This document summarizes a study examining the use of supplemental vitamin D among infants who were breastfed for prolonged periods. The study found that only 15.9% of infants who were predominantly breastfed for at least 6 months received supplemental vitamin D. Use of vitamin D was significantly associated with parental agreement that their pediatrician recommended supplementation and disagreement that breast milk contains all needed nutrition. While 36.4% of pediatricians recommended vitamin D for all breastfed infants, only 44.6% of parents of predominantly breastfed infants whose doctor recommended vitamin D actually gave the supplementation to their child. Educational efforts are needed to increase compliance with vitamin D supplementation guidelines among both physicians and parents.
Vita D Perrine Cg Ea At Adherence To Vit D Recommendations Among Us Infants P...alisonegypt
This study examined adherence to vitamin D recommendations among US infants using data from the Infant Feeding Practices Study II from 2005-2007. The researchers estimated the percentage of infants meeting the 2003 and 2008 vitamin D recommendations from the American Academy of Pediatrics at various ages from 1 to 10.5 months. They found that use of oral vitamin D supplements was low, ranging from 1% to 13% regardless of whether infants were breastfed, formula-fed, or mixed-fed. Most infants did not consume adequate amounts of vitamin D according to the 2008 recommendation, suggesting pediatricians should encourage vitamin D supplementation for breastfed and partially breastfed infants.
Effect Of An Educational Intervention About Breastfeeding On The Knowledge,Biblioteca Virtual
This study evaluated the impact of an educational intervention on pediatric residents' knowledge, confidence, and clinical behaviors regarding breastfeeding. The residents completed pre- and post-intervention questionnaires to assess knowledge and confidence. Telephone interviews with breastfeeding mothers after clinic visits evaluated residents' clinical behaviors. The results showed that residents' knowledge scores increased significantly after the intervention. Their clinical behaviors when interacting with breastfeeding mothers also improved substantially. The educational intervention was effective in enhancing residents' support of breastfeeding patients.
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 study analyzed survey responses from 1,323 mothers who stopped breastfeeding their infants before 12 months to identify the primary reasons for stopping breastfeeding at different infant ages. The researchers conducted factor analysis to group mothers' reasons into seven constructs: lactation issues, psychosocial factors, nutritional concerns, lifestyle interference, medical issues, pumping difficulties, and self-weaning. Across all ages, mothers most frequently cited their infant not being satisfied by breast milk alone as a key reason for stopping. Younger, unmarried, and lower-income mothers tended to stop earlier. Reasons for stopping varied by infant age, from lactation issues in early months to self-weaning in later months.
A pediatrician provides safety tips for common summer activities like swimming, sun exposure, fires, and biking. Parents are advised to closely supervise young swimmers and apply sunscreen before going outdoors. Burns from barbecues and fireworks can be avoided by keeping children away from all fire sources. Wearing a helmet is critical for biking and skating safety. A pre-sports physical exam can help determine if a child is physically ready for athletics and identify any health issues.
Association Of Breastfeeding Intensity And Bottle Emptying Behaviors At Early...Biblioteca Virtual
This study examined the relationship between breastfeeding intensity, bottle emptying behaviors, and risk of excess weight in infants. The study found:
1) Infants who were breastfed at low (20% of milk feeds) or medium (20-80% of milk feeds) intensities in early infancy were over twice as likely to have excess weight in late infancy compared to infants breastfed at high (80% of milk feeds) intensities.
2) Infants who often emptied bottles in early infancy were 69% more likely to have excess weight in late infancy than infants who rarely emptied bottles.
3) Mothers' encouragement of bottle emptying was negatively associated with infants' risk of
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.
Exclusive Breastfeeding Reduces Acute Respiratory Infection And DiarrheaBiblioteca Virtual
This study examined the relationship between breastfeeding practices and infant mortality in Dhaka, Bangladesh. The researchers followed over 1600 infants from birth to 12 months. They found that exclusive breastfeeding declined from 53% at 1 month to 5% at 6 months. Partial or no breastfeeding was associated with a 2-3 times higher risk of infant death from all causes, acute respiratory infection (ARI), and diarrhea compared to exclusive breastfeeding. The study suggests that exclusive breastfeeding in early infancy reduces infant mortality, particularly from ARI and diarrhea.
Vita D Perrine Cg Ea At Adherence To Vit D Recommendations Among Us Infants P...alisonegypt
This study examined adherence to vitamin D recommendations among US infants using data from the Infant Feeding Practices Study II from 2005-2007. The researchers estimated the percentage of infants meeting the 2003 and 2008 vitamin D recommendations from the American Academy of Pediatrics at various ages from 1 to 10.5 months. They found that use of oral vitamin D supplements was low, ranging from 1% to 13% regardless of whether infants were breastfed, formula-fed, or mixed-fed. Most infants did not consume adequate amounts of vitamin D according to the 2008 recommendation, suggesting pediatricians should encourage vitamin D supplementation for breastfed and partially breastfed infants.
Effect Of An Educational Intervention About Breastfeeding On The Knowledge,Biblioteca Virtual
This study evaluated the impact of an educational intervention on pediatric residents' knowledge, confidence, and clinical behaviors regarding breastfeeding. The residents completed pre- and post-intervention questionnaires to assess knowledge and confidence. Telephone interviews with breastfeeding mothers after clinic visits evaluated residents' clinical behaviors. The results showed that residents' knowledge scores increased significantly after the intervention. Their clinical behaviors when interacting with breastfeeding mothers also improved substantially. The educational intervention was effective in enhancing residents' support of breastfeeding patients.
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 study analyzed survey responses from 1,323 mothers who stopped breastfeeding their infants before 12 months to identify the primary reasons for stopping breastfeeding at different infant ages. The researchers conducted factor analysis to group mothers' reasons into seven constructs: lactation issues, psychosocial factors, nutritional concerns, lifestyle interference, medical issues, pumping difficulties, and self-weaning. Across all ages, mothers most frequently cited their infant not being satisfied by breast milk alone as a key reason for stopping. Younger, unmarried, and lower-income mothers tended to stop earlier. Reasons for stopping varied by infant age, from lactation issues in early months to self-weaning in later months.
A pediatrician provides safety tips for common summer activities like swimming, sun exposure, fires, and biking. Parents are advised to closely supervise young swimmers and apply sunscreen before going outdoors. Burns from barbecues and fireworks can be avoided by keeping children away from all fire sources. Wearing a helmet is critical for biking and skating safety. A pre-sports physical exam can help determine if a child is physically ready for athletics and identify any health issues.
Association Of Breastfeeding Intensity And Bottle Emptying Behaviors At Early...Biblioteca Virtual
This study examined the relationship between breastfeeding intensity, bottle emptying behaviors, and risk of excess weight in infants. The study found:
1) Infants who were breastfed at low (20% of milk feeds) or medium (20-80% of milk feeds) intensities in early infancy were over twice as likely to have excess weight in late infancy compared to infants breastfed at high (80% of milk feeds) intensities.
2) Infants who often emptied bottles in early infancy were 69% more likely to have excess weight in late infancy than infants who rarely emptied bottles.
3) Mothers' encouragement of bottle emptying was negatively associated with infants' risk of
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.
Exclusive Breastfeeding Reduces Acute Respiratory Infection And DiarrheaBiblioteca Virtual
This study examined the relationship between breastfeeding practices and infant mortality in Dhaka, Bangladesh. The researchers followed over 1600 infants from birth to 12 months. They found that exclusive breastfeeding declined from 53% at 1 month to 5% at 6 months. Partial or no breastfeeding was associated with a 2-3 times higher risk of infant death from all causes, acute respiratory infection (ARI), and diarrhea compared to exclusive breastfeeding. The study suggests that exclusive breastfeeding in early infancy reduces infant mortality, particularly from ARI and diarrhea.
Breastfeeding And Verbal Ability Of 3 Year Olds In A Multicity SampleBiblioteca Virtual
This study examined the relationship between breastfeeding and verbal ability in 3-year-olds, as measured by the Peabody Picture Vocabulary Test (PPVT). The study used data from 1,645 mothers in the Fragile Families and Child Wellbeing Study. It found that after adjusting for maternal verbal ability scores on the PPVT, the positive association between breastfeeding and child verbal scores was reduced. The benefits of breastfeeding on cognition were only seen for children of mothers with more than a high school education. For less educated mothers, breastfeeding status did not impact child verbal scores. The results suggest maternal verbal skills mediate the link between breastfeeding and child development, and the cognitive benefits of breastfeeding depend on other
Clinician Support And Psychosocial Risk Factors Associated With BreastfeedingBiblioteca Virtual
This study examined factors associated with breastfeeding discontinuation at 2 and 12 weeks postpartum in a cohort of 1007 low-risk mothers who initiated breastfeeding. The study found that breastfeeding rates declined over time, with 13% discontinuing by 2 weeks and 45% discontinuing by 12 weeks. Factors associated with earlier discontinuation included lack of breastfeeding confidence, early breastfeeding problems, Asian race, lower education, and depressive symptoms. Receiving encouragement from clinicians was associated with lower risk of discontinuing by 12 weeks, as was not returning to work or school by 12 weeks. The results suggest clinician support and addressing maternal mental health could help promote longer breastfeeding duration.
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
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.
