In-Hospital Formula Supplementation in Appalachian Women Intending to Exclusively Breastfeed.

OBJECTIVE: In-hospital formula supplementation places infants at risk for early breastfeeding cessation. The study's aim was to identify predictive and protective factors for in-hospital formula supplementation in individuals documented as wanting to exclusively breastfeed and residing in a geographic region with adverse social determinants of health and low breastfeeding rates. Additionally, we wished to determine if lactation consultation served as a protective factor against supplementation. METHODS: In this cross-sectional study, we retrospectively reviewed 500 randomly selected charts of newborns born in a 12 month period at a regional tertiary care hospital. We included healthy, full-term neonates having a recorded maternal decision to exclusively breastfeed. Maternal-newborn dyad characteristics were compared between those exclusively breastfeeding and those with in-hospital formula supplementation. RESULTS: Of the 500 charts, 70% of individuals desired to exclusively breastfeed. Overall, 41% of breastfed newborns were supplemented with formula before discharge, and 32% of women met with lactation consultants prior to supplementation. No statistically significant association was present between exclusive breastfeeding at discharge and meeting with a hospital lactation consultant (p = 0.55). When controlling for the confounders of maternal demographics and lactation consultation, significant associations with formula supplementation included Cesarean delivery (odd ratio: 2.08, 95% confidence interval: 1.04-4.16), primiparity (2.48, 1.27-4.87), and high school level of education (2.78, 1.33-5.78). CONCLUSIONS: Maternal characteristics of high school level educational, primiparity, and Caesarean delivery place individuals at risk for in-hospital formula supplementation in individuals wishing to exclusively breastfeed. Addressing barriers to exclusive breastfeeding is essential to enhance maternal and newborn health equity.

Parenting in emerging adulthood: an examination of parenting clusters and correlates.

The changing nature of the transition to adulthood in western societies, such as the United States, may be extending the length of time parents are engaged in "parenting" activities. However, little is known about different approaches parents take in their interactions with their emerging-adult children. Hence, this study attempted to identify different clusters of parents based on the extent to which they exhibited both extremes of control (psychological control, punishment, verbal hostility, indulgence) and responsiveness (knowledge, warmth, induction, autonomy granting), and to examine how combinations of parenting were related to emerging adult children's relational and individual outcomes (e.g. parent-child relationship quality, drinking, self-worth, depression). The data were collected from 403 emerging adults (M age = 19.89, SD = 1.78, range = 18-26, 62% female) and at least one of their parents (287 fathers and 317 mothers). Eighty-four percent of participants reported being European American, 6% Asian American, 4% African American, 3% Latino, and 4% reported being of other ethnicities. Data were analyzed using hierarchical cluster analysis, separately for mothers and fathers, and identified three similar clusters of parents which we labeled as uninvolved (low on all aspects of parenting), controlling-indulgent (high on both extremes of control and low on all aspects of responsiveness), and authoritative (high on responsiveness and low on control). A fourth cluster was identified for both mothers and fathers and was labeled as inconsistent for mothers (mothers were above the mean on both extremes of control and on responsiveness) and average for fathers (fathers were at the mean on all eight aspects of parenting). The discussion focuses on how each of these clusters effectively distinguished between child outcomes.

The emergence of mother-infant co-regulation during the first year: links to infants' developmental status and attachment.

This study examined development and stability in emerging patterns of co-regulation in mother-infant dyads (n=101) over the later half of the first year of life. Links to infants' attachment and developmental status were also examined. Co-regulated patterns of interactions demonstrated significant developmental shifts over time, with mother-infant dyads becoming increasingly more symmetrical and less unilateral in their interaction. Additionally, differences in co-regulation patterns at 6 months predicted subsequent attachment status at 12 months of age. Specifically, securely attached infants engaged in higher levels of symmetrical co-regulation with mothers at 6 months of age while insecurely attached infants engaged in more unilateral patterns of interactions. Furthermore, symmetrical co-regulation at 6 months was positively linked to infants' mental development and psychomotor development at 9 months of age while asymmetrical and unilateral patterns of co-regulation at 6 months was negatively linked to infants' mental development. Findings suggest an important antecedent role of early patterns of dyadic co-regulation to later developmental status and attachment organization.

A Comparative Study of Arm-Restraint Methodology: Differential Effects of Mother and Stranger Restrainers on Infants' Distress Reactivity at 6 and 9 Months of Age.

This study examined both differential patterns and the stability of infants' (N = 70) distress reactivity across mother and stranger arm-restraint conditions when infants were 6 and 9 months of age. Reactivity measures included observational variables for the rise, intensity, and duration of infant distress as well as motor activities associated with escape behaviors. Correlation analyses revealed that infant behaviors during arm restraint were modestly stable across conditions and over time; however, mean comparisons also showed that infants' distress responses appear to be sensitive to protocol parameters (whether restrainer is mother or stranger). At 6 months of age, infants cried more during maternal restraint than with strangers and exhibited escape behaviors more frequently with mothers. Findings further indicate that infants' distress reactivity undergoes developmental alterations from 6 to 9 months of age, with infants crying more quickly, reaching peak intensity of distress faster, and displaying more distress at 9 months compared to 6 months. These changes in infants' reactivity were particularly accentuated during maternal compared to stranger restraint conditions at 9 months of age.