems with solid foods in their children. Birth outcomes were comparable between groups, except for lower weight-for-length birth percentiles in children of women with ED history.

CONCLUSION

Whilst examined mothers with ED history are more concerned about feeding their children, ED psychopathology does not affect the quality of mother-infant interaction during feeding at the transition to autonomous eating at ten months of age.

Impact of Milk on the Move breastfeeding support campaign on students' and employees' attitudes, subjective norms, intention, knowledge, and awareness

OBJECTIVE

To evaluate the impact of a campus-based breastfeeding support campaign grounded in the Theory of Reasoned Action.

PARTICIPANTS

Seventy-eight students and employees.

METHODS

An online survey was administered pre- and post-campaign to measure attitudes, subjective norm, normative and behavioral beliefs, intention, knowledge, and awareness. Regression analyses identified the most influential factors for intention to support breastfeeding on campus at both times. Paired sample t-tests compared changes over time.

RESULTS

Attitudes, but not subject norm, had a significant impact on intention to support breastfeeding on campus at both times (p < .01). Subjective norm improved over time (p = .04), whereas changes to attitudes, normative and behavioral beliefs, intention, and knowledge were small and mostly not significant. Participants' gained awareness that a lactation space is available on campus (p = .034) and that students can be excused from class to pump (p = .005).

CONCLUSIONS

Future campus-based efforts should target breastfeeding attitudes, knowledge, and awareness of breastfeeding supports.

Effects of responsive breastfeeding intervention on breastfeeding and infant growth in China: A randomised controlled trial

Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self-determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother-infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self-efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post-partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post-partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self-perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post-partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post-partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: -2.09; 95% CI: -2.88 to -1.31; p < 0.001), 6 weeks post-partum (MD: -4.35; 95% CI: -5.20 to -3.49; p < 0.001) and 3 months (MD: -4.89; 95% CI: -5.70 to -4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post-partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post-partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post-partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post-partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post-partum, the intervention group's infants showed slower weight (t = -0.90, p = 0.371) and length (t = -0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post-partum, there was a significant difference in both weight (t = -3.46, p = 0.001) and length (t = -2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self-confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow-up in future research.

Reported Adherence to the 10 Steps to Successful Breastfeeding Is Higher Among Baby-Friendly Hospitals

OBJECTIVE

Quantify and compare reported breastfeeding support practices in the Baby-Friendly Hospital Initiative (BFHI) and non-BFHI facilities.

DESIGN

Cross-sectional survey.

SETTING

Regions across the US.

PARTICIPANTS

Two hundred and eighty-six facilities (110 BFHI and 176 non-BFHI) selected by a stratified (by hospital size) random sample of 50% BFHI and 50% non-BFHI facilities.

INTERVENTION

Emailed survey Fall 2019 through Spring 2020.

MAIN OUTCOME MEASURE

Reported adherence to the 10 Steps to Successful Breastfeeding.

ANALYSIS

Wilcoxon rank sum test with continuity correction, Pearson chi-square test of independence, and Fisher's exact test.

RESULTS

Baby-Friendly Hospital Initiative facilities were more likely to report adherence to the 10 Steps to Successful Breastfeeding. Only 2 of the reported steps were not significantly different: immediate postnatal care and responsive feeding.

CONCLUSIONS AND IMPLICATIONS

This research supports breastfeeding support interventions within hospitals as both BFHI and non-BFHI facilities have room for improvement. Interventions targeting non-BFHI facilities are an opportunity to close the disparity in breastfeeding care.

The impact of ever breastfeeding on children ages 12 to 36 months: A secondary data analysis of the standardization study of the Dominican system for evaluating early childhood development

Extensive research has shown that breastfeeding offers many benefits to children, including advantages in lifelong health, physical development, cognitive function, behavior, and brain development, compared to those not breastfed. In the Dominican Republic, the prevalence of exclusive breastfeeding among infants aged 0-6 months remains low, and the lack of a surveillance system has made it challenging to measure the impact of breastfeeding on early childhood development (ECD). This study aims to address the effect of ever breastfeeding on ECD. We conducted secondary data analysis from the Dominican System for Measuring Early Childhood Development (SIMEDID), a screening tool adapted and validated to the Dominican context that measures four areas of development: gross-motor, fine-motor, language, and socioemotional development. The data from SIMEDID can be cross-analyzed with other datasets generated by the National Institute for Early Childhood Comprehensive Care (INAIPI) that include information about breastfeeding. The children were evaluated during the standardization study of SIMEDID. To determine the breastfeeding impact, we: 1) conducted an analysis of covariance using ECD scores as dependent variables and ever breastfed as the independent variable, with age and sex as covariates (previously confirmed with an analysis of variance indicating the relevance of age and sex at birth in ECD); 2) analyzed the relative risk (RR) of developmental delay by breastfeeding status. We studied a sample of 699 Dominican children aged 12-36 months who receive services at INAIPI (the government institution responsible for administering comprehensive early childhood services). The results show that ever breastfed children had higher scores in overall ECD than those who were not; higher scores in language and fine motor development primarily drove this effect. The never breastfed group had a greater risk of developmental delay in fine motor and socioemotional development. These findings underscore the importance of promoting and supporting breastfeeding to improve child neurodevelopmental outcomes. This is particularly relevant in low-resource settings, where mothers may need additional support. Moreover, the study's results provide evidence of SIMEDID's validation, which can help inform future research and evidence-based decision-making toward optimal ECD in similar contexts.

Awareness and Support of Responsive Bottle Feeding Among WIC Counselors and Caregivers: A Formative Qualitative Study

OBJECTIVE

To understand the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) counselor experiences discussing responsive bottle feeding during counseling and WIC participants' knowledge, understanding, and use of responsive bottle feeding.

METHODS

Qualitative descriptive, semistructured interviews with 23 participants (8 WIC counselors and 15 WIC participants) were conducted online via Zoom. The WIC counselors and mothers of WIC-enrolled bottle-fed infants were recruited through a network of WIC clinics in North Carolina. Interviews were recorded, transcribed, and collaboratively analyzed using content analysis.

RESULTS

The WIC participants received responsive infant feeding support from WIC counselors but often in the context of breastfeeding. WIC counselors provided valuable support for families but were challenged by limited training on responsive bottle feeding, balancing promoting breastfeeding with supporting mothers' feeding decisions, and time constraints.

CONCLUSIONS AND IMPLICATIONS

Findings provide preliminary support for the need to develop and pilot an intervention focused on promoting responsive feeding for parents of bottle-fed infants.

A Pilot Feasibility Randomized Controlled Trial of Effects of Opaque Bottles on Maternal Sensitivity, Infant Intake, and Infant Weight Status

BACKGROUND

Conventional clear infant feeding bottles provide visual cues about the amount of milk consumed, which may decrease caregivers' sensitivity to infant cues, increase infant intake, and lead to greater infant weight gain.

