Breastfeeding practices and head circumference in young children: a systematic review

ABSTRACT OBJECTIVE To review observational studies on the association between breastfeeding (BF) practices and head circumference (HC) of children < 2 years old. METHODS A systematic review was conducted using the following electronic databases of health sciences: PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs), Web of Science and Scopus. We selected observational studies published in any language from January 01, 2010 to November 19, 2021, from different populations that investigated the association between BF practice and HC among healthy children < 2 years old. Titles and abstracts were screened independently by two evaluators. RESULTS From the 4,229 articles identified, 24 were included in this review: 6 cross-sectional, 17 longitudinal, and 1 case-control. The studies varied in their definition of the variables for BF and in reporting its practice, frequency, duration, and feeding method. Regarding HC, the authors analyzed the mean differences, abnormal values (z-score above + 2SD or below -2SD according to the World Health Organization (WHO) growth standards, 2007), and longitudinal growth parameters. The findings of this review suggest that BF may have a positive relationship with HC at the beginning of life. CONCLUSIONS Our findings suggest that BF, especially exclusive BF, may play a protective role against abnormal HC values in young children. However, more robust evidence with standardized BF indicators and WHO growth standards (2007) are required.

Infant feeding knowledge and practice among HIVpositive mothers attending HIV treatment centres in Lagos

Background: Twenty five to forty percent of children will be infected with HIV in the absence of any form of intervention which is Prevention of Mother to Child Transmission (PMTCT). Objectives: This study determined the infant feeding knowledge and practices among HIV positive mothers attending HIV treatment centers in Lagos. Methods: A descriptive crosssectional design was used for the study. A multistage sampling technique was used to select / recruit 290 HIV positive mothers with babies between the ages of 2weeks to 18months, attending PMTCT services into the study Pre-tested interviewer administered structured questionnaire was used to collect data and analysis was done using Epi-info software. Chi-square and Fischer exact tests were used to determine association between the dependent and independent variables. The pvalue was set at 0.05. Results: Majority of the respondents (58.9%) were within the age range of 31 ­ 40 years and about half had a secondary school level of education. Exclusive formula feeding (40.3%) and exclusive breast feeding (42.4%) were feeding options known by the majority of the respondents. More than half (55.5%) of the mothers had a good knowledge of infant feeding options. Exclusive breastfeeding (EBF) was practiced by majority (55.5%) of the respondents, 21.4% practiced exclusive formula feeding (EFF) while only 6% practiced mixed feeding (MF). Knowledge of infant feeding options and the attitude towards exclusive breast feeding being enough in the first 6 months of life were associated with infant feeding options practiced; those with good knowledge of infant feeding options did not practice MF (9.7%) (p = 0.013). Conclusion: knowledge of infant feeding options was good and poor knowledge was associated with exclusive formula feeding. Majority practiced EBF. Educational programmes targeted at improving the knowledge of HIV and infant feeding options as well as strengthening of counseling sessions at PMTCT clinic would help reduce the risk of HIV transmission to the child.

A perspective on partially hydrolyzed protein infant formula in nonexclusively breastfed infants / 소아과

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow's milk and processed to adjust for the nutritional needs of infants. However, cow's milk is one of the most common causes of food allergy, affecting 2%–5% of all formula-fed infants during their first year of life. One strategy to prevent cow's milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

Middle East Consensus Statement on the Diagnosis and Management of Functional Gastrointestinal Disorders in <12 Months Old Infants / 대한소아소화기영양학회지

