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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (30 September 2019) | Viewed by 53653

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Special Issue Editors

Dr. Ada Garcia

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Guest Editor

School of Medicine, University of Glasgow, Glasgow, UK
Interests: nutrition in early years; complementary feeding; undernutrition; public health nutrition interventions; evaluation; infant foods; diet quality; infant feeding behaviours
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Amy Brown

E-Mail Website
Guest Editor

College of Human and Health Sciences, Swansea University, Swansea, UK
Interests: infant nutrition; breastfeeding; weaning; obesity; pregnancy; postnatal depression; parenting

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on “Infant and Young Child Feeding” in the International Journal of Environmental Research and Public Health.

The provision of sufficient, adequate, and safe nutrition during the first years of life is essential to infant development but also provides the basis for healthy eating patterns that can extend to adulthood. Supportive environments, both physical and emotional, for the promotion of breastfeeding, the introduction of solid foods, and the provision of healthy diets in early years are important to child health. Examples of these environments are the neonatal environment, home and early years establishments, family, workplaces, community support, health care/policy support, and, more recently, “online/virtual” space. Understanding the role of nature and nurture (environment) on feeding practices during early years using an evidence-based approach is needed to plan interventions to optimize outcomes and practice. The evaluation of interventions to improve infant feeding practices that are of public health relevance is essential to inform practice and policy. Global infant feeding issues such as undernutrition and nutrition transition will also be considered.

This Special Issue seeks papers on infant feeding, including those on the impact of diet and environmental conditions on public health. Epidemiological and intervention studies, high-quality qualitative studies, and novel and high-quality narrative or systematic reviews will be considered. Cross-sectional surveys not properly powered or those purely describing nutrition surveys using non-representative samples will not be prioritized.

The venue is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

The listed keywords suggest just a few of the many topics of interest.

Dr. Ada Garcia
Prof. Dr. Amy Brown
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Infant nutrition
Breastfeeding
Complementary feeding
Diet
Early years
Social participation
Environmental exposure
Public health nutrition interventions
Community-based approaches
Feeding behavior

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Published Papers (11 papers)

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Research

14 pages, 530 KiB

Open AccessArticle

An Exploration of Complementary Feeding Practices, Information Needs and Sources

by Ada L. Garcia, Sarah Looby, Kimberley McLean-Guthrie and Alison Parrett

Int. J. Environ. Res. Public Health 2019, 16(22), 4311; https://doi.org/10.3390/ijerph16224311 - 6 Nov 2019

Cited by 30 | Viewed by 4704

Abstract

Following complementary feeding (CF) guidelines might be challenging for mothers lacking time, resources and/or information. We aimed to explore CF practices, information needs and channels used to obtain information in parents living in areas of socioeconomic deprivation. Sixty-four parents of infants aged 4–12 months completed a short questionnaire and 21 were interviewed. Mean (SD) weaning age was 5 ± 2.5 months, foods given >7 times/week included commercial baby foods (33%) and fruits (39%) while 86% gave formula daily. The main sources of CF information were friends and family (91%), the internet (89%) and health visitors (77%). Online forums (20%), e.g., Facebook and Netmums, were used to talk to other parents because they felt that “not enough” information was given to them by health professionals. Parents felt access to practical information was limited and identified weaning classes or online video tutorials could help meet their needs. Themes identified in qualitative findings were (1) weaning practices (i.e., concerns with child’s eating; and (2) information sources and needs (i.e., trust in the National Health Service (NHS) as a reliable source, need for practical advice). In conclusion, parents are accessing information from a number of non-evidence-based sources and they express the need for more practical advice. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

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12 pages, 1207 KiB

Open AccessArticle

The Low Prevalence of Overweight and Obesity in Czech Breastfed Infants and Young Children: An Anthropological Survey

by Jitka Riedlová, Markéta Paulová, Jana Vignerová, Marek Brabec, Petr Sedlak and Dagmar Schneidrová

Int. J. Environ. Res. Public Health 2019, 16(21), 4198; https://doi.org/10.3390/ijerph16214198 - 30 Oct 2019

