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Objective: Primary: to identify the potential relationship between duration of tube feeding and success of oral feeding in preterm infants; secondary: to identify the potential relationships among duration of tube feeding and alert behavioral states, orally directed behaviors, and nutritive sucking., Design: A descriptive correlational study., Setting: A Level III NICU at an inner-city hospital., Participants: Twenty-eight preterm infants who were born between 28 and 32 weeks gestational age, were clinically stable, and were expected to have at least 1 week of tube feeding during their initial hospitalizations., Methods: Data were collected daily from participants' electronic medical records and at one-time oral feeding evaluations within 48 hours after the removal of the feeding tube., Results: We found a significant negative correlation between duration of tube feeding and oral feeding success (p = .000). We found no correlations between duration of tube feeding and alert behavioral states, orally directed behaviors, or nutritive sucking., Conclusion: Although the duration of tube feeding is a nonmodifiable factor, preterm infants who are anticipated to have extended durations of tube feeding may be at risk for delayed oral feeding success., (Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Problem: Supplementation of breastfed babies is common during the hospital stay., Background: The Baby Friendly Hospital Initiative (BFHI) optimises practices to support exclusive breastfeeding, yet supplementation is still prevalent., Objective: To determine predictors for supplementation in a cohort of breastfed babies in a Baby-Friendly hospital., Methods: Electronic hospital records of 1530 healthy term or near term singleton infants and their mothers were examined retrospectively and analysed to identify factors associated with in-hospital supplementation using Poisson regression (unadjusted and adjusted)., Findings: Fifteen percent of breastfed infants were supplemented during their hospital stay. Analysis by multivariable Poisson regression found that supplementation was independently associated with overweight (reference normal weight) (aRR [adjusted relative risk]=1.46; 95% CI: 1.11-1.93); primiparity (aRR=1.40; 95% CI: 1.09-1.80); early term gestation (37-37 6 weeks, aRR=2.79; 95% CI: 1.88-4.15; 38-38 6 weeks, aRR=2.03, 95%CI: 1.46-2.82); birthweight less than 2500 grams (reference 3000-3499 grams) (aRR=3.60; 95% CI: 2.32-5.60) and use of postpartum uterotonic (aRR=2.47; 95% CI: 1.09-5.55). Greater than 65 minutes of skin-to-skin contact at birth reduced the risk of supplementation (aRR=0.66; 95% CI; 0.48-0.92)., Conclusion: These identified predictors for supplementation, can inform the development of interventions for mother-infant pairs antenatally or in the early postpartum period around increased breastfeeding education and support to reduce supplementation. It may also be possible to reduce supplementation through judicious use of postpartum uterotonics and facilitation of mother-infant skin-to-skin contact at birth for greater than one hour duration., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Breastfeeding rates in Ireland are among the lowest in Europe. Breastfeeding groups can provide support, information, and friendship for women. However, there is little research exploring community breastfeeding groups led by Public Health Nurses providing universal maternal and child care to all postnatal mothers in the community in Ireland., Aim: The aim of this study was to explore breastfeeding women's experiences of a Public Health Nurse led support group., Methods: A qualitative descriptive design to explore women's experiences of a community breastfeeding support group was conducted. Data were collected using one to one interviews with breastfeeding women (n=7) in a primary healthcare setting. Transcripts were analysed using Burnard's thematic content analysis., Results: The overall theme identified was 'normalising breastfeeding' which emerged from the subthemes 'socialising and sharing', 'information and support seeking', 'building confidence', 'overcoming embarrassment', 'negative perceptions of others', and 'promoting breastfeeding to others'., Discussion: Women who attended the PHN led breastfeeding support group found it to be a cocoon of 'normality', whereas breastfeeding was considered almost something to be ashamed of in other circumstances. Many women attributed their success with breastfeeding to the support group., Conclusion: Facilitating a sense of normalcy for breastfeeding women at individual, community and societal levels was essential in promoting breastfeeding. The community support group was influential in normalising breastfeeding for a sample of women, by minimising the potential for embarrassment, promoting social interaction and sharing, building confidence and knowledge. This buffered the effects of negative attitudes of others and personal feelings of shame., (Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objective: Determine maternal and infant characteristics associated with adding cereal into the bottle., Design: Secondary data analysis., Participants: Study participants were immigrant, low-income, urban mother-infant dyads (n = 216; 91% Hispanic, 19% US-born) enrolled in a randomized controlled trial entitled the Bellevue Project for Early Language, Literacy and Education Success., Main Outcome Measures: Maternal characteristics (age, marital status, ethnicity, primary language, country of origin, education, work status, income, depressive symptoms, and concern about infant's future weight) and infant characteristics (gender, first born, and difficult temperament)., Analysis: Fisher exact test, chi-square test, and simultaneous multiple logistic regression of significant (P < .05) variables identified in unadjusted analyses., Results: Twenty-seven percent of mothers added cereal into the bottle. After adjusting for confounding variables identified in bivariate analyses, mothers who were single (P = .02), had moderate to severe depressive symptoms (P = .01) and perceived their infant had a difficult temperament (P = .03) were more likely to add cereal into the bottle. Conversely, mothers who expressed concern about their infants becoming overweight were less likely to add cereal (P = .02)., Conclusions and Implications: Health care providers should screen for adding cereal in infant bottles. Further research is needed to investigate the impact of adding cereal into the bottle on weight trajectories over time. Causal associations also need to be identified to effectively prevent this practice., (Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

