Yngve Hofvander

Breastfeeding Patterns in Relation to Thumb Sucking and Pacifier Use

Objectives. To analyze the influence of thumb sucking and pacifier use on breastfeeding patterns in exclusively breastfed infants, on the duration of exclusive breastfeeding, and on the total breastfeeding duration. Study Design. Descriptive, longitudinal, prospective study. Setting. The subjects were recruited from a population of 15 189 infants born in the maternity ward at the University Hospital, Uppsala, Sweden between May 1989 and December 1992. Study Population. 506 mother–infant pairs. Methods. Daily recordings by the mothers on infant feeding from the first week after delivery through the duration of the study. Fortnightly home visits with structured interviews by a research assistant. Results. Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours, shorter duration of exclusive breastfeeding, and shorter total breastfeeding duration compared with no pacifier use. These associations were not found for thumb sucking. The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use. Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration. Conclusions. More frequent use of a pacifier was associated with shorter breastfeeding duration, even among a group of mothers who were highly motivated to breastfeed. breastfeeding duration, breastfeeding pattern, exclusive breastfeeding, pacifier use, thumb sucking.

Breastfeeding patterns in exclusively breastfed infants : a longitudinal prospective study in Uppsala, Sweden.

Exclusive breastfeeding was studied among 506 infants in Uppsala, Sweden, based on daily recordings during the first 6 mo. The mothers had previously breastfed at least one infant for at least 4 mo. Most of the mothers considered that they breastfed on demand. Wide variations in breastfeeding frequency and suckling duration were found both between different infants and in the individual infant over time. At 2 wk, the mean frequency of daytime feeds (based on one 13‐d record) between different infants ranged from 2.9 to 10.8 and night‐time feeds from 1.0 to 5.1. The daytime suckling duration (based on one 24‐h record) ranged from 20 min to 4h 35min and night‐time duration from 0 to 2h 8 min. At any given age, a maximum of only 2% of the infants were not breastfed during the night. At 4 mo, 95% of the infants were breastfeeding and 40% were exclusively breastfed at this age. Longer breastfeeding duration and longer duration of exclusive breastfeeding were both associated with higher frequency of breastfeeds, longer breastfeeding of the previous child and higher education. No gender differences were found. Maternal smoking was associated with shorter duration of exclusive breastfeeding, and pacifier use was associated with shorter duration of both exclusive breastfeeding and total breastfeeding. This study confirms that every mother‐infant pair needs to be understood as a unique dyad throughout lactation. These data demonstrate a wide range of patterns among women who are exclusively breastfeeding and indicate that it would be inappropriate to put pressure on individual families to adopt preconceived patterns of infant feeding.

FACTORS RELATED TO EARLY TERMINATION OF BREAST FEEDING A Retrospective Study in Sweden

Abstract. In 1972, 298 mothers representative of the city of Uppsala in general breast fed their babies for only a brief period of time despite a clear wish to continue—36% up to 8 weeks. The most common reason for terminating breast feeding was that the “milk dried up” (66%). More precise reasons commonly mentioned were anxiety of all kinds, lack of motivation, stress, tiredness and work outside the home. It was further found that mothers who enjoyed their breast feeding, were well educated, were older than 25 years and belonged to social class 1, tended to breast feed longest.

A PROSPECTIVE STUDY OF INDIVIDUAL COURSES OF BREAST FEEDING

Abstract. A prospective study of the course of breast feeding was carried out in 75 randomly selected women. Weekly interviews were performed from the day after delivery until the termination of breast feeding, but in no case for longer than 6 months. In each case a detailed analysis was made of the factors leading to transient lactation crises or to complete cessation of breast feeding. A second group of 71 mothers, also randomly selected, was interviewed in retrospect only, 6 months after delivery, and served as controls. Twenty‐four weeks after delivery 47% of the mothers in the weekly interview group were still breast feeding. The corresponding figure in the control group was 38%. In both groups only few mothers terminated lactation for medical reasons, while about one fourth stopped for some other reason and about one half because of a combination of factors. Brief case reports are presented to illustrate how varying the factors were that threatened breast feeding.

The amount of milk consumed by 1-3 months old breast- or bottle-fed infants.

