Breastfeeding rates and hospital breastfeeding practices in Canada: a national survey of women. Help me make it through the night: behavioral entrainment of breast-fed infants' sleep patterns. Factors influencing breastfeeding in children less than 2 years of age in Lao PDR. Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials. The effect of breast-feeding frequency on serum bilirubin levels. Predictors and Consequences of In-Hospital Formula Supplementation for Healthy Breastfeeding Newborns What information, advice, and support do women want with breastfeeding? Severe neonatal hypernatraemia: a population based study Ten Steps to Successful Breastfeeding programme to promote early initiation and exclusive breastfeeding in DR Congo: a cluster-randomised controlled trial. The Effect of Early Initiation of Colostrum Feeding on Proliferation of Intestinal Bacteria in Neonates Comparison of the effect of two systems for the promotion of exclusive breastfeeding Women's perceptions of breastfeeding barriers in early postpartum period: a qualitative analysis nested in two randomized controlled trials. Breast-feeding of Term Infants
BACKGROUND The Baby-Friendly Hospital Initiative was launched by the World Health Organization and UNICEF in 1989 to promote , protect , and support breastfeeding worldwide . The objective of this study was to report breastfeeding rates and adherence to the Baby Friendly Hospital Initiative of the World Health Organization and UNICEF in Canada , as reported by participants in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System . METHODS Eligible women ( n = 8,244 ) were identified from a r and omly selected sample of infants born 3 months before the May 2006 Canadian Census , and stratified by province or territory . Birth mothers living with their infants at the time of interview were invited to participate in a computer-assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada . Interviews took approximately 45 minutes and were completed when infants were between 5 and 10 months old ( between 9 and 14 months in the territories ) . Completed responses were obtained from 6,421 women ( 78 % response rate ) . Nineteen of 309 questions concerned early mother-infant contact and breastfeeding practice s. RESULTS Breastfeeding intention ( 90.0 % ) and initiation ( 90.3 % ) rates were high , although exclusive breastfeeding rates at 6 months after birth ( 14.4 % ) were lower than desirable . The findings suggested a low adherence to several best practice s advocated by the Baby-Friendly Hospital Initiative . CONCLUSION Although breastfeeding initiation rates were relatively high in Canada , exclusive breastfeeding duration fell short of globally recommended st and ards The study objective was to investigate whether exclusively breast-fed infants could be taught to sleep through the night ( defined from 12:00 AM to 5:00 AM ) during the first 8 weeks of life . The design was short-term longitudinal , from the last trimester of pregnancy until the eighth week after birth . Twenty-six first-time parents and their newborn were r and omly assigned to treatment and control groups ( 13 in each group ) . Treatment parents were instructed to offer a " focal feed " ( between 10 PM and 12 AM ) to their infants every night , to gradually lengthen intervals between middle-of-the-night feeds by carrying out alternative caretaking behaviors ( eg , reswaddling , diapering , walking ) , and to maximize environmental differences between day and nighttime . All parents kept 72-hour diaries of their infants ' feeding and sleeping patterns every week from birth to 8 weeks of age and rated their infants ' temperament at birth and at 8 weeks . By 3 weeks , treatment infants showed significantly longer sleep episodes at night . By 8 weeks 100 % of treatment infants were sleeping through the night compared to 23 % of control infants . Treatment infants were feeding less frequently at night but compensated for the relatively long nighttime interval without a feed by consuming more milk in the early morning . Milk intake for 24-hour periods did not differ between groups . Treatment infants were rated as more predictable on Bates ' Infant Characteristics Question naire . It is concluded that parents can have a powerful influence on the development of their infants ' sleep patterns . Frequent night waking in breast-fed infants often results in early termination of lactation . ( ABSTRACT TRUNCATED AT 250 WORDS AIM This study aim ed to investigate the prevalence of , and factors influencing , exclusive breastfeeding ( EBF )  at 6 months and continued breastfeeding ( CBF ) at 2 years . METHODS Between January and February 2007 , a cross-sectional study was conducted using a  semi-structured question  naire in 40 villages in the Vientiane capital and the Vientiane province of Lao PDR . A total of 400 mothers with children less than 2 years old were recruited by multistage r and om sampling . Based on the 1991 World Health Organization Breastfeeding Indicators , children were classified into three