A History of Infant Feeding

The historical evolution of infant feeding includes wet nursing, the feeding bottle, and formula use. Before the invention of bottles and formula, wet nursing was the safest and most common alternative to the natural mother''s breastmilk. Society''s negative view of wet nursing, combined with improvements of the feeding bottle, the availability of animal''s milk, and advances in formula development, gradually led to the substitution of artificial feeding for wet nursing. In addition, the advertising and safety of formula products increased their popularity and use among society. Currently, infant formula-feeding is widely practiced in the United States and appears to contribute to the development of several common childhood illnesses, including atopy, diabetes mellitus, and childhood obesity.     

Psychosocial and behavioral factors related to the post-partum placements of infants born to cocaine-using women

OBJECTIVE: One objective was to determine if cocaine-using women who did not maintain infant custody (NMC) would report more psychological distress, domestic violence, negative coping skills, lower social support and more childhood trauma than cocaine-using women who maintained custody (MC) of their infant. A second objective was to evaluate the relative contribution of psychosocial factors to infant placement. METHODS: Psychosocial profiles of MC women (n=144) were compared with NMC (n=66) cocaine-using women. Subjects were low income, urban, African-American women who delivered an infant at a county teaching hospital. The Brief Symptom Inventory (BSI), an assessment of coping strategies (COPE), Multidimensional Scale of Perceived Social Support (MSPSS), Conflict Tactics Scale (CTS) and Childhood Trauma Questionnaire (CTQ) were administered. The associations of infant placement status to demographic factors, drug use and psychosocial measures were evaluated. RESULTS: The NMC group reported greater overall psychological distress, psychoticism, somatization, anxiety and hostility than the MC group. The NMC group had more childhood neglect and physical abuse and used more negative coping strategies than the MC group. Lack of prenatal care [OR=.83, CI (.75-.91), p<.0001], heavier prenatal cocaine use [OR=2.55, CI (1.13-4.34), p<.007], greater psychological distress [OR=2.21, CI (1.13-4.34), p<.02] and a childhood history of emotional neglect [OR=1.10, CI (1.02-1.19), p<.02] were associated with increased likelihood of loss of infant custody after control for other substance use and demographic variables. CONCLUSIONS: NMC women have more negative psychological and behavioral functioning post-partum than MC women. Less prenatal care and greater cocaine use, psychological distress and maternal childhood emotional neglect are associated with the post-partum placement of infants born to cocaine-using women. PRACTICE IMPLICATIONS: Results of this study indicate that poor, urban women who use cocaine prenatally display several measurable differences on psychosocial and behavioral risk factors based on child placement status. Among these risk factors heavier cocaine use, lack of prenatal care, more severe psychological symptoms and early childhood experiences of emotional neglect increase the likelihood of loss of infant custody. Routine, objective assessments of psychosocial and behavioral characteristics of women who use cocaine during pregnancy can aid Child Protective Service workers and clinicians by providing baseline data from which to tailor interventions and set improvement criteria for mother-child reunification.     

Pregnancy and delivery for women with a history of child sexual abuse

OBJECTIVE: To study whether women with a history of child sexual abuse are at increased risk of delivering low birth weight infants. Secondary aims were to study smoking habits, obstetric complications, health care use, and health complaints during pregnancy among women with a history of child sexual abuse. METHOD: In a case control study, 82 women with birth of a low birth weight infant (< 2500 g) (cases) and 91 women with birth of a normal birth weight infant (controls) were interviewed about experiences of child sexual abuse. RESULTS: Fourteen percent of the women disclosed a history of child sexual abuse involving at least genital touch. Birth of a low birth weight infant was not associated with a history of child sexual abuse (OR 1.03, 95% CI .44-2.40). More women with a history of child sexual abuse were smokers during pregnancy (56% vs. 31%) compared with nonabused women. Abused women reported lower age at menarche and sexual debut. Nonscheduled contacts with the antenatal care clinic and discomfort during pregnancy were more frequent among abused women when controlled for low birth weight. CONCLUSIONS: Women who delivered low birth weight infants were not more likely to have experienced child sexual abuse than women who delivered nonlow birth weight infants. Abused women were unemployed and daily smokers more often than nonabused women. Some of the abused women reported more health complaints, and more use of health care services during pregnancy, but did not have more obstetric complications during pregnancy and delivery.     