Cited by 1 | Viewed by 3412

Abstract

The aim of this study is to evaluate the prevalence of overweight and obesity in a sample of children who were exclusively or predominantly breastfed for at least 6 months compared to Czech references that were constructed based on a representative sample of children, regardless of their mode of feeding. Between 2008 and 2011, a longitudinal study on the growth of breastfed infants was carried out in the Czech Republic. Forty-three GP pediatricians addressed parents at 18-month preventive examinations and collected data on the families’ socio-economic conditions and the infants’ feeding conditions. The children were measured (length, weight, and head circumference), and anthropometric measurements from 10 previous preventive examinations were obtained from the health records. Out of the collected 1775 questionnaires, 960 children were selected according to the criteria of the WHO Multicentre Growth Reference Study. For the purpose of this study, 799 children who were exclusively or predominantly breastfed for at least 6 months were selected. We found that the proportions of children who were classified as overweight (>90th percentile) or obese (>97th percentile) at 6, 12, and 18-month examinations were far below the proportions of the Czech references. An update of the Czech references and growth charts is highly recommended by GP pediatricians for the valid assessment of growth and nutritional status, including a screening of overweight and obesity in primary preventive health care. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

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12 pages, 283 KiB

Open AccessArticle

Maternal and Infant Health in Abu Dhabi: Insights from Key Informant Interviews

by Hazel Gardner, Katherine Green, Andrew Gardner and Donna Geddes

Int. J. Environ. Res. Public Health 2019, 16(17), 3053; https://doi.org/10.3390/ijerph16173053 - 22 Aug 2019

Cited by 4 | Viewed by 2874

Abstract

Consequent upon rapid development in Abu Dhabi, there has been a rise in chronic disease, the susceptibilities to which are influenced by events occurring in early life. Hence, maternal and infant health are key areas in public health policy. Following a study of maternal and infant health in a cohort of mothers in Abu Dhabi between 2002 and 2004, seven key informant interviews were undertaken to elucidate the study findings through the impressions of Emirati women in positions within the healthcare area—including ministries, hospitals, and universities in Abu Dhabi. Semi-structured interviews were based on five key questions that covered the cultural responsiveness of the maternal health services—breastfeeding, health education, and physical and recreational activity. The responses were analysed using a thematic content technique and indicated that the status of women, cultural beliefs and practices, limited health knowledge, and language differences between the local population, healthcare providers, and health promoting materials were important themes. The study highlighted areas for future research and policy, including the communication gaps between healthcare professionals and women, the influences of advertising and the media on health issues, heath education, and ways to increase women’s participation in physical exercise. It is vital to consider non-medical determinants of health alongside biomedical determinants, to help develop culturally appropriate health strategies for this population. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

10 pages, 477 KiB

Open AccessArticle

What Can Meal Observations Tell Us about Eating Behavior in Malnourished Children?

by Antonina N. Mutoro, Ada L. Garcia and Charlotte M. Wright

Int. J. Environ. Res. Public Health 2019, 16(12), 2197; https://doi.org/10.3390/ijerph16122197 - 21 Jun 2019

Cited by 5 | Viewed by 3759

Abstract

Responsive feeding is an important aspect of child care, yet little is known about child eating and caregiver feeding behavior in Kenya. This study aimed to develop a mealtime observation methodology and assess child eating and caregiver feeding behavior in healthy and undernourished children in Nairobi. Healthy (n = 6) and undernourished (n = 13) children aged 6–24 months were observed during a meal, with standardized rating of child interest in food, mood, distraction and caregiver responsiveness. Eating and feeding behavior varied with the stage of the meal. Child interest in food decreased and child and caregiver distraction increased as the meal progressed. Healthy children were happy and interested in food during meals, but undernourished children often had low interest in food (7/13). The 7 undernourished children eating home food were distracted (3) and unhappy (5) but children eating ready-to-use therapeutic foods (6) were all happy and undistracted. Caregivers of healthy children offered encouragement more often during meals than caregivers of undernourished children (5/6 healthy, 3/13 undernourished). Meal observations were resource intensive and could give only a snapshot of the child feeding experience. More efficient research methods that can capture a general assessment of infant eating behavior are needed. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

