This document summarizes research on the optimal duration of exclusive breastfeeding. It discusses how the WHO recommendation had been 4-6 months but was changed to around 6 months in 2001 based on evidence from over 3,000 studies. The resolution passed by the World Health Assembly urges exclusive breastfeeding for six months as a global recommendation, taking into account the expert committee's findings that exclusive breastfeeding for six months does not harm growth and protects against infection.
Breastfeeding Continues To Increase Into The New MillenniumBiblioteca Virtual
This document summarizes a study that analyzed breastfeeding rates in the United States in 1996 and 2001 using data from the Ross Laboratories Mothers Survey. The study found that between 1996 and 2001, rates of breastfeeding initiation and continuation to 6 months increased significantly across all demographic groups, with the largest increases seen among black mothers, younger mothers, and those participating in the WIC program. By 2001, breastfeeding initiation in the US reached its highest recorded rate of 69.5%, while exclusive breastfeeding at 6 months reached 17.2%. The increases put the US closer to meeting the Healthy People 2010 goals, but more support may still be needed for certain groups to meet the 6-month exclusive breastfeeding goal.
Breastfeeding Practice and Breastfeeding Self-efficacy Among first time Nepal...Ambika Rai
This document outlines a proposed study on breastfeeding practices among adolescent mothers in Nepal. The study aims to describe breastfeeding rates at 6 weeks postpartum and compare breastfeeding self-efficacy among mothers with exclusive, partial, or no breastfeeding. The conceptual framework is based on self-efficacy theory. The methodology describes a descriptive comparative design using surveys of 110 adolescent mothers attending a well-baby clinic. Data will be analyzed to classify breastfeeding practices and compare self-efficacy scores. The results could inform policies to improve breastfeeding among adolescent mothers in Nepal.
Annals of Nutritional Disorders & Therapy is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of nutritional disorders resulting from either excessive or inadequate intake of food and nutrients leading to various Nutritional diseases including obesity, eating disorders, malnutrition, developmental abnormalities that could be prevented by diet, hereditary metabolic disorders that retort to dietary treatment, food allergies and intolerances, and potential hazards in the food supply. It also focuses upon the chronic diseases caused due to improper nutrition such as cardiovascular disease, hypertension, cancer, and diabetes mellitus.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Annals of Nutritional Disorders & Therapy journal accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of nutritional disorders resulting from either excessive or inadequate intake of food and nutrients.
Nursing toddlers and children beyond infancy provides significant health benefits. Breastmilk continues to be an important source of nutrition for toddlers, providing key nutrients. Extended breastfeeding is linked to fewer illnesses in toddlers, reduced risk of various diseases, and increased cognitive development. Breastfeeding also has benefits for mothers such as reduced risk of various cancers, easier weight loss, and increased child spacing. Health organizations recommend breastfeeding for at least the first two years as part of a child's normal healthy development and nutrition.
This document discusses nutrition from infancy to childhood. It covers topics such as the importance of breastfeeding, introducing complementary foods, appropriate feeding practices, and ensuring nutrition from foods as children grow. The key messages are that breastfeeding provides significant benefits, complementary foods should be introduced around 6 months in addition to breastmilk, and diet should become more varied and nutritious as children develop.
Promoting breast feeding as a right of the childNaeem Zafar
In this presentation we will see how breast feeding,, a natural phenomenon and protector of human species has to be protected by Universal laws and legislation. Yet we have to fight for this right through awareness raising and advocacy to the government as well as lay public.
Infant Nutrition The first 1000 days and the long-term impact on health New F...Rosie Long (ANutr)
The article discusses nutrition in the first 1000 days of life from conception to age 2 and its long-term impact on health. It notes that early nutrition programs infant development and increases risks for obesity and related diseases later in life. Breastfeeding is recommended for the first 6 months as breast milk is superior and reduces health risks, while infant formula is an alternative for babies not breastfed after 6 months. The protein content of formula is discussed as higher early protein intake may increase later obesity risk, leading some companies to reduce protein levels in formula, though regulations limit reductions.
The document discusses the revised training package for the Baby Friendly Hospital Initiative (BFHI). Some key points:
- The BFHI was launched in 1991 to promote breastfeeding. Over 15,000 facilities in 134 countries have achieved Baby-Friendly status.
- However, progress in designating new hospitals has slowed since 1996. On average, less than seven hospitals per country are designated each year.
- WHO and UNICEF have developed a revised 20-hour training course package to revitalize the BFHI both quantitatively and qualitatively.
- The package includes updates to certain steps and new/optional criteria on areas like HIV/AIDS, labor/childbirth care, and compliance with
Breastfeeding Continues To Increase Into The New MillenniumBiblioteca Virtual
This document summarizes a study that analyzed breastfeeding rates in the United States in 1996 and 2001 using data from the Ross Laboratories Mothers Survey. The study found that between 1996 and 2001, rates of breastfeeding initiation and continuation to 6 months increased significantly across all demographic groups, with the largest increases seen among black mothers, younger mothers, and those participating in the WIC program. By 2001, breastfeeding initiation in the US reached its highest recorded rate of 69.5%, while exclusive breastfeeding at 6 months reached 17.2%. The increases put the US closer to meeting the Healthy People 2010 goals, but more support may still be needed for certain groups to meet the 6-month exclusive breastfeeding goal.
Breastfeeding Practice and Breastfeeding Self-efficacy Among first time Nepal...Ambika Rai
This document outlines a proposed study on breastfeeding practices among adolescent mothers in Nepal. The study aims to describe breastfeeding rates at 6 weeks postpartum and compare breastfeeding self-efficacy among mothers with exclusive, partial, or no breastfeeding. The conceptual framework is based on self-efficacy theory. The methodology describes a descriptive comparative design using surveys of 110 adolescent mothers attending a well-baby clinic. Data will be analyzed to classify breastfeeding practices and compare self-efficacy scores. The results could inform policies to improve breastfeeding among adolescent mothers in Nepal.
Annals of Nutritional Disorders & Therapy is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of nutritional disorders resulting from either excessive or inadequate intake of food and nutrients leading to various Nutritional diseases including obesity, eating disorders, malnutrition, developmental abnormalities that could be prevented by diet, hereditary metabolic disorders that retort to dietary treatment, food allergies and intolerances, and potential hazards in the food supply. It also focuses upon the chronic diseases caused due to improper nutrition such as cardiovascular disease, hypertension, cancer, and diabetes mellitus.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Annals of Nutritional Disorders & Therapy journal accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of nutritional disorders resulting from either excessive or inadequate intake of food and nutrients.
Nursing toddlers and children beyond infancy provides significant health benefits. Breastmilk continues to be an important source of nutrition for toddlers, providing key nutrients. Extended breastfeeding is linked to fewer illnesses in toddlers, reduced risk of various diseases, and increased cognitive development. Breastfeeding also has benefits for mothers such as reduced risk of various cancers, easier weight loss, and increased child spacing. Health organizations recommend breastfeeding for at least the first two years as part of a child's normal healthy development and nutrition.
This document discusses nutrition from infancy to childhood. It covers topics such as the importance of breastfeeding, introducing complementary foods, appropriate feeding practices, and ensuring nutrition from foods as children grow. The key messages are that breastfeeding provides significant benefits, complementary foods should be introduced around 6 months in addition to breastmilk, and diet should become more varied and nutritious as children develop.
Promoting breast feeding as a right of the childNaeem Zafar
In this presentation we will see how breast feeding,, a natural phenomenon and protector of human species has to be protected by Universal laws and legislation. Yet we have to fight for this right through awareness raising and advocacy to the government as well as lay public.
Infant Nutrition The first 1000 days and the long-term impact on health New F...Rosie Long (ANutr)
The article discusses nutrition in the first 1000 days of life from conception to age 2 and its long-term impact on health. It notes that early nutrition programs infant development and increases risks for obesity and related diseases later in life. Breastfeeding is recommended for the first 6 months as breast milk is superior and reduces health risks, while infant formula is an alternative for babies not breastfed after 6 months. The protein content of formula is discussed as higher early protein intake may increase later obesity risk, leading some companies to reduce protein levels in formula, though regulations limit reductions.
The document discusses the revised training package for the Baby Friendly Hospital Initiative (BFHI). Some key points:
- The BFHI was launched in 1991 to promote breastfeeding. Over 15,000 facilities in 134 countries have achieved Baby-Friendly status.
- However, progress in designating new hospitals has slowed since 1996. On average, less than seven hospitals per country are designated each year.
- WHO and UNICEF have developed a revised 20-hour training course package to revitalize the BFHI both quantitatively and qualitatively.
- The package includes updates to certain steps and new/optional criteria on areas like HIV/AIDS, labor/childbirth care, and compliance with
Breastfeeding, Childhood Obesity And The Prevention Of Chronic DiseasesBiblioteca Virtual
This document summarizes evidence linking breastfeeding to prevention of childhood obesity and discusses biological mechanisms that may explain this link. It reviews 11 studies that found breastfeeding was associated with reduced risk of childhood obesity. It also discusses how breastfeeding promotes appetite regulation and leads to slower weight gain in infants. While more research is still needed, the evidence suggests breastfeeding has potential as a cost-effective way to address the childhood obesity epidemic.
Final research paper written for Introduction to Child Development in fall 2019. This paper discusses the benefits of breastfeeding for the child and the mother.
Infant and young child feeding in emergenciesPrithwiGhosh1
This document provides guidance on infant and young child feeding in emergencies. It outlines key actions to protect, promote and support optimal infant and young child feeding practices during emergencies. Some of the main points covered include:
- The importance of emergency preparedness and having policies in place to guide responses. National governments should lead coordination of infant and young child feeding responses, with UNICEF or UNHCR providing support as needed.
- Multi-sector collaboration is essential, as is training emergency staff across sectors on infant and young child feeding issues. Needs assessments should inform context-specific responses.
- Immediate action is needed to protect recommended feeding practices and support higher risk groups. Donations of breast
- A study in rural Senegal found that prolonged breastfeeding actually increased infant length gain in the second and third years of life. The negative correlation between height and breastfeeding duration was likely due to mothers weaning healthier children earlier.
- Two reviews concluded that the timing of introducing complementary foods between 4-6 months had little impact on infant growth, as long as children were breastfed and living in environments without major economic constraints.
- Breastfeeding was associated with a lower risk of childhood overweight and obesity in several studies from the US and UK. However, a mother's weight appeared to be a stronger predictor of her child's weight.
This document discusses breastfeeding, including its definition, benefits, and proper techniques. Breastfeeding provides ideal nutrition for infants and benefits both mother and baby. It reduces infant mortality and risk of disease. The document outlines breast anatomy, milk production, nutritional needs of breastfeeding mothers, recommended positions, contraindications, and nursing interventions to support breastfeeding.
A discourse the ideal feeding practices from pregnancy to infancy with a closer look into malnutrition, breastfeeding, complementary feeding and related interventions.
This was a talk that I gave to the Maryland Chesapeake Chapter of National Association of Pediatric Nurse Practitioners to update them on breastfeeding issues.
Proper nutrition is essential for brain development from prenatal stages through adulthood. Poor nutrition can lead to lowered immune systems, improper brain development, and health issues. Nutrition directly impacts gene expression and the brain's ability to reach its full potential. Adequate intake of nutrients like choline, folic acid, iron and zinc is especially important for the developing brain.
The document outlines Methodist Dallas Medical Center's plan to achieve Baby-Friendly designation by adopting several evidence-based practices. The plan includes having a neonatal admission nurse care for infants in the same location as mothers to promote skin-to-skin contact and rooming-in. Research shows these practices improve breastfeeding and maternal-infant bonding. The plan also delays unnecessary interventions like early infant bathing to prevent hypothermia and supports breastfeeding within one hour of birth.
