Breastfeeding,
how...
Cochrane
reviews
Kramer
MS, Barr RG, Dagenais S, Yang H, Jones P, Ciofani L,
Jané F. Pacifier use, early weaning, and cry/fuss
behavior: a randomized controlled trial. JAMA
2001;286:322-6
Step 9 of
the Baby Friendly Hospital Initiative strongly discourages
the use of pacifiers because of its reported association,
in several observational studies, with early weaning.
But such studies are unable to determine whether the
association is causal. To test whether regular pacifier
use is causally related to weaning by 3 months postpartum,
a double-blind randomised trial was conducted in the
postpartum unit of a university hospital in Montreal,
Quebec, Canada, on 281 healthy, breastfeeding women
and their healthy, term singleton infants allocated
to 1 of 2 groups. A nurse trained in lactation counselling
recommended to avoid pacifier use and suggested alternative
ways to comfort a crying or fussing infant to the women
of the intervention group (IG; n = 140) but not to those
of the control group (CG; n = 141). A total of 258 mother-infant
pairs (92%) completed the follow-up. Compared to CG,
women in the IG significantly increased total avoidance
of pacifier use (38.6% vs 16.0%), reduced daily use
(40.8% vs 55.7%), and decreased the mean number of pacifier
insertions per day (0.8 vs 2.4 at 4 weeks; 0.8 vs 3.0
at 6 weeks; and 1.3 vs 3.0 at 9 weeks). In the analysis
based on random allocation, the intervention had no
discernible effect on weaning at 3 months (18.9% vs
18.3%), and no effect was observed on cry/fuss behavior.
When random allocation was ignored, however, a strong
association between exposure to daily pacifier use and
weaning by 3 months was observed (25.0% in the exposed
vs 12.9% in the non exposed infants). These results
strongly suggest that pacifier use is a marker of breastfeeding
difficulties or reduced motivation to breastfeed, rather
than a true cause of early weaning.
Hornell
A, Hofvander Y, Kylberg E. Introduction of solids
and formula to breastfed infants: a longitudinal prospective
study in Uppsala, Sweden. Acta Paediatr 2001;90:477-82
The introduction
of solids and formula was studied among 506 breastfed
infants in Uppsala, Sweden, based on daily recordings
during the first year. The mothers had previously breastfed
at least one infant for at least 4 months. Thirty-four
per cent of the infants were introduced to solids before
the age of 4 months (4-6 months is recommended in Sweden).
Accustoming the infants to solids was a lengthy process:
it took a median of 28 days from the first introduction
of solids to consumption of more than 10 ml daily, and
46 days before the infants ate 100 ml or more of solids
in one day for the first time. These durations were
longer the younger the infant was at the introduction
of solids. Thirty-two per cent of infants given formula
consumed 100 ml or more the first time it was given,
and 49% did so within one week, regardless of infant
age. Parents and healthcare personnel need to be aware
that accustoming breastfed infants to solid food is
a lengthy process, and that there is a strong age effect
on this duration. It is also important to consider what
consequences the (usually) more abrupt introduction
of formula might have on breastfeeding.
Black
MM, Siegel EH, Abel Y, Bentley ME. Home and videotape
intervention delays early complementary feeding among
adolescent mothers. Pediatrics 2001;107:E67
Is it possible
to change feeding habits in the presence of contradictory
cultural norms? To evaluate the effect of an intervention
to delay the early introduction of complementary feeding,
181 first-time, low-income, black mothers less than
18 years old, were recruited from 3 urban hospitals
in Baltimore, Maryland, USA. Infants were born at term,
with birth weight appropriate for gestational age and
no congenital problems. Shortly after delivery, mothers
and grandmothers completed a baseline assessment, and
mothers were randomized into an intervention (IG) or
control group (CG). IG mothers received home visits
every other week for 1 year, plus a videotape made by
an advisory group of black adolescent mothers. The intervention
focused on: 1) recognition of infants’ cues; 2)
non-food strategies for managing infant behaviour; and
3) mother-grandmother negotiation strategies. At 3 months,
a subset of 121 mothers reported on their infant’s
intake through a food frequency questionnaire. Mothers
who fed their infant only breast milk, formula, or water
were classified as optimal feeders (39%); those who
added complementary foods were classified as less optimal
feeders (61%). After controlling for infant age and
family income, mothers of infants in the optimal feeders
group were more likely to report accurate messages regarding
the timing of complementary food and nearly four times
more likely to be in the intervention group. The success
of this intervention shows the importance of using ethnographic
research to design programmes for behavioural change
in the face of contradictory cultural norms.
DiGirolamo
AM, Grummer-Strawn LM, Fein S. Maternity care practices:
implications for breastfeeding. Birth 2001;28:94-100
To assess
the impact of five Baby Friendly practices (early breastfeeding
initiation, no supplements, rooming-in, breastfeeding
on demand, no pacifiers) on breastfeeding in the USA,
a longitudinal mail survey was administered to a national
sample of women prenatally through 12 months postpartum.
