by Anne Eglash MD, IBCLC, FABM
Does a mother’s knowledge of breastfeeding recommendations have an impact on how long she nurses her infant? Most major professional health and governmental organizations, such as the American Academy of Pediatrics, the American Academy of Family Physicians, and the United States Healthy People 2020 recommend exclusive breastfeeding until 6 months, with continued breastfeeding along with complementary foods until at least a year.
Common reasons that come to mind regarding premature weaning include breast/nipple pain, low supply, back to work issues and lack of social support. The question is whether women wean early simply because they don’t understand or know recommendations regarding duration of breastfeeding.
The authors of a recently published article used data collected from the 2005-2007 Infant Feeding and Practices Study II, a research project that sent questionnaires to approximately 3000 new mothers in the USA, to explore the relationship between knowledge of breastfeeding recommendations and infant feeding practices.
Most of the respondents to the study were non-Hispanic White, had at least some college education, and were married.
According to their data, what % of the women in this national survey did not know the national breastfeeding recommendations (as per Healthy People 2020 goals)?
- 11%
- 21%
- 41%
- 66%
- 82%
See the Answer
The answer is B
Knowledge of Breastfeeding Recommendations and Breastfeeding Duration: A Survival Analysis on Infant Feeding Practices II
Wallenborn Jordyn T., Ihongbe Timothy, Rozario Sylvia, and Masho Saba W.. Breastfeeding Medicine. April 2017, 12(3): 156-162
Background:
According to the American Academy of Pediatrics, infants should be exclusively breastfed for the first 6 months of life followed by breastfeeding with complementary food for up to 2 years of age or beyond. Knowledge of breastfeeding recommendations may greatly influence breastfeeding practices; however, the association between a woman’s knowledge of exclusive breastfeeding recommendations and breastfeeding duration is not well explored. This study aims to examine the relationship between knowledge of exclusive breastfeeding recommendations before birth and breastfeeding duration.
Materials and Methods:
Data from the prospective, longitudinal 2005–2007 Infant Feeding and Practices Study II were analyzed (N = 2,935). Knowledge of national breastfeeding recommendations (yes; no) was based on a survey question asking the recommended length of breastfeeding. Breastfeeding duration was reported in weeks and was analyzed as any breastfeeding or exclusive breastfeeding. Cox proportional hazard models were used to obtain crude and adjusted hazard ratios (HRs) and 95% confidence limits (CLs).
Results:
Overall, 91.7% of women did not exclusively breastfeed the recommended duration and one in five (21.4%) did not know current breastfeeding recommendations. Women without knowledge of exclusive breastfeeding recommendations had a lower probability of breastfeeding compared with women with knowledge of breastfeeding recommendations. Furthermore, after adjusting for confounders, women without knowledge of exclusive breastfeeding recommendations had 11% higher risk (HR = 1.11; 95% CL = 1.01–1.23) of ceasing breastfeeding at every point in time compared with women who reported knowledge of breastfeeding recommendations while exclusive breastfeeding was not significant.
Conclusions:
Findings from this study provide evidence that a mother’s knowledge of exclusive breastfeeding recommendations impacts breastfeeding practices. Healthcare providers and public health professionals should educate mothers about breastfeeding.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
These researchers found that women who were not knowledgeable about breastfeeding recommendations had a shorter mean duration of breastfeeding.
They also found that those with knowledge of the 6- month exclusive breastfeeding recommendation had a longer duration of any breastfeeding, but this knowledge didn’t have an impact on exclusive breastfeeding duration.
Other researchers have also found that knowledge of the recommendation on exclusive breastfeeding does not necessarily lead to exclusive breastfeeding for 6 months. The question is why?
Health care providers may play a role in this issue. I suspect that many and possibly the majority of physicians and other pediatric providers don’t recommend waiting until 6 months to start solids when counseling families at the 2 and 4 month well child visits. I hear from many patients that their physicians recommend starting solids around 4-6 months, despite recommendations from their own professional organizations.
Recent infant feeding recommendations from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition committee on Nutrition, may also encourage physicians to recommend earlier introduction to solids. The committee sanctions the introduction of solids, particularly allergenic foods like peanuts, at 4 months, to reduce the risk of food allergies. In its confusing summary, the committee also acknowledges that exclusive breastfeeding until 6 months is a ‘desirable goal’.
Parents are also influenced by family members, friends, and others who suggest that 4 months of age is a normal time to introduce solids. Infants display behaviors at 4 months of age that parents perceive as readiness for solids, such as watching the movement of mom’s fork to mouth during a meal, waking up more at night, and appearing to have an increased appetite. In addition, families might add solids in order to make up for a drop in milk supply due to work stress.
This study provides evidence that we as health care providers and community breastfeeding supporters should ensure that breastfeeding families understand current recommendations on complementary feedings. It is also reasonable for us to explore families’ ideas and plans about the introduction of solids, in order to understand factors that lead families to offer complementary foods earlier than 6 months.