Exploratory study: barriers for initiation and/or discontinuation of breastfeeding in mothers of children with Down syndrome.

BACKGROUND: The aim of the study is to identify the barriers associated with breastfeeding in mothers of Puerto Rican children with Down. METHOD: A non-probabilistic sample (n = 26) of mothers was used in the study. The sample was obtained in an institution in Puerto Rico specializing in care of infants with Down Syndrome [IDS]. A self-administered questionnaire was used consisting of six sections. Descriptive statistics were used for data analysis. RESULTS: The majority of interviewed mothers (80.8%) had 70.0% or higher correct answers regarding the benefits of breastfeeding. 84.6% of the mothers who decided not to breastfeed or who discontinued breastfeeding reported as the main reason that the baby presented sucking problems and 50.0% of the participants were not allowed to have their baby with them during their stay in the hospital. 84.3% of the participants indicated having breastfed their IDS and 61.5% stated that they would not breastfeed in public places. CONCLUSION: Active support, instruction, and collaboration among members of the health care team are essential for breastfeeding success.

Formula labeling violations to the WHO Code: a quantitative and qualitative analysis.

BACKGROUND: The WHO Code on Marketing of Breastmilk Substitutes is intended to be adopted as a minimum requirement by all governments and aims to protect infant health by preventing inappropriate marketing of breastmilk substitutes. Labels need to have correct and clear dispositions since they frequently are the only source of vital information for consumers regarding the content of the product and its uses. OBJECTIVE: The purpose of this study was to determine violations to the provisions of the International Code Article 9 regarding infant formula labeling existing in Puerto Rico. METHODS: A quantitative and qualitative evaluation of 34 labels of infant formula was done. Instrument 4-A of the IBFAN Monitoring Project (IMPIII) and the Standard IBFAN Monitoring (SIM) was utilized. This instrument included 14 criteria that identified violations to the International Code of Breastmilk Substitutes on labeling. Descriptive analysis was used for all variables. The 34 labels evaluated represent 77.3% of infant formula labels of the four companies which market them in the island. RESULTS: All the labels (100%) that were evaluated were found to violate the Code in one or more of its dispositions. Most striking violations include: a statement that breastfeeding is best is lacking in 73.5%, as well as a statement that the product should be used only on the advice of a health worker. None of the labels are written in Spanish, the local language. Text which may idealize the use of infant formula or discourage breastfeeding is present in 97.1% of the samples, and the same percentage has a photo or picture idealizing the use of infant formula. CONCLUSIONS: It is vital to produce legislation that implants the WHO Code in Puerto Rico in order to regulate indiscriminate marketing practices and their subsequent ill effects on children's health and breastfeeding practices.

Exploratory study: knowledge about the benefits of breastfeeding and barriers for initiation in mothers of children with spina bifida.

The aim of the study is to identify the level of knowledge on breastfeeding by mothers of infants with spina bifida and the barriers encountered in initiating breastfeeding. A non-probabilisitic sample (n=30) of mothers was used in this study. The sample was obtained in two institutions specializing in care for infants with congenital anomalies in Puerto Rico. A self-administered questionnaire was used consisting of six sections. Descriptive statistics were used for data analysis. Among participants, 56.7% had adequate knowledge on the benefits of breastfeeding. The most frequently encountered barriers in initiating breastfeeding were related to the neonatal intensive care unit (NICU). Problems with the medical and nursing procedures, routines, support from personnel, and adequacy of the environment were the most frequent. It is important to develop a education to encourage nurses and other health care professionals need suggest, support and encourage breastfeeding to mothers of infants with neural tube defects.

Puerto Rican primary physicians' knowledge about folic acid supplementation for the prevention of neural tube defects.

BACKGROUND: We conducted a study of a group of primary physicians in Puerto Rico to evaluate their knowledge about folic acid supplementation to prevent neural tube defects. METHOD: The study design was transverse-correlational. A total of 66 primary physicians in two hospitals (public and private) participated in the study. The sample was nonrandom and opportunistic, and only those physicians present in the hospitals at the moment of distribution of the questionnaires participated. A self-administered and anonymous questionnaire was used. Descriptive statistics and cross-tabular analysis were used to describe the results of this study. Inferential statistics were also used, including Chi square and t-tests to establish the associations/differences between physician knowledge and the independent variables. RESULTS: Of the participants, 87.9% demonstrated an inadequate knowledge about folic acid supplementation for the prevention of neural tube defects as part of preconception care and only 12.1% demonstrated adequate knowledge. Older physicians had greater knowledge about folic acid. Also, women demonstrated greater knowledge about folic acid than did men. Most of the physicians who always recommend supplementation to their patients demonstrated a greater knowledge about folic acid, and all participants with adequate knowledge came from the public hospital. CONCLUSIONS: Despite a concerted effort by the Health Department of Puerto Rico to provide education in the importance of folic acid supplementation to reduce the incidence of neural tube defects, primary physicians in two Puerto Rican hospitals generally have not availed themselves of this training and showed a lack of knowledge on this important clinical issue.

