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Cow's milk protein allergy (CMPA) affects 2% to 3% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding health care providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices. This study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages. A total of 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness. Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care. [ABSTRACT FROM AUTHOR]

The study examines the influence of a diversified diet, changes in the consistency of introduced foods, and the method of meal preparation during infancy on the development of sensitization and/or allergy in toddlers. Introducing more product groups into the diet reduced the risk of allergy at 6 months of age (adjusted odds ratio [aOR] = 0.17; 95% confidence interval [CI] 0.04-0.71; P = 0.015) and at 12 months (aOR = 0.14; 95% CI 0.03-0.57; P = 0.006). Children with allergy and/or sensitization had been introduced to fewer product groups at 6 months (P = 0.003; P < 0.001; P = 0.008) and at 12 months (P = 0.001, P < 0.001; P = 0.001) compared with those without allergy and/or sensitization. Children with allergy and/or sensitization were fed ready-made, ie, purchased, products significantly more often than self-prepared foods compared with children without allergy and/or sensitization (P = 0.001; P = 0.006). Allergic and/or sensitized children tended to be switched to solids later (11 vs 10 months, P = 0.041; P = 0.037) (12 vs 10 months, P = 0.013) than children without sensitization and/or allergy. The earlier introduction of a varied diet reduced the risk of allergy and/or sensitization. Delaying the introduction of solid foods and using ready-made products instead of self-prepared ones increases the risk of allergy in toddlers. [ABSTRACT FROM AUTHOR]

The article describes the case of a 32-day-old female infant who experienced poor feeding, mild cough, lack of appetite decreased activity, and sub febrile fever. Topics discussed include vital signs at admission to the hospital, mechanisms in the etiology of respiratory virus-associated neurological complications, and potential causes of hyponatremia, which is said to increase the disease severity in infants hospitalized with respiratory syncytial virus (RSV) infection.

This investigation assessed the effect of side-lying position on infant oropharyngeal swallow physiology. Infant modified barium swallow studies (MBS) recordings were retrospectively examined in matched-pairs comparing at-risk infants swallowing in both an upright/cradled position and a side-lying position. Swallow parameters were measured independently and through a consensus coding approach. Infants fed in side-lying position showed a decrease in airway invasion severity as compared with when those same infants were fed in an upright/cradled position (P =.009). Bolus location at the time of swallow initiation was higher when infants were fed in side-lying position as compared with cradle position (P =.024), representing decreased risk of airway invasion. Infants fed in side-lying position demonstrated fewer swallows per breaths (P =.032). This pilot study validates the need for additional research to further define the mechanisms related to this improvement, and to determine how diagnosis and medical stability moderate these findings. [ABSTRACT FROM AUTHOR]

Objective: Assess caregivers' knowledge about juice and sugar-sweetened beverages (SSBs) and identify factors that contribute to their early introduction. Methods: One hundred forty-four parents of young infants completed a 45-item questionnaire focused on infant nutrition. Results: Seventy-two percent of parents plan to give juice to their babies starting in the first year of life; only 16% plan to introduce SSBs. Parents with some college education or more were significantly less likely to report an intention to introduce juice (P <.0001) and SSBs (P <.001) in their children's diets. Education level was significantly associated with knowledge about juice and SSBs (P <.001). Parents with higher knowledge were significantly less likely to plan on introducing juice (P <.001) and SSBs (P <.001). Conclusion: Parents of young infants lack enough knowledge about the detrimental effects of juice and sugary drinks. These knowledge gaps give pediatric providers a unique opportunity to provide anticipatory guidance starting in early infancy on the adverse health effects of juice and SSBs. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 40-day-old White male born at 38 weeks of gestation by vaginal delivery was admitted to our pediatric emergency department for liquid stools without signs of blood or mucus in the previous 24 hours. The article discusses FPIES is a potentially severe non-IgE-mediated food allergy that primarily presents in infancy which is typically manifests as delayed gastrointestinal symptoms after the ingestion of a specific food culprit.

In 2018, the American Academy of Pediatrics warned consumers over the increasing use of imported infant formulas. The purpose of this study was to assess the usage of imported European infant formula among parents in a large urban private practice. An anonymous survey was distributed at well-child appointments to a convenience sample of parents at an urban private pediatric practice from November 2017 to March 2018. Of the 750 eligible respondents, 552 (74%) completed the survey. Of the parents using formula, 20% were using imported European infant formulas. The most commonly used formula was Holle (33%), and 72% were acquired from web-based third-party vendors. Parents chose to use these formulas because they believed that European formulas contained better ingredients. Only 8% of parents received information about European infant formula from their pediatricians. Pediatricians need to be aware of these formulas and their risks to educate families on the use and safety of these formulas. [ABSTRACT FROM AUTHOR]