OBJECTIVE

This study examined feasibility, adherence, acceptability, and preliminary effectiveness of an intervention in which families received clear vs opaque bottles.

DESIGN

A pilot feasibility randomized controlled trial was conducted.

PARTICIPANTS/SETTING

Participants included mothers (N = 76) with young infants (2.9 ± 1.4 months old). Data collection occurred between December 2018 and July 2022 and within San Luis Obispo and Santa Barbara Counties, California. All assessments occurred within participants' homes.

INTERVENTION

Participants were randomized to use clear (Clear group, n = 38) or opaque (Opaque group, n = 38) bottles for 12 weeks.

MAIN OUTCOME MEASURES

We assessed feasibility of recruitment and retention, participant perceptions of study bottles, participant adherence to the intervention, maternal sensitivity to cues, infant intake (mL and mL/kg), and infant weight-for-length z-scores (WLZ).

STATISTICAL ANALYSES PERFORMED

Data were analyzed using linear regression, χ2 analysis, and repeated-measures analysis of variance (ANOVA).

RESULTS

Of 842 potential participants, 295 (35%) could not be reached after initial contact, 166 (20%) declined to participate, and 305 (36%) were ineligible. Of those who declined, 16 (10%) declined because they did not want to use study bottles. No differences were observed for loss to follow-up for Clear (8 of 38; 21%) vs Opaque (5 of 38; 13%) groups (P = 0.36) or for reported use of assigned bottles for Clear (89.8% ± 24.5% of daily feedings) vs Opaque (90.1% ± 22.1%) groups (P = 0.96). No group differences were observed for sensitivity to cues (P = 0.52) or intake (mL, P = 0.53 or mL/kg, P = 0.56) at follow-up. Opaque group infants had lower WLZ at follow-up compared with Clear group infants (mean difference, 0.47; 95% confidence interval, 0.08, 0.86; ηp2 = 0.17), adjusting for baseline WLZ.

CONCLUSIONS

Relative to providing clear bottles, providing families with opaque bottles appeared feasible and acceptable, with good adherence. Although preliminary, study findings suggest the potential of opaque bottles to support healthier weight outcomes for bottle-fed infants.

Physiologically-based pharmacokinetic model to predict doxorubicin and paclitaxel exposure in infants through breast milk

Limited information is available concerning infant exposure and safety when breastfed by mothers receiving chemotherapy. Whereas defining distribution to breast milk is important to infer drug exposure, infant pharmacokinetics also determine to what extent the infant will be exposed to potential toxic effects. We aimed to assess the impact of chemotherapy containing breast milk on infants by predicting systemic and local (intestinal) exposure of paclitaxel and doxorubicin in infants through breast milk using a physiologically-based pharmacokinetic (PBPK) approach. Whole-body PBPK models of i.v. paclitaxel and doxorubicin were extended from the literature, with an oral absorption component to enable predictions in infants receiving paclitaxel or doxorubicin-containing breast milk. For safety considerations, worst-case scenarios were explored. Finally, paclitaxel and doxorubicin exposures in plasma and intestinal tissue of infants following feeding of breast milk from paclitaxel- or doxorubicin-treated mothers were simulated and breast milk discarding strategies were evaluated. The upper 95th percentile of the predicted peak concentrations in peripheral venous blood were 3.48 and 0.74 nM (0.4%-1.7% and 0.1%-1.8% of on-treatment) for paclitaxel and doxorubicin, respectively. Intestinal exposure reached peak concentrations of 1.0 and 140 μM for paclitaxel and doxorubicin, respectively. Discarding breast milk for the first 3 days after maternal chemotherapy administration reduced systemic and tissue exposures even further, to over 90% and 80% for paclitaxel and doxorubicin, respectively. PBPK simulations of chemotherapy exposure in infants after breastfeeding with chemotherapy containing breast milk suggest that particularly local gastrointestinal adverse events should be monitored, whereas systemic adverse events are not expected.

Knowledge and Use of Paced Bottle-Feeding Among Mothers of Young Infants

OBJECTIVE

To describe mothers' awareness and use of paced bottle-feeding (PBF) and to investigate whether the use of PBF was associated with maternal characteristics and infant feeding practices.

METHODS

Cross-sectional, online survey. Participants were mothers of infants < 12 months of age (n = 197). Participants self-reported their awareness and use of PBF, demographic characteristics, and infant feeding practices.

RESULTS

Of the 41% of participants who indicated they had or maybe had heard of PBF, 23% used PBF and 35% sometimes used PBF. Use of PBF was not associated with mother or infant characteristics. Participants who used PBF were significantly less likely to encourage their infant to finish the bottle (odds ratio, 0.04; 95% confidence interval, 0.01-0.79).

CONCLUSIONS AND IMPLICATIONS

Paced bottle-feeding was associated with lower likelihood of one dimension of pressuring feeding practices, encouraging infant bottle-emptying. More research is needed to determine the effectiveness of PBF in promoting healthy feeding outcomes.

The Psychological Benefits of Breastfeeding: Fostering Maternal Well-Being and Child Development

The value of breastfeeding surpasses its utilitarian role in nourishing, encompassing profound psychological advantages for mothers and children. The orchestration of emotional bonds relies on the interplay of oxytocin and prolactin, fundamental hormones that underpin maternal attachment, mitigate postpartum depression, and cultivate self-confidence. Simultaneously, breastfeeding promotes infant development by fostering robust brain growth, bolstering immune defenses, and nurturing cognitive and emotional maturation - all of which are nurtured through maternal interactions. We must respond to the call for heightened advocacy of breastfeeding. This entails delivering education, easily accessible support, and creating an environment where breastfeeding is normalized. By dispelling misconceptions and eradicating stigmatization associated with breastfeeding, we can amplify awareness and empower mothers to make well-informed decisions for their newborns. These implications reverberate extensively. Enhanced maternal mental well-being and self-assurance form the bedrock of healthier family dynamics. At the same time, the dividends of cognitive, emotional, and immunological enrichment in children represent a more promising future. At a societal level, the embrace and promotion of breastfeeding cultivate an environment that places immense value on the health and happiness of both mothers and children. This journey is more profound than mere sustenance; it signifies a complex web of advantages. Elevating awareness and support for breastfeeding solidifies the global commitment to comprehensive maternal and child welfare and the flourishing of meaningful relationships.