This document discusses infant nutrition from birth to one year. It defines newborns and infants, outlines their growth and nutritional needs, and provides guidelines for introducing solid foods and water. Proper infant nutrition is important for development as infants rely on caretakers to feed them. Nutritional needs change as infants grow, starting with frequent feedings of breastmilk or formula, then adding cereals and pureed foods before self-feeding table foods by 12 months. Guidelines recommend slowly introducing one new food at a time to identify allergies.
This document outlines a lecture on infant nutrition. It discusses assessing newborn health, including birthweight and factors related to infant mortality. It covers infant development, including motor, cognitive, and digestive system development. It also addresses energy and nutrient needs of infants, including calories, protein, fat and other nutrients. The document discusses physical growth assessment of infants and common feeding practices in early infancy, including breastfeeding and formula. It concludes by covering the development of infant feeding skills.
The document discusses the importance of proper nutrition during the first 1,000 days of life, from pregnancy to age 2. It notes that malnutrition during this critical window can impair physical and cognitive development with lifelong consequences. Providing adequate nutrition, breastfeeding, and complementary feeding is crucial for children's growth, educational performance, economic productivity, and national development. The document emphasizes investing in the health, nutrition and care of mothers and young children to help countries achieve their development goals.
This document discusses infant and young child feeding practices. It covers the benefits of breastfeeding for the child, mother, and community. Breast milk provides optimal nutrition and protects against infection. Complementary foods should be introduced at 6 months while continuing breastfeeding up to 2 years. The WHO emphasizes nutrition in the first 1000 days of life. Exclusive breastfeeding for 6 months and appropriate complementary feeding practices according to guidelines promote child health and development.
Power of nutrition for the first 1000 days by jess 06082016 slideshareJessWongHuiJuan1
The document is a presentation by Wong Hui Juan on nutrition in the first 1000 days of life. It covers topics like the importance of nutrition during pregnancy, lactation, and complementary feeding. It discusses recommendations for introducing solid foods at 6 months, appropriate food textures and amounts as the baby grows. The presentation provides information on meeting nutrient needs and establishing healthy eating habits. It also addresses common concerns parents have around feeding such as poor appetite, food allergies and illness.
Infant Nutrition to 2020- An Ideation StudyBrand Acumen
This document summarizes the findings of a study on infant nutrition trends conducted for Company X. Key trends identified include growing demand for fresh, local, whole foods and concerns about the overall nutrition quality and safety of the food supply. Issues like childhood obesity, vitamin/mineral deficiencies, and unhealthy eating behaviors are ongoing problems. The document also discusses awareness and perceptions of functional foods and emerging research areas like personalized nutrition using mobile technologies. Identification of current nutrition, behavior, and weight management trends in both children and adults is provided to help inform new product development opportunities.
Risk Factors For Excess Weight Loss And Hypernatremia In Exclusively Breast F...Biblioteca Virtual
The document discusses risk factors for excessive weight loss and hypernatremia in exclusively breastfed infants. It found that factors like primiparity, delayed initiation of breastfeeding after delivery, fewer than 4 stools per day, pink diaper color, breast conditions making breastfeeding difficult, cesarean delivery, and use of extra heaters were associated with greater weight loss and higher rates of hypernatremia in the infants studied. The results suggest that prompt initiation of breastfeeding and interventions if breastfeeding problems occur can help promote successful breastfeeding and prevent issues like excessive weight loss and dehydration in newborns.
Infant and young child feeding a tool for assessing national practices polici...Paul Mark Pilar
This document provides a tool for assessing national practices, policies, and programs related to infant and young child feeding. It contains three parts:
1. An assessment of key infant feeding practices based on WHO indicators.
2. An evaluation of national policies and achievement of targets from the Innocenti Declaration and Global Strategy.
3. An analysis of components of a comprehensive national infant feeding program.
The tool is designed to help countries identify strengths and weaknesses in order to improve protection, promotion, and support of optimal infant feeding. It can assist in developing plans and tracking progress toward global goals.
Moringa is a plantfood of high nutritional value, ecologically and economically beneficial and readily available in the countries hardest hit by the food crisis. http://miracletrees.org/ http://moringatrees.org/
A Systematic Review Of Maternal Obesity And Breastfeeding Intention, Initiati...Biblioteca Virtual
This document summarizes a systematic review examining the relationship between maternal overweight/obesity and breastfeeding intention, initiation and duration. The review identified 27 studies on this topic. The studies generally found that obese women had shorter intended and actual breastfeeding duration compared to normal weight women. Specifically, obese women were less likely to intend to or initiate breastfeeding, and breastfed for shorter durations even after adjusting for confounding factors. The relationship between maternal obesity and delayed onset of lactation was also observed. However, the reasons for these relationships are not fully understood and require further qualitative research.
Breastfeeding And The Nutritional Transition In The Latin American And Caribb...Biblioteca Virtual
This document analyzes trends in breastfeeding duration in Latin America and the Caribbean using data from Demographic and Health Surveys conducted between the 1980s and 1990s. The key findings are:
1) Breastfeeding duration remained higher in rural versus urban areas and among less educated versus more educated women, although these differences are decreasing over time.
2) In five of six countries examined, breastfeeding duration continued to increase in both rural and urban areas between the mid-1980s and mid-1990s.
3) Breastfeeding duration improved more among women with the highest levels of education and declined among those with the lowest levels of education.
4) Overall, breastfeeding duration has increased in
Breastfeeding, Childhood Obesity And The Prevention Of Chronic DiseasesBiblioteca Virtual
This document summarizes evidence linking breastfeeding to prevention of childhood obesity and discusses biological mechanisms that may explain this link. It reviews 11 studies that found breastfeeding was associated with reduced risk of childhood obesity. It also discusses how breastfeeding promotes appetite regulation and leads to slower weight gain in infants. While more research is still needed, the evidence suggests breastfeeding has potential as a cost-effective way to address the childhood obesity epidemic.
Final research paper written for Introduction to Child Development in fall 2019. This paper discusses the benefits of breastfeeding for the child and the mother.
Infant and young child feeding in emergenciesPrithwiGhosh1
This document provides guidance on infant and young child feeding in emergencies. It outlines key actions to protect, promote and support optimal infant and young child feeding practices during emergencies. Some of the main points covered include:
- The importance of emergency preparedness and having policies in place to guide responses. National governments should lead coordination of infant and young child feeding responses, with UNICEF or UNHCR providing support as needed.
- Multi-sector collaboration is essential, as is training emergency staff across sectors on infant and young child feeding issues. Needs assessments should inform context-specific responses.
- Immediate action is needed to protect recommended feeding practices and support higher risk groups. Donations of breast
- A study in rural Senegal found that prolonged breastfeeding actually increased infant length gain in the second and third years of life. The negative correlation between height and breastfeeding duration was likely due to mothers weaning healthier children earlier.
- Two reviews concluded that the timing of introducing complementary foods between 4-6 months had little impact on infant growth, as long as children were breastfed and living in environments without major economic constraints.
- Breastfeeding was associated with a lower risk of childhood overweight and obesity in several studies from the US and UK. However, a mother's weight appeared to be a stronger predictor of her child's weight.
This document discusses breastfeeding, including its definition, benefits, and proper techniques. Breastfeeding provides ideal nutrition for infants and benefits both mother and baby. It reduces infant mortality and risk of disease. The document outlines breast anatomy, milk production, nutritional needs of breastfeeding mothers, recommended positions, contraindications, and nursing interventions to support breastfeeding.
A discourse the ideal feeding practices from pregnancy to infancy with a closer look into malnutrition, breastfeeding, complementary feeding and related interventions.
This was a talk that I gave to the Maryland Chesapeake Chapter of National Association of Pediatric Nurse Practitioners to update them on breastfeeding issues.
Proper nutrition is essential for brain development from prenatal stages through adulthood. Poor nutrition can lead to lowered immune systems, improper brain development, and health issues. Nutrition directly impacts gene expression and the brain's ability to reach its full potential. Adequate intake of nutrients like choline, folic acid, iron and zinc is especially important for the developing brain.
The document outlines Methodist Dallas Medical Center's plan to achieve Baby-Friendly designation by adopting several evidence-based practices. The plan includes having a neonatal admission nurse care for infants in the same location as mothers to promote skin-to-skin contact and rooming-in. Research shows these practices improve breastfeeding and maternal-infant bonding. The plan also delays unnecessary interventions like early infant bathing to prevent hypothermia and supports breastfeeding within one hour of birth.
This document discusses infant nutrition from birth to one year. It defines newborns and infants, outlines their growth and nutritional needs, and provides guidelines for introducing solid foods and water. Proper infant nutrition is important for development as infants rely on caretakers to feed them. Nutritional needs change as infants grow, starting with frequent feedings of breastmilk or formula, then adding cereals and pureed foods before self-feeding table foods by 12 months. Guidelines recommend slowly introducing one new food at a time to identify allergies.
This document outlines a lecture on infant nutrition. It discusses assessing newborn health, including birthweight and factors related to infant mortality. It covers infant development, including motor, cognitive, and digestive system development. It also addresses energy and nutrient needs of infants, including calories, protein, fat and other nutrients. The document discusses physical growth assessment of infants and common feeding practices in early infancy, including breastfeeding and formula. It concludes by covering the development of infant feeding skills.
The document discusses the importance of proper nutrition during the first 1,000 days of life, from pregnancy to age 2. It notes that malnutrition during this critical window can impair physical and cognitive development with lifelong consequences. Providing adequate nutrition, breastfeeding, and complementary feeding is crucial for children's growth, educational performance, economic productivity, and national development. The document emphasizes investing in the health, nutrition and care of mothers and young children to help countries achieve their development goals.
This document discusses infant and young child feeding practices. It covers the benefits of breastfeeding for the child, mother, and community. Breast milk provides optimal nutrition and protects against infection. Complementary foods should be introduced at 6 months while continuing breastfeeding up to 2 years. The WHO emphasizes nutrition in the first 1000 days of life. Exclusive breastfeeding for 6 months and appropriate complementary feeding practices according to guidelines promote child health and development.
Power of nutrition for the first 1000 days by jess 06082016 slideshareJessWongHuiJuan1
The document is a presentation by Wong Hui Juan on nutrition in the first 1000 days of life. It covers topics like the importance of nutrition during pregnancy, lactation, and complementary feeding. It discusses recommendations for introducing solid foods at 6 months, appropriate food textures and amounts as the baby grows. The presentation provides information on meeting nutrient needs and establishing healthy eating habits. It also addresses common concerns parents have around feeding such as poor appetite, food allergies and illness.
Infant Nutrition to 2020- An Ideation StudyBrand Acumen
This document summarizes the findings of a study on infant nutrition trends conducted for Company X. Key trends identified include growing demand for fresh, local, whole foods and concerns about the overall nutrition quality and safety of the food supply. Issues like childhood obesity, vitamin/mineral deficiencies, and unhealthy eating behaviors are ongoing problems. The document also discusses awareness and perceptions of functional foods and emerging research areas like personalized nutrition using mobile technologies. Identification of current nutrition, behavior, and weight management trends in both children and adults is provided to help inform new product development opportunities.
Risk Factors For Excess Weight Loss And Hypernatremia In Exclusively Breast F...Biblioteca Virtual
The document discusses risk factors for excessive weight loss and hypernatremia in exclusively breastfed infants. It found that factors like primiparity, delayed initiation of breastfeeding after delivery, fewer than 4 stools per day, pink diaper color, breast conditions making breastfeeding difficult, cesarean delivery, and use of extra heaters were associated with greater weight loss and higher rates of hypernatremia in the infants studied. The results suggest that prompt initiation of breastfeeding and interventions if breastfeeding problems occur can help promote successful breastfeeding and prevent issues like excessive weight loss and dehydration in newborns.
