Infant and young child feeding practices and its associated factors among mothers of under two years children in a western hilly region of Nepal.

Infant and young child feeding is a key area to improve child survival and promote healthy growth and development. Nepal government has developed and implemented different programs to improve infant and young child feeding practice. However, the practice remains poor and is a major cause of malnutrition in Nepal. This study aims to identify infant and young child feeding practices and its associated factors among mothers of children aged less than two years in western hilly region of Nepal. A descriptive cross-sectional study was carried out among 360 mothers of under two years' children in Syangja district. A semi structural questionnaire was used. Data was entered in EpiData and analyzed using IBM SPSS version 21. Descriptive statistics were used to report the feeding practices and other independent variables. Bivariate and multivariate logistic regression model was used to establish the factors associated with infant and young child feeding practices. The prevalence of breastfeeding, timely initiation of breastfeeding, exclusive breastfeeding, timely initiation of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet (MAD) were 95.6%, 69.2%, 47.6%, 53.3%, 61.5%, 67.3% and 49.9% respectively. Normal delivery (AOR 6.1, 95% CI 1.2-31.3) and higher maternal autonomy (AOR 5.2, 95% CI 1.8-14.6) were significantly associated with exclusive breastfeeding. Similarly, crop production and food security (AOR 3.8, 95% CI 1.9-7.7), maternal knowledge on MAD (AOR 2.5, 95% CI 1.0-6.2) and maternal autonomy (AOR 4.2, 95% CI 2.1-8.4) were significantly associated with minimum acceptable diet. Factors such as maternal education, maternal health services utilization, maternal knowledge, and maternal autonomy were associated with infant and young child feeding practices, which warrants further attention to these factors to reduce malnutrition.

Nutritional Aspects of Commercially Available Complementary Foods in New Zealand Supermarkets.

Optimal nutrition in early childhood fosters growth and development whilst preventing morbidity and mortality in later life. There is little research in New Zealand on commercially available complementary foods (CACFs). This cross-sectional study of the nutritional aspects and packaging of CACFs used data collected in four major supermarket chains in New Zealand in 2019 (Nutritrack). Of the 197 CACFs analysed, 43 (21.8%) were inappropriately recommended for consumption by children four months of age or older, 10 (5.1%) had added salt, and 67 (34.0%) contained free sugars. The majority (n = 136, 69.0%) contained ingredients with a sweet flavour. Relatively sweet vegetables like carrot and sweetcorn were used more often than bitter vegetables such as broccoli and spinach. The described texture of most (n = 145, 62.1%) wet 'spoonable' products was of the lowest complexity (smooth, puréed, custard). CACFs would adequately expose children to cow's milk and wheat but not to other common food allergens (cooked hen's egg, soy, fish, crustacean shellfish, peanut, and tree-nuts). If children's diets include CACFs, non-commercial meals must be offered as well in order to meet nutritional guidelines related to the introduction of common food allergens, diversity of flavours, and complex textures for infants and toddlers.

Infant Food Security in New Zealand: A Multidimensional Index Developed from Cohort Data.

Food security (FS) during infancy is associated with lifelong outcomes. New Zealand is a developed economy that reports poor childhood nutrition-related health statistics, particularly among minority children, yet has no measure of FS applicable to infancy. The objective was to develop an FS index for New Zealand infants and examine its association with demographic covariates and health outcomes. Within a large (n = 6853) nationally representative cohort, variables describing infant food consumption, breastfeeding, and maternal food-related coping methods were collected from mothers during late infancy. An FS index was derived using confirmatory factor analysis. Associations were assessed by logistic regressions and described using odds ratios (OR) and ≥95% confidence intervals (CI). Fifteen percent of the cohort was highly FS, 43% tenuously food insecure (FIS), and 16% highly food insecure (FIS). Infants from minority ethnic groups had lower odds of being food secure, as did those born to the youngest mothers, mothers who smoked, or those who lived in low-income households. FIS infants had higher odds of morbidity. Interventions to improve infant FS should focus on improving dietary quality, and should give particular consideration to minority infants. We identified that FIS shows wide ethnic and socioeconomic inequity, and is associated with poorer health. The most important driving factors of FIS included poor quality weaning diets, as well as poverty and its proxies. Any interventions to improve infant FS should focus on increasing fruit and vegetable consumption to recommended intake levels, and should give particular consideration to minority infants.