Knowledge about breastfeeding in mothers of infants with gastroesophageal reflux.

Infants with gastroesophageal reflux disease (GERD) who are breastfed have significantly shorter clinical episodes of the condition than artificially fed infants. The purpose of this study was to identify the knowledge about the benefits of breastfeeding in mothers of babies 0-12 months of age with gastroesophageal reflux. A non-probabilistic sample was taken among patients from various private radiological centers. Sixty mothers completed a self-administered questionnaire, with a median age of 26 years and an educational level of 14 years. Seventy one percent breastfed their last baby, but only 18.6% practiced exclusive breastfeeding. The pediatrician suggested formula to 53.3% of the mothers, and 64% of the mothers were told to combine breast milk with vegetables as treatment for the GERD. Inadequate knowledge about the benefits of breastfeeding was exhibited by 27% of the mothers. Mothers of infants with GERD need education on the importance of breastfeeding. Further research is necessary on the factors which impact the duration of breastfeeding in this population.

Profile of calls to a breastfeeding clinic information and help telephone line

Breastfeeding mothers need orientation and help in order to succeed with breastfeeding. Lack of support from health professionals and societal barriers result in a median duration of breastfeeding in Puerto Rico of only 3 weeks. A telephone warm line at our breastfeeding clinic tries to provide some much-needed support and orientation. The purpose of this study was to determine the principal reasons for calls to the warm line and the action taken by the counselor. Five hundred and thirty three calls were received in a 4-month period. They were handled by certified lactation educators who gathered demographic and feeding information from the mother and registered the action taken. Descriptive analysis was used with crosstabs tables and multi-response analysis; chi-square test was used to establish the association between variables. 78.7 of callers were breastfeeding fully, while 21.3 were breastfeeding partially or formula feeding, 62.8 of the babies were 2 months old or less. 68.8 of the calls originated in the metropolitan San Juan area. The source of the referral was family/friend in 64.2 of calls, while only 9.8 of the callers were referred by a physician, 3.0 by hospital personnel and 2.0 by other health care providers. Significant differences between full breastfeeders and partial or artificial feeders were found in calls related to position (p = 0.01), engorgement (p = 0.04), breast refusal (p = 0.001), product information (p = 0.02), medications (p = 0.009), breastmilk management and storage (p = 0.001), and relactation (p = 0.02). Actions taken by the counselor included orientation, referral to breastfeeding specialist physician and referral to breastfeeding support groups or classes. Results indicate that more active promotion of referral to breastfeeding support groups or classes is warranted since this action was taken in only 14.5 of fully breastfeeding mothers and 12.6 of partial breastfeeding or formula users. Promotion of the warm line among physicians, hospitals and other health care professionals is also needed.

The management of labor and delivery and its implications for breastfeeding

The main professional organizations of obstetrical and pediatric care providers in the United States and Puerto Rico have issued official position papers in favor of breastfeeding. Routine labor and delivery practices, however, constitute frequent barriers for the initiation, type and duration of breastfeeding. Many of these practices, moreover, lack the scientific basis to justify their routine use. We analyze in this article some of the most common obstetrical practices and their impact on breastfeeding.

La lactancia materna en Puerto Rico: patrones tradicionales, tendencias nacionales e estrategias para el futuro / Breast feeding in Puerto Rico: traditional patterns, national trends and future strategies

The Puerto Rican society has gone through profound transformations during the past 50 years. Industrialization and the incorporation of women into the labor force have been accompanied by medicalization of the reproductive process and a progressive reduction in the prevalence of breastfeeding as the cultural norm for nutrition of infants. The data base for 1990 places Puerto Rico significantly below Latin America and the United States in the percentage of reastfed infants. The authors report their experience in the promotion of reastfeeding during the last 5 years. The principal negative factors which inder the beginning and maintenance of successful breastfeeding are of a social nature. The orientation of physicians towards technology underrates the benefits of breastfeeding. The marketing strategies of the corporations which manufacture artificial milk continuously violate the International Code for Marketing of breast Milk Substitutes and disfigure the community's perception on the benefits of breastfeeding. The lack of social and legal support for the breastfeeding working mother frequently prevents her from carrying out successful breastfeeding for the recommended period of time. Strategies are presented for the overturn of the existent barriers which have reduced breastfeeding in Puerto Rico to the present precarious levels