We evaluate maternal perspectives of frenotomy for ankyloglossia in newborns. We searched highly frequented forums like babycenter.com for comments related to frenotomy posted from 2012 to 2017. We applied modified grounded theory, reviewed posts for thematic synthesis, and calculated frequencies for each theme. High decisional conflict, low discussion of surgical complications, and an overall moderate positive experience were noted. Mothers posted about breastfeeding issues (n = 227, 74.7%) and overall experience (n = 229, 75.3%). Posts related to breastfeeding include discomfort ("I can no longer physically take the pain"; n = 93, 30.6%). Parents posted frequently about a satisfactory outcome ("It was so worth it to improve our nursing relationship"; n = 133, 43.8%), but dissatisfactory outcome ("I'm still having problems latching and am pumping. It's brutal"; n = 31) was present in 10.2%. These results aid in understanding parental thoughts of frenotomy. Physicians can use these self-reported maternal perspectives on frenotomy to guide counseling and improve shared decision making for parents. [ABSTRACT FROM AUTHOR]

The Neonatal Eating Assessment Tool (NeoEAT)–Bottle-feeding is a parent-report assessment of bottle-feeding behavior in infants less than 7 months old with evidence of validity and reliability. The purpose of this study was to establish norm-reference values to guide score interpretation and clinical decision making. Parents of 478 healthy, typically developing infants completed the NeoEAT–Bottle-feeding. Descriptive statistics were calculated for the following age groups: 0 to 2, 2 to 4, 4 to 6, and 6 to 7 months. NeoEAT–Bottle-feeding total scores decreased with increasing infant age. The Infant Regulation subscale contributed the most to the total score and remained high across the first 6 months of life, then decreased dramatically in the 6- to 7-month age group. The 90th and 95th percentile values for the total score and subscale scores can be used to identify infants with problematic feeding, guide referral, tailor treatment, and assess response to treatment. [ABSTRACT FROM AUTHOR]

Background. Pasteurized donor human milk (DHM) use for healthy newborns is increasing; however, no studies have explored its effect on breastfeeding outcomes. Patients and Methods. We enrolled 60 healthy, term breastfeeding newborns with ≥4.5% weight loss in the first 36 hours in a randomized controlled trial. Thirty newborns were randomly assigned to early limited-volume DHM supplementation and 30 newborns to exclusive breastfeeding. Mothers were surveyed at 1 week and 1, 2, and 3 months regarding the mode of infant feeding. Comparing infants randomized to DHM supplementation with those exclusively breastfeeding, there was no significant difference in the proportion using formula at 1 week (21% vs 7%, P =.15), nor in the proportion of any breastfeeding (79% vs 90%, P =.30) or breastfeeding without formula at 3 months (62% vs 77%, P =.27). Conclusion For newborns with ≥4.5% weight loss in the first 36 hours, early limited-volume supplementation with DHM is unlikely to have a significant favorable impact on breastfeeding outcomes. [ABSTRACT FROM AUTHOR]

The article presents a case study related to 2-month-old white female presented with feeding difficulty to her primary care physician. Topics include the routine laboratory tests has showed hyperkalemia with serum potassium and associated metabolic acidosis, and the repeat serum potassium in the emergency department has also elevated, and she was admitted to the intensive care unit.

This study examined the factors that influence Latina mothers’ decisions to initiate breastfeeding, formula feeding, or both, and when a given neonatal feeding method is decided, in order to assess the optimum time for healthcare providers to discuss nutrition decisions. A Spanish-speaking health care provider orally administered a 24-question survey to self-identified Latina mothers in the Newborn Nursery at North Carolina Children’s Hospital after delivery. A total of 152 Latina mothers, aged 17 to 43 years, were interviewed from September 2014 to September 2015. Three decisive factors resulted from multivariate analysis regarding a participant’s decision to exclusively breastfeed: age (27.3 years or younger); deciding about feeding method before pregnancy; and believing that exclusively breastfeeding is best for an infant’s growth and development. Overall, 95% of Latina mothers made their decision regarding their infant’s nutrition before delivery. Newborn nurseries have trended toward the allocation of substantial resources to the mission of enhancing the likelihood of breastfeeding initiation and success in the newborn period. Perhaps a reallocation of some of these resources for educational interventions earlier in pregnancy should be considered. [ABSTRACT FROM AUTHOR]

