A controlling maternal feeding style can have negative consequences for child weight and eating style (Ventura & Birch, 2008). Mothers who breastfeed during the first year exert lower levels of control over child feeding (Farrow & Blissett, 2008). Explanations for this relationship speculate that experience of breastfeeding reduces control as breastfeeding requires an infant-led approach (Taveras et al. 2004) or alternatively that maternal attitudes predict both initiation of breastfeeding and later maternal control (Farrow & Blissett, 2006a). The nature of this relationship is explored in this thesis. Mothers reported their intended and actual feeding style during milk feeds when pregnant and at six months postpartum using a modified version of the Child Feeding Questionnaire (Birch, Fisher, Grimm-Thomas, Markey, Sawyer, & Johnson. 2001). Maternal use of control in the form of scheduling and encouraging milk feeds was evident. A high level of control was associated with a shorter breastfeeding duration (p < 0.001). Control beliefs were present prenatally with intended breastfeeding duration inversely associated with intended control. Furthermore, attitudes towards the infant-led nature of breastfeeding were associated with both breastfeeding duration and control. Breastfed infants need to be fed to infant demand and amount consumed is immeasurable whilst formula feeding is open to maternal manipulation. A belief that breastfeeding was inconvenient was associated with scheduling feeds whilst concerns over milk intake and low confidence were associated with encouraging feeds. Whilst scheduling feeds was a stable behaviour predictive from prenatal intention, encouraging feeds was fluid and related to maternal experience. Concerns about infant size or feeding difficulties increased use of encouraging feeds. Maternal desire for control may therefore drive breastfeeding duration, explaining the association between breastfeeding and later feeding style. The findings have important implications for breastfeeding duration, early programming of appetite and bodyweight and later maternal feeding style.

A alimentação da criança no primeiro ano de vida é essencial para o crescimento e desenvolvimento adequados. A Organização Mundial de Saúde (OMS) recomenda que o aleitamento materno seja exclusivo até os seis meses de vida e que os alimentos complementares sejam introduzidos a partir desta idade. Os objetivos desta pesquisa foram estimar a prevalência do aleitamento materno em crianças menores de 1 ano de idade e descrever a alimentação complementar entre as crianças estudadas. O estudo transversal, descritivo abrangeu 821 crianças menores de um ano de idade vacinadas na Segunda Etapa da Campanha Nacional de Vacinação nos Postos de Saúde da cidade de Guarapuava-PR. A coleta dos dados foi realizada com as mães e/ou responsáveis por crianças menores de 1 ano de idade que compareceram aos Postos de Saúde naquela data. O instrumento utilizado nesta pesquisa foi o questionário elaborado e validado pelo Instituto de Saúde da Secretaria Estadual de Saúde de São Paulo-SP e parcerias. A análise dos dados deu-se através da análise das freqüências simples de todas as variáveis coletadas. Com relação aos indicadores de aleitamento materno, 68,9% das crianças estavam em aleitamento materno, sendo 86,2% e 39,8% entre crianças menores de 4 e 6 meses, respectivamente. Considerando os indicadores de aleitamento materno exclusivo e predominante, verificou-se que entre as crianças menores de 4 meses foi de 46,4% e 41,4%, respectivamente. Para as crianças menores de 6 meses, verificou-se os seguintes percentuais: 37,3% e 18,9%, respectivamente. Entre as crianças menores de quatro e seis meses, 31,9% e 45,3% estavam recebendo outro tipo de leite que não o humano. Entre as crianças menores ou iguais a 4 meses, 5,1% estavam em alimentação complementar, e entre as menores ou iguais a 6 meses 14% , recebendo chá, água, suco, fruta, sopa de legumes e comida de panela nas últimas 24 horas. Este estudo mostrou que os indicadores de Aleitamento Materno – Aleitamento Materno e Aleitamento Materno Exclusivo estão muito aquém do preconizado pela OMS e que a introdução da alimentação complementar é precoce tanto entre crianças amamentadas como em crianças não amamentadas. / What children eat in the first year of life is essential with a view to adequate growth and development. The World Health Organization (WHO) recommends exclusive breastfeeding up to six months of age and that complementary foods be introduced from that age onwards. This study aimed to examine the prevalence of breastfeeding among children under 1 year old, as well as to describe the introduction of complementary foods among the children in this study. A cross-sectional and descriptive study was realized among 821 infants under 1 year old who were vaccinated in the Second Phase of the National Vaccination Campaign at Health Centers in Guarapuava-PR, Brazil. Data collection involved the mothers and/or responsibles for infants under 1 year old who came to the Health Centers on that day, using the questionnaire elaborated and validated by the Health Institute of the São Paulo State Health Secretary and its partners. The collected data were subject to simple frequency analysis of all variables. As to breastfeeding indicators, 68.9% of the infants received breastfeeding, with 86.2% and 39.8% of children under 4 and 6 months, respectively. Exclusive and predominant breastfeeding indicators corresponded to 46.4% and 41.4%, respectively, among children under 4 months old, against 37.3% and 18.9% for children under 6 months of age. 31.9% and 45.3% of children under 4 and 6 months old were receiving nonhuman milk. 5.1% of children aged 4 months or older and 14% of those aged 6 months or older received complementary feeding, having consumed tea, water, juice, fruit, vegetable soup and homemade food during the last 24 hours. This study has shown that Breastfeeding – Breastfeeding and Exclusive Breastfeeding indicators remain much below the levels set by the WHO and that complementary foods are introduced at an early stage for children who are breastfed or not.