Perspective: Novel Commercial Packaging and Devices for Complementary Feeding.

In recent years, so-called baby food pouches and other novel packaging and devices have been marketed for complementary feeding. To date, no experimental studies have been conducted to determine health and nutrition effects or the safety of baby food pouches and related feeding devices. Yet, these products hold the potential to fundamentally change the ways in which infants and children consume solid foods in infancy and early childhood. In this review, a selection of complementary feeding devices and their potential effects on breastfeeding, formula-feeding, safe and appropriate complementary feeding, and the timely transition to family foods are explored. Because manufacturers have innovated older designs of traditional feeding bottles and pacifiers for complementary feeding, perspectives on potential health effects and the safety of devices are drawn from research on feeding bottles and pacifiers. Recommendations include scaling up research on the safety, nutrition, and health impacts of commercial packaging and devices. In addition, manufacturers should ensure that devices conform to consumer product safety commission specifications and that instructions for use are in line with policies protecting pediatric dental health. Marketing of commercial devices and packaging should conform to the International Code of Marketing of Breastmilk Substitutes.

Reasons for Infant Feeding Decisions in Low-Income Families in Washington, DC.

BACKGROUND: Breastfeeding rates for low-income, African American infants remain low. OBJECTIVE: This study aimed to determine the barriers, support, and influences for infant feeding decisions among women enrolled in the Washington, DC, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) after revisions in the WIC package to include more food vouchers for breastfeeding mothers and their infants and improvement of in-hospital breastfeeding support. METHODS: We surveyed 100 women, using a 42-item verbally administered survey that asked about demographics, infant feeding method, and influences and support for feeding decisions. RESULTS: The majority of participants (76%) initiated breastfeeding; 31% exclusively breastfed in the hospital. Participants were more likely to breastfeed if they had some college education, were unemployed or employed full-time, had only one child, and had been breastfed themselves as infants. Barriers to prolonged breastfeeding included limited support after hospital discharge, pain, and perceived insufficient milk supply. Participants in this study had higher breastfeeding initiation and in-hospital exclusivity rates after improvement of in-hospital breastfeeding support. CONCLUSION: Clients of WIC initiated breastfeeding at a high rate but either supplemented with formula or stopped breastfeeding for reasons that could be remedied by improved prenatal education, encouragement of exclusive breastfeeding in the hospital, and more outpatient support.

Optimal Distribution and Utilization of Donated Human Breast Milk.

BACKGROUND: The nutritional content of donated expressed breast milk (DEBM) is variable. Using DEBM to provide for the energy requirements of neonates is challenging. OBJECTIVE: The authors hypothesized that a system of DEBM energy content categorization and distribution would improve energy intake from DEBM. METHODS: We compared infants' actual cumulative energy intake with projected energy intake, had they been fed using our proposed system. Eighty-five milk samples were ranked by energy content. The bottom, middle, and top tertiles were classified as red, amber, and green energy content categories, respectively. Data on 378 feeding days from 20 babies who received this milk were analyzed. Total daily intake of DEBM was calculated in mL/kg/day and similarly ranked. Infants received red energy content milk, with DEBM intake in the bottom daily volume intake tertile; amber energy content milk, with intake in the middle daily volume intake tertile; and green energy content milk when intake reached the top daily volume intake tertile. RESULTS: Actual median cumulative energy intake from DEBM was 1612 (range, 15-11 182) kcal. Using DEBM with the minimum energy content from the 3 DEBM energy content categories, median projected cumulative intake was 1670 (range 13-11 077) kcal, which was not statistically significant ( P = .418). Statistical significance was achieved using DEBM with the median and maximum energy content from each energy content category, giving median projected cumulative intakes of 1859 kcal ( P = .0006) and 2280 kcal ( P = .0001), respectively. CONCLUSION: Cumulative energy intake from DEBM can be improved by categorizing and distributing milk according to energy content.