The association of early feeding practices with eating behaviors and maternal indulgent feeding behaviors among Saudi preschoolers

Evidence from previous work suggest that feeding practices during the first years of life may influence the development of eating behaviors later in childhood. Early feeding practices may also predict later maternal feeding behaviors. Mothers from an Arab/Middle Eastern background may adopt unique early feeding practices. The objective of this study was to examine the association of offering fruit juice and date syrup-milk mixture in a baby bottle during infancy with: 1) Child eating behaviors during preschool years; 2) Maternal indulgent feeding practices during preschool years. Mothers of preschoolers (n = 115) completed questions adopted from the Children's Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire-Arabic (CFQ-A), as well as questions assessing early feeding practices and demographic characteristics. Unadjusted and adjusted logistic regression models were tested to examine the association of early feeding practices with child eating behaviors and maternal indulgent feeding behaviors. Odds ratios (ORs) and respective 95% confidence intervals (CI) were derived. Adjusting for covariates, children who were ever offered fruit juice in a baby bottle as infants were more likely to have high food responsiveness at preschool, compared to children who were not (OR = 2.93, 95% CI = 1.16, 7.42). Mothers who reported ever offering fruit juice in a baby bottle when their children were infants were more likely to adopt greater use of food as a reward when their children were at preschool (OR = 3.25, 95% CI = 1.22, 8.68). Early feeding practices are associated with child eating and maternal feeding behaviors later in childhood. Future longitudinal studies are needed to further establish these associations. Findings from this study can help inform community awareness and education programs to prevent maladaptive feeding practices and promote appropriate feeding strategies throughout childhood.

Breastfeeding sick children in hospital: Exploring the experiences of mothers in UK paediatric wards

There is a paucity of literature exploring the challenges of breastfeeding sick children in hospital. Previous research has focused on single conditions and hospitals which limits understanding of the challenges in this population. Although evidence suggests that current lactation training in paediatrics is often inadequate, it is unclear where the specific training gaps are. This qualitative interview study of UK mothers aimed to explore the challenges of breastfeeding sick infants and children on a paediatric ward or paediatric intensive care unit. From 504 eligible respondents, a sample of 30 mothers of children aged 2-36 months with various conditions and demographic backgrounds was purposively chosen, and a reflexive thematic analysis undertaken. The study identified previously unreported impacts such as complex fluid needs, iatrogenic withdrawal, neurological irritability and changes to breastfeeding behaviour. Mothers described breastfeeding as emotionally and immunologically meaningful. There were many complex psychological challenges such as guilt, disempowerment, and trauma. Wider struggles such as staff resistance to bedsharing, inaccurate breastfeeding information, lack of food and inadequate breast pump provision made breastfeeding more challenging. There are numerous challenges related to breastfeeding and responsively parenting sick children in paediatrics, and these also impacted maternal mental health. Staff skill and knowledge gaps were widespread, and the clinical environment was not always conducive to supporting breastfeeding. This study highlights strengths in clinical care and provides insight into what measures are perceived as supportive by mothers. It also highlights areas for improvement, which may inform more nuanced paediatric breastfeeding standards and training.

The development of interoceptive hunger signals

Hunger is often reported when people experience certain internal sensations (e.g., fatigue) or when they anticipate that a food will be good to eat. The latter results from associative learning, while the former was thought to signal an energy deficit. However, energy-deficit models of hunger are not well supported, so if interoceptive hungers are not "fuel gauges," what are they? We examined an alternate perspective, where internal states signaling hunger, which are quite diverse, are learned during childhood. A basic prediction from this idea is offspring-caregiver similarity, which should be evident if caregivers teach their child the meaning of internal hunger cues. We tested 111 university student offspring-primary caregiver pairs, by having them complete a survey about their internal hunger states, alongside other information that may moderate this relationship (i.e., gender, body mass index, eating attitudes, and beliefs about hunger). We observed substantial similarity between offspring-caregiver pairs (Cohen's ds from 0.33 to 1.55), with the main moderator being beliefs about an energy-needs model of hunger, which tended to increase similarity. We discuss whether these findings may also reflect heritable influences, the form that any learning might take, and the implications for child feeding practices.

Development of an Individualized Responsive Feeding Intervention-Learning Early Infant Feeding Cues: Protocol for a Nonrandomized Study

BACKGROUND

Responsive infant feeding occurs when a parent recognizes the infant's cues of hunger or satiety and responds promptly to these cues. It is known to promote healthy dietary patterns and infant weight gain and is recommended as part of the Dietary Guidelines for Americans. However, the use of responsive infant feeding can be challenging for many parents. Research is needed to assist caregivers recognize infant hunger or satiety cues and overcoming barriers to using responsive infant feeding.

OBJECTIVE

The Learning Early Infant Feeding Cues (LEIFc) intervention was designed to fill this gap by using a validated coaching approach, SS-OO-PP-RR ("super," Setting the Stage, Observation and Opportunities, Problem Solving and Planning, Reflection and Review), to promote responsive infant feeding. Guided by the Obesity-Related Behavioral Intervention Trials model, this study aims to test the feasibility and fidelity of the LEIFc intervention in a group of mother-infant dyads.

METHODS

This pre-post quasi-experimental study with no control group will recruit mothers (N=30) in their third trimester (28 weeks and beyond) of pregnancy from community settings. Study visit 1 will occur prenatally in which written and video material on infant feeding and infant hunger and satiety cues is provided. Demographic information and plans for infant feeding are also collected prenatally via self-report surveys. The use of responsive infant feeding via subjective (survey) and objective (video) measures is recorded before (study visit 2, 1 month post partum) and after (study visit 5, 4 months post partum) intervention. Coaching on responsive infant feeding during a feeding session is provided by a trained interventionist using the SS-OO-PP-RR approach at study visits 3 (2 months post partum) and 4 (3 months post partum). Infant feeding practices are recorded via survey, and infant weight and length are measured at each postpartum study visit. Qualitative data on the LEIFc intervention are provided by the interventionist and mother. Infant feeding videos will be coded and tabulated for instances of infant cues and maternal responses. Subjective measures of responsive infant feeding will also be tabulated. The use of responsive infant feeding pre-post intervention will be analyzed using matched t tests. Qualitative data will be examined to guide intervention refinement.

RESULTS

This study initially began in spring 2020 but was halted because of the COVID-10 pandemic. With new funding, recruitment, enrollment, and data collection began in April 2022 and will continue until April 2023.

CONCLUSIONS

After refinement, the LEIFc intervention will be tested in a pilot randomized controlled trial. The long-term goal is to implement LEIFc in the curricula of federally funded maternal-child home visiting programs that serve vulnerable populations-those that often have infant feeding practices that do not align with recommendations and are less likely to use responsive infant feeding.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44329.

A mixed methods study of siblings’ roles in maternal feeding practices in early childhood: an application of the learning from experience process

Background

Firstborn children have higher rates of obesity compared to secondborns, perhaps due, in part, to differential feeding practices. Despite the centrality of siblings in family life and potential for influence, almost nothing is known about the role of siblings in parent feeding practices in early childhood.