M.Cur. / A lot of mothers and babies are being discharged earlier from the hospital because of limits with the medical aids on the length of stay. In a few ofthese cases the mother and baby were readmitted because of health problems that persisted after they had been discharge. The question arises as to where the problem lies and what are the reasons so many patients are discharged with health problems and what can be done to prevent or reduce these problems. This study investigates the health status of the mother and their health problems on being discharged. The sample came from mothers with medical aids, in the post natal unit, in a selected clinic and ready to go home. Guidelines were developed to prevent these health problems or how to handle them differently. A literature study was undertaken on the normal physiological changes that take place with the birth of the baby and after the mothers have been discharged. According to this study changes and abnormalities could be identified. An instrument was developed to assess the mother's condition on discharge and to identify possible complications that could develop at home and obstruct health promotion. The results show that some of the mothers were discharged with one or other health problem that could cause severe problems at home. The biggest problem identified was with breast-feeding as well as oedema of the feet and hands. There were also a few mothers still unsure as to how to handle their babies. Guidelines were formed to help the nursing staff to supply information for the mother on early discharge and to help prevent health problems or to lessen them. The guidelines help the mothers to know how to look for the signs and symptoms of health problems at home Recommendations were made regarding future research on this issue.

Magister Curationis - MCur / Background: In 2009, approximately 130 000 children in Southern Africa under the age of 15 were newly infected with HIV, with vertical transmission being the most common cause of HIV infection. HIV positive mothers are therefore faced with a unique dilemma about which infant feeding choice to make. Prior to 2006,formula feeding was the recommended feeding choice in an attempt to minimise vertical transmission of HIV. In 2006, the risks associated with formula feeding necessitated a change in the recommendations to allow for either exclusive formula feeding or exclusive breastfeeding. The clinical guidelines were reviewed in 2010, when research on the effectiveness of prevention of mother to child transmission efforts suggested a decrease in such transmissions, even when exclusive breastfeeding. Currently the recommendations focus on the contextual appropriateness of the infant feeding choice. The imminent withdrawal of free formula is a new development within the prevention efforts. Aims and Objectives: This study aimed to describe the infant feeding choices of HIV positive mothers on discharge from a level two hospital, in Cape Town. The study objectives included determining the infant feeding choice and the factors that influence HIV positive mothers’ infant feeding choice on discharge from the hospital. Research Methodology: A descriptive survey study design was used as it lends itself to the description of the new developments regarding prevention of mother to child transmission and the meaning it has for the infant feeding choices made by HIV positive mothers. A quantitative approach was used to establish the specified factors that currently affect HIV mothers’ infant feeding choices. A nonrandom consecutive sampling technique was used. The data collection method took the form of a questionnaire. Data analysis was performed through SPSS 20 to produce descriptive and inferential statistics to establish relationships between the independent and dependent variables. Results and Recommendations: The number of exclusive breastfeeding participants was higher (54%) than the exclusively formula feeding participants (46%), which is in keeping with the institution’s trends for the previous year (2011). Statistical significance was difficult to establish due to the small scale of the study, but clinical significance with the establishment of the factors influencing infant feeding choices was considered. These led to the following recommendations: reorientation of infant feeding counselling towards the criteria of acceptability, feasibility, affordability,sustainability and safety, in view of the withdrawal of free formula and promotion of exclusive breastfeeding as the single infant feeding strategy. Ethical Considerations: Ethical clearance was sought from the Ethics Committee of the University of the Western Cape, Research Committee of the level two hospital and informed consent was obtained from the participants.