Randomized, Controlled Trial Of A Prenatal And Postnatal Lactation ConsultantBiblioteca Virtual
This randomized controlled trial evaluated the effectiveness of a prenatal and postnatal lactation consultant intervention on the duration and intensity of breastfeeding up to 12 months. Over 300 low-income women receiving prenatal care at two community health centers were randomly assigned to an intervention or control group. The intervention group received individualized support from lactation consultants including prenatal meetings, a postpartum hospital visit, and home visits/phone calls. The trial found the intervention group was more likely to breastfeed through 20 weeks and had higher breastfeeding intensity scores at 13 and 52 weeks compared to the control group. US-born women in the control group had the lowest breastfeeding intensity. The study concluded the "best-practices" lactation
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.
This document summarizes a national survey of breastfeeding rates in US hospitals designated as "Baby-Friendly" in 2001. The survey found that Baby-Friendly hospitals had higher rates of breastfeeding initiation (83.8% vs national rate of 69.5%) and exclusive breastfeeding during hospital stay (78.4% vs national rate of 46.3%) compared to national averages. The 3 Steps to Successful Breastfeeding that were most difficult for hospitals to meet were paying for infant formula (Step 6), training staff (Step 2), and limiting formula marketing (Step 7). Overall, the results suggest that Baby-Friendly designation is associated with higher breastfeeding rates, regardless of hospital demographic factors.
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.
Breastfeeding Rates In The United States By Characteristics Of The Child,Biblioteca Virtual
This study analyzed breastfeeding rates in the United States using data from the 2002 National Immunization Survey. It found that over two-thirds of infants were ever breastfed, but rates of exclusive and continued breastfeeding dropped significantly by 6 and 12 months. Certain groups had lower rates, including non-Hispanic black children, those in daycare, enrolled in WIC, from lower socioeconomic status families, or younger or less educated mothers. The results suggest more efforts are needed to improve and support breastfeeding, especially among disadvantaged populations.
The Effects Of Early Pacifier Use On Breastfeeding DurationBiblioteca Virtual
This study examined the effects of pacifier use on breastfeeding duration in a cohort of 265 breastfeeding mother-infant dyads in the United States. The researchers found that:
1) Pacifier introduction by 6 weeks was associated with a 53% increased risk of shortened duration of full breastfeeding and a 61% increased risk of shortened overall breastfeeding duration.
2) Mothers who introduced pacifiers tended to breastfeed less frequently, with statistically significant differences at 2 and 12 weeks.
3) At 12 weeks, mothers using pacifiers were more likely to report breastfeeding being inconvenient and having insufficient milk supply.
4) Pacifier use begun before 2 weeks or 6 weeks was not significantly associated
The document discusses the neuropsychological effects of sleep training techniques on infants and breastfeeding. It summarizes research showing that ignoring infant cries raises cortisol levels, which is toxic to developing brains. While early studies found no long-term harm from techniques like controlled crying, more recent research has identified weaknesses in those studies and found unintended consequences like increased crying and premature breastfeeding cessation. The document concludes that sleep training offers no benefits and may interfere with breastfeeding, so it should not be recommended given the potential for harm.
Crimson Publishers-Care for Both Partners before Conception: The Logical Star...CrimsonPublishers-PRM
Crimson Publishers-Care for Both Partners before Conception: The Logical Starting Place To Improve Fertility and Every Aspect of Reproduction By Janette E Roberts* in Perceptions in Reproductive Medicine
Findings from Suzanie Adina MAT SAAT’s PhD research at Loughborough University that explored the experiences of Malay children whose parent has cancer and their information needs and behaviour to cope with the challenges they faced as dependent children and care-givers.
The survey of 1940 pediatricians in India found that 61% observed more celebrations at the birth of baby boys. 52% saw that baby boys had more appropriate weight for their age. 57% clinically observed more malnutrition in girls. 41% found that parents were more inclined to breastfeed baby boys. 61% noticed that school dropouts were more common among baby girls.
The Abecedarian study was a randomized controlled trial that provided full-time, high-quality early childhood education to 111 infants from low-income families in North Carolina between 1972-1977. Children were randomly assigned to a treatment group that received educational childcare from infancy through age 5 or a control group. The study found that children in the treatment group scored significantly higher than the control group on tests of cognitive development by age 18 months and maintained this advantage through age 8, demonstrating the powerful impact early education can have on child development.
The document discusses 7 key health principles for kids:
1) Kids are born to be healthy without drugs or sickness unless caused by behaviors/environment.
2) Healthy food intake and avoiding sugars/preservatives is important to prevent obesity and related diseases.
3) Kids need daily outdoor activity and exercise to develop properly and maintain a healthy weight.
It also discusses risks of off-label drug use in children, medical errors as a cause of children's deaths, adverse drug reactions, and benefits of chiropractic care for children's health and development. The document advocates for natural health approaches over excessive drug use for kids.
CLARITY BPA: a Novel Approach to study EDCsDES Daughter
by the Collaborative on Health and the Environment
On this call Retha Newbold, MS, Researcher Emeritus, National Toxicology Program, National Institute of Environmental Health Sciences, discussed the program called “The Consortium Linking Academic and Regulatory Insights on the Toxicity of Bisphenol A (CLARITY-BPA)” which is an interagency agreement, conducted under the auspices of the National Toxicology Program (NTP), between The National Institute of Environmental Health Sciences (NIEHS) supported grantees, the staff of the Division of the National Toxicology Program (DNTP) at NIH/NIEHS, and the Food and Drug Administration at the National Center for Toxicological Research (FDA/NCTR). The goals of the consortium are to enhance the utility of a perinatal 2-year GLP chronic toxicity study on BPA for regulatory decision-making by incorporating a wide range of doses and some additional disease-related endpoints that are not usually covered.
To this end, 12 NIEHS grantees are studying hypothesis-driven mechanisms by investigating specific endpoints that maybe altered by BPA including behavioral/neuroendocrine, immune function, cardiac, reproductive tract, cancer, thyroid, and other organ systems. This consortium is unique in that it combines the knowledge and skills of the NTP staff with experts from the academic field who are covering more mechanistic studies. Although this program focuses on BPA, it may provide an example of how to better study effects of other endocrine disrupting chemicals especially since numerous organ systems may be involved.
Sources: http://www.healthandenvironment.org/partnership_calls/14639
Do Baby Friendly Hospitals Influence Breastfeeding Duration On ABiblioteca Virtual
This study examined the influence of Baby-Friendly Hospital Initiative (BFHI) compliance on breastfeeding rates and duration in Switzerland. The authors conducted a national survey in 2003 of over 2800 mothers who had given birth in the previous 9 months. They collected data on breastfeeding practices and the hospital of delivery. They found that infants born in hospitals with high BFHI compliance had significantly longer durations of exclusive, full, and any breastfeeding compared to other hospitals, even after controlling for other factors. This supports the hypothesis that increased BFHI implementation in Switzerland has contributed to improved national breastfeeding outcomes since 1994. However, the authors note mothers choosing BFHI hospitals may also breastfeed longer regardless of the hospital practices.
The EAT study was a randomized controlled trial that evaluated whether introducing common allergenic foods like peanut, egg, and milk earlier would prevent food allergies in breastfed infants compared to exclusive breastfeeding for 6 months. Over 1300 infants were randomly assigned at 3 months of age to either the early introduction group, which introduced the foods between 3-6 months, or the standard introduction group. The primary outcome was food allergy to one of the foods between 1-3 years of age. The intention-to-treat analysis found no significant difference in food allergy rates between the groups. However, per-protocol and consumption-based analyses raised the possibility that prevention may be dose-dependent.
Над презентацией поскрипели мозгами старший креатор Наташа Нуждина, стратег Ника Глазунова и креативный директор Женя Корнеева. В ней мы постарлись суммировать опыт работы над нашими проектами за несколько лет и на основе наших кейсов систематизировать подходы к построению бренд-платформы в интернете для разных типов брендов и аудиторий.
Breastfeeding And Verbal Ability Of 3 Year Olds In A Multicity SampleBiblioteca Virtual
This study examined the relationship between breastfeeding and verbal ability in 3-year-olds, as measured by the Peabody Picture Vocabulary Test (PPVT). The study used data from 1,645 mothers in the Fragile Families and Child Wellbeing Study. It found that after adjusting for maternal verbal ability scores on the PPVT, the positive association between breastfeeding and child verbal scores was reduced. The benefits of breastfeeding on cognition were only seen for children of mothers with more than a high school education. For less educated mothers, breastfeeding status did not impact child verbal scores. The results suggest maternal verbal skills mediate the link between breastfeeding and child development, and the cognitive benefits of breastfeeding depend on other
Clinician Support And Psychosocial Risk Factors Associated With BreastfeedingBiblioteca Virtual
This study examined factors associated with breastfeeding discontinuation at 2 and 12 weeks postpartum in a cohort of 1007 low-risk mothers who initiated breastfeeding. The study found that breastfeeding rates declined over time, with 13% discontinuing by 2 weeks and 45% discontinuing by 12 weeks. Factors associated with earlier discontinuation included lack of breastfeeding confidence, early breastfeeding problems, Asian race, lower education, and depressive symptoms. Receiving encouragement from clinicians was associated with lower risk of discontinuing by 12 weeks, as was not returning to work or school by 12 weeks. The results suggest clinician support and addressing maternal mental health could help promote longer breastfeeding duration.
Speaker presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 17-19, 2019 in Washington, DC. Find out more about this forum at www.usnewshot.com.
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.