Methods

Participants (n = 117) were mothers of consecutively born siblings. Firstborns participated in an RCT that compared a responsive parenting intervention designed for primary prevention of obesity against a safety control. Secondborns participated in an observational cohort. Multilevel models tested whether and how firstborn characteristics (temperament, appetite, rapid weight gain) at 16 weeks and 1 year were associated maternal feeding practices of secondborns in infancy at 16 weeks, 28 weeks, and 1 year (food to soothe) and at ages 1, 2, and 3 years (structure-and control-based feeding practices). A purposive subsample (n = 30) of mothers also participated in semi-structured interviews to further illuminate potential sibling influences on maternal feeding practices during infancy and toddlerhood.

Results

Firstborn characteristics did not predict secondborn feeding in infancy (all ps > 0.05). Firstborn negative affect, however, predicted mothers’ less consistent mealtime routines (b (SE) = − 0.27 (0.09); p = 0.005) and more pressure (b (SE) = 0.38 (0.12); p = 0.001). Firstborn appetite predicted mothers’ less frequent use of food to soothe (b (SE) = − 0.16 (0.07); p = 0.02) when secondborns were toddlers. Firstborn surgency, regulation, and rapid weight gain, however, did not predict secondborn feeding practices during toddlerhood (all ps > 0.05). Interviews with mothers revealed three ways that maternal experiences with firstborns informed feeding practices of secondborns: 1) Use of feeding practices with secondborn that worked for the firstborn; 2) Confidence came from firstborn feeding experiences making secondborn feeding less anxiety-provoking; and 3) Additional experiences with firstborn and other factors that contributed to secondborn feeding practices.

Conclusions

Some firstborn characteristics and maternal experiences with firstborns as well as maternal psychosocial factors may have implications for mothers’ feeding practices with secondborns. Together, these mixed methods findings may inform future research and family-based interventions focused on maternal feeding of siblings in early childhood.

Presence of Five Chemotherapeutic Drugs in Breast Milk as a Guide for the Safe Use of Chemotherapy During Breastfeeding: Results From a Case Series

Little is known about infant's safety of chemotherapy during breastfeeding where evidence is limited to a few case reports. This lack of knowledge has led to a general tendency to advise against breastfeeding during cytotoxic therapy despite the overwhelming benefits that breastfeeding offers to both the mothers and their children. In this case series, the presence of five chemotherapies in breast milk was determined. The aim was to obtain insight into the presence of these drugs in breast milk to inform and help clinicians in making informed decisions for women who want to breastfeed. Three patients collected 24-hour samples of breast milk every day for 1, 2, or 3 weeks after chemotherapy, 210 in total. After determination of drug concentrations, the infant daily dose, relative daily infant dose (RID%) and cumulative RID were calculated. Cumulative RIDs in patients varied from 10% to values lower than 1%. Rich data allowed us to design a table which gives predictions on the amount of days that breast milk has to be discarded to reach cumulative RIDs below 5, 1, and 0.1% for each compound. For cyclophosphamide, paclitaxel, and carboplatin, cumulative RIDs below 1 or 0.1% are reached if breast milk is discarded for 1-3 days after administration. This might suggest that breastfeeding in between cycles is an option. However, other pharmacological parameters should also be taken into consideration. For doxorubicin, also the levels of the active metabolite doxorubicinol need quantification. Similarly, breastfeeding during treatment with cisplatin might give substantial exposure and we advise caution.

Associations between infant and maternal characteristics measured at child age 5 months and maternal feeding styles and practices up to child age two years

Facilitating positive feeding practices from infancy may be an important strategy to prevent childhood overweight and obesity. Since the feeding situation early in life constitutes a bidirectional relationship, it is important to understand the impact of both maternal and infant characteristics on maternal feeding practices to intervene in a customized and tailored way. Few studies have concurrently examined associations between maternal and infant characteristics in relation to early maternal feeding practices. The aim of the present study was to explore potential associations between infant and maternal characteristics measured at child age five months, and maternal feeding styles and practices during the child’s first two years. Cross-sectional data from a Norwegian randomized controlled trial in which participants responded to questionnaires at child age 5 months (n = 474), 12 months (n = 293) and 24 months (n = 185) were used to explore potential associations. All maternal and child predictor variables were collected at child age five months. Maternal feeding styles and practices were mapped using subscales from the Infant Feeding Questionnaire at child age 5 and 12 months and the Child Feeding Questionnaire and the Parental Feeding Style Questionnaire at child age 24 months. The subscale-scores were split into roughly equal tertiles, and the upper or lower tertile for the outcome of interest were used to create binary outcome variables. Multivariable binary logistic regression models were conducted for each outcome. We found that maternal education and mental health symptoms as well as infant weight, temperament and feeding mode were associated with maternal feeding styles and practices over time. Our findings indicate that risk factors which may have long-term implications for child weight and health outcomes can be identified early. Larger, population-based studies with a longitudinal design are needed to further explore these pathways.

Mother-infant interactions and infant intake during breastfeeding versus bottle-feeding expressed breast milk

Bottle-fed infants are at higher risk for rapid weight gain compared with breastfed infants. Few studies have attempted to disentangle effects of feeding mode, milk composition and relevant covariates on feeding interactions and outcomes. The objective of the present study was to compare effects of breastfeeding directly at the breast versus bottle-feeding expressed breast milk on feeding interactions. Mothers with <6-month-old infants (n = 47) participated in two counterbalanced, feeding observations. Mothers breastfed their infants directly from the breast during one visit (breast condition) and bottle-fed their infants expressed breast milk during the other (bottle condition). Masked raters later coded videos using the Nursing Child Assessment Parent-Child Interaction Feeding Scale. Infant intake was assessed. Mothers self-reported sociodemographic characteristics, infant feeding patterns (i.e. percentage of daily feedings from bottles) and level of pressuring feeding style. Mother and infant behaviours were similar during breast and bottle conditions. Percent bottle-feeding moderated effects of condition on intake (P = 0.032): greater percent bottle-feeding predicted greater intake during the bottle compared with breast condition. Effects of feeding mode were not moderated by parity or pressuring feeding style, but, regardless of condition, multiparous mothers fed their infants more than primiparous mothers (P = 0.028), and pressuring feeding style was positively associated with infant intake (P = 0.045). Findings from the present study do not support the hypothesis that feeding mode directly impacts dyadic interaction for predominantly breastfeeding mothers and infants, but rather suggest between-subject differences in feeding experiences and styles predict feeding outcomes for this population.

