Dual modality feeders: a group of human milk feeders with unique practices and needs.

OBJECTIVE: Dual modality feeding (DMF) - feeding human milk interchangeably from the breast and from a bottle - comes with unique practical, emotional and relational challenges, as well as support needs. Yet, there is little research that explores the experiences of individuals who use DMF in the Canadian context. The aim of this study is to explore the practices, challenges, reasons and enablers of DMF. DESIGN: Repeat, semi-structured one-on-one interviews were conducted at 8 weeks and 22 weeks postpartum. Interview transcripts were thematically analysed using a critical feminist lens. SETTING: Nova Scotia, Canada. PARTICIPANTS: Ten DMF mothers. RESULTS: DMF practices were influenced by a mix of social and material circumstances, including breast-feeding challenges, the involvement of support persons, finances and access to lactation support. Individuals who predominantly fed at the breast expressed milk strategically to mitigate transitory breast-feeding challenges, for convenience under specific circumstances, and to share feeding responsibilities with other caregivers for personal and practical reasons. Individuals who mainly bottle-fed did so due to long-term breast-feeding challenges or a need to return to employment. Enablers of successful DMF were consistent between the two groups and included practical, personal and relational aspects. CONCLUSIONS: DMF is a unique practice compared to feeding human milk solely from the breast or bottle. Despite the potential growing prevalence of DMF, it is currently understudied and inadequately addressed in existing support programmes in Nova Scotia. Tailored programming and public messaging are needed to support DMF families.

Relative Importance of Well-Being Determinants in Atlantic Canadian Families During the Pandemic.

Framed by the socio-ecological model of well-being, we examined the relative importance of factors contributing to three dimensions of well-being (child, parent, and family) during the COVID-19 pandemic. A sample of 536 participants from the Atlantic provinces of Canada answered a cross-sectional survey in 2021, covering experiences during the pandemic (eg, changes in family life and well-being). Well-being was assessed with 3 single-item measures on positive change in the life of children, parents, and families during the pandemic. This study involved 21 predictor variables (eg, change in time spent on various family activities). Using multiple regression and measures of relative importance based on the Lindeman, Merenda and Gold (lmg) method, we identified the variables most important to predicting well-being. Twenty-one predictors accounted for 21% of the variance in child well-being, 25% in parent well-being, and 36% in family well-being. Well-being at all 3 levels (child, parent, and family) shared the same top predictor (family closeness). The top 6 predictors of well-being at each level were related to leisure (eg, play) and time-use (eg, to prepare meals, engage in self-care, and rest). The effect sizes were smaller for child well-being than at the parent or family level, suggesting there may be important predictors of child well-being not accounted for in these analyses. This study may inform family-level programing and policy that seeks to promote well-being for children and their families.

Influence of the 2019 Canada's Food Guide on the Food Environment in Childcare and Early Learning Centres.

Purpose: This study investigated the potential influence of the 2019 Canada's Food Guide (CFG) on the eating environment and food provided in early learning and childcare centres across Canada.Methods: Directors of childcare centres were invited to complete an online survey about their awareness and adoption of the 2019 CFG and submit their menus for analysis.Results: Twenty-five directors completed the survey, and eighteen cycle menus were analyzed. Frequency and the types of foods offered in childcare centres were assessed. Ninety-two percent reported being aware of the changes in the food guide. Many challenges including the lack of support and resources, cost of food, and food reluctance could affect their ability to apply the changes, especially the incorporation of plant-based protein and the uncertainty around the amount of dairy products to provide. Menu analysis indicated frequency of offering items from the various food groups. Vegetables were mostly offered during lunchtime with an average offering rate of 4.83 ± 0.24 times per week.Conclusion: Representatives of early learning and childcare centres identified having difficulties in interpreting and applying the changes in the 2019 CFG. Dietitians have the knowledge and skills required to support childcare centres through training opportunities, workshops, toolkits, and advocacy.