The feed and wrap technique refers to the use of feeding and swaddling to induce natural sleep in infants. It can be used prior to an magnetic resonance imaging (MRI) scan, avoiding sedation or anesthesia. We performed a retrospective review of feed and wrap MRI scans in infants 3 months or younger over a 2-year period at our center (279 scans) to evaluate the efficacy of this technique. Of scan results reviewed, 79% addressed the clinical question, 20% partially addressed the clinical question, and 1% were technically inadequate. History of preterm birth (odds ratio [OR] = 2.368; P = .032) and spine MRI (OR = 2.821; P = .001) were associated with a less-successful scan outcome. The feed and wrap technique can be used successfully in infants undergoing MRI; however, it may be less successful in preterm infants and those requiring spinal MRI. A standardized technique performed by experienced personnel may avoid anesthesia and sedation in infants who require MRI. [ABSTRACT FROM AUTHOR]

We examined consumption of different types of infant formula (eg, cow’s milk, soy, gentle/lactose-reduced, and specialty) and regular milk among a nationally representative sample of 1864 infants, 0 to 12 months old, from the National Health and Nutrition Examination Survey, 2003-2010. Among the 81% of infants who were fed formula or regular milk, 69% consumed cow’s milk formula, 12% consumed soy formula, 5% consumed gentle/ lactose-reduced formulas, 6% consumed specialty formulas, and 13% consumed regular milk products. There were differences by household education and income in the percentage of infants consuming cow’s milk formula and regular milk products. The majority of infants in the United States who were fed formula or regular milk consumed cow’s milk formula (69%), with lower percentages receiving soy, specialty, gentle/sensitive, or lactose-free/reduced formulas. Contrary to national recommendations, 13% of infants younger than 1 year consumed regular milk, and the percentage varied by household education and income levels. [ABSTRACT FROM AUTHOR]

A case study is presented of an infant born to a 28-year-old gravida 2, para 2 mother. Diagnosis of mother with gestational hypertension in triage; maternal urine drug screen showed positive for cocaine and opioids and developed neonatal abstinence syndrome. Further she was treated of hyperphagia in a full-term neonate due to neonatal abstinence syndrome.

Objective. To evaluate the reliability and validity of the Infant Gastrointestinal Symptom Questionnaire (IGSQ), a tool to assess feeding tolerance in infants. Methods. Qualitative methods were used to develop IGSQ content across 5 symptom clusters, yielding a 13-item index of parent-reported infant digestion and elimination behaviors over the prior 7 days. Classical psychometric methods evaluated factor structure, interrater and retest reliability, and validity in 4 prospective studies of 836 infants. Results. Interrater and retest reliability were acceptable to good. IGSQ Index score was highly correlated (r = 0.89) with daily parent reports. IGSQ scores were significantly different between infants whose parents planned to switch formulas because of perceived feeding problems and those without parental concerns. Conclusions. The IGSQ is a practical, reliable, and valid method for assessment of infant gastrointestinal-related behaviors. Its use in clinical studies can provide empirical evidence to advance parent education regarding both normal and clinically meaningful feeding-related behaviors. [ABSTRACT FROM AUTHOR]

Background and Objectives. Breast milk feeding and solid food introduction can influence infant growth, but are rarely examined together. The objectives were to describe relationships between feeding practices, feeding practices and weight gain, and how the relationship of breast milk feeding and growth may change when breastfed infants start solid foods before 6 months. Methods. Data were analyzed on 438 infants from the Moms2Moms Study (2011-2012, Ohio), using multivariable linear and logistic regression models to explore each of the relationships. Results. For each additional month of breast milk feeding, solid food introduction was delayed by 1.32 days (95% CI 0.11 to 2.53) and average weight gain per month decreased by 5.05 g (95% CI 7.39 to 2.17). There was no association between solid food introduction and growth. Conclusions. Longer breastfeeding duration was associated with slower growth regardless of solid food introduction. Age at solid food introduction was not associated with growth. [ABSTRACT FROM AUTHOR]

Objective. To describe the timing of introduction and type of food introduced to infants with a family history of atopy. Methods. We conducted a secondary analysis of foods introduced each month to an interventional birth cohort of 149 infants at risk for atopy. Results. Seven percent of infants received solid food prior to 4 months of age; 13% after 6 months of age. Hyperallergenic foods were introduced on average in the following order: wheat (8.7 months); eggs (11.2 months); soy (13.0 months); fish (13.4 months); peanut (20.2 months); tree nuts (21.8 months); and other seafood (21.8 months). Asian race (odds ratio 3.94; 95% CI 1.14-13.58) and maternal history of food allergy (odds ratio 3.86; 95% CI 1.29-11.56) were associated with late food introduction. Conclusion. Variation in timing of food introduction may reflect cultural preferences and/or previous experience with food allergy, as well as the ambiguous state of current recommendations. [ABSTRACT FROM PUBLISHER]