The purpose of this study was to describe the extent to which mothers engage in distracting activities during infant feeding. Mothers reported engaging in other activities during 52% of feedings; television watching was the most prevalent activity reported. Further research on the impact of distraction on feeding outcomes is needed., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To explore the maternal breastfeeding self-efficacy of Chinese women, the breastfeeding behaviors of newborns, and the relationship with breastfeeding outcomes at 6 weeks postpartum., Design: Descriptive correlation study., Setting: Postnatal ward of a regional maternity hospital, Participants: All postnatal Chinese women who were admitted from mid-February 2010 to mid-March 2010 with the intention of breastfeeding., Methods: The Infant Breastfeeding Assessment Tool (IBFAT) was used to assess neonatal breastfeeding behaviors, and a modified Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form (MBSES-SF) was used to examine the breastfeeding self-efficacy of mothers., Results: A total of 199 postnatal women were recruited. At 6 weeks postpartum, 85 (42.7%) infants were bottle-fed, 66 (33.2%) were complementary breastfed, and 48 (24.1%) were exclusively breastfed. The significant contributing factors for exclusive breastfeeding were women who planned to breastfeed for at least 6 months (odds ratio [OR] = 5.537, 95% confidence interval [CI] [2.430, 12.619], p ≤ 0.001), women with a high level of breastfeeding self-efficacy (OR =, 7.776, 95% CI [2.546, 23.748], p ≤ 0.001), and those women whose infants had high-IBFAT scores (OR = 2.381, 95% CI [1.019, 5.562], p = .045)., Conclusions: Maternal breastfeeding confidence and newborn breastfeeding behavior are strong predictors of breastfeeding duration as well as exclusivity. Health care professionals should monitor the breastfeeding behavior of newborns and not only provide mothers with the factual information on breastfeeding but help also them to develop maternal confidence in breastfeeding before they are discharged., (© 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Research Question: How do women who choose not to breastfeed perceive their healthcare experience?, Method: This qualitative research study used a phenomenographic approach to explore the healthcare experience of women who do not breastfeed. Seven women were interviewed about their healthcare experience relating to their choice of feeding, approximately 4 weeks after giving birth. Six conceptions were identified and an outcome space was developed to demonstrate the relationships and meaning of the conceptions in a visual format., Findings: There were five unmet needs identified by the participants during this study. These needs included equity, self sufficiency, support, education and the need not to feel pressured., Conclusion: Women in this study who chose not to breastfeed identified important areas where they felt that their needs were not met. In keeping with the Code of Ethics for Nurses and Midwives, the identified needs of women who do not breastfeed must be addressed in a caring, compassionate and just manner. The care and education of women who formula feed should be of the highest standard possible, even if the choice not to breastfeed is not the preferred choice of healthcare professionals., (Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Australia has high breastfeeding initiation rates however, at 3 and 6 months exclusive breastfeeding rates fall below global recommendations. Research suggests significant others in a woman's life can influence infant feeding decisions and practices but how and why they do so needs investigation., Research Question: This study explored grandmothers' perceptions of their role in supporting new families and examined the potential for grandmothers to influence infant feeding decisions and parenting practices of new mothers in an area of Sydney, Australia, with low breastfeeding maintenance rates., Participants and Method: A qualitative, descriptive study was conducted in South Western Sydney, Australia. Eleven grandmothers participated in one to one interviews and three of these also participated in a group discussion., Results: Analysis revealed three themes: 'Presence'; 'Position'; and 'Power versus Preservation' which provide insight into the complexity of the grandmother-new mother relationship and describe the potential influence that grandmothers may have on infant feeding and parenting., Discussion and Conclusion: The findings highlight challenges and dilemmas faced by grandmothers in their supportive role for the new mother in her breastfeeding and early parenting experience and the difficulties grandmothers face in balancing potential risks and rewards in their interactions with the new family., (2009 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objective: To appraise the psychometric properties of clinical feeding assessment tools used in a neonatal population., Data Sources: PubMed, OvidMedline, CINHAL, and PsycINFO databases from 1980 to 2007. Reference lists of all identified articles were also reviewed., Study Selection: Research reports written in English that utilized or validated clinical feeding assessment tools., Data Extraction: In total, 941 articles were reviewed. Seven neonatal clinical feeding assessment tools were identified and categorized into three groups: tools used for assessing either bottle-feeding or breastfeeding behaviors, tools used only for assessing bottle-feeding behaviors, and tools used only for assessing breastfeeding behaviors., Results: The psychometric properties of none of the seven assessment tools identified were satisfactory, and the limited representativeness of the samples of the psychometric research was noted in all assessment tools identified. The Neonatal Oral-Motor Assessment Scale appeared to have been examined more thoroughly and showed more consistent results in psychometric properties than the others, despite its own limitations., Conclusions: A psychometrically sound neonate feeding assessment tool has not yet been empirically validated. Clinicians who use these tools for clinical and research purposes should take into account this lack of evidence of psychometric soundness and interpret results of assessment with precautions. Well-designed research is needed to study the scientific integrity of these instruments for program evaluations in neonatal care.