Randomized, Controlled Trial Of A Prenatal And Postnatal Lactation ConsultantBiblioteca Virtual
This randomized controlled trial evaluated the effectiveness of a prenatal and postnatal lactation consultant intervention on the duration and intensity of breastfeeding up to 12 months. Over 300 low-income women receiving prenatal care at two community health centers were randomly assigned to an intervention or control group. The intervention group received individualized support from lactation consultants including prenatal meetings, a postpartum hospital visit, and home visits/phone calls. The trial found the intervention group was more likely to breastfeed through 20 weeks and had higher breastfeeding intensity scores at 13 and 52 weeks compared to the control group. US-born women in the control group had the lowest breastfeeding intensity. The study concluded the "best-practices" lactation
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.
This document summarizes a national survey of breastfeeding rates in US hospitals designated as "Baby-Friendly" in 2001. The survey found that Baby-Friendly hospitals had higher rates of breastfeeding initiation (83.8% vs national rate of 69.5%) and exclusive breastfeeding during hospital stay (78.4% vs national rate of 46.3%) compared to national averages. The 3 Steps to Successful Breastfeeding that were most difficult for hospitals to meet were paying for infant formula (Step 6), training staff (Step 2), and limiting formula marketing (Step 7). Overall, the results suggest that Baby-Friendly designation is associated with higher breastfeeding rates, regardless of hospital demographic factors.
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.
Breastfeeding Rates In The United States By Characteristics Of The Child,Biblioteca Virtual
This study analyzed breastfeeding rates in the United States using data from the 2002 National Immunization Survey. It found that over two-thirds of infants were ever breastfed, but rates of exclusive and continued breastfeeding dropped significantly by 6 and 12 months. Certain groups had lower rates, including non-Hispanic black children, those in daycare, enrolled in WIC, from lower socioeconomic status families, or younger or less educated mothers. The results suggest more efforts are needed to improve and support breastfeeding, especially among disadvantaged populations.
The Effects Of Early Pacifier Use On Breastfeeding DurationBiblioteca Virtual
This study examined the effects of pacifier use on breastfeeding duration in a cohort of 265 breastfeeding mother-infant dyads in the United States. The researchers found that:
1) Pacifier introduction by 6 weeks was associated with a 53% increased risk of shortened duration of full breastfeeding and a 61% increased risk of shortened overall breastfeeding duration.
2) Mothers who introduced pacifiers tended to breastfeed less frequently, with statistically significant differences at 2 and 12 weeks.
3) At 12 weeks, mothers using pacifiers were more likely to report breastfeeding being inconvenient and having insufficient milk supply.
4) Pacifier use begun before 2 weeks or 6 weeks was not significantly associated
The document discusses the neuropsychological effects of sleep training techniques on infants and breastfeeding. It summarizes research showing that ignoring infant cries raises cortisol levels, which is toxic to developing brains. While early studies found no long-term harm from techniques like controlled crying, more recent research has identified weaknesses in those studies and found unintended consequences like increased crying and premature breastfeeding cessation. The document concludes that sleep training offers no benefits and may interfere with breastfeeding, so it should not be recommended given the potential for harm.
Crimson Publishers-Care for Both Partners before Conception: The Logical Star...CrimsonPublishers-PRM
Crimson Publishers-Care for Both Partners before Conception: The Logical Starting Place To Improve Fertility and Every Aspect of Reproduction By Janette E Roberts* in Perceptions in Reproductive Medicine
Findings from Suzanie Adina MAT SAAT’s PhD research at Loughborough University that explored the experiences of Malay children whose parent has cancer and their information needs and behaviour to cope with the challenges they faced as dependent children and care-givers.
The survey of 1940 pediatricians in India found that 61% observed more celebrations at the birth of baby boys. 52% saw that baby boys had more appropriate weight for their age. 57% clinically observed more malnutrition in girls. 41% found that parents were more inclined to breastfeed baby boys. 61% noticed that school dropouts were more common among baby girls.
The Abecedarian study was a randomized controlled trial that provided full-time, high-quality early childhood education to 111 infants from low-income families in North Carolina between 1972-1977. Children were randomly assigned to a treatment group that received educational childcare from infancy through age 5 or a control group. The study found that children in the treatment group scored significantly higher than the control group on tests of cognitive development by age 18 months and maintained this advantage through age 8, demonstrating the powerful impact early education can have on child development.
The document discusses 7 key health principles for kids:
1) Kids are born to be healthy without drugs or sickness unless caused by behaviors/environment.
2) Healthy food intake and avoiding sugars/preservatives is important to prevent obesity and related diseases.
3) Kids need daily outdoor activity and exercise to develop properly and maintain a healthy weight.
It also discusses risks of off-label drug use in children, medical errors as a cause of children's deaths, adverse drug reactions, and benefits of chiropractic care for children's health and development. The document advocates for natural health approaches over excessive drug use for kids.
CLARITY BPA: a Novel Approach to study EDCsDES Daughter
by the Collaborative on Health and the Environment
On this call Retha Newbold, MS, Researcher Emeritus, National Toxicology Program, National Institute of Environmental Health Sciences, discussed the program called “The Consortium Linking Academic and Regulatory Insights on the Toxicity of Bisphenol A (CLARITY-BPA)” which is an interagency agreement, conducted under the auspices of the National Toxicology Program (NTP), between The National Institute of Environmental Health Sciences (NIEHS) supported grantees, the staff of the Division of the National Toxicology Program (DNTP) at NIH/NIEHS, and the Food and Drug Administration at the National Center for Toxicological Research (FDA/NCTR). The goals of the consortium are to enhance the utility of a perinatal 2-year GLP chronic toxicity study on BPA for regulatory decision-making by incorporating a wide range of doses and some additional disease-related endpoints that are not usually covered.
To this end, 12 NIEHS grantees are studying hypothesis-driven mechanisms by investigating specific endpoints that maybe altered by BPA including behavioral/neuroendocrine, immune function, cardiac, reproductive tract, cancer, thyroid, and other organ systems. This consortium is unique in that it combines the knowledge and skills of the NTP staff with experts from the academic field who are covering more mechanistic studies. Although this program focuses on BPA, it may provide an example of how to better study effects of other endocrine disrupting chemicals especially since numerous organ systems may be involved.
Sources: http://www.healthandenvironment.org/partnership_calls/14639
Do Baby Friendly Hospitals Influence Breastfeeding Duration On ABiblioteca Virtual
This study examined the influence of Baby-Friendly Hospital Initiative (BFHI) compliance on breastfeeding rates and duration in Switzerland. The authors conducted a national survey in 2003 of over 2800 mothers who had given birth in the previous 9 months. They collected data on breastfeeding practices and the hospital of delivery. They found that infants born in hospitals with high BFHI compliance had significantly longer durations of exclusive, full, and any breastfeeding compared to other hospitals, even after controlling for other factors. This supports the hypothesis that increased BFHI implementation in Switzerland has contributed to improved national breastfeeding outcomes since 1994. However, the authors note mothers choosing BFHI hospitals may also breastfeed longer regardless of the hospital practices.
The EAT study was a randomized controlled trial that evaluated whether introducing common allergenic foods like peanut, egg, and milk earlier would prevent food allergies in breastfed infants compared to exclusive breastfeeding for 6 months. Over 1300 infants were randomly assigned at 3 months of age to either the early introduction group, which introduced the foods between 3-6 months, or the standard introduction group. The primary outcome was food allergy to one of the foods between 1-3 years of age. The intention-to-treat analysis found no significant difference in food allergy rates between the groups. However, per-protocol and consumption-based analyses raised the possibility that prevention may be dose-dependent.
Над презентацией поскрипели мозгами старший креатор Наташа Нуждина, стратег Ника Глазунова и креативный директор Женя Корнеева. В ней мы постарлись суммировать опыт работы над нашими проектами за несколько лет и на основе наших кейсов систематизировать подходы к построению бренд-платформы в интернете для разных типов брендов и аудиторий.
How to use data and experience marketing to create lifetime customersGRAPE
Lars Birkholm Petersen presented on using data and experience marketing to create lifetime customers. He discussed how marketing through isolated channels creates disconnected customer experiences. The key steps are to collect customer data to develop a single view of each contact, align objectives and strategies, and provide contextualized experiences that support customer needs in real-time. Experience marketing can increase conversions by personalizing interactions and providing a seamless brand experience across channels.
The document discusses Beto Fernandez's learnings from the Cannes Festival over several years. It lists 7 topics of learning: 1) Multi-platform Ideas, 2) Innovations, 3) Becoming a global hit before the festival, 4) Balancing investment and reputation, 5) Crafting strong arguments, 6) Conducting social experiments, and 7) Creating impact for social good. Under each topic are examples from various years of campaigns that exemplify each learning point.
Big Ideas, Small Screens: Making better ads and experiences for mobileGRAPE
The document discusses making effective ads and experiences for mobile devices. It notes that mobile usage is surpassing desktop usage and marketing dollars are shifting to mobile accordingly. It emphasizes focusing on people rather than technology, understanding the capabilities of different mobile devices, and creating experiences that are uniquely suited to the mobile context and take advantage of features like location. Specific examples discussed include a Volkswagen campaign connecting drivers to the brand both in and out of their cars, and an NFL-related Madden game campaign tapping into second screen mobile usage while watching TV.
Как оценить эффективность сообщества во Вконтакте GRAPE
Андрей Волков о том, что лучше: сообщество с 100 500 подписчиков и высокой виральностью или сообщество с 150 000 подписчиков и высоким ER? На что надо обращть внимание при работе с сообществом VK и как оценить качественность его ведения.