Aims. To evaluate the impact of oligofructose (OF)-supplemented infant formula on fecal microbiota, stool characteristics, and hydration. Methods. Ninety-five formula-fed infants were randomized to α-lactalbumin-enriched control formula (CF) or identical formula with 3.0 g/L OF (EF) for 8 weeks; 50 infants fed human milk (HM) were included. Results. Eighty-four infants completed the study, 70 met per-protocol criteria. Over 8 weeks, bifidobacteria increased more in EF than CF group (0.70 vs 0.16 log10 bacterial counts/g dry feces, P = .008); EF was not significantly different from HM group (P = .32). EF group stool consistency was intermediate between CF and HM groups; at week 8, EF group had softer stools than CF (5-point scale: 1 = hard, 5 = watery; consistency score 3.46 vs 2.82, P = .015) without significant differences in stool frequency. Physician-assessed hydration status was normal for all infants. Conclusions. Infant formula with 3.0 g/L OF promoted bifidobacteria growth and softer stools without adversely affecting stool frequency or hydration. [ABSTRACT FROM PUBLISHER]

Partially hydrolyzed formulas (pHF) represent a significant percentage of the infant formula market. A new whey-based, palm olein oil (PO)–free pHF was developed and a masked, randomized, parallel growth study was conducted in infants fed this formula or a commercially available whey-based pHF with PO. Infants between 0 and 8 days were to be enrolled and studied to 119 days of age. Growth and tolerance of infants were evaluated. Mean weight gain from 14 to 119 days of age was similar between groups. There were no significant differences between groups in weight, length, head circumference (HC), or length or HC gains. Infants fed the new PO-free pHF had significantly softer stools than those fed the PO-containing formula except at 119 days of age. This study demonstrates that whereas growth of infants fed different formulas during the first 4 months of life may be similar, infants may tolerate individual formulas differently. [ABSTRACT FROM PUBLISHER]

Background. The extent to which pediatricians inform parents about gestation-adjusted age growth plotting is unclear. Uninformed parents may have decreased satisfaction of infant growth. Subsequent early introduction of solid foods may lead to avoidant feeding behaviors and poor parental perception of infant feeding patterns. Methods. Questionnaires regarding infant growth and feeding behaviors were given to parents (n = 76) of premature infants. The Wilcoxon rank-sum and χ2/Fisher’s exact tests were used. Results. Uninformed parents were less satisfied with their infant’s growth (P < .002). Uninformed parents had more developmentally unready infants at the time of solid food introduction compared with informed parents (P = .03). Significant differences were found in avoidant feeding behaviors and parental perception of infant feeding patterns between developmentally ready and unready infants. Conclusion. Pediatricians should adjust for gestational age when plotting growth and assess for developmental readiness for premature infants when recommending solid foods. [ABSTRACT FROM PUBLISHER]

Objective. To examine the nutrient intakes in young children and to compare their intakes with the dietary reference intakes (DRIs). Design. Longitudinal study observing the child’s food and beverage intakes as he or she grows from 12 to 18 months. Methods. Three interviewer-administered 24-hour dietary recalls over 1 week were collected from the mother to assess the child’s intakes at 12 and 18 months of age. Intakes were calculated at the 10th, 25th, 50th, 75th, and 90th percentiles and compared with the DRIs to determine the proportions below and above cutoff values. Results. Nutrient intakes met or exceeded energy and nutrient requirements, with some exceptions. Diets were deficient in healthy fats, iron, fiber, and potassium and excessive in calories, synthetic folate, preformed vitamin A, zinc, and sodium. Conclusions. Health professionals should emphasize foods that are nutrient dense while decreasing highly processed foods for children. [ABSTRACT FROM PUBLISHER]

Background. Food insecurity (FI) is common, but studies in families with infants are rare. Objectives. To determine prevalence of FI, assess the effect public benefits have on FI, assess strategies to stretch nutritional resources (eg, using generic formula), and investigate FI’s relationship to anthropometric measurements. Methods. A cross-sectional survey was completed. FI was classified using the US Department of Agriculture’s 6-item indicator set. Results. A convenience sample of 144 infant caregivers was surveyed. Thirty-one percent endorsed FI. FI was more common among those receiving WIC and SNAP (39% vs 22%; P < .05). Fifteen percent stretched infant formula (27% FI vs 9% food secure; P < .01), 58% would not use generic formula, and 50% believed that generic and brand name formulas were not equivalent. There was no significant association between FI and anthropometric measurements. Conclusions. FI and formula stretching were common, even among families receiving public benefits. Many families were cautious about using generic formula. [ABSTRACT FROM PUBLISHER]

This study sought to determine the relationship between maternal controlling feeding styles and maternal perception of their infant’s ability to regulate feeding and infant weight. A cross-sectional survey of 208 mothers with infants between 2 weeks and 6 months old was performed in a private pediatric office. The authors assessed the relationship between restrictive and pressuring feeding styles with (a) maternal perception of the infant’s ability to regulate feeding and (b) infant weight (both actual and perceived). Restrictive feeding style was associated with the perception that infants could not recognize their own hunger or satiety and with concern that the infant would become overweight in the future. Pressuring feeding style was associated with the perception that the baby’s appetite is less than other babies and with concern that the infant would become underweight in the future. Maternal perceptions of infant feeding and weight should be incorporated into early obesity prevention strategies. [ABSTRACT FROM PUBLISHER]

