Journal of Human Lactation

Early feeding choices may affect long-term health outcomes. Therefore, understanding body composition changes in healthy breastfed infants has become an important research focus.

The aims of this review were to investigate the body composition changes that occur during weight loss in breastfed term newborns and to examine body composition differences between exclusively/predominantly breastfed and exclusively formula-fed infants in the first 6 months of life.

We performed a review of the existing literature using PubMed. We searched for studies published in English since January 1, 2000, that involved human infants ranging in age from birth to 6 months. We used the following MEDLINE Medical Subject Headings: ((breastfeeding) OR (infant formula)) AND ((body composition) OR (bioelectrical impedance) OR (absorptiometry, photon) OR (total body potassium) OR (isotope dilution) OR (air-displacement plethysmography)). Our search yielded 6 studies.

Two studies reported that newborn weight loss was due to a reduction in the quantity of both fat mass and fat-free mass. Three out of 4 articles that evaluated body composition changes according to method of feeding reported no differences in body composition between exclusively/predominantly breastfed and exclusively formula-fed infants in the first 4.5 months of life. One study reported that exclusively breastfed infants at 3 months of age and exclusively breastfed boys at 6 months of age had higher fat mass contents compared to exclusively formula-fed infants.

Because of the limited number of studies available, larger studies are needed to clarify the differences in body composition between exclusively/predominantly breastfed and exclusively formula-fed infants.

Choline is an important component of human breast milk and its content varies considerably among breastfeeding women and lactation periods.

The aim of this study was to assess the relationship between breast milk choline contents and inflammatory status in breastfeeding women.

Breast milk choline compounds and serum C-reactive protein (CRP) concentrations were determined in breastfeeding women at 1 to 3 (n = 53) or 22 to 180 (n = 54) days postpartum, expressing colostrum or mature milk, respectively.

Median concentrations of free choline, phosphocholine, glycerophosphocholine, phospholipid-bound choline, and total choline were 71, 38, 96, 194, and 407 µmol/L or 93, 351, 958, 186, and 1532 µmol/L in colostrum or mature milk, respectively. Median serum CRP concentrations were 4.13 mg/L and 0.33 mg/L at 1 to 3 days and 22 to 180 days postpartum, respectively. At 1 to 3 days postpartum, milk free choline, phosphocholine, glycerophosphocholine, and total choline as well as serum CRP concentrations were significantly higher in breastfeeding women who delivered by cesarean section than those who delivered via the vaginal route. Serum CRP concentration was positively correlated with colostrum free choline (r = 0.703; P < .001), phosphocholine (r = 0.759; P < .001), glycerophosphocholine (r = 0.706; P < .001), and total choline (r = 0.693; P < .001), whereas it was negatively correlated (r = −0.442; P < .001) with colostrum phospholipid-bound choline. Serum CRP was also negatively correlated with mature milk free choline (r = −0.278; P < .05), but no correlation was found between serum CRP and other choline compounds in mature milk.

These data show that the concentrations of milk choline compounds are associated with inflammatory status of breastfeeding women, particularly during the first few days after delivery.

Despite estimates that 83% of mothers in the United States receive labor pain medications, little research has been done on how use of these medications affect onset of lactation.

To investigate whether use of labor pain medications is associated with delayed onset of lactation (DOL).

We analyzed data from the 2005-2007 Infant Feeding Practices Study II, a longitudinal study of women from late pregnancy through the entire first year after birth (n = 2366). In multivariable logistic regression analyses, we assessed the relationship between mothers’ use of labor pain medication/method and DOL (milk coming in > 3 days after delivery).

Overall, 23.4% of women in our sample experienced DOL. Compared with women who delivered vaginally and received no labor pain medication, women who received labor pain medications had a higher odds of experiencing DOL: vaginal with spinal/epidural only (aOR 2.05; 95% CI, 1.43-2.95), vaginal with spinal/epidural plus another medication (aOR 1.79; 95% CI, 1.16-2.76), vaginal with other labor pain medications only ([not spinal/epidural]; aOR 1.84; 95% CI, 1.14-2.98), planned cesarean section with spinal/epidural only (aOR 2.13; 95% CI, 1.39-3.27), planned cesarean with spinal/epidural plus another medication (aOR 2.67; 95% CI, 1.35-5.29), emergency cesarean with spinal/epidural only (aOR 2.17; 95% CI, 1.34-3.51), and emergency cesarean with spinal/epidural plus another medication (aOR 3.03; 95% CI, 1.77-5.18).