The study focused on 1085 women with prenatal intention
to breastfeed for more than 2 months who initiated breastfeeding.
Only 7% of mothers experienced all five Baby Friendly
practices. The strongest risk factors for early breastfeeding
termination were late breastfeeding initiation and supplementing
the infant. Compared with mothers experiencing all five
Baby Friendly practices, mothers experiencing none were
approximately eight times more likely to stop breastfeeding
early. The need to work with hospitals to increase adoption
of the Baby Friendly practices is illustrated by the
small proportion of mothers who experienced all five
practices measured in this study.
Scott
J, Landers M, Hughes R, Binns C. Factors associated
with breastfeeding at discharge and duration of breastfeeding.
J Paediatr Child Health 2001;37:254-61
To identify
determinants of the initiation and duration of breastfeeding
amongst Australian women, a prospective cohort study
was carried out in 556 women in Perth and 503 women
from the Darling Downs area, Australia. Breastfeeding
at discharge was most strongly associated with perceived
paternal support of breastfeeding. Duration of breastfeeding
was most strongly associated with the length of time
a mother intended to breastfeed. Interventions that
aim to increase the length of time a woman intends to
breastfeed, and that highlight the role of the father
in successful breastfeeding, are recommended to help
achieve recommended targets for breastfeeding initiation
and duration.
Sikorski
J, Boyd F, Dezateux C, Wade A, Rowe J. Prevalence
of breastfeeding at four months in general practices
in south London. Br J Gen Pract 2001;51:445-50
To determine
the prevalence of breastfeeding at birth and at four
months in a sample of women from urban general practices,
its variation between practices, and relation to practice
population deprivation scores, a cross-sectional questionnaire
survey based on a random cluster sample of women with
infants aged four months in 25 general practices in
South London was carried out. Responses were received
from 1053 out of 1532 mothers (69%). Of these, 87% (897)
had breastfed at birth, while 59% (609) were still breastfeeding
their babies at four months. Mothers in rented accommodation
were less likely to breastfeed than owner-occupiers,
as were women of white, compared with those of black,
ethnic origin. Those who completed up to two years and
more than two years education after the age of 16 were
almost three times more likely to breastfeed at four
months than mothers whose formal education was completed
at or before 16 years. Practice-specific rates of breastfeeding
ranged from 71% to 100% at birth and 22% to 83% at four
months. Median age of starting solids was 16 weeks.
It is concluded that housing tenure, maternal education,
and ethnic group are significantly associated with breastfeeding
prevalence at four months.
Tappin
DM, Mackenzie JM, Brown AJ, Girdwood RW, Britten J,
Broadfoot M. Comparison of breastfeeding rates in
Scotland in 1990-1 and 1997-8. BMJ 2001;322:1335-6
In Scotland,
breastfeeding at 7 days of age increased by 6.4%, from
35.6% in 1990-1 to 42.0% in 1997-8. The largest increase
(11.5%) was seen in Edinburgh and the largest decrease
(5.5%) in Aberdeen. About 2.6% of the observed 6.4%
increase can be explained by increase in maternal age.
The target of 50% breastfeeding at 6 weeks of age by
2005 will not be met unless further health promotion
measures are implemented quickly.
Cochrane
reviews
Snowden
HM, Renfrew MJ, Woolridge MW. Treatments for breast
engorgement during lactation (Cochrane Review).
Cochrane Database Syst Rev 2001;2:CD000046
National
surveys have shown that painful breasts are the second
most common reason for giving up breastfeeding in the
first two weeks after birth in the UK. One factor contributing
to such pain can be breast engorgement. Views differ
as to how engorgement arises, although restrictive feeding
patterns in hospital are likely to have contributed
in the past. These differing views are reflected in
the range of solutions offered to treat engorgement
in breastfeeding mothers, and these treatments are assessed
in this review. Eight trials, involving 424 women, were
included. Three different studies were identified which
used cabbage leaves or cabbage leaf extracts; no overall
benefit was found. Ultrasound treatment and placebo
were equally effective. Use of Danzen (an anti-inflammatory
agent) significantly improved the total symptoms of
engorgement when compared to placebo as did bromelain/trypsin
complex. Oxytocin and cold packs had no demonstrable
effect on engorgement symptoms. Initial prevention of
breast engorgement, through competent counselling on
good latching, should remain the key priority.
Prepared
by the Geneva Infant Feeding Association (GIFA),
a member of the International Baby Food Action Network
(IBFAN)
Editors:
Marina Ferreira Rea, Adriano Cattaneo
Copies
of Breastfeeding Briefs sent upon request to GIFA, Avenue
de la Paix 11, 1202 Geneva, Switzerland,
Fax: +41-22-798 44 43, or to UNICEF country offices.
Available
also in French, Spanish, Portuguese and Arabic.
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