Background: Fat distribution, rather than total body fat, has been identified as a significant risk factor for chronic disease. Patterning of subcutaneous fat, in particular, may play a pervasive role in shaping the metabolic milieu that is critical for disease development. Several studies have shown that early-life nutrition may influence later body composition. The effect of breastfeeding and formula feeding on early patterns of subcutaneous fat deposition, however, are uncertain. Objective: At a time when early infant growth is emerging as a predictor for later chronic disease, it is the aim of the present analysis to investigate whether feeding style (breastfeeding versus formula feeding) modifies subcutaneous fat growth rates and trajectories in the first year of life with a focus on the historical iterations of WHO infant feeding recommendations (0 to 4 months, 4 to 6 months, and 6 to 12 months of age). Methods: This is an ex post-facto design that utilizes data collected as part of a longitudinal growth study in the first year of life. Subcutaneous fat mass was anthropometrically assessed weekly by skinfold thickness (triceps, quadriceps, calf, subscapular, suprailiac, midaxillary, and abdominal) in 21 infants. Feeding data were collected through daily parental records and are entered here as a categorical variable (predominantly breast fed and predominantly formula fed). Multi-level mixed effects models for repeated measures were used (STATA 14) adjusting for age, sex, weight, birthweight, and number of feeding episodes per day. Statistical significance was accepted at p Results:Infants experienced fat accretion only during the first four months, and this was limited to peripheral skinfolds. Thereafter, subcutaneous skinfolds followed a trend of declining rates. Breastfed and formula fed infants, however, demonstrated different patterns of subcutaneous fat deposition in both the sum of skinfolds and in each skinfold site. During the first four months, formula fed infants experienced greater rates for the subscapular, abdominal, suprailiac, trunk, quadriceps, sum of skinfolds (p Conclusion: Weekly skinfold assessments of seven subcutaneous sites have identified that feeding style predicts differences in deposition patterns in the first year of life. Breastfed infants demonstrated both slower rates of accretion and decline by comparison with their formula fed peers. This analysis further suggests that the first four months may be a critical period for subcutaneous fat deposition. Feeding specific effects were identified for truncal deposition and utilization, which suggests that future studies may benefit from depot-specific inquiries.

Clinical Issue Health Canada recommends exclusive breastfeeding for the first 6 months post birth and then the addition of complementary foods with breastfeeding extending to a minimum of two years. Breastfeeding initiation rates in Canada are currently at around 87% but, by one month, about 21% of women have stopped breastfeeding. Engorgement and edema in breast tissue can lead to breastfeeding challenges which may contribute to early weaning. Purpose The purpose of this pilot research study was to explore the relationship between intravenous (IV) fluids given to mothers during the peripartum period and postpartum breast or nipple swelling in the first ten days postpartum and determine if a larger study was warranted and feasible. The research question for this pilot study was, "What is the relationship between the amount of IV fluids given to labouring women and edema of the breast and areola complex experienced by breastfeeding women in the first 10 days postpartum?" Methods It is a prospective, longitudinal, observational cohort pilot study with repeated measures and a within-subjects design. Participants are first time mothers who planned to exclusively breastfeed and gave birth to a single, healthy newborn by means of a spontaneous vaginal birth, Mother and baby were discharged home together with no contraindications to exclusive unrestricted breastfeeding. Descriptive statistics are reported and linear regression analysis is used to model the relationship between IV therapy and postpartum breast edema. Results Women who received IV fluids during labour had higher levels of edema postpartum and rated their breasts as firmer as and more tender than women who did not receive IV fluids. Participants who had IV fluids appeared to be less aware of the fullness associated with lactogenesis II, and the pattern of fullness they described appeared to be related to edema noted. Participants who did not have IV fluids appeared to have unrelated patterns of fullness and edema, and therefore appeared more aware of the onset of lactogenesis II. The results support a larger study about the relationships between maternal perinatal IV fluids and breast or nipple changes.

This diploma thesis deals with the degree of autonomy of women in the issue of breastfeeding in the Czech environment. It examines in particular the form of current breastfeeding and its normativity through narativ interviews with women who had breastfeeding experience. The aim of this work is to expose the form of the current brestfeeding standard, its limits, negativity and impacts through feminist optics and offer possible solutions in the discourse of breastfeeding. The basic theoretical starting point of the thesis is the development of infant feeding standards, its promotion and legislative anchoring in the Czech Republic as social approach of brestfeeding as well. In particular, the thesis deals with the feminist critique of the discourse of the fight, which provides the necessary arguments for looking at the phenomenon of breastfeeding standard in a different way and introducing the standard as social and cultural constructed. The analysis is the result of introducing current breastfeeding standards in the Czech republic as a directive reuqirement towards women to breastfeed which threatens women's integrity. Keywords breastfeeding standard, breastfeeding support strategy, breastfeeding promotion, feminist critique, breastfeeding experience

