BACKGROUND: There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES: To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.To examine the effectiveness of different care providers and (where information was available) training.To explore the interaction between background breastfeeding rates and effectiveness of support. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. 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: This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. Results of the analyses continue to confirm that all forms of extra support analyzed together showed a decrease in cessation of 'any breastfeeding', which includes partial and exclusive breastfeeding (average risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.95; moderate-quality evidence, 51 studies) and for stopping breastfeeding before four to six weeks (average RR 0.87, 95% CI 0.80 to 0.95; moderate-quality evidence, 33 studies). All forms of extra support together also showed a decrease in cessation of exclusive breastfeeding at six months (average RR 0.88, 95% CI 0.85 to 0.92; moderate-quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95% CI 0.71 to 0.89; moderate quality, 32 studies). We downgraded evidence to moderate-quality due to very high heterogeneity.We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes. AUTHORS' CONCLUSIONS: When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.

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Support for healthy breastfeeding mothers with healthy term babies

BACKGROUND Although complementary feeding is a universal practice, the methods and manner in which it is practiced vary between cultures, individuals and socioeconomic classes. The period of complementary feeding is a critical time of transition in the life of an infant, and inappropriate complementary feeding practices, with their associated adverse health consequences, remain a significant global public health problem. Educational interventions are widely acknowledged as effective in promoting public health strategy, and those aimed at improving complementary feeding practices provide information about proper complementary feeding practices to caregivers of infants/children. It is therefore important to summarise evidence on the effectiveness of educational interventions to improve the complementary feeding practices of caregivers of infants. OBJECTIVES To assess the effectiveness of educational interventions for improving the complementary feeding (weaning) practices of primary caregivers of children of complementary feeding age, and related health and growth outcomes in infants. SEARCH METHODS In November 2017, we searched CENTRAL, MEDLINE, Embase, 10 other databases and two trials registers. We also searched the reference lists of relevant studies and reviews to identify any additional studies. We did not limit the searches by date, language or publication status. SELECTION CRITERIA Randomised controlled trials (RCTs), comparing educational interventions to no intervention, usual practice, or educational interventions provided in conjunction with another intervention, so long as the educational intervention was only available in the experimental group and the adjunctive intervention was available to the control group. Study participants included caregivers of infants aged 4 to 24 months undergoing complementary feeding. Pregnant women who were expected to give birth and commence complementary feeding during the period of the study were also included. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data on participants, settings, interventions, methodology and outcomes using a specifically-developed and piloted data extraction form. We calculated risk ratios (RR) and 95% confidence intervals (CIs) for dichotomous data, and mean differences (MD) and 95% CIs for continuous data. Where data permitted, we conducted a meta-analysis using a random-effects model. We assessed the included studies for risk of bias and also assessed the quality of evidence using the GRADE approach. MAIN RESULTS We included 23 studies (from 35 reports) with a total of 11,170 caregiver-infant pairs who were randomly assigned to receive an educational intervention delivered to the caregiver or usual care. Nineteen of the included studies were community-based studies while four were facility-based studies. In addition, 13 of the included studies were cluster-randomised while the others were individually randomised. Generally, the interventions were focused on the introduction of complementary feeding at the appropriate time, the types and amount of complementary foods to be fed to infants, and hygiene. Using the GRADE criteria, we assessed the quality of the evidence as moderate, mostly due to inadequate allocation concealment and insufficient blinding.Educational interventions led to improvements in complementary feeding practices for age at introduction of complementary foods (average RR 0.88, 95% CI 0.83 to 0.94; 4 studies, 1738 children; moderate-quality evidence) and hygiene practices (average RR 1.38, 95% CI 1.23 to 1.55; 4 studies, 2029 participants; moderate-quality evidence). For duration of exclusive breastfeeding, pooled results were compatible with both a reduction and an increase in the outcome (average RR 1.58, 95% CI 0.77 to 3.22; 3 studies, 1544 children; very low-quality evidence). There was limited (low to very low-quality) evidence of an effect for all growth outcomes.Quality of evidenceThere is moderate to very low-quality evidence that educational interventions can improve complementary feeding practices but insufficient evidence to conclude that it impacts growth outcomes. AUTHORS' CONCLUSIONS Overall, we found evidence that education improves complementary feeding practices.

