Promoting breastfeeding : a guide for health professionals working in the WIC and CSF programs /

Abstract: A guide for health providers who work in perinatal health care systems provides a variety of ideas and successful approaches for promoting breastfeeding among low-income women, based on the premise that breastfeeding is the best method for feeding infants in the early months of life. The material is organized into 4 principal sections covering background information on various aspects of breastfeeding, specifically for low-income women; approaches to breast-feeding education at each of the 4 distinct phases of the prenatal and postpartum periods; sample lesson plans that may be used by health professionals or paraprofessionals in individual or group sessions; and a tabulation of references and resources for the use of health professionals in breastfeeding promotion efforts. (wz).

Social and behavioural determinants of early childhood caries

Background: To investigate the association between selected social and behavioural (infant feeding and preventive dental practices) variables and the presence of early childhood caries in preschool children within the north Brisbane region. Methods: A cross sectional sample of 2515 children aged four to five years were examined in a preschool setting using prevalence (percentage with caries) and severity (dmft) indices. A self-administered questionnaire obtained information regarding selected social and behavioural variables. The data were modelled using multiple logistic regression analysis at the 5 per cent level of significance. Results: The final explanatory model for caries presence in four to five year old children included the variables breast feeding from three to six months of age (OR=0.7, CI=0.5, 1.0), sleeping with the bottle (OR=1.9, CI=1.5, 2.4), sipping from the bottle (OR=1.6, CI=1.2, 2.0), ethnicity other than Caucasian (OR=1.9, CI=1.4, 2.5), annual family income $20,000-$35,000 (OR = 1.7, CI=1.3, 2.3) and annual family income less than $20,000 (OR=2.1, CI=1.5, 2.8). Conclusion: A statistical model for early childhood caries in preschool children within the north Brisbane region has been constructed using selected social and behavioural determinants. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Caries experience in preschool children referred for specialist dental care in hospital

Background : Increasing numbers of preschool children are being referred for specialist dental management in a paediatric hospital. Most cases have severe early childhood caries and require comprehensive management under general anaesthesia. The present study investigated risk factors for disease presence at initial consultation. Methods : A convenience sample of 125 children under four years of age from the north Brisbane region were examined and caries experience recorded using dmft and dmfs indices. A self-administered questionnaire obtained information regarding social, demographic, birth, neonatal, infant feeding and dental health behaviour variables. The data were analysed using the chi-square and one-way analysis of variance procedures. Results : Ninety-four per cent of referred children had severe ECC with mean dmft of 10.5 ± 3.8 and mean dmfs of 27.1 ± 15.1. Prevalence of severe ECC was significantly higher in children allowed a sweetened liquid in the infant feeding bottle (99 per cent) and allowed to sip from an infant feeding bottle during the day (100 per cent). Mean dmfs was significantly higher in children allowed to sleep with a bottle (28.7) and sip from a bottle during the day (29.9), children from a non-Caucasian background (31.8), those children that commenced regular toothbrushing between 6 to 12 months of age (28.1), had no current parental supervision of daily tooth-brushing (34.2) and had not taken daily fluoride supplements (27.8), vitamin supplements (27.8) or prescription medicine previously (27.6). Conclusions : The behavioural determinants for severe early childhood caries presence in hospital-referred children were similar to those identified in the regional preschool population.

Multi-level zero-inflated Poisson regression modelling of correlated count data with excess zeros

Count data with excess zeros relative to a Poisson distribution are common in many biomedical applications. A popular approach to the analysis of such data is to use a zero-inflated Poisson (ZIP) regression model. Often, because of the hierarchical Study design or the data collection procedure, zero-inflation and lack of independence may occur simultaneously, which tender the standard ZIP model inadequate. To account for the preponderance of zero counts and the inherent correlation of observations, a class of multi-level ZIP regression model with random effects is presented. Model fitting is facilitated using an expectation-maximization algorithm, whereas variance components are estimated via residual maximum likelihood estimating equations. A score test for zero-inflation is also presented. The multi-level ZIP model is then generalized to cope with a more complex correlation structure. Application to the analysis of correlated count data from a longitudinal infant feeding study illustrates the usefulness of the approach.

