Background: Women are recommended to breastfeed exclusively for six month; despite this the frequency of breastfeeding duration is decreasing in Sweden. Research indicates that there is an association between attitudes towards breastfeeding and perceived difficulties and initiation and duration of breastfeeding. The aim: to study women’s attitudes to breastfeeding and their perceived difficulties with breastfeeding expressed on parent oriented websites on the Internet. Method: Data consisting of users posts corresponding to the aim of the study were collected from two parent oriented websites on the Internet. Data collecting started at the 16th of September 2014 and continued until data saturation was obtained. A total of 933 posts were included. Data were analyzed using inductive qualitative content analysis. Results: Breastfeeding was a sensitive subject to many women and it evoked strong emotions among both the women and the social surroundings. Due to lack of prior knowledge regarding breastfeeding and insufficient and inadequate support from the social surroundings in particular from health care personnel, breastfeeding became problematic and difficult to obtain. Conclusions: To promote women’s and children’s health it´s important that information about breastfeeding and formula given by health care personnel is evidence based. The women also need increased information about breastfeeding and formula during pregnancy and continual follow-ups after the baby is born. / Bakgrund: Kvinnor rekommenderas att helamma i sex månader, trots detta sjunker amningsfrekvensen i Sverige. Studier påvisar att attityder kring amning och upplevda svårigheter kring amning påverkar initiering och upprätthållande av amning. Syfte: Syftet var att undersöka vilka attityder till amning och upplevda svårigheter kring amning kvinnor uttryckte på föräldraforum. Metod: Data i form av inlägg som svarade mot studiens syfte samlades in från två föräldraforum på internet. Insamlandet påbörjades den 16/9-2014 och pågick tills datamättnad var uppnådd. Totalt inkluderades 933 inlägg. Data analyserades genom en induktiv kvalitativ innehållsanalys. Resultat: Amning var ett känsligt ämne som väckte starka känslor hos ammande kvinnor och omgivningen. Brist på förkunskaper hos kvinnan samt otillräckligt och felaktigt stöd från omgivningen och framförallt vårdpersonal gjorde amningen problematisk och svår att upprätthålla. Slutsats: För att främja barns och kvinnors hälsa är det av stor vikt att hälso-och sjukvårdspersonal ger stöd och råd kring amning och ersättning baserad på evidensbaserad kunskap. Vidare behöver även kvinnorna ges möjlighet till utökad information kring amning och ersättning redan under graviditet med kontinuerlig uppföljning efter förlossning.

The aim of this research was to examine differences in general nutrition knowledge and prenatal sources of infant feeding information among women planning to feed breast milk, breast-milk substitutes, or a combination of breast milk and breast-milk substitutes. Subjects completed a demographic survey, a test of nutrition knowledge, and a questionnaire on sources of infant feeding information. There were no statistical differences in age, education, and nutrition knowledge scores among women in the three groups. A significant relationship was observed between education and nutrition knowledge; women who had attended college courses scored higher.003) on the nutrition knowledge test than those who had not attended. Health care providers (82%) and reading materials (82%) were the most frequently cited sources of infant feeding information. While general nutrition knowledge appears to be positively related to education, it does not appear to influence the infant feeding decision. / Department of Family and Consumer Sciences

Breast fed infants appear to grow less rapidly after the first three months of age when compared with current standards from the National Center for Health Statistics (NCHS). The NCHS standards are a composite of two other studies both of which used formula fed infants or infants who were breast fed for a short period of time. Current literature suggests a breast fed infant's deviation from NCHS standards should be considered a normal pattern with no apparent deleterious consequences to a breast fed infant. This study was undertaken to determine whether differences do exist between the growth patterns of breast fed infants in Muncie, Indiana, and NCHS standards, and if so, at what age do the differences become apparent. For this study growth data were gathered for 66 infants. The subjects were women who attended the Obstetrical and Family Practice Clinics of Ball Memorial or were patients of private physicians in Muncie and Delaware County, Indiana and who volunteered to participate in the study. Women who were free of chronic conditions were elgible to participate in the study. A 24-hour data collection period was conducted one day each month for one calendar year or as long as the subjects remained in the study. Immediately before and after each nursing during the 24-hour time period weight measurements were taken and recorded for the infants. Lengths were measured once at this time. The analysis of data from this study is similar to previous studies, and showed that weight gain in particular, but also length gain, of the breast fed infant was slower after three months of age in comparison to NCHS standards and supports the recommendations of others that the weight gain of breast fed infants should not be compared to current NCHS standards and new growth charts based on breast fed infants are needed. / Department of Family and Consumer Sciences