Mothers who received labor pain medications were more likely to report DOL, regardless of delivery method. This information could help inform clinical decisions regarding labor/delivery.

Cup feeding has been used as an alternative feeding method for preterm infants.

The purpose of this study was to determine the effect of bottle and cup feeding on exclusive breastfeeding rates at hospital discharge and 3 and 6 months post-discharge in late preterm infants.

Included in the study were preterm infants of 32 to 35 weeks’ gestation fed only by intermittent gastric tube at the time of recruitment; 522 infants were randomly assigned to 2 groups: the cup-fed group (n = 254) and bottle-fed group (n = 268). Main outcomes were prevalence of exclusive breastfeeding at discharge and 3 and 6 months after discharge, and length of hospital stay.

Infants randomized to cup versus bottle feeding were more likely to be exclusively breastfed at discharge home (relative risk [RR], 1.58; 95% confidence interval [CI], 1.36-1.83), 3 months after discharge (RR, 1.64; 95% CI, 1.42-1.89), and 6 months after discharge (RR, 1.36; 95% CI, 1.14-1.63). There was no significant difference between groups for length of hospital stay. The mean hospital stay was 25.96 ± 2.20 days in the bottle-fed group and 25.68 ± 2.22 days in the cup-fed group. There was no significant difference between groups for time spent feeding, feeding problems, or weight gain in hospital.

Cup feeding significantly increased the likelihood of late preterm infants being exclusively breastfed at discharge and 3 and 6 months after discharge, and cup feeding did not increase the length of hospital stay. Overall, we recommend cup feeding as a transitional method prior to breastfeeding for late preterm infants during hospitalization.

Although it is well established that human milk varies widely in macronutrient content, it remains common for human milk fortification for premature infants to be based on historic mean values. As a result, those caring for premature infants often underestimate protein intake. Rapid precise measurement of human milk protein, fat, and lactose to allow individualized fortification has been proposed for decades but remains elusive due to technical challenges.

This study aimed to evaluate the accuracy and precision of a Fourier transform (FT) mid-infrared (IR) spectroscope in the neonatal intensive care unit to measure human milk fat, total protein, lactose, and calculated energy compared with standard chemical analyses.

One hundred sixteen breast milk samples across lactation stages from women who delivered at term (n = 69) and preterm (n = 5) were analyzed with the FT mid-IR spectroscope and with standard chemical methods. Ten of the samples were tested in replicate using the FT mid-IR spectroscope to determine repeatability.

The agreement between the FT mid-IR spectroscope analysis and reference methods was high for protein and fat and moderate for lactose and energy. The intra-assay coefficients of variation for all outcomes were less than 3%.

The FT mid-IR spectroscope demonstrated high accuracy in measurement of total protein and fat of preterm and term milk with high precision.

Infant feeding data are often collected retrospectively through maternal report. Validation studies show that maternal report of initiation and duration of any breastfeeding is accurate but that report of duration of exclusive breastfeeding may be less accurate.

This study aimed to compare infant feeding data collected longitudinally throughout the first 6 months of life with maternal report of duration of exclusive breastfeeding collected 2 years postpartum.

Infant feeding data were collected prospectively throughout the first 6 months of life from medical records and maternal report, including maternal 24-hour recall. At 2 years postpartum, we asked mothers of these same infants how long they exclusively breastfed their infants. Their responses were compared to the prospectively collected data. Simple and multiple linear regressions tested for any significant predictors of the difference between the prospectively collected data and maternal report at 2 years.

Of the 292 mothers included in the final analysis, only 88 (30.1%) mothers reported a duration of exclusive breastfeeding at 2 years postpartum that matched the prospectively collected data. Sixty-four women reported exclusively breastfeeding for the recommended 6 months (21.9%), but according to the prospectively collected data, only 2 women (0.7%) breastfed exclusively through 6 months. The median difference between the prospectively collected data and maternal report at 2 years was 1 month (IQR, 0-4).