The process of implementing a new baby-friendly hospital initiative for nurses: a grounded theory study

Maternity nursing practice is changing across Canada with the movement toward becoming “baby friendly.” The World Health Organization (WHO) recommends the Baby-Friendly Hospital Initiative (BFHI) as a standard of care in hospitals worldwide. Very little research has been conducted with nurses to explore the impact of the initiative on nursing practice. The purpose of this study, therefore, was to examine the process of implementing the BFHI for nurses. The study was carried out using Corbin and Strauss’s method of grounded theory. Theoretical sampling was employed, which resulted in recruiting and interviewing 13 registered nurses whose area of employment included neonatal intensive care, postpartum, and labour and delivery. The data analysis revealed a central category of resisting the BFHI. All of the nurses disagreed with some of the 10 steps to becoming a baby-friendly hospital as outlined by the WHO. Participants questioned the science and safety of aspects of the BFHI. Also, participants indicated that the implementation of this program did not substantially change their nursing practice. They empathized with new mothers and anticipated being collectively reprimanded by management should they not follow the initiative. Five conditions influenced their responses to the initiative, which were (a) an awareness of a pro-breastfeeding culture, (b) imposition of the BFHI, (c) knowledge of the health benefits of breastfeeding, (d) experiential knowledge of infant feeding, and (e) the belief in the autonomy of mothers to decide about infant feeding. The identified outcomes were moral distress and division between nurses. The study findings could guide decision making concerning the implementation of the BFHI.

Seafood inclusion in commercial main meal early years' food products

Acknowledgement We are grateful to the food manufacturers for answering queries and supplying missing nutritional information. Source of funding The study was funded by the Seafish and Interface Food and Drink as part of a Doctorate Scholarship undertaken at the University of Aberdeen. © 2015 John Wiley & Sons Ltd.

Seafood inclusion in commercial main meal early years' food products

Acknowledgement We are grateful to the food manufacturers for answering queries and supplying missing nutritional information. Source of funding The study was funded by the Seafish and Interface Food and Drink as part of a Doctorate Scholarship undertaken at the University of Aberdeen. © 2015 John Wiley & Sons Ltd.

Anticipatory Accounts

C. Wright Mills called for a truly sociological analysis of actors’ “motive talk,” which decouples the commonsense link between the reasons actors give for their actions and their mental state prior to those actions. Subsequent theoretical and empirical work has focused almost entirely on actors’ retrospective accounting for untoward conduct that has already taken place. The other aspect of Mills’s program, the reasons actors give for potentially untoward future conduct and in particular the empirical investigation of the link between the availability of an acceptable vocabulary of motives for anticipated conduct and the eventual enactment of that conduct, has been largely ignored. This article seeks to rehabilitate these lost dimensions using data from a longitudinal study of mothers’ infant feeding choices and practices. It examines how mothers account, in advance, for the possibility that they may eventually feed their babies in ways they consider suboptimal. Thirty of the thirty-six women interviewed indicated that they intended to breastfeed, emphasizing the benefits of this practice to their babies. However, seventeen of these women also anticipated that they might abandon breastfeeding and presented elaborate accounts of the motives that could lead them to do so. The findings support Mills’s claim that the availability of an acceptable vocabulary of motives for untoward conduct increases the probability that one will engage in such conduct. Mothers who had offered elaborate anticipatory accounts for abandoning breastfeeding were much more likely to do so than those who did not offer such accounts.

Expertise and forms of knowledge in the government of families

This paper examines the relationship between the state and the individual in relation to an aspect of mundane family life – the feeding of babies and young children. The nutritional status of children has long been a matter of national concern and infant feeding is an aspect of family life that has been subjected to substantial state intervention. It exemplifies the imposition upon women the ‘biologico-moral responsibility’ for the welfare of children (Foucault 1991b). The state’s attempts to influence mothers’ feeding practices operate largely through education and persuasion. Through an elaborate state-sponsored apparatus, a strongly medicalised expert discourse is disseminated to mothers. This discourse warns mothers of the risks of certain feeding practices and the benefits of others. It constrains mothers through a series of ‘quiet coercions’ (Foucault 1991c) which seek to render them self-regulating subjects. Using data from a longitudinal interview study, this paper explores how mothers who are made responsible in these medical discourses around child nutrition, engage with, resist and refuse expert advice. It examines, in particular, the rhetorical strategies which mothers use to defend themselves against the charges of maternal irresponsibility that arise when their practices do not conform to expert medical recommendations.

