OBJECTIVE: The objective of this study is to determine the relationship between child feeding practices and current maternal depression with malnutrition among young children in a rural community.
METHODS: This is a case-control study consisting of 52 Malay mothers of malnourished children (case) and 50 Malay mothers of well-nourished children (control) in Kuala Langat, Selangor, Malaysia. Structured questionnaires on child feeding practices and Beck Depression Inventory: Second Edition questionnaire were distributed to mothers.
RESULTS: Depressed mothers stopped exclusive breastfeeding (2.8 ± 2.1 months) earlier than non-depressed mothers (3.7 ± 2.0 months; p = 0.045). Binary logistic regression analysis showed current maternal depression was a primary contributor associated with risk of malnutrition in children (adjusted odds ratio: 2.5, 95% confidence interval: 1.08-6.09), and followed by the number of children (adjusted odds ratio: 1.3, 95% confidence interval: 1.02-1.77).
CONCLUSION: Mothers who experienced depression were twice as likely to have malnourished children. Each additional child in the family will increase the risk of malnutrition by 1.3 times. Maternal depression is associated with child feeding practices and malnutrition among young children in the studied population. Preliminary screening to identify depression symptoms should be conducted to all mothers as early as the first trimester to prevent the incidence of malnutrition in children.
METHODS: A total sample of 300 subjects aged 6 to 23 months was recruited from urban suburbs of Kuala Lumpur and Putrajaya. Compliance with each IYCF indicator was computed according to WHO recommendations. Dietary intake based on two-day weighed food records was obtained from a sub-group (N = 119) of the total sample. The mean adequacy ratio (MAR) value was computed as an overall measure of dietary intake adequacy. Contributions of core IYCF indicators to MAR were determined by multinomial logistic regression.
RESULTS: Generally, the subjects showed high compliance for (i) timely introduction of complementary foods at 6 to 8 months (97.9%); (ii) minimum meal frequency among non-breastfed children aged 6 to 23 months (95.2%); (iii) consumption of iron-rich foods at 6 to 23 months (92.3%); and minimum dietary diversity (78.0%). While relatively high proportions achieved the recommended intake levels for protein (87.4%) and iron (71.4%), lower proportions attained the recommendations for calcium (56.3%) and energy (56.3%). The intake of micronutrients was generally poor. The minimum dietary diversity had the greatest contribution to MAR (95% CI: 3.09, 39.87) (p = 0.000) among the core IYCF indicators.
CONCLUSION: Malaysian urban infants and toddlers showed moderate to high compliance with WHO IYCF indicators. The robustness of the analytical approach in this study in quantifying contributions of IYCF indicators to MAR should be further investigated.
OBJECTIVES: To assess the effect of restricted versus unrestricted pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health.
SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2016) and reference lists of retrieved studies.
SELECTION CRITERIA: Randomised and quasi-randomised controlled trials comparing restricted versus unrestricted pacifier use in healthy full-term newborns who have initiated breastfeeding.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach.
MAIN RESULTS: We found three trials (involving 1915 babies) for inclusion in the review, but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 1.01; 95% confidence interval (CI) 0.96 to 1.07, two studies, 1228 infants), and at four months of age (RR 1.01; 95% CI 0.94 to 1.09, one study, 970 infants, moderate-quality evidence), and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.98 to 1.02, two studies, 1228 infants), and at four months of age (RR 0.99; 95% CI 0.97 to 1.02, one study, 970 infants). None of the included trials reported data on the other primary outcomes, i.e. duration of partial or exclusive breastfeeding, or secondary outcomes: breastfeeding difficulties (mastitis, cracked nipples, breast engorgement); infant's health (dental malocclusion, otitis media, oral candidiasis; sudden infant death syndrome (SIDS)); maternal satisfaction and level of confidence in parenting. One study reported that avoidance of pacifiers had no effect on cry/fuss behavior at ages four, six, or nine weeks and also reported no effect on the risk of weaning before age three months, however the data were incomplete and so could not be included for analysis.
AUTHORS' CONCLUSIONS: Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. Evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.