Infant feeding practices in the Peruvian Amazon: implications for programs to improve feeding / Prácticas de alimentación de lactantes en la Amazonia Peruana: implicaciones para los programas de mejora de la alimentación

OBJECTIVE: To characterize feeding practices in a community in the Peruvian Amazon and to consider how this information could be used to strengthen programs and policies designed to improve nutrition and reduce child malnutrition in vulnerable communities METHODS: Data from three structured questionnaires were combined to produce a comprehensive depiction of feeding in a sample of 246 infants from birth through 8 months of life in the community of Santa Clara de Nanay near Iquitos, Peru. Breastfeeding initiation practices, exclusive breastfeeding in the first 180 days of life, the introduction of solids, and complementary feeding practices from 6-8 months, were described and related to maternal, infant, and household characteristics, including food insecurity RESULTS: The median duration of exclusive breastfeeding was 19 days. However, over the first 180 days of life, children were exclusively breastfed on 46.1% of days. Overall, 68.3% of infants received some semi-solid or solid food between 0-6 months and all had received semi-solids by the end of 8 months of age. The proportion of infants consuming a minimally acceptable (frequent and diverse) complementary diet was 2.9%, 7.9%, and 16.1% at 6, 7, and 8 months respectively CONCLUSIONS: Although breastfeeding is nearly universal, promotion programs are needed in Santa Clara to 1) delay the introduction of plain water, other non-breast milk liquids, and semi-solid foods; 2) extend the period of exclusive breastfeeding; and 3) increase food diversity and the frequency of feeding during the period of complementary feeding. These results can be used to guide programs and policies to improve nutrition and reduce child malnutrition.

OBJETIVOS: Determinar las prácticas de alimentación en una comunidad de la Amazonia peruana y analizar cómo esta información podría usarse para fortalecer los programas y las políticas diseñadas para mejorar la nutrición y reducir la desnutrición infantil en las comunidades vulnerables MÉTODOS: Se combinaron datos de tres cuestionarios estructurados para obtener una descripción integral de la alimentación en una muestra de 246 lactantes, desde el nacimiento y hasta los 8 meses de vida, en la comunidad de Santa Clara de Nanay cerca de Iquitos, Perú. Se describieron las prácticas de iniciación de la lactancia materna, lactancia materna exclusiva en los 180 primeros días de vida e introducción de alimentos sólidos y las prácticas de alimentación complementaria desde los 6 hasta los 8 meses, y se las relacionó con las características maternas, de los lactantes y los hogares, lo que incluyó la inseguridad alimentaria RESULTADOS: La mediana de duración de la lactancia materna exclusiva fue 19 días. Sin embargo, en los 180 primeros días de vida los niños habían sido amamantados exclusivamente 46,1% de los días. En términos generales, 68,3% de los lactantes recibieron algún alimento semisólido o sólido entre los 0 y los 6 meses de vida, y hacia el final del octavo mes de vida todos habían recibido alimentos semisólidos. La proporción de lactantes cuyo régimen alimentario complementario había sido mínimamente aceptable (frecuente y diverso) fue 2,9% a los 6 meses, 7,9% a los 7 meses y 16,1% a los 8 meses CONCLUSIONES: A pesar de que la lactancia materna es prácticamente universal, en Santa Clara son necesarios programas de promoción para 1) retrasar la introducción de agua corriente, otros líquidos fuera de la leche materna y alimentos semisólidos; 2) extender el período de lactancia materna exclusiva, y 3) aumentar la diversidad de los alimentos y la frecuencia de la alimentación durante el período de alimentación complementaria. Estos resultados pueden ser útiles para guiar los programas y las políticas de mejora de la nutrición y reducir la desnutrición infantil.