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11 pages, 340 KiB

Open AccessArticle

Evaluation of Knowledge, Attitudes, and Practices about Exclusive Breastfeeding among Women in Italy

by Diana Cascone, Davide Tomassoni, Francesco Napolitano and Gabriella Di Giuseppe

Int. J. Environ. Res. Public Health 2019, 16(12), 2118; https://doi.org/10.3390/ijerph16122118 - 14 Jun 2019

Cited by 31 | Viewed by 10813

Abstract

Background: The aim of this study was to assess the level of knowledge, attitudes and behaviors of women about breastfeeding in Italy. Methods: A cross-sectional survey was carried out between January and June 2016 in the Campania Region among mothers who were going to six public vaccination centers. Data were collected by two researchers through face to face interviews. Results: Two thirds of the women had heard on exclusive breastfeeding (64.6%) and the 71% of them knew that exclusive breastfeeding should be practiced for at least six months. Nearly all mothers had breastfed their child (93.2%), but only 33.3% of them had practiced exclusive breastfeeding for at least six months. Women who agree that breastfeeding creates a positive relationship between the mother and the child, who practiced exclusive breastfeeding during the hospital stay, and who had received breastfeeding advice at hospital discharge were more likely to practice exclusive breastfeeding for at least six months. Conclusions: The results of this survey may be helpful to policy makers and managers when planning educational interventions on breastfeeding both during pregnancy and during hospital admissions for delivery. Indeed, there is a need to increase efforts to make mothers aware of health benefits of breastfeeding for themselves and their offspring during their hospital stay after delivery. This research has the potential to increase exclusive breastfeeding rates and subsequent maternal and child health outcomes. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

10 pages, 312 KiB

Open AccessArticle

Stakeholder Attitudes towards Donating and Utilizing Donated Human Breastmilk

by Welma Lubbe, Charlene S. Oosthuizen, Robin C. Dolman and Namukolo Covic

Int. J. Environ. Res. Public Health 2019, 16(10), 1838; https://doi.org/10.3390/ijerph16101838 - 23 May 2019

Cited by 18 | Viewed by 4086

Abstract

The promotion and support of human milk banks (HMBs) can enhance exclusive breastfeeding rates. The success and sustainability of HMBs depend on the support from relevant healthcare workers and related communities. This study aimed to determine attitudes of key stakeholders, including mothers, healthcare workers and grandmothers, regarding the donation and receipt of human breastmilk. This study was conducted at a public hospital and clinics in the North West Province, South Africa. Eight focus group discussions explored the attitudes regarding donating and receiving human breastmilk: three groups with mothers of infants (n = 13), three with grandmothers (>60 years old) (n = 17) and two with healthcare professionals working with infants (n = 11). Four main themes emerged: perception regarding breast and formula feeding; exposure to the concept of “wet nursing”; breastmilk donation; and utilization and opinions of community members and traditional healers. Specific barriers identified included the processes for donating and receiving milk, safety, human immuno-deficiency virus (HIV) screening and cultural beliefs. Mothers’ fears included having insufficient milk for their own infants, changes in the quality of donated milk during pasteurization and transportation and HIV transmission. Despite barriers towards donations to and the use of HMBs, sufficient information could enhance donations by mothers and breastmilk utilization. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

12 pages, 814 KiB

Open AccessArticle

Physical Activity During Pregnancy is Associated with Improved Breastfeeding Outcomes: A Prospective Cohort Study

by Phung Thi Hoang Nguyen, Colin W. Binns, Cong Luat Nguyen, Anh Vo Van Ha, Khac Tan Chu, Dat Van Duong, Dung Van Do and Andy H. Lee

Int. J. Environ. Res. Public Health 2019, 16(10), 1740; https://doi.org/10.3390/ijerph16101740 - 16 May 2019