Что и зачем надо считать в Social media. А главное – как! | Андрей ВолковGRAPE
ЧТО И ЗАЧЕМ НУЖНО СЧИТАТЬ, НАЧИНАЯ, ПРОДОЛЖАЯ И ЗАКАНЧИВАЯ РАБОТАТЬ С СОЦИАЛЬНЫМИ СЕТЯМИ
Пожалуй самой обсуждаемой темой последних пары лет является вопрос об измерении эффективности работы в социальных сетях. В первую очередь это связано с тем, что социальные сети отчасти были дискредитированы в предыдущий период, когда создание группы Вконтакте и станицы на Facebook было МОДНЫМ среди бренд менеджеров и это было самоцелью.
На текущий момент бренд-менеджеры хотят большей прозрачности и требуют от агентств целостные системы оценки эффективности их работы.
Как оценивать эффективность работы в социальных сетях? Нужно ли создавать многотысячные сообщества, и следить за тем, чтобы Engagement rate и отток из группы были лучше бенчмарка? Безусловно нужно, но сами по себе эти метрики зачастую не являются показателями эффективности при решении конкретных бизнес задач.
Для того, чтобы понять, на какие показатели все-таки стоит ориентироваться, начнем издалека – сначала поймем что есть собственно ЗАДАЧА.
В любой задаче есть:
1. начальная позиция (ПУНКТ А)
2. желаемая конечная позиция (ПУНКТ И)
3. необходимые вводные для решения поставленной задачи.
Далее решающий должен:
1. понять, каким конкретно способом поставленную цель можно достичь располагая имеющимися данными.
2. Если по пути решения задачи что-то идет не так – способ решения задачи нужно корректировать.
Vita d defic insuffic pregnancy johnson am j perinatol 2010Alison Stevens
This study aimed to determine the incidence of vitamin D deficiency, insufficiency, and sufficiency in African American, Hispanic, and Caucasian pregnant women. The researchers found that 97% of African Americans, 81% of Hispanics, and 67% of Caucasians had vitamin D deficiency or insufficiency. African American women had the lowest average vitamin D levels and were most at risk for deficiency. Race was the strongest risk factor for vitamin D insufficiency in pregnant women.
1) Lower maternal vitamin D status was associated with greater femoral metaphyseal cross-sectional area and higher femoral splaying index in fetuses at 19 weeks and 34 weeks gestation, suggesting maternal vitamin D insufficiency can influence fetal femoral development as early as 19 weeks.
2) Over a third of mothers had vitamin D levels considered insufficient or deficient. Lower maternal vitamin D levels were related to increased femoral splaying but not femur length in fetuses.
3) Across maternal vitamin D sufficiency groups, femoral splaying indices at 19 weeks increased from 0.074 in sufficient mothers to 0.078 in insufficient and 0.084 in deficient mothers, indicating less optimal fetal bone development with lower maternal vitamin
Indie music originated in the 1950s-60s as a rebellion against the domination of major music labels. It was a low-budget, DIY movement that encouraged experimentation. Key early artists included The Velvet Underground and Captain Beefheart. No genre is harder to define, as Indie has incorporated elements of many styles over time. In the 2000s, the popularity of bands like Arctic Monkeys and Franz Ferdinand introduced Indie to a new generation of mainstream listeners. However, some argue this commercial success dilutes Indie's rebellious spirit. Dubstep is now seen by some as a new underground genre carrying the torch of innovation and exclusivity once held by Indie.
This document provides an overview of Spock, a testing and specification framework for Java and Groovy applications. It discusses the key features of Spock including state based testing, data driven testing, interaction based testing using mocking, and extensions. Examples are provided to demonstrate state based testing with given/when/then blocks, data driven testing using the where clause, and interaction based testing using mocks.
Este documento ofrece recomendaciones para planificar el tiempo libre y las vacaciones. Sugiere programar actividades personales, familiares y sociales teniendo en cuenta el presupuesto y las posibilidades reales. Recomienda considerar actividades socioculturales como talleres, teatro o música; actividades al aire libre como excursiones o charlas sobre la naturaleza; y deportes para desarrollar aptitudes físicas. El objetivo es aprovechar el tiempo libre para el esparcimiento y el desarrollo personal y de habilidades nuevas.
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.
This study assessed how mothers learn about proper handling of infant formula and whether they follow safe practices. The study found that most mothers did not receive instruction from health professionals on formula preparation or storage. Many mothers did not fully read or understand package label instructions. While most believed following safety directions was important, many mothers engaged in unsafe practices like not always washing hands before preparing formula or heating bottles in microwaves. No consistent maternal traits predicted unsafe practices. More education is needed to promote proper formula handling and reduce risks of illness.
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.
There are two main feeding methods for preterm infants in the NICU - practitioner-driven feeding (PDF) and infant-driven feeding (IDF). Recent research shows IDF decreases time to full oral feeds and earlier hospital discharge. IDF relies on infant feeding cues rather than scheduled intervals. While physicians and nurses initially resisted IDF due to biases, education increased confidence in the method. IDF is now widely adopted as it improves outcomes for infants and lowers hospital costs without compromising safety. Further research is still needed on high-risk infants and implementing IDF protocols.
This document from the American Academy of Pediatrics outlines their policy statement on breastfeeding and the use of human milk. The key points are:
1) Extensive research has demonstrated significant health benefits for infants and mothers from breastfeeding, including reduced risk of infectious diseases, sudden infant death syndrome, diabetes, obesity, and improved cognitive development.
2) The policy statement provides recommendations for pediatricians and healthcare professionals to promote, protect, and support breastfeeding through individual practice, hospitals, medical schools, and communities.
3) Certain infectious diseases like HIV may preclude breastfeeding in some situations, but exclusive breastfeeding for the first 6 months does not increase HIV transmission risk according to some studies in developing countries.
This document discusses vitamin D supplementation for breastfed infants. It begins by presenting a case of an infant with seizures from vitamin D deficiency. It then reviews the clinical presentations of acute versus chronic vitamin D deficiency. Risk factors for deficiency include limited sunlight exposure and fat malabsorption. The American Academy of Pediatrics recommends all infants receive a daily vitamin D supplement of 400IU. While breastmilk contains little vitamin D, breastfeeding is still recommended with supplementation. Oral liquid vitamin D drops are available for infants without other vitamins. However, many breastfed infants still do not receive supplements.
This randomized controlled trial evaluated the effects of high-dose docosahexaenoic acid (DHA) supplementation on neurodevelopmental outcomes in preterm infants. The study found that:
1) Overall, high-DHA supplementation did not significantly improve Bayley Mental Development Index (MDI) scores at 18 months corrected age compared to standard DHA supplementation.
2) However, girls who received high-DHA supplementation had significantly higher MDI scores than girls who received standard supplementation.
3) Infants born weighing less than 1250g who received high-DHA supplementation tended to have higher MDI scores, but the difference was not statistically significant after adjustment for confounders.
Vita D Defic Mothers Newborns Merewood Pediatrics 2010alisonegypt
This study found high rates of vitamin D deficiency in mothers and newborns in Boston, Massachusetts. 58% of infants and 36% of mothers had vitamin D levels below 20 ng/mL. Risk factors for infant deficiency included a deficient mother, winter birth, black race, and a maternal BMI over 35. Prenatal vitamin use was protective against deficiency for both mothers and infants, however 30% of mothers still had low vitamin D levels despite taking prenatal vitamins.
Lamotrigine In Breast Milk And Nursing Infants Determination Of ExposureBiblioteca Virtual
This study characterized lamotrigine concentrations in breast milk and nursing infant plasma in 30 women taking lamotrigine who were breastfeeding their infants. The mean ratio of lamotrigine in breast milk compared to maternal plasma was 41.3%. There was a non-significant trend for higher concentrations in breast milk 4 hours after the maternal dose. Infant plasma concentrations were 18.3% of maternal plasma concentrations. The theoretical infant dose was 0.51 mg/kg per day and the relative infant dose was 9.2%. Mild thrombocytosis was seen in 7 of 8 infants tested but no adverse effects were reported in breastfed infants. The study provides valuable data on lamotrigine exposure during breastfeeding.
Vita d defic mothers newborns merewood pediatrics 2010Alison Stevens
This study found high rates of vitamin D deficiency in newborns and their mothers in Boston, Massachusetts. The median vitamin D level was below the sufficient level in 58% of infants and 36% of mothers. Risk factors for infant deficiency included having a deficient mother, winter birth, black race, and a maternal BMI over 35. Prenatal vitamin use was protective against deficiency for both infants and mothers, however over 30% of mothers still had insufficient levels despite prenatal vitamin use. The results suggest prenatal vitamins may not provide enough vitamin D to ensure sufficiency.
2 physiology and benefits of bf, risk of artificial feeding230113Varsha Shah
Here are the answers to the true/false and multiple choice questions:
1. True
2. True
3. False
4. True
5. False
6. e. Tonsillitis
7. e. Infertility
8. c. Higher cost to feed a lactating mother
9. f. No free sponsorship from pharma, samples of formula and less earnings for hospital
10. d. Mother can do house works, can take care of sibling and save money
11. c. Causes high incidence of jaundice
12. e. All of the above
13. a. Exclusive breast feeding till 6 month
Professor Forsyth studied the health outcomes of 543 children from lower and higher socioeconomic groups. He found that (1) in the lower socioeconomic group, breastfed children had similar or significantly better health outcomes than formula-fed children, even compared to formula-fed children in the higher socioeconomic group. Subsequent studies discussed in the document found that (2) exclusive breastfeeding for at least 15 weeks reduced respiratory illness and that (3) one month of exclusive breastfeeding conferred protection against allergies and respiratory issues into childhood and adolescence. Overall, the document reviews extensive evidence that breastfeeding leads to improved health outcomes related to infectious disease, cognitive development, cardiovascular risk factors, obesity, and diabetes among others.
