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Despite improvements in food production and healthcare services, the burden of malnutrition in Uganda has for the last 30 years remained unacceptably high with rates of stunting (chronic undernutrition) and anemia (proxy for micronutrient deficiency) currently estimated at 29% and 53%, respectively among young children aged 6-59 months. Considering that both undernutrition and over nutrition are greatly attributed to monotonous diets characterized by limited dietary diversity and overdependence on starchy refined grains or roots as staples, there is need to improve the population's awareness of appropriate dietary practices. To improve nutrition education, the Infant and Young Child-feeding national counseling cards for community volunteers (IYCF cards) that were developed by United Nations Children's Fund (UNICEF), are currently the standard package used in Uganda's health sector to educate caregivers on appropriate child-feeding practices. In this study, the effectiveness of a three-group food guide was evaluated against IYCF cards. A randomized, controlled intervention trial engaged three randomly selected distant groups of child-caregiver pairs (n=40) concurrently in one of three treatments namely: (i) nutrition education using a threefood group guide (FG), (ii) nutrition education using age-appropriate IYCF cards, and (iii) negative control group that engaged in hair-plaiting sessions. At baseline, all groups had randomly selected caregivers of children aged 6-14 months and were met once a week for five consecutive weeks during the intervention. Caregivers were interviewed at baseline and 2 months after the interventions to determine changes in child-feeding practices while their children were concurrently measured to determine changes in their nutritional status. At baseline, caregivers in the three treatment arms exhibited inappropriate child-feeding practices indicated by low child-feeding index (CFI) scores, which were also related to poor nutritional status of their children. After the interventions, children in FG group were given more varied animal-source foods than those in IYCF cards group (p = 0.02). Compared to controls, caregivers in FG group gave their children significantly more snacks (p = 0.01), their child-feeding practices indicated by CFI scores significantly improved (p = 0.001) and their children exhibited better growth patterns indicated by weight-for-age (p = 0.02) and MUAC-forage (p = 0.03) Z-scores. These findings, therefore, indicate that the three-group food guide is more likely to improve child-feeding practices and growth patterns than IYCF cards. Hence, there is need to integrate the food guide into IYCF materials to foster child-feeding practices and growth. Key words: Dietary guidance, three-group food guide, Infant and Young Child Feeding counseling cards, nutrition education Trial Registration: Pan African Clinical Trial Registry (PACTR202002810799672), INTRODUCTION Globally, malnutrition is a major underlying cause of childhood mortality [1-4] and is associated with impaired physical and mental development [5-7]. Undernutrition manifests as underweight, wasting, and stunting and [...]

Introduction The purpose of the study is to evaluate delivery method and breastfeeding initiation in women enrolled in group prenatal care (CenteringPregnancy) and in traditional prenatal care. Methods Data were obtained from medical records of a hospital-based midwifery practice in south central Connecticut that offered both types of prenatal care programs. Medical information from 307 women enrolled in this practice was included in the analysis. Out of the 307, 80 were enrolled in group prenatal care. Socio-demographic, lifestyle, and previous and current obstetrical information from medical records formed the basis of comparison. Bivariate and logistic regression analyses were carried out. Results Women in Centering had fewer planned cesarean sections (1.3 vs. 12.8%) and had a higher breastfeeding initiation (88.7 vs. 80.0%). However, Centering women were found to have a higher portion of unplanned cesarean sections (27.5 vs. 11.0%). Both the unadjusted and the adjusted odds ratios of having a cesarean planned delivery were lower in the group care. Women in Centering had 2.44 (95% CI 1.05, 5.66) times the odds of breastfeeding initiation compared to the odds for women in traditional prenatal care after adjusting for maternal age, smoking status, gestation and race. Discussion CenteringPregnancy can have positive impact for the woman and baby. This program implementation saw lower rates of elective cesarean sections and increased breastfeeding compared to women in traditional care., Author(s): Deb Risisky [sup.1] , Ronna L. Chan [sup.2] , Victoria A. Zigmont [sup.1] , Syed Masood Asghar [sup.3] , Nancy DeGennaro [sup.4] Author Affiliations: (1) Department of Public Health, [...]