Introduction/Background Research indicates nutrition and environment in the first year of a child's life are crucial in their development and growth and can contribute to lower chances of developing obesity and other health concerns. Key factors that can determine these outcomes include the bacteria and resulting short chain fatty acids (SCFAs) present in the gut. This composition may be affected by feeding modality (formula feeding vs breastfeeding), exposure to the mother’s microbiota, weight status of the child, and type of delivery. This research aims to identify the impact of infant feeding modality on toddlers' fecal fermentation profile, and if there are associations between weight status and microbiome, fecal fermentation profile. Methods/ Procedures Participants (n=40) were recruited during well-child pediatric appointments at ETSU’s Pediatric primary care clinic. Researchers explained the requirements of the study and participants were provided with a 90-question food frequency questionnaire (FFQ) for children ages 2-7, including 90 questions and asks about a child's typical intake over the previous 6-month period. The food list was developed from NHANES III dietary recall data. The child’s history was obtained, including current age, birth length and weight, delivery type (C-section or vaginal), feeding method (breast, bottle fed, or both) and duration. The child’s weight and height were obtained, and body mass index (BMI) calculated. Participant-provided stool samples were freeze-dried and ground, and SCFAs were extracted using a procedure developed by Schwiertz et al. that was modified. One mL of the SCFA extraction solution, containing Oxalic acid (0.1 mol/L), Sodium Azide (40 mmol/L), and Caproic acid (0.1 mmol/L) (internal standard) was added to 80 mg of a freeze-dried stool sample in a 16 x 100 mm disposable culture tube, and analyzed using a Shimadzu GC2010 gas chromatograph with SigmaAldrich ZB-Wax Plus capillary column. Samples were run in duplicate, and values for each participant were averaged. Data analysis was generated using SAS software, Version 9.4 of the SAS System, Copyright © 2013 SAS Institute Inc. Results Initial findings showed no significant differences in the SCFA composition of obese vs non-obese toddlers in the sample. However, there were significant differences in the amount of specific SCFAs (isobutyrate, isovaleric acid, and octanoic acid) in toddlers who were formula fed as infants versus toddlers who were breastfed, and those fed a combination of breastmilk, and formula (p < 0.05). Further analysis will determine if these initial results may be contributed to overall dietary intake, and more specifically fiber intake.

The study objective was to identify demographic, medical, and health behavior factors that predict breastfeeding initiation in a rural population with low breastfeeding rates. Participants were 2323 women who experienced consecutive deliveries at 2 hospitals, with data obtained through detailed chart review. Only half the women initiated breastfeeding, which was significantly associated with higher levels of education, private insurance, nonsmoking and non-drug-using status, and primiparity, after controlling for confounders. Follow-up analyses revealed that smoking status was the strongest predictor of failure to breastfeed, with nonsmokers nearly twice as likely to breastfeed as smokers and with those who had smoked a pack per day or more the least likely to breastfeed. Findings reveal many factors placing women at risk for not breastfeeding and suggest that intervention efforts should encourage a combination of smoking cessation and breastfeeding while emphasizing that breastfeeding is not contraindicated even if the mother continues to smoke.

Indiana University-Purdue University Indianapolis (IUPUI) / The benefits of breastfeeding are widely known and documented, yet breastfeeding rates at six months have remained well below desired levels. In order to fully understand the breastfeeding experience in the early postpartum period and all the intricacies involved, researchers need to provide mothers with the opportunity to talk about their experiences during the time when there are the most difficulties and when they are most likely to discontinue, the first four weeks postpartum. The purpose of this study was to more fully understand, in their own words, the experiences of mothers who began breastfeeding their infant after birth and may or may not have been breasting at four weeks postpartum. A single research question guided this study: What are the lived experiences of breastfeeding mothers during the first four weeks postpartum? Eight mothers who delivered in the past four to six weeks were interviewed. Data were analyzed using a Heideggerian hermeneutic phenomenological approach. This method was chosen because it allowed the researcher to conduct interviews and explore the lived experience of breastfeeding mothers and to uncover the concealed meaning within the phenomena. This methodology provided a richness that might not be possible through description alone. The narratives shared by the mothers demonstrated that initiating breastfeeding and sustaining it in the early postpartum period was a complex process. Each mother’s breastfeeding experience was unique to her but also similar to someone else’s. The overall constitutive pattern of Getting the Hang of It was selected and consisted of four themes and nine subthemes. The four themes included: Physical Experiences, Emotional Complexities, Infant Involvement in Breastfeeding Process, and Support. These themes and their subsequent subthemes provide insight into the complexities experienced by mothers in order to acquire the skills they needed to breastfeed their infants. Breastfeeding mothers, who have had favorable and unfavorable experiences, are willing to share a wealth of information. Health professionals should encourage mothers to talk about their experiences and listen to what they are saying. Through listening they can provide mothers with the resources and support needed to meet their breastfeeding goals.