Objective. To compare the incidence of postdischarge feeding dysfunction and hospital/subspecialty visits for feeding problems during the first year of life in late (34 to 3667 weeks) and early-preterm (25 to 3367 weeks) infants. Methods. In this prospective study, the authors sent questionnaires to parents of early (n = 319) and late (n = 571) preterm infants at 3, 6, and 12 months corrected age. Parents’ perceptions of infants’ feeding skills, comfort with feeding, and hospital/subspecialty visits for feeding difficulties were obtained. Results were analyzed with χ2 tests and Spearman’s correlations. Results. Early preterms had more oromotor dysfunction at 3 (29% vs 17%) and 12 months (7% vs 4%) and more avoidant feeding behavior at 3 months (33% vs 29%). In both groups, oromotor dysfunction and avoidant feeding behavior improved over time. Frequency of poor appetite and hospitalization/subspecialty visits were similar. Conclusion. Pediatricians should screen all preterm infants for feeding dysfunction during the first year. [ABSTRACT FROM PUBLISHER]

The article discusses guides to deal with behavioral feeding difficulties for pediatricians. It states that an organic pathology must be considered because food refusal may reflect underlying medical condition. It cites that an infant who takes a bottle in eagerness and rears back in apparent pain and cries after a few sips which suggests an upper gastrointestinal pathology. In children with no underlying organic cause, attention is needed to effect resolution. To calm crying infants, parents must be encouraged to feed in a quite room with dim lights and white noise. Moreover, it implies to help pediatricians avoid problems on inappropriate concerns of parents.

Healthy, term infants received extensively hydrolyzed casein formula (EHF; control), the same formula supplemented with Lactobacillus rhamnosus GG (EHF-LGG), or partially hydrolyzed whey:casein (60:40) formula supplemented with LGG (PHFLGG), in this double-blind, randomized, controlled, parallel, prospective study. Anthropometric measures and 24-hour dietary and tolerance recalls were obtained at 30, 60, 90, 120, and 150 days of age. Blood collected in a subset of infants was analyzed for fatty acid profiles in plasma and red blood cells and for markers of allergic sensitization. Adverse events were recorded throughout the study. Growth rates were not statistically different between EHF and PHF-LGG and between EHF and EHF-LGG from day 14 to day 30, 120, or 150. No relevant differences in formula tolerance, adverse events, or allergic and immune markers were demonstrated between groups. The extensively and partially hydrolyzed formulas supplemented with LGG support normal growth in healthy, term infants and are well tolerated and safe. [ABSTRACT FROM AUTHOR]

Very fussy or extremely fussy infants were randomized to receive: soy-based formula (Soy: n = 82) or a partially hydrolyzed cow's milk protein (CMP), low-lactose formula (PHF: n = 77) in a multicenter, double-blind, randomized, parallel, prospective 28-day feeding trial. Body weight and infant formula tolerance were reported. Adverse events were recorded throughout the study. A significant reduction in mean scores of fussiness, gas, spit-up, and crying compared with baseline measures was observed in infants who received either Soy or PHF within 1 day of formula intake; improvement in symptoms was sustained by study end. Stool consistency remained constant through day 28 in the PHF group, whereas stools in the Soy group became more firm by day 2 and did not return to prestudy consistency. PHF, with a protein profile patterned more closely on human breast milk, improved symptoms of formula intolerance as well as soy-based formula. [ABSTRACT FROM AUTHOR]

Objective To determine rates of breast-feeding in the first 2 months of life at an inner-city pediatric practice. Methods Using retrospective chart reviews, we examined all visits through 2 months of age for infants seen from April 1, 2007, to June 29, 2007, at the Pediatric Practice of Rainbow Babies and Children's Hospital, Cleveland, Ohio, which serves a low-income urban population. Rates of breast-feeding were analyzed by visit number and by infant age category. Results We reviewed all 557 visits occurring between birth and 2 months of age for all 223 eligible infants. At visit 1 (median age 5 days), the rates of exclusive and any breast-feeding were 22.0% and 40.8%, respectively. By visit 3 (median age 43 days), the rates of exclusive and any breast-feeding were 10.6% and 24.5%, respectively. Conclusions These inner-city breast-feeding rates are substantially below reported regional and national rates. Barriers to implementing urgently needed interventions are discussed. [ABSTRACT FROM AUTHOR]