groups , 6 - 23-month-old children for assessing EBF at 6 months , 12 - 15-month-old children for CBF at 1 year and 20 - 23-month-old children for CBF at 2 years . RESULTS The prevalence of EBF at 6 months and CBF at 2 years were 19.4 % ( n= 283 ) and 18.6 % ( n= 43 ) , respectively . Some of the factors influencing EBF at 6 months in a univariate logistic regression model included : location of residence , ( OR : 19.19 , 95 % CI 6.96 - 57.01 ) , ethnicity ( OR : 3.15 , 95 % CI 1.63 - 6.08 ) , encouragement of the child 's father ( OR : 9.03 , 95%CI 1.21 - 67.57 ) and inter-spousal communication ( OR : 5.20 , 95 % CI 2.34 - 11.56 ) . A majority of the mothers ( 75.0 % ) had watched television advertisements for infant formula from Thail and , and 48.4 % reported that they wanted to buy formula milk after having watched them . CONCLUSION This study showed a low prevalence of EBF at 6 months in the studied area in Lao PDR . Some of the factors that had a strong impact on EBF at 6 months included : location of residence , ethnicity , father 's involvement , early breastfeeding plan , Mother 's Card in antenatal care and television advertisement . There may be opportunities for government to review a range of policies relating to paternal involvement , antenatal care and formula advertising that could help to improve EBF rate BACKGROUND Although the benefits of exclusive breastfeeding for child health and survival , particularly in the post-neonatal period , are established , the independent beneficial effect of early breastfeeding initiation remains unclear . We studied the association between timing of breastfeeding initiation and  post-enrolment neonatal and post-neonatal mortality up to 6 months of age , as well as the associations between breastfeeding pattern and mortality . METHODS We examined associations between timing of breastfeeding initiation , post-enrolment neonatal mortality ( enrolment 28 days ) , and post-neonatal mortality up to 6 months of age ( 29 - 180 days ) in a large cohort from three neonatal vitamin A trials in Ghana , India , and Tanzania . Newborn babies were eligible for these trials if their mother reported that they were likely to stay in the study area for the next 6 months , they could feed orally , were aged less than 3 days , and the primary caregiver gave informed consent . We excluded infants who initiated breastfeeding after 96 h , did not initiate , or had missing initiation status . We pooled the data from both r and omised groups of the three trials and then categorised time of breastfeeding initiation as : at ≤1 h , 2 - 23 h , and 24 - 96 h. We defined breastfeeding patterns as exclusive , predominant , or partial breastfeeding at 4 days , 1 month , and 3 months of age . We estimated relative risks using log binomial regression and Poisson regression with robust variances . Multivariate models controlled for site and potential confounders . FINDINGS Of 99 938 enrolled infants , 99 632 babies initiated breastfeeding by 96 h of age and were included in our prospect i ve cohort . 56 981 ( 57·2 % ) initiated breastfeeding at ≤1 h , 38 043 ( 38·2 % ) at 2 - 23 h , and 4608 ( 4·6 % ) at 24 - 96 h. Compared with infants initiating breastfeeding within the first hour of life , neonatal mortality between enrolment and 28 days was higher in infants initiating at 2 - 23 h ( adjusted relative risk 1·41 [ 95 % CI 1·24 - 1·62 ] , p<0·0001 ) , and in those initiating at 24 - 96 h ( 1·79 [ 1·39 - 2·30 ] , p<0·0001 ) . These associations were similar when deaths in the first 4 days of life were excluded ( 1·32 [ 1·10 - 1·58 ] , p=0·003 , for breastfeeding initiation at 2 - 23 h , and 1·90 [ 1·38 - 2·62 ] , p=0·0001 , for initiation at 24 - 96 h ) . When data were stratified by exclusive breastfeeding status at 4 days of age ( p value for interaction=0·690 ) , these associations were also similar in magnitude but with wider confidence intervals for initiation at 2 - 23 h ( 1·41 [ 1·12 - 1·77 ] , p=0·003 ) and for initiation at 24 - 96 h ( 1·51 [ 0·63 - 3·65 ] , p=0·357 ) . Exclusive breastfeeding was also associated with the lower mortality during the first 6 months of life ( 1 - 3 months mortality : exclusive vs partial breastfeeding at 1 month 1·83 [ 1·45 - 2·32 ] , p<0·0001 , and exclusive breastfeeding vs no breastfeeding at 1 month 10·88 [ 8·27 - 14·31 ] , p<0·0001 ) . INTERPRETATION Our findings suggest that early initiation of breastfeeding reduces neonatal and early infant mortality both through increasing rates of exclusive breastfeeding and by additional mechanisms . Both practice s should be promoted by public health programmes and should be used in models to estimate lives saved . FUNDING Bill & Melinda Gates Foundation through a grant to the WHO OBJECTIVE Our purpose was to evaluate the effect of breast-feeding frequency on serum bilirubin levels in the first 3 days after birth . STUDY DESIGN Two hundred seventy-five infants were r and omly assigned to a frequent or dem and breast-feeding schedule . RESULTS Infants in the frequent group ( n = 131 ) nursed nine ( 