Book Reviews

Infant Feeding: Parental Perceptions, Behaviors and Health Effects

"This is a fascinating book but not one to skim through quickly. Aimed at researchers, practitioners and health professionals, many of its chapters could be expanded to book-length, describing experimental studies or literature reviews on a range of behavioural, biological and health questions around infant feeding.A fair bit of stamina may be needed to get through the first two chapters, which although covering important topics, appear to be written more for readers already familiar with the authors’ academic field. Nonetheless, they help to establish something of the range of research around breastfeeding that has taken place over the past 50 years.

Chapter 1 reviews evidence for the nutritional and biological effects of breastfeeding, while Chapter 2 summarises more than four decades of research at the University of Wisconsin’s School of Nursing, on the development of theoretical models to understand mothers’ experience of feeding. The work stresses the need for those supporting mothers with feeding problems to consider the mothers’ perceptions and goals in order to help resolve any issues.I found subsequent chapters more accessible, and was especially interested in studies touching upon the relationships between breastfeeding behaviour and maternal depression, and self-image.

Chapter 3, for example, describes a doctoral study suggesting that depressed mothers may need additional feedback, based on an objective measure of how much milk her baby is receiving, in order to help raise their self-efficacy, or confidence, around breastfeeding. Chapter 4 describes a study showing that breastfeeding appears to help overcome the negative effect of depression on a mother’s interactivity with her baby during feeding: depressed mothers who breastfeed are more similar in their interactivity with babies to non-depressed mothers, compared to depressed mothers who bottle feed, across the first three months of life.

The reasons are unclear but could involve the role of tactile stimulation in triggering the release of oxytocin in the mother, which in turn improves her mood and interactivity with her child. In Chapter 5, Amy Brown from the University of Swansea highlights the strong influence that a mother’s body weight and body image can have on her feeding decisions in the first year. For example, mothers with higher body weight and concerns about their weight are more likely to be restrictive in how they feed their infants, regardless of their baby’s actual body weight. A mother’s dissatisfaction with her body image may also reduce self-esteem and contribute to anxiety and depression - all of which can influence decisions around breastfeeding.A major theme throughout the book is the shift in research over the past few decades from a focus on the quality of attachment between mother and baby to the practice of responsive feeding and its influence on infant growth and weight. Responsive feeding refers to a practice in which the mother or other caregiver responds sensitively to infant feeding cues for hunger and satiety and avoids the use of controlling actions such as force-feeding.

This is thought to encourage better feeding practice in multiple settings, as reviewed in Chapters 9 and 10. In low-income countries such as Bangladesh, responsive feeding can lead to improved weight gain in faltered growth or underweight children, but only if linked to access to nutritional foods. Although a complex picture, in some settings this may relate to the apparent controlling behaviour of caregivers who are concerned that undereating may cause illness or death, and high rates of food refusal by young children. Intriguingly, the same strategy - encouraging responsive feeding - is showing promise in slowing weight gain and reducing the risk of obesity. This is of broader policy and practical relevance, as interventions aimed at encouraging a more responsive style of feeding are now endorsed by WHO and UNICEF as a way to tackle both underweight and faltered growth in children, and childhood obesity.

The statistics are sobering: 30% of children under five in low- and middle-income countries are stunted (168 million), while obesity affects 40 million children under five worldwide.Clinical guidelines provided by WHO, the US Academy of Nutrition and Dietetics and the American Academy of Pediatrics promote responsive feeding, based on the premise that babies have an innate ability to self-regulate their food. They advocate that parents should focus on choosing what a child eats, while the child be allowed to decide how much they eat. Practitioners are recommended to discuss with parents how to respond to infant hunger and satiety cues, including when bottle feeding, to allow infants to pause and rest between feeds.I was disappointed with the little direct attention given to the reasons why bottle feeding is associated with poorer outcomes, and how a practitioner might help overcome these when supporting mothers who are bottle feeding. Only Chapter 6 directly examines differences between breast and bottle feeding, with an impressively detailed comparison of the mechanics of mouth positioning and sucking patterns, for example, and how these may influence infant feeding and growth.

It dispels certain notions based on earlier studies, such as babies who are bottle fed having lower oxygen saturation than babies who are breastfed. Once thought to be due to differences in coordination of sucking, breathing and swallowing, more recent studies using soft teats instead of hard rubber teats reveal no such differences. Similarly, the idea of ‘nipple confusion’, in which infants who are offered bottle feeding may develop a preference for this over breastfeeding, has no scientific basis. While anecdotal and clinical reports suggest it, observational studies do not support a causal link between bottle introduction and breastfeeding cessation.Of considerable practical use, the book’s editor John Worrobey, reviews and catalogues 15 different methods for measuring and evaluating the behaviour and interaction of feeding mothers and babies, from birth to toddlerhood, for use in both research and clinical observational assessment.

This includes a ‘Feeding checklist’ which can differentiate reliably between the responsive and non-responsive behaviours of mothers and babies who are either thriving or showing faltered growth.Some of the experimental studies described are limited by their small size or uncertainty over their applicability to other health care settings. The topics covered, however, provide sufficient food-for-thought to prompt debate around what we do actually understand about what goes on during infant feeding, and how this information can be used to develop appropriate interventions that enhance the feeding experience for all mothers and their babies, tailored to different situations and decisions about breast versus bottle feeding." - Dr. Julie Clayton, Editor Perspective, NCT. This review will be published in the June edition of MIDIRS Digest

For more information about this book, please click here.

Informed Parents, Healthy Kids: Information You Need to Know to Find the Right Mental Health Practitioner

“Few books exist on the topic of guiding parents concerning the choice of health care providers in finding professional services for their emotionally distressed or psychologically disordered children and teens. And even fewer still have the substantial evidence based from science, the exceptional depth and breadth of the author’s clinical experience, and the wisdom contained in this book. I can think of no better resource for a parent to turn to first concerning the science-based care and treatments their child may require than this one. It will certainly be the first I recommend to families when asked for advice on this matter. My compliments to the author for investing the extraordinary amount of time such a book requires and the care taken in its preparation and my compliments to the reader for having the good sense to use it to guide them in their choice of health care professionals for their child..” - Russell A. Barkley, Ph.D., Clinical Professor of Psychiatry, Virginia Treatment Center for Children and Virginia Commonwealth University Medical Center, Richmond, VA, USA

"This book is a wonderful resource for families and clinicians alike. Dr. Paniagua’s content in Informed Parents, Healthy Kids can be used to empower families in finding mental health providers that will provide services that are aligned with their cultural values. In order to make decisions, families need to have a good understanding of the purpose of intervention services and they need to recognize how critical it is to have a provider that is a true partner in supporting their needs. The old days of the mental health provider as “expert” and setting treatment goals outside the knowledge of the family are over. We are now in a pluralistic society that implores mental health providers to partner with families and set culturally appropriate treatment goals. The material shared in this book is a perfect tool for enabling that process to occur." - Janine Jones, Ph.D, NCSP, Associate Professor, School Psychology, Director, School Psychology Program, University of Washington, USA

To read the review, click here - Thomas A. Parham, Ph.D., President of California State University, Dominguez Hills, USA

For more information about this book, please click here.