Responsive Feeding Environments in Childcare Settings: A Scoping Review of the Factors Influencing Implementation and Sustainability.

Children benefit from responsive feeding environments, where their internal signals of hunger and satiety are recognized and met with prompt, emotionally supportive and developmentally appropriate responses. Although there is existing research on responsive feeding environments in childcare, there is little synthesized literature on the implementation practices using a behavior change framework. This scoping review sought to explore the factors influencing the implementation and sustainability of responsive feeding interventions in the childcare environment, using the behavior change wheel (BCW). A total of 3197 articles were independently reviewed and 39 met the inclusion criteria. A thematic analysis identified the factors influencing the implementation and sustainability of responsive feeding, including the following: (1) pre-existing nutrition policies, (2) education and training, (3) provider beliefs and confidence, (4) partnership development and stakeholder engagement and (5) resource availability. The most common BCW intervention functions were education (n = 39), training (n = 38), environmental restructuring (n = 38) and enablement (n = 36). The most common policy categories included guidelines (n = 39), service provision (n = 38) and environmental/social planning (n = 38). The current literature suggests that broader policies are important for responsive feeding, along with local partnerships, training and resources, to increase confidence and efficacy among educators. Future research should consider how the use of a BCW framework may help to address the barriers to implementation and sustainability.

Early pandemic impacts on family environments that shape childhood development and health: A Canadian study.

OBJECTIVES: Changes to income and employment are key social determinants of health that have impacted many families during the COVID-19 pandemic. This research aimed to understand how changes to employment and income influenced family environments that contribute to early childhood development and health. METHODS: A concurrent triangulation mixed method design was used through a cross-sectional survey on early impacts of the COVID-19 pandemic involving families with young children in the Canadian Maritime provinces (n = 2158). Analyses included multivariate regression models to examine whether changes to employment and income predicted changes to Family access to resources and social support, parenting Abilities and self-care at home, and home Routines and Environments (FARE Change Scale). Content analysis was used to identify themes from the open-ended questions. RESULTS: Changes to employment and income early in the pandemic like no longer working but continued to receive salary, working fewer hours for the same salary earned before the pandemic, no longer working nor receiving salary, working fewer hours resulting in salary reduction, essential worker status and household income were significant predictors of FARE Change Scale when ethnicity/cultural background and province of residence are controlled (P < .05). Themes provided a description of family impacts, including shifting employment and income, finding time and capacity, feelings of guilt and the creation of new routines. CONCLUSION: Our study provides insight on the implications of public health restrictions, such as the importance of increased time for parents (through reduced work hours) and access to resources and social support to support child development and health.

Family Feeding Practices of Parents on Prince Edward Island: A Focus on Responsive Feeding.

The home environment and parental influence are strong predictors of eating behaviours in young children and can influence healthy development. The objective of this study was to describe the feeding practices of a sample of families on Prince Edward Island. Eleven parent participants were recruited, one-on-one interviews were held, and a thematic analysis was conducted. Conversations with parents revealed that the family feeding environment is influenced by a multitude of factors that change daily and need to be navigated based on the age of the child. Parents saw family meals as time together and an opportunity to model healthy eating behaviours; however, they faced several challenges at mealtimes, including perceived picky eating. Parents recognized their children's hunger and satiety cues, although they respected satiety signals more often if children ate what they perceived as a lot of food. Many parents used food as a reward to encourage their children to eat more but recognized that it could lead to the development of undesirable habits. Despite the complex factors that influence feeding, dietitians can work with families to foster a responsive feeding environment by encouraging family meals, recognizing and respecting hunger and satiety cues, and understanding typical changes in eating behaviours as children age.

Comparison of Responsive Feeding Practices in Child Care and Home Environments in Nova Scotia.