Privacy, Early Colostrum, and Gestational Age are Associated with Exclusive Breastfeeding in Preterm and Sick Term Infants

Our study was designed to assess the rates of exclusive breastfeeding (defined as direct breastfeeding) and the use of mother's own milk (MOM) in preterm infants and sick term infants at discharge and to identify potential influencing factors such as gestational age, early colostrum, and privacy. The study was conducted at a German level III neonatal department. All preterm and sick term infants admitted to the neonatal intensive care unit, the pediatric intensive care unit, the intermediate care unit, and the low care ward were included in the study. Infants were recruited between March and October 2015 (phase 1) and April to July 2016 (phase 2). Due to an emergency evacuation, privacy was limited during the first phase. Breastfeeding and the use of MOM were assessed daily using a self-designed score. In total, 482 infants of 452 mothers were included. More than 90% initiated breastfeeding and one-third were exclusively breastfed at discharge. Extremely immature infants and late preterm infants were less likely to be exclusively breastfed at discharge. Privacy (p<0.001) and early colostrum (p=0.002) significantly increased exclusive breastfeeding. Conclusion Extremely immature and late preterm infants were least likely to be exclusively breastfed at discharge and need special support. Interventions such as privacy and early colostrum should be promoted to increase breastfeeding.

Infant feeding experiences and concerns among caregivers early in the COVID-19 State of Emergency in Nova Scotia, Canada

The global emergency caused by the novel coronavirus (COVID-19) pandemic has impacted access to goods and services such as health care and social supports, but the impact on infant feeding remains unclear. Thus, the objective of this study was to explore how caregivers of infants under 6 months of age perceived changes to infant feeding and other food and health-related matters during the COVID-19 State of Emergency in Nova Scotia, Canada. Four weeks after the State of Emergency began, between 17 April and 15 May 2020, caregivers completed this online survey, including the Perceived Stress Scale. Participants (n = 335) were 99% female and mostly White (87%). Over half (60%) were breastfeeding, and 71% had a household income over CAD$60,000. Most participants (77%) received governmental parental benefits before the emergency, and 59% experienced no COVID-19-related economic changes. Over three quarters of participants (77%) scored moderate levels of perceived stress. Common themes of concern included social isolation, COVID-19 infection (both caregiver and infant), and a lack of access to goods, namely, human milk substitutes ('infant formula'), and services, including health care, lactation support, and social supports. Most COVID-19-related information was sought from the internet and social media, so for broad reach, future evidence-based information should be shared via online platforms. Although participants were experiencing moderate self-perceived stress and shared numerous concerns, very few COVID-19-related changes to infant feeding were reported, and there were few differences by socio-economic status, likely due to a strong economic safety net in this Canadian setting.

ABM Clinical Protocol #1: Guidelines for Glucose Monitoring and Treatment of Hypoglycemia in Term and Late Preterm Neonates, Revised 2021

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical conditions that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Breastfeeding, Physical Growth, and Cognitive Development

BACKGROUND AND OBJECTIVES

Breastfeeding is an evidence-based recommendation for all countries, but breastfeeding rates have been declining in many middle-income settings. One reason behind this decline is the perception that breastfeeding may not be necessary in modern urban settings, where clean water is available and alternative foods are abundant. We investigate the importance of breastfeeding for early childhood development in the modern urban context of São Paulo, Brazil.

METHODS

In our study, we used data from the ongoing prospective Western Region Birth cohort in São Paulo, Brazil. Children were recruited at birth and managed for 3 years. Durations of exclusive and mixed breastfeeding were our primary independent variables. Our secondary independent variable was an indicator for compliance with World Health Organization (WHO) breastfeeding recommendations. Our primary outcomes of interest were indicators of children's physical, cognitive, language, and social-emotional development at 3 years of age. Adjusted estimates and 95% confidence intervals were calculated by using linear and logistic regression.

RESULTS

Complying with WHO recommendations to exclusively breastfeed for 6 months followed by complementary feeding until 2 years of age was associated with a 0.4-SD increase in overall child development (β: .38; confidence limit = 0.23 to 0.53), a 0.6-SD increase in height-for-age z score (β: .55; confidence limit = 0.31 to 0.79), and a 67% decrease in the odds of stunting (odds ratio = 0.33; 95% confidence interval = 0.20 to 0.54).

CONCLUSIONS

Our results suggest that even in settings with easy access to complementary foods, complying with WHO breastfeeding recommendations is important for healthy physical growth and cognitive development.

Longitudinal analysis of growth trajectories in young children of Chinese-born immigrant mothers compared with Australian-born mothers living in Victoria, Australia

BACKGROUND

Chinese immigrants are the third largest immigrant group in Australia. Little is known about growth trajectories of their offspring when moving to a Western country. The aim was to describe the growth trajectories between birth to 3.5 years in children of Chinese-born immigrant mothers compared with Australian-born mothers living in Victoria, Australia.

METHODS

Ten nurse measured weights and lengths from birth to 3.5 years were used to examine growth trajectory using linear spline multilevel models. Five knot points were identified at visit 2 (0.5 months), visit 4 (2 months), visit 5 (4.5 months), visit 8 (18 months) and visit 9 (25 months).

RESULTS

Ethnic disparities in growth trajectories between these two groups were revealed in models adjusted for birth weight, sex and level of socioeconomic disadvantage. Children of Chinese-born compared with Australian-born mothers revealed different growth rates and significant differences in predicted mean body mass index Z score (zBMI) at all time points from birth to 44 months, except for 12 months. Specifically, when compared with children of Australian-born mothers, children of Chinese-born mothers started with lower predicted zBMI from birth until 0.5 months, had a higher zBMI from 1 to 8 months and a lower zBMI from 12 to 44 months. Early and sharp acceleration of growth was also observed for children of Chinese-born mothers (0.5-2 months) when compared with children of Australian-born mothers (2-18 months).

CONCLUSION

Differences in growth trajectories exist between young children of Chinese-born and Australian-born mothers. Better understanding of these ethnically patterned growth trajectories is important for identifying key opportunities to promote healthy growth in early life.

Nutrition- and feeding practice-related risk factors for rapid weight gain during the first year of life: a population-based birth cohort study

Background

Rapid weight gain (RWG) during infancy increases the risk of excess weight later in life. Nutrition- and feeding practices associated with RWG need to be further examined. The present study aimed to examine nutrition- and feeding practice-related risk factors for RWG during the first year of life.

Methods

A population-based longitudinal birth cohort study of 1780 infants, classified as having RWG or non-RWG during 0–3-4, 0–6 and 6–12 months. RWG was defined as a change > 0.67 in weight standard deviation scores. Associations between nutrition- and feeding practice-related factors and RWG were examined with logistic regression models.