Infant and young child feeding a tool for assessing national practices polici...Paul Mark Pilar
This document provides a tool for assessing national practices, policies, and programs related to infant and young child feeding. It contains three parts:
1. An assessment of key infant feeding practices based on WHO indicators.
2. An evaluation of national policies and achievement of targets from the Innocenti Declaration and Global Strategy.
3. An analysis of components of a comprehensive national infant feeding program.
The tool is designed to help countries identify strengths and weaknesses in order to improve protection, promotion, and support of optimal infant feeding. It can assist in developing plans and tracking progress toward global goals.
Moringa is a plantfood of high nutritional value, ecologically and economically beneficial and readily available in the countries hardest hit by the food crisis. http://miracletrees.org/ http://moringatrees.org/
A Systematic Review Of Maternal Obesity And Breastfeeding Intention, Initiati...Biblioteca Virtual
This document summarizes a systematic review examining the relationship between maternal overweight/obesity and breastfeeding intention, initiation and duration. The review identified 27 studies on this topic. The studies generally found that obese women had shorter intended and actual breastfeeding duration compared to normal weight women. Specifically, obese women were less likely to intend to or initiate breastfeeding, and breastfed for shorter durations even after adjusting for confounding factors. The relationship between maternal obesity and delayed onset of lactation was also observed. However, the reasons for these relationships are not fully understood and require further qualitative research.
Breastfeeding And The Nutritional Transition In The Latin American And Caribb...Biblioteca Virtual
This document analyzes trends in breastfeeding duration in Latin America and the Caribbean using data from Demographic and Health Surveys conducted between the 1980s and 1990s. The key findings are:
1) Breastfeeding duration remained higher in rural versus urban areas and among less educated versus more educated women, although these differences are decreasing over time.
2) In five of six countries examined, breastfeeding duration continued to increase in both rural and urban areas between the mid-1980s and mid-1990s.
3) Breastfeeding duration improved more among women with the highest levels of education and declined among those with the lowest levels of education.
4) Overall, breastfeeding duration has increased in
Back To Sleep An Educational Intervention With Women, Infants, And Children P...Biblioteca Virtual
This document describes a study that tested an educational intervention with black parents to promote safe infant sleep practices and reduce the risk of SIDS. The intervention involved 15-minute educational sessions for groups of 3 to 10 parents at a WIC clinic. Surveys before and after the sessions found that the intervention increased the likelihood parents would place infants on their back rather than prone, decreased bedsharing and citing infant comfort as reasons for position. At 6-month follow-up, parents who received the intervention were more knowledgeable about safe sleep recommendations compared to a control group. The intervention was effective in informing parents and changing behaviors to reduce SIDS risk.
This document provides examples of basic marketing templates for creating flyers, coupons, and advertisements. It includes templates for sales announcements, location listings, coupon offers, and general promotional messages. The templates can be used as provided or customized with a business' own artwork and details.
Dr. Reynolds and other members of the American Military University (AMU) Masters of Disaster program received awards at a conference. The summary includes AMU alumni and students working the conference booth and accepting awards for outstanding student chapter of the year. Pictures at the social event show AMU students and alumni networking and discussing the conference.
The document outlines a reflective practice model of professional educational development that includes three stages: planning decisions, implementation decisions, and evaluative decisions. In the planning stage, teachers consider lesson objectives, activities, connecting to prior knowledge, and organization. In the implementation stage, teachers consider student ability levels, special needs, and checking understanding. In the evaluative stage, teachers consider the lesson's success, strengths/weaknesses, student learning, and need for changes in future lessons.
This document discusses the design and testing of MiCardia's Dynamic Mitral Annuloplasty device. The device aims to address the shortcomings of current treatments for ischemic mitral regurgitation (IMR) by using radiofrequency energy to reshape an implanted annuloplasty ring and reduce recurrent MR. Animal studies and initial human implants demonstrate the device's ability to decrease the mitral annulus diameter and improve leaflet coaptation both during surgery and percutaneously. Future developments discussed include a tricuspid valve version, a transcatheter delivery method, and a magnetic ring that can be adjusted non-invasively.
Pluto is the smallest dwarf planet in our solar system, smaller than 7 moons. It was reclassified from a planet to a dwarf planet in 2006 due to its small size. Pluto has an elliptical orbit that takes 90,465 days to complete and rotates on its axis every 6.39 days.
The document discusses common mistakes in test-driven development (TDD). It presents the results of a survey of programmers that identified the most common deviations from TDD practices. The top deviations included writing complex tests, forgetting to refactor, refactoring other code while working on a test, and not implementing the simplest code to pass a test. The document concludes that while TDD is not always followed perfectly, its principles still provide benefits if applied conscientiously.
This document discusses strategic career planning and provides advice for proactively managing one's career. It compares the roles of a lawyer and business owner, noting business owners are more proactive. A Harvard Business Review survey found women ranked higher than men in leadership characteristics except envisioning. The document urges taking a strategic approach to one's career by defining overarching and interim goals, gaining necessary experiences, and speaking up about goals and development plans. It concludes by offering contact information to discuss career consulting services.
Antenatal Peer Support Workers And Initiation Of Breast Feeding Cluster Rando...Biblioteca Virtual
This study assessed the effectiveness of an antenatal peer support worker service on the initiation of breastfeeding. The study involved a cluster randomized controlled trial of 66 antenatal clinics and 2511 pregnant women in a deprived, multiethnic population in Birmingham, UK. Clinics were randomly assigned to receive the peer support worker intervention (n=1140) or standard antenatal care (n=1371). The primary outcome of breastfeeding initiation did not differ significantly between the intervention (69.0%) and control (68.1%) groups after adjusting for clustering. Ethnicity, parity and mode of delivery predicted initiation, but the peer support worker intervention did not increase initiation rates.
This document provides information on nipple pain which is a common reason for mothers to stop breastfeeding prematurely. It discusses the most common causes of nipple pain including incorrect positioning and attachment of the baby to the breast. Effective attachment is described as having the baby's chin in contact with the breast and mouth open wide. Signs of candidiasis, a possible cause of nipple pain, and its treatment with antifungal creams or tablets are also outlined. The document concludes with a summary of managing sore nipples which includes addressing positioning problems, treating potential infections, and considering referral for continued issues.
Breastfeeding And Early Weaning Practices In Northeast BrazilBiblioteca Virtual
This study examined breastfeeding practices in 4 towns in northeast Brazil by interviewing 364 mothers. The researchers found:
1) While mothers were positive about breastfeeding, exclusive breastfeeding was rare and the median duration of exclusive breastfeeding was 0 days.
2) The median age for introducing other milk was 24 days, and the median duration of breastfeeding was 65 days for mothers who introduced other milk within the first month compared to 165 days for other mothers.
3) Pacifier use in the first week, intention to introduce other milk in the first month, giving water/tea in the first week, and leaving the maternity ward before breastfeeding was established were associated with introducing other milk within the first month
1. Breastfeeding provides numerous health benefits for both infants and mothers. It reduces the risk of breast cancer in mothers and lowers the risk of HIV transmission from mother to child.
2. Exclusive breastfeeding for the first 3-6 months of life protects infants from common illnesses like diarrhea and pneumonia. It also supports optimal infant nutrition and development.
3. For HIV-positive mothers, exclusive breastfeeding or replacement feeding with formula can be appropriate depending on individual circumstances. Proper support is crucial to help mothers make informed choices about infant feeding.
Characteristics Of Breastfeeding Practices Among Us MothersBiblioteca Virtual
1) More than half of breastfeeding mothers exclusively breastfed (breast milk only) until 4 months of age, after which exclusive breastfeeding declined sharply. Formula supplementation peaked at 42% at 1 month and declined to 15% at 1 year.
2) Around 6% of mothers reported exclusively pumping breast milk rather than directly breastfeeding.
3) Maternal reports showed considerable variation in behaviors related to common breastfeeding advice on frequency, duration, and intervals of feedings over the infant's first year.
A STUDY OF THE PERCEPTION ON EXCLUSIVE BREASTFEEDING AMONG POSTNATAL MOTHERS ...edianbiir
This document presents a study on the perception of exclusive breastfeeding among postnatal mothers at Legon Hospital in Ghana. It provides background information on the benefits of exclusive breastfeeding for six months and highlights breastfeeding rates in Ghana. While nearly all Ghanaian mothers initiate breastfeeding, exclusive breastfeeding rates drop significantly after the first few months. The study aims to address the lack of record keeping on exclusive breastfeeding and mother support groups at Legon Hospital.
Dealing With Fears Of Chemical Pollution Of BreastmilkBiblioteca Virtual
This document discusses fears about chemical pollution in breastmilk, specifically related to dioxins. It summarizes several studies that have found:
1) The majority (90-95%) of human exposure to dioxins comes from food, while only 5-10% comes from air.
2) Effects from dioxin exposure were more strongly associated with transplacental (in utero) exposure rather than breastmilk exposure.
3) Ongoing studies support the recommendation that breastfeeding should continue to be promoted due to its overall health benefits for infants, and concerns about dioxin exposure should not unduly influence a mother's decision to breastfeed.
This study examined predictors of breastfeeding duration in Australia by following 587 women from hospital discharge through 52 weeks postpartum. The researchers found that less than half of infants were receiving any breast milk at 6 months, and only 12% were exclusively breastfed. By 12 months, only 19.2% received any breast milk. Factors positively associated with longer breastfeeding duration included higher maternal infant feeding attitudes and negatively associated factors included breastfeeding difficulties in the first 4 weeks, maternal smoking, early pacifier introduction, and early return to work. Relatively few women achieved international breastfeeding recommendations.
Opinions And Practices Of Clinicians Associated With Continuation Of Exclusiv...Biblioteca Virtual
This study examined how clinician opinions and practices are associated with continuation of exclusive breastfeeding. The study prospectively followed 288 low-risk mother-newborn pairs who were breastfeeding at 4 weeks. Mothers completed interviews at 4 and 12 weeks, and their obstetric and pediatric clinicians completed surveys. The primary outcome was exclusive breastfeeding at 12 weeks. The study found that clinicians who recommended formula supplementation if an infant was not gaining weight or who felt their breastfeeding advice was not important were associated with early discontinuation of exclusive breastfeeding. Continued exclusive breastfeeding support from clinicians may help improve breastfeeding rates at 6 months.
This document summarizes a study on trends in infant nutrition in Saudi Arabia and compliance with WHO recommendations. The study found:
1) Breastfeeding initiation was high at 91.6%, but 28.1% of infants began breastfeeding over 6 hours after birth.
2) Bottle feeding was introduced by 1 month for 51.4% of infants and by 6 months for 90%.
3) The majority (80.8%) of infants began solid foods between 4-6 months, and 40% of infants under 12 months were given whole milk.
4) Current infant feeding practices in Saudi Arabia do not comply with WHO recommendations of exclusive breastfeeding for 6 months. Early introduction of complementary foods reduces
1) The study aimed to identify factors associated with exclusive breastfeeding (EB) in children under 4 months old in Botucatu, Brazil.
2) 38% of children were exclusively breastfed, while 33.4% consumed cow's milk, 29.2% tea, and 22.4% water.
3) The use of a pacifier and difficulty breastfeeding were associated with an absence of EB, while the population attributable risk percentage for pacifier use was estimated at 46.8%.
This document discusses approaches to promoting breastfeeding among pregnant women. It begins by outlining the Baby Friendly Hospital Initiative from WHO and UNICEF to advocate increasing breastfeeding rates. Improved breastfeeding could save thousands of children's lives daily. The Innocenti Declaration established breastfeeding as the global goal for health and called on governments to develop breastfeeding policies. Many US agencies and organizations support breastfeeding, though rates remain below goals. The document emphasizes the importance of educational, social and institutional support for breastfeeding mothers.
This study investigated complementary feeding practices for children in their first year of life in Botucatu, Brazil. The researchers interviewed 1,238 caregivers of children under 1 year old during a vaccination campaign. They found that complementary foods were introduced early, leading to low rates of exclusive breastfeeding under 4 months (36.9%). Children under 4 months commonly consumed tea (30.7%) and fruits (54.1%). Food given to children was often inappropriate for their age, such as family foods given to children aged 6-8 months (48.8%) and soup given to over 8 months (71.6%). The findings suggest interventions are needed in the city to promote proper complementary feeding practices.