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.
Recent Advances in of BREAST FEEDING : Dr Sharda Jain Lifecare Centre
This document discusses the importance of breastfeeding and providing human milk to newborns within the first hour after birth, known as the "Golden Hour." It recommends exclusively breastfeeding or providing pasteurized donor human milk during this critical period, as formula feeds are not recommended. Initiating feeding within the Golden Hour provides significant health benefits and can reduce neonatal mortality rates. Challenges to early feeding include caesarean deliveries and ensuring babies receive an adequate volume of milk. New products like NeoLact 70 Prime aim to provide short term human milk-based nutrition for all newborns during the Golden Hour to promote gut health and a smooth transition to breastfeeding.
Chatterjee (UNICEF) on HIV and Infant Feedingericpgreen
This document summarizes challenges around infant feeding for HIV-positive mothers in resource-limited settings. It discusses the risks of different feeding options like breastfeeding or replacement feeding. While exclusive breastfeeding carries lower HIV transmission risk, replacement feeding risks increased infant mortality from diseases like diarrhea if adequate water and sanitation are not available. Ensuring replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS criteria) is difficult, and maintaining consistent formula supply over months is a challenge. Ongoing studies are exploring antiretroviral use by mothers and infants to reduce HIV transmission through breastfeeding. Public health recommendations depend on individual circumstances and support systems available.
Success Of Strategies For Combining Employment And BreastfeedingBiblioteca Virtual
1) The study examined strategies that mothers use to combine breastfeeding and paid employment, and the impact of these strategies on breastfeeding intensity and duration.
2) The strategies included: directly breastfeeding from the breast, pumping milk, a combination of pumping and direct breastfeeding, and neither pumping nor direct breastfeeding during work.
3) Pumping milk only and directly breastfeeding only were the most common strategies. These strategies as well as a combination of pumping and direct breastfeeding were associated with smaller decreases in breastfeeding intensity compared to neither pumping nor direct breastfeeding.
4) Directly breastfeeding from the breast, with or without pumping, was associated with longer breastfeeding duration compared to pumping only.
Breastfeeding Friendly Physician’S Office Optimizing Care For Infants And C...Biblioteca Virtual
This document provides recommendations for making a physician's office more breastfeeding-friendly. It begins with background information on the importance of physician support for breastfeeding. It then lists 19 specific recommendations for optimizing care for breastfeeding infants and children. The recommendations address establishing office policies, educating staff and patients, avoiding promotion of breastmilk substitutes, supporting breastfeeding in the office, and collaborating with local hospitals and resources. The document concludes with recommendations for future research.
The Infant Feeding Practices Study II (IFPS II) was a longitudinal study that collected data from over 4,900 pregnant women from 2005 to 2007 regarding infant feeding practices, health, and related issues during the first year of the infant's life. Questionnaires were administered prenatally and monthly during the first year. The study aimed to understand infant feeding in the context of changes since the previous IFPS study in the 1990s. It provided detailed information on breastfeeding, formula feeding, complementary foods, and other factors to help evaluate infant feeding recommendations and policies.
Similar to Vita d supple breatfed infants pediatrics 2010 (20)
Sue Amphlett founded Parents Against Injustice in 1985 after her family was wrongly accused of child abuse. Her youngest daughter had fractures from minor falls but doctors initially suspected abuse. This led to an investigation where Sue and her family felt marginalized as strangers passed judgement on them. The process was long, traumatic and damaging as they tried to prove their innocence without support. Most people caught up in similar situations lose self-esteem and cannot cope as their life structure revolves around their children. Sue felt the process focused too much on child protection and not enough on properly investigating allegations and supporting families impacted.
court applications under the children's actAlison Stevens
This document provides information about mediation and the requirement to attend a Mediation Information and Assessment Meeting (MIAM) before applying to family court regarding disputes over children or finances.
It states that applicants are now legally required to consider mediation through attending a MIAM before submitting a court application, to explore if mediators can help resolve arrangements. Exceptions include cases involving domestic violence, where evidence must be provided.
It provides details on what mediators do, how mediation can help give more control and be less stressful than court. It provides information on finding mediators and mediation services online or by scanning a QR code, and that MIAM attendance is free if qualifying for legal aid.
Applicants
This document provides guidance on the rules for McKenzie Friends in family court proceedings. It summarizes that litigants in person have a right to reasonable assistance from a layperson known as a McKenzie Friend. The presumption is in favor of allowing a McKenzie Friend unless fairness or justice require otherwise. A McKenzie Friend may provide moral support, take notes, help with paperwork, and quietly advise on legal points, but cannot address the court or examine witnesses without permission. The court has discretion to grant rights of audience or litigation to McKenzie Friends in some cases.
The document provides an overview of child protection processes and offers tips for dealing with a child protection situation. It explains that child protection focuses on assessing adults for risk to children and that the local authority has a duty to investigate potential harm and intervene even without prosecution being likely. It describes the roles of various professionals involved like social workers, police, and solicitors. Key tips include remaining calm, keeping records, listening to professionals, and understanding what the social services consider in their assessments of the home and family environment.
The document discusses guidelines for McKenzie Friends (MKFs) assisting litigants in family court proceedings. It provides an overview of current legislation regarding MKFs, their role and responsibilities, and best practices. Key points include:
- MKFs can provide support to litigants but cannot act as their legal representative or address the court without special permission.
- Litigants have a strong presumption to receive assistance from an MKF unless fairness or justice say otherwise. Objections from other parties do not outweigh this presumption.
- It is best practice for potential MKFs to introduce themselves to the judge assigned to the case in advance whenever possible to avoid objections from other parties.
- Applications to
The document sets out the code of practice for social care workers in the UK. It outlines six key responsibilities for social care workers: 1) protect service users' rights and interests, 2) establish trust with service users, 3) promote independence while preventing harm, 4) respect service users' rights while preventing harm to others, 5) uphold public trust in social care services, and 6) be accountable for their work and improve their skills. It also provides guidance on how the public can complain about a social care worker's conduct.
1) The author and her partner had twins via IVF who both had medical issues from birth. Their daughter stopped breathing at 4 months old and was diagnosed with a seizure, but the author believed it was related to acid reflux.
2) A few days later, both twins were found to have subdural bleeding and fractures through medical imaging at the hospital. The parents were accused of non-accidental injury (NAI) by hospital staff.
3) Over many months, the parents fought accusations from social services and underwent supervised care of their children. Eventually, the author was diagnosed with Ehlers-Danlos syndrome (EDS), which she believed explained her children's health issues, but authorities remained skeptical
1) The document discusses several cases of infants who experienced fractures, retinal hemorrhages, and brain injuries. In each case, the injuries were attributed to Shaken Baby Syndrome but the author argues they were actually due to an autoimmune response triggered by vaccination or infection.
2) The author's hypothesis is that vaccination or infection damages the beta cells in the pancreas, causing hypoinsulinemia. This inhibits cellular uptake of vitamin C, leading to "tissue scurvy" and failure of proteins involved in coagulation. This results in the bruising, bleeding, and fractures seen in the "triad".
3) Blood tests in the cases showed markers of coagulation disorders, vitamin deficiencies, and
This document is a quotation from G.A. Pindar & Son (NZ) Ltd for printing a 300-page book titled "Shaken Baby Syndrome". The quotation includes specifications for the physical book, project scope, pricing assumptions, preliminary pricing broken down by quantity, project sequence, and notes on pricing, production process, and terms of trade. Key details are the 300 page extent, paperback binding, 4 color cover and 1 color internal print, and pricing of $17.28 per book for a 2,000 unit print run in New Zealand or $12.75 per book for a 3,000 unit print run in China.
This document summarizes 6 case studies of children who experienced fractures, retinal hemorrhages, and brain injuries. In each case, the injuries were initially attributed to non-accidental trauma (such as shaken baby syndrome), but laboratory tests revealed evidence of autoimmune reactions, vitamin deficiencies, and coagulation disorders following vaccination or childhood illness. The document argues that fractures, hemorrhages, and encephalopathy in these cases were actually caused by an autoimmune response to antigenic stimulation from vaccines or infections, rather than abuse.
This document establishes a pilot scheme for care and supervision proceedings and other proceedings under Part 4 of the Children Act 1989. The pilot scheme will assess new practices and procedures to support the 26 week time limit for these types of cases. It modifies various Family Procedure Rules and Practice Directions to implement the pilot scheme, including establishing case management hearings and timelines. Courts can choose to begin participating in the pilot scheme on one of four start dates between July 2013 and October 2013.
This document outlines the key stages and timelines of the court process for care, supervision, and other Part 4 proceedings based on the Public Law Outline. It includes:
1) The typical stages and timelines for proceedings, including case management hearings, issues resolution hearings, and final hearings, with the aim of resolving proceedings within 26 weeks.
2) Relevant rules, practice directions, and guidance that must be considered in applying the Public Law Outline.