7.5 to 10.5 ) times per day ( median and inner 80 % ) , and the dem and group ( n = 143 ) fed 6.5 ( 5.5 to 8.0 ) times per day . The serum bilirubin level was measured in all infants between 48 and 80 hours ( median 53 hours , inner 80 % 48 to 68 hours ) and was 7.4 ( 1.8 to 10.7 ) mg/dl in the frequent group and 8.0 ( 2.9 to 11.2 ) mg/dl in the dem and group ( p = 0.103 ) . There was no correlation between the frequency of breast-feeding and the serum bilirubin level . CONCLUSION Within the range of the frequency of nursing observed in this study , we could not demonstrate a significant effect on serum bilirubin levels in the first 3 days after birth Background : Although exclusive breastfeeding is recommended for the first 6 months , the use of breast milk substitutes is widespread around the world . Objectives : To describe the patterns of infant formula supplementation among healthy breastfeeding newborns , to identify factors contributing to in-hospital formula supplementation , and to assess the dose-response relationship between the amount of in-hospital formula supplementation and the duration of any breastfeeding . Methods : A sample of 1246 breastfeeding mother – infant pairs was recruited from 4 public hospitals in Hong Kong and followed prospect ively for 12 months or until weaned . Multiple logistic regression analysis was used to examine factors associated with in-hospital supplementation . Cox regression analysis was used to explore the impact of in-hospital supplementation  on breastfeeding duration . Results : Of the total , 82.5 % of newborns were supplemented in the hospital ; one-half received formula within 5 hours of birth . Assisted vaginal delivery ( odds ratio [ OR ] = 2.06 , 95 % confidence interval [ CI ] 1.03 , 4.15 ) , cesarean section ( OR = 3.45 , 95 % CI 1.75 , 6.80 ) , and higher birth weight ( OR = 1.56 , 95 % CI 1.12 , 2.18 ) were positively associated with in-hospital formula supplementation , whereas initiating breastfeeding in the delivery room ( OR = 0.55 , 95 % CI 0.33 , 0.89 ) was associated with decreased likelihood of in-hospital supplementation . Any infant formula in the first 48 hours was associated with a shorter duration of breastfeeding ( hazard ratio [ HR ] = 1.51 , 95 % CI 1.27 , 1.80 ) , but there was no dose-response effect . Conclusion : In-hospital formula supplementation is common in Hong Kong hospitals and appears to be detrimental to breastfeeding duration . Continued efforts should be made to avoid the provision of infant formula to breastfeeding babies while in the hospital unless medically indicated BACKGROUND Breastfeeding conveys many benefits , but women often encounter difficulties in the first few weeks . The objective of this study was to examine women 's perspectives on the information , advice , and support they receive with breastfeeding . METHODS A qualitative analysis was conducted of women 's responses to open questions about their experiences of breastfeeding support . Participants were recruited as part of a r and omized controlled trial of additional support from volunteer breastfeeding counselors , and they completed question naires when their babies were 6 weeks old . RESULTS Of the 720 women recruited to the trial , 654 began breastfeeding and completed postnatal question naires ; 492 ( 75 % ) participants were first-time mothers and 200 ( 31 % ) were of minority ethnic origin . At 6 weeks , 249 ( 38 % ) women were exclusively breastfeeding , 183 ( 28 % ) were both breastfeeding and bottle-feeding , whereas 222 ( 34 % ) were exclusively bottle-feeding . Although many women commented positively on their experiences , others thought they did not receive the information and support they needed . Thematic analysis of women 's responses to open questions identified five components of the support that women wanted : information about breastfeeding and what to expect , practical help with positioning the baby to breastfeed , effective advice and suggestions , acknowledgment of mothers ' experiences and feelings , and reassurance and encouragement . CONCLUSIONS Maternity services should address the components identified by the study findings as constituting good breastfeeding support . Guidance and information for family members and training for those involved in peer or professional initiatives should take into account women 's views on what support they want , together with when and how they want it provided Aims To describe incidence , presentation , treatment and short term outcomes of severe neonatal hypernatraemia ( SNH , sodium ≥160 mmol/l ) . Methods Prospect i ve , population based surveillance study over 13 months using the British Paediatric Surveillance Unit . Cases were > 33 weeks gestation at birth , fed breast or formula milk and < 28 days of age at presentation . Results Of 62 cases of SNH reported ( 7 , 95 % CI 5.4 to 9.0 per 1 00 000 live births ) , 61 mothers had intended to achieve exclusive breast feeding . Infants presented at median day 6 ( range 2–17 ) with median weight loss of 19.5 % ( range 8.9–30.9 ) . 