Infant Feeding And Feeding Transitions During The First Year Of LifeBiblioteca Virtual
This document summarizes infant feeding patterns during the first year of life based on data from the Infant Feeding Practices Study II. Key findings include:
1) While 83% of infants were breastfed in the hospital, 42% of these infants also received formula supplementation. By 3 months, 61% of infants received formula.
2) Solid foods were introduced earlier than recommended, with 40% of infants consuming cereal and 17% consuming fruits/vegetables by 4 months of age.
3) Early introduction of solids was associated with discontinuing breastfeeding earlier and consuming more fatty/sugary foods by 12 months.
Why Do Women Stop Breastfeeding Findings From The Pregnancy RiskBiblioteca Virtual
This study examined breastfeeding behaviors using data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) from 2000-2001. The authors found that 32% of women did not initiate breastfeeding, 4% stopped within the first week, 13% stopped within the first month, and 51% continued for over 4 weeks. Younger women and those with limited socioeconomic resources were more likely to stop breastfeeding early. Common reasons for stopping included sore nipples, perceived inadequate milk supply, and difficulties with breastfeeding. Women's predelivery intentions impacted their likelihood of initiating and continuing breastfeeding.
Role baby friendly hospital initiative on KAP of nursing mothersAnjum Hashmi MPH
The document summarizes a study on the role of the Baby Friendly Hospital Initiative (BFHI) on the knowledge and practices of nursing mothers regarding infant feeding. The study compared mothers who delivered at a Baby Friendly Hospital (BFH) versus a non-BFH. It found that some feeding practices were better in the BFH group, such as a lower rate of pre-lacteal feeding and longer duration of exclusive breastfeeding. However, the non-BFH group had a higher rate of initiating breastfeeding within the first hour. The BFHI was found to have a beneficial impact on certain infant feeding practices and the duration of exclusive breastfeeding.
The document provides guidance for childcare centers on supporting breastfeeding mothers by educating staff on breastmilk storage guidelines, the benefits of breastfeeding for mothers, babies, and childcare centers, and recommendations for helping working mothers continue breastfeeding including establishing and maintaining milk supply. The goal is to increase support for breastfeeding mothers using childcare so they can continue providing breastmilk for their babies.
This document discusses breastfeeding and related policies and practices. It notes that breastfeeding rates in India are low, with only 24% of children breastfed within 1 hour of birth and 46% exclusively breastfed for the first 6 months. Several national and international policies aim to promote and protect breastfeeding, including the International Code of Marketing of Breastmilk Substitutes (1981) and the Innocenti Declaration (1990). The document outlines best practices for breastfeeding, challenges to optimal rates, and strategies to support working mothers in continuing breastfeeding, such as paid maternity leave, breastfeeding breaks, and workplace facilities. Overall it emphasizes the critical importance of exclusive breastfeeding for child health, development, and survival.
Mothers And Clinicians Perspectives On Breastfeeding Counseling During Routin...Biblioteca Virtual
This document summarizes a study examining breastfeeding counseling provided during routine preventive visits from the perspectives of both mothers and their clinicians. The study involved surveying 429 mother-newborn pairs and their 121 obstetric and pediatric clinicians. The results identified several areas of disagreement between what mothers reported discussing with clinicians regarding breastfeeding duration, continuation after returning to work, and specific advice provided, highlighting potential unintentional gaps in communication around breastfeeding counseling during routine visits.
Nutrition And The 0 6 Months Infants (Final)guest8258fa
The document discusses recommendations for infant feeding for the first 6 months of life, including the benefits of exclusive breastfeeding. It notes that breastfeeding provides optimal nutrition for infant growth and development, protects against disease, and has cognitive and economic benefits. It also addresses challenges to breastfeeding such as lack of support, misinformation, and non-optimal healthcare and social practices.
The document discusses the importance of optimal breastfeeding practices for infant and young child health and development. It notes that exclusive breastfeeding for the first six months, followed by continued breastfeeding for up to two years or beyond, provides crucial nutrition and protects against disease and death. However, breastfeeding rates have declined globally due to inappropriate promotion of breastmilk substitutes. The World Health Organization and various countries have since implemented policies and legislation like the International Code of Marketing of Breastmilk Substitutes to protect breastfeeding practices.
Malnutrition is a major health problem for infants and young children worldwide. Inadequate nutrition during the first two years of life can negatively impact growth, health, and development. The document discusses the importance of breastfeeding and complementary feeding. Exclusive breastfeeding for the first six months meets infant nutritional needs and protects against illness. After six months, other foods should be introduced along with continued breastfeeding to two years or beyond. Improper complementary feeding can impair growth. The study aims to examine awareness of breastfeeding and complementary feeding practices in urban and rural Bangladeshi communities and how malnutrition impacts infection rates in children.
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The Optimal Duration Of Exclusive Breastfeeding
1. Breastfeeding Briefs
June 2001
no. 31 and 32
Nancy Jo Peck, our Scientific Advisor and GIFA colleague for 20 years, began Breastfeeding
Briefs in 1984 and edited the publication of 30 issues until her death in February 2001. We all
remember with much appreciation her professional devotion to work for children and are pleased
that Breastfeeding Briefs can continue in her memory.
The new editiors are Dr. Marina Rea, Institute of Child Health in Sao Paulo , Brazil and
Dr. Adriano Cattaneo, Istituto per l'Infanzia in Trieste, Italy.
The optimal duration of exclusive breastfeeding
Since 1979, the WHO recommendation for the duration of exclusive breastfeeding has been “4-6 months”.
In 1994 and 1996, the World Health Assembly (WHA) and UNICEF recommended introduction of complementary
foods at the age of about six months, thus recognizing that exclusive breastfeeding should be fostered for about the
first six months. But the WHO did not change its previous recommendation, stating that further evidence was
needed despite the fact that the world's experts have argued that evidence supporting the change in the
recommendation was sufficient. IBFAN has always maintained that the delay in changing the recommendation
resulted mainly in large profits gained by infant food manufacturers from sales of complementary foods for two
additional months of complementary feeding. During the 53rd WHA in the year 2000, the Brazilian delegation
proposed a resolution in favour of exclusive breastfeeding for six months. The draft resolution did not pass and the
WHO Secretariat tried to postpone any further resolution on infant feeding to 2002. But the members of the WHO
Executive Board in January 2001 clearly stated the need for the resolution. Therefore the Board decided to keep the
recommended duration of exclusive breastfeeding in brackets (“4-6 months” vs “about 6 months”) until an expert
committee decided on this issue and also decided to forward the resolution to be discussed at the 54th WHA in May
2001. In March, the report issued by the Expert Committee which was finally convened by the WHO Secretariat
put an end to the long debate by endorsing exclusive breastfeeding for 6 months.1 Despite pressure from the baby
food industry and some last-minute uncertainty, resolution WHA54.2 was eventually passed on 18 May 2001.
The resolution urges Member States to "... support exclusive breastfeeding for six months as a global public
health recommendation taking into account the findings of the WHO Expert Technical Consultation on optimal
duration of exclusive breastfeeding and to provide safe and appropriate complementary foods, with continued
breastfeeding for up to two years or beyond ...". The Expert Committee had identified, reviewed and evaluated more
than 3,000 references. The studies comparing exclusive or predominant breastfeeding for about four months with the
same pattern of feeding for about six months did not show an adverse effect of the latter on growth and major
morbidity. The review, however, could not rule out an increased risk of growth faltering in some infants who are
exclusively breastfed for six months, particularly in populations with severe maternal malnutrition and a high
prevalence of intrauterine growth retardation. There might also be a risk of poorer iron status in infants exclusively
breastfed for six months in populations in which maternal iron status and infant stores of iron are not optimal. On the
other hand, the review confirmed that exclusive breastfeeding for six months protects against gastrointestinal infection,
even in settings where hygienically prepared complementary foods are used, and confers an advantage in prolonging
the duration of lactational amenorrhoea in mothers who breastfeed frequently (10-14 feeds a day). The
recommendation to exclusively breastfeed for six months applies to populations. It is clear that some mothers will be
unable to, or choose not to, follow this recommendation; they should be supported to optimize their infants’ nutrition.
Particular attention should be paid to the nutritional status of pregnant and lactating mothers, the micronutrient status
of infants living in areas with high prevalence of iron, zinc, and vitamin A deficiencies, the routine care of individual
infants, including assessment of growth and of clinical signs of micronutrient deficiencies.2
1
WHO. Expert consultation on the optimal duration of exclusive breastfeeding. Conclusions and recommendations. Document
A54/INF.DOC./4, Geneva, 28-30 March 2001.
2
WHO. Global strategy for infant and young child feeding. Document A54/7, Geneva, 9 April 2001.
2. Highlight
Dewey KG. Nutrition, growth, and complementary feeding of the breastfed infant. Pediatr Clin North Am 2001;48:87-104
The following conclusions about infant feeding are well substantiated by the evidence available to date, although additional
research is needed on many issues. Breastmilk alone can meet nutrient needs during the first 6 months, with the possible
exception of vitamin D in certain populations, and iron in infants of relatively low birth weight. Complementary foods offered
before 6 months of age tend to displace breastmilk and do not confer any growth advantage over exclusive breastfeeding.
Breastmilk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat,
and most vitamins. Breastfed infants tend to gain less weight and usually are leaner than are formula-fed infants in the second
half of infancy. This difference does not seem to be the result of nutritional deficits but rather infant self-regulation of energy
intake. New growth charts based on infants breastfed throughout the first year of life are being developed by WHO. The
nutrients most likely to be limiting in the diets of breastfed infants are minerals, such as iron, zinc, and calcium. Using the
following guidelines can help to ensure that the nutrient needs after 6 months of life of the breastfed child are met:
1. Continue to breastfeed as often as the infant desires. 2. Aim for a variety of complementary foods, with fruits, vegetables,
and animal products (e.g., meat, fish, poultry, or eggs) offered daily. 3. Iron-fortified cereals and meats can provide adequate
iron. 4. Calcium can be obtained from cheese, yogurt, and other dairy products (although fresh cow's milk is not recommen-
ded before 12 months). 5. Avoid giving too much juice. 6. Be alert to any signs that the child's appetite, growth, or develop-
ment is impaired. 7. When in doubt, a balanced vitamin-mineral supplement is advisable. 8. Make mealtimes enjoyable.
Breastfeeding, why...