Results

Of the participating infants, 47% had RWG during 0–3-4 months, 46% during 0–6 months and 8% during 6–12 months. In the fully adjusted models, bottle-feeding at birth and at 3–4 months and nighttime meals containing formula milk were positively associated with RWG during 0–3-4 months (p < 0.05 for all). Breastfeeding at 3–4 months and nighttime meals containing breast milk were negatively associated with RWG during this period (p < 0.001). Bottle-feeding at birth, 3–4 and 6 months and nighttime meals containing formula milk at 3–4 months were positively associated with RWG during 0–6 months (p < 0.01 for all). Breastfeeding at 3–4 and 6 months was negatively associated with RWG (p < 0.01). During 6–12 months, only bottle-feeding at 3–4 months was positively associated with RWG (p < 0.05).

Conclusions

RWG was more common during the first 6 months of life and bottle-feeding and formula milk given at night were risk factors for RWG during this period.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12887-020-02391-4.

Mixed milk feeding: a systematic review and meta-analysis of its prevalence and drivers

CONTEXT

Extensive literature is available on exclusive breastfeeding and formula-feeding practices and health effects. In contrast, limited and unstructured literature exists on mixed milk feeding (MMF), here defined as the combination of breastfeeding and formula feeding during the same period in term infants > 72 hours old (inclusion criterion).

OBJECTIVE

A systematic review and meta-analysis were performed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, on the global prevalence of MMF (primary outcome) and related drivers and practices (secondary outcomes).

DATA SOURCES

The search of MMF in generally healthy populations was conducted across 6 databases, restricted to publications from January 2000 to August 2018 in English, Spanish, French, and Mandarin.

DATA EXTRACTION

Two reviewers independently performed screenings and data extraction according to a priori inclusion and exclusion criteria.

DATA ANALYSIS

Of the 2931 abstracts identified, 151 full-text publications were included for data extraction and 96 of those were included for data synthesis (the majority of those were cross-sectional and cohort studies). The authors summarized data across 5 different categories (feeding intention prenatally, and 4 age intervals between > 72 hours and > 6-23 months) and 5 regional subgroups. The overall prevalence of MMF across different age intervals and regions varied between 23% and 32%; the highest rate was found for the age group 4-6 months (32%; 95% confidence interval, 27%-38%); regional comparisons indicated highest MMF rates in Asia (34%), North and South America (33%), and Middle East and Africa together (36%), using a random effects meta-analysis model for proportions. Some drivers and practices for MMF were identified.

CONCLUSION

MMF is a widespread feeding reality. A shared and aligned definition of MMF will help shed light on this feeding practice and evaluate its influence on the duration of total breastfeeding, as well as on infants' nutrition status, growth, development, and health status in the short and long terms. PROSPERO registration number CRD42018105337.

Positive parenting approaches and their association with child eating and weight: A narrative review from infancy to adolescence

Parents play a critical role in the development of children's eating behaviours and weight status, serving as providers, models and regulators of the food environment. Many research reviews have focused on the robust body of evidence on coercive control in feeding: how parenting practices such as restriction and pressure to eat increase children's risk for developing undesirable eating behaviours and unhealthy weight outcomes. Fewer reviews adopt a strengths-based perspective focusing on the ways that parents can actively support the development of healthy eating behaviours and weight trajectories. Emerging research on such positive parenting styles and practices offers solutions beyond the avoidance of coercive control, as well as opportunities to highlight parallels between research on food parenting and the broader, well-established developmental literature on positive parenting. The focus of this review is to summarize what is known regarding benefits of positive parenting styles and practices for child eating and weight outcomes and discuss recommendations for future research. Current evidence supports starting with responsive feeding and parenting during infancy and incorporating structure and limit setting in early childhood, with monitoring and mealtime structure remaining important during middle childhood and adolescence. Areas for future research include: (1) further examination of the implications of identified food parenting practices and styles among diverse groups and caregivers; (2) increased consideration of child factors (eg, temperament) as moderators or mediators; and (3) further clarification of the relationship between general parenting and food parenting.

Associations between Bottle-Feeding during Infancy and Obesity at Age 6 Years Are Mediated by Greater Infancy Weight Gain

Objective: To explore whether the association between bottle-feeding during the first year and childhood obesity at age 6 years is mediated by change in weight-for-age z-score (ΔWAZ) during infancy. Methods: Participants were 1062 mother-child pairs who participated in the Infant Feeding Practices Study II and Year 6 Follow-Up. Mothers completed 1 prenatal questionnaire, 10 postpartum questionnaires during the first year, and 1 follow-up questionnaire at 6 years. Child weights were reported by mothers and used to determine ΔWAZ from birth to later infancy. Causal mediation analysis was used to determine the average direct effect of bottle-feeding on obesity at age 6 years and the average causal mediation effect of bottle-feeding through ΔWAZ. Results: Infants who experienced rapid increases in bottle-feeding frequency during the first 6 months had significantly greater ΔWAZ compared with infants who had consistently low bottle-feeding frequency until 12 months of age [β = 0.45, 95% confidence interval (CI) 0.11-0.80]. Significant predictors of obesity at age 6 years were larger birth weight [adjusted odds ratio (AOR) = 4.27, 95% CI 2.42-7.64] and larger ΔWAZ (AOR = 1.59, 95% CI 1.29-1.98). An indirect effect of bottle-feeding, mediated via ΔWAZ, accounted for 59% of the total effect of bottle-feeding on obesity at age 6 years. Conclusions: Rapid increases in bottle use during the first 6 months postpartum predicted greater risk for obesity at age 6 years via an indirect mediation effect of larger ΔWAZ from birth to later infancy.

Early risk factors for postpartum depression: A longitudinal Japanese population-based study

BACKGROUND

Postpartum depression (PPD) negatively impacts maternal health, parenting and development of children. Most previous studies on PPD risk factors are based on Western populations. Additionally, little is known about the association between psychosocial factors during early pregnancy period and PPD. We aimed to identify early risk factors for PPD until three months after delivery using a longitudinal population-based sample from Japan.

METHODS

The data was collected from 1050 mothers at four time points: first trimester, after the birth, and one and three months post-delivery. Mothers who had a Japanese Edinburgh Postnatal Depression Scale (EPDS) cutoff score above 9 at one or 3 months after delivery were recognized as having PPD (n = 91/8.7%).

RESULTS

Negative feelings about pregnancy, combined breast and bottle feeding, first-time motherhood, motherhood 24 or less years old, perceived maternal mental illness before pregnancy, and lack of social support were all significantly associated with PPD at three months after delivery.

LIMITATIONS

The data was collected from one city in Japan, which limits the generalization of the findings. Additionally, PPD was assessed by an EPDS questionnaire, and not by a clinical interview.

CONCLUSIONS

Even after controlling for the perceived mental illness before pregnancy, several risk factors as early as in the first trimester were associated with PPD. These risk factors should be identified and the mothers should be offered a suitable intervention, in order to prevent the development of PPD.