Objective Appropriate and timely complementary feeding practices are fundamental to a child's growth, health, and development during the first 2 years of life. This study aimed to understand (1) Ghanaian mother's complementary feeding practices, and (2) their perceived and observed impacts of complementary feeding on their children. Methods Ghanaian mothers with children 4-24 months of age were recruited from four communities in the Komenda Edina Eguafo Abrem district in the Central Region of Ghana (n = 99). A qualitative methodological approach with focus group interview discussions was used. Eleven focus group interviews were conducted, and were audio recorded and transcribed. The audio transcriptions were coded and analyzed into pertinent themes, meta-themes, and theoretical concepts. Results Over 80 % (85) of mothers reported poor knowledge about the effects of complementary feeding on their children and 45 % (45) of the children were undernourished, indicating inappropriate complementary feeding practices. Some mothers held misconceptions about the effect of food on children's health. Four overarching themes were identified: (1) mothers' background knowledge about food, child health and growth outcomes, (2) mothers' motivation in feeding their children, (3) barriers to feeding, (4) foods mothers offered their children. Conclusion for Practice Nutrition education on complementary feeding is needed for Ghanaian mothers. Health facilities and community outreach programs could be a venue to provide education to mothers regarding infant and young child feeding practices in Ghana., Author(s): Bridget K. Egyir[sup.1] , Samantha A. Ramsay[sup.1] , Barry Bilderback[sup.2] , SeAnne Safaii[sup.3] Author Affiliations: (1) School of Family and Consumer Sciences, University of Idaho, Niccolls Bldg. Room 109B, [...]

Background Our goal was to identify how parental feeding practices from the nutrition literature link to general parenting styles from the child development literature to understand how to target parenting practices to increase effectiveness of interventions. Stand-alone parental feeding practices could be targeted independently. However, parental feeding practices linked to parenting styles require interventions treating underlying family dynamics as a whole. Objective To predict parenting styles from feeding practices and to test three hypotheses: restriction and pressure to eat are positively related whereas responsibility, monitoring, modeling, and encouraging are negatively related to an authoritarian parenting style; responsibility, monitoring, modeling, and encouraging are positively related whereas restriction and pressure to eat are negatively related to an authoritative parenting style; a permissive parenting style is negatively linked with all six feeding practices. Design Baseline data of a randomized-controlled intervention study. Subjects/setting Two hundred thirty-nine parents (93.5% mothers) of first-grade children (134 boys, 105 girls) enrolled in rural public schools. Measures Parental responses to encouraging and modeling questionnaires and the Child Feeding Questionnaire, as well as parenting styles measured by the Parenting Styles and Dimensions Questionnaire. Statistical analyses Correlation and regression analyses. Results Feeding practices explained 21%, 15%, and 8% of the variance in authoritative, authoritarian, and permissive parenting, respectively. Restriction, pressure to eat, and monitoring (negative) significantly predicted an authoritarian style (Hypothesis 1); responsibility, restriction (negative), monitoring, and modeling predicted an authoritative style (Hypothesis 2); and modeling (negative) and restriction significantly predicted a permissive style (Hypothesis 3). Conclusions Parental feeding practices with young children predict general parenting styles. Interventions that fail to address underlying parenting styles are not likely to be successful.

Background There are few validated instruments measuring parental beliefs about parent-child feeding relations and child compliance during meals. Objective To test the validity of the Feeding Demands Questionnaire, a parent-report instrument designed to measure parents' beliefs about how their child should eat. Methods Participants were 85 mothers of 3- to 7-year-old same-sex twin pairs or sibling pairs, and their children. Mothers completed the eight-item Feeding Demands Questionnaire and the Child Feeding Questionnaire, plus measures of depression and fear of fat. Statistical analyses Psychometric evaluations of the Feeding Demands Questionnaire included principal components analysis, Cronbach's [alpha] for internal consistency, tests for convergent and discriminant validities, and Flesh-Kincaid for readability. Results The Feeding Demands Questionnaire had three underlying factors: anger/frustration, food amount demandingness, and food type demandingness, for which subscales were computed. The Feeding Demands Questionnaire showed acceptable internal consistency ([alpha] ranging from .70 to .86) and was written at the 4.8th grade level. Mothers reporting greater anger/frustration during feeding were more likely to pressure their children to eat, while those reporting greater demands about the type of foods their children eat were more likely to monitor child fat intake. Mothers reporting greater demands about the amount of food their children eat were more likely to restrict eating, pressure children to eat, and monitor their fat intake. Conclusions The Feeding Demands Questionnaire appears valid for assessing maternal beliefs that children should comply with rules for eating and frustration during feeding. Different demand beliefs can underlie different feeding practices.