Hop LT, Gross R, Giay T, Sastroamidjojo S, Schultink W, Lang women had been enrolled in a randomized trial of vitamin
NT. Premature complementary feeding is associated with poorer A. Women self-selected to breastfeed or formula feed after
growth of Vietnamese children. J Nutr 2000;130:2683-90 being counselled. Breastfeeders were encouraged to
practice exclusive breastfeeding for 3-6 months. The
Four cohorts of newborn children, consisting of 90 infants
probability of HIV was compared in three groups: 157
born in 1981, 90 in 1982, 60 in 1983 and 60 in 1984, were
formula-fed (never breastfed); 118 exclusively breastfed
studied to investigate the association between premature
for 3 months or more; and 276 mixed-fed. The three
initiation of complementary feeding and physical growth.
feeding groups did not differ in any risk factors for
The weights and heights of children were measured
transmission, and the probability of detecting HIV at birth
monthly up to 1 year, then every 3 months for year 2 and 3,
was similar. The probabilities of HIV detection remained
and once every 6 months in year 4. Information on feeding
similar among never and exclusive breastfeeders up to 6
practices and diseases of the children was obtained by
months (19.4%), whereas the probability among mixed
interviewing the mothers at each home visit. All but three
breastfeeders soon surpassed both groups, reaching 26.1%.
children (98.6%) were breastfed. Although 87% of the
By 15 months, the cumulative probability of HIV infection
mothers breastfed their children for at least 1 year, only
remained lower among those who exclusively breastfed for
3.3% of the infants were breastfed exclusively at the age of
3 months or more than among other feeding patterns
4 months. Partially breastfed and weaned infants gained
(24.7% vs 35.9%). The authors conclude that infants
weight more slowly than those exclusively or predomi-
exclusively breastfed for 3 months or more had no excess
nantly breastfed. From 1 to 3 months, exclusively breastfed
risk of HIV infection over 6 months than those never
infants grew more quickly in both weight and length,
breastfed. These findings, if confirmed elsewhere, can
followed by predominantly breastfed infants. From 3 to 6
influence public health policies on feeding choices
months, exclusively breastfed infants gained more weight
available to HIV-infected mothers in developing countries.
compared with the other groups. In the older period (6-12
months), exclusively and predominantly breastfed infants
grew in length more quickly than partially breastfed and Williams C, Birch EE, Emmett PM, Northstone K. Stereoacuity
weaned groups. However, there was no difference in at age 3.5 y in children born full-term is associated with prenatal
weight gain among groups. Morbidity from diarrhoea and and postnatal dietary factors: a report from a population-based
acute respiratory infections was significantly lower for the cohort study. Am J Clin Nutr 2001;73:316-22
3 or more months exclusively breastfed group. These
Observational studies suggested that breastfeeding benefits
results show a long-term deterioration of physical growth
the visual development of preterm children, which has
in infants who received premature complementary feeding
been attributed to the presence of docosahexaenoic acid
and confirm the importance of exclusive breastfeeding for
(DHA) in breastmilk. Randomized studies showed that
at least 3 months.
preterm children require a dietary supply of DHA in the
first few weeks of life for optimal visual development, but
Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, Coovadia it is unclear whether full-term children experience similar
HM; South African Vitamin A Study Group. Method of feeding benefits from breastmilk or DHA supplements. The
and transmission of HIV-1 from mothers to children by 15
objective of this study was to compare visual acuity at age
months of age: prospective cohort study from Durban, South
Africa. AIDS 2001;15:379-87
3.5 years in healthy, full-term children who were breastfed
and in similar children who had not been breastfed after
This paper represents the follow-up to 15 months of the adjustment for socioeconomic status and maternal diet.
study published by the same authors in 1999 (Lancet The results show that children who had been breastfed for
1999;354:471-6), when the infants had been observed up to 4 months were 2.77 times more likely to achieve high-
age 3 months. A total of 551 HIV-infected pregnant grade stereoscopic vision than were children who had not
3. been breastfed. Children whose mothers ate oily fish presence or absence of maternal asthma or atopy in the
during pregnancy were also 1.57 times more likely to child.
achieve high-grade stereoscopic vision than were children
whose mothers did not eat oily fish. The authors suggest
that for full-term infants, breastfeeding is associated with Romieu I, Werneck G, Ruiz Velasco S, White M, Hernandez M.
enhanced stereoscopic vision at age 3.5 years, as is a Breastfeeding and asthma among Brazilian children. J Asthma
maternal DHA-rich antenatal diet, irrespective of later 2000;37:575-83
infant feeding practice. The authors examined the association of breastfeeding and
the presence of chronic respiratory symptoms among 5,182
Brazilian schoolchildren 7-14 years of age. The prevalence
Horwood LJ, Darlow BA, Mogridge N. Breast milk feeding and of medically diagnosed asthma and current wheeze were
cognitive ability at 7-8 years. Arch Dis Child Fetal Neonatal Ed respectively 4.6% and 11.9%. 90% of the mothers had
2001;84:F23-7 breastfed their child. Differently from the previous study
(Wright et al.) no exclusive breasfeeding was reported.
280 survivors from a national birth cohort of 413 New
Children who had not been breastfed were more likely to
Zealand very low birthweight infants born in 1986 were
have a medical diagnosis of asthma, experience current
assessed at age 7-8 years on measures of verbal and
wheeze, and wheeze after exercise, than children who had
performance intelligence quotient (IQ). At the same time
been breastfed for more than 6 months. This effect was
mothers were questioned as to whether they had elected to
only present among children with no family history of
provide expressed breastmilk at birth and the total duration
asthma. The low prevalence of asthma and wheeze
of breastmilk feeding. Some 73% of mothers provided
observed in this population may be partly related to the
expressed breastmilk and 37% breastfed for four months or
high level of breastfeeding.
longer. Increasing duration of breastmilk feeding was
associated with increases in both verbal IQ and
performance IQ: children breastfed for eight months or Bener A, Denic S, Galadari S. Longer breastfeeding and
longer had mean verbal IQ scores that were 10.2 points protection against childhood leukaemia and lymphomas. Eur J
higher and performance IQ scores that were 6.2 points Cancer 2001;37:234-8
higher than children who did not receive breastmilk. These The authors investigated the role of breastfeeding in
differences were substantially reduced after control for protecting against childhood acute leukaemia and
selection factors associated with receipt of breastmilk. lymphomas in a case-control study comprising 117
Nevertheless, even after control for confounding factors, patients, aged 2-14 years, with acute lymphocytic
there remained a significant association between duration leukaemia, Hodgkin's and non-Hodgkin's lymphoma, as
of breastmilk feeding and verbal IQ. These findings add to well as 117 controls matched for age, sex and ethnicity.
a growing body of evidence to suggest that breastmilk The median duration of breastfeeding among patients was
feeding may have small long-term benefits for child significantly shorter than among controls: 7 (range 0-23)
cognitive development. and 10 (range 0-20) months, respectively. Breastfeeding of
0-6 months' duration, when compared with feeding of
longer than 6 months, was associated with increased risk
Wright AL, Holberg CJ, Taussig LM, Martinez FD. Factors for acute leukaemia and Hodgkin's and non-Hodgkin's
influencing the relation of infant feeding to asthma and recurrent lymphomas (2.47, 3.75, and 4.06 times, respectively). In
wheeze in childhood. Thorax 2001;56:192-7 multivariate analysis, breastfeeding duration continues to
be an independent predictor of lymphoid malignancies. In
Is the relation between breastfeeding and childhood asthma conclusion, breastfeeding lasting longer than 6 months
altered by the presence of maternal asthma? Healthy non- may protect against childhood acute leukaemia and
selected newborn infants (n=1246) were enrolled at birth to lymphomas.
investigate this hypothesis. Asthma was defined as a
physician diagnosis of asthma plus asthma symptoms
reported on at least 2 questionnaires at 6, 9, 11 or 13 years. Jones G, Riley M, Dwyer T. Breastfeeding in early life and bone
Recurrent wheeze (4 or more episodes in the past year) mass in prepubertal children: a longitudinal study. Osteoporos Int
was reported by questionnaire at seven ages in the first 13 2000;11:146-52
years of life. Duration of exclusive breastfeeding was The aim of this study was to determine whether
based on prospective physician reports or parental breastfeeding in early life is associated with bone mass in
questionnaires completed at 18 months. Atopy (a skin 330 8-year-old male and female children from Southern
manifestation of allergy, considered part of asthma Tasmania, representing 47% of those who originally took
syndrome) was assessed by skin test responses at the age part in a birth cohort study of risk factors for Sudden Infant
of 6 years. The relationship between breastfeeding, asthma, Death Syndrome (Lancet 1991;337:1244-7; N Engl J Med
and wheeze differed with the presence or absence of 1993;329:377-82; JAMA 1995;273:783-9). Breastfeeding
maternal asthma and atopy in the child. Children with intention and habit were assessed in both 1988 and 1996.
asthmatic mothers were almost 9 times more likely to have Bone mineral density was measured by X-ray
asthma if they had been exclusively breastfed. This densitometry. Children who were breastfed had higher
relationship was only evident for atopic children. In bone mineral density at the femoral neck, lumbar spine and
contrast, the relation between recurrent wheeze and total body compared with those who were bottle-fed. This
breastfeeding was age dependent. In the first 2 years of association with breastfeeding was present in children born
life, exclusive breastfeeding was associated with about at term but not those born preterm, and remained
50% lower rates of recurrent wheeze, regardless of the significant after adjustment for size, lifestyle factors and
4. socioeconomic factors. Breastfeeding for less than 3 Zheng T, Duan L, Liu Y, Zhang B, Wang Y, Chen Y, Zhang Y,
months was not associated with increased bone mass at any Owens PH. Lactation reduces breast cancer risk in Shandong
site. In conclusion, this study has demonstrated a beneficial Province, China. Am J Epidemiol 2000;152:1129-35
association between breastfeeding in early life and bone The authors conducted a hospital-based case-control study
mass in 8-year-old children born at term, particularly those in Shandong Province, China, in 1997-1999. A total of 404
breastfed for 3 months or longer, which appears biological. cases and an equal number of controls were included.
If this association is confirmed in other populations and Detailed information regarding lactation, menstruation, and
persists until the attainment of peak bone mass, then the reproduction was collected through in-person interviews.
implication would be that osteoporosis prevention The authors found a significant inverse association
programmes need to start very early in life. between duration of lactation and breast cancer risk. For
women who breastfed for more than 24 months per child,
Leeson CP, Kattenhorn M, Deanfield JE, Lucas A. Duration of
the risk was about 50% lower when compared with those
breast feeding and arterial distensibility in early adult life: who breastfed for 1-6 months per child. A significantly
population based study. BMJ 2001;322:643-7 reduced risk of breast cancer was also found for those
whose lifetime duration of lactation totaled 73-108 months
This study tested the hypothesis that duration of and for those who breastfed for 109 or more months.
breastfeeding is related to changes in vascular function Further stratification by menopausal status resulted in the
relevant to the development of cardiovascular disease. same conclusion. These data suggest that prolonged
Participants were 331 adults (171 women, 160 men) aged lactation reduces breast cancer risk.
between 20 and 28 years, born in Cambridge Maternity
Hospital, UK. The distensibility of the brachial artery was
measured against type and duration of infant feeding Chang-Claude J, Eby N, Kiechle M, Bastert G, Becher H.
determined by a retrospective questionnaire. The results Breastfeeding and breast cancer risk by age 50 among women in
showed that the longer the period of breastfeeding the less Germany. Cancer Causes Control 2000;11:687-95
distensible the artery wall was in early adult life. The The authors report the results of a population-based case
vascular changes observed were not explained by control family study of breast cancer among women
alterations in plasma cholesterol concentration in adult life. diagnosed by the age of 50, conducted in two geographic
Participants, however, were self-selected and there might areas in Germany, to evaluate the effect of breastfeeding
have been other infant feeding factors associated with the on risk of breast cancer. Among parous women (553 cases,
outcome that were not detected by the retrospective 1,094 age-matched controls), having ever breastfed a child
questionnaire. In addition, there is no evidence of an for at least 1 month did not confer protection. However,
association between distensibility of the brachial artery and risk of breast cancer significantly decreased with
subsequent development of cardiovascular disease. To increasing duration of breastfeeding and the estimated risk
conclude, the possible causal relationship between was 40% lower for 13-24 months of cumulative
breastfeeding in infancy and increased risk of breastfeeding and 50% lower for 25 months or more.
cardiovascular disease is not demonstrated and these data These results support a protective role of prolonged
should not alter current recommendations in favour of breastfeeding against the development of breast cancer in
breastfeeding. predominantly premenopausal women.
Singhal A, Cole TJ, Lucas A. Early nutrition in preterm infants
and later blood pressure: two cohorts after randomised trials.
Lancet 2001;357:413-9 Breastfeeding, how...