Biphasic Glucocorticoid Rhythm in One-Month-Old Infants: Reflection of a Developing HPA-Axis?

CONTEXT

The hypothalamus-pituitary-adrenal (HPA) axis displays a diurnal rhythm. However, little is known about its development in early life.

OBJECTIVE

To describe HPA-axis activity and study possible influencing factors in 1-month-old infants.

DESIGN

Observational.

SETTING

Amsterdam University Medical Center, location VU University Medical Center (VUMC), and Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam.

PARTICIPANTS

Fifty-five mother-infant pairs.

INTERVENTIONS

Collection of breast milk and infants' saliva 1 month postpartum for analysis of glucocorticoids (GCs; ie, cortisol and cortisone) using liquid chromatography- tandem mass spectrometry.

MAIN OUTCOME MEASURE

GC rhythm in infants' saliva and associations with vulnerability for maternal psychological distress (increased Hospital Anxiety and Depression Scale [HADS] score) or consultation at the Psychiatric Obstetric Pediatric (POP clinic), season at sampling, sex, and breast milk GC rhythmicity analyzed with SigmaPlot 14.0 software (Systat Software, San Jose, CA, USA) and regression analyses.

RESULTS

A significant biphasic GC rhythm was detected in infants, with mean peaks [standard error of the mean, SEM] at 6:53 am [1:01] and 18:36 pm [1:49] for cortisol, and at 8:50 am [1:11] and 19:57 pm [1:13] for cortisone. HADS score, POP consultation, season at sampling, and sex were not associated with the infants' GC rhythm. Breast milk cortisol maximum was positively associated with infants' cortisol area-under-the-curve (AUC) increase and maximum. Higher breast milk cortisone AUC increase, AUC ground, and maximum were associated with an earlier maximum in infants. Breast milk and infant GC concentrations were associated between 6:00 am and 9:00 am.

CONCLUSIONS

A biphasic GC rhythm, peaking in the morning and evening, was seen in 1-month-old infants at a group level. Breast milk GC parameters might be associated with the infants' GC rhythm, possibly caused by a signaling effect of breast milk GCs, or as an associative effect of increased mother-infant synchrony. These results contribute to an increased understanding of early life HPA-axis development.

Exploration of Responsive Feeding During Breastfeeding Versus Bottle Feeding of Human Milk: A Within-Subject Pilot Study

Background: Responsive feeding promotes optimal feeding patterns and growth trajectories. Breastfeeding is thought to facilitate responsive feeding, but research to date has been limited to comparing formula-feeding and breastfeeding dyads. Using a within-subject approach, we aimed to assess maternal responsiveness to infant cues during two human milk feeding sessions differing by feeding modality (breastfeeding versus bottle feeding). Materials and Methods: Nine mother-infant dyads (infants ≤6 months) were recruited from the Halifax Regional Municipality, Nova Scotia, from April to May 2018. Two human milk-feeding sessions, directly from the breast and from a bottle, were video-recorded in participants' homes, then scored using the validated Nursing Child Assessment Satellite Training (NCAST) Caregiver/Parent-Child Interaction Feeding Scale. The second half of feeding sessions were coded for infant satiation cues. Results: All women earned a college degree or higher, and were partnered. Mothers were aged mean ± standard deviation 33.2 ± 4.0 years; infants were 14.6 ± 6.9 weeks old and six (67%) were female. Mothers were more sensitive to infant cues during breastfeeding (NCAST Maternal Sensitivity to Cues sub-scale score, 15.0 ± 1.0) than bottle feeding (13.4 ± 1.6; p = 0.016). There was a significantly longer latency from feeding session midpoint to the first satiation cue during breastfeeding (minutes:seconds; 3:00 ± 1:53 versus 0:45 ± 1:18 bottle feeding, p = 0.038). There was no difference in the number of infant cues by feeding modality. Conclusions: Despite the small sample with high socioeconomic status, this pilot study highlights differences in maternal responsiveness to infant cues by feeding modality with human milk, which warrants further investigation.

Development and Validation of a New Questionnaire Assessing Feeding Styles in Toddlers: Toddler Feeding Style Questionnaire (TFSQ)

PURPOSE

To develop and validate a new questionnaire assessing feeding styles in toddlers, the Toddler Feeding Style Questionnaire (TFSQ).

DESIGN AND METHODS

An instrumental design was used in this study. A convenience sample of 546 Spanish mothers of a toddler (12-24 months-old) completed the TFSQ and a web-based survey to obtain data on feeding styles, sociodemographic and anthropometric characteristics, weaning and attachment style. Items were developed and classified into two content domains: responsiveness and demandingness. For the construct validity analysis, the sample was randomly divided into two halves used to the exploratory and confirmatory factor analysis, respectively. Validation hypotheses about the differences in the TFSQ scores were suggested.

RESULTS

The factorial analysis revealed a responsiveness scale and a demandingness scale. The McDonald's Omega and Cronbach's alpha values coincided in both scales, being 0.84 and 0.75, respectively. A high responsiveness and demandingness feeding styles degree of agreement showed a statistically significant association with the correspondent scale (p < .01). The 33.3% of children who are overweight or obese have mothers who classify themselves as neglectful. Both scales were related to the mothers' attachment styles, toddler's age and the time of weaning at 6 and 12 months.

CONCLUSIONS

The TFSQ provides a valid and reliable Responsiveness and Demandingness scale to evaluate feeding styles in toddlers.

PRACTICE IMPLICATIONS

Parental feeding styles influence future eating behavior and children's weight. There is a lack of validated instruments used to evaluate feeding styles in toddlerhood based on the two theoretical dimensions of responsiveness and demandingness.

Duration of breastfeeding is associated with emotional eating through its effect on alexithymia in boys, but not girls

Emotional eating (EE), or eating in response to negative emotions, was earlier shown to be associated with difficulty in identifying emotions (alexithymia). To improve our understanding of possible causes of alexithymia and EE, we assessed possible associations with duration of breastfeeding in infancy. The aim of the present study was to examine in a prospective, longitudinal study whether duration of breastfeeding is associated with EE in adolescence, through its effect on alexithymia difficulty identifying emotions, and whether this mediation effect is contingent on gender. Our hypothesis was that longer duration of breastfeeding would be associated with lower EE in adolescence through its effect on lower alexithymia difficulty identifying feelings in boys but not in girls (Moderated mediation). The sample included 129 children and their families (67 boys and 62 girls). Duration of breastfeeding was reported by the mother when the infant was 15 months old. Alexithymia difficulty identifying feelings (Toronto Alexithymia Scale) and EE (Dutch Eating Behavior Questionnaire) were reported by the child at 12 years of age. EE was also reported by the child at 16 years of age. Moderated mediation was significant for EE at 12 years, and borderline significant for EE at 16 years. As hypothesized, for boys but not for girls, longer duration of breastfeeding was related to less difficulties in identifying feelings, resulting in lower degrees of EE in adolescence. It is concluded that breastfeeding in infancy may protect boys against EE through its positive association with better ability to identify feelings.