Extending Models of Sensitive Parenting of Infants to Women at Risk for Perinatal Depression

Objective. Recognizing that not all mothers at risk for depression engage in insensitive parenting, this study examined predictors of individual differences in sensitive parenting of infants by mothers with histories of depression, who are at elevated risk for depression during the perinatal period. Design. We examined maternal personal characteristics, context, and early infant temperament as predictors of sensitive parenting. Seventy-six women with a history of major depression were followed through pregnancy and postpartum and observed during play and feeding interactions with their 12-month-old infants. Results. Maternal personal characteristics (recurrence of clinically significant depression symptom levels during pregnancy or postpartum and higher trait anxiety), context (lower social context and lower income), and early infant temperament (higher negative affectivity, surgency/extraversion, and orienting/regulation) are often associated with less sensitive parenting, with stronger and clearer associations for play than feeding and with some differences based on whether sensitivity was defined as affective matching or rated sensitivity. Conclusions. The findings extend support for multi-determination of sensitive parenting of infants to women with histories of depression, albeit with small to medium effect sizes, and suggest ways to identify those who may be most at risk for insensitive parenting and the potential value of intervening in pregnancy to enhance subsequent sensitivity of parenting.     

How does women’s education influence infant survival? A structural equation model using aggregate data from 95 low- and middle-income countries

Previous studies have shown that women’s education increases infant survival with a magnitude that varies along methodological designs. Besides, the causal chain from women’s education to infant survival has so far remained largely unknown. This cross-country study investigates the relationship between women’s education and infant survival in 95 low- and middle-income countries using a comprehensive set of mediating and control variables. The article applies structural equation modelling on aggregate data, which were produced by the UN, UNESCO, UNICEF and the World Bank. The independent variables are from 2000 to 2009, and the dependent variable, infant mortality, is from 2018. The models are adjusted for income level, population size and extreme epidemic or political instabilities. Structural equation modelling is an advantageous method to specify how women’s education affects infant survival explicitly through the indirect influences of an enhanced child health provision and through an increased reproductive autonomy for women. Overall, women’s education is an equally important variable with poverty alleviation and women’s reproductive autonomy in explaining the cross-country variation in infant survival. The models, taking into account key child health policies, provide new evidence on how women’s education is mediated to better infant survival in low- and middle-income countries.     

Disposition and health outcomes among infants born to mothers with no prenatal care

ObjectiveThis study assessed infant disposition and health outcomes among offspring born to mothers without prenatal care, based on maternal characteristics and the reason for lack of prenatal care (i.e., denial of pregnancy, concealment of pregnancy, primary substance use, financial barriers and multiparity).MethodsA retrospective record review was completed at an urban academic medical center. Subjects were women who presented at delivery or immediately postpartum with no history of prenatal care (N = 211), and their infants.ResultsInfants of mothers with substance use problems had the highest rates of referral to child protective services and out-of-home placement at discharge, though mothers with other reasons for no prenatal care also experienced both referral and placement. Infants born to mothers using substances experienced the highest rates of neonatal intensive care unit admission, and the lowest mean birth weight.ConclusionsThough those without prenatal care experienced a variety of adverse outcomes, substance use problems were most frequently correlated with adverse infant outcomes. Mothers who either had lost custody of other children or with substance use problems were at highest risk of losing custody of their infants. Those who denied or concealed their pregnancy still frequently retained custody.Practice implicationsAmong mothers without prenatal care, those with substance use problems were least likely to retain custody of their infant at hospital discharge. Custody status of the mother's other children was also independently associated with infant custody. Mothers who denied or concealed their pregnancy still often retained custody. Referrals of mothers with no prenatal care for psychiatric evaluation were rare, though referrals to social work were frequent. Child protective services occasionally did not investigate referrals in the denial and concealment groups. Healthcare providers should be aware of the medical and psychological needs of this vulnerable population of infants and mothers.     