To assess the familiarity of pediatricians with commercially available formulas and their use for cow's milk protein allergy and colic, a list of formulas was generated by visiting several grocery stores. Pediatricians were ask to indicate their familiarity with these and other ‘specialized’ formulas with regard to protein and carbohydrate sources, energy content, hypoallergenicity, and indication for infant colic. The participants answered an average of 46% of the questions correctly. Respondents were very familiar with 27% of the formulas, and unfamiliar with 35%. The highest score was 70%, and 10% of the responders correctly answered 65% or more of the questions. Fifty-one percent correctly identified the protein source of the formulas; 32% correctly identified the carbohydrate source. The energy content of the formulas was correctly identified by 54%. These data suggest that pediatricians have a poor understanding of the content and appropriate use of neonatal and infant formulas. [ABSTRACT FROM AUTHOR]

To assess the effect of docosahexaenoic acid and arachidonic acid supplementation in infant formula on the incidence of respiratory illnesses, pediatricians assigned infants to receive docosahexaenoic acid/arachinonic acid—supplemented formula or control formula. Anthropometrics, medical history, and illnesses were reported. Among 1342 infants, there was a higher incidence of bronchiolitis in control versus docosahexaenoic acid/arachinonic acid— supplemented groups at 5, 7, and 9 months (P < .01). Weight, length, and head circumference were similar for both groups. Infants fed formula supplemented with 0.32% docosahexaenoic acid and 0.64% arachidonic acid experienced a lower incidence of bronchiolitis compared with infants fed formula supplemented with no docosahexaenoic acid/arachidonic acid or lower levels of docosahexaenoic acid/arachidonic acid in the first year of life. [ABSTRACT FROM AUTHOR]

The article offers information about methemoglobinemia in patients associated with food protein-induced enterocolities. Methemoglobinemia in newborns can be congenital, wherein it is due to hemoglobin M, or it is infancy acquired methemoglobinemia in which the rate of heme iron oxidation to the ferric state is greater than the erythrocytes' capacity to reduce methemoglobin. According to the authors, endogenous methemoglobinemia in infants is mostly reported in relation to diarrheal illnesses and acidosis. They assess that endogenous methemoglobinemia in young infants can occur as a complication of inflammation caused by protein intolerance, and that Neocate formula is the definite way to treat these infants. Details about the two case reports of infants with methemoglobinemia are cited.

The charts of children with gastrostomy or jejunostomy tubes followed in the Tube Feeding Clinic at the Children's Hospital of Wisconsin from January 1999 to June 2002 were reviewed. Prevalence of selected nutrient deficiencies were determined and their association with growth and caloric intake was measured. One hundred fifty patients (60% male) met the inclusion criteria. The mean age of children was 7 years 6 months (SD ± 5 years 4 months). As a proportion of total caloric intake, the mean percentage of calories from formula was 92% (± 15). No deficiencies of vitamins D or E were found. Ferritin concentration below lower limits of the age-appropriate range of normal (LLN) was found in 30 of 122 (25%) and hemoglobin was below LLN in 12 of 139 (9%). One patient each had vitamin A, calcium, phosphorus, and magnesium serum concentrations below LLN. Below normal serum zinc was found in 43 of 142 (30%). Ninety-one of 134 patients (68%) had below normal selenium levels, and 29 of 126 (23%) had both zinc and selenium deficiency. A significant association was found between percentage of recommended daily allowance (RDA) of calories received and selenium concentration below LLN. Patients with selenium deficiency received a mean of 75% (± 21) of the RDA of calories for age, whereas patients without deficiency received a mean of 91% (± 19) of the RDA of calories for age (p <0.0001). There was a negative association between deficiency and weight for age: patients with selenium deficiency were 33 % mean weight for age percentile (± 30), compared to 21 % (± 27, p < 0.05) for those without selenium deficiency. There was a negative correlation between the percentage of RDA of calories and height for age, weight for age, and weight for height (p < 0.05). [ABSTRACT FROM AUTHOR]

The objective of this randomized study was to determine if fiber-supplemented soy formula reduced regurgitation in young infants. We compared regurgitation in 179 infants randomly assigned cow's milk-based (CM, 90) formula or soy formula with fiber (SF, 89). Initial daily incidence was similar (CM, 3.6; SF, 3.9 episodes), but significantly lower after 7 days on SF (CM, 3.4; SF, 2.3; p = 0.001). Less frequent regurgitation after 7 days on SF was sustained after 28 days (CM, 48%; SF, 31% of feedings; p = 0.001). Feeding SF effectively managed regurgitation while providing balanced nutrition without altering caloric distribution as occurs with adding rice cereal to formula. [ABSTRACT FROM AUTHOR]