This paper covers algorithms for the management of regurgitation, constipation and infantile colic in infants. Anti-regurgitation formula may be considered in infants with troublesome regurgitation, while diagnostic investigations or drug therapy are not indicated in the absence of warning signs. Although probiotics have shown some positive evidence for the management of functional gastrointestinal disorders (FGIDs), the evidence is not strong enough to make a recommendation. A partially hydrolyzed infant formula with prebiotics and β-palmitate may be considered as a dietary intervention for functional constipation in formula fed infants. Lactulose has been shown to be effective and safe in infants younger than 6 months that are constipated. Macrogol (polyethylene glycol, PEG) is not approved for use in infants less than 6 months of age. However, PEG is preferred over lactulose in infants >6 months of age. Limited data suggests that infant formula with a partial hydrolysate, galacto-oligosaccharides/fructo-oligosaccharides, added β-palmitate may be of benefit in reducing infantile colic in formula fed infants in cases where cow's milk protein allergy (CMPA) is not suspected. Evidence suggests that the use of extensively hydrolyzed infant formula for a formula-fed baby and a cow's milk free diet for a breastfeeding mother may be beneficial to decrease infantile colic if CMPA is suspected. None of the FGIDs is a reason to stop breastfeeding.

Alimentación con fórmula de inicio a libre demanda contra capacidad gástrica durante el periodo de transición / On demand infant formula vs. gastric capacity during the neonatal transition period

Introducción: La indicación del aporte por fórmula al recién nacido puede ser a libre demanda (LD) o por capacidad gástrica calculada (CGC). El objetivo de este trabajo fue determinar si la técnica de alimentación (LD vs. CGC) influye en el volumen ingerido, la tolerancia a la fórmula y el riesgo de hipoglucemia. Métodos: Se diseñó un ensayo clínico abierto no aleatorizado en neonatos a término, sanos, vigilados durante 24 h. Se determinó el volumen total ingerido (ml/kg), la tolerancia oral (vómitos-regurgitaciones, perímetro abdominal), la repercusión en el peso y datos de hipoglucemia. Resultados: Se analizaron en total 154 neonatos (CGC = 90 y LD = 64). Los neonatos en LD consumieron una mayor cantidad de fórmula (8 ml/kg; IC 95% 5-11) con mayor variación entre toma. No hubo diferencias en el porcentaje de pérdida ponderal (2.1% vs. 2%, p = 0.80). Los neonatos en LD mostraron más vómito (17.2% vs. 6.7%, p = 0.02) y mayor distención abdominal (43.8% vs. 22.2%, p = 0.007). Solo un neonato del grupo CGC mostró hipoglucemia (p = 1). Conclusiones: La alimentación por CGC permite una ingesta constante con menor riesgo de intolerancia, sin aumentar la posibilidad de hipoglucemia o pérdida de peso.

Background: Newborn formula feeding can be given ad libitum (AL) or as calculated gastric capacity (CGC). The objective of the study was to determine if the technique used to offer the newborn formula (AL vs. CGC) modifies volume intake, tolerance and risk for hypoglycemia. Methods: The study design was an open, nonrandomized clinical trial. Patients were healthy term newborns. All newborns were followed for 24 h. We determined the total volume ingested (ml/kg), oral tolerance (vomiting, regurgitation, abdominal circumference), impact on weight and hypoglycemic events. Results: One hundred fifty four infants were included (CGC = 90 and AL = 64). The AL group consumed slightly more formula (8 ml/kg, 95% CI 5-11) with greater variation between intakes. There was no difference in the percentage of weight loss (2.1% vs. 2%, P = 0.78). AL group also showed more vomiting (17.2% vs. 6.7%, P = 0.02) and increased abdominal distension (43.8% vs. 22.2%, P = 0.007). Only one newborn in the CGC group had hypoglycemia (P = 1.00). Conclusions: CGC feedings allows constant intake with less risk for intolerance without increasing the possibility of hypoglycemia or weight loss.

Pregnancy, delivery mode, and infant feeding among HIV-infected women in China: A meta-analysis / 第二军医大学学报