Lenghth of Maternity Leave and Quality of Mother-Infant Interactions

The aim of this study was to assess the association between the length of maternity leave and the quality of mother-infant interactions; 198 employed mothers of 4-month-old infants were interviewed and videotaped in their homes during a feeding time. Hierarchical multiple regression analyses indicated a direct association between shorter length of leave and more negative affect and behavior in maternal interactions with their infants. Infant and mother stressor/protective variables added significantly in predicting the quality of the mother-infant relationship. There were also significant interaction effects between the length of leave and these variables. Mothers who either reported more depressive symptoms or who perceived their infant as having a more difficult temperament and who had shorter leaves, compared with mothers who had longer leaves, were observed to express less positive affect, sensitivity, and responsiveness in interactions with their infants. The public policy implications of the relation between length of maternity leave, maternal and infant individual differences, and the quality of mother-infant interactions are discussed.     

The Contribution of Infant, Maternal, and Family Conditions to Maternal Feeding Competencies

OBJECTIVE: Because little is known about the role of family problem-solving processes in the development of mothers' competencies in feeding a very low birth-weight (VLBW) infant, we explored the contribution made by the competence in negotiating displayed by a mother and family member as they jointly problem solve infant-care issues. The infant's neonatal biomedical condition, maternal depressive symptoms, and family poverty status may also contribute to feeding competencies. DESIGN: A sample of 41 mothers of VLBW infants from 2 longitudinal studies who were observed during feeding at 1 and 8 months infant postterm age, with a family member of their choosing, participated in a dyadic problem-solving exercise. We assessed maternal feeding competencies with the Parent-Child Early Relational Assessment (Clark, 1997) and dyadic negotiating competence using an observational scale from the Iowa Family Interaction Rating Scales (Melby & Conger, 2001). We classified infant condition through medical record audit. Maternal depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression (CES-D) Scale (L. S. Radloff, 1977), and family poverty status was determined through the mother's report of family income. RESULTS: Mothers' feeding competencies, structured into 2 factors, Parental Positive Affective Involvement, Sensitivity, and Responsiveness (PPAISR) and Parental Negative Affect and Behavior (PNAB, scored in the direction of low negativity) were stable from 1 to 8 months, accounting for the entire set of predictor variables. Neonatal biomedical condition had no effect on either PPAISR or PNAB; depressive symptoms were negatively associated with PNAB at 8 months; poverty status negatively predicted both PPAISR and PNAB at 1 and 8 months; and negotiating competence of the mother-family member dyad was positively associated with PNAB at 1 month. CONCLUSIONS: Evidence that family poverty status and dyadic negotiating competence were both associated with maternal feeding competencies supports inclusion of these family-level variables in a model of feeding competencies. A mother's negotiating competence with another family member who takes a responsible role in infant care may support maternal feeding competencies during a VLBW infant's early weeks when parenting patterns are forming.     

Acoustic Characteristics of Naturally Occurring Cries of Infants with "Colic"

Although infantile colic has long been defined by a perceived excessive amount of crying, acoustic attributes of the cry sound may also contribute to perceptions that this early social behavior is excessive or problematic. From an original sample of 76 infants (38 infants referred to physicians for problematic crying, or "colic," and 38 pair-matched comparison infants), 48 infants who produced naturally occurring cry bouts both before and after an evening feeding were studied: 11 infants with Wessel's colic, 15 infants with non-Wessel's colic, and 22 comparison infants. Standard and vociferous cry segments were selected from up to 2 min of tape-recorded crying for spectrum analysis. Vociferous cry segments had a longer duration, a higher fundamental frequency, and a greater percentage of dysphonation than did standard segments. No differences between infant groups were found in cries before feeding. After feeding, infants who were problematic criers, independent of Wessel's criteria, showed a greater percentage of dysphonation in the vociferous cry segment than did comparison infants. This finding resulted from a decrease in dysphonation in the cries of comparison infants after feeding and an increase in those of infants with non-Wessel's colic. The dominant frequency also increased after feeding in the vociferous cries of infants with Wessel's colic, resulting in these infants having higher-pitched cries after feeding than infants in the other 2 groups. Results indicate that infants who are perceived to have problematic crying have objectively different acoustic features in their cry sounds that are particularly aversive, and that complaints about excessive crying cannot be accounted for simply on the basis of reporting bias in overly concerned or emotionally labile parents.     

