Guidelines for young children feeding in the Caribbean - part II

This is the second of a three-part series by the Caribbean Food and Nutrition Institute (CFNI) on revised guidelines for young children feeding in the Caribbean. In Part I, the guidelines dealt with the period before birth. These covered maternal nutrition and guidelines for promoting, protecting and supporting breastfeeding. This part covers the broad area of breastfeeding, nutrition of the newborn with low birthweight or other special requirements, and replacement feeding for infants who are not breastfed. It also discusses the introduction of complementary foods with emphasis on the continuation of breastfeeding for two years and beyond.(AU)

A multi-centre safety and efficacy trial of a preterm infant formula supplemented with long chain polyunsaturated fatty acids (LCP) (48 weeks PCA analysis)

LCP supplementation of premature infant formula has been shown to produce plasma and erythrocyte lipid profiles similar to human milk (HM)-fed preterm infants. Previous studies reported decreased growth with LCP supplemented formula. This prospective, double-blind, randomised, controlled, parallel trial compared safety, growth and phospholipid fatty acid (PFA) levels in preterm infants fed preterms formula with (L+) or without (Lo) LCP. The study consisted of Phase I: enrolment to 40 weeks (wk) postconceptual age (PCA); and Phase II: 40 to 48 wk PCA. Infants (birth weight 750-2000 g, 0-28 days of age) were fed L+ or L preterm formula, 24 Kcal/oz during Phase I, and 20 Kcal/oz during Phase II. A control group was exclusively HM-fed preterms who, if weaned at the end of Phase I, received L. HM and formula intake were unrestricted. Weight (wt), length (Lt), head circumference (OFC) and upper mid-arm circumference (MAC), and phospholipid profiles were measured at 40 and 48 wk PCA. Adverse events were monitored. 183/288 infants completed Phase II. There were no difference in growth rates between formula groups. At 48 wk PCA, mean PFA levels in infants fed L+ were similar to HM-fed and were significantly higher than the L fed group. Adverse events were similar between the 2 formula groups. The number of infants who were discontinued because of an adverse event was similar among all groups. In conclusion the LCP preterm infant formula is safe, support normal growth and maintains phospholipid profiles similar to HM-fed infants.(AU)

Breast feeding in developing countries

Human milk has recently been reappraised with respect to its nutritional content, and anti-infective properties. Concerns with global food supply, economics of infant feeding, contraception and prevention of infections are specially relevant to developing countries. The benefits of breast feeding for the Third World is highlighted, reviewing the special advantages over adapted cow's milk (AU)

Prevalence of dental caries and enamel defects in the primary dentition of Antiguan pre-school children aged 3-4 years including an assessment of their habits

In 1989 a national survey was carried out on children aged 3 to 4 years attending nursery schools, to investigate the prevalence of caries experience, nursing bottle caries and enamel defects in the primary dentition, and these children's dentally related habits. In the first part of the study, examination of 482 Antiguan children showed that the dmft and dmfs values were 0.80 and 1.26 respectively, and that 77 percent of the children were caries free; 4.6 percent of children had nursing bottle caries; and enamel defects occurred in 24 percent of children. No significant differences was found in oral health between urban and rural samples. In the second part, which was an interview survey, habits such as thumb sucking (13 percent), not brushing their teeth (3 percent), and swallowing fluoride toothpaste (13 percent) were found among 369 children. In the third (a questionnaire) survey, a response rate of 63 per cent was obtained. Significantly more of the children with nursing bottle caries (78.6 percent) had the habit of sleeping with a feeding bottle than occurred in caries free children (25.6 percent), but there was no difference in the infant feeding pattern. The children with enamel defects were breast fed for a shorter period and had an earlier introduction to bottle feeding, compared with children without enamel defects. In the final part of the survey, an assessment of snack eating habits at school, a 58 percent response rate was achieved. The majority of children often brought healthier snacks, together with daily sugar-rich drinks. Significantly more caries free children brought sugary snacks less frequently than children with caries experience. (AU)

Babyvoedingspraktijken in de kustvlakte van Suriname / Infant food practices in the coastal region of Suriname

Results from a qualitative study into the determinants of infant food practices in Suriname. It was conducted from May until December 1991, in the Districts of Paramaribo, Saramacca, Nickerie and Commewijne. The factors were studied which influence the choice of infant food and the amount at which those factors themselves can be influenced. A historical description of the infant food practices in the world and in Suriname is given. The study and its results by area and target population were discussed, whereupon these were compared to similar studies and publications. Surinamese mothers appear to be content with both breast and bottle feeding. WHO standards should be modified to Surinamese uses and necessities. Possible public campaigning and other activities are also put forward

