The world's children--the children's world. The Rosen von Rosenstein award.

I feel very honoured to have been selected for the Nils Rosén von Rosenstein award. My thanks are due to the Swedish Paediatric Society.

Why women don't breastfeed: a national survey.

UNLABELLED: Breastfeeding is a behaviour that is influenced by many complex factors and confounders. Various social and psychological factors may thus be missed in studies of the prevalence and duration of breastfeeding. The prevalence of breastfeeding is extremely high in the rich Scandinavian countries where the mothers are given paid maternity leave for at least one year. CONCLUSION: National and international women's organizations could improve the conditions for breastfeeding by pressing for a prolongation of the period of maternity leave worldwide.

Growth under privileged conditions of healthy Swedish infants exclusively breastfed from birth to 4-6 months: a longitudinal prospective study based on daily records of feeding.

AIM: In most studies the methodology used to study growth in relation to breastfeeding patterns cannot ensure that exclusive breastfeeding has in fact occurred since birth. The aim of this study was to investigate the growth of healthy infants in Sweden in whom exclusive breastfeeding for the first 4-6 mo was ascertained through daily feeding records and to compare the results with the World Health Organization (WHO) "12-month breastfed pooled data set" and the Euro-Growth references for exclusively breastfed infants, as well as with the National Center for Health Statistics (NCHS)/WHO reference. METHODS: 147 exclusively breastfed infants and 325 non-exclusively breastfed Swedish infants, with a birthweight of > or = 3 kg, were included. The mothers had previous breastfed at least one infant for at least 4 mo. Weight was recorded fortnightly and length monthly. RESULTS: Infants exclusively breastfed since birth showed similar growth in weight and height to that of the non-exclusively breastfed infants. During the first 6 mo of life the growth of exclusively breastfed infants was also similar to that of the infants regularly receiving formula at 12-16 wk of age, mostly in addition to breast milk. The monthly growth increments were fairly similar to those of the "WHO pooled breastfed data set" and the Euro-Growth references for exclusively breastfed infants. CONCLUSION: In an affluent society truly exclusively breastfed infants seem to have the same growth during the first half year of life as non-exclusively breastfed infants with a high breastfeeding rate.

Introduction of solids and formula to breastfed infants: a longitudinal prospective study in Uppsala, Sweden.

UNLABELLED: 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 1 infant for at least 4 mo. Thirty-four per cent of the infants were introduced to solids before the age of 4 mo (4-6 mo is recommended in Sweden). Accustoming the infants to solids was a lengthy process. Life-table analyses showed a median duration of 28 d from the first introduction of solids to consumption of >10 ml daily, and 46 d before the infants ate > or = 100 ml of solids in 1 d 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 > or = 100 ml the first time it was given, and 49% did so within I wk, regardless of infant age. CONCLUSION: 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.

Infant feeding practices during the first six months of life in a rural area in Tanzania.

OBJECTIVE: To assess breastfeeding practices in infants aged 0-6 months, focussing particularly on beliefs, knowledge and practices affecting exclusive breastfeeding. DESIGN: A house-to-house survey with individual interviews using a structured questionnaire, key informants interviews and focus group discussions. PARTICIPANTS: One hundred and seven mothers were interviewed, nearly all of those living in Nkinga community with infants less than seven months old. The focus group discussions and key informant interviews were also held. SETTING: Nkinga community, Igunga District, Tabora region, Tanzania. RESULTS: Sixty four per cent of the sample was put to the breast within two to eleven hours. Prelacteal feeds were given to about 25% of the infants. The type of prelacteal fluid given was mainly glucose water in hospital and plain water with home deliveries. Forty six per cent of the mothers discarded colostrum. The median duration of exclusive breastfeeding was about two months and of full breastfeeding was about four months. CONCLUSION: The average duration of exclusive breastfeeding, though far below recommended levels, is higher than is found in most studies in Africa and Tanzania. This may be due to the efforts of hospital staff who had received special training on breastfeeding in recent years.

Solids and formula: association with pattern and duration of breastfeeding.

OBJECTIVES: To study changes in pattern and duration of breastfeeding associated with the introduction of solids and formula. STUDY DESIGN: Descriptive longitudinal, prospective study. SETTING: The participants were recruited from the maternity ward in the University Hospital in Uppsala, Sweden, between May 1989 and December 1992. A total of 15 189 infants were born during the period, 1 177 mother-infant pairs were found eligible for participation; 57% declined because of the perceived high workload. Study Population. Five hundred six mother-infant pairs. METHODS: Daily recordings by the mothers on infant feeding, from the first week after delivery to the second menstruation postpartum or a new pregnancy; fortnightly home visits with structured interviews by a research assistant. RESULTS: Introduction of solids was associated with no or minor changes in breastfeeding frequency and suckling duration. Breastfeeding frequency remained constant the first month after the introduction and then declined slowly, while daily suckling duration started to decline slowly when solids were introduced. Breastfeeding duration was not associated with infants' age at introduction of solids. In infants given formula, as soon as regular formula feeds started, the breastfeeding frequency and suckling duration declined swiftly. The younger an infant was at the start of regular formula feeds, the shorter the breastfeeding duration. CONCLUSIONS: Health care personnel and parents need to be aware that introduction of solids and introduction of formula can have very different consequences for breastfeeding. If the aim is to introduce other foods to breastfed infants under the protection of breast milk, it is important to realize that formula is also another food and needs to be treated as such.