Purpose: The values, beliefs and practices between the family home and child care environment can play a role in shaping a responsive food environment for young children, but few studies have explored the differences across these settings. The purpose of this study was to compare responsive feeding practices in child care and home environments through the framework of the 2019 Canada Food Guide healthy eating recommendations.Methods: Nova Scotia families and child care providers completed an online survey on responsive feeding. Independent-samples t-tests explored the differences between family and child care respondents on variables related to the 2019 Canada's Food Guide, including: food variety, mindfulness, eating with others, cooking more often, and enjoyment of food. A directed content analysis was used to code the open-ended qualitative questions.Results: Family respondents (n = 603) were more likely to report offering a variety of foods, repeated exposures to new foods, and asking children about fullness. Child care respondents (n = 253) were more likely to sit with children during meals and less likely to encourage children to finish their food.Conclusions: The results identify potential points of intervention, including the importance of increasing communication to ensure mutually supportive messages and environments for healthy eating.

Responsive feeding values and practices among families across the Canadian Maritime provinces.

Children benefit from responsive feeding practices where their internal signals of hunger and satiety are valued and met with prompt, emotionally supportive, and developmentally appropriate responses. Using an online survey, this study describes responsive feeding values and practices among parents of young children (0-5 years) (n = 1039) across 3 Canadian Maritime provinces. Independent-samples t-tests and 1-way ANOVA were performed to determine the differences in survey questions related to the responsive feeding practices and values. First-time parents and parents with younger children report implementing more consistently some of the challenging responsive feeding practices, such as avoiding pressuring their children to eat, compared with parents with multiple children and parents with children ages 3-5 years. Parents often have well-intended reasons to encourage their children to eat; however, these can coincide with non-responsive practices with food such as pressuring, rewarding, and restriction. These coercive practices may be ineffective and counterproductive as they reinforce reasons to eat unrelated to appetite and self-regulation. Preschool and early feeding interventions that support parents in understanding normal child development, including typical eating behaviours and self-regulation, could help to equip them for challenging feeding experiences and encourage long-term responsive feeding practices. Novelty: First-time parents and parents with younger children report more consistently avoiding pressuring their children to eat, compared with parents with multiple children and parents with children ages 3-5 years. Parents often have well-intended reasons to encourage their children to eat; however, these can coincide with non-responsive practices such as pressuring, rewarding, and restriction.

Food and Nutrient Intakes of Nova Scotian Children in Home and Childcare Environments.

Purpose: To describe the energy (E), sodium, saturated fat, sugar, and fibre intakes of a sample of children attending regulated childcare (RCC) in Nova Scotia.Methods: Nutrient analyses from 79 food records were compiled and grouped by intakes in and outside of RCC, age, sex, location of the RCC (urban or rural), and nutrient intake data. Descriptive statistics and independent t tests were conducted.Results: Mean E and macronutrients were within recommended ranges and, for days attending RCC, 45%E was consumed in RCC. Saturated fat intake was 12%E on average. Mean sodium intake exceeded or approached the tolerable upper limit for 3-year olds (1726 mg/day) and 4-5-year olds (1770 mg/day), respectively. Total sugar was 27%E intake and significantly more sugar was consumed outside RCC and by boys compared to girls. Mean daily dietary fibre intake was below recommended levels (15 g/day).Conclusions: On average dietary intakes of children exceeded recommendations for sodium, saturated fat, and sugar with higher intakes outside RCC. The foods provided by RCC have a positive influence on children's intakes, but given the pervasiveness of sugar and sodium in the food environment and the challenges of feeding children, support is needed for both RCC and families to encourage healthy eating behaviours for positive growth and development.

Effect of video game playing and a glucose preload on subjective appetite, subjective emotions, and food intake in overweight and obese boys.

