Maternal employment characteristics as a structural social determinant of breastfeeding after return to work in the European Region: a scoping review.

BACKGROUND: The European Region has the lowest rate of exclusive breastfeeding at 6 months worldwide. Improving work-related breastfeeding issues is important given that women may have difficulties combining work and breastfeeding, especially those in precarious working situations, which adds to their adversity. This scoping review overviews research on the maternal employment characteristics that support breastfeeding continuation after return to work in the European Region. METHODS: Studies published from 2013 to 2023 were collected from Scopus, PubMed, and PsycInfo. Quantitative and qualitative studies published in English or French that explored the association between maternal employment characteristics and any breastfeeding status, duration, or experience were included. Participants included were mothers of healthy children who continued breastfeeding after resuming work. The main determinants were work-related factors that can lead to socially differentiated working conditions, including type of employment (e.g., occupation, employed/self-employed status, type of contract, working time, occupational prestige), working conditions (e.g., work schedule, decision latitude, latitude to organize worktime), and work environment (e.g., occupational exposure, family-friendly workplace policy, social support). The geographic area encompassed countries included in the World Health Organization European Region. RESULTS: Of the 693 single studies retrieved and screened, 13 were included in the review. Eight studies focused on combining work and breastfeeding, while the others had a broader spectrum by investigating breastfeeding determinants. The represented countries were Spain (n = 4), France (n = 4), UK (n = 2), Ireland (n = 2), and the Netherlands (n = 1). Results highlighted the heterogeneity of measures, time frames, and fields of inquiry, thus revealing a lack of conceptual framework regarding the links between work, breastfeeding, and social health inequalities. Nonetheless, being self-employed, working in a non-manual profession with time flexibility, having lactation rooms at work, being supported by co-workers, and having a breastfeeding workplace policy were salient factors that supported breastfeeding in working mothers. CONCLUSIONS: Supporting working mothers who choose to breastfeed is important given the myriad of adverse factors faced by mothers and their children. These results advocate for targeted actions at the workplace such as time flexibility, breastfeeding facilities, and the promotion of breastfeeding-friendly policies.

Is breastfeeding duration related to the health of migrant mother-child dyads experiencing homelessness? The ENFAMS cross-sectional survey.

BACKGROUND: Literature from the general population shows a consensus about the health benefits associated with breastfeeding for both mothers and children. However, studies investigating these issues in the context of homelessness and migration are rare. This research aimed to examine the relations of any breastfeeding duration with health outcomes among migrant mother-child dyads experiencing homelessness. METHODS: Data were collected among sheltered and mainly foreign-born mothers experiencing homelessness, and their children aged 6 months to 5 years, from the ENFAMS cross-sectional survey (n = 481, 2013-Great Paris area). Any breastfeeding duration, along with various health outcomes of both the mother and her child, was ascertained by face-to-face questionnaires administered by trained interviewers to mothers (perceived physical and emotional health and maternal depression) or by trained psychologists to children (adaptive behaviours). Nurses measured weight and height [thus allowing them to calculate body mass index (BMI)] and haemoglobin concentration (mother-child dyad) and maternal blood pressure. Multivariable linear and modified Poisson regression analyses were performed to examine outcome-wide associations between any breastfeeding duration ≥6 months and the various mother-child outcomes. RESULTS: Any breastfeeding ≥6 months was associated with lower systolic blood pressure in mothers (B = -0.40, 95% confidence interval = -0.68 to -0.12). No association was observed with the other outcomes. CONCLUSIONS: The relevance of supporting breastfeeding to improve mothers' physical health holds true in the context of migration and homelessness. It is therefore important to support breastfeeding in these settings. Moreover, given the documented social complexity of breastfeeding practices, interventions should take mothers' socio-cultural heritage and the structural barriers they face into account.

11 and 15-month-old infants do not compensate immediately for energy variation, and no further adjustment occurs 12 or 24 hours later.

Previously, we demonstrated that, in the short term, infants undercompensated for the energy from a preload given 25 min before an ad libitum meal. However, although not consistent, there is evidence in young children that caloric adjustment may occur over longer periods. We investigated the extent to which further energy adjustment occurs up to 24 h after a single meal preceded by preloads of varying energy density (ED) in infants that are 11 and 15 months old. Short-term caloric adjustment was measured in 11- and 15-month-old infants through a preload paradigm meal in the laboratory. To assess their caloric adjustment over longer periods (12 and 24 h), we used 24 h dietary records to evaluate the energy intake (EI) after each visit to the laboratory. Three COMPX scores were calculated according to three different time periods after preload consumption (0 h [i.e., short-term], 12 h or 24 h). Our main result was that, on average, regardless of the time period considered, the infants undercompensated their EI after preload consumption: at 11 and 15 months, caloric adjustment was partial and similar overtime. Considering that a slight repeated imbalance of the energy balance may promote rapid weight gain over the first months, this study calls for further research focusing on facilitators and barriers of efficient appetite control abilities in infancy.