Is breastfeeding on the decline: the need to reinforce existing policies

The advantages of breast feeding are many. There is now strong scientific evidence indicating that breastfeeding plays an important role in preventing breast cancer, and in avoiding a further pregnancy in the first six months after delivery. Furthermore, the human immune virus has been isolated in breast milk. Recent evidence has emerged, however, which indicates that breeastfeeding is declining in developing countries. This is related to a variety of factors such as the introduction of modern technology, inappropriate advertising and promotion of infant formulae and lack of adequate social support systems. There is also scientific evidence which shows that the combined oral contraceptive pill significantly decreases milk output. In the light of this trend of declining breastfeeding, and new information pertaining to breastfeeding, there is urgent need for policy-makers in developing countries critically to examine their breastfeeding policies. This will provide them with an oppertunity to update these policies and at the same time develop strategies to promote breastfeeding and reverse the negative trends. (AU)

Feeding practices of infants, and beliefs of mothers in Western Jamaica

An infant feeding survey was carried out in three parishes in Cornwall County, Jamaica, from March to August, 1984, in an attempt to determine the feeding practices of infants and beliefs of mothers in Western Jamaica. Forty-one enumeration districts (EDs) were randomly selected from two strata, urban and rural, in proportion to the population distribution. Six hundred and fourteen households with children under thirty-six months of age were selected from 41 EDs. The results showed that the prevalence of breastfeeding was 98 percent. Despite the high frequency of breastfeeding, infant formula was introduced very early, and only about half the mothers introduced semi-solids and solids within one month of the recommended time. The most popular foods, identified as good foods, were also popular weaning foods. It is concluded that there is need for adequate training of both primary and secondary health-care staff, and reinforcement of the effectiveness of nutrition education programmes is also important (AU)

Perinatal care in six Eastern Caribbean countries

A study of six Caribbean countries (Antigua, the Bahamas, Barbados, Dominica, Saint Lucia, and St. Vincent) was conducted in December 1981 for the purpose of evaluating perinatal health care in those countries. The following account provides an overview of the results of that study. (AU)

Whole-body protein turnover and nitrogen balance in young children at intakes of protein and energy in the region of maintenance

Nitrogen balance and whole-body protein turnover were measured in children aged about one year taking diets which provided 1.7 or 0.7 g milk protein/kg/d at three levels of metabolizable energy, 80, 90 and 100 kcal/kg/d. All the children were in positive nitrogen balance at all levels of energy intake on 1.7 g protein/ kg/d. Nitrogen equilibrium was maintained on 0.7 g protein/kg/d when the energy intake exceeded 90 kcal/kg/d, but on 80 kcal/kg/d nitrogen balance was negative. Whole-body protein turnover was measured from the enrichment in urinary ammonia following a continuous infusion of15N-glycine. The variation between individuals on the same diet was significantly greater than the variation within individuals at different levels of energy intake. For the group as a whole protein synthesis on 1.7 g protein/kg/d was 0.74, 0.75 and 0.87 g N/kg/d on 100, 90 and 80 kcal/kg/d respectively;whereas on 0.7 g protein/kg/d it was 0.37, 0.38 and 0.40 g N/kg/d. These results show that over this range of intakes protein synthesis decreased as dietary protein fell, but tended to increase as energy intake fell. (AU)

What is the weanling's dilemma? Dietary faecal bacterial ingestion of normal children in Jamaica

Childhood gastroenteritis and malnutrition have been associated with a high bacterial contamination of weaning foods and bottle feeds in particular. We have cultured the bottle feeds of 90 well-nourished and 11 undernourished children aged 6-23 months. Four-fifths of the feeds had more than 10,000 viable faecal organisms/ml and two-thirds had more than 10,000 viable faecal organisms/ml and two-thirds had more than 100,000. The level of contamination did not differ between milks and porridges or with different methods of sterilization. There was no relationship between the level of contamination and nutritional status of the children. Those who were being breast fed at the time of sampling had expereinced fewer episodes of gastroenteritis. The results indicate that well-nourished children can ingest large numbers of viable faecal organisms with relative impunity, particularly if they are breastfed. The factors which dictate a child's response to a load of faecal bacteria should be explored to explain why some children do not succumb. (Summary)

Infant feeding practices in St. Vincent and factors which affect them

Surveys of one to two-year old children in two towns in St. Vincent in 1975 found that there may have been a slight decline in breastfeeding since the late 1960s. Although lactation failure was rare, supplementary bottle feeding was usually begun during the early weeks of life. Sevrage, the complete cessation of breastfeeding, occurred by seven months of age for half of the children in the sample. One of the major factors leading to early sevrage was probably the introduction of bottle feeding. This may operate through an earlier return of fertility post-partum (and thus "pregnancy" as the reason for weaning), or because the sweet, easily-drained bottle is preferable to the breast for the infant (and thus the baby "weans himself"). While many of the factors influencing current infant feeding practices are now largely of historical interest, such as slavery, others are currently amenable to intervention. These include poor health and nutritional status of mothers, inappropriate advice given by health professionals, and the advertising and promotion of infant foods by their manufacturers and sales persons (AU)

Obstetric management, breastfeeding, bonding, and subsequent child development: guidelines for the Caribbean

These guidelines highlights the importance of the role of obstetric personnel who have the immediate responsibilities in the preparation of mothers for breastfeeding and its initiation