Observations and Conversations: Home Preparation of Infant Formula Among a Sample of Low-Income Mothers in the Southeastern US.

OBJECTIVE: Explore infant formula preparation attitudes and beliefs among low-income, formula-feeding, Southeastern US mothers. DESIGN: Cross-sectional study using in-home observations and in-depth interviews. SETTING: Participant homes. PARTICIPANTS: Thirteen low-income mothers of normal birth weight, healthy, term infants aged ≤3 months, who were predominantly feeding powdered or from-concentrate formula. VARIABLES MEASURED: Reading formula preparation instructions; order of added ingredients; leveling powdered formula scoop(s); adding cereal or other ingredients to bottles. PHENOMENON OF INTEREST: Perceptions of formula preparation or manipulation. ANALYSIS: Descriptive statistics described sample characteristics and home observation variables. Thematic analysis of in-depth interviews revealed the following major themes: formula preparation can be intimidating; expressions of complex heuristic perceptions about formula preparation; cost and convenience motivate maternal behaviors; and infant cues override recommendations. Data from qualitative and quantitative activities were triangulated. RESULTS: Behaviors, including improper reconstitution and modifications/additions to prepared formula (eg, infant cereal) were observed during home observations and/or described during in-depth interviews. Inconsistencies were detected between observed behaviors (eg, adding too much water to the bottle) and those reported during in-depth interviews (eg, stating over-dilution could be detrimental to the infant's health). CONCLUSIONS AND IMPLICATIONS: Targeting knowledge or skills gaps and behavioral motivators in the formula-feeding population could positively affect infant-feeding practices that occur outside of recommendations.

Maternal reported indicators and causes of insufficient milk supply.

BACKGROUND: Although the breastfeeding initiation rate is high in China, exclusivity is low. Not having enough breast milk has been frequently reported as a reason for supplementing and weaning. OBJECTIVE: The objective was to explore maternal perception of indicators and causes of self-reported insufficient milk supply (IMS) among a sample of southwestern Chinese mothers. METHODS: This was a cross-sectional study, conducted in a hospital in Chengdu, China. RESULTS: The majority of mothers were of Han ethnicity and primiparous. Most initiated breastfeeding (n = 325, 95.3%). Among mothers who had weaned by the time of questionnaire completion, more than half (n = 52) reported IMS as a reason, and 53.8% of these mothers reported this occurring during the first 2 days postpartum. Mothers often identified IMS by using less sensitive indicators of adequate intake such as receiving a hungry look from the infant after nursing (34.6%) and not feeling the presence of milk (28.8%). More sensitive indicators of adequate intake, such as the number of wet/soiled diapers, were not reported. More than a third of mothers (39.2%) could not express a reason for the occurrence of IMS. Among those who identified reasons, nearly one-fourth of mothers attributed IMS, at least partially, to dietary factors such as poor appetite (23.5%). CONCLUSION: Self-reported IMS appears to be a common barrier to breastfeeding continuation among this sample of Chinese mothers. Culturally appropriate intervention, designed to inform mothers how to correctly identify and address IMS, might be an effective strategy to support optimal infant-feeding behaviors in China.

Breastfeeding Knowledge, Attitudes, and Intention in a Sample of Undergraduate Students in Mainland China.

BACKGROUND: Despite the high breastfeeding initiation rate in China (> 90%), the low exclusivity rate is of concern. Some traditional behaviors, combined with increasing popularity of infant formula, may negatively affect future breastfeeding rates. As suggested by the theory of planned behavior, understanding breastfeeding beliefs of young adults may help identify and address misperceptions of future parents, supporting maintenance of the current initiation rate while increasing rates of exclusivity and duration. No research has evaluated these factors among young adults in Mainland China. OBJECTIVE: The objective was to explore any relationships between breastfeeding knowledge, attitudes, previous experiences, and future intention among undergraduate students in Mainland China. METHODS: This was a cross-sectional, quantitative study conducted from May to June 2012. A convenience sample of 395 students from a major public university in southwest China participated in the survey. RESULTS: Breastfeeding knowledge was moderate (76.7% of total score), and breastfeeding was considered to be painful (34.2%), to make breasts sag (43.1%), and to restrict the freedom of mothers (52.5%). In addition, 58.2% of students reported that they would feel embarrassed if they or their partners were to breastfeed in public, and acceptability of breastfeeding in public was low (34.7%). Three-fourths of the students (75.1%) expressed future breastfeeding intent, though males were more likely to report this intention (ie, to support a partner in breastfeeding) than were females (81.3% vs 71.7%, P = .04). CONCLUSION: To create a more breastfeeding-friendly culture, future research is warranted to explore these negative beliefs about breastfeeding and to counter misunderstandings among future parents in Mainland China.

Breastfeeding knowledge, attitudes, prior exposure, and intent among undergraduate students.

BACKGROUND: Understanding breastfeeding knowledge, attitudes, and exposures among nonpregnant youth who are likely to be future parents may provide significant pathways to successfully increasing breastfeeding as the normal, accepted way of feeding infants. However, based on a recent review of the literature, only 3 studies have assessed these factors in nonpregnant, young adults in the United States in the past 10 years. OBJECTIVE: The objective of this study was to gather more recent data regarding breastfeeding knowledge, attitudes, and prior exposure among undergraduate university students. METHODS: This was a cross-sectional survey, conducted in November 2010. A convenience sample, consisting of undergraduates in attendance in 2 sections of an introductory nutrition class at a large research university, was used for this project (N = 248). RESULTS: Breastfeeding knowledge was relatively good. However, overall breastfeeding attitudes were more neutral, which appeared to be explained by the belief that breastfeeding is painful, restrictive, and inconvenient, both in general and specifically for the working mother. Though support for breastfeeding in public was low, men were significantly less likely than women to believe it to be embarrassing or unacceptable. In addition, breastfeeding attitudes were more positive among older students and those who were breastfed as infants. Those who were breastfed as infants were also significantly more likely to intend to breastfeed future children. CONCLUSIONS: Though this sample indicates good breastfeeding knowledge, attitudes were more neutral, and support for breastfeeding in public appears low. This finding is contradictory and warrants further exploration.