Objective: To know about the ongoing pregnancy rate, cesarean section rate of HIV-infected pregnant women and formula feeding rate of their infants in China during 2003-2011. Methods: Databases including PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang Database (WF) and Chinese Biological Medical Literature Database (CBM) were searched from the date of their establishment to May 2013; the literatures published in both Chinese and English reporting ongoing pregnancy, cesarean section of HIV-infected pregnant women, or formula feeding of their infants were collected. Then according to the inclusion criteria, two researchers independently screened the literature, extracted the data and assessed the quality of the included articles. Meta-analyses were conducted using the Comprehensive Meta-Analysis software (V2.0, Biostat, Englewood, New Jersey). Meta regression analysis was conducted to identify the source of heterogeneity. Results: Of the total 2 356 records, 61 eligible articles were finally included. The results of meta-analysis showed that nationally, the rate of pregnancy continuation rates among HIV-infected pregnant women during 2003-2011 were 67.50% (95%CI[51.73%, 80.10%]), 60.49% (95%CI[18.59%, 91.13%]), 51.80% (95%CI[28.13%, 74.68%]), 62.59% (95%CI[54.60%, 69.96%]), 64.93% (95%CI[50.18%, 77.29%]), 70.65% (95%CI[62.20%, 77.88%]), 65.66% (95%CI[59.70%, 71.16%]), 67.85% (95%CI[52.66%, 80.02%]), and 75.00% (95%CI[59.46%, 85.99%]), respectively; the caesarean section rates among these women during 2004-2010 were 26.33% (95%CI[9.41%, 55.14%]), 43.40% (95%CI[34.30%, 52.96%]), 42.57% (95%CI[35.73%, 49.70%]), 69.43% (95%CI[13.48%, 97.07%]), 46.68% (95%CI[27.27%, 67.16%]), 61.14% (95%CI[49.37%, 71.75%]) and 56.60% (95%CI[36.36%, 74.85%]), respectively; and the formula feeding rates of exposed infants were kept at relatively high levels (90.00% above) for all the years except for 2005, which was 82.65%. Conclusion: The overall rate of pregnancy continuation of HIV-infected pregnant women represents an increase in recent years in China; the cesarean section rate is high, fluctuating and increasing; the formula feeding rate of their infants keeps stable at a high level.

Nutritional Status and Eating Behavior of Lactating Women in Daejeon / 대한지역사회영양학회지

Nutrients intake status of 73 lactating women, that is 45 breast feeding (BF), 13 formula feeding (FF) and 15 mixed feeding (MF), living in Daejeon was investigated. Self-recorded food intakes for two weekdays and eating behaviors using questionnaires were surveyed from May to August 2008. Subjects aged 29.2 +/- 3.4 years and their infants aged 8.2 +/- 3.2 months. Body mass index of the subjects was 21.0 +/- 3.2. Of the subjects 23.3% were employed. Daily energy intake was 1953 +/- 391 kcal. Mean adequacy ratio (MAR) was 0.77 +/- 0.14 and was higher in FF (0.86 +/- 0.13) than in BF (0.76 +/- 0.11) and MF (0.72 +/- 0.18). Nutrients that over 50% of the subjects took less than estimated average requirement were vitamin A, riboflavin, folate, vitamin C and calcium. And index of nutritional qualities of those 5 nutrients were below one Forty six and sixths percent (46.6%) of the subjects showed GMFVD = 11111 pattern of five food group intakes and 57.5% took meals three times daily, 56.2% skipped often breakfast, and 64.4% dined out two times and more per week. Subjects having lower MAR ( or = 0.83, n = 24), showed more skipping daily meals and less frequency of eating-out, and took less legumes, vegetables, fishes, and milk. As the results, intakes of calcium, vitamin A, riboflavin, folate, and vitamin C were insufficient in lactating women, especially in BF and MF mothers. Meal skipping and low intakes of dairy foods, legumes, vegetables, and fishes might have adverse influences on nutritional status of lactating women. Accordingly, nutrition care program for lactating women should be focused on intake of three meals daily and a variety of food.

