Infant Feeding Practices in the US

Infant Feeding Practice Study 2: A Summary and Perspective

In the October 2008 edition of Pediatrics, a series of research papers were published detailing results of the Infant Feeding Practices Study 2 (IFPS2).  The IFPS2 is a survey of infant feeding practices in the United States that was conducted by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).  In this study, 4,900 women were enrolled prenatally and greater than 2,000 were followed through first year of the infant’s life.  Participating mothers received 1 prenatal and approximately 10 postnatal questionnaires during the course of the survey.

The study provides valuable information regarding the feeding practices of caregivers to their infants in the United States.  Grummer-Strawn et al. found that although 83% of survey respondents initiated breastfeeding, the percentage who breastfed declined rapidly to 50% at six months and 24% at 12 months.   Additionally nearly half of all breastfed infants were supplemented with infant formula in the hospital and nearly half of all infants were fed solid foods before four months of age.   Those who were fed solids at this age were more likely to discontinue breastfeeding at 6 months of age.

Shealy et al. found that more mothers reported exclusive breastfeeding at three months than at any other time, after which exclusive breastfeeding declined.  Similarly, more than half of the breastfeeding mothers fed their infants nothing other than breast milk until four months of age.  Additionally, the authors found that slightly more than one third of breastfeeding mothers supplemented with infant formula from three to seven months.  The percentage of breastfed infants whose diets were supplemented with infant formula declined from 42% in the hospital to 34% at age three months, and remained at this level until age nine months. This article also described several aspects of breastfeeding practice that appeared to deviate from common advice. Additionally, the authors identify 4 major factors that influence breastfeeding that should be included in effective breastfeeding counseling, which are variable among women.

DiGirolamo et al. reported that only 8% of mothers experienced all six of the Baby-Friendly hospital practices measured; those who experienced a greater number of these practices were more likely to have continued breastfeeding to six weeks. Initiating breastfeeding within the first hour of life, providing only breastmilk, and no pacifier use were the 3 Baby-Friendly practices associated with a longer duration of breastfeeding. However, the authors found no association between not providing a formula sample or coupon in hospital gift pack and increased breastfeeding duration.

In a study on breastfeeding and the workplace, Fein et al. found that direct feeding of the infant from the breast was associated with longer breastfeeding duration after return to work than pumping only.  It was therefore recommended that workplace support for breastfeeding focus on ways to allow the infant to feed directly from the breast; recommended strategies include teleworking, allowing the infant to come to work, and having someone bring the infant to work for breastfeeding.

Li and colleagues discuss self reported reasons why mothers stop breastfeeding. The perception that the infant was not satisfied by breast milk alone was consistently cited as 1of the top 3 reasons regardless of weaning age.  For older babies, a common reason cited was that the baby lost interest or started to wean himself/herself. This information may be useful for the development of effective breastfeeding interventions.

Li et al. reported that infants who often emptied bottles in early infancy were more likely than those who rarely emptied bottles to have excess weight during late infancy.

Labiner-Wolfe et al. found that the majority of formula-feeding mothers did not receive instruction on formula preparation (77%) or storage (73%) from a health professional, although 85% believed that following safe-storage directions was very important.  Additionally, the authors found that 30% of mothers did not read some of the safe-use directions on the formula package label, but 89% did read the instructions for preparation and use, suggesting that the label directions may be the most relied upon source of information that mothers use to assure safe preparation and use.  Findings from this study suggest that additional efforts are needed to improve education of consumers by health professionals on appropriate formula handling.  Such instruction might help improve compliance with safe handling recommendations.

Fein and colleagues reported on complementary feeding practices and association with maternal education.  The authors list the following advantages of using commercial baby foods as compared to family foods including less chance of contaminants, fewer additives, no added salt or sugar and appropriate fortification with vitamins and minerals.  The minority of mothers did not follow recommend complementary feeding practices. Notably, approximately 20% of infants received solids before 4 months of age and 7% received solids after 6 months of age. Nearly 30% of mothers introduced cow’s milk before 1 year of age. Less educated mothers were less likely to follow recommendations than more educated mothers.

Dee et al reported on supplemental iron sources amongst breastfed infants. Results indicated that approximately one third of the term infants who were breast fed were also fed iron-fortified formula.  At 6 months of age, of the infants who were only breastfed, 23% had no regular supplemental iron source in their diet.  Nearly all formula (98%) consumed by infants in the study was iron-fortified.

According to the authors, more research is needed to better understand various factors behind current infant feeding practices in the United States.

To view the studies in full, visit: http://pediatrics.aappublications.org/content/vol122/Supplement_2/index.shtml (subscription to Pediatrics required.)