Social support, locus of control, and parenting in three low-income groups of mothers: black teenagers, black adults, and white adults

Mother's social support, their instrumental use of extended family members and of professionals for help, and their sense of personal control were examined as predictors of parenting skill in 3 groups of low-income women. Separate regression models were generated for black adult mothers, white adult mothers, and black teen mothers, all of whom had at least 1 infant. Black teen and white adult mothers who sought help with child-rearing problems from extended family members were more skillful parents. Among white mothers, use of professionals for help with child-rearing problems and mothers' sense of internal control were also significant predictors. Black adult mothers' parenting skill was predicted only by locus of control. These prediction models suggest that in 2 of the groups, social ties to significant others were the linkages through which child-rearing information flowed to affect parenting behavior.     

The incidence of infant physical abuse in Alaska

OBJECTIVES: To determine the incidence of and risk factors associated with infant (< 1 year of age) physical abuse in Alaska. METHODS: A population-based retrospective cohort study for the 1994-2000 resident birth cohort was conducted by linking data from birth certificates, Child Protective Services, a statewide hospital-based trauma registry, hospital discharge data, and the Alaska Infant Mortality Review (including death certificates). The main outcome measures were the incidences of overall physical abuse and abuse resulting in hospitalization or death. A case of child abuse was defined as an instance of substantiated physical abuse to an infant identified in the Child Protective Services database or an infant death with homicide identified on the death certificate as the manner of death. RESULTS: During the 7-year study period, there were 70,842 births and 325 cases of physical abuse including 72 that led to hospitalization (n = 58), death (n = 4), or both (n = 10); respective incidences for all abuse and abuse leading to hospitalization or death were 4.6 and 1.0 per 1000 live births. Following multivariate analyses, the risk factors with the highest population attributable risks were maternal or paternal education < or = 12 years, unmarried mother, and maternal prenatal substance use. To determine if the study methodology was likely to have missed cases of severe abuse, we examined information for all 216 infants hospitalized for trauma during the study period who did not have identification of abuse in one of the study databases; of these, at least 39 had injuries inconsistent with the reported mechanism (a long bone or skull fracture that reportedly resulted from a fall of less than 3 feet or from a caretaker's arms or for which the caretaker denied a history of trauma). Conclusions: Alaska has one of the highest documented infant physical abuse incidences reported in the literature and abuse is associated with potentially modifiable-primarily social-risk factors. Despite this high incidence, substantial under-reporting of hospitalized cases likely occurs.     

Three Randomized Controlled Trials of Early Long-Chain Polyunsaturated Fatty Acid Supplementation on Means-End Problem Solving in 9-Month-Olds

This study examines whether feeding infants formula supplemented with long-chain polyunsaturated fatty acids (LCPUFA) improves cognitive function of 9-month-olds. Participants included 229 infants from 3 randomized controlled trials. Children received either formula supplemented with docosahexaenoic acid and arachidonic acid, or a control formula beginning at 1–5 days (12-month feeding study), or following 6 weeks (6-week-weaning study) or 4–6 months of breastfeeding (4-to 6-month weaning study). Infants were assessed with a 2-step problem solving task. In the 12-month feeding and 6-week weaning studies, supplemented children had more intentional solutions (successful task completions) and higher intention scores (goal-directed behaviors) than controls. These results suggest that LCPUFA supplementation improves means-end problem solving.     

