Barbara Davis Goldman, Judith B. Borja, Lorraine C. Taylor, and Margaret E. BentleyThe University of North Carolina at Chapel HillEarly Infant Feeding Practices: Impact of Informational Support With African American WIC-Eligible First-Time Mothers
American Academy of Pediatrics Policy
Statement: Breastfeeding and the Use of
Human Milk *
- Breastfeeding recommended for all infants if not specifically contraindicated.
- Exclusive breastfeeding (with no other liquids or solids) for approximately the first 6 months is optimal. Breastfeeding should be continued along with other foods for at least the first year and beyond, as long as mutually desired by mother and child.
- Complementary foods rich in iron should be introduced gradually beginning around 6 months of age, though individual infants may need them as early as 4 months and others may not be ready until 8 months of age. During the first 6 months, water and juice are unnecessary and may be unwise.
* Pediatrics, Vol. 115, No. 2, February 2005
Breastfeeding Initiation and Informational Support*
- There has been a significant rise in the risk of child overweight and obesity, especially in minority populations. Current research suggests that genetic, cultural, and social environments have important influences on this phenomenon.
- One aspect of the social environment not very well explored is how informational support – information received from support networks as well as intervention programs – influences feeding decisions and behaviors that could potentially increase the risk of overweight among infants.
- In this study we examine the relationship between informational support (number and type of infant feeding information sources) and infant feeding practices among first-time African-American mothers for whom informational support may play an important role.
- We use data from the Infant Care, Feeding, and Risk of Obesity Study, an ongoing longitudinal study that examines a broad range of factors associated with the risk of obesity in the first two years of life. The study collects extensive data on feeding styles, maternal and infant nutrient intakes, infant temperament and other child outcomes.
- First-time African-American mothers are recruited from WIC clinics in Durham, Orange, and Wake Counties in North Carolina. These mothers and their infants are followed postpartum with in-home visits at 3, 6, 9, 12, and 18 months. There were 217 mothers recruited at baseline.
- This study presents data from the 3-month survey using a sample of 194 mothers for whom we have complete data at 3 months for this analysis
WIC: Special Supplemental Nutrition Program for Women, Infants, and Children*
Population Served: low-income, nutritionally at risk pregnant and post-partum women
Loving Support Makes Breastfeeding Work is the WIC breastfeeding promotion campaign, national in scope and implemented at the state level. The goals of the campaign are to encourage WIC participants to INITIATE and CONTINUE breastfeeding. WIC mothers choosing to breastfeed are provided information through counseling and educational materials.
WIC mothers are encouraged to breastfeed if possible, but WIC provides iron-fortified infant formula for mothers who choose this feeding method. Participants generally receive checks or vouchers to purchase specific foods each month that are designed to supplement their diets. In addition to infant formula (iron-fortified or special therapeutic formulas), WIC foods include iron-fortified infant cereal and adult cereal, vitamin C-rich fruit or vegetable juice, eggs, milk, cheese, peanut butter, dried beans/peas, tuna fish and carrots.
*WIC is administered by the Food and Nutrition Service of the US Department of Agriculture (from www.fns.usda.gov/wic/)
* Logistic regression results (presented as Odds Ratios)
** Models controlled for: maternal age, household size, work status, maternal education, depressive symptoms score (marital status excluded – all non-single mothers initiated breastfeeding)
- INITIATION of breastfeeding was associated with participation in maternal/child health research studies. Intensity of exposure to informational support (i.e. number of interventions and number of info sources) rather than specific sources appear to have a weak influence on initiation of breastfeeding (the relationship approaches significance).
- Neither CONTINUATION of breastfeeding at 3 months, nor INAPPROPRIATE FEEDING PRACTICES at 3 months, was associated with measures of informational support.
- The message about initiating breastfeeding is being received, but additional efforts supporting continuation of breastfeeding are necessary.
- Inappropriate feeding (solids and liquids other than milk at 3 months) is common in this sample. Informational support doesn’t appear to influence this behavior. Clearly other factors are contributing, which need to be addressed to modify this potentially obesigenic pattern.
Initiation of breastfeeding
- Initiation of breastfeeding was surprisingly high, given that low-income African American women have the lowest breastfeeding rates in the US.
- For these first-time WIC-eligible African American mothers, 71% of the total group (all 24 married mothers and 67% of the single mothers) initiated breastfeeding.
- Of those who initiated breastfeeding, only 12% stopped breastfeeding in a week or less
- But only 23% of the total group were still breastfeeding even occasionally at 3 months.
How 3 month old infants are fed in this sample
BF+ SJ 1.03%
BF ONLY 6.70%
BF+ FORM 3.61%
BF + FORM +
FORMULA + SOLIDS/JUICE 63.92%
* Multiple sources of information are ranked; first source mentioned considered as source most relied on
Infant Care, Feeding, and Risk of Obesity, M. E. Bentley, PI
NICHD 5 R01 HD042219
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