Exclusive breastfeeding practices in the Coast region, Tanzania.

Background: Although breastfeeding in general is common and culturally accepted in many sub-Saharan countries, recommended exclusive breastfeeding infants to 6 months is rare. In rural Tanzania, data on infant feeding practices is rare. Objective: To examine and describe exclusive breastfeeding practices in rural settings (Coast Region) of Tanzania. Methods: A cross-sectional study was conducted in Coast Region of Tanzania involving 342 mothers. Only mothers with children aged between 6 and 23 months were interviewed in their residences. Data analyses included descriptive and logistic regression analyses. Results: The majority, 66%, of mothers reported to have breastfed their new born within the first hour of life. About 30% reported to have breastfed exclusively for up to at least six months. Those who did not practice complete exclusive breastfeeding mentioned insufficient milk as the main reason. Correlates of exclusive breastfeeding included maternal education and attitudes towards exclusive breastfeeding. Conclusion: The rate of exclusive breastfeeding in rural areas like the Coast Region of Tanzania is still very low. Programs aimed to promote exclusive breastfeeding must take multi-factorial considerations.

Early consumption of liquids different to breast milk in Mexican infants under 1 year: results of the probabilistic National Health and Nutrition Survey 2012

Introduction: Studies on infant dietary intake do not generally focus on the types of liquids consumed. Objective: To document by age and breastfeeding status, the types of liquids present in the diet of Mexican children under 1 year of age (< 1 y) who participated in the National Health and Nutrition Survey 2012 (ENSANUT-2012). Methods: Analysis of the infant < 1 y feeding practices from the ENSANUT-2012 survey in non-breastfed (non-BF) and breastfed (BF) infants by status quo for the consumption of liquids grouped in: water, formula, fortified LICONSA milk, nutritive liquids (NL; thin cereal-based gruel with water or milk and coffee with milk) and non-nutritive liquids (non-NL) as sugared water, water-based drinks, tea, beans or chicken broth, aguamiel and coffee. In this infants < 1 y we analyzed the not grouped consumption of liquids in the first three days of life (newborns) from the mother's recall. Percentage and confidence intervals (95% CI) were calculated adjusting for survey design. Statistical differences were analyzed by Z test. Results: We observed a high consumption of human milk followed by formula (56.7%) and water (51.1%) in infants under 6 months of age (< 6 mo). The proportion of non-BF infants consuming non-NL was higher than for BF infants (p < 0.05). More than 60% of older infants (6 mo and < 1 y) consumed formula and were non-BF. In newborns formula consumption was predominant, followed by tea or infusion and water. Conclusions: Non-breast milk liquids are present undesirably in Mexican infants' diet and non-NL are consumed earlier than NL, revealing inadequate early dietary practices.

Dietary associations of fathers and their children between the ages of 20 months and 5 years

OBJECTIVE: To examine associations between dietary intakes of fathers and their children at child age 20 months, 3·5 years and 5 years, and to determine if fathers' intake predicts change in children's intake between 20 months and 3·5 and 5 years of age.

DESIGN: The diets of fathers and their first-born children participating in the longitudinal Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program were assessed using FFQ and three 24 h recalls, respectively.

SETTING: Sixty-two pre-existing first-time parent groups were selected from fourteen local government areas within a 60 km radius of Deakin University Burwood, Victoria, Australia.

SUBJECTS: Fathers and their first-born children at 20 months (n 317), 3·5 years (n 214) and 5 years of age (n 208).