Longer breastfeeding durations may enhance cognition and accelerate motor development; motor development, and in particular, crawling, may lead to dramatic changes in cognition. Based on these empirical relations, the hypothesis that crawling mediates breastfeeding duration and cognitive outcome was tested. Specifically, it was hypothesized that longer breastfeeding durations would significantly predict both earlier crawling and higher cognitive scores at 2 years of age, that earlier crawling would also predict higher cognitive scores, and that earlier crawling would account for part of the relationship between longer breastfeeding durations and higher cognitive scores. A sample of 44 full term infants from Winnipeg, Manitoba was followed longitudinally between birth and 2 years of age. Data on breastfeeding duration and crawling were collected through daily parent checklists, with supplemental breastfeeding information obtained via questionnaires. Near the toddlers’ 2nd birthdays, cognitive abilities were assessed with the MacArthur Communicative Development Inventory: Words and Sentences (Fenson et al., 1993) and the Parent Report of Children’s Abilities (Saudino et al., 1998). All 3 key variables were measured on continuous scales, and a mediational analysis based on Baron and Kenny’s (1986) classic approach of 3 regressions was used. Several covariates were considered for inclusion in the regressions, but none reached significance in preliminary tests and thus, were not included. In the first 2 regression analyses, exclusive and partial breastfeeding durations significantly predicted neither cognitive scores (p = .59) nor age of crawling attainment (p = .41). The 3rd regression analysis showed a significant, small-to-medium effect size for earlier crawling attainment predicting higher cognitive scores (p < .05, adjusted R2 = .09). However, crawling onset had no effect on the breastfeeding-cognition link. The overall test of the mediation was inconclusive, due to low power. The significant finding between age of crawling onset and cognitive outcomes at 2 years of age may be due to earlier crawling altering the course of development, to reverse causation whereby more cognitively advanced infants are motivated to crawl sooner, or to a 3rd variable affecting both crawling and cognition. Future research should continue to explore motor and cognitive connections in infant development.

Breastfeeding is recommended as the optimal source of nutrition for newborns for the first 6 months of life and beyond with the addition of complementary foods. While breastfeeding initiation rates have been increasing, duration rates remain a concern as many women prematurely discontinue due to difficulties encountered rather than maternal choice. In addition, there is a sizable gap between rates of exclusive breastfeeding and current recommendations. Targeting modifiable variables that may be amenable to intervention is one strategy to improve breastfeeding outcomes. One such modifiable variable is breastfeeding self-efficacy. Although research has clearly shown that breastfeeding self-efficacy is predictive of breastfeeding duration and exclusivity, it is unknown whether it can be enhanced to improve breastfeeding outcomes. The purpose of this pilot randomized controlled trial was to examine the feasibility and compliance of a newly developed trial protocol and the acceptability of an intervention to increase breastfeeding self-efficacy in the immediate postpartum period. Secondary outcomes included determining whether there were any trends between groups related to breastfeeding self-efficacy, duration, and exclusivity. Participants included 150 primiparous mothers who were breastfeeding their healthy, full-term infants. Eligible and consenting mothers were randomized to either a control group (standard postpartum care) or an intervention group (standard postpartum care plus the self-efficacy intervention). Participants allocated to the intervention group received three individualized, self-efficacy enhancing sessions with the researcher; two sessions were conducted in hospital, and one was administered via telephone 1 week following hospital discharge. A research assistant blinded to group allocation collected outcome data at 4 and 8 weeks postpartum. The results suggested that the administration of the intervention was feasible and that there was a high degree of protocol compliance; the majority of participants reported that the intervention was beneficial. Secondary outcomes identified that there was a trend among participants in the intervention group to have improved breastfeeding outcomes, including higher rates of breastfeeding self-efficacy, duration, and exclusivity at 4 and 8 weeks postpartum. Preliminary evidence also suggested that the self-efficacy intervention may have assisted to decrease perceptions of insufficient milk supply among the intervention group participants. Overall, the findings from this pilot trial indicated that a larger trial is warranted.

Longer breastfeeding durations may enhance cognition and accelerate motor development; motor development, and in particular, crawling, may lead to dramatic changes in cognition. Based on these empirical relations, the hypothesis that crawling mediates breastfeeding duration and cognitive outcome was tested. Specifically, it was hypothesized that longer breastfeeding durations would significantly predict both earlier crawling and higher cognitive scores at 2 years of age, that earlier crawling would also predict higher cognitive scores, and that earlier crawling would account for part of the relationship between longer breastfeeding durations and higher cognitive scores. A sample of 44 full term infants from Winnipeg, Manitoba was followed longitudinally between birth and 2 years of age. Data on breastfeeding duration and crawling were collected through daily parent checklists, with supplemental breastfeeding information obtained via questionnaires. Near the toddlers’ 2nd birthdays, cognitive abilities were assessed with the MacArthur Communicative Development Inventory: Words and Sentences (Fenson et al., 1993) and the Parent Report of Children’s Abilities (Saudino et al., 1998). All 3 key variables were measured on continuous scales, and a mediational analysis based on Baron and Kenny’s (1986) classic approach of 3 regressions was used. Several covariates were considered for inclusion in the regressions, but none reached significance in preliminary tests and thus, were not included. In the first 2 regression analyses, exclusive and partial breastfeeding durations significantly predicted neither cognitive scores (p = .59) nor age of crawling attainment (p = .41). The 3rd regression analysis showed a significant, small-to-medium effect size for earlier crawling attainment predicting higher cognitive scores (p < .05, adjusted R2 = .09). However, crawling onset had no effect on the breastfeeding-cognition link. The overall test of the mediation was inconclusive, due to low power. The significant finding between age of crawling onset and cognitive outcomes at 2 years of age may be due to earlier crawling altering the course of development, to reverse causation whereby more cognitively advanced infants are motivated to crawl sooner, or to a 3rd variable affecting both crawling and cognition. Future research should continue to explore motor and cognitive connections in infant development.