To determine whether age of bottle-weaning is associated with overweight in young children, National Health and Nutrition Examination Survey III data for 3027 children aged 3-5 years were analyzed. The main outcome measure, the child's body mass index (BMI), was measured as: <85%, 85-95%, >95%. Mean bottle-weaning age was 18.78 months. After adjustment for potential confounders, each additional month of bottle use corresponded to a 3% increase in the odds of being in a higher BMI category (95% CI 0.0099-0.0535). Prolonged bottle use in young children is associated with increased risk of overweight. From a preventive medicine standpoint, decreasing exposure to this potential risk for childhood overweight is indicated. Clin Pediatr. [ABSTRACT FROM AUTHOR]

This study was a cross-sectional survey of primary female caregivers during their childs 4-month well-child visit. Our objectives were to document current caregiver awareness of infant feeding guidelines, and calculate the frequency of and reasons for early introduction of solid foods. Questionnaires were completed for 102 children. Forty-five respondents (44%) introduced solids at less than 4 months of age. Hispanic caregivers, OR 0.2 (0.07-0.9), and those who breastfed (partial or exclusive), OR 0.4 (0.2-0.9), were less likely to introduce cereal at less than 4 months of age. Among caregivers who introduced solids at less than 4 months, 36 (80%) stated that the child was not satisfied with formula or breast milk alone and 24 (53%) stated that solids helped the child sleep better at night. Thirty-four caregivers (76%) who started solids at less than 4 months were aware of guidelines regarding proper infant feeding practices. Despite knowledge of infant feeding guidelines, female caregivers frequently introduce solids at less than 4 months of age. Early targeted anticipatory guidance is needed to address the most common reasons caregivers begin solid foods before the recommended age. Clin Pediatr. [ABSTRACT FROM AUTHOR]

Focuses on the role of infant feeding practices on the dental health of children. Review of literature regarding infant feeding practices and its implications on the dental health of children; Dental anticipatory guidance implications to facilitate diet counseling in infancy.

Explores the legal, ethical and professional issues relating to the withdrawal of nutrition and hydration from children. Role and responsibilities of pediatricians regarding infants with severe life-limiting handicaps; Legal standards regarding withholding nutrition and hydration from severely handicapped infants; Paternalistic view that treatment options should be tailored to the physician's appraisal of what is best.

The article describes the case of a healthy 4-month old boy of Iranian descent presented due to parental concerns about appearance of multiple pink spots in his diaper. The family was provided education and told to follow up if the symptoms persisted given the likelihood of a benign urate crystal formation diagnosis. Likely causes of the persistent red-appearing urine were the patients' ethnicity and diet and the parents were advised to change to standard 20 kcal/oz infant formula.

Characterizes failure to imbibe among infants by performing a feeding assessment among 128 patients. Need for pediatric subspecialty care and nasogastric or gastrostomy tube feeding among patients with failure to imbibe; Association between prolonged infant feeding time reported by parents and inadequate caloric intake in infants with failure to imbibe.

Examines the effect of early supplementation with manufactured milks on breastfeeding status at 20 weeks of postpartum in mothers of healthy term infants. Presentation of phase I and phase II subjects; Definitions for the outcome variable breastfeeding; Percentage of mothers breastfeeding versus weaned based on feeding pattern at week 2 postpartum.

Data from a national survey of new mothers were analyzed to determine the effect that demographic characteristics, breast-feeding instructions and infant formula discharge kits had on breast-feeding patterns established in the hospital. Results indicated that mothers who exclusively breast-fed their infant were more likely to be affluent, college educated, and not working outside the home. Mothers who exclusively breast-fed their infants in the hospital and subsequently practiced partial breast-feeding or formula, or cow's milk feeding were more likely to return to the work force within the first 6 postpartum months. Mothers who partially breast-fed their infants in the hospital were more likely to have a low-birth-weight neonate. Stepwise logistic regression analysis indicated that greater total family income, a better education, and having more than one child had positive significant effects on exclusive breast-feeding by the first and fourth month. Women who received a formula discharge kit compared with those who did not had a slightly higher probability of initiating partial breast-feeding (10 vs. 7% by the first month; 27 vs. 25% by the fourth month). Maternal employment had a large impact on duration of exclusive breast-feeding. By the fourth month, mothers who were employed had a higher probability of initiating partial breast-feeding (43 vs. 19%) compared with mothers who were not in the work force. [ABSTRACT FROM AUTHOR]

Few studies have described the woman who chooses breast-feeding by more than simple demographics. The purpose of our study was to characterize new mothets by their infant feeding decisions, by demographic and obstetrical data, and by sources of personal support they received during their pregnancies and in making their infant feeding decisions. To this end, 220 were interviewed, including 116 who chose to breast feed. Breast-feeding women were more likely to be older, more educated, married, more affluent, experienced with breast-feeding, to have demonstrated gàod prenatal habits, and to have received support from other sources than th6se who chose bottle feeding. Participation in Lam aze classes, previous successful breast-feeding, and maternal education were signifi&x#00EB;ant predictors of feeding choice, nd mode of delivery predicted duration of breastfeeding. Low income women who chose breastfeeding resembled low income bottle feeders in certain mcdical/social fàçtors; but they showed support patterns similar to middle to upper in- come women. [ABSTRACT FROM AUTHOR]