Cited by 15 | Viewed by 5309

Abstract

Physical activity is important for health, but little is known about associations between physical activity during pregnancy and breastfeeding. The aim of this study was to investigate any association between antenatal physical activity and breastfeeding duration. A prospective cohort of 2030 Vietnamese women, recruited between 24 and 28 week-gestation was followed up to twelve months postpartum. Physical activity was determined using the pregnancy physical activity questionnaire at baseline interview. Data was available for 1715 participants at 12 months, a 15.5% attrition rate. At 12 months 71.8% of mothers were still breastfeeding. A total of 20.9% women met physical activity targets and those mothers undertaking higher levels of physical activity had a lower risk of breastfeeding cessation by twelve months [hazard ratios HR = 0.59 (95% CI 0.47–0.74), p < 0.001, and HR = 0.74 (0.60–0.92), p = 0.006; respectively] when compared to the lowest tertile. Similarly, women with increased levels of physical activity have higher rates of breastfeeding at twelve months, compared to the lowest level [odds ratio OR = 1.71 (95% CI 1.29–2.25) and 1.38 (1.06–1.79)]. Higher levels of physical activity by pregnant women are associated with improved breastfeeding outcomes. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

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11 pages, 296 KiB

Open AccessArticle

Assessing the Potential for Integrating Routine Data Collection on Complementary Feeding to Child Health Visits: A Mixed-Methods Study

by Louise Tully, Charlotte M. Wright, Deirdre McCormick and Ada L. Garcia

Int. J. Environ. Res. Public Health 2019, 16(10), 1722; https://doi.org/10.3390/ijerph16101722 - 16 May 2019

Cited by 5 | Viewed by 3031

Abstract

There is no routine data collection in the UK on infant dietary diversity during the transition to solid foods, and health visitors (HVs) (nurses or midwives with specialist training in children and family health) have the potential to play a key role in nutrition surveillance. We aimed to assess items for inclusion in routine data collection, their suitability for collecting informative data, and acceptability among HVs. A mixed-methods study was undertaken using: (i) an online survey testing potential questionnaire items among parents/caregivers, (ii) questionnaire redevelopment in collaboration with community staff, and (iii) a survey pilot by HVs followed by qualitative data collection. Preliminary online questionnaires (n = 122) were collected to identify useful items on dietary diversity. Items on repeated exposure to foods, aversive feeding behaviors, flavor categories, and sugar intake were selected to correspond to nutrition recommendations, and be compatible with electronic records via tablet. HVs surveyed 187 parents of infants aged 12 months. Semi-structured interviews indicated that HVs found the questionnaire comparable with standard nutrition conversations, which prompted helpful discussions, but questions on eating behavior did not prompt such useful discussions and, in some cases, caused confusion about what was ‘normal.’ Lack of time among HVs, internet connectivity issues, and fear of losing rapport with parents were barriers to completing electronic questionnaires, with 91% submitted by paper. Routine nutrition data collection via child health records seems feasible and could inform quality improvement projects. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

18 pages, 809 KiB

Open AccessArticle

Association between Breastmilk LC PUFA, Carotenoids and Psychomotor Development of Exclusively Breastfed Infants

by Monika A. Zielinska, Jadwiga Hamulka, Iwona Grabowicz-Chądrzyńska, Joanna Bryś and Aleksandra Wesolowska

Int. J. Environ. Res. Public Health 2019, 16(7), 1144; https://doi.org/10.3390/ijerph16071144 - 30 Mar 2019

Cited by 43 | Viewed by 5581

Abstract

The first months of infant life are crucial for proper neurodevelopment, which may be influenced by several factors, including nutrition and nutrients (e.g., long-chain polyunsaturated fatty acids (LC PUFA) and carotenoids) of which the concentration in breastmilk is diet-dependent. This study analysed the relationship between the average concentrations of selected LC PUFA and carotenoids in breastmilk samples from the first and third months of lactation and the psychomotor development of exclusively breastfed infants at the sixth month of life. Infant psychomotor development was assessed using the Children Development Scale (DSR). The average age of infants during the assessment was 6.6 ± 0.2 months and 30.9 ± 3.8 years for mothers (n = 39 mother–infant pairs). The average concentration of docosahexaenoic acid (DHA) was 0.50% of fatty acids. The average concentration of carotenoids was 33.3 nmol/L for β-carotene, 121 nmol/L for lycopene and 33.3 nmol/L for lutein + zeaxanthin. The total results of the Performance scale and Motor subscale were 39 centiles and 4.1 points, respectively. Adjusted multivariate regression models revealed associations between breastmilk DHA and motor development (β = 0.275; p ≤ 0.05), α-linolenic acid (ALA; β = 0.432; p ≤ 0.05), n-3 LC PUFA (β = 0.423; p ≤ 0.05) and β-carotene (β = 0.359; p ≤ 0.05). In addition, an association between the Perception subscale and DHA was observed (β = 0.316; p ≤ 0.05; model 2). There were no significant associations between the overall Performance scale scores. Due to the positive association between concentrations of n-3 LC PUFA (ALA and DHA) and β-carotene in breastmilk and infant motor development, it is important to provide these nutrients with breastmilk. According to the diet-dependent concentration of these compounds in breastmilk, breastfeeding mothers should have a diet abundant in dietary sources of these nutrients, e.g., fish, nuts, seeds, vegetable oils, vegetables and fruits. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