While studies have examined risk factors and consequences of child maltreatment in general, relatively few have focused specifically on neglect, especially maternally perpetrated child neglect. This is despite evidence that neglect is the most common and most rapidly increasing form of maltreatment, with some of the most serious long-term effects on child development. Maternal neglect constitutes a substantial disturbance in the mother-child relationship. For this reason, after establishing the epidemiology of neglect at a population level, this thesis examines the neurobiology of patterns of mother-infant attachment using functional MRI. Disturbance in mother-infant attachment, in conjunction with family, social and societal risk and protective factors, constitutes the likely pathway to maternal neglect. Specific objectives were: 1) to describe the magnitude of the problem of maternal neglect in Australia, using longitudinal population-based studies; 2) to identify risk and protective factors associated with neglect, both in a high risk population of extremely low birth weight (ELBW) infants and a representative birth cohort; 3) to specifically explore whether breastfeeding was protective against maternally perpetrated neglect; 4) to examine the consequences of child neglect on infant cognitive development and head growth; and 5) to determine how maternal brain and endocrine responses differ according to patterns of adult attachment security. In Part A, two cohort studies examined the epidemiology of child abuse and neglect among mothers and their infants born at the Mater Mothers’ Hospital in Brisbane, Australia. Cohort databases were confidentially linked with official notifications of child abuse and neglect. The first cohort included 353 ELBW infants who were assessed at birth and at 1, 2 and 4 years of age. The second cohort included 7223 children whose mothers were enrolled prenatally into the Mater-University of Queensland Study of Pregnancy (MUSP), where data were collected at birth, 6 months, and 5 and 14 years. The initial ELBW study examined all reported notifications of neglect, while the MUSP study focused particularly on substantiated maternally perpetrated neglect and the protective effect of breastfeeding. These studies examined a broad range of social and biological predictors. Outcome variables for child neglect were examined in the ELBW cohort using cognitive z-scores and growth parameters. Analytic techniques included multivariate modelling. In Part B, the neurobiology of mother-infant attachment was examined by monitoring a cohort of 61 first-time mothers from Houston, Texas, over 4 study visits. The mothers’ attachment classifications were determined during pregnancy using the Adult Attachment Interview. At 6 months, mother-infant pairs were videotaped, and serum oxytocin measures collected before, during and after interaction. At 10 months, the mothers viewed pictures of their own and unknown infants during functional MRI scanning. The first report examined the brain responses of 28 mothers to happy, neutral and sad infant face cues. The next compared brain responses of 15 mothers with “secure” attachment patterns to 15 “insecure/dismissing” mothers, and also examined differences in peripheral oxytocin response to mother-infant interaction. Data were analysed using a general linear model and repeated measures ANOVA. Overall, more than 1 in 10 children were reported for suspected child maltreatment, 3-5% as a result of substantiated neglect and 3% with maternally perpetrated neglect, with higher rates seen in the ELBW cohort. Duration of breastfeeding was inversely associated with the odds of maternal neglect, with non-breastfeeding mothers almost 4 times more likely to neglect their child compared to mothers who breastfed for 4 or more months, after adjusting for covariates. Other significant risk factors for substantiated maternal neglect included low education, young maternal age, and race, which were also significant univariate predictors in the ELBW population. ELBW children exposed to neglect showed a progressive decline in cognitive functioning over the first 4 years of life, as well as a significantly reduced head circumference at 2 and 4 years. When mothers viewed their own infant’s faces, compared with an unknown infant, key dopamine-associated reward processing regions of the brain were activated, including the midbrain’s ventral tegmental area/substantia nigra, striatum and prefrontal cortex. Mothers with an insecure/dismissing type of attachment showed significantly less activation of these reward regions in response to both happy and sad own-infant faces. On viewing their own infant’s crying faces, these mothers showed activation of the anterior insula, a region involved in feelings of unfairness, pain and disgust. “Secure” mothers showed greater peripheral oxytocin responses during mother-infant interaction, which were correlated with activation of the pituitary/hypothalamic region of the brain, where oxytocin is produced and secreted. These findings confirm the magnitude of neglect as a public health concern, with identifiable consequences and specific risk and protective factors. The neurobiological studies identify neuroendocrine systems associated with mother-infant responses and patterns of adult attachment. Together, these studies theoretically link secure mother-infant attachment with brain reward activation and oxytocin response, breastfeeding success, and a reduced risk for maternal neglect. Implications for prevention and intervention, and future research plans, are discussed.

No description available.

No description available.

Thesis (M.S.P.H.)--University of Michigan, 1932.