Lactancia materna vs. alimentación con fórmulas lácteas. Estudio comparativo de sus efectos en el desarrollo psicomotriz en niños entre 6 a 24 meses de edad, realizado en el hospital Guayaquil Abel Gilbert Pontón, octubre 2004 - marzo 2005 / Breastfeeding vs. Formula feeding. A comparative study of its effects on motor skills of children between 6 to 2 months at Abel Gilbert Pontón Hospital in Guayaquil: october 2004 – march 2005

Tipo de estudio: Casos y controles. Objetivo General: Evaluar el desarrollo motor, cognoscitivo y psicosocial de niños entre 6 y 24 meses, que recibieron lactancia materna o alimentación con fórmulas lácteas, durante los primeros 6 meses de vida. Específicos: Determinar el porcentaje de madres que dan lactancia materna a sus hijos los primeros 6 meses de vida. Determinar el porcentaje de madres que dan alimentación con fórmulas lácteas a sus hijos, durante los primeros 6 meses de vida. Establecer el cociente madurativo y número de banderas rojas, en niños de 6 a 24 meses de vida de acuerdo al tipo de lactancia recibida. Resultados.- De los 66 niños entre 6 y 24 meses de edad, 15 fueron alimentados exclusivamente durante los primeros 6 meses de vida con fórmulas lácteas, mientras que los 51 restantes con leche materna. En lo que respecta a la valoración del cociente madurativo, en el dominio motor de los niños alimentados con leche materna, presentó un promedio de 100 puntos en la escala de desarrollo, mientras que los lactados con fórmulas fue de 94 puntos. En el dominio cognoscitivo, los niños alimentados con leche materna obtuvieron un promedio en el cociente madurativo de 99 puntos, mientras que los alimentados con fórmulas, 90 puntos. El dominio psicosocial los lactados maternalmente 98 puntos; y los alimentados con fórmulas, un promedio de 93 puntos. En la relación porcentual del número de banderas rojas (signos de alarma que sugieren retraso en el desarrollo), hubo un mayor número en el grupo de los alimentados con fórmulas, predominando aun más en el dominio cognoscitivo. Conclusiones.- Existieron en el estudio, mas niños lactados maternalmente, que alimentados con fórmulas durante los primeros 6 meses de vida. Se obtuvo mejores cocientes madurativos en el grupo de niños alimentados con leche materna en los dominios motor y sobre todo cognoscitivo, a excepción del dominio psicosocial, en el cual no se rechaza

Type of Study: Case ControlObjectives General: Evaluate development of motor, cognoscitive and psychosocial skills of children between 6 to 24 months that were breastfed or formula fed during the first 6 months of life.Specific:a)To determine the percentage of mothers that breastfed their children the first 6 months of life.b)To determine the percentage of mothers that formula feed their children during the first 6 months of life.c)To establish the coefficient of development and number of red flags in children between 6 to 24 months of life depending on the type of nutrition received. Results: Total of 66 children between 6 to 24 months, 15 were formula fed during the first six months while 51 were breastfed. Children that were breastfed they had an average of 100 points in motor skills while children that were formula fed had 94 points on the development scale. In the cognoscitve skills children that were breastfed had 99 points on the development scale while children that were formula fed had 90 points. In the psychosocial aspect children that were breastfed had 98 points and that were formula fed had 93 points. In the percentage of red flags in development there was a greater number in children that were formula fed.Conclusions:In this study there were more children breastfed that formula fed in there first six months. Overall, children that were breastfed had better motor and cognoscitive skills. An exception was psychosocial skill where there was no difference between the two groups. In the percentage of red flags in development there was a greater number in children that were formula fed.

Growth Patterns of Breast Fed and Formula Fed Infants / 소아과

PURPOSE: The purpose of this study is to compare the growth pattern of breast fed and formula fed infants in the first 1 year of life. METHODS: Anthropometric data (weight, length, head circumference) of at birth, 1, 3, 6, 9 and 12 months were collected by chart review and characteristics of subjects were collected by questionnaires. Among 358 infants, breast fed infants were 161 (84 males, 77 females) and formula fed infants were 90 (42 males, 48 females). Neither group was given solid foods before 4 months. The weight for age, length for age and head circumference for age were calculated. Breast fed infants were separated into 2 groups (breast fed for 4-11 months and breast fed for more than 12 months). RESULTS: Characteristics of infants and mothers were similar in both groups except for maternal age. Mean weight of breast fed group was lower than that of formula fed group at 12 months of age (male: P=0.004, female: P=0.004). However, mean weight of 12 months breast fed group was below formula fed groups weight at 9 and 12 months (P< 0.05). Mean length and head circumference were similar between groups. CONCLUSION: The growth indices of breast fed and formula fed infants are similar at birth, but weight curves of two groups differ in the first 1 year.

