Infant Feeding: Parental Perceptions, Behaviors, and Health Effects

John Worobey (Editor)
Department of Nutritional Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA

Series: Pediatrics – Laboratory and Clinical Research
BISAC: MED069000

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Although infant feeding may be considered the primal form of mother–infant interaction, its treatment as a worthy subject of scientific investigation has only recently ascended to a position of importance. The reasons for our current interest are varied and important. For example, over the past fifty years the methods for studying feeding have improved, whether one speaks of analyzing the composition of milk or the synchrony of the dyadic give-and-take during a feeding.

Secondly, with breastfeeding rates having risen dramatically recently, the correlates of this societal change are undeniably of increased empirical interest. Finally, the current child obesity epidemic has propelled infant feeding to the forefront of the variety of public health strategies that will be needed to slow this crisis. The contributors to the present volume are all well-established researchers in the area of mother-infant interactions that surround infant feeding. With a mixture of theoretical underpinnings, methodological advances, and samples of current research, this book should serve as a useful reference for scientists and practitioners interested in the behavioral and health issues that surround infant feeding.
(Imprint: Nova Biomedical)

Preface

Chapter 1
Breastfeeding: Nutrition and Behavior
(Mariella Baldassarre, Antonio Di Mauro, Diana De Bellis, Nicola Laforgia, University of Bari Aldo Moro, Italy)

Chapter 2
Feeding an Infant, Healthy or Fragile: Mothers’ Experience of Feeding and its Meaning
(Karen Pridham, University of Wisconsin-Madison, WI, USA)

Chapter 3
Breastfeeding Self-Efficacy in the Mother-Infant Dyad
(Shera C. Thomas-Jackson, Mallory Boylan, Sybil L. Hart, Texas Tech University, TX, USA)

Chapter 4
Breastfeeding Impacts Brain Activation and Interaction Patterns in Infants of Depressed Mothers
Nancy Aaron Jones, Melannie Platt, Krystal D. Mize, Florida Atlantic University, FL, USA)

Chapter 5
Breastfeeding and its Relation to Cortisol Response, Temperament, Arousal, and Better Learning and Memory in Infancy
(Laura A. Thompson, Gin Morgan, Melissa Stauble, Cynthia Unger, New Mexico State University, NM, USA, and others)

Chapter 6
Breasts versus Bottles for Infant Feeding: What’s the Difference?
(Alison K. Ventura, Haley Terndrup, California Polytechnic University, CA, USA)

Chapter 7
The Impact of Maternal Weight, Body Image and Eating Behavior on Infant Feeding Decisions during the First Year
(Amy Brown, Swansea University, United Kingdom)

Chapter 8
Are Controlling Parental Behaviors During Feeding and Play Moderated by Child Weight?
(Claire Farrow, Laura Houldcroft, Jackie Blissett, Aston University, United Kingdom, and others)

Chapter 9
Responsive Feeding and its Impact on Faltered Growth and Rapid Growth in Infancy
(Katherine Isselmann DiSantis, Arcadia University, PA, USA)

Chapter 10
Responsive Feeding and Growth among Infants and Toddlers in Low- and Middle-Income Countries
(Maureen M. Black, University of Maryland School of Medicine, MD, USA)

Chapter 11
Observational Scales of Mother-Infant Feeding: A Catalogue and Review
(John Worobey, Rutgers–The State University of New Jersey, NJ, USA)

Index

"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

Audience: With a mixture of theoretical underpinnings, methodological advances, and samples of current research, it is hoped that this book will serve as a useful reference for those interested in the behavioral and health issues that surround infant feeding, whether one is a researcher, practitioner, or simply wants to explore the roots of early human social interaction.

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