12 had jaundice and  57 weight loss  as a presenting feature . 58 presented with weight loss ≥15 % . 25  babies had not stooled in the 24 h prior to admission . Serum sodium fell by median 12.9 mmol/l per 24 h ( range 0–30 ) . No baby died , had seizures or coma or was treated with dialysis or a central line . At discharge , babies had regained 11 % of initial birth weight after a median admission of 5 ( range 2–14 ) days . 10 were exclusively breast fed on discharge from hospital . Conclusions Neonatal hypernatraemia at this level , in this population , is strongly associated with weight loss . It occurs almost exclusively after attempts to initiate breast feeding , occurs uncommonly and does not appear to be associated with serious short term morbidities , beyond admission to hospital BACKGROUND Optimisation of breastfeeding practice s could reduce high mortality rates in children younger than 5 years , but in DR Congo , despite near-universal breastfeeding initiation and nine of ten children still breastfeeding at 1 year of age , exclusivity remains a difficulty . We assessed the effect on breastfeeding outcomes of a short-cut implementation of a programme called the Ten Steps to Successful Breastfeeding , the key component of the Baby-Friendly Hospital Initiative ( BFHI ) . METHODS We did a cluster-r and omised controlled trial and r and omly assigned  health-care clinics in Kinshasa , DR Congo , to st and ard care ( control group ) , BFHI steps 1 - 9 ( steps 1 - 9 group ) , or BFHI steps 1 - 9 plus additional support during well-child visits ( steps 1  -  10 group ) with computer-generated r and om numbers used to assign matched pairs to study groups . Mothers at these clinics who had given birth to one healthy baby during enrolment , and who expressed their intentions of visiting a well-baby session at the same clinic , were eligible and received the treatment assigned to their clinic . Mother-infant pairs were excluded if the mothers intended to attend well-baby clinic visits at a different health facility , or to travel before the child was aged at least 6 months . Participants and independent interviewers were masked to group assignment ( ie , they were recruited after r and omisaion and training of the clinic staff and were not informed of the study scheme ) , but clinical staff were unmasked . BFHI steps 1 - 9 and 1 - 10 were given by health-care staff trained with the WHO/UNICEF BFHI course . The primary outcomes were breastfeeding initiation within 1 h of birth and exclusive breastfeeding at age 14 and 24 weeks , assessed at face-to-face interviews in the clinic . Analysis was by intention to treat . Prevalence ratios ( PR ) were adjusted for cluster effects and baseline characteristics . This trial is registered at Clinical Trials.gov , number NCT01428232 , and is closed to new participants . FINDINGS Between May 24 , and Aug 25 , 2012 , we r and omly assigned two eligible clinics to control , two to BFHI steps 1 - 9 , and two to BFHI steps 1 - 10 . We enrolled 975 eligible mother-infant pairs ( 304 in the control group , 363 in the steps 1 - 9 group , and 308 in the steps 1 - 10 group ) . 230 ( 76 % ) of infants in the control group , 263 ( 72 % ) in the steps 1 - 9 group , and 220 ( 71 % ) in the steps 1 - 10 group were breastfed within 1 h of birth ; these results did not differ significantly between groups . Prevalence of exclusive breastfeeding at age 14 weeks was 89 ( 29 % ) in the control group , 237 ( 65 % ) in the steps 1 - 9 group ( adjusted PR 2·20 , 95 % CI 1·73 - 2·77 ) , and 129 ( 42 % ) in the steps 1 - 10 group ( 1·40 , 1·13 - 1·74 ) . At age 24 weeks , the prevalence of exclusive breastfeeding was 36 ( 12 % ) in the control group , 131 ( 36 % ) in the steps 1 - 9 group ( 3·50 , 2·76 - 4·43 ) , and 43 ( 14 % ) in the steps 1 - 10 group ( 1·31 , 0·91 - 1·89 ) . INTERPRETATION In the setting of health-care clinics in DR Congo with a high proportion of mothers initiating breastfeeding , implementation of basic training in BFHI steps 1 - 9 had no additional effect on initiation of breastfeeding but significantly increased exclusive breastfeeding at 6 months of age . Additional support based on the same training material s and locally available breastfeeding support material s , offered during well-child visits ( ie , step 10 ) did not enhance this effect , and might have actually lessened it One hundred eighty normal neonates with an average weight above 2.50 kg and having no feeding difficulties were divided into two groups and r and omly assigned to either colostrum or to glucose water feeding regimens during the 3-day stay at the maternity ward . The effects of the feeding regimens on intestinal colonization were studied by examining the stools of the neonates . All bacteria recovered were identified quantitatively and biochemically . Of the 180 mothers , 105 complied with the instructions on feeding regimens . The majority of the neonates receiving colostrum had significantly lower bacterial counts than those on glucose water ( p < 0.001 ) . The results of the