Video game playing (VGP) is associated with overweight/obesity (OW/OB). VGP and caloric preloads in the pre-meal environment influence short-term food intake (FI) in healthy-weight children. Therefore, the purpose of the present study was to examine the effect of pre-meal VGP and a glucose preload on subjective emotions, subjective appetite, and FI in boys with OW/OB. On 4 separate mornings, boys with OW/OB (n = 22; mean ± SD: age = 11.9 ± 1.6 years; body mass index percentile = 94.3 ± 3.9) participated in 4 test conditions. Two hours after a standardized breakfast, boys consumed equally sweetened preloads (250 mL) of sucralose (0 kcal) or glucose (200 kcal), with or without 30 min of subsequent VGP. Immediately after each test condition, FI was evaluated during an ad libitum pizza meal. Subjective appetite was measured at 0 (baseline), 15, and 30 min. Subjective emotions (aggression, anger, excitement, disappointment, happiness, upset, and frustration) were measured at 0 and 30 min. VGP did not affect FI, but the glucose preload decreased FI compared with the sucralose control (Δ = -103 ± 48 kcal, p < 0.01). However, cumulative FI (preload kcal + meal kcal) was 9% higher after the glucose preload (p < 0.01). Subjective appetite increased with time (p < 0.05) but was not influenced by preload or VGP. Frustration was the only subjective emotion that increased following VGP (p < 0.01). A glucose preload, but not VGP, suppressed FI in boys with OW/OB, suggesting a primary role of physiological factors in short-term FI regulation.

Breast, Formula and Combination Feeding in Relation to Childhood Obesity in Nova Scotia, Canada.

Breastfeeding has been rigorously studied in relation to childhood obesity prevention. Few studies have examined whether combination feeding­breast milk and formula­may also be protective against obesity. This study aimed to investigate the relationship between breastfeeding duration, combination feeding and overweight and obesity among Canadian school children. We analyzed data from a 2011 cross-sectional, population based survey (n = 5,560), which included self-reported infant feeding behaviours, a food frequency questionnaire and measured height and weight. Multilevel regression methods were used to examine the association between breastfeeding duration and overweight and obesity adjusting for socioeconomic status, diet quality and physical activity. Thirty-four percent of children were breastfed for <1 week or never while 32% were breastfed for at least 6 months. In the fully adjusted model, children who were only formula fed or who were combination fed for <6 months were more likely to be overweight or obese relative to children who were only breastfed (OR 1.29, 95% CI 1.04-1.60 and OR 1.35, 95% CI 1.09-1.69, respectively). When examining overweight and obese children separately, those who were only formula fed were more likely obese (OR 1.57, 95% CI 1.10-2.25) relative to their peers who were only breastfed. And those who were combination fed for <6 months relative to those only breastfed were more likely to be overweight (OR 1.29, 95% CI 1.01-1.66). Breastfeeding, in the absence of formula feeding, appears to have a protective effect on childhood obesity. While combination feeding confers less benefit than only breastfeeding, it is more desirable than formula feeding alone. Strategies and social policies are needed to promote exclusive and longer breastfeeding duration and should be integrated with comprehensive efforts to prevent childhood obesity and to reduce the burden of chronic diseases in the long term.

Infant feeding practices and children's weight status.

PURPOSE: Feeding practices for young Canadian children from economically disadvantaged neighbourhoods were examined to determine adherence to infant feeding recommendations and factors associated with children's weight status. METHODS: Data for the study were collected from 1996 to 2003 as part of Better Beginnings, Better Futures, a longitudinal primary prevention initiative in Ontario. Study subjects were 546 children at age three months and 483 children at age 48 months. RESULTS: Mothers who had less than a high school education (odds ratio [OR] = 1.83, confidence interval [CI] = 1.01-3.29) and mothers who did not attend prenatal classes (OR = 2.37, CI = 1.33-4.24) were more likely to use formula. Mothers who were single parents were three times more likely to have an obese child (OR = 3.35, CI = 1.39-8.06) than were mothers who were married or with a partner. CONCLUSIONS: Targeted strategies are needed for families as single-parent households were predictive of obesity in young children. Innovative encouragement to participate in prenatal programming for pregnant women who have less than a high school education may improve breastfeeding rates.