Influencia de la velocidad de crecimiento y tipo de alimentación láctea sobre la reserva corporal de hierro a los dos meses de edad

Introducción. El objetivo del estudio es establecer la influencia que tiene la alimentación láctea y la velocidad de crecimiento sobre la reserva de hierro (Fe) a los 2 meses de edad. Material y métodos. En un estudio longitudinal y aleatorio, se incluyeron a neonatos de término sanos, registrando las variables de crecimiento (peso, longitud supina, perímetro cefálico), así como los valores de hemoglobina (Hb) y ferritina sérica (FS) al nacimiento, 1 y 2 meses de edad, de acuerdo al tipo de alimentación láctea (materna, sucedáneos o mixta). Resultados. Se incluyeron 127 casos, con 57, 14 y 56 lactantes para cada grupo de alimentación. No ocurrieron diferencias estadísticas en la velocidad de crecimiento, entre los 3 grupos. Los valores promedio de Hb fueron de 19.6, 18.8 y 19.1 g/dL, de 14.3, 13.3 y 13.7 g/dL y de 12.0, 11.7 y 11.7 g/dL, para la FS los valores promedio fueron de 333, 297 y 347 µg/L, de 253, 277 y 258 µg/L y al segundo mes de edad 237, 227 y 243 µg/L, sin diferencias estadísticas. La prevalencia global de deficiencia de Fe fue de 3.9%. Conclusiones. Los preparados comerciales de la leche, fortificados con 12 mg/L de Fe, no presentan ventaja adicional a la leche materna, la velocidad de crecimiento corporal, valores de Hb y reserva de Fe a los 2 meses de edad.

Introduction. The objective of this study was to establish the influence of milk feeding and growth velocity on iron store at 2 months of age. Material and methods. In a longitudinal and randomized study, we included to healthy newborn, anthropometric data (weight, height, and cephalic perimeter), hemoglobin (Hb), and serum ferritin (SF) values at birth, 1 and 2 months of age were obtain according to type of milk feeding received (breast, formula fortified with iron at 12 mg/L or mixed). Results. We included 127 cases, with 57, 14 and 56 newborn for each group. No statistical differences were observed in growth velocity. The values average of Hb were of 19.6, 18.8 and 19.1 g/dL, of 14.3, 13.3 and 13.7 g/dL and of 12.0, 11.7 and 11.7 g/dL, for the FS the values average were of 333, 297 and 347 µg/L, of 253, 277 and 258 µg/L and 2 month of age 237, 227 and 243 µg/L, without statistical differences. The global prevalence of iron deficiency was of 3.9%. Conclusions. Milk formulas, fortified with iron at 12 mg/L, do no represent additional advantage in body growth, Hb values and iron store.

Infant Feeding Practices and the Factors that Influence Feeding Practices among Women in Seoul and the Chungbuk Area / 대한지역사회영양학회지