Data from a state supported project providing multidiscipline (clinical social work, nursing, nutrition, obstetrics, and pediatrics) assistance to low-income women judged to be at high perinatal risk by medical and social history were analyzed regarding infant feeding decisions. Data from 2,124 subjects delivered from 1976 to 1985 were available for analysis. The population tended to be single (77%), black (66%), poorly educated (63% less than a high school education), and young (mean age 21.8 years). Thirty-six percent were primiparas. The decision to breastfeed was associated with white race, older maternal age, higher educational level, marriage, and earlier utilization of prenatal care. Prenatal infant feeding plans were compared with actual postpartum decisions for 1,168 women. Only 3 percent of those initially planning to bottle feed changed their minds postpartum and breastfed although 31 percent of those initially planning to nurse ultimately chose artificial feeding. Ten percent of women were initially undecided; one-third of this group ultimately breastfed, two-thirds bottle fed. Overall the percentage of women in the project who were breastfeeding rose from 15 percent to 22 percent from the early to later years of the project (p < 0.0001). [ABSTRACT FROM AUTHOR]

Family interactional processes surrounding infant feedings in 34 consecutive cases of nonorganic failure to thrive (NFT) admitted to a university teaching hospital are reported. Observations of family interactions for 90 minutes, including one feeding, yielded clinically useful information not readily available from other sources. Behaviors that supported inadequate feedings were reliably identified in 79 percent of the families. Failure of mothers to appropriately respond to their infants' cues, coupled with few signs of emotional attachment, were present in only 26 percent of cases, and inadequate child-care knowledge and skills in only 6 percent. Thus, widely held conceptual models explained perpetuation of inadequate feedings in only 32 percent of cases. Instead, sibling rivalry, displaced maternal anger, and undermined mother were among the problems found. Assessments of family members' interactions surrounding feedings have the potential to enhance the current management of NFT. [ABSTRACT FROM AUTHOR]

A survey of iron-fortified commercial foods commonly marketed for consumption by infants was conducted in 1972 and again in 1982. Positive changes had occurred in infant formulas and cereals during that decade, in availability of fortifying iron, level of fortification, and label information. Miscellaneous iron-containing products, cookies, and crackers were unreliable sources of dietary iron in both 1972 and 1982. Availability of fortifying iron in regular cereals had improved by 1982, though 10 percent lacked the label information. Fortified infant formulas and cereals contribute iron of high bioavailability to the typical infant diet in amounts equal to the USRDA. Food manufacturers need to continue to apply knowledge gained through research to sustain the lessened but still highly prevalent incidence of anemia in 1-2-year old children. [ABSTRACT FROM AUTHOR]

A new routine infant formula has been developed and clinically tested. The clinical study reported hen involved 337 normal newborns cared for by six private pediatric group practices Infants were examined regularly by the investigators until six months of age. Serum biochemistries, hematology and growth and tolerance variables were compared to infants fed control formulas and to reported values for breast-fed infants. This new formulation compared favorably, in all areas studied here, to controls and previously reported values. [ABSTRACT FROM AUTHOR]

This study compares the morbidity of two groups of healthy, full-term infants (25 in each group) who were exclusively either bottle-fed or breast-fed for 5 months. There were no statistically significant differences in morbidity between the two groups except for a borderline greater frequency of upper respiratory infections in the bottle-fed group. Although the study groups are limited in size, the results suggest that, when appropriate hygienic measures are taken and statistical biases eliminated, differences in morbidity between bottle-fed and breast-fed babies are relatively minor. The data also show that modern infant formulas seem to be nutritionally complete in that there was no difference in the rate of growth or in hematological parameters measured in the bottle-fed and breast-fed group. [ABSTRACT FROM AUTHOR]

One hundred eighty-two consecutive newborns from a university-based private practice were enrolled in a comprehensive nutritional program in an attempt to lower the incidence of ponderosity in the group. The program emphasized an individualized approach in which the feeding instructions given to parents varied with the growth pattern of their child. Whereas specific modalities of feeding, such as breast vs. bottle and early vs. late addition of baby foods, appeared not to modify growth, the group as a whole exhibited a trend to lower weight-for-length index (WLI) and less ponderosity than in previous published reports. We propose that the individualized nutritional program may have resulted in this improvement, and that such attention to detail will likely be more rewarding than an approach which emphasizes only general nutritional information to the group as a whole. [ABSTRACT FROM AUTHOR]