3) Clarification that the court has flexible powers to direct the process, including holding hearings without notice or resolving stages at different times than outlined, based on each case's specific circumstances.
PAIN aims to ensure fair treatment of families and strict procedures by authorities. It accepts not all families are innocent but takes no sides except the child's best interest. However, it advocates for families' rights which can be overlooked.
The document discusses unexplained fractures in children that may indicate brittle bone disease rather than non-accidental injury. It summarizes 128 cases referred to the author related to unexplained fractures in children living in the UK. In many cases, the author determined the children had forms of brittle bone disease like osteogenesis imperfecta or temporary brittle bone disease. For those returned to parents, no subsequent evidence of non-accidental injury was found in long-term follow-ups of over 400 patient-years. The document concludes some rare cases of brittle bone disease can be difficult to diagnose but falsely accusing parents of abuse in such cases can cause significant harm to families.
This document presents two case reports of infants who were diagnosed with shaken baby syndrome but may have had alternate explanations. Both infants' mothers had nutritional deficiencies during pregnancy and smoked. The infants were formula fed without vitamin C supplements. Both experienced apparent life-threatening events after vaccines and developed bruising, fractures, and other findings commonly associated with shaken baby syndrome. However, the author proposes the infants may have had vitamin C deficiency, as their symptoms and laboratory results resembled Barlow's disease or scurvy. The author argues vitamin C deficiency should be considered before diagnosing shaken baby syndrome.
Three cases of infants and children presenting with concerning medical issues are described. All three cases had signs of metabolic dysfunction, including prolonged prothrombin time and liver abnormalities. One case also presented with the "triad" of subdural hemorrhage, retinal hemorrhage, and encephalopathy. The document concludes that these presentations may have been caused by deficiencies or abnormalities of vitamins C, D, and K resulting from malnutrition or liver dysfunction, rather than presumed abuse as initially diagnosed.
Bruising forensic study adc.2009.177469.fullAlison Stevens
This study examined autopsy reports of 135 infants between 7-364 days old to determine the significance of bruising. The researchers found that 21 infants (15.6%) had bruising, and of those, 17 (81%) also had other injuries. Only 9 of the 114 non-bruised infants (8%) had other injuries. Bruising was significantly associated with other injuries and homicide. Bruising had a sensitivity of 65% and specificity of 96% for detecting other injuries, increasing to 71% sensitivity at <6 months when independent mobility is limited. The presence of bruising in infants is a significant marker for other injuries including homicide.
3. Because the vitamin D content in hu- supplement, their breastfed infants. TABLE 1 Statements Regarding Vitamin D
Supplementation and Rickets on the
man milk may be relatively low, breast- We were particularly interested in the Practitioner Vitamin D Survey and
fed infants are at risk for rickets un- role that their child’s pediatrician had Parental Survey of Infant Feeding
less they are exposed to adequate in influencing this choice. Before the Practitioner vitamin D survey
amounts of sunshine to produce en- project, we postulated that approxi- In order to practice high quality medicine it is
important to follow AAP practice guidelines.
dogenous vitamin D or receive it from mately one third of infants who were A major limitation of the AAP recommendation
other sources.1–4 For more than a de- breastfed for at least 6 months would that all breastfed infants receive
cade, supplemental vitamin D has been receive supplemental vitamin D and supplemental vitamin D is that the
recommendation is not evidence-based.
recommended for certain infants who that a parent’s decision regarding sup- Routinely recommending vitamin D for
are breastfed to prevent rickets.5 In plementation would be highly influ- breastfed babies may result in some
2003, the American Academy of Pediat- enced by the recommendation of their mothers electing to formula feed instead.
Some of my breastfed patients will likely
rics (AAP) recommended that all child’s pediatrician.
develop rickets if they don’t receive
breastfed infants receive at least 200 supplemental vitamin D.
IU/day of supplemental vitamin D; METHODS Parental survey of infant feeding
I think that giving vitamins to babies and young
in 2008, the recommendation was A prospective observational study was children is important for their overall
changed to at least 400 IU/day.2,6 conducted by the Puget Sound Pediat- health.
Estimates of physician adherence to ric Research Network (PSPRN), a re- Vitamins may be needed to prevent rickets or
other bone diseases in some babies.
the AAP recommendations regarding gional practice-based network of pri- It is inconvenient to give vitamins to young
vitamin D supplementation vary. A mary care pediatric practices in the babies.
1999 survey of North Carolina pediatri- Seattle, Washington, area. For this When my baby was less than 6 months old,
he/she didn’t need any extra vitamins
cians found that 44.6% recommended project, 44 PSPRN practitioners from 7 because the breast milk or formula that
the supplement for all breastfed in- private practice offices and 1 inner- he/she took had everything my baby needed.
fants, and 38.6% recommended it for city pediatric clinic participated. The If babies are out in the sunlight and fresh air
they don’t need extra vitamins.
some infants.7 These results are simi- study consisted of 2 surveys, including
My child’s doctor recommended that I give my
lar to a study of Las Vegas, Nevada, a practitioner vitamin D survey and an baby vitamins.
pediatricians in which 48% recom- infant-feeding survey completed by
mended vitamin D for breastfed in- parents. Survey data were collected
fants.8 Recently, it was reported that between July 2006 and June 2008. responses to statements by pedia-
89% of responding pediatricians in the Before collecting data on infants, the tricians who indicated that they rec-
US military recommended supplemen- practitioner vitamin D survey was dis- ommended vitamin D for all breastfed
tation for all, or some, infants fed hu- tributed to 44 PSPRN pediatricians. The infants were compared with the re-
man milk.9 More important, however, pediatricians were asked about their sponses of those who had some other
there have been few data on whether current recommendation regarding vi- practice regarding supplementation.
these recommendations influence pa- tamin D supplementation for breastfed Likert-scale responses were trans-
rental behavior and how many breast- infants. Possible responses included formed to an ordinal scale for the anal-
fed infants actually receive supple- recommend vitamin D for all breastfed ysis. Regression analysis was used to
mental vitamin D. In a study on the patients; recommend for “high-risk” chil- assess differences; generalized esti-
prevalence of hypovitaminosis D in dren; discuss pros and cons of supple- mating equation techniques were used
young children in the Boston, Massa- mentation with parents; and do not rou- to account for the clustering of pedia-
chusetts, area, Gordon et al10 reported tinely discuss vitamin D with parents. tricians in different practices.11
that only 2% of breastfed infants re- Pediatricians were asked to indicate The infant-feeding survey was distrib-
ceived supplemental vitamin D. their level of agreement with 4 state- uted to parents of children 6 to 24
We conducted a study to determine the ments regarding supplemental vitamin months old at the time of an office visit
rate of supplemental vitamin D usage D by using a 6-point Likert scale, with to a PSPRN practice. This survey was
among a group of infants from the Se- possible responses to each statement anonymous; no identifying health in-
attle, Washington, area who were pre- ranging from “completely agree” to formation was collected. Surveys were
dominantly breastfed for at least the “completely disagree.” The statements available in both English and Spanish
first 6 months of life. We were inter- on vitamin D usage are shown in Table 1. and were distributed by a research as-
ested in identifying the reasons par- For the analysis of data in the prac- sistant who visited practices on a reg-
ents choose to supplement, or to not titioner vitamin D surveys, the ularly scheduled basis. Surveys were
106 TAYLOR et al
Downloaded from www.pediatrics.org. Provided by Stanford Univ Med Ctr on February 5, 2010
4. ARTICLES
also distributed to parents by office mula daily during the first 6 months of garding supplementation and use of
staff in participating practices during life and “never” or “almost never” re- vitamin D in study patients was as-
multiple data-collection periods that ceived Ն16 oz of formula in 1 day. Be- sessed. Parental agreement with
ranged from 1 to 3 months. cause commercial formula contains statements regarding vitamin D use
For the infant-feeding survey, parents 400 IU/L,12 the infants who were de- was dichotomized; responses of “com-
of age-eligible children provided the fined as being predominantly breast- pletely agree” or “agree” were com-
current age of their child and were fed received Ͻ100 IU of vitamin D from pared with all other responses for
asked the initial type of feeding for him formula on a routine basis and never each item. Similarly, the response to
or her (breast milk or infant formula). or almost never received 200 IU daily. the item in the infant-feeding survey in
On the basis of the recommendation which parents were asked how im-
Parents of those infants who were ini-
for 200 IU of supplemental vitamin D portant their child’s pediatrician’s
tially breastfed were asked how long
daily that was in place when the study recommendation was regarding sup-
their child received human milk, how
data were collected,2 none of these plemental vitamin D was dichotomized
much formula their child received on a
predominantly breastfed, unsupple- by comparing responses of “very im-
routine basis, and how often the child
portant” or “important” to other
received Ն16 oz of formula in a single mented study children received Ͼ50%
responses.
day (possible responses included of the recommended vitamin D dose
“never or almost never,” “a few days from infant formula on a daily basis Each individual characteristic or belief
each week,” “almost every day,” or and virtually never received all of the was compared with the use of vitamin
“every day,”). Parents were asked recommended dose from this source. D in predominantly breastfed study pa-
whether their child routinely received The rate of supplemental vitamin D use tients. Those characteristics and be-
in the children who were predomi- liefs statistically associated with vita-
a multivitamin (all containing vitamin
min D use in univariate analyses,
D) during the first 6 months of life. The nantly breastfed for at least 6 months
defined as an odds ratio (OR) with a
parent was also asked to provide the was calculated. The rate of breast-
95% CI that did not include 1.0, were
name of his or her child’s pediatrician feeding, prolonged breastfeeding,
included in a multivariate model to
during the child’s first 6 months of life and vitamin D use was also com-
identify factors independently associ-
and to indicate how important this puted for children from different ra-
ated with vitamin D use in breastfed
physician’s recommendation was re- cial and ethnic groups; 95% confi-
children.