Determinants of complementary feeding practices among Nepalese children aged 6-23 months: findings from Demographic and Health Survey 2011.

BACKGROUND: The adoption of inappropriate feeding practices is one of the reasons for under nutrition in Nepal and elsewhere. The objective of this study was to describe the rate of and identify the factors associated with providing the World Health Organization (WHO) recommended infant feeding practices of minimum dietary diversity, minimum meal frequency and minimum acceptable diet in Nepal amongst young children between 6-23 months in 2011. METHODS: Data from Nepal Demographic and Health Survey (NDHS) 2011 was used. Prevalence of minimum dietary diversity, minimum meal frequency and minimum acceptable diet was obtained by using descriptive statistics. A Chi-square test (χ2) followed by multiple logistic regression analyses were used to determine the adjusted effect of potential factors on the outcome variables. RESULTS: Of the 698 children aged 6-23 months; while 535 (76.6%) received the minimum meal frequency, only 212 (30.4%) children received the minimum dietary diversity, and 185 (26.5%) received an acceptable diet. Children of older mothers (>35 years); educated mothers and fathers; and mothers from all the development regions except the Mid-western region were more likely to have been provided with the recommended dietary diversity. Children of mothers who had attended ≥4 antenatal visits and who lived in the Eastern region were more likely to provide their child with the recommended meal frequency. Children of mothers, who attended ≥ 4 antenatal visits, were educated and whose fathers had at least a secondary education were more likely to meet the recommended acceptable diet standards. CONCLUSION: Young children aged less than two years in Nepal are at risk for not meeting the WHO recommended infant feeding standards given that only about one in three children were provided with the recommended dietary diversity and acceptable diet. This finding suggests that the majority of children are at risk of under nutrition. An appropriate mix of health education and food supplements could be a feasible option for Nepal to improve the number of children who meet the recommended infant feeding guidelines, reduce under nutrition and improve the survival rates of young children.

Rotafolio de consejería sobre alimentación, desarrollo y enfermedades prevenibles de la niñez / Counseling flipchart on childhood feeding, development and preventable diseases

El rotafolio, como instrumento usado para la presentación de información, sirve de guía tanto para el personal de salud, como para la orientación de los pacientes, particularmente de madres con niños recién nacidos, lactantes y preescolares (menores de cinco años). En él, van paso a paso con los detalles sobre la alimentación del niño, incluyendo temas como peso, vacunación, suplementación y hasta recetas de cocina pensadas para los niños de las edades señaladas. Un instrumento didáctico de gran calidad fotográfica.

Complementary feeding for infants 6 to 12 months.

Complementary feeding, also known as weaning, mixed feeding or introduction of solid foods, should begin for infants by six months of age (26 weeks) but not before 17 weeks. Breast milk or infant formula should continue during the complementary feeding period with amounts gradually reduced as the variety of foods increases. As all infants' needs are different, health care professionals have to be aware of key nutrients and foods needed at the same time as monitoring growth and understanding the needs of parents and the resources available to them.

New guidelines for managing cow's milk allergy in infants.

The prevalence of allergic disease has increased markedly over the last 50 years. Food allergy usually manifests in early childhood as part of the so-called atopic march and most commonly includes one or more of the following foods: cow's milk, hen's egg, soy, peanuts and tree nuts, wheat, sesame seed, kiwi fruit and seafood. In the UK about 2% of infants develop cow's milk protein allergy (CMPA), but as many as 15% of infants present with symptoms suggestive of an adverse reaction to cow's milk protein. The diagnosis of CMPA is based on one or more of the following: a detailed clinical history, allergy test results (skin prick testing [SPT] and/or specific immunoglobulin E [IgE]) and, if required, supervised incremental milk challenges. The majority of UK primary care centres do not have access to these tests and may also be unfamiliar with the interpretation or results. In addition, they do not have the facilities for supervised food challenges. Empirical treatment is often required pending confirmation of allergy or referral to a specialist centre, but requires clear guidelines. No consensus guidelines currently exist for the diagnosis and management of CMPA in the UK. An international task force has recently published proposed guidelines for the management of CMPA. These provide separate algorithms covering the diagnosis and management of CMPA for both breast-fed and formula-fed infants and discuss the use of hypoallergenic formulae, elimination diets and diagnostic tests. Revisions and adaptations for the UK market are required and are discussed in this article.