The research group that published the previous article Deshpande AD, Gazmararian JA. Breastfeeding education and
reported also the follow up to 13-16 years of a cohort of support: association with the decision to breastfeed. Eff Clin
926 children who were born prematurely and had Pract 2000;3:116-22
participated at birth in two parallel randomised trials in
five neonatal units in the UK. The same children had been To identify factors associated with the initiation and
studied before for other outcomes (Arch Dis Child duration of breastfeeding in managed care enrollees who
1984;59:722-30; BMJ 1990;300:837-40; Lancet had had a normal vaginal delivery, a telephone survey of
1992;339:261-4; BMJ 1998;317:1481-7). The mean 5,213 new mothers (4 to 6 months postpartum) was
arterial blood pressure at age 13-16 years was lower in the conducted (response rate 72%). 75% of respondents
66 children assigned banked breastmilk (alone or in reported ever breastfeeding, and of those women, 75%
addition to mother's milk) than in the 64 assigned preterm reported breastfeeding for more than 6 weeks. In adjusted
formula (81.9 vs 86.1 mm Hg). No differences were found multivariate analyses, breastfeeding was affected by
in the term formula (n=44) vs preterm formula (n=42) education, employment, and marital status. Women who
comparison. The children followed up at age 13-16 years were more likely to breastfeed were those who attended
were similar to those not followed up in terms of social childbirth classes, those who received prenatal
class and anthropometry at birth. Breastmilk consumption breastfeeding advice, and those who received postpartum
was associated with lower later blood pressure, a protective breastfeeding assistance. Breastfeeding for more than 6
factor for cardiovascular disease. The data provide weeks postpartum was associated with education,
experimental evidence of programming of a cardiovascular employment status, and the adequacy of postpartum
risk factor by early diet and further support the long-term information. These findings suggest that in the USA health
beneficial effects of breastmilk. plans and employees may promote breastfeeding by
providing breastfeeding education and support.
5. months. Adolescents identified three main influences on
Abada TS, Trovato F, Lalu N. Determinants of breastfeeding in infant feeding decisions and practices: (1) their perceptions
the Philippines: a survival analysis. Soc Sci Med 2001;52:71-81 of the benefits of breastfeeding, (2) their perceptions of the
problems with breastfeeding, and (3) influential people. In
This study examines modern and traditional factors that this study, teens reported no single influence which
may lengthen or shorten the duration of breastfeeding. determined infant feeding choices. The decision to
Specifically, health sector, socio economic, demographic, breastfeed was a dynamic process. Teens recognized that
and supplementary food variables are analysed among a breastfeeding offered many benefits including facilitating
large representative sample of women in the Philippines. maternal-child bonding and promoting the baby's health,
The results show that traditional factors associated with but concern was raised regarding a potential for excessive
breastfeeding (use of solid foods such as porridge and attachment between teen mother and baby. Fear of pain,
applesauce, and prenatal care by a traditional embarrassment with public exposure, and unease with the
nurse/midwife) do not play a significant role in the act of breastfeeding acted as barriers for teenagers who
mother's decision to continue breastfeeding. Factors were considering breastfeeding. The adolescents' mothers
associated with modernity are significant in explaining continued to be an important influence. The ranges of
early termination of breastfeeding (respondent's education, perceptions and influences that minority adolescent
prenatal care by a medical doctor, delivery in a hospital, mothers have identified as affecting their infant feeding
and use of infant formula). The findings of this study choices, illustrated and explained in the teens' own words,
suggest that health institutions and medical professionals are helpful to health care providers as they counsel teen
can play a significant role in promoting breastfeeding in mothers about infant feeding options.
the Philippines; and educational campaigns that stress the
benefits of lactation are important strategies for
encouraging mothers to breastfeed longer. Donath SM, Amir LH. Does maternal obesity adversely affect
breastfeeding initiation and duration? J Paediatr Child Health
2000;36:482-6
Arora S, McJunkin C, Wehrer J, Kuhn P. Major factors
influencing breastfeeding rates: Mother's perception of father's To examine the relationship between maternal obesity and
attitude and milk supply. Pediatrics 2000;106:E67 the initiation and duration of breastfeeding, an analysis was
made of the 1995 National Health Survey, in which
To determine factors influencing feeding decisions, personal interviews were conducted on a sample of private
breastfeeding and/or bottle initiation rates, as well as dwellings and a list sample of non-private dwellings in all
breastfeeding duration, a mail survey was carried out in States and Territories of Australia. Mothers between the
245 mothers whose infants received well-child care from ages of 17 and 50 years (n=1991) with children under the
birth to 1 year of age in a family medicine practice of a age of 4 years in 1995 participated in the study. Of the
530-bed community-based hospital in northwestern group of mothers with a body mass index (BMI) of 20-25,
Pennsylvania. The breastfeeding initiation rate was 44.3%. 89.2% initiated breastfeeding, compared with 82.3% of
By the time the infant was 6 months old, only 13% of these mothers with a BMI of 30 or more. There was also a
were still breastfeeding. The decision to breastfeed or to significant difference between the mean and median
bottle-feed was most often made before pregnancy or duration of breastfeeding of obese and non-obese mothers.
during the first trimester of pregnancy. The most common These differences remained significant when maternal
reasons mothers chose breastfeeding included: 1) benefits smoking, age and other sociodemographic factors were
to the infant's health, 2) naturalness, and 3) emotional taken into consideration. Health professionals should be
bonding with the infant. The most common reasons bottle- aware that obese women may be at increased risk of not
feeding was chosen included: 1) mother's perception of breastfeeding or stopping breastfeeding prematurely.
father's attitude, 2) uncertainty regarding the quantity of
breast milk, and 3) return to work. By self-report, factors
that would have encouraged bottle-feeding mothers to Volpe EM, Bear M. Enhancing breastfeeding initiation in
breastfeed included: 1) more information in prenatal adolescent mothers through the Breastfeeding Educated and
classes; 2) more information from TV, magazines, and Supported Teen (BEST) Club. J Hum Lact 2000;16:196-200
books; and 3) family support. To overcome obstacles, The purpose of this study was to determine if specific
issues surrounding perceived barriers, such as father's breastfeeding education, provided by a lactation consultant
attitude, quantity of milk, and time constraints, need to be in group classes for pregnant adolescents, would increase
discussed with each parent. breastfeeding initiation among students enrolled in a high
school adolescent pregnancy program. 91 pregnant
Hannon PR, Willis SK, Bishop-Townsend V, Martinez IM, adolescents participated in the study and were divided into
Scrimshaw SC. African-American and Latina adolescent mothers' two groups: those who did not receive specific
infant feeding decisions and breastfeeding practices: a qualitative breastfeeding education and those who did. There were no
study. J Adolesc Health 2000;26:399-407 significant differences in breastfeeding initiation with
regard to age or ethnicity. Of the 48 adolescents who
To explore minority teen mothers' perceptions of received no specific education, 7 (14.6%) initiated
breastfeeding and the influences on infant feeding choices, breastfeeding. Of the 43 adolescents in the education
a qualitative study using semistructured ethnographic group, 28 (65.1%) initiated breastfeeding, which indicates
interviews and focus groups was conducted with 35 Latina a significant difference between groups with regard to
and African-American girls in Chicago between the ages infant feeding choice. The results of this study indicate that
of 12 and 19 years who were primiparous and were targeted educational programmes designed for the
currently pregnant or had delivered within the past 3 adolescent learner may be successful in improving
6. breastfeeding initiation in this population. from 8 women maintained on methadone doses of 25 to
180 mg/day. Methadone levels in milk ranged from 27 to
260 ng/ml, with a mean level for the group of 95 ng/ml.
Lu MC, Lange L, Slusser W, Hamilton J, Halfon N. Provider The mean daily methadone ingestion, based on a newborn
encouragement of breastfeeding: evidence from a national survey. intake of 475 ml/day of breastmilk, was 0.05 mg/day. This
Obstet Gynecol 2001;97:290-5
level is small and consistent with those in other published
To examine the influence of provider encouragement on reports. Breastfeeding duration ranged from 2.5 to 21
breastfeeding among women of different social and ethnic months. There were no adverse effects associated with
backgrounds in the United States, a nationally repres- breastfeeding or weaning. This study supports the
entative sample of 2,017 parents with children younger compatibility of breastfeeding and methadone maintenance
than 3 years was surveyed by telephone. The responses of therapy.
the 1,229 women interviewed were included in the Riordan J, Gross A, Angeron J, Krumwiede B, Melin J. The
analysis. Respondents were asked to recall whether their effect of labor pain relief medication on neonatal suckling and
breastfeeding duration. J Hum Lact 2000;16:7-12
physicians or nurses had encouraged or discouraged them
from breastfeeding. 34.4% of respondents did not initiate The relationship of labour pain relief medications with
breastfeeding. 73.2% of women reported having been neonatal suckling and breastfeeding duration was
encouraged by their physicians or nurses to breastfeed; examined in 129 mothers delivering vaginally. Suckling
74.6% of women who were encouraged initiated scores for intravenous and epidural groups were similar
breastfeeding, compared with only 43.2% of those who while those who received a combination of both
were not encouraged. Women who were encouraged to intravenous and epidural medications were lower.
breastfeed were more than 4 times as likely to initiate Breastfeeding duration did not differ between unmedicated
breastfeeding as women who did not receive encourage- and medicated groups; however, dyads with low suckling
ment. The influence of provider encouragement was scores weaned earlier than those with medium or high
significant across all strata of the sample. In populations scores. Labour pain relief medications diminish early
traditionally less likely to breastfeed, provider suckling but are not associated with duration of
encouragement significantly increased breastfeeding breastfeeding through 6 weeks postpartum.
initiation, by more than 3-fold among low-income, young,
and less-educated women; by nearly 5-fold among black
women; and by nearly 11-fold among single women.
Hoseth E, Joergensen A, Ebbesen F, Moeller M. Blood glucose
levels in a population of healthy, breast fed, term infants of
Sheehan A. A comparison of two methods of antenatal appropriate size for gestational age. Arch Dis Child Fetal
breastfeeding education. Midwifery 1999;15:274-82 Neonatal Ed 2000;83:F117-9
The objective of this study was to compare a woman- The blood glucose concentration of 223 healthy, breastfed,
centered antenatal breastfeeding programme based on con- term infants of appropriate size for gestational age was
cepts of peer and husband/partner support with a control determined at different times (between one and 96 hours)
group, who received antenatal breastfeeding education led after delivery. One sample of blood glucose was taken
by a midwife childbirth educator. In a large private from each infant independent of the feeding time. Infants
hospital in Sydney, Australia, 154 highly educated suspected of suffering from intrapartum hypoxia were
primiparous women who attended childbirth classes were excluded. Blood glucose concentration one hour after
assigned to the control group (n=86) or to the experimental delivery was not significantly lower than at any other time.
group (n=68) in which representatives of the Nursing Only two infants had low blood glucose concentrations one
Mothers Association of Australia, their male partners and a hour after delivery (1.4 and 1.9 mmol/l). There were no
mother who was willing to demonstrate breastfeeding significant differences in blood glucose concentration
provided the intervention. No differences were found between sexes, methods of delivery, infants delivered with
between groups in relation to maternal perceptions of or without analgesia, and infants born to smokers or non-
success or duration of breastfeeding, which was overall smokers, and there was no further correlation between
very high when compared to previously reported blood glucose concentration and gestational age, umbilical
breastfeeding duration rates in Australia. This research cord pH, or Apgar score. The authors conclude that very
found that a peer-led model of breastfeeding education was few healthy, breastfed, term infants of appropriate size for
as effective as a midwife-led group in producing gestational age have low blood glucose levels, and there is
breastfeeding initiation and duration rates higher than no indication for blood glucose monitoring in these infants.
others previously reported, with the potential to enhance
social support networks.