Breastfeeding Prevalence among an Alaskan Inupiat Eskimo Population

Breastfeeding provides valuable immunologic, nutritional, and psychological advantages to infants and is the most desirably complete diet for the infant during the first 6 months of life. The purpose of this exploratory study was to determine the prevalence of breastfeeding in a group of Alaskan Inupiat Eskimos, who live in northern Alaska. A convenience sample of 36 women making up three age cohorts was utilized (women ages 18 to 25, N=11; ages 26 to 40, N=14; ages 41 to 60, N=11). Data collected from these women on their choice of infant-feeding method contributed to measuring the prevalence of breastfeeding. Prevalence was also measured by categorizing the children of these women into three age groups and further classifying them as to how they were fed when they were infants. Statistical analysis was performed utilizing 95% confidence intervals. Results revealed that, in this sample and over the past 20 years, a substantial decline has occurred in the percentage of Inupiat infants exclusively breastfeeding for 6 months or longer. Data also indicated a downward trend in the percentage of mothers between the ages of 26 and 39 who initiate breastfeeding; however, among the mothers aged 18 to 25, data reflected a rising trend.     

基于三次多项式变速算法的中药粉剂下药系统

中药粉剂配方下药系统是一个精度高、反应大滞后的系统,难以使用传统的方法进行下药控制。为有效实现中药粉剂快速、稳定、高精确度的下药问题,本文提出一种利用三次多项式加减速控制算法来实现在线分析医生处方上的中药粉剂配量,并通过Profibus光纤模块控制远程变频电机以计算所得运动曲线进行下药控制。实验结果验证了此方法的有效性。     

Cognitive Behavior Modification and Informed Teacher Treatments for Shy Children

Three levels of feed forward information and five levels of feedback information were administered during a 200 two-cue trial experiment to 150 subjects. The feed forward information consisted of instructions on correlative relationships and cue validities. The feedback information consisted of outcome feedback presented at different rates. Results indicated that: subjects provided with a psychologically relevant MCPL setting with labeled cues can perform at a very high level of proficiency without feed forward or feed-back information; statistically naive subjects are unable to use feed forward information to improve their performance; whether subject performance increases or decreases when provided with feedback information depends upon the performance index used; and withdrawal of feedback generally has little effect upon subject performance.     

A thematic analysis of the self‐directed learning experiences of 13 breast cancer patientsy

Although self‐directed learning is a common response for many of the 183 000 American women who are diagnosed with breast cancer each year, very little is known about the nature of the experience for them. Four themes emerged from interviews with 13 breast cancer patients describing their self‐education efforts in regard to their disease. A qualitative paradigm was used for this study with data collected using a pilot‐tested semi‐structured interview protocol. Purposeful sampling technique was employed to identify information‐rich subjects who were within three years of diagnosis and who had used self‐directed learning extensively in coping with their breast cancer. Using the constant comparative method, four common themes emerged from the analysis of the interviews. First, empowerment: the women in this study felt stronger and more in control in their breast cancer situations because of their self‐directed learning efforts. Second, connectedness: the women in this study satisfied their need for connecting with other people in meaningful ways, particularly with other survivors, through their self‐directed learning efforts. Third, selective learning: the women in this study were interested in learning about those things which directly related to their situations and which they perceived as positively influencing their ability to cope. Finally, the search for meaning: the women in this study were searching for more than just information about breast cancer. They also sought to understand why they had breast cancer and what meaning the experience should have for them in the future. The findings support prior research in regard to important aspects of self‐directed learning, women and learning and breast cancer. At the same time, the results have contributed new information about self‐directed learning in a crisis situation suggesting that in such cases the emotional context must be considered.     