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Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under

Objective To analyze the prevalence of ultra-processed food intake among children under one year of age and to identify associated factors. Methods A cross-sectional design was employed. We interviewed 198 mothers of children aged between 6 and 12 months in primary healthcare units located in a city of the metropolitan region of Sao Paulo, Brazil. Specific foods consumed in the previous 24 h of the interview were considered to evaluate the consumption of ultra-processed foods. Variables related to mothers’ and children's characteristics as well as primary healthcare units were grouped into three blocks of increasingly proximal influence on the outcome. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with ultra-processed food intake. Results The prevalence of ultra-processed food intake was 43.1%. Infants that were not being breastfed had a higher prevalence of ultra-processed food intake but no statistical significance was found. Lower maternal education (prevalence ratio 1.55 [1.08–2.24]) and the child's first appointment at the primary healthcare unit having happened after the first week of life (prevalence ratio 1.51 [1.01–2.27]) were factors associated with the consumption of ultra-processed foods. Conclusions High consumption of ultra-processed foods among children under 1 year of age was found. Both maternal socioeconomic status and time until the child's first appointment at the primary healthcare unit were associated with the prevalence of ultra-processed food intake.

http://www.scielo.br/pdf/jped/v95n5/0021-7557-jped-95-05-0584.pdf

Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo, Brazil.

Identificar os fatores associados a introducao de alimentos nao recomendados no primeiro ano de vida, entre criancas residentes em municipios de baixo nivel socioeconomico. Estudo multicentrico transversal com 1.567 criancas de 12 a 59 meses de idade residentes em 48 municipios participantes do plano Brasil Sem Miseria da Regiao Sul do Brasil. Aplicou-se questionario estruturado aos responsaveis pelas criancas para a obtencao das informacoes sociodemograficas e idade na qual alimentos nao recomendados foram introduzidos pela primeira vez na alimentacao complementar. A prevalencia de introducao de acucar antes dos quatro meses de idade da crianca foi de 35,5% (n = 497; IC95%: 33,1-38,0). As prevalencias de introducao de biscoito doce/salgado, queijo petit suisse e gelatina antes do sexto mes de vida da crianca foram de 20,4% (n = 287; IC95%: 18,3-22,3), 24,8% (n = 349; IC95%: 22,4-27,1) e 13,8% (n = 192; IC95%: 12,0-15,7), respectivamente. Identificou-se associacao entre a menor escolaridade materna (RP = 1,25; IC95%: 1,03-1,51) e a menor renda mensal familiar (RP = 1,22; IC95%: 1,01-1,48) com a introducao de alimentos nao recomendados. Verificou-se a introducao de alimentos nao recomendados no primeiro ano de vida entre criancas residentes em municipios de alta vulnerabilidade socioeconomica da Regiao Sul do Brasil, e esta pratica associou-se a menor escolaridade materna e menor renda familiar mensal.

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Introduction of inappropriate complementary feeding in the first year of life and associated factors in children with low socioeconomic status

Objectives: to examine indicators relating to access to child health care and markers of unhealthy patterns of eating in Brazilian children aged under two years and to set these in the context of the National Health System 's current child healthcare agenda. Methods: a descriptive cross-sectional study using data from the 2013 National Health Survey. Prevalences and confidence intervals of 95% (CI95%) were estimated for the total population, Brazilian macroregions and urban or rural location of household. Results: a first medical consult before the seventh day of life was reported in only 28.7% of children. Supervision of growth and child development was carried out primarily at basic health units (57.2%; CI95%: 54.8-59.6). Theneonatal screening, newborn hearing screening and red reflex tests were conducted with a frequency of 70.8% (CI95%: 69.0-72.7), 56.0% (CI95%: 53.8-58.3) and 51.1% (CI95%: 48.9-53.3), respectively. Disparities were found in preventive health care, with lower access among children living in rural households or in the North and Northeast regions. Soda consumption was reported for 32.3% and consumption of biscuits or cake for 60.8% of children,indicating premature introduction of unhealthy foods into the child's diet. Conclusions: the findingspoint to disparities in access to child healthcare and a high prevalence of unhealthy eating habits in infancy.