Background Research suggests that parents use specific child-feeding strategies to influence their child's weight based on perceptions and concerns about their child's overweight risk, but limited data are available on ethnically diverse low-income populations. Objective This cross-sectional study examined associations between mothers' perception and concern about children's weight, child-feeding strategies, and child overweight in an ethnically diverse population. Subjects Mothers of preschool children (n=967) who participated in a federally funded nutrition program were asked how they fed their child, how they perceived child's weight, and whether or not they were concerned about their child becoming overweight. Statistical analyses performed Logistic regression to calculate odds of maternal perception/concern given child weight, feeding strategy given maternal perception/concern, and child overweight given feeding strategy. Results Only 21% (n=23/108) of overweight preschoolers were perceived as overweight. Maternal perception of overweight was not associated with feeding strategies. About 53% (n=76/144) of Hispanic, 42% (n=23/55) of African-American, and 29% (n=223/768) of white mothers reported concern about their child becoming overweight. Mothers reporting concern were more likely to restrict child's intake of select foods (odds ratio 5.94; 95% confidence interval 1.74 to 20.28) and less likely to pressure child to eat (odds ratio 0.39; 95% confidence interval 0.15 to 0.99); however, these strategies did not predict child overweight. Conclusions Mothers concerned about their child becoming overweight were more likely to restrict children's intake of specific foods and less likely to pressure their child to eat; however, this study did not detect an association between feeding strategies and child overweight.

Objective To assess the prevalence of breastfeeding and formula feeding, the age of introduction to specific foods, and the types of foods and beverages consumed by Hispanic infants and toddlers compared with similarly aged non-Hispanic infants and toddlers living in the United States. Design Descriptive and comparative analysis of dietary recall data and responses to specific interview questions, which were collected in the 2002 Feeding Infants and Toddlers Study. Breastfeeding status, timing of introduction of complementary foods, percentage consuming foods from specific food groups, and the most frequently consumed fruits and vegetables by Hispanic and non-Hispanic childrens by age group (4-5 months, 6-11 months, 12-24 months). Subjects A national random sample of 371 Hispanic and 2,637 non-Hispanic infants and toddlers between the ages of 4 and 24 months. Statistical analysis: To test for differences between Hispanic and non-Hispanic children in the percentage who consumed a particular food item, we calculated percentages and standard errors in SUDAAN and 95% and 99% confidence intervals. The most frequently consumed fruits and vegetables were determined by tallying the percentage of infants and toddlers who consumed each specific fruit or vegetable on a given day. Results Although there were some similarities, the early flavor and food experiences of Hispanic infants were different from similarly aged non-Hispanic infants in several ways. Hispanic infants younger than 1 year of age were more likely to have ever been breastfed and those who were 4 to 5 months were more likely than non-Hispanics to be eating pureed baby foods on a daily basis. Although less likely to be eating noninfant cereals and baby food vegetables, 6- to 11-month-old Hispanics were more likely to be eating fresh fruits, fruit-flavored drinks, baby cookies, and foods such as soups, rice, and beans that are common in many Hispanic cultures. When fruits were introduced into the Hispanic child's diet, they were most commonly consumed fresh. This higher prevalence of being fed soups, rice, beans, and sweetened fruit-flavored drinks as well as tortillas was also observed among the 12- to 24-month-old toddlers. Conclusions Dietetics professionals should be aware of the cultural differences in the foods fed to infants and toddlers that may contribute to the development of long-term food preferences and impact on nutrition. Understanding the factors that underlie food preferences is important if we are to develop evidence-based strategies to improve children's eating habits and lower their risks factors associated with obesity and other chronic diseases. J Am Diet Assoc. 2006;106:S96-S106.

The purpose of this study was to examine the impact of newsletter interventions distributed to mothers of preschoolers on child feeding practices and physical activity behaviors of children. Caucasian (90%), middle-class (79%) participants were divided into 3 groups: a group that received weekly newsletters for 12 weeks (n = 30), a group that received all newsletters in the form of 1 booklet the first week of the intervention (n = 30), and a control group (n = 30). Child feeding practices and physical activity behaviors were assessed using questionnaires before and after the intervention. At baseline, mean child feeding practices (CFP), pressure to eat, restriction, perceived responsibility, and monitoring scores did not differ among groups (3.4 [+ or -] 0.5, 2.4 [+ or -] 0.9, 3.1 [+ or -] 0.9, 4.6 [+ or -] 0.5, and 3.9 [+ or -] 1.0, respectively, range = 1-5). There was a significant decrease in the pressure to eat score for participants in the newsletter group (2.5 [+ or -] 1.0 to 2.1 [+ or -] 1.0, P < .01).There was no interaction of group and time on CFP score. At baseline, 43% of the participants said that their child spent [greater than or equal to] 1 hour/day in active play (activity resulting in heavy breathing), 36% said that their child spent [greater than or equal to] 1 hour/day in outdoor play, and 63% said their child watched television < 2 hour/day. There were no differences in activity practices among groups. A significant increase in outdoor play was observed in female children of participants in the newsletter group (P < .001) and male children of participants in the control group (P < .05). The newsletters and booklets were well received by participants and are viable intervention options for mothers of preschoolers. Funded by the Texas Human Nutrition Research Fund.

Purpose: This study was conducted to compare the difference between the amount of enteral feeding volume ordered with the amount delivered. Background/Significance: While deciding the dosing method (continuous vs intermittent) [...]