preliminary study indicated that early initiation of colostrum feeding to neonates where potable water is not readily available will supress the proliferation of bacteria in the neonates BACKGROUND Promotion of breastfeeding is an important child-survival intervention , yet little is known about which promotional strategies are the most effective . We aim ed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil -- a hospital-based system and the same system combined with a programme of home visits . METHODS In February , 2001 , maternity staff from two hospitals in Pernambuco , Brazil , were trained according to the Baby-Friendly Hospital Initiative ( BFHI ) . In a r and omised trial between March and August , 2001 , 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding ( n=175 ) or no home visits ( n=175 ) . Breastfeeding practice s were studied on days 1 , 10 , 30 , 60 , 90 , 120 , 150 , and 180 by research ers unaware of group allocation . The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months . Analyses were by intention to treat . FINDINGS The hospital-training intervention achieved a high rate ( 70 % ) of exclusive breastfeeding in the hospitals , but this rate was not sustained at home and at 10 days of age only 30 % of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10 - 180 differed significantly ( p<0.0001 ) , with a mean aggregated prevalence of 45 % among the group assigned home visits compared with 13 % for the group assigned none . INTERPRETATION The BFHI achieves high rates of exclusive breastfeeding in hospital ; however , in Brazil at least , the rates fall rapidly thereafter . Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed . A combination of promotional systems ( hospital-based and in the community ) is needed OBJECTIVES This study examined women 's perceptions of early infant feeding experiences and identified early postpartum barriers to successful breastfeeding . SUBJECTS AND METHODS We conducted semistructured exit interviews at 6 months postpartum with a sub sample of participants ( n=67 ) enrolled in two r and omized controlled trials of breastfeeding promotion . Study arms included ( 1 ) routine pre- and postnatal visits with an International Board Certified Lactation Consultant ( IBCLC ) ( LC group ) , ( 2 ) electronically prompted guidance from prenatal care providers ( EP group ) , ( 3 ) EP+LC combined , and ( 4 ) st and ard of care ( control group ) . Interview transcripts were coded using grounded theory and analyzed in MAXqda . Code matrices were used to identify early postpartum breastfeeding barriers and were further examined in relation to treatment group using a mixed methods analysis . RESULTS The majority of the participants reported experiencing at least one barrier to breastfeeding . Barriers to breastfeeding were more commonly reported in the early postpartum than late postpartum period . The most common barrier during the early postpartum period was the perception of inadequate milk supply ( " lactational " ) ( n=18 ) , followed by problems with latch , medical problems that were perceived as precluding breastfeeding , and medical staff and hospital practice s. Participants frequently reported that the IBCLCs assisted them in anticipating , managing , and overcoming these barriers . CONCLUSIONS Our findings underscore the importance of integrating IBCLCs into routine pre- and postpartum care because they provide critical support that effectively addresses early postpartum barriers to breastfeeding On those maternity wards where " rooming in " is not practice d , infants are fed according to fixed schedules . The purpose of this study was to investigate possible differences between two common feeding regimens , three-hourly vs. four-hourly feeds during the first 3 days of life . A group of 152 singleton , full-term infants with birth weights 2,500 - 2,990 g , born at Bikur Cholim Hospital in Jerusalem from February 1988 , to August 1988 , were r and omly assigned to one of two breast-feeding groups and followed prospect ively . The study group ( 62 infants ) was breast-fed every 4 hours , and the control group ( 90 infants ) every 3 hours . The two groups were statistically similar for mean maternal age , parity , ethnic origin , social class , neonatal Apgar scores , birth percentile , and mean birth weights . Infants who breast-fed every 4 hours did not have greater transitional weight loss or higher serum bilirubin levels compared to infants fed at 3 hour intervals
BACKGROUND Baby-led breastfeeding is recommended as best practice in determining the frequency and duration of a breastfeed .
An alternative approach is described as scheduled , where breastfeeding is timed and restricted in frequency and duration .
It is necessary to review the evidence that supports current recommendations , so that women are provided with high- quality evidence to inform their feeding decisions .
OBJECTIVES To evaluate the effects of baby-led compared with scheduled ( or mixed ) breastfeeding for successful breastfeeding , for healthy newborns .