Current studies on two separate topics: breastfeeding postpartum length of hospital stay

IN THIS COLUMN, THE AUTHOR EXAMINES RECENT RESEARCH ON TWO SEPARATE TOPICS: 1) breastfeeding; 2) postpartum length of hospital stay. Recent studies suggest long-term effects of breastfeeding that benefit both mother and infant. Benefits include a reduced risk of breast cancer in breastfeeding mothers and a reduced level of total and LDH cholesterol in adults who were breastfed as infants. Infants of mothers with maternal asthma had lower rates of asthma if the mother breastfed. In a study of women in the United States who planned to breastfeed, those mothers who breastfed exclusively and planned to breastfeed more than three months were more likely to achieve their goals than mothers who planned to combine breast and human-milk substitute feeds and to breastfeed less than three months.In a Canadian study, shortened postpartum stays led to increased re-admission to hospital for mothers with cesarean births. In contrast, in a Massachusetts study, shortened postpartum stays did not lead to an increase in infant visits for urgent care. However, the Massachusetts study did not reflect a decrease in maternity-related costs associated with shortened length of postpartum stay.     

Neonatal respiratory instability and infant development.

This study examines the relationships between neonatal sleep respiratory instability and infant development. A group of 122 full-term healthy infants was observed during a nap within the first and fourth weeks of life. During each nap, a continuous polygraphic recording was obtained of respiratory activity and extraocular movements. The relative frequency and average duration of apneic pauses (greater than or equal to 2 sec) in each testing session for an infant were employed to calculate a measure of respiratory instability (PSA4) previously found to be related to the occurrence of prolonged sleep apnea. 28 of the infants in this study were maintained at home on apnea monitors. The Bayley Scales of Infant Development were administered to each infant at approximately 9 months of age. Comparisons of infants with high versus low PSA4 values and of monitored versus unmonitored infants were not strongly distorted by imbalances in birth weight, sex, race, birth order, method of feeding, Sudden Infant Death Syndrome (SIDS) sibship, parental education, age at developmental assessment, and developmental tester. Those with increased respiratory instability (PSA4 greater than or equal to -0.04) within the first week of life averaged significantly lower in mental and psychomotor development. Utilization of home apnea monitors was not significantly associated with developmental scores.     

The Role of Dyadic Affect in Play and Infant Sex in Predicting Infant Response to the Still-Face Situation

This study was designed to examine mothers' and 3-month-old infants' affect in play and infant sex as predictors of infants' response to the still-face situation. Infants who evidenced negative affect in play were likely to respond with negative displays during a subsequent still-face situation. Maternal positivity in play was positively correlated with infants' social gaze in the still-face situation. In addition, maternal positivity and infant sex significantly interacted in predicting infant affective response in the still-face situation. For girls, maternal positivity was associated with decreased expressivity. For boys, maternal positivity was associated with early positive bids, which were followed by negative bids and moderately negative affect. Finally, maternal positivity and its interaction with infant sex provide unique information beyond the carry-over effect from infant affect in play to infant response to the still-face. Results are discussed in terms of patterns of individual and joint regulation.     

Communication between children and carers during mealtimes

Mealtimes are identified as an important learning environment where socialisation and language development takes place. Caregivers can facilitate the structure of a child's learning in the mealtime setting. The aim of this study was to gain an understanding about the nature of communication in a normal population during mealtimes. This is important to help understanding about the nature of communication and interaction in children with disabilities during mealtimes. Participants were six typically developing preschool children aged from 8 months to 3;05 years. Caregivers of the children supported their child having a typical meal at home. Each mother–child dyad was video‐recorded by the researchers during a typical meal for up to 30 minutes. Each recording was transcribed by the researchers, and specific communicative features were counted and coded; caregiver comments about appropriate mealtime behaviour, child verbal and nonverbal initiation, caregiver questions and comments about meal enjoyment, caregiver praise of child, and caregiver repetition to coax feeding. A caregiver questionnaire was also completed to obtain information about the child's feeding, any early history of feeding difficulties and typical mealtime routine. The results indicated that the most considerable difference were between the dyads who had reported early feeding difficulties and those who had not reported any. Carers who supported children who had a history of early feeding difficulties used more language to manage and guide the child's behaviour during the mealtime. Caregivers who reported early feeding difficulties appeared to be more concerned with how their child was presenting at the meal (i.e., appropriate behaviour and meal enjoyment). This information has important implications for supporting children with complex needs during mealtimes.