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16 pages, 543 KiB

Open AccessArticle

Mothers’ Understanding of Infant Feeding Guidelines and Their Associated Practices: A Qualitative Analysis

by Andrea Begley, Kyla Ringrose, Roslyn Giglia and Jane Scott

Int. J. Environ. Res. Public Health 2019, 16(7), 1141; https://doi.org/10.3390/ijerph16071141 - 29 Mar 2019

Cited by 25 | Viewed by 5324

Abstract

There is limited evidence to describe Australian mothers’ understanding of the Australian Infant Feeding Guidelines (AIFG). A qualitative inductive methodological approach was used in this study to explore experiences with the introduction of solid food. Seven focus groups with 42 mothers of children aged 4–18 months were conducted in disadvantaged areas in Perth, Australia. The mean age of infants was 9.6 months and mean age of introduction of solid food was 4.3 months (range 1.2 to 7.5 months). Almost half of the mothers in this study were aware of the AIFG however, only half again could correctly identify the recommended age for introducing solid food. Four themes and nine subthemes emerged from the analysis. Themes were (1) Every child is different (judging signs of readiness); (2) Everyone gives you advice (juggling conflicting advice); (3) Go with your gut—(being a “good” mother); and (4) It’s not a sin to start them too early or too late (—guidelines are advice and not requirements). The findings indicated that in spite of continued promotion of the AIFG over the past ten years achieving the around six months guideline is challenging. Professionals must address barriers and support enablers to achieving infant feeding recommendations in the design education materials and programs. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

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13 pages, 1415 KiB

Open AccessArticle

Family Factors Associated with Selected Childhood Nutrition Aspects in Central Poland

by Katarzyna Zadka, Ewelina Pałkowska-Goździk and Danuta Rosołowska-Huszcz

Int. J. Environ. Res. Public Health 2019, 16(4), 541; https://doi.org/10.3390/ijerph16040541 - 13 Feb 2019

Cited by 10 | Viewed by 3743

Abstract

Childhood diet has a significant influence on diet-related diseases in adulthood, so an understanding of environmental influences on nutrition, is important. The aim of this cross-sectional study was to indicate family factors associated with some aspects of children’s nutrition in Central Poland. A questionnaire was used to investigate 892 mothers’ approach to breastfeeding, frequency of eating with children at fast food restaurants, and serving them snacks, sugary drinks, and fried food. Prevalence of dental caries among children, based on the mothers’ self-assessment, was also assessed. Majority of the mothers breastfed for a period not longer than six months. There was a positive association between breastfeeding duration and mothers’ education level and the number of children in a family. Sweets were used as a reward, more often among younger children and in families with higher number of children. The frequency of consumption of sweet beverages rose with the child’s age and decreased with mother’s education level and family income. It was also more frequent in rural areas. Most children received snacks and fried food at least once a week. There was a negative association between eating with parents at fast food restaurants and, both, the number of children in the family and living in a village. Fast food consumption rose with the mother’s education level and family income. Prevalence of dental caries according to mothers’ declarations was much lower than in national studies but was associated with frequent consumption of snacks and sweet beverages in the examined population. Extensive activities to reduce the occurrence of dental caries at the national level and education concerning the role of a family environment in providing a proper childhood nutrition, with a special emphasis on breastfeeding benefits, seems necessary for Polish parents. Designing community-wide education campaigns referencing population-based programs and other health and disease prevention activities, need to be promoted. Full article

(This article belongs to the Special Issue Infant and Young Child Feeding)

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