garding the decision of whether to give dence intervals (CIs) around point
his or her infant vitamins; responses estimates were calculated. Finally, during the study period, there
were categorized with a 5-point Likert was increasing publicity regarding vi-
Characteristics and parental beliefs tamin D deficiency in children and
scale that ranged from “very impor- associated with supplemental vitamin adults.13,14 To protect the anonymity of
tant” to “very unimportant.” Parents D use in children who were predomi- study children and their parents, we
were also asked to provide the race nantly breastfed for at least 6 months did not collect data on the date that
and ethnicity of their child. were assessed with the use of logistic infant surveys were completed (these
Six statements regarding vitamin D regression. Generalized estimating dates corresponded to dates of physi-
supplementation were listed on the equation techniques were used in cian visits, which is considered to be
survey. As with the practitioner survey, these analyses to account for the clus- identifiable health information).15 How-
parents indicated their level of agree- tering of patients in different prac- ever, information on the surveys was
ment with each statement by using a tices.11 Characteristics assessed in- entered into databases as they were
6-point Likert scale. The statements on cluded race, ethnicity, and age. Data on collected. To assess the effects of sec-
the infant-feeding survey are listed in the infant-feeding surveys regarding ular trends in vitamin D use during the
Fig 1. the child’s pediatrician during the first study period (2006 –2008), we catego-
Much of the analysis of data in the 6 months of life were linked to re- rized study patients into tertiles on the
infant-feeding surveys was focused on sponses on the practitioner vitamin D basis of the chronological order of
those children who were predomi- surveys. On the basis of this linkage, when their data were entered into the
nantly breastfed for at least the first 6 the association between having a pedi- study databases.
months of life. Children were consid- atrician who recommended vitamin D The study was approved by the Seattle
ered to be predominantly breastfed if for all breastfed infants versus having Children’s Hospital’s institutional re-
they routinely received Յ8 oz of for- a provider who had another policy re- view board.
PEDIATRICS Volume 125, Number 1, January 2010 107
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5. RESULTS 2433 completed surveys
-69 surveys on children <6 mo or >25 mo old
A total of 44 PSPRN pediatricians com-
2364 surveys on eligible children (97.2%)
pleted the practitioner vitamin D sur-
vey. At the time that the survey was
completed, 16 pediatricians (36.4%) in-
dicated that they routinely recom- 1945 initially breastfed (82.6%) 411 formula fed (17.4%) 8 missing
mended supplemental vitamin D for all
of their breastfed patients. Fourteen
respondents (31.8%) recommended 1456 infants breastfed for ≥6 mo (75%)
supplemental vitamin D for breastfed 4 missing
infants who were at high risk for de-
veloping rickets. Six pediatricians
- 287 infants who took ≥8 oz/d formula on
(13.6%) responded that they discussed routine basis and/or 16 oz formula a few
the pros and cons of supplementation d/wk or more (20.1%)
-29 with missing data
with parents of breastfed infants, and
8 (18.2%) indicated that they did not
routinely discuss vitamin D supple-
1140 infants predominately
mentation with parents. breastfed for ≥6 mo
(58.6% of those initially breastfed)
Physicians who did not recommend vi-
tamin D for all breastfed infants had FIGURE 1
Survey completion and breastfeeding practices in study children.
significantly higher levels of agree-
ment with the statement, “A major lim-
itation of the AAP recommendation TABLE 2 Rate of Initial Breastfeeding Among Study Infants of Different Racial and/or Ethnic Groups
and Rates of Being Predominately Breastfed for at Least 6 Months
that all breastfed infants receive sup-
Race/Ethnicity No.a % Initially % Predominantly
plemental vitamin D is that the recom-
Breastfed Breastfed for Ն6 mo
mendation is not evidence based,”
Black 120 62.5 24.2
than pediatricians who recommended American Indian/Alaskan Native 42 88.1 52.4
vitamin D for all breastfed infants (39 Asian/Pacific Islander 427 81.5 44.8
total responses; P ϭ .011). Those prac- White 1695 85.1 52.4
Hispanic ethnicityb 232 73.7 41.0
titioners who were not universally rec- a Data on children whose parents indicated that they were of multiple races are included in more than 1 race category.
ommending vitamin D also had higher b Includes children from all racial groups.
levels of agreement than those who
universally recommended supplemen-
tation for breastfed children with the breastfeeding practices of their chil- As shown in Fig 1, surveys were com-
statement indicating that recommend- dren are summarized in Fig 1. Among pleted by parents of 1140 children who
ing supplementation might lead some the 2364 eligible children whose par- were predominantly breastfed for at
mothers to choose to not breastfeed ents completed surveys, 1945 (82.6% least the first 6 months of life. The rest
their infants (P ϭ .042). There were no [95% CI: 81.0%– 84.1%]) were mainly of the analysis was focused on these
significant differences in levels of fed with human milk during their first 1140 study infants and toddlers. Over-
agreement for the statement regard- month of life. The race and ethnicity of all, 181 of 1139 of these children
ing the importance of following AAP eligible children are shown in Table 2 (15.9% [95% CI: 13.8%–18.1%]) were
guidelines and the statement regard- along with the rates of initial breast- routinely given supplemental vitamin D
ing the possibility of rickets in breast- feeding and the proportion who were during the first 6 months of life. Infor-
fed children who were not supple- predominantly fed human milk for at mation on vitamin D use for 1 child was
mented between those pediatricians least 6 months. The mean age of the missing. Use of supplemental vitamin
who routinely recommended vitamin D infants and toddlers at the time their D in predominantly breastfed infants
and those who had another policy re- parents completed the survey was 12.1 varied according to race, with val-
garding supplementation. months (SD: 4.8 months); 25% were ues ranging from 14.2% (95% CI:
Data on completion of the infant- aged 8 months or younger, and 25% 11.9%–16.6%) among white children to
feeding survey by parents and on were aged 16 months or older. 27.1% (95% CI: 20.9%–34.0%) among
108 TAYLOR et al
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6. ARTICLES
TABLE 3 Univariate Association Between Vitamin D Use and Patient Characteristics, Parental tamin D supplementation and that vita-
Beliefs, and Policy of the Child’s Pediatrician Among Study Children Who Were
Predominantly Breastfed for at Least the First 6 Months of Life mins are important for a child’s over-
Variable ORa 95% CI No.b all health were the only variables that
White 0.63 0.44–0.90 1089 were positively and significantly asso-
Nonwhite race and/or Hispanic ethnicityc 1.67 1.22–2.27 1089 ciated with the use of vitamin D. Con-
Black 1.12 0.49–2.62 1089 versely, parental agreement that sup-
Asian/Pacific Islander 2.02 1.43–2.87 1089
Hispanic ethnicity 0.93 0.56–1.54 1084 plementation is unnecessary because
Child’s age 1.00 0.97–1.03 1139 breast milk has all needed nutrition
Parent agrees: vitamins important for overall health 5.22 3.45–7.90 1101 and that giving vitamins is inconve-
Parent agrees: vitamins needed to prevent rickets/other diseases 2.77 1.93–3.98 1020
Practitioner survey: child’s doctor recommends vitamin D for all 3.88 2.23–6.73 926 nient were both significantly associ-
breastfed infants ated with not using vitamin D. Addi-
Parent agrees: child’s doctor recommended vitamin D 19.52 10.61–35.93 1083 tional models that included all racial
Parent agrees: vitamins unnecessary, breast milk has all needed nutrition 0.07 0.04–0.13 1109
Parent agrees: giving vitamins inconvenient 0.59 0.42–0.84 1087
variable terms and/or data on the
Parent agrees: vitamins not needed if infant is out in sunlight 0.29 0.17–0.49 1074 child’s pediatrician’s recommendation
Child’s doctor’s recommendation regarding vitamin D important in 2.88 1.65–5.03 1037 regarding supplementation were ana-
parent’s decision about vitamin D supplementation
a
lyzed. The results of every analysis
OR was calculated by using logistic regression after accounting for clustering of children into different practices.
b No. indicates number of valid responses to each item. were similar. Parental agreement that
c Of the study children, 335 of 1090 (30.7%) were nonwhite race and/or Hispanic ethnicity; information on vitamin D
vitamin D was recommended by the
supplementation was collected for 1089 of these children.
child’s physician (adjusted ORs rang-
ing from 7.76 to 8.93 in different analy-
Asian/Pacific Islander children. A total tritional rickets are nonwhite and/or ses) and agreement that vitamins are
of 29 black patients were predomi- Hispanic,16 only 1 race variable (non- good for overall infant health (ad-
nantly breastfed for at least 6 months; white race and/or Hispanic ethnicity, justed ORs: 1.98 –2.23) were signifi-
6 of these children (20.7%) received or non-Hispanic white race) was in- cantly associated with providing sup-
supplemental vitamin D. The rate of vi- cluded in the model. In addition, be- plementation; agreement that breast
tamin D usage among Hispanic chil- cause 213 predominantly breastfed milk had all needed nutrition (adjusted
dren who were breastfed for at least 6 study children had an initial primary ORs: 0.10 – 0.12) and agreement that
months without significant formula care provider who was not a member giving vitamins is inconvenient (ad-
supplementation was 15.8% (95% CI: of PSPRN and did not complete the justed ORs: 0.45– 0 .46) were statisti-
9.1%–24.7%). practitioner survey, data on the child’s cally associated with not giving vita-
The univariate association between vi- pediatrician’s vitamin D recommenda- min D.