In order to obtain baseline data for the development of an educational program on breastfeeding, a survey was carried out to investigate infant feeding practices, the characteristics the subjects have in common, and the factors that influence the feeding methods among women in Seoul and the Chungbuk area. Subjects included 671 lactating mothers who visited public health centers or pediatric clinics between December 1999 and February 2000, and were interviewed using a questionnaire. The results were as follows : With respect to feeding methods, the incidence of breastfeeding, formula feeding, mixed feeding and formula feeding switched from breastfeeding was 20.6%, 29.8%, 11.6%, and 38.0%, respectively. With respect to the characteristics the subjects had in common, the incidence of women who planned their infants' feeding methods before pregnancy, during pregancy, and after delivery was 48.7%, 31.0%, and 20.3%, respectively. The incidence of women who started breastfeeding in the hospital after delivery was 38.8%. About seventy seven percet of the subjects had not previously attended an educational program on breastfeeding, and most of these wanted to participate in the future in an educational program to learn about breastfeeding. Some of the topics they were interested in were 'Nutritional Management for Sufficient Breast Milk' (60.3%), "Breast Care" (25.0%), and "Correct Nursing Positions" (9.8%). Most (88.2%) of the women who breastfeed suffered from physical discomforts including discomfort of the waist, and legs and discomfort due to cracked or sore nipples. "Insufficient breast milk" was the main reason for breastfeeding cessation or for switching to formula feeding. With respect to formula feeding practices, the main reasons for selecting a specific brand of formula were "the same brand the hospital used after delivery" (34.3%) and "an advertised brand" (23.3%). The strongest factor for promoting breastfeeding was "the support of husband or parents", next were "breastfeeding in the hospital after delivery" and "planning to breastfeed before pregnancy" in that order. The characteristics the subjects had in common relating to formula feeding were "mother's job", "high economic level", "Caesarian section" and "planning to breastfeed after delivery". In conclusion, it is recommended that breastfeeding be pro-moted, and educational programs be developed and offered as soon as possible to each group which had unfavorable attitudes toward breastfeeding. In addition, the monitoring and supervision of formula advertisements is required to protect consumers from the adverse effects of exaggerated advertising.

The Economic Benefits of Breastfeeding / 대한지역사회영양학회지

To compare the costs incurred by infant feeding between mothers who breastfed their infants and those who fed them infant formula, a questionnaire survey was carried out to 136 mothers living in Seoul, Cheongju and Chungju who breastfed and 199 mothers who formula-fed their infants. The cost of formula-feeding was estimated based on the expenditures for formula and feeding apparatus, and the time needed to wash bottles and prepare formula. The cost of breastfeeding was estimated based on the expenditures for food for the additional nutritional intake of these mothers. The mean cost of formula-feeding was 1,870,125won during the first year of the baby's life. The food cost for the additional nutritional intake of the breastfeeding mothers was 203,004 won per year. The extra medical cost for respiratory illnesses in the formula-fed group compared to the breastfed group was 62,920 won because the formula-fed infants required medical attention for respiratory illnesses more often than the breast-fed infants. Therefore, breastfeeding could save 1,730,041 won during the first year of an infant's life. We may have underestimated the cost savings from breastfeeding because we did not take into account the potentially decreased costs of fertility control and the health benefits for mothers, as well as the decreased usage of water and gas. Analyses showed that breastfeeding is not only nutritionally advantageous, but also economically advantageous for families and society.

Nationwide Survey on Current Status of Formula Feeding in Infants

PURPOSE: Although breast milk is considered the best source of nutrition for infants because of its superiority over powdered milk, there are circumstances when breast milk is unavailable. Committee on Nutrition of the Korean Pediatric Society conducted an investigation into the current status of formula feeding in Korea. METHODS: This investigation was conducted using questionnaires produced by our committee and distributed to mothers of children under the age of two who were using formula feeding at 10 university hospitals and 22 public health centers nationwide between March 1999 to September 1999. A comparative analysis according to location, birth order, mother's occupation, education, housing tenure and normal birth status was performed on all 2696 questionnaires using the chi-square test. RESULTS: Formula feeding was found in 49.4% and formula feeding combined with breast milk were 21.5% of the respondents. The percentage of formula feeding was higher in working mothers who underwent a Cesarean section in metropolitan areas. The inadequacy of breast milk was the most common reason for feeding powdered rnilk followed by the unhealthy condition of the mother and mother's return to work. Of those investigated, 94.9% said that they changed products at each stage as recommended by the manufacturer. Promotions for special formulas were more active in metropolitan areas than other areas, and 57.7M said that they used special formulas based on recornmendations by the doctor and acquaintances(15.5%) or after seeing an advertisement(14.0%). CONCLUSION: This investigation revealed that many rnothers were misinformed concerning formula feeding and pediatricians should provide mothers with education, shedding light on proper feeding methods.