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Healthcare and unhealthy eating among children aged under two years: data from the National Health Survey, Brazil, 2013

O objetivo foi avaliar o impacto da atualizacao de profissionais de saude em relacao aos Dez Passos da Alimentacao Saudavel para Criancas Menores de Dois Anos sobre as praticas alimentares no primeiro ano de vida. Participaram do estudo unidades basicas de saude (UBS) do Municipio de Porto Alegre, Rio Grande do Sul, Brasil, randomizadas em controle (n = 11) e intervencao (n = 9). Unidades de saude que possuem servico de saude comunitaria como Estrategia Saude da Familia (ESF) foram incluidas como um cluster de intervencao (n = 12). As praticas alimentares das criancas incluidas no estudo foram avaliadas quando elas tinham 6 (n = 918) e 12 meses (n = 799) de idade. Os resultados mostraram que o tempo medio de duracao do aleitamento materno exclusivo foi significativamente maior nos dois grupos que receberam a intervencao (2,56 ± 1,91 mes nas US-ESF e 2,32 ± 1,63 mes nas UBS-intervencao) comparados as UBS-controle (1,91 ± 1,60 meses). Houve impacto positivo na qualidade da alimentacao complementar das criancas atendidas nos servicos de saude que participaram da intervencao, especialmente naqueles com ESF.

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Impacto da atualização de profissionais de saúde sobre as práticas de amamentação e alimentação complementar

This study aimed to evaluate the impact on feeding practices for infants (<1 year of age) resulting from update training for health workers in the Ten Steps to Healthy Feeding of Children Under Two. Health Care Centers (HCC) in Porto Alegre Rio Grande do Sul State Brazil were randomized into a control group (n=11) and an intervention group (n=9). Health centers organized according to Brazils Family Health Program (FHP) were included as an intervention cluster (n=12). Infant feeding practices were evaluated at the health centers at 6 months (n=918) and again at 12 months of age (n=799). The results showed that mean duration of exclusive breastfeeding was significantly longer in the two groups that received the intervention (2.56+/-1.91 months in the FHP intervention and 2.32+/-1.63 months in the HCC intervention) compared to the HCC control group (1.91+/-1.60 months). There was a positive impact on the quality of complementary feeding of infants treated at the health centers that participated in the intervention especially those with the FHP.

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The impact of health workers’ training on breastfeeding and complementary feeding practices

/pdf/impacto-de-la-formacion-de-los-profesionales-de-la-salud-en-42jqj21ajk.pdf

Impacto de la formación de los profesionales de la salud en la práctica de la lactancia materna y la alimentación complementaria

Modelo de formação continuada, na modalidade a distância, para profissionais de saúde sobre os "dez passos da alimentação saudável para crianças menores de dois anos"

The Perception of Girls About Maternal Attitudes and the Relation with their Body (Dis)satisfactionIt is believed that the concern with the body has started earlier, especially among girls. Studies have suggested an important relation between their body (dis)satisfaction and maternal attitudes. It was analyzed the prevalence of body (dis)satisfaction among 8 to10 year-old-girls and the relation between their mother’s perception of their own weight and their daughters’. The (dis)satisfation was obtained through the Children’s Figure Rating Scale and the maternal influence applying a self-administered questionnaire. Anthropometric data were collected to calculate the BMI. Out of 97 girls, 73.2% were dissatisfied, and 52.6% would like to lose weight. The bivariate analysis was significant for BMI, diet, maternal own weight concern and maternal encouragement to be thin. The results showed high prevalence of dissatisfied girls, suggesting the need for preventive programs, since the maternal attitudes towards their own body and her daughters’, as well as the BMI had influence on (dis)satisfaction.

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Cíntia Mendes Gama

Papers

Impacto da atualização de profissionais de saúde sobre as práticas de amamentação e alimentação complementar

The impact of health workers’ training on breastfeeding and complementary feeding practices

Impacto de la formación de los profesionales de la salud en la práctica de la lactancia materna y la alimentación complementaria

Modelo de formação continuada, na modalidade a distância, para profissionais de saúde sobre os "dez passos da alimentação saudável para crianças menores de dois anos"

A Percepção de Meninas Sobre as Atitudes Maternas e sua Relação com a (In)satisfação Corporal