Meier PP, Brown LP, Hurst NM, Spatz DL, Engstrom JL,
McCarthy JJ, Posey BL. Methadone levels in human milk. J Hum Borucki LC, Krouse AM. Nipple shields for preterm infants:
Lact 2000;16:115-20 effect on milk transfer and duration of breastfeeding. J Hum Lact
2000;16:106-14
Pregnant women on methadone maintenance therapy
frequently want to nurse yet are often discouraged from This study reports breastfeeding outcomes for 34 preterm
doing so because of concern about the amount of infants whose mothers used ultrathin silicone nipple
methadone that may be in the breastmilk. This study shields to increase milk transfer. Mean milk transfer was
analyzed the levels of methadone in the milk of nursing compared for two consecutive breastfeedings with and
mothers and compared these levels to those in other without the nipple shield. Total duration of breastfeeding
published reports. 14 breastmilk samples were obtained was calculated for a maximum of 365 days. Mean milk
7. transfer was significantly greater for feedings with the This study was designed to obtain policy- and programme-
nipple shield (18.4 ml vs. 3.9 ml), with all 34 infants relevant data on exclusive breastfeeding in Lesotho.
consuming more milk with the nipple shield in place. Qualitative information was obtained through focus groups
Mean duration of nipple shield use was 32.5 days, and and individual interviews with mothers, grandmothers and
mean duration of breastfeeding was 169.4 days; no nurses. This was complemented with quantitative data
association between these variables was noted. The nipple collected through a clinic-based survey of mothers. The
shield was used for 24.3% of the total breastfeeding qualitative and the quantitative findings consistently
experience, with no significant association between the converged, illustrating a culture of infant feeding in which
percentage of time the shield was used and total duration breastfeeding was central, but exclusive breastfeeding was
of breastfeeding. These findings are the first to indicate an unknown concept and not practised. Grandmothers
that nipple shield use increases milk intake without seemed to be more in tune with the ideal of exclusive
decreasing total duration of breastfeeding for preterm breastfeeding as they had given their young infants thin
infants. gruel only occasionally. Contemporary mothers, in
contrast, regularly gave their young infants water. Mothers
Killersreiter B, Grimmer I, Buhrer C, Dudenhausen JW, Obladen and grandmothers frequently cited nurses as the source of
M. Early cessation of breastmilk feeding in very low birthweight advice for giving water. Grandmothers were adamant in
infants. Early Hum Dev 2001;60:193-205 pointing out that they had never given water to their own
young infants and asserted that they avoided giving it to
This investigation was carried out to assess the duration of
their grandchildren as they considered it unnecessary and
breastmilk feeding and to analyze risk factors for early
harmful. According to the grandmothers, water
cessation of breastmilk feeding in term and very preterm
supplementation was a new practice that had been
infants. A cohort study was performed in 89 consecutive
introduced through the clinics. Efforts to discourage water
very low birthweight (VLBW) infants (<1500 g) who
supplementation and encourage exclusive breastfeeding in
survived for at least one week, and 177 term infants with
this setting need to be directed both at mothers and health
birthweights >2500 g born in the same hospital matched
providers.
for gender and multiplicity. Median duration of breastmilk
feeding, as determined from charts and questionnaires
mailed to the mothers at 6 and 12 months corrected age, Margolis LH, Schwartz JB. The relationship between the timing
was 36 days in VLBW infants, compared to 112 days in of maternal postpartum hospital discharge and breastfeeding. J
control infants. In both VLBW and control infants, Hum Lact 2000;16:121-8
smoking during pregnancy, low maternal and paternal
school education were each significantly associated with This study examines the association between discharge
short duration of breastmilk feeding. In VLBW infants, timing and breastfeeding, controlling for demographic,
multiple pregnancy and gestational age <29 weeks were economic, and health factors that influence both. The
each associated with prolonged breastmilk feeding, as were results demonstrate that mothers who spent 1 night in the
maternal age >35 years and spontaneous pregnancy (as hospital were almost twice as likely to breastfeed than
opposed to pregnancy following infertility treatment) in mothers who spent 2 or 3 nights in the hospital. Instead of
term infants. Multivariate analysis revealed that VLBW, basing discharge solely on predetermined rules, derived
smoking and low parental school education were largely from financial criteria, attention to the decision-
independent negative predictors of breastmilk feeding. making process should be an important part of newborn
While these results emphasize the need for special support discharge policies.
of VLBW infant mothers promoting lactation, the
relationships between smoking, school education and Hall RT, Simon S, Smith MT. Readmission of breastfed infants
breastmilk feeding in both strata show that efforts to in the first 2 weeks of life. J Perinatol 2000;20:432-7
increase breastmilk feeding require a public health
perspective. The purpose of the study was to look at factors associated
with readmission of breastfeeding infants for jaundice
and/or dehydration. The records of 125 breastfeeding
Cohen RJ, Brown KH, Rivera LL, Dewey KG. Exclusively infants who were admitted to hospital from 1995 to 1997
breastfed, low birthweight term infants do not need supplemental in the first 2 weeks of life with diagnoses of jaundice,
water. Acta Paediatr 2000;89:550-2 dehydration, or feeding problems were reviewed. Infants
Breastmilk intake, urine volume and urine-specific gravity with hemolytic disease, infection, or other underlying
(USG) of exclusively breastfed, low birthweight (LBW) causes were excluded. This study confirms that
term male infants in Honduras were measured during 8- prematurity and short hospital stay (less than 3 days) are
hour periods at 2 (n=59) and 8 (n=68) weeks of age. risk factors for readmission of breastfeeding infants with
Ambient temperature was 22-36 C° and relative humidity jaundice and/or dehydration.
was 37-86%. Maximum USG ranged from 1.001 to 1.012,
all within normal limits. It is concluded that supplemental Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z,
water is not required for exclusively breastfed, LBW term Dzikovich I, Shapiro S, Collet JP, Vanilovich I, Mezen I, Ducruet
infants, even in hot conditions. T, Shishko G, Zubovich V, Mknuik D, Gluchanina E,
Dombrovskiy V, Ustinovitch A, Kot T, Bogdanovich N,
Ovchinikova L, Helsing E, for the PROBIT Study Group.
Almroth S, Mohale M, Latham MC. Unnecessary water Promotion of Breastfeeding Intervention Trial (PROBIT): a
supplementation for babies: grandmothers blame clinics. Acta randomized trial in the Republic of Belarus. JAMA
Paediatr 2000;89:1408-13 2001;285:413-20
8. The objective of this study was to assess the effects of having no prior support. At 4 weeks postpartum, 17 out of
breastfeeding promotion on breastfeeding duration and 25 (68%) and 26 out of 26 (100%) women in the control
exclusivity and gastrointestinal and respiratory infection and intervention groups, respectively, continued to
and atopic eczema among infants. 31 maternity hospitals breastfeed. Results indicate that postpartum care
and polyclinics in the Republic of Belarus were randomly augmented with individualized professional support
assigned to receive an experimental intervention (n=16) commenced in the hospital and continued in the
modeled on the Baby-Friendly Hospital Initiative (BFHI) community, significantly increases the duration of
of the WHO and UNICEF, which emphasizes health care breastfeeding among women who identify themselves as
worker assistance with initiating and maintaining being without support for the first month postpartum.
breastfeeding and lactation and postnatal breastfeeding
support, or a control intervention (n=15) of continuing Hoddinott P, Pill R, Hood K. Identifying which women will stop
usual infant feeding practices and policies. A total of breastfeeding before three months in primary care: a pragmatic
17,046 mother-infant pairs consisting of full-term singleton study. Br J Gen Pract 2000;50:888-91
infants weighing at least 2500 g and their healthy mothers
who intended to breastfeed were followed-up for 12 In Britain only 42% of women who initiate breastfeeding
months; 16,491 (96.7%) completed the entire follow-up. are still breastfeeding at four months, despite well
Infants from the intervention sites were significantly more documented health benefits. To explore whether
likely than control infants to be breastfed to any degree at sociodemographic and social support information collected
12 months (19.7% vs 11.4%), were more likely to be routinely by health visitors at the new birth assessment can
exclusively breastfed at 3 months (43.3% vs 6.4%) and at 6 help predict which women will give up breastfeeding
months (7.9% vs 0.6%), and had a significant reduction in before three months, a survey of 279 consecutive births in
the risk of one or more gastrointestinal tract infections three general practices was carried out in an inner-London
(9.1% vs 13.2%) and of atopic eczema (3.3% vs 6.3%), but borough. Health visitors collected sociodemographic,
no significant reduction in respiratory tract infection. infant feeding, and social support data at the new birth
Implementation of the BFHI increases the duration and assessment 10 to 14 days after birth and at an
degree (exclusivity) of breastfeeding and decreases the risk immunisation visit at three to four months after birth.
of gastrointestinal tract infection and atopic eczema in the Three variables were found to be significantly associated
first year of life. These results provide a solid scientific with breastfeeding at three months. Younger women and
underpinning for future interventions to promote women with moderate to poor emotional support as
breastfeeding. assessed by their health visitor were less likely to still be
breastfeeding at three months. White women who left full-
time education at age 16 years or below were least likely to
Shariff F, Levitt C, Kaczorowski J, Wakefield J, Dawson H, be breastfeeding at three months but educational level was
Sheehan D, Sellors J. Workshop to implement the baby-friendly not a significant predictor for women from other ethnic
office initiative. Effect on community physicians' offices. Can
Fam Physician 2000;46:1090-7
backgrounds. This pragmatic study illustrates how
information collected during routine clinical care by health
To assess the effect of a self-appraisal questionnaire and a visitors can help predict which women will give up
workshop for office staff in promoting the "10 Steps to breastfeeding before three months. This could be useful to
Baby-Friendly Office" in Canada, an early intervention identify women whose social support needs are not being
group of primary care pediatricians attended the workshop met and who may benefit from local initiatives.
in October 1997 (n=23) and a late-intervention group in
April 1998 (n=23). Self-appraisals were completed before
the workshops by all participants in October 1997, by 37 McInnes RJ, Love JG, Stone DH. Evaluation of a community-
offices in April 1998, and by 34 offices in October 1998. based intervention to increase breastfeeding prevalence. J Public
Health Med 2000;22:138-45
Of the 34 offices completing all assessments, none
followed all 10 steps. Initial mean score was 4.4 steps. The The aim of the study was to determine whether peer
workshop intervention improved overall mean scores from counselling in the antenatal and post-natal period would
4.3 to 5.6. The self-appraisal tool alone had no effect on increase the prevalence and duration of breastfeeding
scores. Areas of improvement were noted in providing among low-income women in Glasgow. The intervention
information to patients and displaying posters to promote comprised peer counselling of pregnant women, support of
breastfeeding. Key steps, such as not advertising breastfeeding mothers and local awareness-raising
breastmilk substitutes and not distributing free formula, did activities. The study subjects were all women attending the
not change. The workshop effected a modest but positive antenatal booking clinic resident in either the intervention
change in breastfeeding promotion. The change was or control area. Of the 995 women enrolled in the study,
maintained at 6 and 12 months after the intervention. data were available for analysis on 919 (92%) to 6 weeks
postnatally. At booking, 18% of the intervention group and
21% of the control group stated an intention to breastfeed.
Porteous R, Kaufman K, Rush J. The effect of individualized At delivery, the proportions initiating breastfeeding were
professional support on duration of breastfeeding: a randomized
controlled trial. J Hum Lact 2000;16:303-8
23% of the intervention subjects and 20% of the controls,
and by 6 weeks post-natally, the proportion providing any
A trial was conducted with 51 women randomly assigned breastmilk had declined to 10% of the intervention group
either to a conventional nursing care group or to an and 8% of the control group. The breastfeeding prevalence
individualized professional support group to examine the was twice as high in the intervention group relative to the
effect of professional support on breastfeeding status at 4 controls at delivery; by 6 weeks post-natally the difference
weeks postpartum. All participants identified themselves as between the two groups was not statistically significant. As
9. the impact of the intervention was not sustained even for was almost 100% higher in smoking than in nonsmoking
the modest duration of 6 weeks postnatally, it would be mothers. A 50% higher adjusted risk was shown in studies
premature to justify widespread use of peer support that had lost-to-follow-up rates below 15% and included
programmes to increase the prevalence of breastfeeding in adequate adjustment for confounding. This review
socially disadvantaged communities. confirms that maternal smoking increases the risk of early
weaning.