Caloric compensation ability around the age of 1 year: Interplay with the caregiver-infant mealtime interaction and infant appetitive traits.

Previously, we demonstrated that infants' caloric compensation ability decreases between 11 and 15 months old. Here, we explored whether the inter-individual variation in infants' caloric compensation ability is associated with caregiver-infant interaction during laboratory test meals or with infant appetitive traits. To describe caregiver-infant interaction, we recorded feeding in laboratory ad libitum meals when the infants were 11 and 15 months old by using a connected weighing scale. We extracted the weight of each offered spoonful and the time interval between two spoonfuls. The caloric compensation score (COMPX) was assessed during the same meals. At 11 and 15 months old, the caregiver rated their infant's appetitive traits by completing the CEBQ-T. Student's t tests were applied to test the relationships between the variables describing the caregiver-infant interaction and the COMPX score. The relationships between the COMPX score or its change and the infants' appetitive traits were assessed with Kendall correlations. Regarding appetitive traits, the more the caloric compensation ability decreased between 11 and 15 months old, the more the infants were perceived as food responsive between these ages (τ = -0.36, p = 0.01, n = 28). At 11 months old, when the time interval between two spoonfuls was positively associated with the previous spoonful weight (i.e., a longer time interval after a larger spoonful weight), the infants exhibited a better caloric compensation ability (t = -2.1, p = 0.04, n = 38). Moreover, this study provides new evidence regarding the importance of a responsive feeding style by suggesting that adapting the feeding pace to the spoonful weight could be a favourable practice associated with better caloric compensation ability by the end of the first year. TRIAL REGISTRATION: This trial was registered at clinicals.gov as NCT03409042 (https://clinicaltrials.gov/ct2/show/NCT03409042).

Caloric compensation in infants: developmental changes around the age of 1 year and associations with anthropometric measurements up to 2 years.

BACKGROUND: Previous results based on dietary recall suggest that the ability to adjust eaten quantities to food energy density (ED) may deteriorate around the age of 1 y. However, this hypothesis has not been investigated experimentally. OBJECTIVES: The first aim of the study was to describe changes in the short-term caloric compensation ability of infants around the age of 1 y. We expected a decrease in this ability with age. The second aim was to identify individual factors [e.g., breastfeeding duration, body mass index (BMI) z-score, and change in BMI z-score] related to interindividual variations in caloric compensation ability. METHODS: We adapted the preload paradigm to calculate a COMPX score. The measure was performed in the laboratory at 11 and 15 mo. The parent offered a food preload that was either low or high in ED (LED = 33 kcal/100 g or HED = 97.9 kcal/100 g, respectively), followed by an ad libitum meal after 25 min. The infants were measured and weighed. Information about the infants' milk-feeding history was collected. RESULTS: We obtained COMPX scores at 11 and 15 mo for 31 infants (12 females). As hypothesized, the caloric compensation ability significantly decreased with age (COMPX11 = 52% ± 133%; COMPX15 = -14% ± 151%; P = 0.03). The more the COMPX score decreased, the more the BMI z-score between 11 and 15 mo increased (P = 0.03) and the higher the BMI z-score was at 2 y (P = 0.03). No associations were found between COMPX scores and breastfeeding duration (all P > 0.60). CONCLUSIONS: Caloric compensation ability decreases between 11 and 15 mo. This decrease is associated with a larger increase in weight status from 11 to 15 mo and a higher weight status at 2 y. This study calls for further research to better understand the early determinants of caloric compensation ability. This trial was registered at www.clinicaltrials.gov as NCT03409042 (https://clinicaltrials.gov/ct2/show/NCT03409042).

Social rivalry triggers visual attention in children with autism spectrum disorders.

Visual social attention is central to social functioning and learning and may act as a reinforcer. Social rivalry, which occurs when an individual is excluded from dyadic interactions, can promote interspecific learning by triggering attention. We applied it to an animal-assisted intervention, where the behaviour of ASD children was compared between an experimental (attention shift of the animal trainer from the dog-child to the dog only) and a control (attention maintained on the dyad) groups (study 1). The results show that ASD children are sensitive to the direction of (visual) social attention and may act, physically and visually, in order to regain it. When the animal trainer concentrated on the dog, the overall visual attention of the ASD children increased, suggesting a heightened awareness towards their environment. They oriented more towards the animal trainer and the dog, contrarily to the control group. The repetition of the procedure was even associated with increased joint attention with the animal trainer (study 2). Thus, ASD children do care about and seek human visual attention. They show an ability to adapt their social behaviour, which questions whether their known deficits in social competencies are hard wired or whether the deficits are in their expression.