Mother⁻Infant Physical Contact Predicts Responsive Feeding among U.S. Breastfeeding Mothers

Responsive feeding—initiating feeding in response to early hunger cues—supports the physiology of lactation and the development of infant feeding abilities, yet there is a dearth of research examining what predicts responsive feeding. In non-Western proximal care cultures, there is an association between responsive feeding and mother–infant physical contact, but this has not been investigated within Western populations. In two studies, we tested whether mother–infant physical contact predicted feeding in response to early hunger cues versus feeding on a schedule or after signs of distress among U.S. breastfeeding mothers. With an online questionnaire in Study 1 (n = 626), physical contact with infants (via co-sleeping and babywearing) predicted increased likelihood of self-reported responsive feeding. Mothers who reported responsive feeding were more likely to exclusively breastfeed for the first six months, breastfeed more frequently throughout the day, and had a longer planned breastfeeding duration than mothers who reported feeding on a schedule or after signs of infant distress. In Study 2 (n = 96), a three-day feeding log showed that mother–infant physical contact predicted feeding in response to early hunger cues but mother–infant proximity (without physical contact) did not. In sum, our results demonstrate that physical contact with infants may shape breastfeeding behavior among U.S. mothers, highlighting a connection between social interaction and infant nutrition that warrants further investigation.

Intravenous immunoglobulin treatment in multiple sclerosis: A prospective, rater-blinded analysis of relapse rates during pregnancy and the postnatal period

BACKGROUND

Multiple sclerosis (MS) affects predominantly young women. Currently available disease-modifying drugs have neither been approved during pregnancy nor nursing.

AIMS

Evaluating the effect of treatment with intravenous immunoglobulin (IVIg) in MS patients with desire to have a baby.

METHODS

In all, 70 MS patients were either treated with IVIg before conception, during first trimester of pregnancy and 12 months postnatal (group I, n = 38) or started IVIg after delivery for 12 months (group II, n = 23) or were untreated (group III, n = 9). Relapse rates and disease progression were analyzed.

RESULTS

Pre-gestational relapse rates differed between groups. Lowest relapse rates were observed during late pregnancy, followed by an elevated relapse rate after delivery compared to the pre-pregnancy year and the first trimester. Only in group I, the postnatal relapse rate did not exceed the relapse rate before conception. IVIg treatment did not influence disease progression after delivery.

CONCLUSIONS

In MS patients, IVIg treatment during and/or after delivery is an option to reduce the incidence of relapses during pregnancy and the postnatal period. Surprisingly, untreated patients becoming pregnant showed an increase in the relapse rate in the first trimester compared with the pre-gestational period. How alterations of hormone status during pregnancy affect disease activity in MS has to be further investigated.

Infant Feeding Beliefs, Attitudes, Knowledge and Practices of Chinese Immigrant Mothers: An Integrative Review of the Literature

Chinese are a fast-growing immigrant population group in several parts of the world (e.g., Australia, Canada, Europe, Southeast Asia, United States). Research evidence suggests that compared to non-Hispanic whites, individuals of Asian-origin including Chinese are at higher risk of developing cardiovascular disease and type 2 diabetes at a lower body mass index (BMI). These risks may be possibly due to genetic differences in body composition and metabolic responses. Despite the increasing numbers of Chinese children growing up in immigrant families and the increasing prevalence of obesity among Chinese, little research has been focused on children of Chinese immigrant families. This integrative review synthesizes the evidence on infant feeding beliefs, attitudes, knowledge and practices of Chinese immigrant mothers; highlights limitations of available research; and offers suggestions for future research. Using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we searched four electronic academic/research databases (CINAHL, Medline, PsycINFO, and PubMed) to identify peer-reviewed, full-text papers published in English between January 2000 and September 2017. Only studies with mothers 18+ years old of normally developing infants were included. Of the 797 citations identified, 15 full-text papers were retrieved and 11 studies (8 cross-sectional studies, 3 qualitative studies) met the inclusion criteria and were included in this review. Reviewed studies revealed high initiation rates of breastfeeding, but sharp declines in breastfeeding rates by six months of age. In addition, reviewed studies revealed that the concomitantly use of breast milk and formula, and the early introduction of solid foods were common. Finally, reviewed studies identified several familial and socio-cultural influences on infant feeding beliefs and practices that may increase risk of overweight and obesity during infancy and early childhood among Chinese children of immigrant families. Nonetheless, as only 11 studies were identified and because the majority of studies (n = 8) were conducted in Australia, additional research including longitudinal studies, and studies conducted in countries with large Chinese immigrant population are needed to further identify and understand influences on Chinese immigrant mothers' beliefs, attitudes, and practices related to infant feeding that may increase risk of child overweight and obesity. This information is needed to develop interventions tailored to the beliefs and needs of this fast-growing immigrant group and aimed at promoting healthy infant feeding practices to prevent childhood overweight and obesity.

Associations between bottle-feeding intensity and maternal encouragement of bottle-emptying

Objective

To explore longitudinal associations between bottle-feeding and maternal encouragement of infant bottle-emptying during the first 6 months of infancy.

Design

Mothers completed questionnaires during the third trimester of pregnancy, then monthly during the first 6 months postpartum. Questionnaires assessed family demographics, maternal and infant weight status, infant feeding patterns and maternal encouragement of infant bottle-emptying.

Setting

The Infant Feeding Practices Study 2, conducted by the US Centers for Disease Control and Prevention and the Food and Drug Administration.

Subjects

Mothers (n 1776).

Results

Repeated-measures regression was used to explore associations between bottle-feeding intensity (BFI; defined as the percentage of daily feedings that were from a bottle) and encouragement of bottle-emptying. Mothers who reported consistently high or consistently low BFI also exhibited consistently higher or lower frequency of encouraging their infants to empty the bottle (respectively) across the first 6 months of infancy, whereas mothers who reported increases in their BFI also exhibited concomitant increases in the frequency to which they encouraged their infants to finish the bottle. More frequent encouragement of bottle-emptying was also associated with feeding expressed breast milk (P<0·001), and lower parity (P=0·01), pre-pregnancy BMI (P=0·002) and infant birth weight (P=0·001).

Conclusions

More frequent use of bottles for infant feeding was significantly associated with more frequent encouragement of bottle-emptying. Further research using causal designs is needed to better understand whether the use of bottles promotes this controlling feeding practice or whether mothers with more controlling feeding practices opt to bottle-feed.