Ladzani R, Steyn NP, Nel JH. An evaluation of the effectiveness
of nutrition advisers in three rural areas of northern province. S Hamprecht K, Maschmann J, Vochem M, Dietz K, Speer CP,
Afr Med J 2000;90:811-6 Jahn G. Epidemiology of transmission of cytomegalovirus from
mother to preterm infant by breastfeeding.Lancet 2001;357:513-8
To evaluate the efficacy of a nutrition education
151 mothers and their 176 preterm infants (gestational age
intervention programme undertaken by trained local
at birth <32 weeks or birthweight <1500 g) were
women (nutrition advisors) in rural villages in South
prospectively screened for cytomegalovirus infection by
Africa, a cross-sectional survey was undertaken in 1989
serology, virus culture, and PCR. Of the 69 seronegative
and again in 1992. Six trained nutrition advisors delivered
breastfeeding control mothers, none had detectable
nutrition education to female caregivers of infants in three
cytomegalovirus DNA in breastmilk and none of their 80
study villages, but not in three control villages, between
infants shed the virus in urine. The proportion of
the surveys. Households were randomly selected. The
cytomegalovirus reactivation in seropositive breastfeeding
response rate of households was 70% (n=1040) at baseline
mothers was 96% (73 of 76). The cumulative rate of
and 84% (n=1263) after intervention. The percentage of
transmission was 37% (27 of 73 mothers; 33 infants). The
women who initiated breastfeeding on the day of birth
infection of the neonates had a mean incubation time of 42
improved significantly in the study area from 60% to 90%.
days. About 50% of the infected infants had no symptoms,
The frequency of feeding infants at 6 months improved
but four had sepsis-like symptoms. This study shows that
too. The introduction of solid foods to infants on the first
breastfeeding as a source of postnatal cytomegalovirus
day of life decreased from 26.5% to 6.3% in the study area.
infection in preterm infants has been underestimated and
A nutrition education programme undertaken by trained
may be associated with a symptomatic infection. Measures,
local women can significantly improve breastfeeding and
such as milk pasteurization, should be taken to inactivate
infant feeding practices in rural areas.
the virus in breastmilk from seropositive mothers given to
preterm infants.
Valdes V, Pugin E, Schooley J, Catalan S, Aravena R. Clinical
support can make the difference in exclusive breastfeeding
success among working women. J Trop Pediatr 2000;46:149-54 Jeffery BS, Mercer KG. Pretoria pasteurisation: a potential
method for the reduction of postnatal mother to child
Exclusive breastfeeding has generally been considered transmission of the human immunodeficiency virus. J Trop
incompatible with working separated from the infant. This Pediatr 2000;46:219-23
prospective, controlled intervention trial conducted in HIV can be transmitted by breastfeeding. The virus is
Chile shows that breastfeeding support, including inactivated by heating. A simple and inexpensive method
anticipatory counselling and monthly clinical follow-up of has been devised by which expressed breastmilk may be
the mother and infant, can significantly increase the pasteurised in a domestic setting. The method uses the
percentage of infants exclusively fed with breastmilk at the principle of heat transfer from 450 ml of water heated to
end of 6 months of life. Over 80% of women from control boiling point in an aluminum pot to a smaller volume of
and intervention groups expressed a desire to breastfeed milk in a glass jar placed into the water. The method was
for more than 6 months and more than 50% thought it was tested using differing starting values for volume of milk
best for the infant to be exclusively breastfed for 6 months. (between 50 and 150 ml); initial temperature of milk
Only 6% of women in the control group were able to (between 37 C° and the ambient temperature); and ambient
complete 6 months of exclusive breastfeeding compared to temperature. Each of the parameters was varied within the
53% of those in the intervention group. The most range indicated while all other conditions were kept
important difference between the strategies used by both constant. Milk temperature remained between 56 and 62.5
groups of mothers for maintaining exclusive breastfeeding C°, the ideal range, for a period ranging from 10 to 15
after returning to work was that only 23% of the control minutes depending on the combination of variables. The
group practiced milk expression compared to 66% in the peak temperature and duration of time in the ideal
intervention group. All women from the supported group temperature range was minimally sensitive to volume of
stated that they would advise a friend to combine exclusive milk, starting temperature of milk, and ambient
breastfeeding and work and that they would like to do so temperature. This method of pasteurisation is feasible and
again with another child. reliable under a range of conditions, but it requires
refinement and further testing under different conditions.
Horta BL, Kramer MS, Platt RW. Maternal smoking and the risk
of early weaning: a meta-analysis. Am J Public Health
Aarts C, Kylberg E, Hornell A, Hofvander Y, Gebre-Medhin M,
2001;91:304-7
Greiner T. How exclusive is exclusive breastfeeding? A
This study reviewed evidence on the effect of maternal comparison of data since birth with current status data. Int J
smoking on early weaning. Analysis was restricted to Epidemiol 2000;29:1041-6
studies in which infants who had never been breastfed There is no accepted and widely used indicator for
were excluded or the prevalence of breastfeeding initiation exclusive breastfeeding since birth. Indeed, the difference
was more than 90%. The risk for weaning before 3 months between "current status" data on exclusive breastfeeding
10. and data on "exclusive breastfeeding since birth" is rarely fewer complications and longer duration of breastfeeding.
recognized. The authors of this paper used data from a
longitudinal study on 506 mother-infant pairs in Sweden to Renfrew MJ, Lang S, Woolridge M. Oxytocin for promoting
examine this issue. The mothers completed daily successful lactation. Cochrane Database Syst Rev 2000; (2):
recordings on infant feeding during the first 9 months after CD000156
birth. A research assistant conducted fortnightly home
A rise in the concentration of oxytocin causes contraction
visits with structured interviews. The results show a wide
of cells around the alveoli and milk ducts, in preparation
discrepancy between the data obtained from the two
for suckling. Lactation failure may result from insufficient
sources. The difference in the exclusive breastfeeding rate
oxytocin. The objective of this systematic review was to
was 92% vs 51% at 2 months, 73% vs 30% at 4 months,
assess the effects of using oral or nasal oxytocin on
and 11% vs 1.8% at 6 months. Current status indicators
lactation. Four controlled trials of 639 women were
based on a 24-hour period may be inadequate and even
included. There was potential for significant bias in these
misleading for many purposes.
trials: restricted breastfeeding schedules may have contrib-
uted to inadequate production of milk by the participants.
Sublingual and buccal preparations of oxytocin were
Cochrane reviews associated with an increase in milk production. Oxytocin
did not appear to increase the incidence of breast pain and
Renfrew MJ, Lang S, Woolridge MW. Early versus delayed 100 IU of oxytocin appeared to be slightly more beneficial
initiation of breastfeeding. Cochrane Database Syst Rev than 10 IU. The reviewers conclude that an appropriate
2000;(2):CD000043 dose of sublingual or buccal oxytocin may help augment
lactation where necessary. However, if women are encour-
It has been suggested that the timing of a baby's first aged and supported with unrestricted breastfeeding, the
breastfeed may influence breastfeeding duration and need for oxytocin would probably be diminished.
emotional attachment. The objective of this review was to Sikorski J, Renfrew MJ. Support for breastfeeding mothers.
assess the effects of breastfeeding soon after birth (within Cochrane Database Syst Rev 2000;(2):CD001141
30 minutes) compared to being breastfed later (between 4
to 8 hours after delivery) on the duration of breastfeeding Exclusive breastfeeding rates at three to four months
and the mother/infant relationship. Three controlled studies remain low in many health care settings. In economically
involving 209 women were included. Compared with late advantaged countries, young mothers, those in low-income
contact and breastfeeding, early contact and breastfeeding groups or those who ceased full-time education at an early
was associated with greater communication between age are least likely to breastfeed. In poorer countries, more
mother and infants in a two-minute observation period (or affluent groups may breastfeed less. The objective of this
0.14, 95% CI 0.03 to 0.61). There was no difference systematic review was to assess the effects of
detected for numbers of women breastfeeding after birth breastfeeding support. 13 controlled trials were included.
(OR for 12 weeks after birth 0.73, 95% CI 0.34 to 1.54). The relative risk for stopping exclusive feeding within two
The reviewers found no differences between early and months was 0.83 (95% CI 0.72 to 0.96). The relative risk
delayed contact in regard to breastfeeding duration. Early for stopping breastfeeding within two months was 0.74
contact was associated with greater communication (95% CI 0.65 to 0.86). One more mother will breastfeed
between mothers and infants. for two months if support is provided for nine women
(95% CI 6 to 21). Similarly, one more woman will
breastfeed exclusively if support is given to nine women
Renfrew MJ, Lang S, Martin L, Woolridge MW. Feeding (95% CI 6 to 40). It is concluded that the provision of extra
schedules in hospitals for newborn infants. Cochrane Database
support by professionals with special skills in
Syst Rev 2000;(2):CD000090
breastfeeding appears to result in more mothers
Regular breastfeeding times have been thought to help breastfeeding their babies until two months of age, and
establish routines and promote infant digestion, while more mothers breastfeeding their babies exclusively to two
frequent breastfeeding has been recommended to enhance months of age.
breastfeeding and infant growth. The objective of this
systematic review was to assess the effects of frequent Donnelly A, Snowden HM, Renfrew MJ, Woolridge MW.
breastfeeding compared with less frequent breastfeeding in Commercial hospital discharge packs for breastfeeding women.
the early days after birth. Three controlled trials involving Cochrane Database Syst Rev 2000;(2):CD002075
400 women were included. There were significant method- Exclusive breastfeeding until around six months of age,
ological limitations in some of the studies. Compared to followed by the introduction of solids with continued
two-hourly, three-hourly or on demand breastfeeding, breastfeeding, is considered to be the optimal nutritional
restricted (less frequent four-hourly breastfeeding) was start for newborn infants. To determine whether the
associated with greater discontinuation of breastfeeding by exclusivity and duration of breastfeeding is affected by
four to six weeks postpartum (RR 1.53, 95% CI 1.08 to giving mothers commercial discharge packs in hospital
2.15). Restricted breastfeeding was associated with which contain artificial formula or promotional material
increased incidence of sore nipples (RR 2.12, 95% CI 1.22 for artificial formula, all randomised controlled trials that
to 3.68), engorgement (RR 2.10, 95% CI 1.25 to 3.21) and examined the effects of commercial discharge packs on
the need to give additional formula feeds (RR 3.14, 95% breastfeeding were systematically reviewed. Nine
CI 1.24 to 8.00). There appear to be a number of randomised controlled trials involving a total of 3,730
disadvantages from restricting breastfeeding to a four- women were analysed. The studies only included women
hourly schedule in the first few days after birth. More from North America. The analysis showed that when
frequent or on demand breastfeeding is associated with
11. comparing commercial discharge packs with any of the
controls (no intervention, non-commercial pack and
combinations of these), exclusive breastfeeding was
reduced at all time points in the presence of commercial
hospital discharge packs. There was no evidence to support
the conjecture that use of hospital discharge packs causes
the early termination of non-exclusive breastfeeding.
Where the introduction of solid food was measured, giving
a commercial pack (with or without formula) reduced the
time before solid food was introduced.
Prepared by the Geneva Infant Feeding
Association (GIFA), a member of the
International Baby Food Action Network
(IBFAN)
Editors: Marina Ferreira Rea, Adriano Cattaneo
Layout: Dorothée Haller
Copies of Breastfeeding Briefs sent upon request to GIFA, Box
157, 1211 Geneva 19, Switzerland, Fax: +41-22-798 44 43, e-mail
<info@gifa.org>, or to UNICEF country offices. Available also in
French, Spanish, Portuguese and Arabic. A contribution of Sfr.
10.-- for a subscription to industrialized countries is gratefully
accepted and can be sent by international postal order to account
no. 12-17653-5