How exclusive is exclusive breastfeeding? A comparison of data since birth with current status data.

BACKGROUND: There is no accepted and widely used indicator for exclusive breastfeeding since birth. Indeed, the difference between 'current status' data on exclusive breastfeeding and data on 'exclusive breastfeeding since birth' is rarely recognized. We used data from a longitudinal study to examine this issue. METHODS: A descriptive longitudinal, prospective study design was used in which 506 mother-infant pairs were included. The mothers completed daily recordings on infant feeding during the first nine months after birth. A research assistant conducted fortnightly home visits with structured interviews. The resulting data on breastfeeding patterns are presented in two different ways: analysis of 'current status' data based on a single 24-hour recording of infant feeding at 2, 4 and 6 months of age, and analysis of data 'since birth', i.e. data on infant feeding for every day, starting from birth until the ages of 2, 4 and 6 months. RESULTS: A wide discrepancy between the results obtained from the two analyses was found. The difference in the exclusive breastfeeding rate was over 40 percentage points at both 2 and 4 months of age (92% versus 51% at 2 months and 73% versus 30% at 4 months) and 9 percentage points at 6 months (11% versus 1.8%). CONCLUSIONS: Current status indicators based on a 24-hour period may be inadequate and even misleading for many purposes. We propose that in many studies an indicator called 'exclusive breastfeeding since birth' could be added.

[Circumcision of boys--a child's right versus parents' right]. / Omskärelse av pojkar--barnets rättigheter står mot föräldrarnas.

Male circumcision was practiced long before Abraham established a covenant with God to the effect that he should circumcize himself and all male members of his house. Thereafter it has become a potent religion-ethnic commandment also in the Islamic world, although it is not mentioned in the Koran. Several million boys are circumcised yearly in for instance traditional Africa and the USA (in the USA originally as prophylaxis against masturbation). In Sweden the yearly figure is some 3000 boys. A comprehensive review of the literature reveals that there are no or only marginal medical benefits of the operation, particularly in view of the fact that up to 10% suffer complications, and also that newborns both experience pain and will respond more strongly to new pain stimuli for years to come. There are two opposing interests--those related to the religious tradition and those related to the welfare of the child as expressed in the United Nations Convention on the Rights of the Child.

Breastfeeding patterns in relation to thumb sucking and pacifier use.

OBJECTIVES: To analyze the influence of thumb sucking and pacifier use on breastfeeding patterns in exclusively breastfed infants, on the duration of exclusive breastfeeding, and on the total breastfeeding duration. STUDY DESIGN: Descriptive, longitudinal, prospective study. SETTING: The subjects were recruited from a population of 15 189 infants born in the maternity ward at the University Hospital, Uppsala, Sweden between May 1989 and December 1992. STUDY POPULATION: 506 mother-infant pairs. METHODS: Daily recordings by the mothers on infant feeding from the first week after delivery through the duration of the study. Fortnightly home visits with structured interviews by a research assistant. RESULTS: Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours, shorter duration of exclusive breastfeeding, and shorter total breastfeeding duration compared with no pacifier use. These associations were not found for thumb sucking. The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use. Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration. CONCLUSIONS: More frequent use of a pacifier was associated with shorter breastfeeding duration, even among a group of mothers who were highly motivated to breastfeed. breastfeeding duration, breastfeeding pattern, exclusive breastfeeding, pacifier use, thumb sucking.

Breastfeeding patterns in exclusively breastfed infants: a longitudinal prospective study in Uppsala, Sweden.

Exclusive breastfeeding was studied among 506 infants in Uppsala, Sweden, based on daily recordings during the first 6 mo. The mothers had previously breastfed at least one infant for at least 4 mo. Most of the mothers considered that they breastfed on demand. Wide variations in breastfeeding frequency and suckling duration were found both between different infants and in the individual infant over time. At 2 wk, the mean frequency of daytime feeds (based on one 13-d record) between different infants ranged from 2.9 to 10.8 and night-time feeds from 1.0 to 5.1. The daytime suckling duration (based on one 24-h record) ranged from 20 min to 4h 35 min and night-time duration from 0 to 2h 8 min. At any given age, a maximum of only 2% of the infants were not breastfed during the night. At 4 mo, 95% of the infants were breastfeeding and 40% were exclusively breastfed at this age. Longer breastfeeding duration and longer duration of exclusive breastfeeding were both associated with higher frequency of breastfeeds, longer breastfeeding of the previous child and higher education. No gender differences were found. Maternal smoking was associated with shorter duration of exclusive breastfeeding, and pacifier use was associated with shorter duration of both exclusive breastfeeding and total breastfeeding. This study confirms that every mother-infant pair needs to be understood as a unique dyad throughout lactation. These data demonstrate a wide range of patterns among women who are exclusively breastfeeding and indicate that it would be inappropriate to put pressure on individual families to adopt preconceived patterns of infant feeding.