Objective: To analyze relationships between stress, moods, and immunity in breastfeeding compared to formula-feeding mothers., Design: A cross-sectional study of 181 healthy mothers, exclusively breastfeeding or formula feeding, studied at 4 to 6 weeks after childbirth., Setting: Mothers were recruited in the postpartum unit of the hospital and then visited in their homes once at 4 to 6 weeks after childbirth for data collection., Main Outcome Measures: Stress, mood, infection symptoms, and serum levels of interferon-gamma and interleukin-10 were measured., Results: Formula-feeding mothers had evidence of decreased interferon-gamma and a decreased serum Th1/Th2 ratio (interferon-gamma/interleukin-10) when perceived stress, dysphoric moods, and negative life events were high, an effect consistent with depression of cellular immunity. However, women who were breastfeeding did not show these relationships., Conclusions: The data suggest that breastfeeding confers some psychoneuroimmunological benefit to mothers, perhaps through prolactin or hypothalamic-hypophyseal-adrenocortical axis stress refractoriness., ((c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses)

The aim is to know whether antenatal olfactory learning have a greater effect than postnatal olfactory learning on infant feeding even in the absence of triggering signals. We evaluated the sucking behavior of infants completely separated from their mothers for 10-14 days since birth. The 12 infants admitted to Chiba Children's Hospital were studied at 10-14 days of age. Oral feeding was initiated at 4-7 days of age. The sucking and expression pressures, frequency, and sucking efficiency were measured during bottle-feeding with exposure to odors of mother's milk, formula, and water. The mother's milk odor elicited more frequent sucking with higher expression pressure than did formula or water. In conclusion, the odor preferences acquired independently from postnatal experience may have a greater effect than postnatal olfactory learning on sucking activity.

Objective: To describe how mothers of preterm infants who are learning to nipple feed view their own and their infant's role in the feeding process., Design: Descriptive, comparative study., Setting: Two neonatal intensive-care units (NICU) in the Midwest., Participants: A convenience sample of 22 mothers of very-low-birth-weight infants., Main Outcome Measures: Interviews were rated for mothers' level of thinking about their co-regulatory role in their infants' feeding on a 6-point scale. The higher the score the more flexible, contingent, adaptive, and reflective the mother's thinking is regarding her infant's and her own behavior during feeding. High and low scores were compared using paired t tests., Results: The co-regulation scores ranged from 1 to 6, with a mean score of 3.3 (SD = 1.4). Mothers scoring higher on the co-regulation measure were significantly older and their infants were younger gestationally at birth. Their infants tended toward having been in the NICU for a longer period of time and spending more days on oxygen., Conclusions: Understanding feeding from the parents' perspective can guide clinicians as they support the development of parents' feeding skills. Intervention, rather than beginning with how to feed, may need to begin with how to take the infant's perspective, how to explore infant behavior that is novel, and ways of viewing the process of feeding as co-regulated.

Objective: To explore the relationship of lifestyle variables to postpartum weight gain and body image attitudes of bottle- and breastfeeding women., Design: Mail survey of new mothers at approximately 4 months postpartum., Setting: Southwestern community., Participants: One hundred one bottle-feeding women (69% white, 20% Hispanic, 11% other) and 106 breastfeeding women (76% white, 19% Hispanic, 5% other) without diabetes. Bottle- and breast-feeding women did not differ on gestational weight gain or weight gain sustained postpartum., Main Outcome Measures: Postpartum weight gain (relative to prepregnancy weight) and body image attitudes., Results: Feeding method (breast or bottle) was not associated with postpartum weight gain in the sample as a whole. Bottle-feeding mothers with higher postpartum gains exercised less, had higher fat intake habits, and were more dissatisfied with body image than mothers with lower gains. Breast-feeding mothers with higher and lower gains did not differ on any lifestyle factors. Overall lifestyle and psychologic skill in managing emotions were related negatively to postpartum body image dissatisfaction in both groups of women., Conclusions: Breastfeeding women did not differ from bottle-feeding women in sustained postpartum weight gain. In bottle-feeding women, lifestyle factors were associated with levels of weight gain. Lifestyle-focused programs for weight management would potentially benefit these women.