In this sample of mothers, report of exclusive breastfeeding practices 2 years after birth was often inaccurate and mothers tended to overestimate duration.

In the United States, 76.9% of women initiate breastfeeding but only 36.0% breastfeed exclusively for 3 months. Lack of support for public breastfeeding may prevent women from breastfeeding in public, which could contribute to low rates of breastfeeding exclusivity and continuation, despite high rates of breastfeeding initiation.

This study aimed to determine whether residents of New York City, New York, were supportive of and comfortable with public breastfeeding.

A population-based public opinion telephone survey of non-institutionalized New York City residents 18 years and older was conducted by the New York City Department of Health and Mental Hygiene.

Overall, 50.4% of respondents were not supportive of public breastfeeding. In the multivariable analysis, there was significant variation in support by race/ethnicity, age, and education. There were no significant differences in support by sex, receipt of food stamps, nativity, or the presence of children younger than 12 years in the home. One-third (33.2%) of respondents were uncomfortable with women breastfeeding near them in public. There was significant variation by education in the multivariable analysis. Lack of comfort was highest among those with a high school education or less (39.9%) and some college (33.8%).

New York City residents are conflicted about whether breastfeeding is a private act or one that can be done in public. For women who want to continue with their intention to breastfeed exclusively, the negative opinion of other residents may cause them to breastfeed only in private, thereby limiting the opportunity to breastfeed for the recommended time.

Limited data exist that explore the association between exclusive breastfeeding and dietary behaviors related to key food choices in later infancy.

This study aimed to examine the relationship between exclusive breastfeeding at 3 months with age of starting complementary feeding and key complementary feeding data collected at 8 to 10 months.

Secondary data analysis was performed on the UK Infant Feeding Survey 2005.

After adjusting for maternal characteristics, exclusive breastfeeding for 3 months, compared to mixed or formula feeding, was positively associated with giving homemade infant foods (adjusted odds ratio [AOR] = 1.41; 95% confidence interval [CI], 1.19–1.66), vegetables (AOR = 1.46; 95% CI, 1.25–1.72), fruits (AOR = 1.73; 95% CI, 1.42–2.11), and fresh foods frequently (AOR = 2.24; 95% CI, 1.41–3.56) at 8 to 10 months of age. Conversely, exclusive breastfeeding for 3 months, compared to mixed or formula feeding, was negatively associated with very early complementary feeding (AOR = 0.35; 95% CI, 0.30–0.42) and giving the following foods at 8 to 10 months of age: baby food from jar (AOR = 0.78; 95% CI, 0.66–0.92), powdered baby food (AOR = 0.73; 95% CI, 0.57–0.94), canned baby food (AOR = 0.48; 95% CI, 0.32–0.71), and ready-made bought meals (AOR = 0.67; 95% CI, 0.57–0.78).

Exclusively breastfeeding for 3 months compared to mixed or formula feeding was positively associated with the introduction of complementary feeding after 4 months and giving infants fruits, vegetables, and homemade infant foods frequently at 8 to 10 months.

The presence of barriers is not sufficient to explain breastfeeding rate disparities. A relatively unexplored area in coping with breastfeeding barriers is culture.

This research aims to better understand the role of culture in a woman’s infant feeding decision by using race and socioeconomic status as indicators of culture.

Focus groups and individual interviews were conducted with 42 pregnant women or mothers of infants younger than 12 months. Focus group composition was determined by self-identified African American or white race and self-reported eligibility for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or ineligibility (non-WIC).

Most participants acknowledged that breastfeeding was best, yet differences arose between groups in the perception of, and reaction to, breastfeeding barriers. WIC and non-WIC participants of both races indicated that some circumstances necessitated formula use. WIC participants felt that this was personally and socially acceptable due to need, whereas non-WIC participants felt that this was personally and socially unacceptable. When a barrier arose, WIC participants of both races felt that the infant feeding choice was not theirs and formula use might be inevitable. In contrast, non-WIC participants of both races expressed that they persevered to continue breastfeeding and did so by establishing small, achievable goals and seeking mentors.