RESULTS: Positive associations were found between fathers' and children's intakes of fruit and sweet snacks at 20 months (P=0·001) and 5 years of age (P=0·012). Fathers' intake at child age 20 months was associated with change in children's intake for fruit, sweet snacks and sugar-sweetened beverages between child age 20 months and 3·5 years, and for sweet snacks and sugar-sweetened beverages between child age 20 months and 5 years (all P<0·05). After adjustment for maternal intake, fathers' intake of sweet snacks remained a predictor of change in children's sweet snack intake between 20 months and 3·5 years of age (P=0·03).

CONCLUSIONS: Associations between the dietary intakes of fathers and their children commence at a young age and continue through early childhood. Fathers should be included in future interventions aimed at improving children's diets.

The predictors of diet quality among Australian children aged 3.5 years

BACKGROUND: It is critical to promote healthy eating early in life. OBJECTIVE: The aim of this study was to examine diet quality and its predictors among Australian preschool-aged children. DESIGN: Diet was assessed at age 3.5 years using multiple 24-hour recalls. Diet quality was assessed using an adapted version of the Revised Children's Diet Quality Index (RC-DQI). Potential predictors of diet quality were from questionnaires at age 3, 9, and 18 months and informed by the ecologic model of childhood overweight. Potential predictors included child's sex, age of introduction to solid foods, breastfeeding status, food acceptance, maternal nutrition knowledge, modeling of healthy eating, self-efficacy, education, and home food availability. PARTICIPANTS: Data from 244 children participating in the Melbourne Infant Feeding, Activity, and Nutrition Trial in 2008-2010 and follow-up data collection in 2011-2013 were examined. MAIN OUTCOME MEASURES: Diet quality at age 3.5 years. STATISTICAL ANALYSES PERFORMED: Bivariate logistic regression was performed to assess the relationship between diet quality and each predictor. A multivariable logistic regression model accounting for influences of covariates, treatment arm, and clustering by group tested associations between diet quality and significant predictors from bivariate analyses. RESULTS: RC-DQI scores had a mean±standard deviation score of 62.8±8.3 points out of a maximum of 85 points. Breastfeeding status (odds ratio [OR] 2.34, 95% CI 1.33 to 4.10) and maternal modeling of healthy eating (OR 1.75, 95% CI 1.01 to 3.03) were positively associated with RC-DQI scores. Both breastfeeding status (OR 3.09, 95% CI 1.63 to 5.85) and modeling (OR 2.01, 95% CI 1.04 to 3.88) remained positively associated with diet quality after adjustment for child age, body mass index z score, energy intake, treatment arm, and clustering. CONCLUSIONS: Breastfeeding status and modeling of healthy eating were independently associated with children's diet quality. Early intervention could assist mothers to practice these behaviors to provide support for improving child diet quality.

Dietary intake and sources of potassium and the relationship to dietary sodium in a sample of Australian pre-school children

The aim of this study was to determine the intake and food sources of potassium and the molar sodium:potassium (Na:K) ratio in a sample of Australian pre-school children. Mothers provided dietary recalls of their 3.5 years old children (previous participants of Melbourne Infant Feeding Activity and Nutrition Trial). The average daily potassium intake, the contribution of food groups to daily potassium intake, the Na:K ratio, and daily serves of fruit, dairy, and vegetables, were assessed via three unscheduled 24 h dietary recalls. The sample included 251 Australian children (125 male), mean age 3.5 (0.19) (SD) years. Mean potassium intake was 1618 (267) mg/day, the Na:K ratio was 1.47 (0.5) and 54% of children did not meet the Australian recommended adequate intake (AI) of 2000 mg/day for potassium. Main food sources of potassium were milk (27%), fruit (19%), and vegetable (14%) products/dishes. Food groups with the highest Na:K ratio were processed meats (7.8), white bread/rolls (6.0), and savoury sauces and condiments (5.4). Children had a mean intake of 1.4 (0.75) serves of fruit, 1.4 (0.72) dairy, and 0.52 (0.32) serves of vegetables per day. The majority of children had potassium intakes below the recommended AI. The Na:K ratio exceeded the recommended level of 1 and the average intake of vegetables was 2 serves/day below the recommended 2.5 serves/day and only 20% of recommended intake. An increase in vegetable consumption in pre-school children is recommended to increase dietary potassium and has the potential to decrease the Na:K ratio which is likely to have long-term health benefits.