Objective: To determine factors influencing infant feeding method choices among women who received services from the Special Supplemental Food Program for Women, Infants, and Children (WIC) during pregnancy in Hawaii., Design: A retrospective survey mailed to all resident mothers who had live births in Hawaii between January 1, 1989, and March 31, 1989, and who received WIC services during pregnancy., Setting: The state of Hawaii., Subjects: The subjects were 322 mothers who received WIC services during pregnancy for whom data were complete, taken from a sample of 2,013 women who had live births in the state of Hawaii (51% response rate) between January 1, 1989, and March 31, 1989, of whom 324 participated in WIC during pregnancy., Main Outcome Measures: Infant feeding method (exclusive breast, exclusive formula or mixed) at hospital discharge., Statistical Analyses Performed: The chi 2 analysis for differences among feeding method groups and multiple logistic regression to calculate odds ratios for independent effects of maternal characteristics and other influences on feeding method choice., Results: Reasons for infant feeding choice, timing of the choice, maternal age, parity, and place of residence were the main factor influencing infant method choice. Health of the infant was the primary reason for choice of feeding method and was the strongest determinant of exclusive breast-feeding (odds ratio = 23.99; confidence interval = 9.75-59.02; P < .0001) and was negatively related to the choice to formula-feed (odds ratio = 0.03; confidence interval = 0.01-0.08; P < .0001)., Applications: Relationship between WIC and hospital lactation consultants could enhance follow up in the hospital and after returning home with WIC mothers who prenatally state an intention to breast-feed. Convenience and bonding are aspects of breast-feeding enjoyed by WIC mothers in Hawaii that could be used in breast-feeding promotion efforts.

Objective: To examine husbands' experiences of having their wives breastfeed., Design: Qualitative method of grounded theory., Setting: In-depth interviews by phone at home., Participants: Fourteen middle-class, urban, Canadian fathers of successfully breastfed infants., Results: The fathers reported a disparity in the types of relationships that their children had with each of their parents as a result of breastfeeding. The process that enabled the fathers to accept this perceived difference was labeled postponing. Four fathering styles, which explain the variation in postponing, were found. The phases of postponing include becoming aware of the disparity, simultaneously developing accepting strategies and acknowledging reinforcing factors, and, finally, developing compensating behaviors to increase the fathers' interactions with their infants and promote closer relationships. When weaning occurred, the fathers' relationships with their children changed as the fathers found ways to catch up., Conclusions: A need exists for realistic education about the realities of breastfeeding for fathers. More outlets for fathers' negative emotions toward breastfeeding need to be found.

Objective: To examine the effects of nonnutritive sucking on the physiologic and behavioral stress reactions of preterm infants at early bottle feedings and to examine the effect of nonnutritive sucking on the feeding performance of preterm infants at early bottle feedings., Design: Quasi-experimental with a matched sample., Setting: A level III neonatal intensive-care unit in a large medical center., Participants: Twenty preterm infants whose gestational ages at birth ranged from 26 to 34 weeks., Interventions: Ten infants were provided nonnutritive sucking for 5 minutes before and 5 minutes after an early bottle feeding. Ten infants served as controls., Main Outcome Measures: Physiologic stress was measured by heart rate and oxygen saturation rate. Behavioral stress was measured by observation of behavioral state. Feeding performance was measured by duration, percentage of formula taken by bottle, and behavioral state after feeding., Results/conclusions: Infants who received nonnutritive sucking before and after bottle feedings were more likely to be in a quiescent behavior state 5 minutes after the feeding (p = .01) and had higher feeding performance scores (p = .01) than infants who did not receive nonnutritive sucking.

Nurses frequently assume that breastfeeding mothers are more attached to their infants than bottle-feeding mothers. The researchers observed 15 breastfeeding and 15 bottle-feeding mothers using the Avant maternal-infant attachment tool. The scores of the two groups were compared and no significant differences were found. The study results and limitations of this study and recommendations for future research are discussed.

This study tests the hypothesis that maternal and infant behaviors during a feed at one month of life co-varies with the infant's weight gain in the 30 days since birth. Thirty mothers-infant pairs were observed via videotape. Each of the tapes was analyzed, with a behavioral coding system adapted for this purpose. A stepwise regression statistical model showed that a statistically significant portion of the weight gain variance was explained by nutritionally functional and social communication behaviors in the mother and social communication behaviors in the infant. These data suggest that a lack of synchrony between the caretaker and the infant during feeding may imperil the infant's growth process.