Macrolevel approaches to improve the availability of complementary foods.

Large numbers of infants and young children suffer from the short- and long-term health effects of poor breastfeeding and complementary feeding practices. Strategies to improve the availability of and access to low-cost fortified complementary foods can play an important corresponding role to that of behavior change in improving nutritional status of young children. However, the nutritional quality of complementary foods used in publicly funded programs is not always optimal, and such programs are costly and reach only a tiny fraction of those who could benefit. To broadly reach the target population, such foods need to be commercially available at affordable prices and promoted in a way that generates demand for their purchase. A sensible long-term policy for the promotion of low-cost fortified complementary foods calls for attention to their nutritional formulations and cost, the economics of production, and the legislative, regulatory, and competitive framework in which marketing occurs. This paper provides information on how to improve the nutritional formulations of fortified complementary foods and outlines the necessary conditions for a market approach to their production and promotion.

Household-level technologies to improve the availability and preparation of adequate and safe complementary foods.

Plant-based complementary foods are the main source of nutrients for many young children in developing countries. They may, however, present problems in providing nutritionally adequate and safe diets for older infants and young children. The high starch content leads to low-nutrient diets that are bulky and dense, with high levels of antinutritive factors such as phytates, tannins, lectins, and enzyme inhibitors. Phytates impair mineral bioavailability, lectins interfere with intestinal structure, and enzyme inhibitors inhibit digestive enzymes. In addition, there is often microbial contamination, which leads to diarrhea, growth-faltering, and impaired development, and the presence of chemical contaminants may lead to neurological disease and goiter. The fact that some fruits containing carotenoids are only available seasonally contributes to the vulnerability of children receiving predominantly plant-based diets. Traditional household food technologies have been used for centuries to improve the quality and safety of complementary foods. These include dehulling, peeling, soaking, germination, fermentation, and drying. While modern communities tend to reject these technologies in favor of more convenient fast-food preparations, there is now a resurgence of interest in older technologies as a possible means of improving the quality and safety of complementary foods when the basic diet cannot be changed for economic reasons. This paper describes the biology, safety, practicability, and acceptability of these traditional processes at the household or community level, as well as the gaps in research, so that more effective policies and programs can be implemented to improve the quality and safety of complementary foods.

The U.S. infant formula industry: is direct-to-consumer advertising unethical or inevitable?

Throughout their history, U.S. based infant formula companies have promoted their products as though they required a prescription. This form of marketing is called "ethical" promotion, which focuses on gaining a physician to parent recommendation for a brand of infant formula. Until Nestle's entry into the U.S. infant formula market in 1988, there was little direct-to-consumer promotion of infant formula. This article provides a background on the history of infant formula practices in the United States and then focuses on a descriptive model to explain how mothers' make their infant formula selection. Finally, we offer suggestions for the "ethical" marketers of infant formula.

Behavioral aspects of development of eating behavior and nutrition status.

Studies on the development of eating behavior in rural India indicated that mothers of young children made food choices that fit into their budgets, and were also influenced by new information. Their choices were still immersed in traditional beliefs, some of which had positive effects on nutrition. Specific childrearing behaviors influenced positive deviance in the growth and psychosocial development of infants and preschoolers. A life-cycle approach to the development of eating behavior that deciphers needs at each stage and linkages between stages is necessary. Cost-benefit needs to be considered when devising strategies for future intervention programs.