tamin D use in predominantly breast- tion policy were not included in the When asked to identify their child’s
fed children and several variables, in- larger model. The results of the multi- main doctor during the first 6 months
cluding race, ethnicity, age, parental variate analysis are shown in Table 4. of life, parents of 927 patients listed a
beliefs, and the policy of the child’s pe- Of the variables assessed in the full PSPRN pediatrician who had com-
diatrician regarding supplementation, model, parental agreement that the pleted the practitioner vitamin D sur-
are summarized in Table 3. In the child’s pediatrician recommended vi- vey (81.3% of those infants who were
unadjusted analyses, most of the vari-
ables assessed were statistically asso-
ciated with supplementation. To iden- TABLE 4 Multivariate Analysis to Identify Patient Characteristics, Parent Beliefs, and Provider
tify characteristics and beliefs that Policies Associated With Vitamin D Supplementation in Predominantly Breastfed Infants
were independently associated with vi- Variable ORa 95% CI
tamin D use in breastfed infants, an Nonwhite race and/or Hispanic ethnicity 1.29 0.81–2.06
analysis including those variables sig- Parent agrees: vitamins important for overall health 1.98 1.17–3.34
Parent agrees: vitamins needed to prevent rickets/other diseases 1.37 0.81–2.31
nificantly associated with supplemen- Parent agrees: child’s doctor recommended vitamin D 7.76 4.11–14.64
tation in univariate comparisons was Parent agrees: vitamins unnecessary, breast milk has all needed nutrition 0.12 0.07–0.23
conducted. Because of both the over- Parent agrees: giving vitamins inconvenient 0.45 0.26–0.76
Parent agrees: vitamins not needed if infant is out in sunlight 0.94 0.42–2.10
lap between several racial and ethnic Child’s doctor’s recommendation regarding vitamin D important in 1.83 0.77–4.39
groups and evidence that Ͼ90% of decision about vitamin D supplementation
children in the United States with nu- a OR calculated using logistic regression after accounting for clustering of children into different practices.
PEDIATRICS Volume 125, Number 1, January 2010 109
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7. predominantly breastfed). Among this secular trend, there were no sig- tific and lay press, has likely increased
these 927 study children, 218 (23.5%) nificant changes in the results; 4 vari- interest in providing vitamin D to
were seen by a health care provider ables (agreeing that the child’s doc- breastfed infants. In our study, we
who indicated that he or she routinely tor recommended supplementation, found that vitamin D use increased sig-
recommended supplemental vitamin D agreeing that vitamins are important nificantly during the final third of our
for all breastfed infants. Parents of for overall infant health, agreeing that study period (roughly covering the pe-
children whose provider universally breast milk has all needed nutrition, riod of late 2007 to mid-2008) when
recommended vitamin D for breastfed and agreeing that giving vitamins is in- there was publicity about vitamin D.13,14
infants were significantly more likely convenient) remained significantly as- However, even during this most recent
to agree that the provider recom- sociated with vitamin D use. period, fewer than one quarter of the
mended this supplement than those of responding parents of predominantly
children whose pediatrician had an- DISCUSSION breastfed infants reported giving vita-
other policy (64.7% and 22.7%, respec- Our results indicate that only a minor- min D to their children. The same fac-
tively; OR: 3.10 [95% CI: 1.95– 4.91]). ity of study children who were predom- tors (their child’s doctor’s recommen-
Parents of nonwhite and/or Hispanic inantly breastfed for Ͼ6 months re- dation and a belief that breast milk has
children were also more likely to agree ceived supplemental vitamin D. This all needed nutrition) remained signifi-
that their child’s provider recom- rate of usage is explained, to a large cantly associated with a parent’s deci-
mended vitamin D than those of white degree, by 2 conflicting influences. sion regarding supplementation.
non-Hispanic children (44.6% and Parents who reported that their child’s
27.8%, respectively; OR: 1.75 [95% CI: As expected, we found a high rate of
pediatrician recommended vitamin D
breastfeeding in this population of in-
1.37–2.27]). Overall, 33.3% of respond- were ϳ8 times more likely to provide
ing parents indicated that their child’s fants seen in primary care pediatric
the supplementation than parents
provider recommended vitamin D practices in the Seattle area. In 2002, it
whose child’s pediatrician did not
supplementation. Among these par- was estimated that 71% of US children
make this recommendation. However,
ents, 44.6% gave the supplement to had ever been breastfed and that
only one third of the parents of breast-
their child versus 2.8% of those 63.2% were breastfed at 1 month of
fed infants indicated that the pediatri-
whose child’s provider did not rec- age. The Pacific region of the country
cian recommended vitamin D. In addi-
ommend vitamin D (OR: 19.52 [95% CI had the highest reported rates of
tion, and perhaps the most striking
10.61–35.93]). breastfeeding, with 76.4% of infants
finding of this study, fewer than half
from this region reportedly being
Among the responding parents of chil- (44.6%) of the parents who responded
dren who were predominantly breast- that vitamin D was recommended by breastfed at 1 month of age.18 We found
fed for at least 6 months, 743 of 1110 their child’s pediatrician actually ad- that 82.6% of the children in our study
(67.0%) agreed with the statement ministered the supplementation. This were mainly breastfed during the first
that vitamin D supplementation is not counterintuitive result is partially ex- month of life. We also found that
required because breast milk has all plained by our finding that 67% of the breastfeeding among black infants
needed nutrition. Only 3.0% of children parents believed that supplementation was more common in our population
of these parents received supplemen- is unnecessary because breast milk than nationally. However, breastfeed-
tal vitamin D. has all needed nutrition. Parents who ing rates in Hispanic infants in our
There was an increase in the use of had this belief were ϳ9 times less study were comparable to US rates for
likely to give supplemental vitamin D Hispanic infants.18 Perhaps more sur-
vitamin D in predominantly breastfed
than those who did not agree with this prising was the finding that 1140 of the
infants during the 2-year study period.
During the first third of the period, statement. 2364 infants in the study (48.2%) were
10.8% of these children received sup- Initially, vitamin D supplementation breastfed with little or no formula sup-
plemental vitamin D; 12.7% received was recommended for breastfed in- plementation for at least 6 months.
the supplement during the middle fants as a method to prevent rickets.2 This is substantially higher than the
third and 24.0% during the last third of However, there is emerging evidence 35.1% of infants nationally who are
the study period (OR: 1.60 [95% CI: that vitamin D may play an important breastfed for at least 6 months.18
1.10 –2.32] for comparison between role in mitigating other disease pro- It is possible that the high rate of
the final and first third of the study pe- cesses in children.1,17 Information breastfeeding in study children was
riod). However, after controlling for about this evidence, both in the scien- linked to the reticence of the respond-
110 TAYLOR et al
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8. ARTICLES
ing pediatricians to recommend vita- man and Svec reported among 128 fants among participating pediatri-
min D in at least 2 ways. Pediatricians military pediatricians.9 cians. Our results suggest that vitamin
who did not universally recommend A potential limitation of this study is D use is strongly linked to physician
supplementation had a belief that rec- that parents of children up to 2 years recommendations. Efforts to increase
ommending vitamin D might cause old were asked to report whether vita- physician acceptance of vitamin D rec-
some parents to not breastfeed their mins were given during the first 6 ommendations should lead to more
infant. Perhaps these practitioners months of life and the reasons for this use in infants and increase compli-
were wary of any intervention that choice. It is possible that some parents ance with AAP guidelines.6 However,
would alter the high prevalence of did not recollect correctly. To some ex- the results of our study also suggest
breastfeeding. Conversely, pediatri- tent, our finding that significantly that there is a strong belief by parents
cians may have been hesitant to bring more parents of study children whose that breast milk has all needed nu-
up supplementation to parents who pediatricians universally recommend trition. To a large degree, this belief
have strong beliefs about the nutri- vitamin D indicated that the practitio- supersedes physician recommenda-
tional advantages of human milk. We ner recommended supplementation tion. Thus, to substantially increase vi-
found that 68.2% of responding pedi- than those whose child’s pediatrician tamin D use in predominantly breast-
atricians recommended vitamin D did not tend to validate the accuracy of fed infants, public health educational
supplementation for some or all parental reporting on the surveys. campaigns should also directly target
breastfed infants. Although this is parents.
higher than rates found in surveys of CONCLUSIONS
providers conducted before the AAP At the time that we began this study in ACKNOWLEDGMENT
recommendation in 2003,7,8 it is 2006, there was significant resistance This study was funded by a grant from
lower than the 89% rate of recom- to the AAP recommendation for sup- the Agency for Healthcare Research
mending supplementation that Sher- plemental vitamin D for breastfed in- and Quality.
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9. Use of Supplemental Vitamin D Among Infants Breastfed for Prolonged Periods
James A. Taylor, Leah J. Geyer and Kenneth W. Feldman
Pediatrics 2010;125;105-111; originally published online Nov 30, 2009;
DOI: 10.1542/peds.2009-1195
Updated Information including high-resolution figures, can be found at:
& Services http://www.pediatrics.org/cgi/content/full/125/1/105
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