ABSTRACT. The consumption of breastmilk was studied by the weighing method in 75 infants aged 1, 2 and 3 months (±1 week), 25 infants in each group. Similarly the same number of infants in the same age groups, bottle‐red ad libitum, was studied and the consumption and consumption pattern were compared between the two groups. The mean and range of consumed amounts of both types of milk were similar to that found in other studies. The means for breastmilk were 656‐773‐776 g and for breastmilk substitutes 713‐811‐853 g in the 1, 2 and 3 months infants, respectively, but with wide variations. When expressed as kcal/kg it appeared to be practically no difference between the two feeding groups. The bottle‐fed infants had fewer meals and had a more even consumption from meal to meal. It is concluded that infants largely regulate themselves the intake they require.

A longitudinal study on anthropometric and clinical development of Indian children adopted in Sweden

One hundred and fourteen children (60% girls) adopted from India through five major adoption organizations, were recruited consecutively. This paper describes the environment of the children in India and in Sweden, discusses the certainty of the ages and reports their condition at arrival in Sweden. The median age at arrival was 9.3 months, 62% being below one year of age (range 3-72 months). Infectious diseases similar in kind and frequency to those noted in child populations in developing countries, were found. Height/age and weight/age mean values were approximately -2 standard deviation scores (SDS) of the NCHS/WHO standard, which is similar to the anthropometric status of Indian average children. There were no significant sex differences. Thirty-seven birth weights were known, the majority below 2,500 g. Psychomotor retardation was found in 29% of the children. In the children with stunting and in those with weight/age less than -3 SDS at arrival there were high percentages of psychomotor retardation, anaemia and combined wasting and stunting. Therefore these children should be regarded as a risk group and be followed up with special care.

Pubertal linear growth of Indian girls adopted in Sweden

Pubertal linear growth in 66 adopted Indian girls was studied. The infancy‐childhood‐puberty standard was used, since it is applicable to Indian girls, and enables determination of the onset and height gain of the pubertal growth phase in an individual. At arrival in Sweden, mean height was —2.8 SDS. Despite rapid catch‐up growth, the girls were still below the reference mean (—0.8 SDS) at the onset of the pubertal growth spurt, which occurred approximately 1.5 years earlier than in Swedish girls and also earlier than in Indian girls. The pubertal height gain, however, was equivalent to that in Swedish girls with similar timing of puberty. The short final height found in some of these girls appears to be related to shortness prior to puberty and to very early onset of an otherwise normal pubertal growth component.

Studies of human milk. II. Concentration of antibodies against Salmonella and Shigella in milk of women from different populations and the daily intake by their breast-fed infants.

ABSTRACT. The concentration in human milk of IgA antibodies against six Salmonella and two Shigella groups was determined in specimens obtained from Swedish and Guatemalan nursing mothers of three different socioeconomic levels. The daily intakes of milk antibodies by their children were also estimated. The results show that the concentrations of specific IgA antibodies in milk vary among the different population groups. There is, however, no difference in daily intake of specific IgA by the children.

Diets of Healthy Swedish Children 4-24 Months Old

ABSTRACT. In a semi‐longitudinal investigation comprising a total of 81 infants studied at one or more of the ages 4, 9, 15 and 24 months, the food intake was recorded on three consecutive days at 4 months and on seven consecutive days at 9, 15 and 24 months (40, 40, 38 and 40 infants, respectively in the four age groups). The median energy intake was lower than the Recommended Dietary Allowances in all age groups. The energy intake derived from fat was low among some of the 9‐month‐old infants. The contribution of sucrose to energy was as high as 10% at 24 months.

Introduction of solids and formula to breastfed infants: a longitudinal prospective study in Uppsala, Sweden.

The introduction of solids and formula was studied among 506 breastfed infants in Uppsala, Sweden, based on daily recordings during the first year. The mothers had previously breastfed at least 1 infant for at least 4 mo. Thirty‐four per cent of the infants were introduced to solids before the age of 4 mo (4–6 mo is recommended in Sweden). Accustoming the infants to solids was a lengthy process. Life‐table analyses showed a median duration of 28 d from the first introduction of solids to consumption of >10 ml daily, and 46 d before the infants ate 100 ml of solids in 1 d for the first time. These durations were longer the younger the infant was at the introduction of solids. Thirty‐two per cent of infants given formula consumed 100 ml the first time it was given, and 49% did so within 1 wk, regardless of infant age.