Nutrition and shiftwork: evaluation of new paramedics' knowledge and attitudes.

PURPOSE: The effect of an oral education intervention on nutrition knowledge was evaluated in new paramedic employees. The evaluation involved measuring knowledge of and attitudes toward nutrition and shiftwork before and after the directed intervention. METHODS: A convenience sample of 30 new paramedic shiftworkers attended a 15-minute education session focused on nutrition management strategies. This matched cohort study included three self-administered surveys. Survey 1 was completed before education, survey 2 immediately after education, and survey 3 after one month of concurrent post-education and employment experience. Knowledge and attitude scores were analyzed for differences between all surveys. RESULTS: Participants were primary care paramedics, 59% of whom were male. They reported that previously they had not received this type of information or had received only a brief lecture. Mean knowledge scores increased significantly from survey 1 to survey 2; knowledge retention was identified in survey 3. A significant difference was found between surveys 2 and 3 for attitudes toward meal timing; no other significant differences were found between attitude response scores. CONCLUSIONS: The education session was successful in improving shiftwork nutrition knowledge among paramedics. Paramedics' attitudes toward proper nutrition practices were positive before the education intervention.

Adolescents' diets do not comply with 2007 Canada's food guide recommendations.

This study evaluated the eating behaviours of students in grade six and, three years later when they were in grade nine, relative to the recommendations of Canada's 2007 Food Guide. Students completed a self-administered questionnaire on eating behaviours in 2002 (n=647) and again in 2005 (n=520) as part of Better Beginnings, Better Futures, a primary prevention initiative among economically disadvantaged communities. McNemar analysis and X(2) analysis were used to assess differences in compliance with the recommendations of the Food Guide. Differences in the mean number of servings of the four food groups and the Other Foods group were examined using independent sample t-tests and paired t tests. In grade six, 5% of males and 7% of females met the minimum number of recommended servings for all four food groups. By grade nine this had dropped to 0.4% and 2% respectively. Among males who completed the questionnaire in both grade six and grade nine there was a decline in the mean number of daily servings for all four food groups. For females a similar trend was observed. The likelihood of adolescents meeting all Food Guide recommendations decreased from grade six to grade nine.

The Better Beginnings, Better Futures project: findings from grade 3 to grade 9.

Although comprehensive and ecological approaches to early childhood prevention are commonly advocated, there are few examples of long-term follow-up of such programs. In this monograph, we investigate the medium- and long-term effects of an ecological, community-based prevention project for primary school children and families living in three economically disadvantaged neighborhoods in Ontario, Canada. The Better Beginnings, Better Futures (BBBF) project is one of the most ambitious Canadian research projects on the long-term impacts of early childhood prevention programming to date. Bronfenbrenner's ecological model of human development informed program planning, implementation, and evaluation. Using a quasi-experimental design, the BBBF longitudinal research study involved 601 children and their families who participated in BBBF programs when children were between 4 and 8 years old and 358 children and their families from sociodemographically matched comparison communities. We collected extensive child, parent, family, and community outcome data when children were in Grade 3 (age 8­9), Grade 6 (age 11­12), and Grade 9 (age 14­15). The BBBF mandate was to develop programs that would positively impact all areas of child's development; our findings reflect this ecological approach. We found marked positive effects in social and school functioning domains in Grades 6 and 9 and evidence of fewer emotional and behavioral problems in school across the three grades. Parents from BBBF sites reported greater feelings of social support and more positive ratings of marital satisfaction and general family functioning, especially at the Grade 9 follow-up. Positive neighborhood-level effects were also evident. Economic analyses at Grade 9 showed BBBF participation was associated with government savings of $912 per child. These findings provide evidence that an affordable, ecological, community-based prevention program can promote long-term development of children living in disadvantaged neighborhoods and produce monetary benefits to government as soon as 7 years after program completion.