Educational and public health efforts to reduce breastfeeding disparities may be enhanced if support is tailored to acknowledge cultural differences among women and address factors that make either breastfeeding or formula feeding acceptable, or even preferable, within their communities.

Buprenorphine has been available in Australia since 2000 as an alternative pharmacotherapy to methadone for the treatment of opioid dependence. However, there is little information in the literature regarding the effect of buprenorphine on the wellbeing of infants exposed to buprenorphine via breast milk, following discharge from hospital.

The aim of the present study was to examine the wellbeing of infants exposed to buprenorphine via breast milk up to 4 weeks postnatally.

Approximately 4 weeks after birth, information on the feeding and sleeping patterns, skin color, infant elimination patterns and hydration, and Neonatal Abstinence Scores of infants (n = 7) exposed to buprenorphine via breast milk was collected via both observation and documentation.

Infants were progressing well, with normal sleep patterns and skin color, and 2 mothers had minor concerns regarding infant elimination patterns. Four infants were exclusively breastfed and 3 were receiving a supplement, with a range of 260 to 700 mL of formula over 24 hours. The sleep patterns following feeding ranged from 1.55 to 3.33 hours, with a median of 2.12 hours.

No adverse effects were detected in infants exposed to buprenorphine via breast milk up to 4 weeks postnatally. Further research using larger samples to assess possible developmental effects over longer periods of time is required.

Increasing the number of infants who are breastfed has become a worldwide health priority because of the extensively documented health and economic benefits of breastfeeding for mothers and their children. It is unfortunate that adolescents initiate and continue breastfeeding at rates lower than adult women. Health care providers can improve these breastfeeding rates through the social support they offer adolescent mothers as they initiate breastfeeding.

The purpose of this study was to explore the needs of adolescents for social support from nurses when initiating breastfeeding.

Secondary qualitative content analysis of 90 adolescents’ responses to 2 open-ended questions was conducted using social support theory as a framework. The 2 researchers independently categorized each response as informational, instrumental, emotional, and/or appraisal social support.

Adolescent mothers wanted nurses to take the time to explain breastfeeding, answer their questions, and provide consistent information that supported their informational needs. Emotional needs were met as the nurse provided for the adolescents’ privacy, treated them with respect, and stayed calm. Nurses met adolescents’ appraisal support needs through praise and encouragement. Participants valued instrumental support that included being given opportunities to work out breastfeeding under a nurse’s guidance.

Adolescents needed a combination of informational, instrumental, emotional, and appraisal support. Adolescent mothers appreciate and value nurses who take the time to dialogue with them about breastfeeding.

Very little population-based research has been conducted around the exclusive breastfeeding practices of Inuit Canadians.

This research aims to assess the distribution of exclusive breastfeeding among Inuit Canadians and to identify factors associated with exclusive breastfeeding as recommended.

We use data from 188 infant-mother dyads who completed the Nunavut Inuit Child Health Survey, a cross-sectional, population-based survey of Inuit children aged 3 to 5 years. A series of multinomial logistic regression models were run to identify factors associated with 4 exclusive breastfeeding durations (≤ 1 month, > 1-< 5.5 months, 5.5-6.5 months, and > 6.5 months).

Of infants, 23% were exclusively breastfed as recommended (ie, between 5.5 and 6.5 months; 95% CI, 16.2-29.3). Many infants (61%) were exclusively breastfed for less than 5.5 months and 16% (95% CI, 10.9-22.0) were exclusively breastfed for more than 6.5 months. Families receiving income support were less likely to discontinue exclusive breastfeeding before 5.5 months (pOR_{1- < 5.5 months} = 0.34; 95% CI, 0.13, 0.85) relative to those not receiving income support, in adjusted models. No other measured factors were significantly related to exclusive breastfeeding duration.

The majority of Inuit Canadian infants receive suboptimal exclusive breastfeeding. National, provincial, and community-specific interventions to protect, promote, and support exclusive breastfeeding should emphasize not only the benefits of exclusively breastfeeding to 6 months but also the importance of timely introduction of complementary foods into the infant’s diet.